bluuebunny/crossref_metadata_2025 huggingface dataset:
Intelligence, academic achievement, and pediatric injury among a large sample of kindergartners
Authors: Schwebel David C. , Brezausek Carl M.
Published: June 2024

Objectives: Previous work reports mixed results on the roles of intelligence and academic achievement on child injury risk. Some early research offered evidence of links between lower levels of intelligence and higher rates of pediatric injury, but other work has suggested there is no relation between the variables. This study investigated the matter further, in the context of a large sample and with strong statistical power.
Methods: Data from a national sample of 8002 kindergartners in the United States, all from low-income families, were analyzed. Intelligence was estimated using the Peabody Picture Vocabulary Test-Revised and academic achievement with the Reading and Mathematics scales of the Woodcock Johnson Psycho- Educational Battery-Revised. Mothers reported whether children had experienced an injury in the previous year that required professional medical attention.
Results: Results of both bivariate and multivariate ordinal logistic regression models suggest higher levels of reading achievement and of mathematics achievement were associated with slightly reduced risk of pediatric injury. Intelligence was not related to injury history.
Conclusions: Academic achievement, but not intelligence, appears to relate in a small but statistically significant inverse manner with risk for pediatric injury among kindergartners from a low-income background. Possible mediators include children’s ability to learn and remember safety-related rules or the fact that parents who encourage learning in the household might also safeguard children more effectively.
Spectrum of injuries in a tertiary care hospital of Karachi, Pakistan
Authors: Nasrullah Muazzam , Muazzam Sana
Published: June 2024

Background: The burden of injuries and disabilities in Pakistan is significant. Our study attempted to describe the circumstances, risk groups, types and severity of injuries experienced by patients attending a tertiary care hospital in Karachi, Pakistan.
Methods: A retrospective study was conducted in the department of Emergency Medicine (ED) at Aga Khan University Hospital of Karachi, Pakistan. Past medical records from June 2006 till May 2007 of injured patients presented to ED were reviewed. Data were recorded regarding the basic epidemiological features, hospital stay, body parts injured and severity of injuries.
Results: A total of 631 patients with injuries were identified. The majority of them were males (80%; n=502), aged 21-40 years (63%). Road traffic injuries (RTIs) 65% (n=411) followed by gunshots (14%, n=85) were the most common types of injuries. Upon arrival to hospital 82% (491/598) of patients had a Glasgow Coma Scale (GCS) ≥13. The mean hospital stay and Injury Severity Score (ISS) of patients were 3.5 days (SD ±6.4) and 4 (SD ±5.2) respectively. The head, neck and face were the most affected body parts (50%; n=276). Three percent (n=17) were pronounced dead on arrival to the ED. Among RTIs, multivariable logistic regression identified sex (aOR: 3.797; 95% CI: 1.066–13.528), and mode of travel (aOR: 2.883; 95%CI: 1.330–6.250) as independent predictors for severe GCS (GCS<8).
Conclusions: RTIs were the most common type of injuries, common among young males. In RTIs, children were mostly pedestrians, and females and motor vehicle occupants were more likely to have severe GCS. This study may assist local authorities in Karachi to prioritize interventions to address common injuries in those who are high at risk.
Litigating to prevent injuries: a strategy for consideration
Authors: Frattaroli Shannon , Teret Stephen P. , Vernick Jon S.
Published: June 2024

The effectiveness of legislation and regulation as tools for injury prevention is well recognized in Europe. There is another tool that has been used effectively in the United States, but which is not substantially discussed in the European injury prevention literature. Litigation against the makers of unsafe products has been used in the US to create an incentive for manufacturers to invest in safer product design rather than risk a lawsuit and pay a penalty for neglect. This commentary discusses the use of litigation in the US as a tool for preventing injuries, and speculates on whether such an intervention might be feasible and desirable in Europe.
Editorial
Authors: La Torre Giuseppe
Published: June 2024

It is rather difficult to give a unique definition of Health Services Research (HSR), since the concept of HSR has been evolving over the last 30 years. According to Last (1988), HSR can be considered the integration of epidemiologic, economic and other analytic sciences in the study of health services. HSR is a type of research, multidisciplinary in nature that can be conducted in several settings focusing on different purposes. The objective, according to the view of the Agency for Healthcare Research and Quality (2002), is to make research capable not only of identifying the most effective ways to organise, manage, finance and deliver high quality care, but also of reducing medical errors and improving patient safety. The relationship between HSR and public health is very strong: on one hand, both disciplines are concerned with the health status of the individual or of the population; while on the other hand, they deal with health systems, health intervention and factors that could influence health status.
The validity of hospital administrative data for outcome measurement after hip replacement
Authors: Baglio Giovanni , Sera Francesco , Cardo Stefania , Romanini Emilio , Guasticchi Gabriella , Labek Gerold , Torre Marina
Published: June 2024

