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Abstract: Background.: Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access. Methods.: Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions. Results.: The invitation letter vs no intervention showed significantly more participation (RR=1.60 95%CI 1.33–1.92; RR=1.52 95%CI 1.28–1.82; RR=1.15 95%CI 1.12–1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR=1.74 95%CI 1.25–2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR=0.99 95%CI 0.94–1.05; RR=1.08 95%CI 0.99–1.17, for breast and cervical cancer, respectively). Conclusion.: Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective. [Copyright &y& Elsevier]

Background A variety of tests have been proposed for colorectal cancer ( CRC), giving rise to uncertainty regarding the optimal approach. The efficacy and effectiveness of different tests are related to both screenee participation and the detection rate. Aim To perform a meta-analysis on adherence and detection rates of CRC screening tests. Methods Relevant publications were identified by MEDLINE/ EMBASE and other databases for the period 1999-2012. A previous systematic review was used for the period before 1966-1999. RCTs and controlled studies including a direct comparison of the uptake rates among different options for CRC screening were included. Adherence and detection rates for advanced neoplasia and cancer were extracted. Risk for bias was ascertained according to CONSORT guidelines. Forrest plots were produced based on random-effect models. Results Fourteen studies provided data on 197 910 subjects. Endoscopic strategies were associated with a lower participation ( RR: 0.67, 95% CI: 0.56, 0.80) rate, but a higher detection rate of advanced neoplasia ( RR: 3.21, 95% CI: 2.38, 4.32) compared with faecal tests. FIT was superior to g- FOBT with regard to both adherence ( RR: 1.16, 95% CI 1.03, 1.30) and detection of advanced neoplasia ( RR: 2.28, 95% CI 1.68, 3.10) and cancer ( RR: 1.96, 95% CI: 1.2, 3.2). Conclusion The superior accuracy of endoscopy compared with faecal tests minimised any impact of the participation rate in determining the detection rate of advanced neoplasia in a screening setting. [ABSTRACT FROM AUTHOR]

This study investigated the effects of antenatal steroid (AS) administration on the clinical conditions of preterm infants shortly after birth, and estimated the residual contribution of AS, after adjusting for the clinical risk index for babies (CRIB), on in hospital mortality. The study population consisted of all infants under 32 weeks gestation or with a birth weight less than or equal to 1500 g admitted within the first week after birth to 11 neonatal intensive care units in the Lazio region of central Italy during the years 1999-2001. A positive effect of Full AS treatment on mortality was mainly among those babies with an intermediate CRIB score while for the sickest babies the benefit of AS treatment disappears.

The aim of the article is to compare utilization of prenatal care, modality of obstetric care, and pregnancy outcomes in foreign born (FB) and Italian born (IB) mothers. The study was carried out in the Lazio region of Central Italy, which has 5 000 000 million inhabitants. Information was obtained from neonatal administrative hospital discharge records, containing data on maternal and neonatal characteristics. During the years 2001 -2002 there were 82 619 live births among lB mothers and 13015 among FB mothers. Results suggest that the utilisation of prenatal care was lower in immigrant mothers.

Background Road Traffic Injuries (RTI) and Home Injuries (HI) represent a relevant public health problem. In the Lazio region of Italy a surveillance system was activated. Objective To describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001–2005. Methods We identified all Emergency Department (ED) visits and then linked them with hospital discharges and mortality registry. From the integrated database, we calculated the rates of ED visits, of hospital admissions, and of mortality, reporting the temporal trends. Results The 5-year surveillance showed a rate of 3151/100 000 for RTI ED visit and of 2976/100 000 for HI ED visit. The 15–29 year old was the group with the highest incidence of RTI ED visit and hospitalisation rate, 6845 and 493 per 100 000 inhabitants respectively; while the highest HI ED visit rate was in 0–4 years old (5958/100 000) and in older persons (3131/100 000) subjects. During the study period RTI and HI ED visit and hospitalisation rate showed a decreasing trend. The RTI surveillance revealed a decreasing trend for hospital admissions, and a decline of fatal cases from 2003, when the drivers license point system began. It identified higher number of fatal cases (22% more) than the official statistics. The HI surveillance revealed a significant increasing trend in more severe cases, and a stable trend for mortalities. Conclusion This study underlines the usefulness of the surveillance in order to monitor temporal trends and effectiveness of preventive measures. [ABSTRACT FROM PUBLISHER]

