Abruzzo Region Research Articles

Disciplinary homogeneity in university departments following the Gelmini law: an exploratory analysis through social networks

The aim of this work is to evaluate the implementation of the Gelmini law; a law that has reorganized the universities into departments in order to create homogeneous scientific centres in the various fields of research. The methodology used to analyse the change in the structure of departments following the new regulation considers the social networks that unify the subject areas according to their current position. With the help of these social networks, we try to understand whether the new departments are really homogeneous research centres or instead are modelled on the previous faculties. The present work has been carried out in relation to the universities of the Abruzzo region and the sectors interconnected with Area 13 on the list of italian university disciplinary sector see Appendix (which contains the fields of economics and statistics), and we can extend the results to other Italian universities. We highlight: (1) the interactions between the scientific discipline sectors and the departments; (2) the definition of a cosector data matrix (binary and weighted ties); and (3) the hierarchical analysis of the cliques of the scientific discipline sectors. We discuss and compare the results to find out the reasons why the universities have still not become homogenous research centres.

Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY

BackgroundPrimary caesarean section (PCS) rate is one of the main indicators of quality of care suggested by the Italian Government. Hospital rankings are usually based on it, therefore lower rates reflect more appropriate clinical practice. The aim of this study is to describe a five-year trend of PCS rate in Abruzzo region from 2009 to 2013 and to examine the medical indications for this mode of delivery.MethodsForty-five thousand one hundred forty-nine deliveries occurring from 2009 to 2013 were collected from all hospital discharge records (HDR) and analyzed. Among them we found 12,542 PCS. Odds ratios (ORs) with 95% confidence interval (95% CI) were estimated using logistic regression methods to evaluate the relationship between maternal risk factors and PCS in hospital over 1000 delivery/yrs.ResultsThe five-year PCS rate was 28.9%, with a decreasing trend from 31.4% in 2009 to 26.1% in 2013. Vasto Civil Hospital shows the lowest PCS rate (17.9% in 2013) among hospitals with a maximum of 1000 deliveries per year, while Pescara Civil Hospital shows the lowest PCS rate (25.4% in 2013) among hospitals with over 1000 deliveries per year. Women with major risk factors for cesarean section delivered more frequently in maternity units over 1000 delivery/yrs. Logistic regression analyses showed as diabetes, hypertension, twin pregnancy, fetal distress and preterm delivery were significant risk factors to deliver in unit over 1000 delivery/yrs. The most frequent (overall 66.6%) discharge diagnosis recorded in Hospital discharge records (HDR) is “Caesarean Delivery Without Indication”. 7.3% of PCS made in Abruzzo concerns women living in other Italian regions. 11.4% of PCS contains one of the indications to caesarean section (CS) that the Italian Guidelines consider appropriate.ConclusionsDuring the analyzed period, Abruzzo showed a decreasing, but still too high, PCS rate, compared to the limits fixed by the Italian Ministry of Health. Considering the limitation of this study, based on administrative data that are poor in clinical information, it is not possible to define the appropriateness of all caesarean sections.

Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region.

BackgroundDue to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV.MethodsThe study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements.ResultsAmong 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively.ConclusionThe presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.

Detection and characterisation of potentially pathogenic species of Vibrio in the Vibrata river, Abruzzo Region, Italy.

This study aimed to isolate, define the genetic profile, assess potential pathogenicity and evaluate the seasonal distribution of Vibrio cholerae, Vibrio parahaemolyticus, and Vibrio vulnificus strains isolated from the Vibrata river (Abruzzo Region, Italy) during a monitoring period of one year. Detection was performed according to ISO/TS 21872-1-2:2007. Species identification and characterisation were achieved using molecular methods. Vibrio spp. were detected in 50% (23) of the water samples. In particular, V. cholerae, V. parahaemolyticus, and V. vulnificus were isolated in 18 (39.1%), 4 (8.7%), and 2 (4.3%) samples, respectively. All V. parahaemolyticus strains were tdh gene negative, 75% were positive for trh gene. In 30 V. cholerae isolates, the polymerase chain reaction (PCR) assay for detecting virulence and regulatory genes (ctxA, toxR, tcpA, ompU, hlyA, tcpI, zot, and stn/sto) revealed 6 genotypes associated to different levels of pathogenicity. Pulsed-field gel electrophoresis (PFGE) characterisation of the V. cholerae strains identified 13 different pulsotypes. A greater degree of similarity was shown for strains isolated in the same period of the year. Results of our study reveal a potential health risk associated with the waters of the Vibrata river, which are used for irrigation and next to the swimming areas of Abruzzo coastline.