Background: Because of the increasing availability of clinical information on the basis of electronically processed data obtained through the hospital discharge records in the HIS, large databases are being set up to develop risk adjustment models for outcome assessment. This study is aimed at assessing the validity of hospital discharge data from the Hospital Information System (HIS) of patients with hip arthroplasty.
Methods: 677 records were extracted from the database of the pilot project “Lazio Region Hip Arthroplasty Register (Ripa-L)” and were compared to the corresponding HIS discharge records. The Ripa-L dataset was used as a reference to evaluate the completeness and accuracy of the socio-demographic and clinical HIS data.
Results: Data such as the patients’ age and sex, principal diagnosis, and surgical procedures, showed a very high level of agreement. By contrast, clinical information about comorbidities on admission and in-hospital complications mostly showed unacceptable variances in the datasets. The sensitivity of hospital data reporting was generally very low for almost all conditions, with the highest value being observed for diabetes (58%) and the lowest for endocrine and peripheral venous diseases (4%).
Conclusions: Gaps in clinical information may compromise the ability to carry out high quality appraisals. In particular, the underreporting of comorbidities in hospital administrative data may lead to misestimation of the providers’ skill and quality of care, as a consequence of imperfect risk-adjustment. Stakeholders should highlight the potentialities related to the use of high quality administrative datasets also in clinical evaluations by stimulating health professionals to further improve the quality of the collected data.
Comparing orthodontic treatment need indexes
Authors: Grippaudo Cristina , Paolantonio Ester Giulia , La Torre Giuseppe , Gualano Maria Rosaria , Oliva Bruno , Deli Roberto
Published: June 2024

Background: Orthodontic Treatment Need Indexes are investigated to evaluate their validity criteria and their formulation on a scientific basis.
Methods: A bibliographic research was performed on Medline Database to find articles about orthodontic treatment need indexes published from 1960 to 2007. English language papers about criteria to establish indexes, their validity and reproducibility, and comparing two or more indexes were chosen.
Results: The study shows that orthodontic treatment need indexes are not based on evidence but are all based on the opinion of experts, although widely shared by the orthodontic community since the use of these indexes in clinical practice. The validity is assessed in terms of objectivity of the measurements needed to evaluate the clinical severity of the case under consideration. In this case, the quantitative methods seem to be more reliable and objective than the qualitative.
Conclusions: Currently in the orthodontic field the theory that orthodontic therapy is useful to prevent any disease in the patients is not supported by evidence based medicine. The recommendations about orthodontic treatment need should come from scientific debates, in order to support consensus based decisions.
Basic analysis of non-European Union immigrants’ hospitalizations and ambulatory care in the province of Ferrara, Northern Italy: the first step to an improved approach to immigrants’ healthcare
Authors: Cucchi Alessandro , Bergamini Mauro , Buriani Orazio , Ferrari Antonella , Giovannini Laura , Marconi Susanna , Montanari Katia , Serenelli Carlotta , Turri Valentina , Gregorio Pasquale
Published: June 2024

Background: Immigration towards Ferrara is a recent occurrence. We evaluated the immigrants’ health requests. Methods: This report is based on data collected by Local Health Authority.
Results: The analysis of ambulatory cares and hospitalizations are comparable. It emerges the age class 31- 65 is the most represented. Females’ requests are more than males’ one, due to pregnancy and gynaecological health requests. The capital hospital sustained the heaviest workload. We found differences respect European Union population regarding length of stay. The predominant kind of access are through emergency room and self-access.
Conclusions: This complex pattern of health care requests requires dedicated approaches.
FoodBioTimerAssay: a new microbiological biosensor for detection of Escherichia coli food contamination
Authors: Berlutti Francesca , Pantanella Fabrizio , De Giusti Maria , Tufi Daniela , Valenti Piera , Boccia Antonio
Published: June 2024

Background: Prevention of foodborne diseases is a fundamental goal for public health and industries engaged in food preparation and distribution. The correct procedure to ensure an effective prevention of foodborne diseases consists essentially in microbiological monitoring and enumeration of indicator microorganisms of faecal contamination at critical control points along the food producing procedures. Here, we propose a new microbiological biosensor, called FoodBioTimerAssay (FBTA), for rapid and reliable detection of Escherichia coli as indicator of faecal contamination in food and surface samples.
Methods: A total of 122 samples were analysed using both experimental FBTA and Reference method. FBTA employs FBTM medium and counts bacteria through microbial metabolism measure: the time required for colour switch (red-to-yellow) of FBTM, due to E. coli metabolism, is correlated to initial bacterial concentration.
Results: FBTA results showed an overall agreement percentage with Reference method equal to 97.54%. Discrepancies concerned three samples (1 food and 2 surface samples). Moreover, the time required to perform FBTA method was 3-fold shorter than Reference one.
Conclusions: FBTA method may be considered a useful tool for detection of E. coli contamination in food and surface samples. Therefore, FBTA method may be successfully employed in risk analysis of foodborne diseases.
The opinions of Finnish specialist physicians on social security system
Authors: Saarinen Arttu O
Published: June 2024

