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Paolo Giorgi Rossi

Publications and source records attributed to Paolo Giorgi Rossi.

At least 19 recordsLinked to original sources
PubMed2007

Home injuries mortality: sensitivity and specificity analysis of different data sources and operative definitions.

UNLABELLED: The aim of this longitudinal study was to test different operational definitions of home accident mortality. METHODS: The sources of data were the Emergency Information System, hospital discharge reports and the mortality registry of the Lazio Region, 2000-2001. We selected all emergency room visits for unintentional traumas that occurred at home. A 9-month follow-up was performed to calculate mortality rates. A sensitivity analysis of in-hospital mortality, deaths within 30 days and deaths from home accident E-codes was performed. A gold standard definition of home accident-related deaths was proposed. RESULTS: We observed 598 home accident-related fatalities (29.1% of all the deaths found in the follow-up study). In-hospital mortality, deaths within 30 days and deaths for home accident E-codes had sensitivity values of 63.4%, 63.4% and 59.4%, respectively; positive predictive values were 78.1%, 67.1% and 100%, respectively. CONCLUSIONS: The best operational definition of home injury was based on in-hospital mortality, while mortality based on E-codes reported on death certificates was lacking. In order to measure the real burden of home injuries, hospital and mortality data must be integrated.

Accidents, Home↗
PubMed2006

Is the type of test used for mass colorectal cancer screening a determinant of compliance? A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy.

BACKGROUND: The efficacy of colorectal cancer screening has been proved, and three different screening tests are recommended by international guidelines: the faecal occult blood test, flexible sigmoidoscopy and colonoscopy. While the effectiveness of a screening program depends on the compliance obtained, the role of the type of test on compliance has not yet been sufficiently studied. AIMS: To measure the effect of the type of screening test used, i.e. faecal occult blood test or flexible sigmoidoscopy, on the compliance to colorectal cancer screening programs. SUBJECTS AND METHODS: A cluster-randomized two-arm trial was conducted. We randomly assigned 20 GP's practices that had an average of 150 patients between 50 and 74 years old. RESULTS: 1449 individuals were referred to faecal occult blood test and 1538 to flexible sigmoidoscopy. The faecal occult blood test obtained higher compliance: 17.2% (95%CI 12.5-25.7) versus 7.0% (95%CI 5.7-9.0). The socio-economic status was an effect modifier of the test type: the effect of the type of test was smaller in low socioeconomic classes. CONCLUSIONS: The type of screening test used for colorectal cancer is a determinant of participation. In a low compliance area, better compliance will result from offering the faecal occult blood test than from the flexible sigmoidoscopy.

Aged↗
PubMed2006

Cost-effectiveness of vaccinating for invasive pneumococcal disease in the elderly in the Lazio region of Italy.

Pneumococcal vaccination among the elderly is currently recommended in several western countries. We estimated the cost-effectiveness of a hypothetical vaccination campaign of 65+ year olds in the Lazio region (Italy). Baseline net costs per event averted and life-year gained, at 2001 prices, were euro 34,681 (95%CI: euro 28,699 to euro 42,929) and euro 23,361, respectively (95%CI: euro 16,419 to euro 38,297). Lower bacteraemic pneumonia incidence and vaccine effectiveness increased the net cost per life-year gained (ICER) to euro 53,899 and euro 74,313, respectively; in the best-case scenario the ICER was euro 4249. The case definition of invasive pneumococcal disease and, consequently, vaccine effectiveness are major uncertainties in countries with low incidence of pneumonia.

Aged↗
PubMed2006

Defining a common set of indicators to monitor road accidents in the European Union.

BACKGROUND: currently road accidents are mostly monitored through mortality and injury rates. This paper reports the methodology and the results of a project set forth by the European Union (EU) and coordinated by the WHO aimed at identifying and evaluating a core set of indicators to monitor the causal chain of road accident health effects. The project is part of the ECOEHIS (Development of Environment and Health Indicators for European Union Countries). METHODS: a group of experts (WG), identified 14 indicators after a review of the information collected at the EU level, each of them representing a specific aspect of the DPSEEA (Driving, Pressure, State, Exposure, Effect, Action) model applied and adapted to the road accidents. Each indicator was scored according to a list of 16 criteria chosen by the WG. Those found to have a high score were analysed to determine if they were compatible with EU legislation and then tested in the feasibility study. RESULTS: 11 of the 14 indicators found to be relevant and compatible with the criteria of selection were proposed for the feasibility study. Mortality, injury, road accident rate, age of vehicle fleet, and distance travelled are the indicators recommended for immediate implementation. CONCLUSION: after overcoming the limitations that emerged (absence of a common definition of death by road accident and injury severity, underestimation of injuries, differences in information quality) this core set of indicators will allow Member States to carry out effective internal/external comparisons over time.

