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Sara Schiavone,1 Maria Teresa Pistone,1 Enrico Finale,2 Andrea Guala,2 Francesco Attena1 1Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy; 2Department of Maternal and Child Health, ASL Verbano Cusio Ossola, Omegna, VB 28887, ItalyCorrespondence: Francesco AttenaDepartment of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5, Naples 80138, ItalyTel +39 081 5666012Email francesco.attena@unicampania.itIntroduction: Patient satisfaction is an indicator of healthcare quality, and expectation is an important determinant. A component of patient satisfaction is the quality of foodservice. An indicator of this quality is the food wasted by hospitalised patients. In the present study, we investigated patient satisfaction regarding food and foodservice, the expectation on food quality and the amount of food wasted in two obstetrics and gynaecology wards in Northern and Southern Italy.Patients and Methods: A questionnaire, including sociodemographic data, rate of food waste, expectations of food quality and characteristics of food and foodservice, was administrated to 550 inpatients in obstetrics and gynaecology wards (275 for each hospital). Univariate analysis was performed to describe the results, and multivariate analysis was carried out to control for sociodemographic data.Results: Northern patients were more satisfied with the quality of food (54.2% vs 36.0%) and foodservice (54.5% vs 38.2%) than southern patients. Northern patients had more positive expectations about the quality of food (69.5% vs 31.6%), whereas southern patients stated that they had no expectations. Southern patients gave more importance to mealtime (72.7% vs 26.2%), and many of them brought food from home to the hospital (30.2% vs 2.2%) through relatives who came to visit them. Southern patients discarded about 41.7% of food served, whereas northern patients discarded only about 15.3%.Discussion: Food waste is a worldwide problem due to its economic, social and environmental effects. Especially in hospitals, food waste could have a negative impact on the overall patient satisfaction.Keywords: food quality, food service, hospital, food waste, patient satisfaction

Most publications about breast cancer do not provide accurate and comprehensive information, giving few or no data about risk/benefit ratios. We conducted a comparative study among 10 European countries about health information on breast cancer screening, assessing the first 10 Web sites addressing the general public that appeared following an Internet search. With the help of medical residents involved in the EuroNet MRPH Association, we analyzed the first 30 results of an Internet search in 10 European countries to determine the first 10 sites that offered screening mammography. We searched for the following information: source of information, general information on mammography and breast cancer screening, potential harms and risks (false positives, false positives after biopsy, false negatives, interval cancer, overdiagnosis, lead-Time bias, and radiation exposure), and potential benefits (reduced mortality and increased survival). The United Kingdom provided the most information: 39 of all 70 possible identified risks (56%) were reported on its sites. Five nations presented over 35% of the possible information (United Kingdom, Spain, France, Ireland, and Italy); the others were under 30% (Portugal, Poland, Slovenia, Netherlands, and Croatia). Regarding the benefits, sites offering the most complete information were those in France (95%) and Poland (90%). Our results suggest that, despite consensus in the scientific community about providing better information to citizens, further efforts are needed to improve information about breast cancer screening. That conclusion also applies to countries showing better results. We believe that there should be greater coordination in this regard throughout Europe.

Questionnaire: Patientâ s informed consent procedure. (PDF 497 kb)

