Bruno Federico | University of Cassino and Southern Latium (original) (raw)

Papers by Bruno Federico

Pediatric Anesthesia, 2005

Research in the field of patient satisfaction first took place in the 1980s in the USA, and later... more Research in the field of patient satisfaction first took place in the 1980s in the USA, and later in Europe, aimed at meeting competitive requirements in the field of health care. Very few studies of this type exist in regard to pediatric anesthesia. Our aim was to develop a rapidly interpretable questionnaire to measure the level of parental satisfaction when their children undergo surgery and provide information on those factors triggering anxiety in these children. Over a period of 18 months 179 parents of children in pediatric surgery responded to 214 questionnaires designed to investigate principally the emotional/behavioral spheres as well as the comfort provided. We found that parents generally expressed a high degree of satisfaction which was good and correlated significantly with environmental comfort and postoperative observations performed by anesthetists and nursing staff. In the children, lack of fear at the moment of being anesthetized, and lack of anxiety on the day preceding surgery, were attributed to the serenity transmitted by the anesthetist and nurses. Significant anxiety resulted from the fear of an unpleasant impact with the operating room.

Journal of Public Health, 2009

Aim The aim of the study was to evaluate whether socio-economic inequalities in the practice of p... more Aim The aim of the study was to evaluate whether socio-economic inequalities in the practice of physical activity existed among children and adolescents, using different indicators of socio-economic status (SES). Subjects and methods Data were derived from the Italian National Health Interview Survey carried out in 2004–2005, which examined a large random sample of the Italian population using both an interviewer-administered and a self-compiled questionnaire. This study was based on a sample of 15,216 individuals aged 6–17 years. The practice of physical activity was measured on the basis of questions regarding frequency and intensity of activity during leisure time over the past 12 months. Parents’ educational and occupational level, as well as family’s availability of material resource, were used as indicators of SES. Multivariable logistic regression analyses were performed to estimate the contribution of each SES indicator to the practice of physical activity, adjusting for potential confounding factors. The results of the regression models are expressed as odds ratio (OR) with 95% confidence intervals (95% CI). Results About 64% of children and adolescents in the sample declared that they participated in moderate or vigorous physical activity at least once a week. After adjustment for gender, age, parental attitudes towards physical activity and geographical area, the practice of physical activity increased with higher parental educational and occupational level and greater availability of material resources. Children and adolescents whose parents held a middle or high educational title were 80% more likely to practice moderate or vigorous physical activity than subjects whose parents had a lower level of education (OR = 1.80, 95% CI: 1.40–2.33), while subjects with unemployed parents had an odds of practicing moderate or vigorous physical activity 0.43 times that of those children whose parents belonged to the top job occupation category (administrative/professionals). Socio-economic differences were about the same when the practice of vigorous physical activity only was considered instead of that of moderate or vigorous physical activity. Conclusion Interventions that promote the practice of physical activity, and especially those aimed at the wider physical and social environment, are strongly needed to contrast socio-economic differences in physical activity among children and adolescents.

American Journal of Public Health, 2007

We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resul... more We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resultant inequality in smoking prevalence among 3 consecutive Italian birth cohorts. We used data from the 1999-2000 Italian National Health Interview Survey, which included 28958 men and 29769 women who were born between 1940 and 1969. The association between smoking variables and level of education was assessed with logistic regression and life table analyses. Inequalities in the lifetime prevalence of smoking increased across the 3 birth cohorts in Italy. At age 40, lower-educated persons in the youngest cohort reported on average 1 to 5 years of additional exposure to regular smoking compared with higher-educated persons. Inequalities in smoking prevalence increased among both men and women because of widening inequalities in initiation rates. Among women, growing inequalities in cessation rates also played a role. The relative contribution of initiation and cessation to socioeconomic inequalities in smoking rates varied by both gender and birth cohort. For the youngest birth cohort, policies that address inequalities in smoking should focus on both initiation and cessation.

Journal of Epidemiology and Community Health, 2005

Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000... more Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. Participants: 451 386 non-institutionalised men and women 25-79 years old. Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers. Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Health & Place, 2007

We investigated differences in smoking prevalence between urban and non-urban area of residence i... more We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas. r

Preventive Medicine, 2004

Background. We aimed to determine the direction and magnitude of socioeconomic inequality in smok... more Background. We aimed to determine the direction and magnitude of socioeconomic inequality in smoking in Italy over the last two decades, focusing on both national and macro-regional patterns.