Crested porcupines (Hystrix cristata): mycophagist spore dispersers of the ectomycorrhizal truffle Tuber aestivum.

Truffles, as hypogeous, ectomycorrhizal fungi, have no means to actively discharge spores into the environment and thus depend on mycophagists for spore dispersal. After consumption of fruiting bodies by animals and passage through the digestive tract, the spores are released in faecal pellets. Recently, in the Abruzzo region (Italy), Hystrix cristata has been spotted inside private truffières, but its role in spore dispersal has never been investigated. Here, we report our research on the occurrence of Tuber aestivum spores in porcupine's faecal contents in a truffière in L'Aquila, Italy, where a H. cristata specimen was photographed. The spores were isolated from faeces by using a suspension of 0.7M ZnSO4. We also verified degradation and disfiguration of the digested spores' reticular ornamentation compared to that of fresh spores from ascomata collected inside the truffière, through measurements performed by scanning electron microscopy. A few truffle spores had germinated within the faeces.

INTEGRATED PHOTOGRAMMETRIC SURVEY AND BIM MODELLING FOR THE PROTECTION OF SCHOOL HERITAGE, APPLICATIONS ON A CASE STUDY

Abstract. The contribution, considering the use of low-cost photogrammetric detection methodologies and the use of asset Historical-BIM, has as its aim the theme of knowledge and the adaptation of safety in school buildings, a topic brought to attention by the many situations of seismic risk that have interested the central Apennines in Italy. The specific investigation is referred to the Abruzzo region, hit by the recent earthquakes of 2016 and 2009 that have highlighted the vulnerability of the building structures involved in a large seismic crater covering large areas of the territory. The need to consider in advance the performance standards of building components, especially concerning the strategic ways of the functions contained in them, starts here. In this sense, the school buildings have emerged among the types on which to pay attention, a study theme to be promptly considered, considering the functions performed within them and the possible criticality of such constructions, often dated, enlarged or readjusted without appropriate seismic adaptation plans. From here derives the purpose of the research that is directed towards a systematic recognition of the scholastic heritage, deriving from objective and rapid surveys at low cost, taking into consideration the as-built and the different formal and structural aspects that define the architectural organisms to analyse and manage through three-dimensional models that can be interrogated using HBIM connected to databases containing information of a structural and functional nature. In summary, through the implementation of information in the BIM model, it will be possible to query and obtain in real time all the necessary information to optimize, in terms of efficiency, costs, and future maintenance operations.

Sustainability, Corporate Social Responsibility, and Corporate Reputation in the Wine Sector

This article offers a comprehensive overview on the relationship between sustainability, corporate social responsibility (CSR), and corporate reputation (CR) by examining a field study case of a wine family firm located in the Abruzzo region of Italy. Through qualitative research methods, direct interviews to the family, social accountability, archives and observations of the company's life, information is organized in thematic areas suggesting the need of an alignment between environmental and business interests. The results are further used in proposing a framework model focused on the identification of key performance indicators (KPI). The main pillars of this concept are evaluating, monitoring and improving CR. The conclusion stresses the importance of replicating this type of modelling initiative with the purpose of professionalizing the wine industry into a more sustainable production and more successful business practices.

Revision and new proposals regarding Salvia officinalis communities after new findings from the Abruzzo region, Central Adriatic Italy

