Alessandra Buja - Academia.edu (original) (raw)
Papers by Alessandra Buja
European Journal of Public Health, 2017
(500 cases in 1990, by T. spiralis). In Lazio (2001) and in Veneto (2008) two epidemics were caus... more (500 cases in 1990, by T. spiralis). In Lazio (2001) and in Veneto (2008) two epidemics were caused by food coming from abroad. Horse (82.74%), wild boar (11.33%), and pig (5.93%) meat were the most important sources of infection. Conclusions A strict surveillance, especially on meat products from endemic countries or from wild animals is necessary to considerably reduce the risk of acquiring the infection: in fact it is impossible to define a region with a negligible risk, and physicians and veterinarians should be regularly trained about this old disease, but still present in our country.
![Research paper thumbnail of [Fragility in a Public Health perspective: principles and tools for a "life course" approach prevention- oriented]](https://attachments.academia-assets.com/111467367/thumbnails/1.jpg)
](Igiene e sanita pubblica, 2021
The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There ... more The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.
Internal and Emergency Medicine, 2021
European Journal of Public Health, 2020
Background Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among me... more Background Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimates the direct costs of care for patients with NSCLC by stage at diagnosis and management phase of pathway recommended in local and international guidelines. Methods Based on the most up-to-date guidelines we developed a detailed “whole-disease” model that lists the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. Then we assigned the cost sustained by the public authorities to each procedure, obtaining an estimate of the total and average per-patient costs of each stage of the disease and management phase in Veneto Region, Italy. Results The mean expected cost of a patient with NSCLC is 22,968 € in the first year: 20,222 € in stage I, 23,935 € in stage II, 23,027 € in stage ...
International journal of environmental research and public health, Sep 19, 2018
Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion progra... more Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI 'before-and-after' study, with assessments scheduled at 6 and 12 months, was to improve the lifestyle of HCWs with at least one cardiovascular risk factor. A tailored motivational counseling intervention, focusing on dietary habits and physical activity (PA) was administered to 167 HCWs (53 males; 114 females). BMI, waist circumference, blood pressure, and cholesterol, triglyceride, and blood glucose levels were measured before and after the intervention. The 6-month results (total sample and by gender) showed a marked effect on lifestyle: PA improved (+121.2 MET, = 0.01), and diets became more similar to the Mediterranean model (+0.8, < 0.001). BMI dropped (-0.2, < 0.03), and waist circumference improved even more (-2.5 cm; < 0.001). Other variables improved significantly: total an...
BMC Research Notes, 2010
Background: Statistics on occupational accidents are based on data from registered employees. Wit... more Background: Statistics on occupational accidents are based on data from registered employees. With the increasing number of immigrants employed illegally and/or without regular working visas in many developed countries, it is of interest to estimate the injury rate among such unregistered workers. Findings: The current study was conducted in an area of NorthEastern Italy. The sources of information employed in the present study were the Accidents and Emergencies records of a hospital; the population data on foreignborn residents in the hospital catchment area (Health Care District 4, Primary Care Trust 20, Province of Verona, Veneto Region, NorthEastern Italy); and the estimated proportion of illegally employed workers in representative samples from the Province of Verona and the Veneto Region. Of the 419 A&E records collected between January and December 2004 among non European Union (non-EU) immigrants, 146 aroused suspicion by reporting the home, rather than the workplace, as the site of the accident. These cases were the numerator of the rate. The number of illegally employed non-EU workers, denominator of the rate, was estimated according to different assumptions and ranged from between 537 to 1,338 individuals. The corresponding rates varied from 109.1 to 271.8 per 1,000 non-EU illegal employees, against 65 per 1,000 reported in Italy in 2004. Conclusions: The results of this study suggest that there is an unrecorded burden of illegally employed immigrants suffering from work related injuries. Additional efforts for prevention of injuries in the workplace are required to decrease this number. It can be concluded that the Italian National Institute for the Insurance of Work Related Injuries (INAIL) probably underestimates the incidence of these accidents in Italy.
