Health Care In Italy Research Articles

Ready to act? Factors associated with nurses’ desire to work in Primary Health Care in Italy

Abstract Background The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation. Methods A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81). Results In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%). Conclusions A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs. Key messages • Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation. • Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.

A Comparative Study to Assess the Energy Efficiency of Temporary Structures to Guarantee Emergency Basic Healthcare in Italy

During emergencies, healthcare is generally provided by tents and temporary shelters, without considering the environmental and social impact of the structures as a priority, in favor of swift response. The resultant constructions intended as a temporary solution often persist for a long time. This paper aims to analyze an alternative and innovative modular structure designed as a transitory solution in emergencies and everyday life. The aim of this study is to assess and compare the energetic performance of a modular adaptive model for basic healthcare for people who are not subscribed to the Italian National Health System. The main goal is to challenge standard models by proposing a new model able to diminish the weaknesses of the current sanitary models, to improve the social conditions, flexibility and energy efficiency, and the thermal comfort of the occupants. In the first part of the paper, the conceptual framework and the preliminary design of the model are described by investigating the benefits of a safe space as a generator space for care services and the community. In the second part, the technological requirements of the system are defined by comparing the use of different panel structures and low-impact technologies. The energy efficiency and environmental impact of the model are assessed by comparing several panel structures in two different climatic areas in Italy (northern and Mediterranean areas) using SketchUp and EnergyPlus simulation. As a result, different configurations of the model are proposed according to the different climatic areas in order to optimize the model, from both an architectural and a technological point of view (box and panel composition).

Perspectives on AI use in medicine: views of the Italian Society of Artificial Intelligence in Medicine.

The first annual meeting of the Italian Society for Artificial Intelligence in Medicine (Società Italiana Intelligenza Artificiale in Medicina, SIIAM) on December 7, 2023, marked a significant milestone in integrating artificial intelligence (AI) into Italy's healthcare framework. This paper reports on the collaborative workshop conducted during this event, highlighting the collective efforts of 51 professionals from diverse fields including medicine, engineering, data science, and law. The interdisciplinary background of the participants played a crucial role in generating ideas for innovative AI solutions tailored to healthcare challenges. Central to the discussions were several AI applications aimed at improving patient care and streamlining healthcare processes. Notably, the use of Large Language Models (LLMs) in remote monitoring of chronic patients emerged as an area of focus. These models promise enhanced patient monitoring through detailed symptom checking and anomaly detection, thereby facilitating timely medical interventions. Another significant proposal involved employing LLMs to improve empathy in medical communication, addressing the challenges posed by cultural diversity and high-stress levels among healthcare professionals. Additionally, the development of Machine Learning algorithms for standardizing treatment in pediatric emergency departments was discussed, along with the need for educational initiatives to enhance AI adoption in rural healthcare settings. The workshop also explored using LLMs for efficient data extraction and analysis in scientific literature, interpreting healthcare norms, and streamlining hospital discharge records. This paper provides a comprehensive overview of the ideas and solutions proposed at the workshop, reflecting the participants' forward-thinking vision and the potential of AI to revolutionize healthcare.

Multi‐Level Governance Feedback and Health Care in Italy in the Aftermath of Covid‐19

At the crossroads of EU studies and public policy analysis, a vast literature identifies global crises as one of the main triggers of change. The present article provides a test of this hypothesis in the case of health care in the aftermath of the pandemic crisis that hit Europe between 2020 and 2022. We use Italy as an extreme case, where both the magnitude of the Covid-19 outbreak and the effect of the pre-existent domestic cost-cutting strategy potentially opened a large window of opportunity for change. Through the lenses of historical institutionalism, we aim to shed light on policy change in multi-level health governance systems. Evidence collected through semi-structured interviews, triangulated with secondary sources, proves that the governance of health care in Italy has experienced no paradigmatic change. We show that “governance feedbacks” have reinforced pre-existing dynamics and inhibited more radical forms of change.