Background: We can argue that opinions are considered to be part of the physician’s professional identity. Professional identity has been considered a result of learning. After graduation physicians usually continue to study to gain a specialisation, and we can assume that this process affects their opinions because every specialty has its own “cultural climate”. Also, specialists have different views towards the welfare state because, for example, of the fact that they work with different types of population groups.
Aim of the study: In this article we will describe how specialists feel about the current level of social security in Finland.
Methods: The empirical analysis in our study is based on postal survey. The 2000 working age physicians’ random survey sample was picked from the register of the Finnish Medical Association (n=1092, response rate 54,6 %). The whole questionnaire included questions dealing with social security, health policy and health care system. The data was analysed using means and multinomial logistic regression analysis.
Results: This study shows that surgeons and radiologists are the most critical of social security. These groups often think that social security is excessive. In contrast, psychiatrists show a stronger tendency to support social security. All in all, Finnish specialists are more critical of the social security system than are nonspecialised physicians.
Conclusions: There are many similarities between Nordic countries when we look at the historical role of medical profession. We can also assume that specialist physicians' opinions on social security are quite similar compared to those of other Nordic countries.
Epidemiological approach to emergent cranial surgery of cranial traumas
Authors: Kaptan Hülagü , Çakıroğlu Kutay , Kasimcan Ömür , Özcan Li Rıza , Yaĝli Emre , Özgun Recep , Kılınçaslan Mehmet , Dlhan Mustafa , Kiliç Celal
Published: June 2024

Objective: In this study, we aim to define the emergent cranial surgery of cranial trauma cases in terms of the reason of occurance, diagnosis, prognostic factors and results. Methods: 153 cases hospitalized in our clinic during a four year period were statistically analysed in accordance with trauma etiology, age, gender, application GCS (Glascow Coma Score) mortality rate, location and established patology.
Results: 76% (116) of the 153 cases were male. The most frequent etiological reasons were, in descending order, traffic accident 52% (n = 80), fall 34% (n = 53), direct trauma to the head 14(n =20). 45% (n = 69) were diagnosed epidural haematomas, 26% (n = 40) were diagnosed depression fractures and 3% (n = 5) were diagnosed intracerebral haematomas. A meaningful statistical difference was found in the comparison of the diagnosis regarding gender (p=0,012) age group (p=0,0282) and GCS (p=0,0001).
Conclusions: In order to prevent cranial traumas, studies aimed at minimizing traffic accidents should be undertaken. The most essential action after the accident has occured is triage, and this is of great importance in order to establish communication among the health institutions.
Research on the health state of the Sicilian population living in areas at environmental or natural risk: the experience of the Regional Department of Epidemiology
Authors: Cernigliaro Achille , Pollina Addario Sebastiano , Nicolotti Nicola
Published: June 2024

Background: In Sicily, people live near areas characterized by the presence of environmental polluting substances derived from urbanization and industrialization. In the areas of Augusta-Priolo (SR),Gela (CL) and Milazzo (ME), the increase of number of pathologies could be linked with environmental pollution. The aim of this paper is to present an overview of the available data and studies to underline the importance of these sources to conduct epidemiological survey in Sicily, besides to the analysis of mortality and morbidity.
Methods: An evaluation of the health status of the residential population was done comparing the mortality and morbidity of the local population with the mortality and morbidity of a reference population. Data was obtained from the Italian national office of statistics and Hospital Discharge Records. Standardized Mortality Ratios and Standardized Hospitalization Ratios were calculated.
Results: In the area of Augusta-Priolo we observed, in for men, a significative increase in mortality and hospital admissions for colon-rectal, trachea, bronchus, lung and pleura cancers. In Biancavilla, we observed an increase in mortality for pleura cancer in men and women and an increase in morbidity in women only. In Gela, a significant increase in mortality in males and females was observed only for tumoral diseases. In Milazzo, we only found a significant increase in the incidence of larynx cancer and cardiovascular disease for men and in women of pulmonary disease for women.
Conclusions: This first review allowed us to update previous analyses of mortality data conducted in the same areas. The results, even taking into account the differences between the areas,, highlights changes in health status related to some diagnostic groups. These could be linked with pollution. Now that the available health data has been revised and updated new studies must be conducted.
Evaluating the impact of healthy cities in Europe
Authors: Green Geoff , Tsouros Agis
Published: June 2024