Background Pulmonary diseases are a common and costly cause of 30-day readmissions. In this study... more Background Pulmonary diseases are a common and costly cause of 30-day readmissions. In this study we analysed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for COPD exacerbation and other major pulmonary diseases. The goal is to tailor disease management programs to improve clinical outcomes and prevent waste in resource use. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 15,069 hospital admissions among residents aged ≥ 65 years for DRGs of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had a twofold significantly higher odd of 30-day readmission than male patien...
Vaccines, 2021
Vaccination against SARS-CoV-2 will likely be the most promising way to combat the pandemic. Even... more Vaccination against SARS-CoV-2 will likely be the most promising way to combat the pandemic. Even if mass vaccination is urgent, it should still always be supported by appropriate patient safety management. The aim of this study, based on failure mode, effects and criticality analysis (FMECA), was to identify possible failures and highlight measures that can be adopted to prevent their occurrence. A team of resident doctors in public health from the University of Padua and specialists in risk analysis in public health examined the mass vaccination process. A diagram was drafted to illustrate the various phases of mass vaccination, analyze the process, and identify all failure modes. Criticalities were ascertained by rating the severity, frequency and likelihood of failure detection on a scale of 1 to 10. We identified a total of 71 possible faults distributed over the various phases of the process, and 34 of them were classified as carrying a high risk. For the potentially high-risk...
BMC Urology
Background The RCC treatment landscape has evolved dramatically over the past decade. The purpose... more Background The RCC treatment landscape has evolved dramatically over the past decade. The purpose of this study is to present a real-world data estimation of RCC’s cost-of-illness for this tumour’s clinical pathway. Methods This investigation is a population-based cohort study using real-world data, which considers all RCC incident cases diagnosed in Local Unit 6 of the Province of Padua in 2016 and 2017 as registered by the Veneto Cancer Registry. Data on drug prescriptions, the use of medical devices, hospital admissions, and visits to outpatient clinics and emergency departments were collected by means of administrative databases. We evaluated the costs of all healthcare procedures performed in the 2 years of follow-up post-RCC diagnosis. The overall and annual average real-world costs per patient, both as a whole and by single item, were calculated and stratified by stage of disease at diagnosis. Results The analysis involved a population of 148 patients with a median age of 65....
Public Health Nutrition
Objectives: To collect and summarise all current data from observational studies, generating evid... more Objectives: To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention. Design: A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed. Results: Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between l...
Dermatology and Therapy
Introduction: A number of studies have examined the impact of tumor stage on direct health care c... more Introduction: A number of studies have examined the impact of tumor stage on direct health care costs of patients with melanoma. This study aimed to investigate the association between the direct costs for melanoma and the patients' clinical and histological characteristics. Methods: The present analysis included 1368 patients diagnosed with melanoma in 2017 in the Veneto Region (northeast Italy) and recorded in a regional population-based melanoma registry. The costs were assessed taking monthly and total direct costs into account. Log-linear multivariable analysis was used to identify the clinical and histological cost drivers, focusing on monthly and total direct costs per patient incurred during the first 2 years after a patient's diagnosis. Results: On multivariable analysis, besides the stage of melanoma, also the presence of mitoses ([ 2) was associated with higher monthly direct costs [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.15-2.08, p = 0.004] in respect to cases with 0-2 mitoses. Vertical growth was associated with higher costs compared with radial growth (OR 1.28, 95% CI 1.00-1.64, p = 0.055). Moreover, the association between the absence of tumor-infiltrating lymphocytes (TILs) and higher monthly direct costs reached statistical significance (OR 1.31, 95% CI 1.05-1.64, p = 0.017). There were no differences in monthly direct costs by patients' sex or age, ulceration, or tumor site. Conclusion: This study showed that not only tumor stage but also other clinical and histopathologic characteristics have an impact on the direct monthly and total costs of treating melanoma. Further studies on the cost
Current Oncology, 2022
Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of c... more Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of cutaneous malignant melanoma (CMM). This study focuses on the changing incidence of CMM over time (from 1990 to 2017) in the Veneto region of Northeast Italy, and its Alpine area (the province of Belluno). The clinicopathological profile of CMM by residence is also considered. A joinpoint regression analysis was performed to identify significant changes in the yearly incidence of CMM by sex and age. For each trend, the average annual percent change (AAPC) was also calculated. In the 2017 CMM cohort, the study includes a descriptive analysis of the disease’s categorical clinicopathological variables. In the population investigated, the incidence of CMM has increased significantly over the last 30 years. The AAPC in the incidence of CMM was significantly higher among Alpine residents aged 0–49 than for the rest of the region’s population (males: 6.9 versus 2.4; females 7.7 versus 2.7, respe...