Objective To explore the relationship between morbidity, hospitalisation, mortality from Road Traffic Injuries (RTI) and Home Injuries (HI) and socioeconomic status (SES) of the area of residence. Source: RTI and HI surveillance based on the integration between the Emergency Department (ED) Hospital and Mortality data of Lazio region. The SES index (five levels: 1 most privileged areas; 5 most deprived areas) was derived using census data. For each injured subject the SES index of its census tract of residence was obtained. Population Residents in Rome, 2005 Italy. Analyses For each level of SES, we computed rates for ED visits, hospitalisation and mortality, adjusted by sex and age. IRR and 95% CI have been estimated using Poisson Regression. Results Out of 127 129 ED visits, 9576 (7.5%) were followed by a hospitalisation and 594 (0.5%) died within 30 days. SES was estimated for 109 993 cases, 87% of the total. The rates of RTI and HI ED visits were higher among the most deprived level of SES (IRR 1.27 95% CI 1.24 to 1.30; IRR 1.33 95% CI 1.29 to 1.37, respectively) compared to the most privileged ones. A strong relation was found between RTI mortalities and poor level of SES. These findings were more marked for 0–4 year old HI and RTI injured and for males. Conclusion RTI and HI incidence were associated to sociodemographic factors. This finding has implications for targeting injury prevention interventions and resources. [ABSTRACT FROM PUBLISHER]

Background: Emergency Clinical Pathways (ECP) for stroke have never been tested in randomized controlled trials (RCTs).Objective: To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy) emergency system.Methods: cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS) and Emergency Room (ER) health professionals trained in the ECP, with those of non-trained EMS and ER controls. Primary outcome measure was the proportion of eligible (aged Results: 2656 patients in the intervention arm and 2239 in the control arm required assistance; 78.3% of the former and 80.6% of the latter were admitted to hospitals, and respectively 74.8% and 78.3% were confirmed strokes. Of the eligible confirmed strokes, 106/434 (24.4%) in the intervention arm and 43/328 (13.1%) in the control arm were referred to the SU in the ITT analysis (RR = 2.01; 95% CI: 0.79-4.00), and respectively 105/243 (43.2%) and 43/311 (13.8%) in the PP analysis (RR = 3.21; 95%CI: 1.62-4.98). Of patients suitable for i.v. thrombolysis, 15/175 (8.6%) in the intervention arm and 2/115 (1.7%) in the control arm received thrombolysis (p = 0.02) in the ITT analysis, and respectively 15/99 (15.1%) and 2/107 (1.9%)(p = 0.001) in the PP analysis.Conclusion: Our data suggest potenti efficiency and feasibility of an ECP. The integration of EMS and ERs with SU networks for organised acute stroke care is feasible and may ameliorate the quality of care for stroke patients.Trial Registration: Current Controlled Trials (ISRCTN41456865). [ABSTRACT FROM AUTHOR]

Background: In recent decades, studies that evaluate training programmes have shown that continuing education for physicians is not very effective in improving performance and behavioural changes. One of our goals was to create a Continuing Medical Education Programme (CMEP) that would result in changing the behaviour of health professionals. In early 2005, a new CMEP was offered to emergency medical services and emergency room professionals to introduce an Emergency Critical Pathway (ECP) for the management of acute stroke patients. This paper illustrates the main characteristics of the educational model and the strategies and activities adopted to realize it. Methods: The training programme was planned and organized applying the concepts and tools of experiential learning. It was organised in three successive phases: 1) interviews with health professionals to identify their learning needs; 2) training the ECP coordinators/facilitators in a residential setting; and 3) on-site training in small groups of health professionals (6-8), led by a coordinator/facilitator. Results: The CME involved 324 emergency health professionals. Participants positively evaluated both the educational programme and the clinical indications of the protocols. Over six months of the ECP training, health professionals treated 657 stroke patients: 153 (23.3%) were transferred to the stroke unit where 15 (9.8%) were thrombolysed. In the same period of the previous year, the professionals treated 638 patients: 99 (15.5%) were transferred to the stroke unit and no patients were thrombolysed. Conclusion: The application of the new educational methodology has contributed to improved management of stroke patients in Latium. [ABSTRACT FROM AUTHOR]

