Background: Immigration towards Ferrara is a recent occurrence. We evaluated the immigrants’ health requests. Methods: This report is based on data collected by Local Health Authority. Results: The analysis of ambulatory cares and hospitalizations are comparable. It emerges the age class 31- 65 is the most represented. Females’ requests are more than males’ one, due to pregnancy and gynaecological health requests. The capital hospital sustained the heaviest workload. We found differences respect European Union population regarding length of stay. The predominant kind of access are through emergency room and self-access. Conclusions: This complex pattern of health care requests requires dedicated approaches.

Aim This study evaluated the knowledge and attitudes of Italian mothers – whose daughters had been vaccinated in 2012 – towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. Methods The survey – part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) – was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test. Results The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test. Conclusions The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.

BACKGROUND:Healthcare professionals have an important role to play both as advisers-influencing smoking cessation-and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach.MATERIALS AND METHODS:A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05.RESULTS:A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization.CONCLUSIONS:The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

BACKGROUND:Little is known about human papilloma virus (HPV) seroprevalence in the healthy Italian population. The aim of the study was to assess seroprevalence of antibodies against HPV 6, 11, 16 and 18 among girls and young women in Italy.METHODS:Sera were tested with a commercially available ELISA assay detecting specific IgG.RESULTS:Seroprevalence was 54.1% in girls between 11 to 18 years old and 8.2% in over 18s. Overall seropositivity in birth cohorts invited for free immunization reached 72.8% and was significantly higher than in other age subgroups. The highest levels of antibodies were detected in girls of 12 years old that should have just completed the vaccination schedule.CONCLUSION:A standardized seroepidemiological survey on HPV represents a useful tool for identifying groups at risk in which immunization is recommended, monitoring of vaccinated women, assessing whether booster vaccination is required.

Background: The aim of this pilot study was to assess the reliability and validity of the questionnaire in young women ≥18 years as tool to examine knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Methods: Reliability analysis was tested and content validity was evaluated using Cronbach's alpha to check internal consistency with the intention to obtain no misunderstanding results. The questionnaire - composed by n. 3 section for a total of n. 69 items- was administered to 30 girls. The study was conducted in 4 Italian cities: Ferrara, Rome, Cassino and Palermo and data were collected in the month of October 2010. Statistical analysis was performed through SPSS 19.0, statistical software for Windows. Results: The higher value of Cronbach’s alpha resulted on 24 items (alpha= 0,774). The addition just one at time of also only one more of the others items got worse the alpha. Cronbach’s alpha on all the III section together (n. 69 items) resulted in a value of 0, 059. Young women generally known HPV can cause cervical cancer (93.3%) and genital warts (16.7%) and 76.7% of them recognize pap test as a screening tool. The main sources of information about HPV vaccination, are represented by magazines / books (33.3%), TV (26.7%), gynecologists (23.3%). Conclusion: This pilot study demonstrated that a reduced version of the questionnaire showed a very good reliability properties in the study and this needs to be taken into account for future studies.

Aims and background. Healthcare professionals have an important role to play both as advisers influencing smoking cessation and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.Methods and study design. A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.Results. Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03-3.97).Conclusions. This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models..

Objective: The aim of this survey is to compare the main sources of information about vaccination against Human papillomavirus (HPV) of young women aged over-18 and under-18 years.Methods: A multicenter study was carried out in Italy through the administration of a questionnaire. Univariate analyses were conducted to evaluate possible differences between age groups and different locations (chi-square test and Fisher test where possible).Results: The sample consisted of 987 young women. The main sources of information about HPV vaccination are represented by magazines/books (23.1%) and TV (20.5%) for the over-18s, while for the under-18s the sources are general practitioners (22.6%) and pediatricians (15.4%). The over-18s with health professionals as parents consult mostly gynecologists (27.7%) and general practitioners (20.5%).Discussion: This study highlights lack of information on HPV vaccination given by health professionals to young women and underlines the need to improve education about cervical cancer, prevention and HPV vaccination. (C) 2013 Elsevier Ltd. All rights reserved.