Journal of preventive medicine and hygiene, Sep 21, 2018
Introduction: Uncompleted visits in the emergency department (UEDC) are a patient safety concern.... more Introduction: Uncompleted visits in the emergency department (UEDC) are a patient safety concern. The purpose of this study was to further investigate risk factors for UEDC, describing socio-demographic characteristics but also access and hospital characteristics both of those left AMA and those who LWBS. Methods: this was a retrospective case–control study on administrative anonymous data using a population-based emergency department database. Results: overall, 9,147,415 patients attended the EDs of Veneto Region from 2011 to 2015. Rate of UEDC was 28,7‰, composed by slightly higher rate of AMA compared to LWBS (15,3‰ Vs 13,4‰). Age, sex, citizenship, residence are sociodemographic factors associated with UEDC and also the characteristics of access as admission mode, the type of referring, the emergency level, waiting time of visit and the type of complaint, finally also the characteristics of the structure as type and volume of hospital could be associate with UEDC. Conclusion: Pa...
Journal of Clinical Medicine, 2021
Across the world, people have avoided seeking medical attention during the coronavirus pandemic, ... more Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients’ characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from −52.4% in March to −18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the “first wave” of the COVID-19 pandemic in Italy), and in the autumn (during the “second wav...
Journal of Preventive Medicine and Hygiene, 2019
Summary Introduction Uncompleted visits to emergency departments (UEDC) are a patient safety conc... more Summary Introduction Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. Methods This was a cross sectional study on anonymized administrative data in a population-based ED database. Results A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7‰, with a slightly higher rate of AMA than of LWBS (15.3‰ vs 13.4‰). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other)...
International Journal of Environmental Research and Public Health, 2021
Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalen... more Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the SGM proportion in young adults and to assess differences in the adoption of risk behaviours compared to their heterosexual counterparts. The study involved university students aged 18–25. Information on socio-demographic and behavioural characteristics were collected. The effect of sexual orientation on risk behaviours was assessed with a multinomial single-step logistic regression analysis. A total of 9988 participants were included. Overall, 518 students (5.2%) self-identified as SGM. While lesbians showed significantly higher odds of only non-regular use of protective barriers (AOR: 11.16), bisexuals showed higher odds for frequent drinking (AOR: 2.67), smoking (AOR: 1.85), multiple s...
Giornale Italiano di Dermatologia e Venereologia, 2021
BACKGROUND While many evidence-based pathways have been introduced to drive quality improvements ... more BACKGROUND While many evidence-based pathways have been introduced to drive quality improvements in cancer care, most of these do not include evidence about their affordability. The main aim of this study is to provide an estimation of the overall budget to cover all the needs of melanoma patients in Veneto Region, managed according to the clinical pathway defined by the Rete Oncologica Veneta. A second objective is to conduct a cost-consequence analysis, comparing two different treatments. METHODS A very detailed whole-disease model was developed describing the patient's pathway from diagnosis through the first year of follow-up. Each procedure involved in the model was associated with a likelihood measure and a cost. The model can be used to estimate the expected direct costs associated with melanoma. RESULTS We can observe that 0 and I stage, despite accounting for a huge percentage of new melanoma cases are characterized by a small percentage of the total costs. Stage III can be considered as the most expensive stage accounting for 54% of the total costs with a 12% of patients. Finally, the stage IV patients, although very few account for almost the 7% of the total costs. Regarding the cost-consequence analysis, it was estimated that the therapies introduced in 2016 led to an approximately 14% increase in the total costs. CONCLUSIONS Modeling a clinical pathway with a high level of detail enables to identify the main sources of spending. The consequent analysis can thus help policy-makers to plan the future resources allocation.
Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. Th... more Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan migrant women, and their access to health care services in northern Italy, by age group and health literacy level.Methods: We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables (lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region. Results: Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occupati...
Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. Th... more Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan immigrant women, and their access to health care services in northern Italy, by age group and health literacy level.Methods: We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables ( lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region. Results: Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occup...