Background: Cities are engines of health development and not merely settings for health promotion. However, political scientists contest the extent of their powers and the scope of their influence.
Methodology: Assuming local governance is a locus of decision-making about intermediate determinants of health, then there are three methodological challenges to evaluating its impact: first, accounting for context; second, addressing multiple, interactive interventions; and third identifying mechanisms for change. ‘Realist’ evaluation is more appropriate for this task than traditional paradigms of public health research.
Review: Commissioned evaluations of the first three phases (1987-2002) of the WHO European Healthy Cities Network are reviewed against the three methodological challenges.
Conclusions: These evaluations are stronger in identifying necessary city structures and processes but weaker, as are the Network cities themselves, in identifying change mechanisms which convert sector interventions into health gains. This lacuna is addressed in Phase IV (2003-2008) of the Network by the themes of healthy urban planning and health impact assessment.
Behavioural profile of drug users attending public drug-treatment centres in Sicily: the role of social context
Authors: Vitale Francesco , Casuccio Alessandra , Bresciani Marco , Maggio Anna M. , Serio Giorgio , Prestileo Tullio , Tramuto Fabio , Gioè Patrizia , Milazzo Giuliano , Filippone Giuseppe , Grasso Marcello , Di Marco Tommaso , Calamusa Giuseppe , Romano Nino
Published: June 2024

Objective: Investigations of injecting drug users (IDUs) have suggested that the social context may influence high-risk behaviours in this population. The aim of this study was to describe knowledge, attitudes and behaviours of IDUs attending public drug-treatment centres in our area.
Study design and methods: A cross-sectional survey was conducted between July 2002 and February 2004, enrolling 607 drug users attending four public drug-treatment centres in the Palermo area. Two of them were located inside the urban area, whereas the other two were in rural districts near the city. All participants answered an anonymous questionnaire concerning social and demographic characteristic and potential high-risk behaviours.
Results: IDUs living in urban context have a higher educational level, higher number of sexual partners, as well as a lower prevalence of exchanging sex for drugs. Conversely, IDUs living in suburban/rural context are less likely to share syringes and more likely to have used light drugs in the past. Suburban/rural IDUs drink more alcohol but smoke less cigarettes/day, although both groups are strong smokers.
Conclusions: The results suggest that public drug-treatment centres should take in consideration the adoption of specific programs targeting specific groups, in line with the profile and needs of the subjects in each context in order to promote approaches leading to risk reduction.
HIA in Switzerland: considerations concerning the experience of the Cantons of Geneva, Jura and Ticino
Authors: Cantoreggi Nicola , Frei Kurt , Simos Jean , Casabianca Antoine , Litzistorf Spina Natacha , Diallo Thierno
Published: June 2024

This article is intended to be an initial report on the experiences gained while using HIA. Although it is provisional and pragmatic, it ought to provide useful elements for comparison with other territorial situations, both Swiss and foreign. The large differences between the three cantonal political-institutional contexts probably explain the profound differences in the way that HIA processes were introduced in each canton. Nevertheless, the article - through the concept of institutionalization - seeks to identify supracantonal elements. Finally, by presenting HIA implementation methods in different Cantons, it endeavours to demonstrate the existence of a common matrix in the Swiss context beyond the differences arising from the actual political-institutional situations linked to them.
The importance of continuing surveillance of risk factors for prevention of cardiovascular diseases
Authors: Lanza Gaetano A.
Published: June 2024

After peaking in the 1960s’, cardiovascular diseases (CVDs) have shown a consistent decline in western countries in recent decades [1].Despite this,CVDs remain the major cause of mortality and morbidity in industrialized populations, with relevant associated socio-economical issues, while their incidence is increasing in developing countries. Several factors have likely contributed to the reduced incidence of CVDs in industrialized societies, including an increase in education and attention to health issues, lifestyle changes and improvement in diagnostic facilities and therapeutic tools. Epidemiologic studies have played an outstanding role in the decline of CVDs. Indeed, they have allowed for the identification of habits and conditions which expose healthy subjects to an increased risk of development of atherosclerosis and its complications They have also led to the implementation of appropriate programs and campaigns aimed at fighting the identified risk factors by means of changes in diet and lifestyle and the use of specific drug treatments. In particular, tight control and prevention of hypertension, smoking and hypercholesterolemia has largely contributed to the reduction of CVDs, accounting for more than 50% of the reduction of mortality from the 1960s’ to the 1990s’ [2].This approach was also crucial in improving the clinical outcomes of secondary prevention for CVDs.
The impact of screening for cardiovascular disease risk factors on population health and inequality. Evidence from the Stockport Screening Programme, United Kingdom
Authors: Baker Deborah , Middleton Elizabeth , McCluskey Serena , Lewis Philip
Published: June 2024