Acceleration↗
PubMed2006

Colorectal cancer screening: recommendations and guideline adherence by physicians from digestive endoscopy centers in the Lazio region, Italy.

INTRODUCTION: Endoscopy plays a key role in colorectal cancer screening; at the beginning of a mass screening campaign, it is important for public health officials to assess physicians' attitudes and adherence to guidelines regarding colorectal cancer screening. METHODS: In April 2004, a questionnaire was sent to all 80 digestive endoscopy centers in the Lazio region, identified by the annual census of the Italian Society of Digestive Endoscopy. The results were compared to those from a similar survey of general practitioners (GPs). RESULTS: Seventy-one centers (89%) returned the questionnaire. Only 3% of physicians said they did not recommend any colorectal cancer screening test. Colonoscopy was perceived as the most effective screening test and was the most recommended (80%). Fecal occult blood test was recommended by 61% of physicians and flexosigmoidoscopy by 11%. Endoscopy centers' physicians recommend screening more than GPs (96.9% vs. 78.3%), while they have a similar level of over-recommending (50.8% vs. 47.2%). Almost 95% of endoscopy physicians properly recommended colonoscopy after positive FOBT. CONCLUSIONS: Neither physicians at endoscopy centers nor GPs tend to follow screening guidelines. Screening programmes should not rely on a single medical specialist, but on interdisciplinary management of the disease to strengthen adherence to existing guidelines.

Attitude of Health Personnel↗
PubMed2006

Unintentional home injuries reported by an emergency-based surveillance system: incidence, hospitalisation rate and mortality.

OBJECTIVE: The aim of this study is to quantify the incidence of home injuries using an integrated surveillance system. It aims to estimate home accident mortality. MATERIAL AND METHODS: The sources of data for this epidemiological descriptive study were the emergency information system, the hospital information system and the mortality registry of Lazio Region, 2000-2001. We selected all emergency department (ED) visits for unintentional traumas that occurred at home. We calculated incidence of ED visits, hospitalisation and mortality rates by sex and age. RESULTS: In the year 2000, 145101 persons visited the ED (2700/100000), 8.1% of whom were then admitted to the hospital. Incidence was higher among children and older people. We observed 620 fatalities, a rate of 0.43%. The mortality registry reported 1042 deceased, a home accident-related mortality rate of 31.1/100000. CONCLUSIONS: Unintentional injuries in the home are a relevant public health problem. Since none of the databases used in the study give a complete measure of the burden of home injuries, we combined the data from all of them to estimate the mortality and the burden of home injuries. Interventions for prevention must identify the specific accidents/injuries they are trying to reduce in order to focus their intervention on the appropriate population.

Accidents, Home↗
PubMed2006

Estimation of Pap-test coverage in an area with an organised screening program: challenges for survey methods.

BACKGROUND: The cytological screening programme of Viterbo has completed the second round of invitations to the entire target population (age 25-64). From a public health perspective, it is important to know the Pap-test coverage rate and the use of opportunistic screening. The most commonly used study design is the survey, but the validity of self-reports and the assumptions made about non respondents are often questioned. METHODS: From the target population, 940 women were sampled, and responded to a telephone interview about Pap-test utilisation. The answers were compared with the screening program registry; comparing the dates of Pap-tests reported by both sources. Sensitivity analyses were performed for coverage over a 36-month period, according to various assumptions regarding non respondents. RESULTS: The response rate was 68%. The coverage over 36 months was 86.4% if we assume that non respondents had the same coverage as respondents, 66% if we assume they were not covered at all, and 74.6% if we adjust for screening compliance in the non respondents. The sensitivity and specificity of the question, "have you ever had a Pap test with the screening programme" were 84.5% and 82.2% respectively. The test dates reported in the interview tended to be more recent than those reported in the registry, but 68% were within 12 months of each other. CONCLUSION: Surveys are useful tools to understand the effectiveness of a screening programme and women's self-report was sufficiently reliable in our setting, but the coverage estimates were strongly influenced by the assumptions we made regarding non respondents.