ABSTRACTSalvia officinalis communities are not common in Italy. Until recently, the studies carried out in Italy have generally not always been thorough regarding the physiognomic type of these communities and have not clearly distinguished between the real garrigues and the pasture communities (with more or less abundant Chamaephytes). A finer approach, allowing a correct interpretation of micro-mosaic patchiness, is necessary when the “elementary area” is chosen to be analyzed, in order to permit this kind of distinction. In the Abruzzo region, on the Central Adriatic side of Italy, this species is quite rare and is exclusively represented by the angustifolia variety. Actually, only few S. officinalis communities were known and studied in the Abruzzo region. New localities were found for this species and related communities. A newly uploaded dataset from the region is documented here, combining literature review data and new relevés, and is analyzed by multivariate methods. Results show that the Salvia officinalis garrigues of the Abruzzo region are not all attributable to the same plant association, as the coenological features of these communities are quite variable, depending mainly on geomorphological and climate features. Only half of the literature relevés previously attributed to the Saturejo montanae-Salvietum angustifoliae association are clearly ascribable to it, while the other half concerns anomalous aspects, poor in diagnostic species. A new set of diagnostic and differential species is proposed for that association; and two new variants have been proposed. We also propose a new association: Euphorbio spinosae-Salvietum angustifoliae, with two sub-associations, both found in newly studied localities. Further similar thorough reviews are desirable for other associations described in South-Eastern Europe, taking into account a fine separation between chamaephyte dominated communities and those that are mainly hemicryptophytic.

2D site response analysis of a cultural heritage: the case study of the site of Santa Maria di Collemaggio Basilica (L’Aquila, Italy)

The Santa Maria di Collemaggio Basilica is an important cultural heritage site and exemplifies Romanesque-Gothic art in the Abruzzo region (central Italy). Erected in the second half of the XII century, the Basilica was severely damaged during the April 6, 2009 L’Aquila earthquake (MW 6.1). In particular, the area of the transept collapsed causing the dome to fall. A refined two-dimensional (2D) geotechnical model was built representing a section that includes the Basilica, in order to better understand the soil response of the Basilica site. The subsoil model was constrained using the geophysical and geotechnical data collected from the seismic microzonation studies, the reconstruction of private damaged buildings and other technical and scientific studies realized in the L’Aquila basin and in the area of the Basilica before and after L’Aquila earthquake. 2D site response analyses were performed to verify the presence of local site effects by comparing simulated versus experimental transfer functions. Moreover, a frequency–wavenumber (f–k) analysis was executed with the aim of evaluating the occurrence of surface waves generated within the basin. 2D seismic effects involve significant amplification in the period range of engineering interest, therein providing an appropriate elastic response spectrum for the restoration of the Basilica.

Post-earthquake controls and damage detection through structural health monitoring: applications in l’Aquila

The paper presents structural health monitoring (SHM) activities performed on some representative cultural heritage (CH) buildings in the city of l’Aquila after the strong earthquake (Mw = 6.3) that struck the Abruzzo region (central Italy) on April 6, 2009. The severity and the extent of damages caused by the earthquake to historical buildings and monument were never reached before in the recent Italian earthquake history. Emergency activities started immediately after the earthquake to protect CH structures, including damage survey and design/implementation of temporary safety measures. Some historic buildings were soon equipped with monitoring systems in order to assess the level of damage and verify the effectiveness of the executed provisional interventions. The paper focuses in particular on two case studies, i.e. the Spanish Fortress and the Civic Tower. The results of preliminary investigations are reported, including damage survey and operational modal analysis for modal parameter identification using ambient vibration tests. 3-year static and dynamic monitoring features, automatically extracted from raw data acquired by continuous monitoring systems, were then processed using a data-driven approach based on regression analysis to filter out the environmental effects. Following this approach data are decomposed into their reversible and irreversible components, the latter being associated with active damaging processes and the residual structural performance of the two buildings assessed.

Combined experimental and computational approach for defect detection in precious walls built in indoor environments

