Giovanni Renga

Effectiveness of an Informative Video on Reducing Anxiety Levels in Patients Undergoing Elective Coronarography: An RCT

Background: Anxiety levels have a considerable effect on patients during hospitalization. Cardiology Departments are characterized by a high turn-over of patients and it is necessary to give clear and exhaustive information routinely in compliance with legal and deontological requirements. Aims: The aim of the study was to evaluate the effectiveness of an informative video, devised for patients undergoing coronarography, on reducing anxiety levels and getting more satisfaction from the received information. Methods: A two arm RCT design was chosen. The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications. Results: Ninety-three patients accepted to take part in the study. The weighted mean difference (WMD) between the anxiety levels of the treated and controlled groups was − 8.24 (CI 95%: − 12.04/− 4.44; p < 0.00001). The WMD of the level of satisfaction for the received information was + 22.23 (CI 95%: + 12.73 /+ 31.73; p < 0.00001). Conclusions: The use of the informative video in Cardiology Departments proves to be highly recommended as an instrument to lower anxiety levels and increase significantly the level of satisfaction deriving from the received information.

Validation of the Italian version of the Discomfort Scale - Dementia of Alzheimer Type

AIM This paper is a report of a study to validate the Discomfort Scale - Dementia of Alzheimer Type in Italian. BACKGROUND Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale - Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. METHODS The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite-group approach and internal consistency and inter-rater reliability were measured. RESULTS The discriminant validity of the Italian Discomfort Scale - Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0.814) and comparisons of overall discomfort scores across nurses show good reliability. CONCLUSION These findings support the use of Discomfort Scale - Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale - Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions.

Visibility, accessibility and quality of Italian public health institutional websites

Background : Since the large volume of health information available on the Web has the potential to improve health, Public Health institutions must represent a strong Internet presence with accessible and scientific information. The aims of the study were to verify the presence and visibility of Italian Institutions on the Web and to evaluate the accessibility and quality of the information provided. Methods : In a focus group setting, 21 keywords were generated, and launched in search-engines Google and MSN. Researchers noted the first 30 results found and determined the position of institutional websites. The accessibility of 303 Public Health websites was assessed in relation to the logo presence and web validation of XHTML, CSS and WAI indicators. Regarding the quality of information, the presence of the HONcode logo in the websites’ homepage was checked. Results : A high percentage of the keywords selected did not lead to any institutional website in the first three pages of Google (19.0%) and MSN (42.8%). Few institutional websites presented the logo indicator and a full web validation. Considering the XHTML indicator, only for 34.0% of the websites there was concordance between the logo presence/absence and results of direct validation, 50.2% for CSS. The quality level seemed to be extremely low. Conclusions :In order to achieve a larger visibility and guarantee accessibility, Public Health websites have to be correctly designed, edited and maintained. Common and strict European laws about health information on the Web have to be arranged, deeply monitored and carefully adjourned in order to guarantee and support the positive role of institutional websites.

Tobacco smoke in Piedmont: attributable morbidity and impact on hospital costs

Background : Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this research is to estimate the smoke attributable morbidity for Piedmont residents in the years 1997-2002 and the related costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods : extraction of hospital admissions for smoking-related diseases; estimate of the proportion of hospital admittances attributable to smoking; estimate of the overall cost and the smoke attributable cost for each year. Results : The attributable proportion in men is clearly higher than in women. In men it decreases from 10.6% in 1997 to 8.2% in 2002, while values among women seem to have reached a plateau. The economic value of the attributable admissions, at current prices, shows a downward trend for men from 1997 to 2001 and an upward one in the year 2002, while for women the trend is fluctuating. Conclusions : This method demonstrates the following original features: we used metanalytic relative risks real prevalence data, considering a fifteen-year latency period between exposure and effect on health.The model that we developed adheres more adherent to the natural history of the disease and to the local health problem, giving us a useful tool for planning purposes.Furthermore, the economic estimate is made for each single DRG instead of applying medium rates for MDC, which happens more frequently at the national level.

Public and private in italian health care: trends and market quotas

Background : The Italian healthcare system has two components: public and private healthcare providers. Both deliver services on behalf of and payable by the national health care service. This study explores therelationships between public and private healthcare providers. Methods : The number of hospital admissions and length of stay or number of times the service was accessed stratified by year 2000, 2001, 2002; DRG; type of hospital admission (ordinary or day hospital/surgery); health provider category: public institutions without a specific reference territory, public institutions with a specific reference territory and accredited private institutions and medical or surgery DRGs. A distinction is made between those DRGs defined as belonging to the private sector and those falling within the public sector, assuming there is a majority market portion for services primarily supplied by the private sector. Case-mix index was utelised as the indicator for the complexity of the cases treated and the comparative performance index was used as the indicator for efficiency. Lastly in order to evaluate the services delivered with an inappropriate organizational profile reference is made the rulings defining Essential Level of assistance. Results : The results showed a shift in the reallocation of service volumes for ordinary admissions towards the private sector; the reallocation relates to the volumes but not to the types of cases treated, since the DRG mix remained substantially unchanged over the 3-year period and those DRG that absorb 51% of services were essentially constant. The private sector never achieved a market majority quota but rather controlled market niches with minority quotas. The private institutions treated less complex cases and worked with lower efficiency levels than the public sector. There was also a shift in the distribution of admissions from ordinary admissions to day hospital/day surgery regimes with a growth in the proportion of the latter. Conclusions : The study confirmed the predominance of public healthcare providers in the Italian healthcare system as well as their higher complexity and efficiency levels.