Preventive Medicine, 2007

Objective. To assess the predictive factors of influenza vaccination among Italian adults, focusi... more Objective. To assess the predictive factors of influenza vaccination among Italian adults, focusing on socioeconomic differences. Methods. A cross-sectional study was carried out using interview and self-reported data on 102,095 subjects aged 25-89 years from the national survey "health conditions and health care services use" conducted in Italy in 1999-2000. Analyses were stratified by age and multiple logistic regression models were used to estimate odds ratios (OR) of influenza vaccination.

Pharmacy World & Science, 2002

Objective: To evaluate the effects of the 1998 revision of CUF Note 55 on doctors" prescribing be... more Objective: To evaluate the effects of the 1998 revision of CUF Note 55 on doctors" prescribing behaviour and drug costs with regard to intramuscularly administered cephalosporins.Method: National data on drug use between January 1998 and June 2000 were provided by the Drug Utilisation Monitoring Centre of the Ministry of Health. The Anatomic Therapeutic Chemical classification and the Defined Daily Dose methodology, as well as population estimates obtained from the Italian National Statistics Institute were used to define consumption as the number of defined daily doses per 1000 inhabitants per day. The cost of these antibiotic medications was determined using the wholesale price reported in Informatore Farmaceutico. Italian inflation rates were used to annuitize the expenditure. “STATA 6.0” software was used for all statistical analyses.Results: The use of cefonicid rose dramatically after the revision (+ 136.3%), whereas the utilisation of the other active ingredients decreased. A decrease of 5.6% in the expenditure for all parenteral cephalosporins was observed in this period while the same figure increased by 2.3% after one year.Conclusion: The exclusion of cefonicid from a restricted list appears to have significantly affected doctors' prescribing practices, while the effect on drug expenditure was contradictory.

BMC Health Services Research, 2009

Background Hospital discharge planning is aimed to decrease length of stay in hospitals as well a... more Background Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30 days, or routine discharge care. The aim of this study was to evaluate whether a hospital DPCH that was compared with routine care, improved patients' outcomes in terms of reduced hospital readmission and mortality rates in patients aged 64 years and older. Methods In a retrospective observational cohort study a sample of 380 subjects aged 64 years and over was examined. Participants were discharged from the hospital S.Giovanni Bosco in Turin, Italy from March 1st, 2005 to February 28th, 2006. Of these subjects, 107 received routine discharge care while 273 patients were referred to care-home (among them, 99 received a long-term care intervention (LTCI) afterwards while 174 did not). Data was gathered from various administrative and electronic databases. Cox regression models were used to evaluate factors associated with mortality and hospital readmission. Results When socio-demographic factors, underlying disease and disability were taken into account, DPCH decreased mortality rates only if it was followed by a LTCI: compared to routine care, the Hazard Ratio (HR) of death was 0.36 (95% Confidence Interval (CI): 0.20 – 0.66) and 1.15 (95%CI: 0.77 – 1.74) for DPCH followed by LTCI and DPCH not followed by LTCI, respectively. On the other hand, readmission rates did not significantly differ among DPCH and routine care, irrespective of the implementation of a LTCI: HRs of hospital readmission were 1.01 (95%CI: 0.48 – 2.24) and 1.18 (95%CI: 0.71 – 1.96), respectively. Conclusion The use of DPCH after hospital discharge reduced mortality rates, but only when it was followed by a long-term health care plan, thus ensuring continuity of care for elderly participants.

Surgery, 2008

Background. Hepatectomy for colorectal liver metastases (CRLM) may offer good long-term survival.... more Background. Hepatectomy for colorectal liver metastases (CRLM) may offer good long-term survival. The impact of the tumor-free surgical margin on long-term results remains controversial, and we have assessed this component in 185 patients. Methods. Between 1992 and 2005, 185 patients underwent primary hepatectomy with curative intent for CRLM (which originated from colon/rectum 133/52, synchronous/metachronous 66/119, and single/multiple 100/85). In this study, 105 major and 80 minor hepatectomies were evaluated; 133 hepatectomies had pedicle clamping. Results. Operative mortality was 1.1%, morbidity was 25.7%, and blood transfusion requirement was 27.6%. Stratification of tumor-free margin in the patients with R0 liver resection was greater than or equal to 10 mm (63.0% of patients), 6--9 mm (11.4% of patients), 3--5 mm (16.5% of patients), and less than or equal to 2 mm (9.1% of patients), with infiltrated margin in the remainder (R1 liver resection 4.9% of the total number of patients). The 3-year, 5-year, and 10-year survival rates were 54.9%, 37.9%, and 22.9%, respectively. Global and surgical margin recurrence rates increased as the tumor-free margin decreased (P = .01 and P < .001, respectively). At univariate analysis, the width of surgical margin (P < .001), transfusion requirement, major hepatectomy, R1 resection, number of metastases, high preoperative CEA, and increasing tumor size (P value from .001 to .03) were associated with lesser rates of long-term survival. A similar association was found with disease-free survival. At multivariate analysis, width of surgical margin was the only independent predictor of both overall (P = .003) and disease-free (P < .001) survival. Although smaller margins were associated with synchronicity, increasing number of, and with bilobar distribution of, metastases which contributed to explaine recurrences away from the margin), the width of surgical margin maintained the prominent impact on outcome. Conclusions. In our patients, the width of the surgical margin was a powerful prognostic factor after hepatectomy for CRLM. A resection margin less than or equal to 5 mm was associated with a greater risk of recurrence on the surgical margin, with a lesser rate of overall and disease-free survival. (Surgery