Background In today's dynamic health-care system, organizations such as hospitals are required to improve their performance for multiple stakeholders and deliver an integrated care that means to work effectively, be innovative and organize efficiently. Achieved goals and levels of quality can be successfully measured by a multidimensional approach like Balanced Scorecard (BSC). The aim of the study was to verify the opportunity to introduce BSC framework to measure performance in St. Anna University Hospital of Ferrara, applying it to the Clinical Laboratory Operative Unit in order to compare over time performance results and achievements of assigned targets. Methods In the first experience with BSC we distinguished four perspectives, according to Kaplan and Norton, identified Key Performance Areas and Key Performance Indicators, set standards and weights for each objective, collected data for all indicators, recognized cause-and-effect relationships in a strategic map. One year later we proceeded with the next data collection and analysed the preservation of framework aptitude to measure Operative Unit performance. In addition, we verified the ability to underline links between strategic actions belonging to different perspectives in producing outcomes changes. Results The BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the specific perspective contribution to overall performance enhancement. After time results comparison was possible depending on the selection of feasible and appropriate key performance indicators, which was occasionally limited by data collection problems. Conclusions The first use of BSC to compare performance at Operative Unit level, in course of time, suggested this framework can be successfully adopted for results measuring and revealing effective health factors, allowing health-care quality improvements.

It is difficult to identify, from a regulatory point of view, the actual competencies of medical directors of public hospitals in Italy. A questionnaire survey was therefore conducted to identify which are the activities actually performed by this professional. One hundred twenty local health authorities participated in the survey. Findings reveal that many activities conducted by the hospital medical director, such a mediation with the local health authorities, are not formally recognized and that the medical director actually conducts more complex activities than those formally pertaining to his role.

BACKGROUND AND AIMS:One of the best-known performance planning and evaluation techniques utilising both monetary and non-monetary data is the Balanced Scorecard (BSC). This is a means of rationalising the global activity of a business in the attempt to create value, and to translate the company vision into a set of tactical objectives and measurable strategies. The aim of this study was to implement and evaluate the use of BSC in two departments of the St. Anna University Hospital, Ferrara: the Analysis Laboratory and Digestive Endoscopy operating units (OU).MATERIALS AND METHODS:With the collaboration of the health workers involved, a precise methodological programme was pursued: Definition of the strategic map from 4 perspectives, according to Kaplan and Norton, Definition of the Key Performance Areas (KPA), or macro-objectives, Identification of the cause-effect relationships between KPAs, Identification of the sub-objectives of each KPA, Definition of the Key Performance Indicators (KPI), Definition of the weight/importance of each objective in the global evaluation.RESULTS:The information gathered permitted the definition of macro- and sub-objectives for each perspective, as well as determining the relevant indicators, standards, weights, frequency of detection and means of acquisition. Strategic maps showing the cause/effect relationships in each OU were created, as were 'evaluation panels', which describe the global performance of each department. For each perspective, the fundamental data were summarised in one table. Evaluation of each perspective yielded a positive result for the majority of the objectives, and the global result (including all 4 perspectives) was found to be satisfactory.DISCUSSION-CONCLUSION:The Balanced Scorecard was implemented in the abovementioned OUs of St. Anna University Hospital, Ferrara, after the health workers themselves realised the need for change.In our research the employees were pleased to be evaluated, not only for the financial outcomes, but also for the satisfaction of improving internal procedure, relationships with the community and their own growth/learning. BSC is an ideal point of contact between the financial and clinical dimensions of management. However, difficulties in its application were faced, among these, at least in the initial phase, the lack of information systems able to drive it, and the complexity of the research for specific indicators needed to be overcome. The time factor (on average, at least two years are required) and the availability of technological resources were also limiting factors.The rapid diffusion of BSC among the principal international profit and non-profit organisations is testament to its great potential. This project could be seen as a preparatory phase in the strategical analysis of a subsequent business plan.

