Italian Public Health Research Articles

Improving health care quality: the implementation of whistleblowing

PurposeIn line with the current literature, the purpose of this paper is to contribute to a better understanding of whistleblowing procedures and their influence on overall organisational quality. To this end, institutional, organisational, and cultural barriers to whistleblowing implementation have been investigated.Design/methodology/approachA qualitative analysis based on three explorative case studies investigates and compares different whistleblowing practices implemented in health care organisations, operating within the Italian National Health Service (INHS).FindingsINHS organisations have implemented whistleblowing procedures in different ways, despite the fact that the procedures are laid down by law. These differences are mainly due to cultural, administrative, organisational, and process barriers, which have a deep impact on whistleblowing integration in managerial practices and their influence on the overall quality of health processes and services.Research limitations/implicationsThis research paper was limited by the analysis of three Italian public health care organisations, which did not allow the generalisability of findings. Therefore, the study offers interesting insights on the way effective whistleblowing systems should be implemented in order to support managers to improve organisation’s management and service quality.Originality/valueThe paper represents one of the first attempts to structurally analyse the practice of whistleblowing in an Italian healthcare system. Therefore the study has mainly focussed not only on the analysis of whistleblowing practices, but also on their impacts on the improvement of organisational processes’ quality and, subsequently, on social well-being.

The association of financial difficulties with clinical outcomes in cancer patients: secondary analysis of 16 academic prospective clinical trials conducted in Italy

Cancer may cause financial difficulties, but its impact in countries with public health systems is unknown. We evaluated the association of financial difficulties with clinical outcomes of cancer patients enrolled in academic clinical trials performed within the Italian public health system. Data were pooled from 16 prospective multicentre trials in lung, breast or ovarian cancer, using the EORTC quality of life (QOL) C30 questionnaire. Question 28 scores financial difficulties related to disease or treatment in four categories from 'not at all' to 'very much'. We defined financial burden (FB) as any financial difficulty reported at baseline questionnaire, and financial toxicity (FT) as score worsening in a subsequent questionnaire. We investigated (i) the association of FB with clinical outcomes (survival, global QOL response [questions 29/30] and severe toxicity), and (ii) the association of FT with survival. Multivariable analyses were performed using logistic regression models or the Cox model adjusting for trial, gender, age, region and period of enrolment, baseline global QOL and, where appropriate, FB and global QOL response. Results are reported as odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CI). At baseline 26% of the 3670 study patients reported FB, significantly correlated with worse baseline global QOL. FB was not associated with risks of death (HR 0.94, 95% CI 0.85-1.04, P = 0.23) and severe toxicity (OR 0.90, 95% CI 0.76-1.06, P = 0.19) but was predictive of a higher chance of worse global QOL response (OR 1.35, 95% CI 1.08-1.70, P = 0.009). During treatment, 2735 (74.5%) patients filled in subsequent questionnaires and 616 (22.5%) developed FT that was significantly associated with an increased risk of death (HR 1.20, 95% CI 1.05-1.37, P = 0.007). Several sensitivity analyses confirmed these findings. Even in a public health system, financial difficulties are associated with relevant cancer patients outcomes like QOL and survival. Any registered clinical trial number should be indicated after the abstract.

Scarce information about breast cancer screening: An Italian websites analysis.

Although the public should have complete and correct information about risk/benefit ratio of breast cancer screening, public knowledge appears generally scarce and oriented to overestimate benefits, with little awareness of possible disadvantages of the screening.We evaluated any document specifically addressed to the general female public and posted on internet by Italian public health services. The presence of false positive, false positive after biopsy, false negative, interval cancer, overdiagnosis, lead-time bias, exposure to irradiation, and mortality reduction was analyzed.Of the 255 websites consulted, 136 (53.3%) had sites addressed to the female public. The most commonly reported information points were the false-positive (30.8% of sites) and radiation exposure (29.4%) rates. Only 11 documents mentioned overdiagnosis, 2 mentioned risk of false positive with biopsy, and only 1 mentioned lead-time bias. Moreover, only 15 sites (11.0%) reported quantitative data for any risk variables.Most documents about breast cancer screening published on the web for the female public contained little or no information about risk/benefit ratio and were biased in favor of screening.

Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

BackgroundDespite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA).MethodsThe present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches.ResultsThe cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge.ConclusionsThe present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service

BackgroundEarly diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System.MethodsTwenty-one toddlers at risk for autism spectrum disorders, aged 20–36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents’ and teachers’ active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months).ResultsChildren made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment.ConclusionOur results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Childhood cancers, risk factors and investigation models for the evaluation of spatio-temporal clusters

This paper introduces a Monograph on childhood cancer clusters addressed to Italian public health workers, paediatricians and paediatric oncologists, and the general public. Two issues have been underlined in most definitions of cancer clusters reported in the literature over the last 30 years. The first is the need for an unbiased methodological approach for the detection and the interpretation of clustering and of individual clusters. The other is the responsibility for scientists and public health workers to unravel suspicious events and to interact with the population in circumstances which may turn out to be false alarms. The relative weight given to epidemiological methods and to risk perception has varied between definitions of clusters given in different periods. In the field of childhood cancer clusters, epidemiological research has produced very little fresh knowledge. However, it is recognized that this is not a sufficient reason for refusing to pay attention to reports of perceived clusters. Models of spatio-temporal interactions according to Birch et al. (2000) are taken in consideration: the literature offers a very limited number of circumstances fitting such models. In Italy, over the years, only two childhood cancer clusters have been reported in the indexed literature, both of them regarded cases of acute lymphatic leukaemia and occurred in Sardinia in the Eighties and in the area of Roma in the Nineties. A possible reason for the paucity of reports (compared, for instance, to the UK scenario) is the limited availability of health statistics.

Can ICT Help to Solve the Clinical Appropriateness Problem?——An Experience in the Italian Public Health

Clinical exams are essential in modern medicine for disease screening, diagnosis and monitoring, but their misuse can lead to resources dissipation. In recent years there has been a significant increase in clinical exams demand. This can be seen both as a positive result of an improved health awareness, mostly in terms of prevention, and as the direct and logical consequence of the medical defensive behaviour, which arises from the potential occurrence of legal controversies and of the clinician's unawareness and indifference about the cost of clinical exams. Often the reasons are related to practical problems, such as the lack of knowledge about an already performed exam, the unavailability or inaccessibility of previous test results, doubts about the reliability of the obtained result for a specific exam or, even, the loss of the previous medical report. In order to reduce the occurrence of inappropriate exams requests we propose an approach, mainly based on Open Data and Open Software, to enforce a suitable set of which can be used to check the appropriateness of the request exam as soon as the request is submitted to the medical unit in charge to perform it. The appropriateness rules come from an open and update repository that can allow the total comprehension about the clinical appropriateness topic and facilitate discussions and debates on the theme. The paper discusses also an implementation of the proposed approach and its application to a public hospital, in Italy.

Food safety and young consumers: Testing a serious game as a risk communication tool

Raising consumers' awareness about food safety issues is one of the primary objectives of Italian public health organizations. New dynamic and interactive tools, based on web applications, are already playing a leading role in health promotion campaigns targeted at adolescents. Among the web-based tools specifically designed for young people, educational videogames have proved especially effective in furthering learning and disseminating information, as they arouse adolescents' interest and curiosity. When a number of cases of Haemolytic-uraemic syndrome (HUS) were reported in 2010, particularly among children, the Italian Ministry of Health stressed the need to implement communication initiatives aimed at raising consumers' awareness of the potential risks associated with raw milk consumption at home. The pilot study described in the article is a relevant example of educational projects implemented in Italy, oriented to transmit knowledge about food risks to young consumers (aged 16–18). To provide correct information on safe milk handling practices and to reduce health issues, including serious ones, the videogame “A mysterious poisoning” was developed. This tool was administered online to 359 upper secondary school students from four different provinces in Italy. The videogame covered all stages of the milk supply chain, from stable to table, and enabled players to identify the crucial moments when milk can be contaminated and to discover safe milk handling practices. By completing a series of tasks, students helped a detective discover the cause of a food poisoning outbreak. This videogame provided an opportunity for students to test their knowledge of the product and to receive more detailed and accurate information. Data collected through two structured questionnaires that were administered before and after the controlled use of the videogame showed that this serious game was capable of changing players' perception of risk exposure and their cognitive associations, particularly increasing their levels of knowledge about the risks associated with raw milk consumption.

Professional training and research: which resources?