Adult↗
PubMed2006

The role of GPs in increasing compliance to colorectal cancer screening: a randomised controlled trial (Italy).

AIMS: To assess the effect of the provider (GPs versus hospital) on the compliance in returning the faecal occult blood test. To analyse the characteristics of the GP associated with high compliance among his beneficiaries. METHODS: A questionnaire about screening attitudes was mailed to the 1192 GPs working in 13 districts of the Lazio region. We asked the GPs to participate in a randomised trial, we sampled 130 GPs and about 1/10 of the GPs' 50-75 year old beneficiaries (n = 3657) were invited to be screened at the GP office and 1/10 (3675) at the nearest gastroenterology centre. RESULTS: 58.5% of the GPs completed the questionnaire and 22.7% agreed to participate in the trial. The compliance in the GP arm was 50%, in the hospital arm 16% (RR 3.4; 95% CI: 3.13-3.70). There was a high variability in the compliance obtained by the GPs. GPs with more than 25 patients visited/day and those incorrectly recommended screening of colorectal cancer obtained a lower compliance (OR 0.74, 95% CI: 0.57-0.95 and OR 0.76, 95% CI: 0.59-0.97, respectively). CONCLUSIONS: The involvement of GPs in colorectal cancer screening can be very effective to enhance the compliance, but the effectiveness is dependent on their willingness to be involved.

Aged↗
PubMed2006

Streptococcus pneumoniae in western Europe: serotype distribution and incidence in children less than 2 years old.

We did a systematic search and synthesis of evidence on the incidence of invasive pneumococcal disease, symptomatic disease, and circulating Streptococcus pneumoniae serotypes in western Europe. Using data from studies published between 1992 and 2005 we calculated a weighted mean invasive pneumococcal disease and pneumococcal meningitis incidence rate per 100,000 children aged 2 years or younger within 95% confidence intervals, together with the prevalence of S. pneumoniae serotypes and resistance to penicillin. Invasive pneumococcal disease incidence was 27.03 cases per 100,000 children under 2 years (95% CI 21.85-33.43) [corrected] Heptavalent conjugate vaccine serotypes account for 43.18-75.32% of isolates among people aged under 18 years of age. 11% of isolates in individuals aged under 18 years were penicillin resistant. The incidence of invasive pneumococcal disease appeared consistently lower in western European countries compared with studies from the USA. Thus the use of studies of vaccine effectiveness based on the US population may lead to an overestimation of the benefits of its introduction in Europe.

Europe↗
PubMed2006

Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC).

OBJECTIVE: To describe actual and preferred place of death of Italian cancer patients and to analyse the preferences met regarding the place of death. DESIGN: Mortality follow back survey of 2000 cancer deaths, identified with a two stage probability sample representative of the whole country. Information on patients' experience was gathered from the non-professional caregiver with an interview. A section of the interview covered information on the actual and preferred place of death of the patients. SETTING: 30 Italian local health districts randomly selected after stratification in four geographical areas. PARTICIPANTS: 1900 of 2000 (95.0%) caregivers of cancer deaths identified. MAIN OUTCOME MEASURES: Prevalence of actual and preferred places of death. RESULTS: Valid interviews were obtained for 66.9% (n = 1271) of the caregivers. Place of death was home for 57.9% of Italian cancer patients, hospital for 34.6%, hospice for 0.7%, nursing home for 6.5%, and ambulance for 0.4%. Wide and significant differences within Italy were seen (home deaths ranged between 94.0% in the south and 28.2% in the north east). Home was the preferred place of death for 93.5% of patients that expressed a preference, with minimal differences within the country (between 89.5% and 99.0%). Overall 67.1% of the sample died in the place where they preferred to die. CONCLUSIONS: Policymakers should encourage health services to focus on ways of meeting individual preferences on place of death. As home was the preferred place of death for most cancer patients, effective programmes to enable the patients to remain at home should be implemented.

Adolescent↗
PubMed2006

The effect of screening programmes on the treatment of benign breast neoplasms: observations from current practice in Italy.