Background: Population based screening for cardiovascular disease risk factors can potentially reduce coronary heart disease mortality and morbidity. There is little contemporary evidence that has examined the actual impact of such a programme on population health and on reducing inequality in health between affluent and deprived areas.
Methods: 82,015 residents of Stockport Health Authority, UK age 35-60 took up an invitation to be screened for cardiovascular disease risk factors from 1989 -1999. We compared uptake of screening and coronary heart disease (CHD) mortality and hospital admissions (1997 – 2003) between screened and unscreened male and female populations from affluent and deprived areas.
Results: Males and females in the unscreened population were more likely to die from CHD (IRR=3.60; p<0.001, IRR=4.64, p<0.001) and to have a hospital episode (IRR=1.75, p<0.001, IRR=1.94, p<0.001) than those in the screened population. This was independent of age and deprivation. The highest rates of CHD mortality and hospital admissions were found for unscreened deprived populations, the lowest for screened affluent populations. For both males and females mean rates of CHD mortality and hospital admissions were significantly lower for those who were screened and living in deprived areas compared to those who were unscreened and living in affluent areas.
Conclusions: Screening for cardiovascular disease risk factors improved the cardiovascular health of the population by targeting and treating ‘high risk’ groups, including those living in deprived areas. The potential of screening to reduce health inequality by promoting faster and more substantial health improvement in deprived areas was not observed in this study.
Real-time PCR detection of Salmonella spp. and Listeria monocytogenes in ready-to-eat foods: a comparison between the biomolecolar method and traditional microbiology
Authors: Quaranta Gianluigi , Laurenti Patrizia , Boccia Stefania , Sezzatini Romina , Amore Rosarita , Ricciardi Gualtiero
Published: June 2024

Objective: The aim of the present study is to evaluate the presence of Salmonella spp. and Listeria monocytogenes in ready-to-eat foods by comparing the performance and sensitivity of BIO-RAD commercial Kits based on real-time PCR detection with traditional culture (ISO) procedures. Materials and methods: Sixty-five samples of ready-to-eat foods were analysed as described above. In order to verify the validity of both culture and biomolecolar methods and to compare the sensitivity of real-time PCR versus conventional culture (ISO) procedures, five food samples were artificially contaminated with the Salmonella enteritidis ATCC strain by using scalar concentration from 103 to 10-1 cfu/g while one food sample was artificially contaminated with the Listeria monocytogenes ATCC strain. Finally, statistical analyses of the results were performed using the statistics “K” to confirm the agreement between the compared methods.
Results: Both procedures showed the absence of Salmonella spp. and Listeria monocytogenes in the processed samples; results in agreement appeared both for the five food samples artificially contaminated with Salmonella enteritidis ATCC strain and for the food sample artificially contaminated with Listeria monocytogenes ATCC strain. The sensitivity of the biomolecolar test was 1 cfu/g. Therefore full agreement between the two methods was detected, with a K value of 1.
Conclusions: The real-time PCR system appears to be extremely useful in the rapid screening of food samples, allowing for the rapid identification of Salmonella spp. and L. monocytogenes.
Pharmaceutical Pricing and Reimbursement Information (PPRI): a European Union project
Authors: Arts Danielle , Habl Claudia , Rosian Ingrid , Vogler Sabine
Published: June 2024

Background: In the European Member States, the systems for pharmaceutical pricing and reimbursement differ significantly. Amongst the administration and policy-makers at both national and European levels there is a lot of interest in the different pharmaceutical systems of the Member States as a means of learning from their experiences in pricing and reimbursement.
Objectives: The general objective of the PPRI–Project – started in April 2005 - is to develop a network of authorities and institutions in order to improve information and knowledge on the pharmaceutical systems in the enlarged European Union. This network should facilitate a regular exchange of information and allow a process of learning from each other.
Project description: The PPRI project team consists of the main partner (ÖBIG), an associated partner (WHOEURO) and a network of partners and observers which represent national stakeholders from almost all EU Member States and a number of international stakeholders. The information on pharmaceutical pricing and reimbursement will be collected and summarised in country reports (“Pharma Profiles”) which follow a homogenous structure. The individual country’s information will be analysed and compared on the basis of a set of indicators (benchmarks).
Deliverables:The main deliverables of the project are:
 • Pharma Profiles, • a benchmarking report, in which pharmaceutical pricing and reimbursement in the Member States is compared,
• a website containing information on the project and on pricing and reimbursement in the Member States, and
 • a conference at the end of the project during which the study results will be disseminated.
The Luxembourg Declaration on Patient Safety: a political comment
Authors: Di Bartolomeo Mars
Published: June 2024

Services provided for European citizens’ healthcare are not services like standard commercial services. Healthcare services need to be accessible, independent of the citizen’s economic or social background and should at the same time be available to all at the best possible quality level.
The Luxembourg Declaration on Patient Safety recognizes these challenging fundamental principles. Patient safety is a key aspect for all European policy makers, as it is a vital question of equitable access to health care. Nevertheless we know that unfortunately a considerable amount of avoidable safety events still occur all across Europe!
However differently organized our national health systems may be, it is vital to share experience and knowledge at a European level in order to be able to learn from the experiences of the different memberstates. No uniform solution can be found and decreed from the bottom down, nevertheless Europe can contribute and help to raise standards by a common effort. The Luxembourg Declaration is a launching pad for European progress in this field as it sets important goals and demonstrates the steps to be undertaken. It is a calling and gives us hope for measurable progress in the future.
EU health stakeholders and patient safety
Authors: Tiddens-Engwirda Lisette
Published: June 2024