Background Pollen exposure has acute adverse effects on sensitized individuals. Information on the prevalence of respiratory diseases in areas with different pollen concentrations is scanty. Aim We performed an ecologic analysis to assess whether the prevalence of allergic rhinitis and asthma in young adults varied across areas with different pollen concentrations in Italy. Methods A questionnaire on respiratory diseases was delivered to random samples of 20–44 year-old subjects from six centers in 2005–2010. Data on the daily air concentrations of 7 major allergologic pollens (Poaceae, Urticaceae, Oleaceae, Cupressaceae, Coryloideae, Betula and Ambrosia) were collected for 2007–2008. Center-specific pollen exposure indicators were calculated, including the average number of days per year with pollens above the low or high concentration thresholds defined by the Italian Association of Aerobiology. Associations between pollen exposure and disease prevalence, adjusted for potential confounders, were estimated using logistic regression models with center as a random-intercept. Results Overall, 8834 subjects (56.8%) filled in the questionnaire. Allergic rhinitis was significantly less frequent in the centers with longer periods with high concentrations of at least one (OR per 10 days = 0.989, 95%CI: 0.979–0.999) or at least two pollens (OR = 0.974, 95%CI: 0.951–0.998); associations with the number of days with at least one (OR = 0.988, 95%CI: 0.972–1.004) or at least two (OR = 0.985, 95%CI: 0.970–1.001) pollens above the low thresholds were borderline significant. Asthma prevalence was not associated with pollen concentrations. Conclusions Our study does not support that the prevalence of allergic rhinitis and asthma is greater in centers with higher pollen concentrations. It is not clear whether the observed ecologic associations hold at the individual level.

Background Informed consent (IC) is an essential step in helping patients be aware of consequences of their treatment decisions. With surgery, it is vitally important for patients to understand the risks and benefits of the procedure and decide accordingly. We explored whether a written IC form was provided to patients; whether they read and signed it; whether they communicated orally with the physician; whether these communications influenced patient decisions. Methods Adult postsurgical patients in nine general hospitals of Italy’s Campania Region were interviewed via a structured questionnaire between the second and seventh day after the surgery at the end of the first surgical follow up visit. Physicians who were independent from the surgical team administered the questionnaire. Results The written IC form was given to 84.5% of those interviewed. All recipients of the form signed it, either personally or through a delegate; however, 13.9% did not know/remember having done so; 51.8% said that they read it thoroughly. Of those who reported to have read it, 90.9% judged it to be clear. Of those receiving the written consent form, 52.0% had gotten it the day before the surgery at the earliest 41.1% received it some hours or immediately before the procedure. The written IC form was explained to 65.6% of the patients, and 93.9% of them received further oral information that deemed understandable. Most attention was given to the diagnosis and the type of surgical procedure, which was communicated respectively to 92.8 and 88.2% of the patients. Almost one in two patients believed that the information provided some emotional relief, while 23.2% experienced increased anxiety. Younger patients (age ≤ 60) and patients with higher levels of education were more likely to read the written IC form. Conclusions The written IC form is not sufficient in assuring patients and making them fully aware of choices they made for their health; pre-operative information that was delivered orally better served the patients’ needs. To improve the quality of communication we suggest enhancing physicians’ communication skills and for them to use structured conversation to ensure that individuals are completely informed before undergoing their procedures. Electronic supplementary material The online version of this article (10.1186/s12910-018-0340-z) contains supplementary material, which is available to authorized users.

Background The role of medicine in society appears to be focused on two views, which may be summarized as follows: “Doing more means doing better” (paradigm A) and “Doing more does not mean doing better” (paradigm B). Main body I compared paradigms A and B both in terms of a single clinical condition and in the general context of a medical system. For a single clinical condition, I analyzed breast cancer screening. There are at least seven interconnected issues that influence the conflict between paradigms A and B in the debate on breast cancer screening: disconnection between research and practice; scarcity of information given to women; how “political correctness” can influence the choice of a health policy; professional interests; doubts about effectiveness; incommensurability between harms and benefits; and the difficulty in making dichotomous decisions with discrete variables. As a general approach to medicine, the main representative of paradigm A is systems medicine. As representatives of paradigm B, I identified the following approaches or movements: choosing wisely; watchful waiting; the Too Much Medicine campaign; slow medicine; complaints against overdiagnosis; and quaternary prevention. I showed that both as a single condition and as a general approach to medicine, the comparison was entirely reducible to a harm-benefit analysis; moreover, in both cases, the two paradigms are in many respects incommensurable. This transfers the debate to the ethical level; consequently, scientists and the public have equal rights and competence to debate on this subject. Moreover, systems medicine has many ethical problems that could limit its spread. Conclusion I made some hypotheses about scenarios for the future of medicine. I particularly focused on whether systems medicine would become increasingly accessible and widespread in the population or whether it would be downsized because its promises have not been maintained or ethical problems will become unsustainable.

