Quality of psychiatric care: validation of an instrument for measuring inpatient opinion.
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OBJECTIVES: To validate a brief self-completed questionnaire for routinely assessing patients' opinions on the quality of care in inpatient psychiatric wards (Rome Opinion Questionnaire for Psychiatric Wards). DESIGN: A preliminary version was assessed for face and content validity by eight psychiatrists and two patient focus groups. The final version was evaluated for acceptability, factor structure, internal consistency, and test-retest reliability. SETTING: An inpatient psychiatric ward in a general hospital in Rome. STUDY PARTICIPANTS: The questionnaire was administered to all consecutive inpatients admitted over a 6-month period (n = 169). Test-retest reliability was evaluated by administering the questionnaire for a second time to 27 inpatients. MAIN OUTCOME MEASURES: Face and content validity: psychiatrists and focus groups' opinions on relevance, importance, and clarity, acceptability: inpatients' opinions on user-friendliness; factor analysis: principal component analysis; internal consistency: Cronbach's alpha; test-retest reliability: Cohen's weighted kappa coefficient, intraclass correlation coefficient RESULTS: After evaluating face and content validity, the questionnaire was reduced to 10 items. Inpatients found the questionnaire to be acceptable. Factor analysis revealed that three factors-professional qualities of staff, information received, and physical environment-explained 67.2% of total variance. Cronbach's alpha was 0.82 for the questionnaire and 0.61, 0.71, and 0.35 for the three factors, respectively. Test-retest reliability was good; weighted kappa higher than 0.9 for three items and 0.6-0.9 for seven items. The intraclass correlation coefficient was 0.80. CONCLUSIONS: The questionnaire seems to be adequate for evaluating patients' opinions on care in inpatient psychiatric wards. Because of its user-friendliness, it may be particularly suitable for routine use. (+info)
Individual and area-based indicators of socioeconomic status and childhood asthma.
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The current study evaluated the association between individual and area-based indicators of socioeconomic status and the prevalence, severity, and lifetime hospitalisation for asthma in children. The representative sample of 4,027 children from Rome, aged 6-7 yrs, used for the 1994 ISAAC (International Study on Asthma and Allergies in Childhood) initiative, was selected. Individual and small area indicators of socioeconomic status were used. Individual data on parents' education and on childhood asthma were gathered from self-administered parental questionnaires. Two small-area indicators (socioeconomic status index (SES) and average income in 1994) were derived using information available at the census tract of residence. Logistic regression models were used to estimate the association of parental education and small area indicators with asthma prevalence, severity, and hospitalisation. Parental smoking was considered in the analysis as a potential confounder. Prevalence of physician diagnosis of asthma (11.3%) increased as father's education decreased. Prevalence of severe asthma (1.6%) increased as maternal and paternal educational levels decreased. Lifetime hospitalisation for asthma (2.8%) was strongly associated with both parental education and small-area indicators of social disadvantage, even when considered simultaneously in the same logistic model. Socioeconomic conditions are associated with asthma occurrence, its severity, and hospitalisation. The association was stronger for asthma severity and hospitalisation. Individual indicators correlated better with the outcomes than area-based indicators. However, living in an underprivileged area is a strong independent predictor of hospital admission for asthma. (+info)
Outbreak of Saccharomyces cerevisiae subtype boulardii fungemia in patients neighboring those treated with a probiotic preparation of the organism.
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We report an outbreak of Saccharomyces cerevisiae subtype boulardii fungemia among three intensive care unit roommates of patients receiving lyophilized preparations of this fungus. The fungemia was probably due to central venous catheter contamination and resolved after fluconazole treatment. The need for stringent application of proper hygiene when using a probiotic preparation of this organism is emphasized. (+info)
Impact of lung volume reduction surgery versus rehabilitation on quality of life.
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This study aims at evaluating the effects of lung volume reduction versus respiratory rehabilitation on quality of life, assessed by three different questionnaires. Sixty emphysematous patients were randomised by computer to receive either surgery (n = 30) or rehabilitation (n = 30). Life quality was evaluated by the Nottingham Health Profile, the Short Form (SF)-36 item and the St George's questionnaires. As reported previously, dyspnoea index, forced expiratory volume in one second, residual volume, 6-min walk test and arterial oxygen tension improved after surgery more than after rehabilitation. Quality of life was significantly improved after surgery as follows Nottingham Health Profile physical mobility; SF-36 physical and social functioning, mental and general health, emotional role; St George's general, activity. At multivariate analysis 6- and 12-month changes after surgery of Short Form-36 physical functioning, general health, and St George's activity domains were significantly correlated with forced expiratory volume in one second, while Short Form-36 social functioning and Nottingham Health Profile isolation correlated with residual volume. Functional and especially symptomatic improvements persisted: dyspnoea index, residual volume, and Short Form-36 and St Georges's physical scores were still significant at 4 yrs. Surgery produces greater and longer effects than rehabilitation on quality of life by improving both physical and psychosocial domains. Symptomatic improvements persisted at 4 yrs. (+info)
An epidemic of gastroenteritis and mild necrotizing enterocolitis in two neonatal units of a University Hospital in Rome, Italy.