The Standing Committee of European Doctors (CPME) has been actively promoting patient safety for a long time, well before the issue was given a firm place on the European and international agendas. Among its efforts to help raise the profile of patient safety, CPME organised a conference on the 4th and 5th April 2005 together with a group of EU health stakeholders that covered the whole spectrum of healthcare delivery.
The European Conference ‘Patient Safety – Making it happen!’ took place in Luxembourg under the auspices of the Luxembourg EU presidency and EU Commissioner Kyprianou and resulted in the “Luxembourg Declaration on Patient Safety”.
This Declaration contains recommendations to the EU, national authorities and healthcare organizations. It underlines the added value of the EU and recommends joining forces with the WHO Alliance for Patient Safety.
A culture of transparency, trust and safety is being sought for through the suggested use of e-health, flows of health information, patient involvement and reporting systems. CPME saw perseverance and commitment pay off as patient safety is now seen as a priority by all health stakeholders and EU institutional bodies (European Commission, presidencies and Council). However all parties realise full well that the Luxembourg Declaration on Patient Safety is only the first step. All efforts are now focussed on follow up and implementation.
The Simpatie project
Authors: Cucic Cule , Somekh David
Published: June 2024

In this article a current European multi-national project in patient safety is described. This project began in Feb. 2005 and will run for two years. It is managed by a consortium of seven NGO’s led by the CBO (Dutch Institute for Healthcare Improvement) and receives 60%of its funding from DGSANCO (the health and social policy division of the European Commission).
The policy framework within which the project evolved is also described. Despite the constraints of Art 152 of the Treaty, support from Commissioner Byrne encouraged a High Level Reflection process (HLRP) on patient mobility and healthcare developments in the EU, which started in June 2002 and involved European Health Ministers.
As a result a series of very positive recommendations were made at the end of 2003 which subsequently were accepted and have affected policy direction in a number of areas e.g. co-operation on e-health, better use of resources as well as quality issues such as patient safety and quality implications of cross-border patient flows.
The paper then reviews current issues in patient safety activity within Europe. Finally the Simpatie project is described. It is comprised of four main elements. First, a mapping exercise to determine the present status of patient safety activity within at least 20 European countries.
It utilises extensive existing networks within and between the members of the consortium and other relevant stakeholders within Europe.
Secondly, a “tool-box” exercise attempts to define common terminology and an expert consensus on measurement tools. This is complemented by the third element, a strategy component which aims to define the basic elements of different approaches to implementing patient safety within health systems. Finally, the last element is dissemination, where involvement of both public and health user organisations will be an important component.
The Danish patient safety experience: the Act on Patient Safety in the Danish health care system
Authors: Lundgaard Mette , Raboel Louise , Broegger Jensen Elisabeth , Anhoej Jacob , Pedersen Beth Lilja
Published: June 2024

This paper describes the process that lead to the passing of the Act for Patient Safety in the Danish health care system, the contents of the act and how the act is used in the Danish health care system.
The act obligates frontline health care personnel to report adverse events, hospital owners to act on the reports and the National Board of Health to communicate the learning nationally.
The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740 adverse events were reported.
The reports were analyzed locally (hospital and region), anonymized and then sent to the National Board of Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts of the system is essential to maintain the level of reporting.
Patient safety: the experience of an Italian teaching hospital
Authors: Marchetti Marco , Capalbo Gennaro , Scanu Anna Laura , Marazzi Ludovico , Fiore Alberto
Published: June 2024

Introduction The risk management project of The University Hospital “A. Gemelli” aims to define the necessary procedures to manage clinical risk, by identifying the structures involved within this process, so that all of the personnel can contribute to a measurable improvement in the safety of both patients and staff.
Methods The Risk Management Program is comprised of 5 long-term phases: Phase 1 - Strategy Definition and Communication: a clear and shared Risk Management Strategy is indispensable to guarantee a coordinated action plan, in order to focus all of the interventions towards the achievement of common and measurable results. Phase 2 - Risk Management System Governance: all of the organisational structures have been activated in order to effectively manage the Risk Management System. The system has been introduced to interact within all areas of the hospital and to transfer information. Phase 3 - Promotion within the Organisation: this phase fosters the aims of the project within the whole organisation, by stressing the concept of “learning from errors”. This is crucial if organisational and healthcare workers are to understand the true aims of risk prevention and protection and offer to contribute to the process. Phase 4 - Risk Assessment: a data survey system was created and institutionalized. This phase begins with an analysis of the information flow, in order to estimate the probabilities that certain risks occur, and ends with defining the interventions to undertake. Risk assessment makes it possible to forecast the consequences of certain risks and thus prioritise those for prevention. Phase 5 - Risk Management: this consists of planning and implementing all of the actions necessary to prevent risks, protect and finance (in terms of prevention) A. Gemelli University Hospital.
Results The results achieved are remarkable especially when one considers the organisation of a complex clinical risk management system within a large university hospital. An information flow that examines and identifies risks from surveying the data has been created. Preventative activities have been planned in the laboratories, transfusion and pharmacotherapy sectors as outlined in the risk map, together with clinical audit activities. Furthermore, all of these issues have been highlighted across all sectors with the creation of an accredited ECM training program as well as the implementation of an anonymous survey. These initiatives have not only increased the interest in Risk Management issues, but have also fostered the integration of different groups and their working methods.
Conclusions Introducing risk management processes to A. Gemelli University Hospital represents a step from the promotion and dissemination phase to that of a formal organic risk management system in medicine. This initiative, involving the participation of all personnel, has produced a measurable improvement in safety of both patients and staff.
Epidemiology of Legionella in environments for recreational, tourism or physical activities
Authors: Spica Vincenzo Romano , Paparini Andrea
Published: June 2024