In thermographic non-destructive evaluation (TNDE), the optimal thermal stimulus to be provided on precious coatings applied on ancient walls confined in indoor environments is a complex problem to solve particularly when low temperatures characterize the room where they were built. In fact, thermal stresses are always the concern of any restorer who is interested in determining both the positions and sizes of superficial and sub-superficial defects. In scientific literature, the use of lamps appears to be dominant, but when large surfaces must be inspected in situ, many problems could arise, such as environmental reflections, emissivity variations, and non-uniform heating, which cause false alarms in defect detections.In this study, the heating phase was carried out by using a wooden tunnel and an air heater. The main physical and geometrical characteristics of these two objects were optimized in order to stimulate the external coating (called “finishing layer” in this study) as homogeneously as possible. In fact, taking into account the very low temperature of the room which contains the inspected aedicule, the energy deposition (heating phase) is enhanced and the energy dispersion (cooling phase) is reduced (thanks to the tunnel) at the same time. This improves the heat transfer phenomenon along the z axis (i.e., the thickness of the wall).The detection of the defects was performed via higher-order statistics thermography (HOST) technique, which processes the thermal images resulting from the heating and cooling phases. Bearing in mind the low emissivity value of the canary grass (i.e., the finishing layer), the use of heating sources in front of it must be minimized; otherwise, spurious reflections can be recorded and then processed.In particular, a computational fluid dynamics (CFD) approach implemented via Comsol Multiphysics® computer program was used to validate the experimental setup. This was applied to a couple of cases in the Baiocco's room subjected to restrictions of the Superintendence for Historical, Architectural, and Environmental Heritage of the Abruzzo region (Italy) owing to its high artistic importance.The exact position of each defect was modelled after a combined visual-acoustical-thermal inspection. An expert restorer helped us in this task. This study is important because, to the best of our knowledge, the problem discussed above has not been solved yet by the scientific community involved in the field of cultural heritage. The results are first thoroughly discussed and second experimentally validated using a combination between thermocouples and ground penetrating radar (GPR) technique, while advantages and disadvantages of the proposed method are highlighted in view of a future perspective of the present work.

"Sgorga il Petrolio dalla Terra d'Abruzzo": oil exploration and production history in the Abruzzo region (Central Italy) across the 20th century

In this article we present some episodes of history of the exploration and exploitation of hydrocarbons in the Pescara Basin (Abruzzo region, Central Italy) during the 20th century.The Tocco da Casauria oil district of this basin have one of the the longest history of exploration and production of hydrocarbons in Italy. Also today this area, together with the nearby Alanno-Scafa area, represents an important calibration for geoscientists to evaluate the hydrocarbon residual potential in the whole region.The history of this oil province, the activities of the first entrepreneurs, geologists and the companies that led to the development of a modern industry in the area are a significant example of the process of transformation and modernization of the national oil system experienced in Italy along the 20th century.The title of this article is inspired by the Istituto LUCE news clip of 7th October 1955 celebrating with emphatic words the discovery of crude oil in the subsurface of the Abruzzo region.

Fluid flow simulation and permeability computation in deformed porous carbonate grainstones

Abstract In deformed porous carbonates, the architecture of the pore network may be modified by deformation or diagenetic processes altering the permeability with respect to the pristine rock. The effects of the pore texture and morphology on permeability in porous rocks have been widely investigated due to the importance during the evaluation of geofluid reservoirs. In this study, these effects are assessed by combining synchrotron X-ray computed microtomography (SR micro-CT) and computational fluid dynamics. The studied samples pertain to deformed porous carbonate grainstones highly affected by deformation bands (DBs) exposed in Northwestern Sicily and Abruzzo regions, Italy. The high-resolution SR micro-CT images of the samples, acquired at the SYRMEP beamline of the Elettra - Sincrotrone Trieste laboratory (Italy), were used for simulating a pressure-driven flow by using the lattice-Boltzmann method (LBM). For the experiments, a multiple relaxation time (MRT) model with the D3Q19 scheme was used to avoid viscosity-dependent results of permeability. The permeability was calculated using Darcy's law once steady conditions were reached. After the simulations, the pore-network properties (effective porosity, specific surface area, and geometrical tortuosity) were calculated using 3D images of the velocity fields. These images were segmented considering a velocity threshold value higher than zero. The study showed that DBs may generate significant heterogeneity and anisotropy of the permeability of the evaluated rock samples. Cataclasis and cementation process taking place within the DBs reduce the effective porosity and therefore the permeability. Contrary to this, pressure dissolution and faulting may generate connected channels which contribute to the permeability only parallel to the DB.

Precipitation and temperature trends over central Italy (Abruzzo Region): 1951–2012