Background Among European Countries, Italy has the highest rate of cesarean section (36.8%), and in the Campania region this rate reaches 60.0%. Question We conducted a retrospective cohort study to evaluate whether participation in antenatal classes during pregnancy reduces the rate of cesarean delivery in southern Italy. Methods We selected three local health authorities, with the lowest, the highest, and an intermediate rate of cesarean delivery. The study included 1893 mothers who brought their children for vaccination and were interviewed about their participation in antenatal classes and their obstetric history. Findings The main causes of cesarean section given in the interview were clinical indications (61.0%), previous cesarean section (31.0%) and woman's request (8.0%). When we excluded emergency cesarean delivery, we found a moderate association between participation in antenatal classes and cesarean section reduction (relative risk = 1.27; 95% CI = 1.08–1.49; in percentage values from 49.3% to 38.8%). Private hospitals and the two local health authorities with higher baseline rates of cesarean section showed an enhanced reduction of these rates. Conclusion Our paper shows moderate efficacy of antenatal classes, which reduced the occurrence of cesarean section by about 10%. However, the cesarean section rate remained high. As it is possible that different classes have a different level of efficacy, a further study on a standardized model of an antenatal classes is in progress, to assess its efficacy in term of cesarean section reduction, with the purpose of its widespread implementation to the whole region.

This article analyzes two major limitations of Western medicine: maturity and incompleteness. From this viewpoint, Western medicine is considered an incomplete system for the explanation of living matter. Therefore, through appropriate integration with other medical systems, in particular nonconventional approaches, its knowledge base and interpretations may be widened. This article presents possible models of integration of Western medicine with homeopathy, the latter being viewed as representative of all complementary and alternative medicine. To compare the two, a medical system was classified into three levels through which it is possible to distinguish between different medical systems: epistemological (first level), theoretical (second level), and operational (third level). These levels are based on the characterization of any medical system according to, respectively, a reference paradigm, a theory on the functioning of living matter, and clinical practice. The three levels are consistent and closely consequential in the sense that from epistemology derives theory, and from theory derives clinical practice. Within operational integration, four models were identified: contemporary, alternative, sequential, and opportunistic. Theoretical integration involves an explanation of living systems covering simultaneously the molecular and physical mechanisms of functioning living matter. Epistemological integration provides a more thorough and comprehensive explanation of the epistemic concepts of indeterminism, holism, and vitalism to complement the reductionist approach of Western medicine; concepts much discussed by Western medicine while lacking the epistemologic basis for their emplacement. Epistemologic integration could be reached with or without a true paradigm shift and, in the latter, through a model of fusion or subsumption.

Italy, along with Poland and Hungary, has the highest cesarean section rate (35.7%) in Europe. Among Italian regions, Campania has the highest rate of cesarean section (58.4%).We developed a standardized antenatal class to evaluate whether women who attend this class during pregnancy have a lower cesarean section rate. This antenatal class was developed according to the indication of the Italian Ministry of Health and the World Health Organization. We selected a cohort of women who participated in this antenatal class and a cohort of women who did not participate. We collected information on the mode of delivery, and other characteristics, of these women from certificate of birth assistance form available in 2 hospitals where the women gave birth.Among women who participated in the antenatal class, there were more Italians, the women were more educated, more women were employed and there were more primiparas compared with those who did not participate. Non-participants of antenatal class showed a higher rate of cesarean section than those who participated (56.2% vs 23.1%; relative risk [RR] = 2.43; 95% confidence interval [CI] 1.95-3.03; P

Background: Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation. Methods: In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20–44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA). Results: Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation. Conclusion: Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.

Supplemental Digital Content is available in the text, 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.