Journal of Surgical Oncology, 2009

Background and ObjectivesSurvival analyses after hepatectomy for colorectal liver metastases (CRL... more Background and ObjectivesSurvival analyses after hepatectomy for colorectal liver metastases (CRLM) mostly address tumor-related factors; this study has simultaneously evaluated interventional factors which may be influenced by the surgeon.Survival analyses after hepatectomy for colorectal liver metastases (CRLM) mostly address tumor-related factors; this study has simultaneously evaluated interventional factors which may be influenced by the surgeon.MethodsOperative and long-term results of 251 consecutive patients undergoing hepatectomy for CRLM between 1992 and 2007 were analyzed.Operative and long-term results of 251 consecutive patients undergoing hepatectomy for CRLM between 1992 and 2007 were analyzed.ResultsMortality was 0.8%, morbidity 22.9%, intraoperative blood transfusion rate 23.1% (19.4% with pedicle clamping, 35.0% without clamping, P = 0.01), R0-resection 93.6% (2/3 with tumor-free margin >5 mm). The 3-, 5-, 10-year overall and disease-free survival rates were 55.2%, 38.9%, 24.2%, and 37.1%, 28.2%, 25.4%. Univariate analysis: lower survival was related to transfusion requirement, tumor size >5 cm, tumor-free margin ≤5 mm, major hepatectomy, R1-resection, multiplicity of CRLM, preoperative CEA ≥50 ng/ml. Multivariate analysis: intraoperative transfusion remained the only independent predictor of survival; tumor-free margin ≤5 mm and multiplicity of CRLM remained independent predictors of disease-free survival within 12 months from hepatectomy; intraoperative transfusion became again the prominent predictor for later recurrences.Mortality was 0.8%, morbidity 22.9%, intraoperative blood transfusion rate 23.1% (19.4% with pedicle clamping, 35.0% without clamping, P = 0.01), R0-resection 93.6% (2/3 with tumor-free margin >5 mm). The 3-, 5-, 10-year overall and disease-free survival rates were 55.2%, 38.9%, 24.2%, and 37.1%, 28.2%, 25.4%. Univariate analysis: lower survival was related to transfusion requirement, tumor size >5 cm, tumor-free margin ≤5 mm, major hepatectomy, R1-resection, multiplicity of CRLM, preoperative CEA ≥50 ng/ml. Multivariate analysis: intraoperative transfusion remained the only independent predictor of survival; tumor-free margin ≤5 mm and multiplicity of CRLM remained independent predictors of disease-free survival within 12 months from hepatectomy; intraoperative transfusion became again the prominent predictor for later recurrences.ConclusionsTwo factors may be influenced by the surgeon: bleeding with requirement for blood transfusion (through the protective effect of pedicle clamping) and width of tumor-free surgical margin. These factors have prominent roles on long-term outcomes after hepatectomy for CRLM. J. Surg. Oncol. 2009;100:538–545. © 2009 Wiley-Liss, Inc.Two factors may be influenced by the surgeon: bleeding with requirement for blood transfusion (through the protective effect of pedicle clamping) and width of tumor-free surgical margin. These factors have prominent roles on long-term outcomes after hepatectomy for CRLM. J. Surg. Oncol. 2009;100:538–545. © 2009 Wiley-Liss, Inc.

Background: Surveillance systems often present data by means of summary measures, like age-standa... more Background: Surveillance systems often present data by means of summary measures, like age-standardised rates. In this study, we aimed at comparing information derived from commonly used measures of smoking with that presented in modified population pyramids (PPs), using the example of the diffusion of smoking in Italy over the past two decades.