Gender and regional differences of avoidable mortality in Italy: a 14-year time-trend analysis

Abstract Background Similar to other European countries, Italy's healthcare system is undergoing significant changes. Variations in ‘avoidable’ mortality (AM) may reflect such changes on management and quality of care. The aim of this study was to investigate the regional and gender-related trends of AM, and to provide evidence for addressing policy and reducing health disparities in Italy. Methods We conducted a 14-year time-trend analysis (2006-2019). Mortality and population data were obtained from the Italian Institute of Statistics. Bi-yearly age-standardized AM was calculated by gender and region, using the joint OECD/Eurostat list that includes both preventable and treatable causes of death. Results Overall, AM showed a significant reduction from 2006/7 to 2018/9 (221.0 vs. 166.4 per 100,000 pop, p < 0.05). A heterogeneous decrease in AM was registered between regions, ranging from −39% of Trento to − 17% of Molise. The analysis showed significant gender differences in AM, with females showing lower rates in both 2006/7 (144.5 vs. 306.3, p < 0.05) and 2018/9 (117.1 vs. 219.9, p < 0.05). Gender differences were also registered across regions, both overall and in terms of yearly % reduction. Conclusions While gender disparities in AM have reduced between 2006 and 2019 in Italy, the study shows that inequalities between regions have increased, thus underlying a worsening in the capacity of the Italian healthcare system to equally provide quality care to its population. We advocate the urgent need to reduce health disparities through a balanced regional development strategy. Key messages • Avoidable mortality is a key indicator for assessing quality and equity of healthcare. We have recorded significant gender and regional differences in this indicator between 2006 and 2019 in Italy. • Targeted interventions are needed to reduce gender and geographic disparities and to achieve the global goals of universalism and accessibility of health services, also in Italy.

Monitoring and evaluation of perinatal healthcare in Italy: data from the National Outcomes Evaluation Programme (years 2015-2021)

Monitoring and evaluation of perinatal healthcare in Italy: data from the National Outcomes Evaluation Programme (years 2015-2021)

A Modular Structure for Immediate and Transitory Interventions to Guarantee Access to Basic Healthcare in Italy

The access to basic healthcare for people who are not registered in the national health system is nowadays a very urgent problem, both in Italy and in the rest of the world. Immigration and poverty are only some of the factors that make one of the primary rights of humanity—healthcare—not a right for everyone. The main problems, which have grown exponentially in the last decade, are at operational level, due to the lack of personnel (mostly volunteers) and the lack of spaces. This paper illustrates procedures and techniques for the design of a small emergency structure that can be moved and positioned in urban contexts. The first part consists of a deep analysis of the problem and of the state of the art of existing typologies. The second part is dedicated to the conceptual framework (requirements, conceptual model) and to the definition of the preliminary design for the new approach to basic non-conventional sanitary spaces. Finally, a virtual case study (project application) in Italy is presented.

Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations

BackgroundHealthcare organizations are extremely complex. The work of their CEOs is particularly demanding, especially in the public sector, though little is known about how the managerial work of a healthcare organization CEO unfolds. Drawing from scholarship on managerial work and management in pluralistic organizations, we sought to answer the questions: What is the content of managerial work of CEOs in public healthcare in Italy? How do healthcare CEOs perform their managerial work in complex interactions with multiple stakeholders?MethodsFor this study we adopted a multi-method approach in which we conducted a survey to investigate CEO behaviors, tracked CEO working time for 4 weeks, and conducted semi-structured interviews with senior CEOs.ResultsCEOs in public healthcare devote most of their time to interaction, which half of which is perceived as being occupied with apparently mundane problems. Nonetheless, devoting time to such activities is functional to a CEO’s goals because change in pluralistic contexts can be achieved only if the CEO can handle the organization’s complexity. CEOs do this by engaging in routines and conversations with professionals, creating consensus, and establishing networks with external stakeholders.ConclusionsCEOs are called to reduce fragmentation and foster cooperation across disciplines and professional groups, with the overarching aim to achieve integrated care. Using an analytical approach we were able to take into account the context and the relational dimension of the managerial work of healthcare CEOs and the specificities of this role.Trial registrationThis article does not report the results of a healthcare intervention on human participants, and the material used in the research did not require ethical approval according to Italian law.

Reorganizing hospital healthcare in Italy at the time of the Recovery Plan

Reorganizing hospital healthcare in Italy at the time of the Recovery Plan

Where are we in shared decision-making in Italy? A brief updated review

The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice.