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In the summer of 1999 a cluster of 18 cases of necrotizing enterocolitis (NEC) occurred in a University Hospital in Rome, Italy. The cases presented with mild clinical and radiological signs, and none died. Seventy-two per cent had a birth weight of > 2500 g, 66.7% had a gestational age of > 37 weeks, 30% presented with respiratory diseases and/or hypoglycaemia. All cases occurred within 10 days of birth and between 5 and 7 days after two clusters of diarrhoea (14 cases). The NEC outbreak had two phases; most cases in the first phase occurred in the at-risk unit, whereas those in the second phase occurred in the full-term unit. In the multivariate analysis, invasive therapeutic procedures, pathological conditions and formula feeding were associated with NEC. Although no predominant common bacteria were isolated, we suggest an infective origin of this outbreak. (+info)
Biomonitoring of traffic police officers exposed to airborne platinum.
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BACKGROUND: Over the past two decades there has been a substantial increase in environmental levels of palladium, platinum, and rhodium, the platinum group elements (PGEs), due to the widespread use of catalytic converters for automotive traction. AIM: To evaluate urinary platinum levels in occupationally exposed subjects. METHODS: A total of 161 employees from the Rome City Police Force were studied; 103 were traffic police involved in controlling streets with an average flow of vehicles, while the remaining 58 were control subjects engaged only in office work. Platinum quantification in the urine samples of these subjects was carried out by sector field inductively coupled plasma mass spectrometry. RESULTS: There were no statistically significant differences between platinum levels in the group of subjects engaged in traffic control and the control group (4.45 (2.42) ng/l v 4.56 (2.84) ng/l, respectively). CONCLUSIONS: Urinary levels were found to be higher than those reported for other urban populations, thus showing a progressive increase in human exposure to Pt. (+info)
Mortality study of workers employed by the Italian National Institute of Health, 1960-1989.
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A cohort mortality study was conducted to evaluate the cancer risk of workers employed by the National Institute of Health in Rome, Italy. Cancer mortality was evaluated for research staff. A deficit of overall cancer mortality was found for the men, but not for the women. Elevated (albeit statistically nonsignificant) standardized mortality ratios were found for cancer of the pancreas (men 155, women 236), cancer of the brain (men 159), lympho- and reticulosarcomas (men 233, women 512), and lymphatic and hematopoietic tumors (women 623). In addition the women had a statistically significantly elevated risk of breast cancer (288). Although most of these results, with the exception of breast cancer among the women, were not statistically significant, due to the limited study size, they point to the existence of excess risks for some tumors. The possibility that these increases are related to exposures occurring in the laboratory setting deserves further consideration. (+info)
Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency.
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BACKGROUND: Direct admission to Coronary Care Unit (CCU) on hospital arrival can be considered as a good proxy for adequate management in patients with acute myocardial infarction (AMI), as it has been associated with better prognosis. We analyzed a cohort of patients with AMI hospitalized in Rome (Italy) in 1997-2000 to assess the proportion directly admitted to CCU and to investigate the effect of patient characteristics such as gender, age, illness severity on admission, and socio-economic status (SES) on CCU admission practices. METHODS: Using discharge data, we analyzed a cohort of 9127 AMI patients. Illness severity on admission was determined using the Deyo's adaptation of the Charlson's comorbidity index, and each patient was assigned to one to four SES groups (level I referring to the highest SES) defined by a socioeconomic index, derived by the characteristics of the census tract of residence. The effect of gender, age, illness severity and SES, on risk of non-admission to CCU was investigated using a logistic regression model (OR, CI 95%). RESULTS: Only 53.9% of patients were directly admitted to CCU, and access to optimal care was more frequently offered to younger patients (OR = 0.35; 95%CI = 0.25-0.48 when comparing 85+ to >=50 years), those with less severe illness (OR = 0.48; 95%CI = 0.37-0.61 when comparing Charlson index 3+ to 0) and the socially advantaged (OR = 0.81; 95%CI = 0.66-0.99 when comparing low to high SES). CONCLUSION: In Rome, Italy, standard optimal coronary care is underprovided. It seems to be granted preferentially to the better off, even after controversial clinical criteria, such as age and severity of illness, are taken into account. (+info)