Laura Dallolio

Assessing the construct validity of the Italian version of the EQ-5D: preliminary results from a cross-sectional study in North Italy

BackgroundInformation on health related quality of life (HR-QOL) can be integrated with other classical health status indicators and be used to assist policy makers in resource allocation decisions. For this reason instruments such as the SF-12 and EQ-5D have been widely proposed as assessment tools to monitor changes in HR-QOL in general populations and very recently in general practice settings as wellAimThe primary goal of our study was to assess the construct validity of the Italian version of the EQ-5D in a general population of North Italy using socio-demographic factors and diagnostic sub-groups. Our secondary goal was to assess the concurrent validity of the EQ-5D and SF-12.MethodsThe SF-12, the EQ-5D plus an additional questionnaire on socio-demographic characteristics, clinical conditions and symptoms were completed by 1,622 adults, randomly selected from the Registry of the Health Authorities of the city of Bologna, Italy. The primary care physician of each subject was contacted to report on the subjects health status.ResultsOur findings indicate that the Italian version of the EQ-5D is well accepted by the general population (91% response rate), has good reliability (Cronbachs alpha 0.73), and shows evidence of construct validity.ConclusionOur data provide a basis for further research to be conducted to assess the validity of the EQ-5D in Italy. In particular future studies should focus on assessing its ability to detect a clinically important change in health related quality of life over time (responsiveness).

Functional and Clinical Outcomes of Telemedicine in Patients With Spinal Cord Injury

OBJECTIVE To compare the 6-month outcomes of telerehabilitation intervention with those of standard care for spinal cord injury (SCI). DESIGN Multicenter randomized controlled trial. SETTING Home, nursing, or unspecialized hospital care provided after discharge from a spinal cord unit. PARTICIPANTS Adult patients with nonprogressive, complete, or incomplete SCI discharged for the first time from the spinal cord unit to their homes (Belgium and Italy) or to their homes or another facility (England). INTERVENTIONS All patients received the standard care they would have normally received after discharge from the spinal cord unit. In addition, patients in the telemedicine group received 8 telemedicine weekly sessions in the first 2 months, followed by biweekly telemedicine sessions for 4 months. MAIN OUTCOME MEASURES Functional status at 6 months, clinical complications during the postdischarge period, and patient satisfaction. RESULTS No significant differences in the occurrence of clinical complications were found between the study groups. A higher improvement of functional scores in the telemedicine group was found only at the Italian site: FIM total score 3.38+/-4.43 (controls) versus 7.69+/-6.88 (telemedicine group), FIM motor score 3.24+/-4.38 (controls) versus 7.55+/-7.00 (telemedicine group; P<.05). Items contributing to this difference were grooming, dressing upper body, dressing lower body, and bed/chair/wheelchair transfer. Higher satisfaction with care was reported by patients in the telemedicine group across all sites. CONCLUSIONS Our study provides some of the first quantitative evidence, based on results from 1 site, that telerehabilitation may offer benefits to patients discharged from a spinal cord unit compared with standard care in terms of functional improvement. Further research is warranted to confirm or disprove this finding.

Peripartum hysterectomy and cesarean delivery: a population-based study.

Objective. To estimate the incidence of peripartum hysterectomy in an Italian Region (Emilia‐Romagna) and investigate its association with cesarean delivery. Design. Population‐based retrospective study using hospital discharge records. Setting. All public and private hospitals in Emilia‐Romagna region, Italy. Population. A total of 151,494 women delivering between 2003 and 2006, 131 of whom had a peripartum hysterectomy. Methods. Peripartum hysterectomy was defined as a hysterectomy performed at the time of delivery or afterwards during the same hospitalization. Incidence rates were calculated by type of delivery. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated with logistic regression to evaluate the association between peripartum hysterectomy and delivery type. Main outcome measures. Incidence rates of peripartum hysterectomy by type of delivery; odds of peripartum hysterectomy after primary or repeat cesarean compared with vaginal delivery without previous cesarean. Results. A total of 131 peripartum hysterectomies were performed among 151,494 deliveries (0.86/1,000 deliveries; 95% CI 0.72–1.03) with 20.7% primary and 9.6% repeat cesarean deliveries. Women undergoing a primary caesarean delivery were more likely to have a peripartum hysterectomy than women having a vaginal delivery who had never had a cesarean delivery (OR 6.48; 95% CI 4.16–10.07). Women undergoing a repeat caesarean delivery were also at increased risk (OR 3.69; 95% CI 2.11–6.46). Conclusions. In this population, primary and repeat cesarean deliveries are associated with an increased risk of peripartum hysterectomy. These results are of particular concern given the steady increase in the cesarean delivery rate in many countries. The pathological mechanism of this association requires further investigation.

Effect of different disinfection protocols on microbial and biofilm contamination of dental unit waterlines in community dental practices.

Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.

Impact of a risk management plan on Legionella contamination of dental unit water.

The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

Prevalence of Simkania negevensis in chlorinated water from spa swimming pools and domestic supplies.

This study aimed to investigate the prevalence of Simkania negevensis in the chlorinated water of spa swimming pools and domestic network systems.

Impact of Adapted Physical Activity and Therapeutic Patient Education on Functioning and Quality of Life in Patients With Postacute Strokes

Objective. The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes. Methods. This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score. Results. Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01. Conclusions. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.

Outcomes from a randomized controlled trial of tele-rehabilitation for people with spinal cord injuries

A randomized controlled trial was conducted in spinal treatment centres in three European countries to evaluate the effectiveness of using Internet-based video-link technology in the first six months after patients were discharged following spinal cord injury. Standardised measures were used with participants prior to randomization to either trial or control group. Both groups received standard post-discharge support, but in addition the trial group had regular videoconference sessions. Each participant received an assessment at two months’ and six months’ post-discharge. The 1 37 participants recruited over two years had a mean age of 42 years. Interim data analysis with 77 patients revealed a significant difference between the trial and control groups when quality of life intra-subject score differences between discharge and month 6 were compared (P = 0.025). Medical complications were not significantly different between trial and control groups. The video-link was well received by the trial group, who preferred to see the person they conversed with. Regular expert consultation using video-link technology benefited participants’ quality of life.

Controlling Legionella and pseudomonas aeruginosa re-growth in therapeutic spas: implementation of physical disinfection treatments, including UV/ultrafiltration, in a respiratory hydrotherapy system

The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties.

Cesarean section rates in Italian regions: 1998-2002

Cesarean section (c-section) rates have been increasing in many countries, and too frequently this rise does not seem to be justified by clinical grounds. To reduce c-section rates and achieve a proportion of 20% is among the goals of the Italian National Health Plan. In the following paper we provide an update on the distribution of rates amongst Italian regions and describe the association between regional hospital volumes and c-section rates. The national c-section rate increased from 31% in 1998 to 36% in 2002. The rates varied among regions and ranged from 20% in the Province of Bolzano to 56% in Campania. A significant association was observed between the regional hospital volumes for deliveries and c-section rates, regions with low hospital volumes performed more c-sections than high volume regions.