This study analyses spatial and temporal trends of precipitation and temperatures over Abruzzo Region (central Italy), using historical climatic data from a dense observation network. The results show a general, although not significant, negative trend in the regionally averaged annual precipitation (− 1.8% of the yearly mean rainfall per decade). This reduction is particularly evident in winter, especially at mountain stations (average − 3% change/decade). Despite this general decreasing trend, a partial rainfall recovery is observed after the 1980s. Furthermore, the majority of meteorological stations register a significant warming over the last 60 years, (mean annual temperature increase of + 0.15 °C/decade), which reflects a rise in both minimum and maximum temperatures, with the latter generally increasing at a faster rate. Spring and summer are the seasons which contribute most to the general temperature increase, in particular at high elevation sites, which exhibit a more pronounced warming (+ 0.24 °C/decade). However, this tendency has not been uniform over 1951–2012, but it has been characterised by a cooling phenomenon in the first 30 years (1951–1981), followed by an even stronger warming during the last three decades (1982–2012). Finally, correlations between the climatic variables and the dominant teleconnection patterns in the Mediterranean basin are analysed to identify the potential influence of large-scale atmospheric dynamics on observed trends in Abruzzo. The results highlight the dominant role of the East-Atlantic pattern on seasonal temperatures, while more spatially heterogeneous associations, depending on the complex topography of the region, are identified between winter precipitation and the North Atlantic Oscillation, East-Atlantic and East-Atlantic/Western Russian patterns.

A database of the structural behavior of masonry in shear

This paper reports the results of several on-site investigations carried out by the authors in the last 20 years in central Italy (Umbria, Marche, Emilia and Abruzzo regions) on masonry wall panels. The use of stone and brickwork masonry has been common for centuries not only for rural residences but also for public and religious buildings. In many areas, where the stone was abundant, stone became the material of choice for all constructions. However from rubble stone to perfectly squared stones, the mechanical properties may highly differ. Test results are reported with an accurate survey and analysis of the masonry typology and mechanical characterization was performed according to ASTM standards and consisted of measurements of shear properties. The paper also reports the experimental results of full-scale tests conducted on brickwork walls using different bonding patterns, mortar types and brick dimensions. These data were recorded in terms of shear strength, elastic properties and deformation capacity and are of critical importance for design, reinforcement or retrofit purposes in earthquake-prone areas. All tests were conducted on site from pre-existing undamaged wall panels. Finally, test results are compared with existing standards and indicate that masonry shear strength is sometimes overestimated by the Italian Building Code.

Preliminary evaluation of the impact of a Web-based HIV testing programme in Abruzzo Region on the prevention of late HIV presentation and associated mortality

ObjectiveThis study aimed to analyze the efficacy of a Web-based testing programme in terms of the prevention of late HIV presentation. The clinical characteristics of patients diagnosed with HIV via the Web-based testing programme were compared to those of patients diagnosed in parallel via standard diagnostic care procedures. MethodsThis study included the clinical and demographic data of newly diagnosed HIV patients enrolled at the study clinic between February 2014 and June 2017. These patients were diagnosed either via standard diagnostic procedures or as a result of the Web-based testing programme. ResultsEighty-eight new cases of HIV were consecutively enrolled; their mean age was 39.1±13.0 years. Fifty-nine patients (67%) were diagnosed through standard diagnostic procedures and 29 (33%) patients came from the Web-based testing programme. Late presentation (62% vs. 34%, p=0.01) and AIDS-defining conditions at presentation (13 vs. 1, p=0.02) were significantly more frequent in the standard care group than in the Web-based group; four of 13 patients with AIDS diagnosed under standard diagnostic procedures died, versus none in the Web-based testing group (p<0.001). ConclusionsWeb-based recruitment for voluntary and free HIV testing helped to diagnose patients with less advanced HIV disease and no risk of death, from all at-risk groups, in comparison with standard care testing.

Estimates of cancer burden in Abruzzo and Molise.

Abruzzo and Molise are two regions located in the south of Italy, currently without population-based cancer registries. The aim of this paper is to provide estimates of cancer incidence, mortality and prevalence for the Abruzzo and Molise regions combined. The MIAMOD method, a back-calculation approach to estimate and project the incidence of chronic diseases from mortality and patient survival, was used for the estimation of incidence and prevalence by calendar year (from 1970 to 2015) and age (from 0 to 99). The survival estimates are based on cancer registry data of southern Italy. The most frequently diagnosed cancers were those of the colon and rectum, breast and prostate, with 1,394, 1,341 and 698 new diagnosed cases, respectively, estimated in 2012. Incidence rates were estimated to increase constantly for female breast cancer, colorectal cancer in men and melanoma in both sexes. For prostate cancer and male lung cancer, the incidence rates increased, reaching a peak, and then decreased. In women the incidence of colorectal and lung cancer stabilized after an initial increase. For stomach and cervical cancers, the incidence rates showed a constant decrease. Prevalence was increasing for all the considered cancer sites with the exception of the cervix uteri. The highest prevalence values were estimated for breast and colorectal cancer with about 12,300 and over 8,200 cases in 2012, respectively. In the 2000s the mortality rates declined for all cancers except skin melanoma and female lung cancer, for which the mortality was almost stable. This paper provides a description of the burden of the major cancers in Abruzzo and Molise until 2015. The increase in cancer survival, added to population aging, will inflate the cancer prevalence. In order to better evaluate the cancer burden in the two regions, it would be important to implement cancer registration.