BMC Public Health, 2020
Background Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies h... more Background Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged ≥65 years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had signifi...
European Journal of Public Health, 2017
(500 cases in 1990, by T. spiralis). In Lazio (2001) and in Veneto (2008) two epidemics were caus... more (500 cases in 1990, by T. spiralis). In Lazio (2001) and in Veneto (2008) two epidemics were caused by food coming from abroad. Horse (82.74%), wild boar (11.33%), and pig (5.93%) meat were the most important sources of infection. Conclusions A strict surveillance, especially on meat products from endemic countries or from wild animals is necessary to considerably reduce the risk of acquiring the infection: in fact it is impossible to define a region with a negligible risk, and physicians and veterinarians should be regularly trained about this old disease, but still present in our country.
Igiene e sanita pubblica, 2021
The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There ... more The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.
Internal and Emergency Medicine, 2021
European Journal of Public Health, 2020
Background Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among me... more Background Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimates the direct costs of care for patients with NSCLC by stage at diagnosis and management phase of pathway recommended in local and international guidelines. Methods Based on the most up-to-date guidelines we developed a detailed “whole-disease” model that lists the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. Then we assigned the cost sustained by the public authorities to each procedure, obtaining an estimate of the total and average per-patient costs of each stage of the disease and management phase in Veneto Region, Italy. Results The mean expected cost of a patient with NSCLC is 22,968 € in the first year: 20,222 € in stage I, 23,935 € in stage II, 23,027 € in stage ...
International journal of environmental research and public health, Sep 19, 2018
Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion progra... more Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI 'before-and-after' study, with assessments scheduled at 6 and 12 months, was to improve the lifestyle of HCWs with at least one cardiovascular risk factor. A tailored motivational counseling intervention, focusing on dietary habits and physical activity (PA) was administered to 167 HCWs (53 males; 114 females). BMI, waist circumference, blood pressure, and cholesterol, triglyceride, and blood glucose levels were measured before and after the intervention. The 6-month results (total sample and by gender) showed a marked effect on lifestyle: PA improved (+121.2 MET, = 0.01), and diets became more similar to the Mediterranean model (+0.8, < 0.001). BMI dropped (-0.2, < 0.03), and waist circumference improved even more (-2.5 cm; < 0.001). Other variables improved significantly: total an...
BMC Research Notes, 2010
Background: Statistics on occupational accidents are based on data from registered employees. Wit... more Background: Statistics on occupational accidents are based on data from registered employees. With the increasing number of immigrants employed illegally and/or without regular working visas in many developed countries, it is of interest to estimate the injury rate among such unregistered workers. Findings: The current study was conducted in an area of NorthEastern Italy. The sources of information employed in the present study were the Accidents and Emergencies records of a hospital; the population data on foreignborn residents in the hospital catchment area (Health Care District 4, Primary Care Trust 20, Province of Verona, Veneto Region, NorthEastern Italy); and the estimated proportion of illegally employed workers in representative samples from the Province of Verona and the Veneto Region. Of the 419 A&E records collected between January and December 2004 among non European Union (non-EU) immigrants, 146 aroused suspicion by reporting the home, rather than the workplace, as the site of the accident. These cases were the numerator of the rate. The number of illegally employed non-EU workers, denominator of the rate, was estimated according to different assumptions and ranged from between 537 to 1,338 individuals. The corresponding rates varied from 109.1 to 271.8 per 1,000 non-EU illegal employees, against 65 per 1,000 reported in Italy in 2004. Conclusions: The results of this study suggest that there is an unrecorded burden of illegally employed immigrants suffering from work related injuries. Additional efforts for prevention of injuries in the workplace are required to decrease this number. It can be concluded that the Italian National Institute for the Insurance of Work Related Injuries (INAIL) probably underestimates the incidence of these accidents in Italy.
Background Pulmonary diseases are a common and costly cause of 30-day readmissions. In this study... more Background Pulmonary diseases are a common and costly cause of 30-day readmissions. In this study we analysed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for COPD exacerbation and other major pulmonary diseases. The goal is to tailor disease management programs to improve clinical outcomes and prevent waste in resource use. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 15,069 hospital admissions among residents aged ≥ 65 years for DRGs of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had a twofold significantly higher odd of 30-day readmission than male patien...