Urinary mutagenicity was evaluated in relation to environmental mutagen exposure (i.e., diet, indoor/outdoor activities, residential area etc.) on the day prior to sample collection, and also considering factors that contribute to the variability of Salmonella mutagenicity assay results. Overnight urine samples from 283 healthy non-smoking residents of northeast Italy (46% males, 20-62 years) were analyzed for mutagenicity on sensitive Salmonella typhimurium strain YG1024 with S9 mix employing the preincubation version of the plate incorporation assay (i.e., the Salmonella reverse mutation test). Urinary mutagenicity varied between 0.02 and 9.84 rev/ equiv. ml, and 7% of samples were positive (i.e., sample elicited a two-fold increase in revertants). There was an evident increase in mutagenicity in subjects with increased intake of mutagen-rich meals (n = 80) (P < 0.01 and positive urine 13% vs. 5%, P = 0.025). Indoor-exposed subjects (n = 65) also showed a higher percentage of positive urine (14% vs. 5%, P = 0.015). In particular, those subjects exposed to cooking fumes the previous evening (n = 28) revealed higher urinary mutagenicity (P = 0.035, positive urine 25% vs. 5%, P < 0.001) than non-indoor exposed. The sources of variability of the mutagenicity assay, mainly the histidine content of the urine concentrate (z = 4.06, P < 0.0001), and to a lesser extent bacterial inoculum size (z = 2.33, P = 0.019), also significantly influenced urinary mutagenicity values. In a linear multiple regression analysis, their effects were still significant (i.e., histidine content P = 0.026 and inoculum size P = 0.021), but the effects of diet, indoor exposure, and other environmental exposures (i.e., traffic and heating system exhausts, residential area) were not. It is concluded that the previous day's exposure to mutagen-rich meals and cooking fumes may influence the presence of mutagenic activity in the overnight urine of non-smoking subjects. This mutagenic activity, which remains in contact with bladder mucosa for several hours, could be considered risk factors for colorectal adenoma and possibly other cancers (i.e., bladder) in non-smokers. Accurate control of histidine content and bacterial inoculum size is strongly recommended when investigating the mutagenic activity of urine from non-smokers.

Background. In Italy, cardiovascular diseases represent an important cause of disability in the elderly. Therefore, it is necessary to provide effective and appropriate diagnostic and therapeutic procedures to all the interested subjects. The aim of our study was to estimate attitudes and behaviors of health personnel and representatives of citizen associations toward the following procedures: thrombolysis, coronary artery bypass, pacemaker implantation, and aortic valve replacement.Methods. Within an Italian multicenter study on the relation between age and treatment of cardiovascular diseases, a questionnaire was administered to a stratified sample of medical doctors (cardiologists, heart surgeons, geriatrics, internists), general practitioners in order to show any existing discrimination in care access as regards age, sex and race of patients.Results. The sample included 283 subjects (73.8% men, median age 47 years). In 53% age was a discriminating factor in the distribution of the therapeutic procedures, with higher statistically significant percentages reported by geriatrics and internists (62.5 and 58.6%, respectively) and lower ones by cardiologists and heart surgeons (48.2 and 41.5%, respectively) (chi(2) = 29.592, p < 0.0001). The influence of the shortest expectancy of life in the elderly is the reason for discrimination in 19.6% of the participants. Race and gender do not represent a discriminating factor for 81 and 92.1% of responders, respectively.Conclusions. The results of our study highlight the presence of different attitudes among health personnel about the distribution of cardiological procedures as regards patients' age, in particular when > 75 years old. An easier access should he given to these patients and this may represent the objective of research aimed at developing better treatments for elderly people.

BACKGROUND:In Italy, cardiovascular diseases represent an important cause of disability in the elderly. Therefore, it is necessary to provide effective and appropriate diagnostic and therapeutic procedures to all the interested subjects. The aim of our study was to estimate attitudes and behaviors of health personnel and representatives of citizen associations toward the following procedures: thrombolysis, coronary artery bypass, pacemaker implantation, and aortic valve replacement. METHODS:Within an Italian multicenter study on the relation between age and treatment of cardiovascular diseases, a questionnaire was administered to a stratified sample of medical doctors (cardiologists, heart surgeons, geriatrics, internists), general practitioners in order to show any existing discrimination in care access as regards age, sex and race of patients. RESULTS:The sample included 283 subjects (73.8% men, median age 47 years). In 53% age was a discriminating factor in the distribution of the therapeutic procedures, with higher statistically significant percentages reported by geriatrics and internists (62.5 and 58.6%, respectively) and lower ones by cardiologists and heart surgeons (48.2 and 41.5%, respectively) (chi2 = 29.592, p < 0.0001). The influence of the shortest expectancy of life in the elderly is the reason for discrimination in 19.6% of the participants. Race and gender do not represent a discriminating factor for 81 and 92.1% of responders, respectively. CONCLUSIONS:The results of our study highlight the presence of different attitudes among health personnel about the distribution of cardiological procedures as regards patients' age, in particular when > 75 years old. An easier access should be given to these patients and this may represent the objective of research aimed at developing better treatments for elderly people.