Legionella is a waterborne microorganism responsible of severe pneumonia. Legionnaire’s disease and Pontiac fever are clinical syndromes related to contaminated environments.
Outbreak sources have been identified in sport facilities, thermal springs, spas, hotels, campsites, cruise ships and other structures for recreational or tourism purposes. Infection spreads by inhalation of contaminated aerosols from showers or whirlpool baths. Exposure to properly maintained swimming pools does not represent a major risk factor. Several prevention strategies and decontamination procedures are available.
Public Health in Europe : 10 years EUPHA
Authors: Kirch Wilhelm
Published: June 2024

What is Public Health (PH)? What are the links between Public Health research and policy in Europe? Where is PH coming from in the 20th century and where is it directed to?
These are some of the questions addressed by Public Health in Europe – 10 years EUPHA, the volume, edited by Prof.W. Kirch and published by Springer in 2004, that presents a selection of the manuscripts from the 10th Annual Congress of EUPHA, held in Dresden in 2002.
Gunnar Tellness, the President of EUPHA, reminds us what PH is, or what it should be: the science devoted to reduce in the population the amount of disease, premature death and disease-related discomfort, sickness and disability.
In addressing these themes,Tellness suggests to improve PH by employing healthpromoting and cultural activities, in order to establish strong collaborations between public agencies, private business, organisations and pioneers.
L'evoluzione dell'ospedale tra reti e centri di eccellenza
Authors: Cicchetti A.
Published: June 2024

Non c’è oggi Paese al mondo in cui la Sanità non rappresenti uno dei temi più forti del dibattito politico, economico e sociale. Indipendentemente dal tipo di sistema sanitario operante, che sia cioè a valenza quasi esclusivamente pubblica, come per esempio in Inghilterra, o ad impronta privata, come negli USA, le questioni di fondo sono comuni: - come soddisfare bisogni in costante progressivo aumento a fronte di risorse inadeguate; - come raggiungere la massima efficienza gestionale; - come garantire ai pazienti cure appropriate e qualità di servizi.
In tale contesto che, ripeto, è comune in tutto il mondo, il nodo più rilevante riguarda l’assistenza ospedaliera.
Costituendo più del 50% della spesa sanitaria, si trova inevitabilmente al centro del sistema, quantomeno per risorse assorbite.
Human and animal integrated influenza surveillance: a novel sampling approach for an additional transmission way in the aquatic bird reservoir
Authors: Delogu Mauro , De Marco Maria A. , Cotti Claudia , Di Trani Livia , Raffini Elisabetta , Puzelli Simona , Webster Robert G. , Cassone Antonio , Donatelli Isabella
Published: June 2024

Background: infectious low pathogenic avian influenza viruses (LPaIVs) have been recently detected on feathers of wild ducks. Laboratory trial results suggested that the preen oil gland secretion, covering waterbirds’ feathers, may attract and concentrate virus particles from aIV-contaminated waters to birds’ bodies. We evaluated whether ducks can become infected by the ingestion of preen oil-associated viral particles, experimentally smeared on their plumage. In addition, we compared virologic and serologic results obtained from mallards whose feathers were experimentally infected, with those from wild mallards naturally carrying aIVs on feathers.
Methods: we experimentally coated 7 mallards (anas plathyrynchos) using preen oil mixed with a LPaIV (h10n7 subtype), and housed them for 45 days with a control, uncoated duck. cloacal, oropharyngeal and feather swabs were collected from all birds and examined for aIV molecular detection and isolation. Blood samples were also taken to detect influenza specific antibodies. In addition, sera from 10 wild mallards, carrying on feathers infectious LPaIV h10n7, were examined.
Results: virologic and serologic results indicated that through self- and allopreening all the birds experimentally coated with the preen oil/aIV mix and the control duck ingested viruses covering feathers and became infected. Virus isolation from feathers was up to 32 days post-coating treatment. one out of 8 wild mallards showing antibodies against type a influenza virus was seropositive for h10 subtype too.
Conclusions: our experimental and field results show evidences suggesting that uninfected birds carrying viruses on their feathers, including immune ones, might play an active role in spreading aIV infection in nature. For this reason, routine aIV surveillance programs, aimed at detecting intestinal and/or respiratory viruses, should include the collection of samples, such as feather swabs, enabling the detection of viruses sticky to preened birds’ bodies....
National preventive plan: putting stewardship into practice
Authors: Federici Antonio , Filippetti Giuseppe , Oleari Fabrizio
Published: June 2024

