1,721,146 research outputs found
La salute mentale nella prospettiva del welfare di comunità
No full textWith greater intensity following the effects produced by the COVID-19 pandemic, mental illnesses, which have always been the last in the economic investments of the Western health care systems, require to be no longer so marginal in national investment programs. The intent of this essay is to offer the reader a broad, albeit not exhaustive, picture of the role that mental health plays in European planning, how psychiatric care has evolved in Italy, and which are the main knots still to be resolved for the issue of mental health to come out of the corner in which it has always been unfortunately confined
Selective referrals in a 'hub and spoke' institutional setting: The case of coronary angioplasty procedures
No full textWe analyse the highly-regulated cardiovascular sector of the health service in the Italian region of Emilia Romagna: this sector is characterised by strict regulatory control and a great emphasis on co-ordination and co-operation between public and private producers. These features have been even more marked since 2000, due to the adoption of the 'hub and spoke' organisational model, whereby a close relationship of selective referral from the network of satellite cardiology units (spokes) to the six Cardiac Surgical Centres (hubs) has been developed, so as to concentrate high risk procedures in highly specialised units. We focus on coronary angioplasty procedures (PTCA) and examine relations among centres before and after the official introduction of this hierarchical system completed the regionalisation of cardiovascular services. Secondly, since earlier regional efforts to reconfigure cardiovascular care by sending referrals to a few major centres may already have produced a high level of co-ordination among units, we investigate what happens to the volume-effect advantage across hospital categories with regard to the likelihood of adverse results for PTCA. We used descriptive statistics and logistic regression models to assess the existence of selective referrals and the concentration of clinical complexity in more specialised centres. Figures were taken from a regional administrative database based on hospital discharge abstracts (SDO) for the period 1998-2000. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved
Different regional organisational models and the quality of health care: The case of coronary artery bypass graft surgery
No full textObjectives: The Italian regions of Emilia-Romagna and Lombardy within the Italian National Health Service provide an opportunity to see if two different approaches to the organisation of care - one more hierarchical and planned, the other more competitive and market-like - influence its quality through examining the relationship between the number of coronary artery bypass grafts (CABGs) and the rate of in-hospital mortality using administrative data for the period 1996-1998. Methods: Descriptive statistics and logistic regression models were used. Results: The volume-outcome relation was statistically significant in both regions (odds ratio 0.71, P < 0.0001). Although CABG performance in Emilia-Romagna was slightly poorer than in Lombardy (OR 1.22, P < 0.05), the potential advantage in terms of the reduced risk of death for patients treated at high-volume versus low-volume hospitals was significantly greater. In Emilia-Romagna, the average performance advantage of high-volume units was more substantial in the case of private accredited hospitals than public hospitals (OR = 0.50, P < 0.0001 versus OR = 0.64, P < 0.0001). In Lombardy, the performance advantage of concentrating CABG procedures was greater in private research hospitals (OR = 0.67, P < 0.0001), whereas results were not statistically significant for the other types of hospital, indicating a good level of performance in both public and private hospitals even at low volumes. This also partially explained the lower mortality rate observed in that region. Conclusions: The degree of hierarchical regionalisation versus market-like arrangements characterising the two systems produced contrasting effects in terms of the quality of CABG surgery. Lombardy's more competitive environment appeared to achieve better performance in terms of a slightly lower probability of adverse outcomes, in a system with no formal assessment of population need and very high per capita revascularisation rates. To improve performance in the more hierarchical system adopted in Emilia-Romagna would require considerable effort to increase CABG surgery in low-volume cardiac units, and to sharpen performance incentives. © The Royal Society of Medicine Press Ltd 2003
Il governo del settore sanitario a livello regionale. Analisi teorica, confronti internazionali e proposte di policy
No full textDipartimento di Scienze Economiche Università di Bologna, Rapporto E.R.V.E.T., Progetto “Nuovo Regionalismo”, Bologna, luglio 1995
La riforma del terzo settore in un welfare che cambia
No full textQuesto lavoro propone una riflessione su alcuni elementi della legge delega che mirano ad accrescere il coinvolgimento del terzo settore nell'ambito dei servizi di cura, con particolare attenzione agli aspetti contenuti nell'articolo 4 laddove il legislatore si ripromette di “valorizzare il ruolo del terzo settore nella fase di programmazione a livello territoriale, relativa al sistema integrato di interventi e servizi socio-assistenziali” (art.4, comma 1 lettera o) e di “riconoscere e valorizzare le reti associative di secondo livello per accrescere la loro rappresentatività presso i soggetti istituzionali” (art.4, comma 1 lettera p)
Analisi della mobilità ospedaliera e indicatori di utilizzo dei servizi ospedalieri in Emilia Romagna
No full textCase report of an hepatoid adenocarcinoma of the stomach
No full textHepatoid adenocarcinoma (HAC) is a rare but important type of extrahepatic tumor that has a morphologic similarity to hepatocellular carcinoma, with production of α-fetoprotein in high amounts and a poor prognosis. Stomach is one of the organs in which HAC has been most commonly identified. We report a case of an old man with a polypoid mass in the prepyloric region. The microscopical aspects were suggestive for an undifferentiated adenocarcinoma, but the positive immunohistochemical staining for α-fetoprotein, α-1-antitrypsin, α-1-antichymotrypsin, and Hep Par1 were crucial for the final diagnosis of hepatoid adenocarcinoma of the stomach. Because of the poor prognosis for this type of tumor, correct and early-stage diagnosis of HAC is essential and long-term follow-up is required
Case report of an hepatoid adenocarcinoma of the stomach
No full textHepatoid adenocarcinoma (HAC) is a rare but important type of extrahepatic tumor that has a morphologic similarity to hepatocellular carcinoma, with production of α-fetoprotein in high amounts and a poor prognosis. Stomach is one of the organs in which HAC has been most commonly identified. We report a case of an old man with a polypoid mass in the prepyloric region. The microscopical aspects were suggestive for an undifferentiated adenocarcinoma, but the positive immunohistochemical staining for α-fetoprotein, α-1-antitrypsin, α-1-antichymotrypsin, and Hep Par1 were crucial for the final diagnosis of hepatoid adenocarcinoma of the stomach. Because of the poor prognosis for this type of tumor, correct and early-stage diagnosis of HAC is essential and long-term follow-up is required
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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