Eventi e modi del morire nelle strutture sanitarie di degenza della regione Piemonte

L’ospedale per acuti e il luogo meno adatto ad accogliere il malato in fase avanzata, sia per il modello organizzativo, sia perche progettato per guarire. Poco si sa su come il paziente affetto da patologie in fase terminale muoia in ospedale, sui problemi che incontra e sul tipo di assistenza che riceve. Questo lavoro replica per il Piemonte lo studio EOLO, gia svolto in Lombardia, Umbria e negli ospedali della provincia di Firenze nel 2002. Obiettivi : descrivere le modalita con cui si muore in ospedale (circostanze, interventi/trattamenti attivati). Valutare se esiste un diverso approccio clinicoassistenziale tra pazienti il cui decesso era un evento atteso o improvviso. Metodi: lo studio e di natura osservazionale (2003) e riguarda gli ospedali pubblici e/o convenzionati del Piemonte con un numero di ricoveri/anno › 8.000. I dati dei pazienti sono stati raccolti in sette giornate di osservazione (compresi sabato e domenica), su tutti i malati deceduti per qualsiasi motivo, tramite intervista ad hoc all’infermiere ed al medico responsabili dell’assistenza, consultazione delle cartella clinica ed infermieristica. Sono esclusi i pazienti deceduti entro 24 ore dal ricovero, i malati di eta pediatrica, i reparti di Pronto soccorso, Rianimazione, UTIC e DEA. Le schede sono anonime, i dati vengono raccolti da personale interno all’ospedale. Risultati attesi : quadro epidemiologico e qualitativo dei casi di morte in ospedale. Epidemiologia dei trattamenti clinici ed assistenziali erogati. Descrizione delle eventuali differenze di decision making tra pazienti il cui decesso e atteso o non atteso. Descrizione delle condizioni e degli eventi (tipo di stanza, assistenza di base, presenza dei parenti) che accompagnano la morte del paziente in ospedale. Conclusioni : i pazienti oncologici e non continuano a morire in ospedale. Si conosce molto poco di quello che succede quando un paziente muore e della gestione della morte in ospedale. Questo lavoro contribuira a valutare i problemi presenti e a studiare le possibili soluzioni.

In remembrance of prof. Bruno Angelillo

Extract:I am very glad to speak about Professor Bruno Angelillo in this occasion (National Conference of Public Health, Naples 2009). Probably Giancarlo De Riu would have done this better of me, but he passed away over two years ago and now I want to associate him in memory with Prof. Angelillo, perhaps for the first time in our academic history. Accepting this task, I realised how emotionally deep and delicate it was, especially considering the professor as the Founder of the Neapolitan School of Hygiene. I hope you will forgive me if in this memory I have necessarily include some personal elements: I will start therefore with a declaration of a heavy conflict of interest! I met professor Angelillo in Cremona, our hometown, before my graduation in Parma. The following March I went for a interview at the Institute of Hygiene of Sassari and in April I moved on a permanent basis to that city! I left behind my student status as a little bit “dispersive”, finding in Bruno Angelillo and Giancarlo De Riu a reference and a guide capable of providing a new order in my life.

Tobacco attributable morbidity and hospital costs in Piedmont: forecast for the years 2003-2014

Background : Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this study is to forecast the smoke-related morbidity for the residents in Piedmont for the years 2003-2014 and the relative costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods : The model uses the risk of hospitalisation among non smokers to predict smoke related morbidity for the period 2003-2014 for both smokers and ex-smokers, by using relative risks (RRs) and smoking prevalence. It should be noted that, because of the 15-year latency between smoke exposure and health outcomes, smoking prevalence of the appropriate time period has been applied to the morbidity data of the following 15 years, thus because of the shift of birth cohorts we are able to make forecasts up until the year 2014. Basing on these data it is possible estimate, separately for smokers and ex-smokers, the aetiological fraction (PAR%) used to estimate smoking attributable admissions and smoking attributable costs. The costs attributable to admissions for smoke-related diseases have been estimated using prices set for 2002 as well as prices adjusted for inflation. Results : A total of 145801 hospitalizations are expected among men and 36959 among females for the period 2003-2014. The economic value of the attributable admissions, at prices adjusted for inflation, increases in the period 2003-2014 with a slowdown in 2014. Data show that in 2014, compared to 2003, a smaller amount of resources, in true value, have been allocated to smoking related admissions (- 11.08%). Conclusions . The model used meta-analytic RR real prevalence data, considering a fifteen-year latency period between exposure and its effect on health. Furthermore, an economic estimate is made for each DRG instead of applying medium rates for Major Diagnostic Categories as is frequently seen at a national level.