According to the WHO-European region Tallin-Charter, Stewardship (S) is on the health agenda of many European countries and in particular of those involved in the devolution of powers, as is the case of Italy. Many observers agree that, in such cases, both the configuration and the application of state authority in the health sector should be realigned so as to achieve desired policy objectives.We present an experience of what could be meant by S in practice, applied to the field of planning preventive interventions.The Italian National Preventive Plan 2010-2012 is a comprehensive Plan dealing with many areas of prevention. For all these areas, the main health objectives, the specific regional goals and the intervention - called “central" actions- that the Ministry of Health (MoH) is in charge of carrying out in order to support regional preventive programs, are stated in this Plan. In order to carry out its task, the MoH has referred to the model of stewardship and has reconsidered its role. Therefore, the MoH has matched the sub-functions of S according to the model outlined by Travis et al, and the prior actions that have been proposed by local and national governments, as the main aspects of how to deal with the governance of prevention. Overall, we experienced that the S framework is a suitable and helpful tool to tackle what the challenge of national planning, in the scenario of devolution, is. In doing so, we have learnt some practical lessons about the running of the system and about how to plan according to stewardship, in particular.Among these, given that the steward’s most specific responsibility in planning is to assure stewardship, a sound capacity building is needed as a cornerstone in evolving the culture of the NHS. Furthermore, in order to put this effectively into practice, the Steward must be able to measure S functions, and putting in practice a S model needs international comparison and cultural growth....
The impact of risk and protective factors on mental health and well-being-Austrian adolescents and migrant adolescents from war-affected countries
Authors: Buchegger-Traxler Anita , Sirsch Ulrike
Published: June 2024

Background: young persons are most strongly affected by displacement through political/military actions. This is also a European problem as well as an issue for the European Union. Applying the social-ecological model by Bronfenbrenner we concentrated on micro- and mesosystems of Austrian adolescents and migrant adolescents of war-affected countries.
Methods: a questionnaire was administered to adolescents in Austria attending schools beyond the mandatory school age, yielding a sample of about 1 100 students from Austrian and immigrant background. We used analysis of variance to compare host and immigrant youth as well as regression analysis to assess the impact of risk and protective factors on youth outcomes.
Results: we do find sex differences for protective factors and youth outcomes but few differences between immigrant and Austrian adolescents. Youth outcomes analysed were somatic symptoms, anxiety, depression, self-esteem, anti-social behaviour, substance use, and academic performance. Important risk factors turned out to be intergenerational conflict, exposure to violence, and social distance. Protective factors include family connectedness, parental monitoring, school connectedness, peer support, and neighbourhood attachment.
Conclusions: the most important protective factor is school connectsdness. Social distance and intergenerational conflict are the dominant risk factors influencing youth outcomes. Our research leads to a better understanding of factors determining the well-being of adolescents and contributes to finding new approaches to prevent or cope with mental health problems of young immigrants. In particular it appears to be important to keep young persons in education and/or training since school connectedness influences mental health and well-being positively.
Association between smoking habits and acne vulgaris. A case-control study
Authors: Mannocci Alice , Semyonov Leda , Saulle Rosella , Skroza Nevena , Potenza Concetta , Boccia Antonio , La Torre Giuseppe
Published: June 2024

Background: acne vulgaris, is one of the most common skin disorder. Previous studies about the role of smoke in the pathogenesis of acne reported contradictory results. The aim of this study was to conduct a case-control study investigating the relationship between tobacco smoking and acne.
Methods: a case-control study was performed during the period September 2009 - February 2010. A questionnaire was administrated to each participant, to assess the association acne - smoke. Cases were outpatients of the Dermatologic Ambulatory of the “Fiorini” Hospital, Sapienza University of Rome (Italy). Controls were age and gender-matched to the cases. The ratio cases-controls was 1:2. A univariate and a multiple logistic regression analysis were conducted; Odds Ratio (OR ) and the relative 95% confidence interval (95%CI) were assessed. The statistical significance was set at p < 0.05.
Results: crude OR for the association acne - smoke was 7.26 (IC=2.27-23.18); adjusted OR for sex and age was 5.47 (IC=1.67-17.97). Of 93 cases, 6 had a severe grade of acne (6.5%), 19 had an intermediate grade of acne (20.4%), and 68 had a mild grade of acne (73.1%). No one of the smokers had a severe grade of acne, one had an intermediate grade of acne and 11 had mild acne; these differences are not statistically significant.
Conclusions: the association between acne and smoke shows an increased risk (OR=7.26) with a statistically significant CI. Moreover, people ≥ 18 years of age have twice the risk compared to persons < 18 years of age (OR=2.31).