Background: Screening programmes should be organized to translate theoretical efficacy into effectiveness. An evidence-based organizational model of colorectal cancer screening (CRCS) should assure feasibility and high compliance. Methods: A multidisciplinary Working Group (WG), reviewed literature and guidelines to define evidence-based recommendations. The WG identified the need for further local studies: physicians' CRCS attitudes, the effect of test type and provider on compliance, and individual reasons for non-compliance. A survey of digestive endoscopy services was conducted. A feasibility study on a target population of 300.000 has begun. Results: Based on the results of population trials and on literature review the screening strategy adopted was Faecal Occult Blood Test (FOBT) every two years for 50-74 year olds and, for positives, colonoscopy. The immunochemical test was chosen because it has 20% higher compliance than the Guaiac. GPs were chosen as the preferred provider also for higher compliance. Since we observed that distance is the major determinant of non-compliance, we choose GPs because they are the closest providers, both geographically and emotionally, to the public. The feasibility study showed several barriers: GP participation was low, there were administrative problems to involve GPs; opportunistic testing by the GPs; difficulties in access to Gastroenterology centres; difficulties in gathering colonoscopy results; little time given to screening activity by the gastroenterology centre. Conclusion: The feasibility study highlighted several limits of the model. Most of the barriers that emerged were consequences of organisational choices not supported by evidence. The principal limit was a lack of accountability by the participating centres. [ABSTRACT FROM AUTHOR]

Latium region conducted a randomised trial to obtain the information needed to plan a colorectal cancer screening (CRCS) program with an evidence based organisation. To assess the effect of the type of faecal occult blood test, Guaiaco v immunochemical, on the compliance to screening of the 50-74 year old population. Other logistical and organisational aspects of the two screening test have also been analysed. 130 general practitioners were sampled who gave the consent to participate in a randomised trial with outcome the compliance to CRCS.

The article assesses the effect of the provider General Practitioners (GP) in hospital on the compliance of the population 50-74 year in returning the FOBT. The compliance obtained using the GP as providers of the FOBT was 3.4 times higher than the compliance obtained using the hospital as provider independently from the type of test and the geographical area. There is a strong correlation between the compliance obtained by the GPs in the half practice population assigned to the GP's surgery arm and the compliance obtained in the half assigned to the hospital arm. The GPs showed scarce interest in the study, probably reflecting a scarce interest to the Colorectal cancer screening (CRCS).

The aim of this study is to evaluate the capability to capture the major number of death cases of different criteria. Home Accidents (HA) data come from a pilot surveillance of all the HA occurring in Lazio Region, Italy 2000. The surveillance is integration between the emergency department information system (ElS), the hospital information system (HIS), and the mortality registry (MR). The gold standard definition of HA mortality in this study was obtained through an analysis of the hospitalization story and of death certificates. Three definitions of HA mortality have been tested: inhospital mortality (IHM); mortality within 30 days from the ED admission or hospital discharge (M30d); and mortality for a trauma/poisoning death cause. High mortality rates has been reported among older people.

The aim of this study is to compare individual and environmental factors associated with hospitalization consequent to Emergency Departments (ED) admission, among injured children in road traffic and home accidents. Logistic regression has been performed to compare the probability of hospitalization for different individual and environmental factors. Probability of hospitalization is higher during the weekend or among males. This analysis highlights differences between road and home accident hospitalization risk. The ages at risk are different; road accidents involve teenagers and seem to be more associated to behavioral risk factors, while domestic injuries principally involve infants.