PURPOSE: In the Lazio region, Italy, mammographic screening programmes were gradually activated from 1999 to 2003, providing an opportunity to compare two unselected populations in the same time period: women who were contacted in writing, and those who had not been contacted. In this study, we compare the incidences of treatments for benign and malignant neoplasms in the two groups. METHODS: The target population was women aged 50-69 years. We linked all incident cases of surgery for benign and malignant breast neoplasms, from the Hospital Information System (1999-2003) to the Mammographic Screening Information System (1999-2001). We calculated incidence, adjusted for age and standardized breast cancer mortality ratio in each area of residence, for benign and malignant neoplasms surgery in non-yet-contacted and contacted woman. Incidence for contacted women was calculated for the two years following initial contact. RESULTS: The target population in Lazio is 681,000; 116,000 women were contacted during the study period and 3252 malignant and 1566 benign neoplasms were surgically treated. Annual incidence was, respectively, 2.0/1000 and 1.1/1000 for malignant and benign neoplasms in women not contacted, and, respectively, 2.9/1000 and 1.1/1000 in the contacted population. Among the contacted group, annual incidence was 4.3/1000 and 1.5/1000 in compliant women, and 2.0/1000 and 0.9/1000 in non-compliant women. About one-half of the surgeries for benign neoplasms in compliant women were treated against the recommendation of the screening programme. CONCLUSIONS: The implementation of the screening programme did not increase the incidence of treatment for benign neoplasms, and detected 50% more malignant neoplasms.

Aged↗
PubMed2005

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial [ISRCTN83029072].

BACKGROUND: The major limit to colorectal cancer screening effectiveness is often low compliance. We studied the reasons for non compliance and determinants of compliance to faecal occult blood tests in Lazio, Italy. METHODS: This is a case-control study nested within a trial that tested the effect of type of test and provider on colorectal cancer screening compliance. Non compliant trial subjects were classified as cases, and compliant subjects were classified as controls. We sampled 600 cases and 600 controls matched by their general practitioner, half were invited for screening at the hospital, and the other half directly at their general practitioner's office. Cases and controls answered questions on: distance from test provider, logistical problems, perception of colorectal cancer risk, confidence in screening efficacy, fear of results, presence of colorectal cancer in the family, and gastrointestinal symptoms. RESULTS: About 31% of cases never received the letter offering free screening, and 17% of the sampled population had already been screened. The first reported reason for non-compliance was "lack of time" (30%); the major determinant of compliance was the distance from the test provider: odds ratio > 30 minutes vs < 15 minutes 0.3 (95% CI = 0.2-0.7). The odds ratio for lack of time was 0.16 (95% IC 0.1-0.26). The effect was stronger if the hospital (0.03 95% CI = 0.01-0.1) rather than the general practitioner (0.3 95% CI = 0.2-0.6) was the provider. Twenty-two percent of controls were accompanied by someone to the test. CONCLUSION: To increase compliance, screening programmes must involve test providers who are geographically close to the target population.

Aged↗
PubMed2005

Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients?--Study protocol of a cluster randomised trial [ISRCTN41456865].

BACKGROUND: Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT), the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865--implementation of pre-hospital emergency pathway for stroke--a cluster randomised trial. METHODS/DESIGN: Two-arm cluster-randomised trial (C-RCT). 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline), or to arm 2 (no intervention, current practice). Arm 1 participants (152 physicians, 280 nurses, 50 drivers) attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the intervention. We will assess the guideline recommendations for emergency and pre-hospital stroke management relative to: 1) promptness of interventions for hyperacute ischaemic stroke; 2) promptness of interventions for hyperacute haemorrhagic stroke 3) appropriate diagnosis. Outcomes will be expressed as proportions of patients with a positive CT for ischaemic stroke and symptoms onset < or = 6 hour admitted to the stroke unit. DISCUSSION: The fields in which this trial will play are usually neglected by randomised controlled trial (RCT). We have chosen the cluster-randomised controlled trial (C-RCT) to address the issues of contamination, adherence to real practice, and community dimension of the intervention, with a complex definition of clusters and an extensive use of routine data to collect the outcomes.

Brain Ischemia↗
PubMed2005

Trying to improve the compliance to colorectal cancer screening: a complex study design for a complex planning question.

The efficacy of faecal occult blood test as primary screening for colorectal cancer has been demonstrated. Screening programs, to be effective, should guarantee high compliance in the target population. The aim of this paper is to describe the design of three connected studies aimed at obtaining precise indications for planning a colorectal cancer screening program with high compliance. We designed a survey, with a randomised controlled trial nested within it, and a case-control study nested within that and defined by the results of the trial. The complex interconnection of studies reflects the aim to produce indications for an evidence-based planning of a public health program, which is itself, a complex phenomenon. The trial was designed to evaluate two different types of tests, Immunochemical and Guaiac, and two different providers, general practitioner and hospital, with a 2 x 2 factorial design. The randomization was performed at two different levels to minimize the loss of power: at the practice level for test type (cluster randomisation) and individual level for provider type.