Why Was the Perception of Human Rights Respect and Care Satisfaction So High in Users of Italian Mental Health Services during the COVID-19 Pandemic?

The aim of this study was to compare users’ and mental health workers’ (MHW) perception of respect of human rights and job/care satisfaction in mental health services in Italy during the COVID-19 pandemic. A sample of users and MHW of Sardinia, Italy, fulfilled the “Well-Being at work and respect for human rights questionnaire” (WWRR). The study included 240 MHW and 200 users. Users showed a higher level of satisfaction of care than MHW of work, and a higher perception of the satisfaction of users and human rights respected for health workers. Both user and MHW responses were about 85% of the maximum score, except for satisfaction with resources. Responses were higher for users, but users and MHW both showed high levels of satisfaction. In previous surveys, MHW of Sardinia showed higher scores in all items of WWRR, except for satisfaction with resources, compared with workers from other health sectors of the same region, and with MHW from other countries. The low score for satisfaction with resources (in users and staff) is consistent with a progressive impoverishment of resources for mental health care in Italy. The study, although confirming the validity of the Italian model, fully oriented towards community, sets off an alarm bell on the risks resulting from the decrease in resources.

The Creation of a Transition Protocol Survey for Childhood, Adolescent, and Young Adult Cancer Survivors in Transition from Pediatric to Adult Health Care in Italy

Purpose: The purpose of the study was to create in Italian a transition protocol survey to monitor the readiness of childhood, adolescent, and young adult (CAYA) cancer survivors who are undergoing transition from pediatric to adult health care. A protocol could support clinical practice through the proposal of individualized transition care pathways for CAYA survivors and inform future scientific studies that focus on barriers to successful transition. Methods: Three international questionnaires that investigate the biopsychosocial issues and needs of survivors were subjected to the Forward and Backward Translation process. Following this, CAYA survivors were recruited from September 2019 to August 2020 in the pediatric oncology centers of the Interregional Pediatric Oncology Network of Piedmont and the Aosta in Italy to participate in cognitive interviews as part of the validation and cultural adaptation process of the questionnaires, which will form the transition protocol survey. Results: Revisions and cognitive interviews with 40 CAYA survivors identified any inadequate expressions and resolved any concepts of misunderstanding or cultural unsuitability for the Italian translation. Overall, they found the scales to be easily understandable, and an Italian version of the scales was produced to create the final transition protocol survey. Conclusion: The transition protocol survey might be used as a valid tool to highlight critical issues to support sustainable transition processes between Italian oncology centers. The protocol can be implemented into clinical practice thus offering CAYA the possibility of resolving some needs, receiving personalized support, and surveillance before the transition.

Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

The COVID-19 pandemic has had a profound impact on the organisation of health care in Italy, with an acceleration in the development of telemedicine. To assess the impact of the COVID-19 pandemic on the spread of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) in Italy, a survey addressed to cardiologists operating in all Italian CIED-implanting centres was launched. A total of 127 cardiologists from 116 Italian arrhythmia centres took part in the survey, 41.0% of all 283 CIED-implanting centres operating in Italy in 2019. All participating centres declared to use RM of CIEDs. COVID-19 pandemic resulted in an increase in the use of RM in 83 (71.6%) participating centres. In a temporal perspective, an increase in the median number of patients per centre followed up by RM was found from 2012 to 2017, followed by an exponential increase from 2017 to 2020. In 36 participating centres (31.0%) a telehealth visits service was activated as a replacement for in-person outpatient visits (in patients with or without CIED) during the COVID-19 pandemic. COVID-19 pandemic has caused an acceleration in the use of RM of CIEDs and in the use of telemedicine in the clinical practice of cardiology.

Community Mental Health Services in Italy.

In 1978, in Italy, approval of Basaglia's reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options. By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units. Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model. Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.

Indoor Radon Concentration and Risk Assessment in 27 Districts of a Public Healthcare Company in Naples, South Italy.