The National Plan of Prevention (PNP 2014-2018) [1], which is the key document for the Italian Public Health, underlines the need to realize for all people an empowerment level able to increase or maintain the health control. At international level, the Ljubljana Charter [2] contains the sanitarian systems commitment to rearrange, in the aim to improve continually the quality, with reference to, in particular, the rate cost /efficacy of the system. The manual for medical practitioners and pediatricians (Ministry of Heath, 2010) [3] acknowledges the seven fields of skills for operators, as defined by the Canadian Patient Safety Institute, the CPSI. Continuous training for health professionals started as a national program in Italy in 2002; some years later (2007) administrative control had been transferred from the Ministry of Health to the National Agency for Health Services, Agenas. At distance training and online updating are now becoming very common, close to traditional kinds of events for training, always in respect of the Evidence Based Medicine (EBM). We can identify, in the continuous sanitarian training system, different roles and various kinds of providers. Relevant organisations include the National Committee for Training, in the Ministry of Health, the Warranty Committee, and the National Observatory about Quality of Training. Regarding research in the field of health, we can consider it as the architrave of the National Health Service; the Report on Health Status in Italy 2012-13 [4] defines some essential aspects of it, such as the improvement of criteria of selection of the projects, to simplify bureaucratic procedures, evaluation and the rapid spread of the results. The National Committee for Sanitarian Research defines the program and initiatives, monitors and evaluates the results. Research institutes involved in Italy must accept different challenges, according with the Singapore Declaration [5], which defined some criteria about loyalty and professional honesty. The European Union invested 80M Euro in research with Horizon 2020, in the aim of destroying barriers and realising, all over the world, a common environment concerning knowledge, research and innovation. A recent piece of research related to the food habits in the age of complementary feeding is Nutrintake 6/36 [6], the first Italian study which confirms some excesses and deficiencies in the diet. It suggests the opportunity of the definition of specific nutritional guidelines.

Analysis of full-text publication and publishing predictors of abstracts presented at an Italian public health meeting (2005-2007).

BackgroundIn Public Health, a thorough review of abstract quality evaluations and the publication history of studies presented at scientific meetings has never been conducted. To analyse the long-term outcome of quality abstracts submitted to conferences of Italian Society of Hygiene and Public Health (SItI) from 2005 to 2007, we conducted a second analysis of previously published material aiming to estimate full-text publication rate of high quality abstract presented at Italian public health meetings, and to identify predictors of full-text publication.MethodsThe search was undertaken through scientific databases and search engines and through the web sites of the major Italian journals of Public Health. For each publication confirmed as a full text paper, the journal name, impact factor, year of publication, gender of the first author, type of study design, characteristics of the results and sample size were collected.ResultsThe overall publication rate of the abstracts presented is 23.5 %; most of the papers were published in Public Health journals (average impact factor: 3.007). Non universitary affiliation had resulted in a lower probability of publication, while some of the Conference topics had predisposed the studies to an increased likelihood of publication as well as poster form presentation.ConclusionsThe method presented in this study provides a good framework for the evaluation of the scientific evidence. The findings achieved should be taken into consideration by the Scientific Societies during the contributions selection phase, with the aim of achieving a continuous improvement of work quality. In the future, it would be interesting to survey the abstract authors to identify reasons for unpublished data.

Metric qualities of the cognitive behavioral assessment for outcome evaluation to estimate psychological treatment effects.

BackgroundCognitive behavioral assessment for outcome evaluation was developed to evaluate psychological treatment interventions, especially for counseling and psychotherapy. It is made up of 80 items and five scales: anxiety, well-being, perception of positive change, depression, and psychological distress. The aim of the study was to present the metric qualities and to show validity and reliability of the five constructs of the questionnaire both in nonclinical and clinical subjects.MethodsFour steps were completed to assess reliability and factor structure: criterion-related and concurrent validity, responsiveness, and convergent–divergent validity. A nonclinical group of 269 subjects was enrolled, as was a clinical group comprising 168 adults undergoing psychotherapy and psychological counseling provided by the Italian public health service.ResultsCronbach’s alphas were between 0.80 and 0.91 for the clinical sample and between 0.74 and 0.91 in the nonclinical one. We observed an excellent structural validity for the five interrelated dimensions. The clinical group showed higher scores in the anxiety, depression, and psychological distress scales, as well as lower scores in well-being and perception of positive change scales than those observed in the nonclinical group. Responsiveness was large for the anxiety, well-being, and depression scales; the psychological distress and perception of positive change scales showed a moderate effect.ConclusionThe questionnaire showed excellent psychometric properties, thus demonstrating that the questionnaire is a good evaluative instrument, with which to assess pre- and post-treatment outcomes.