Aged↗
PubMed2005

Road traffic injuries in Lazio, Italy: a descriptive analysis from an emergency department-based surveillance system.

STUDY OBJECTIVE: Road crashes are the leading cause of death for young adults in industrialized countries. In most countries, the only data available are the police-based statistics, which report the number of deaths and injuries, without any information about severity or diagnosis. We describe the results of an emergency department (ED)--based integrated surveillance system of road-crash health consequences in the Lazio region (5.3 million inhabitants) for 2000. METHODS: We identified all ED visits in the emergency database and then linked them with hospital discharges and mortality registry. Deaths that occurred at the site of the crash were identified in the mortality registry. Cases are classified according to body region affected, nature of the injury, and severity. RESULTS: We found 146,600 cases, for an overall incidence of 2,700 per 100,000 and a peak of 8,000 per 100,000 in 20- to 24-year-old men. There were 597 fatalities for men and 205 female fatalities, with an overall mortality of 15.9 per 100.000 and a hospitalization rate of 224 per 100,000. CONCLUSION: Our surveillance system reported a 6-times-higher incidence of road-traffic injuries, with 139 more fatalities than the national statistics of the same year. The underreporting in police reports and the absence of diagnostic information reveal the need for health-based surveillance systems of road-traffic injuries.

Accidents, Traffic↗
PubMed2005

The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial.

INTRODUCTION: We conducted a cluster-randomized trial aimed at assessing the effect of the type of faecal occult blood, guaiac or immunochemical test on screening compliance. METHODS: We sampled 130 general practitioners (GPs) who consented to participate in the trial. We randomly allocated half of them to the guaiac (Hemo-Fec) and half to the immunochemical test (OC-Hemodia). We sampled 2/10 of the GPs' 50-75-year-old patients (n=7332) and randomly divided this population into half. One half was invited to be screened at the GP's office and the other to the nearest gastroenterology ward. The principal outcome was the percentage of returned tests. RESULTS: The immunochemical test had a compliance of 35.8% and the guaiac of 30.4% (relative risk [RR] 1.20; 95% confidence interval [CI] 1.02-1.44). The difference was mostly due to a higher probability of returning the sample: 93.8% and 88.6% for immunochemical and guaiac, respectively (RR 1.06; 95% CI 1.02-1.10). The guaiac test had a higher prevalence of positives (10.3% versus 6.3%, RR 0.603; 95% CI 0.433-0.837). There was a higher variability in the results obtained with the guaiac test compared with the immunochemical (F[1, 12] = 16.25; P=0.0017). CONCLUSIONS: Compliance is more likely with the immunochemical than the guaiac test, independent of the provider. Guaiac tests show a higher variability of the results among centres. The successful implementation of a screening programme requires a period of standardization of the test reading in order to avoid unexpected work overload for colonoscopy services.

Aged↗
PubMed2004

Survey on colorectal cancer screening knowledge, attitudes, and practices of general practice physicians in Lazio, Italy.

BACKGROUND: Several international guidelines have recommended the involvement of general practitioners (GPs) in screening programs, but current evidence suggests this is very difficult. We implemented a survey to understand the attitudes, knowledge, and practices regarding colorectal cancer screening of GPs in the Lazio region. METHODS: Survey of all GPs working in 13 of the 50 districts in Lazio using a mail-in questionnaire. RESULTS: Out of 1192 GPs, 699 responded (59%). Ninety-four percent consider CRC a preventable disease. Knowledge about oncological screenings is higher in GPs using the guidelines as source of information. Twenty-five percent properly recommend the available screening tests for colorectal cancer, 22% do not recommend any, 6% under-recommend, and 47% over-recommend. Adequate knowledge of oncological screenings is positively associated with correct recommendation. Thirty-two percent of GPs recommend inappropriate follow-up tests for patients with positive fecal occult blood test. CONCLUSIONS: The low response rate reveals the lack of GP's interest in screening. Knowledge about screening and use of guidelines as sources of scientific information are important factors to improve attitudes about screening, but there is a large percentage of well-informed GPs who do not recommend colorectal cancer screening at all. Currently, many GPs do not properly follow the patients up after a positive FOBT.

Attitude of Health Personnel↗