Radon is a major source of ionizing radiation exposure for the general population. It is known that exposure to radon is a risk factor for the onset of lung cancer. In this study, the results of a radon survey conducted in all districts of a Public Healthcare in Italy, are reported. Measurements of indoor radon were performed using nuclear track detectors, CR-39. The entire survey was conducted according to a well-established quality assurance program. The annual effective dose and excess lifetime cancer risk were also calculated. Results show that the radon concentrations varied from 7 ± 1 Bq/m3 and 5148 ± 772 Bq/m3, with a geometric mean of 67 Bq/m3 and geometric standard deviation of 2.5. The annual effective dose to workers was found to be 1.6 mSv/y and comparable with the worldwide average. In Italy, following the transposition of the European Directive 59/2013, great attention was paid to the radon risk in workplaces. The interest of the workers of the monitored sites was very high and this, certainly contributed to the high return rate of the detectors after exposure and therefore, to the presence of few missing data. Although it was not possible to study the factors affecting radon concentrations, certainly the main advantage of this study is that it was the first in which an entire public health company was monitored in regards to all the premises on the underground and ground floor.

Модели и правовое регулирование здравоохранения в Польше и Италии

Goal – the paper assessed (main objective) the assumptions of the selected models and legislation regulating health care in the studied countries and examined their impact on the implementation of the constitutional guarantee of access to health services (specific objective). Research methodology – the descriptive method was mainly used, with elements of system‑legal and formal‑legal analysis, as well as cause‑and-effect analysis. Score/results – main hypothesis was negatively verified (the assumptions of adopted models of health care in Poland and Italy lead to the improvement of constitutional guarantee of access to health services), while the specific one was positively verified (adopted conditions have a significant impact on the functioning of health care in Italy and Poland, in particular during the COVID‑19 pandemic). Originality/value – organise and systematise the healthcare reality described.

Mortality amenable to health care services and health inequalities across the regions of Italy

Abstract Background Amenable mortality is an indicator that measures the extent to which health services contribute to the improvement of the health of a population. It can also highlight geographical and socioeconomic inequalities. Therefore, it is used to assess quality and performance of health care systems, both at national and subnational level. The Italian National Health Service sets the essential levels of care (Livelli Essenziali di Assistenza, LEA), a health-benefit package for all citizens. Because every region is responsible for providing the LEA and can offer additional health care, monitoring the performance of the Regional Health Services (RHSs) is of increasing interest. Methods We used Nolte and McKee's list of amenable conditions to analyze the temporal trend of the standardized mortality rate (per 100.000) in Italy from 2006 to 2015, overall and by gender. We also examined the standardized rate at regional level by comparing the two-year periods 2006/7 and 2014/5, overall and by gender. Results Between 2006 and 2015, the overall mortality rate decreased from 81 to 68 per 100.000 population; this reduction was more pronounced in men (91 to 76 per 100.000, -16.5%) than in women (72 to 62 per 100.000, -13.9%). The decreasing trend in amenable mortality affected Italian regions differently, with northern regions showing steeper reductions as compared to southern regions. As a result, 2014/5 was the first time men's mortality in North Italy (68 per 100.000) was lower than women's mortality in South Italy (72 per 100.000). Conclusions The overall reduction of amenable mortality shows that Italy's health care services keep contributing to the improvement of population health. Nevertheless, by analyzing RHS performance we saw that differences in organization of care lead to differences in health care quality and performance across regions. Deaths amenable to health care services contribute to inequalities between Northern and Southern Italy. Key messages Because universal health coverage is necessary but not sufficient to reduce health inequalities, investing into better-quality services should be recognized as a priority. Amenable mortality can highlight areas of intervention to reduce inequalities in the provision of health care services.

The impact of the great economic crisis on mental health care in Italy

The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007–2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.

The impact of the great economic crisis on mental health care in Italy

The impact of the great economic crisis on mental health care in Italy

Go Fund Medicine: verso un nuovo fundraising in sanità?

The use of innovative fundraising tools and techniques has been essential to quickly meet the needs of the Italian healthcare system in the Covid-19 emergency The purpose of this work, after a review of the theoretical and academic debate on fundraising in healthcare in Italy, is to present the main trends in the use of fundraising tools and techniques to support the national healthcare system Through a Systems Thinking model, it will be shown that online donations, and in particular crowdfunding, are proving to be a powerful, positive and effective tool to face the current emergency Copyright © FrancoAngeli