Integration between orthodox medicine, homeopathy and acupuncture for inpatients: Three years experience in the first hospital for Integrated Medicine in Italy

The hospital in Pitigliano (Tuscany) is the first hospital in Italy to put into practice a model of Integrated Medicine. This clinical setting caters for the use of complementary medicine (homeopathy and acupuncture (針灸 zhēn jiǔ)) alongside orthodox therapies (conventional medicine). The therapeutic model implicates doctors who are experts in complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué) and the rest of the hospital personnel working together as equals. This contribution explains the difficulties, critical aspects and potential of this innovative setting.The clinical setting for Integrated Medicine was evaluated in part through observation and in part through the analysis of approval questionnaires. The writers of the questionnaires were the orthodox medical personnel and the hospital patients.The project is still evolving today in spite of the initial partial contrariety of some doctors in the hospital and some external doctors in the area. However, it can already be considered a positive experience, as confirmed by the high approval gained from many health workers and most of the hospital patients. Moreover, the follow-up carried out through specific surgeries dedicated to CAM is extremely positive.Up to now 532 inpatients suffering from acute illnesses, relapse of a chronic illness or neurological or orthopaedic rehabilitation following strokes, brain haemorrhage, neurological illness or limb prosthesis operations have been treated. This work has tried to illustrate the innovative and positive experience for the Italian public health authorities so that it may also be useful to anyone who would like to promote similar initiatives within its public health Institution.

Political priority of oral health in Italy: an analysis of reasons for national neglect

Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy. Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous. Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith. There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern. Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.

Logistic regression of attitudes and coverage for influenza vaccination among Italian Public Health medical residents.

A few number of literature specifically addresses vaccination uptake among Public Health Residents (PHRs). Influenza vaccine attitudes and risk perceptions of PHRs across Italy were studied, contributing to literature on influenza vaccination uptake predictors, in particular among young physicians. An online survey was conducted in 25 Schools of Public Health in Italy in 2011-2012. Results were analysed using prevalence and logistic regression methods. A total of 365 Italian public health residents were included in the study. Vaccination uptake was confirmed by 22.2 and 33.2% of PHRs in 2010-2011 and 2011-2012, respectively. For the 2010-2011 influenza season, vaccination was associated with male sex (adj-OR 3.43; 95% CI = 1.5-7.84) and vaccination history (adj-OR 29.44; 95% CI = 6.4-135.04). For the 2011-2012 season, vaccination was significantly associated with having had between one and three influenza vaccinations in the previous five years (adj-OR 11.56; 95% CI = 6.44-20.75) or more than three (adj-OR 13643; 95% CI = 30.8-604.7) and with individual participation in general population vaccination campaigns (adj-OR 1.85; 95% CI = 1.01-3.41). Italian residents in public health have no confidence and a low personal risk perception about vaccinations therefore taking no measures to protect patients, general population and themselves. Annual influenza vaccination acceptance is associated with influenza vaccine uptake in the previous years and personal involvement in general population vaccination campaigns. These factors should be considered for the design of future campaigns targeting public health residents.

Public Health Genomics education in post-graduate schools of hygiene and preventive medicine: a cross-sectional survey.

BackgroundThe relevance of Public Health Genomics (PHG) education among public health specialists has been recently acknowledged by the Association of Schools of Public Health in the European Region. The aim of this cross-sectional survey was to assess the prevalence of post-graduate public health schools for medical doctors which offer PHG training in Italy.MethodsThe directors of the 33 Italian public health schools were interviewed for the presence of a PHG course in place. We stratified by geographical area (North, Centre and South) of the schools. We performed comparisons of categorical data using the chi-squared test.ResultsThe response rate was 73% (24/33 schools). Among respondents, 15 schools (63%) reported to have at least one dedicated course in place, while nine (38%) did not, with a significant geographic difference.ConclusionsResults showed a good implementation of courses in PHG discipline in Italian post-graduate public health schools. However further harmonization of the training programs of schools in public health at EU level is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-213) contains supplementary material, which is available to authorized users.

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy.