Vaccines, 2021
Vaccination against SARS-CoV-2 will likely be the most promising way to combat the pandemic. Even... more Vaccination against SARS-CoV-2 will likely be the most promising way to combat the pandemic. Even if mass vaccination is urgent, it should still always be supported by appropriate patient safety management. The aim of this study, based on failure mode, effects and criticality analysis (FMECA), was to identify possible failures and highlight measures that can be adopted to prevent their occurrence. A team of resident doctors in public health from the University of Padua and specialists in risk analysis in public health examined the mass vaccination process. A diagram was drafted to illustrate the various phases of mass vaccination, analyze the process, and identify all failure modes. Criticalities were ascertained by rating the severity, frequency and likelihood of failure detection on a scale of 1 to 10. We identified a total of 71 possible faults distributed over the various phases of the process, and 34 of them were classified as carrying a high risk. For the potentially high-risk...
BMC Urology
Background The RCC treatment landscape has evolved dramatically over the past decade. The purpose... more Background The RCC treatment landscape has evolved dramatically over the past decade. The purpose of this study is to present a real-world data estimation of RCC’s cost-of-illness for this tumour’s clinical pathway. Methods This investigation is a population-based cohort study using real-world data, which considers all RCC incident cases diagnosed in Local Unit 6 of the Province of Padua in 2016 and 2017 as registered by the Veneto Cancer Registry. Data on drug prescriptions, the use of medical devices, hospital admissions, and visits to outpatient clinics and emergency departments were collected by means of administrative databases. We evaluated the costs of all healthcare procedures performed in the 2 years of follow-up post-RCC diagnosis. The overall and annual average real-world costs per patient, both as a whole and by single item, were calculated and stratified by stage of disease at diagnosis. Results The analysis involved a population of 148 patients with a median age of 65....
Public Health Nutrition
Objectives: To collect and summarise all current data from observational studies, generating evid... more Objectives: To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention. Design: A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed. Results: Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between l...
Dermatology and Therapy
Introduction: A number of studies have examined the impact of tumor stage on direct health care c... more Introduction: A number of studies have examined the impact of tumor stage on direct health care costs of patients with melanoma. This study aimed to investigate the association between the direct costs for melanoma and the patients' clinical and histological characteristics. Methods: The present analysis included 1368 patients diagnosed with melanoma in 2017 in the Veneto Region (northeast Italy) and recorded in a regional population-based melanoma registry. The costs were assessed taking monthly and total direct costs into account. Log-linear multivariable analysis was used to identify the clinical and histological cost drivers, focusing on monthly and total direct costs per patient incurred during the first 2 years after a patient's diagnosis. Results: On multivariable analysis, besides the stage of melanoma, also the presence of mitoses ([ 2) was associated with higher monthly direct costs [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.15-2.08, p = 0.004] in respect to cases with 0-2 mitoses. Vertical growth was associated with higher costs compared with radial growth (OR 1.28, 95% CI 1.00-1.64, p = 0.055). Moreover, the association between the absence of tumor-infiltrating lymphocytes (TILs) and higher monthly direct costs reached statistical significance (OR 1.31, 95% CI 1.05-1.64, p = 0.017). There were no differences in monthly direct costs by patients' sex or age, ulceration, or tumor site. Conclusion: This study showed that not only tumor stage but also other clinical and histopathologic characteristics have an impact on the direct monthly and total costs of treating melanoma. Further studies on the cost
Current Oncology, 2022
Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of c... more Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of cutaneous malignant melanoma (CMM). This study focuses on the changing incidence of CMM over time (from 1990 to 2017) in the Veneto region of Northeast Italy, and its Alpine area (the province of Belluno). The clinicopathological profile of CMM by residence is also considered. A joinpoint regression analysis was performed to identify significant changes in the yearly incidence of CMM by sex and age. For each trend, the average annual percent change (AAPC) was also calculated. In the 2017 CMM cohort, the study includes a descriptive analysis of the disease’s categorical clinicopathological variables. In the population investigated, the incidence of CMM has increased significantly over the last 30 years. The AAPC in the incidence of CMM was significantly higher among Alpine residents aged 0–49 than for the rest of the region’s population (males: 6.9 versus 2.4; females 7.7 versus 2.7, respe...