Spillover effects in local public spending

ABSTRACTThis paper investigated the fiscal interactions between Italian municipalities over the period 2001–11 and found a positive horizontal interdependence in spending decisions. The results are robust to different specifications of the spatial neighbours and are confirmed by a natural experiment (an earthquake in the Abruzzo region of Italy in 2009) that creates an exogenous variation in the neighbours’ spending. Furthermore, there is no evidence of yardstick competition when one considers political effects, while a negative relationship is found between spatial interaction and the size of the municipality. Thus, it can be concluded that spillover effects drive the strategic interactions in spending decisions.

Increasing trend in admission rates and costs for acute diverticulitis during 2005-2015: real-life data from the Abruzzo Region.

Background:Scarce data are available on the epidemiological trend of diverticulitis and its financial burden in Italy. The aim of this work was to explore a potential variation in the rate and costs of hospital admissions for uncomplicated and complicated diverticulitis over the last decade.Methods:We selected all hospitalizations for diverticulitis of residents in the Abruzzo Region, Italy between 2005 and 2015. Age-standardized hospitalization rates (HRs) per 100,000 inhabitants for overall, uncomplicated and complicated diverticulitis were calculated. A linear model on the log of the age-standardized rates was used to calculate annual percentage changes (APC). Costs were derived from the official DRG tariff.Results:From 2005 to 2015, the HR for acute diverticulitis increased from 38.9 to 45.2 per 100,000 inhabitants (APC + 1.9%). The HR for complicated diverticulitis increased from 5.9 to 13.3 (APC + 7.6%), whereas it remained stable for uncomplicated diverticulitis. The mean hospital cost was 1.8-times higher for complicated diverticulitis compared with that for uncomplicated disease and 3.5-times higher for patients with a surgery stay compared with that for patients with a medical stay.Conclusion:During the last decade, in the Abruzzo Region, the HRs for diverticulitis and their costs increased significantly, mainly due to disease complications. Further studies are needed to explore strategies to prevent complications and to realise cost-saving policies.

Comorbidities and Risk-Adjusted Maternal Outcomes: A Retrospective Study on Administrative Data

Objective: The aim of this study was the evaluation of maternal outcomes and of the associated risk factors occurred in Abruzzo region, Italy, from 2009 to 2013. Methods: The study considered all the deliveries performed from 2009 to 2013 in Abruzzo region, Italy. Data were collected from all hospital discharge records. Univariate logistic regression analyses were performed to calculate crude odds ratios for each comorbidity. Stepwise multiple logistic regression models with backward selection were performed to identify predictors of the most frequent outcomes. Results: 57, 260 deliveries were analyzed. Severe complication occurred in 0.9% of all deliveries. The most frequent complications were “Severe Hemorrhage”, “Hysterectomy”, “Uterine rupture” and “Severe pre-eclampsia/eclampsia”. Malignant cancer (OR=55.76), coagulation disorders (OR=37.21), acute pulmonary disease (OR=29.75), placenta previa (OR=26.51), caesarean section (OR=3.24) and age (OR=1.08) were associated with a higher risk of hysterectomy. Anemia (OR=14.64), coagulation disorders (OR=10.31), cardiac disease (OR=12.74), pregnancy hypertension (OR=2.66), major pre-eclampsia/eclampsia (OR=2.78), placenta previa (OR=9.42) and multiple pregnancy (OR=3.69) were associated to severe hemorrhage. Thrombocytopenia (OR=26.04) and diabetes (OR=5.05) were associated to uterine rupture. Overweight or obesity (OR=25.88) and pregnancy cardiovascular disease (OR=25.85) were associated to pre-eclampsia. Conclusions: Maternal comorbidities are associated with increased risk of complications and may result in substantial costs to the health care system.