BackgroundPublic health genomics is an emerging multidisciplinary approach, which aims to integrate genome-based knowledge in a responsible and effective way into public health. Despite several surveys performed to evaluate knowledge, attitudes and professional behaviors of physicians towards predictive genetic testing, similar surveys have not been carried out for public health practitioners. This study is the first to assess knowledge, attitudes and training needs of public health professionals in the field of predictive genetic testing for chronic diseases.MethodsA self-administered questionnaire was used to carry out a cross-sectional survey of a random sample of Italian public health professionals.ResultsA response rate of 67.4% (797 questionnaires) was achieved. Italian public health professionals have the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but they need additional training to increase their methodological knowledge. Knowledge significantly increases with exposure to predictive genetic testing during postgraduate training (odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.05–2.88), time dedicated to continuing medical education (OR = 1.53, 95% CI = 1.14–2.04) and level of English language knowledge (OR = 1.36, 95% CI = 1.07–1.72). Adequate knowledge is the strongest predictor of positive attitudes from a public health perspective (OR = 3.98, 95% CI = 2.44–6.50). Physicians show a lower level of knowledge and more public health attitudes than other public health professionals do. About 80% of public health professionals considered their knowledge inadequate and 86.0% believed that it should be improved through specific postgraduate training courses.ConclusionsSpecific and targeted training initiatives are needed to develop a skilled public health workforce competent in identifying genomic technology that is ready for use in population health and in modeling public health genomic programs and primary care services that need to be developed, implemented and evaluated.

Medical Treatment of Subjects with Gender Identity Disorder: The Experience in an Italian Public Health Center

ABSTRACTHormonal treatment is the main element during the transition program for transpeople. The aim of this paper is to describe the care and treatment of subjects, highlighting both the endocrine-metabolic effects of the hormonal therapy and the quality of life during the first year of cross-sex therapy in an Italian gender team. We studied 83 subjects (56 male-to-female [MtF], 27 female-to-male [FtM]) with hematological and hormonal evaluations every 3 months during the first year of hormonal therapy. MtF persons were treated with 17βestradiol and antiandrogens (cyproterone acetate, spironolactone, dutasteride); FtM persons were treated with transdermal or intramuscular testosterone. The WHO Quality of Life questionnaire was administered at the beginning and 1 year later. Hormonal changes paralleled phenotype modifications with wide variability. Most of both MtF and FtM subjects reported a statistically significant improvement in body image (p < 0.05). In particular, MtF subjects reported a statistically significant improvement in the quality of their sexual life and in the general quality of life (p < 0.05) 1 year after treatment initiation. Cross-sex therapy seems to be free of major risks in healthy subjects under clinical supervision during the first year. Selected subjects show an optimal adaptation to hormone-induced neuropsychological modifications and satisfaction regarding general and sexual life.

Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies

In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.

Study for the quality assessment of abstracts presented to Italian public health national conferences: a six years survey.

Oral and poster presentations at congresses are essential to spread scientific knowledge among the medical community. Many scientific societies have analyzed the quality of papers presented at their meetings but no information on abstracts' evaluation has been presented in Public Health field. This study aims to examine the quality of abstracts presented at annual meetings of Italian Public Health Society (SItI) in the period 2005-2010 through a validated checklist grid, evaluating eight dimensions: Inherency, Structure, Originality, Objectives, Study design, Sources, Results, Conclusions. Each item was scored from 0 to 3 points (max score: 24) and we used the average score in our study (15) as threshold of good quality. A multivariate analysis was performed in order to investigate predictors of score of abstracts presented. A total of 4,399 abstracts (1,172 oral communications, 3,227 posters) was examined. Around 60% were submitted by Universities and around 40% were from Central Italy. The highest quality was found in the fields of Vaccines (average score 18.9), Infectious Diseases (18) and in abstracts submitted by Universities (16.4). Predictors of lower quality identified were geographical area and affiliation (p= 0.002). Abstracts containing well-written Results, Conclusions and Objectives (3 points) were more likely to be of high quality(OR=55.6, OR=41.9, and OR=157.4; p>0.001) CONCLUSIONS: This is the first European study evaluating the quality of abstracts in the public health field. A reliable evaluation tool is fundamental to offer a transparent methodology of assessment and to improve the quality of research.

Planning and control of medical device investments by Italian public health authorities: A means to improve the decision-making process

Within the context of increased health care spending in Italy and governmental cost-containment efforts, attention has focused on the medical device sector also in light of the newly introduced centralized procurement policy, of Health Technology Assessment, and of the Government’s call for a more managerial-type approach by public health authorities. In this scenario, it became necessary to analyse investments in medical devices and to assess their contribution not only to the health of patients, but also to – if any – the whole economy and to the nation’s economic growth. Public health authorities must now also assess the effect of investments on profitability by evaluating investment regenerations based on the diagnosis-related group revenue for inpatients and on the Regional tariffs established by the Italian National Health Service for outpatients. Knowledge of the medical device sector, and planning and control systems, will enable public health authorities to improve their internal decision-making ...