Journal of preventive medicine and hygiene, Sep 21, 2018
Introduction: Uncompleted visits in the emergency department (UEDC) are a patient safety concern.... more Introduction: Uncompleted visits in the emergency department (UEDC) are a patient safety concern. The purpose of this study was to further investigate risk factors for UEDC, describing socio-demographic characteristics but also access and hospital characteristics both of those left AMA and those who LWBS. Methods: this was a retrospective case–control study on administrative anonymous data using a population-based emergency department database. Results: overall, 9,147,415 patients attended the EDs of Veneto Region from 2011 to 2015. Rate of UEDC was 28,7‰, composed by slightly higher rate of AMA compared to LWBS (15,3‰ Vs 13,4‰). Age, sex, citizenship, residence are sociodemographic factors associated with UEDC and also the characteristics of access as admission mode, the type of referring, the emergency level, waiting time of visit and the type of complaint, finally also the characteristics of the structure as type and volume of hospital could be associate with UEDC. Conclusion: Pa...
Journal of Clinical Medicine, 2021
Across the world, people have avoided seeking medical attention during the coronavirus pandemic, ... more Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients’ characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from −52.4% in March to −18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the “first wave” of the COVID-19 pandemic in Italy), and in the autumn (during the “second wav...
Journal of Preventive Medicine and Hygiene, 2019
Summary Introduction Uncompleted visits to emergency departments (UEDC) are a patient safety conc... more Summary Introduction Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. Methods This was a cross sectional study on anonymized administrative data in a population-based ED database. Results A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7‰, with a slightly higher rate of AMA than of LWBS (15.3‰ vs 13.4‰). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other)...
International Journal of Environmental Research and Public Health, 2021
Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalen... more Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the SGM proportion in young adults and to assess differences in the adoption of risk behaviours compared to their heterosexual counterparts. The study involved university students aged 18–25. Information on socio-demographic and behavioural characteristics were collected. The effect of sexual orientation on risk behaviours was assessed with a multinomial single-step logistic regression analysis. A total of 9988 participants were included. Overall, 518 students (5.2%) self-identified as SGM. While lesbians showed significantly higher odds of only non-regular use of protective barriers (AOR: 11.16), bisexuals showed higher odds for frequent drinking (AOR: 2.67), smoking (AOR: 1.85), multiple s...
Giornale Italiano di Dermatologia e Venereologia, 2021
BACKGROUND While many evidence-based pathways have been introduced to drive quality improvements ... more BACKGROUND While many evidence-based pathways have been introduced to drive quality improvements in cancer care, most of these do not include evidence about their affordability. The main aim of this study is to provide an estimation of the overall budget to cover all the needs of melanoma patients in Veneto Region, managed according to the clinical pathway defined by the Rete Oncologica Veneta. A second objective is to conduct a cost-consequence analysis, comparing two different treatments. METHODS A very detailed whole-disease model was developed describing the patient's pathway from diagnosis through the first year of follow-up. Each procedure involved in the model was associated with a likelihood measure and a cost. The model can be used to estimate the expected direct costs associated with melanoma. RESULTS We can observe that 0 and I stage, despite accounting for a huge percentage of new melanoma cases are characterized by a small percentage of the total costs. Stage III can be considered as the most expensive stage accounting for 54% of the total costs with a 12% of patients. Finally, the stage IV patients, although very few account for almost the 7% of the total costs. Regarding the cost-consequence analysis, it was estimated that the therapies introduced in 2016 led to an approximately 14% increase in the total costs. CONCLUSIONS Modeling a clinical pathway with a high level of detail enables to identify the main sources of spending. The consequent analysis can thus help policy-makers to plan the future resources allocation.
Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. Th... more Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan migrant women, and their access to health care services in northern Italy, by age group and health literacy level.Methods: We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables (lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region. Results: Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occupati...
Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. Th... more Background: Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan immigrant women, and their access to health care services in northern Italy, by age group and health literacy level.Methods: We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables ( lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region. Results: Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occup...
BMC Public Health, 2020
Background Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies h... more Background Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged ≥65 years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had signifi...