OBJECTIVE: To assess elderly individuals' demand for emergency department (ED) care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648). STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs) in 43.1% of cases, 1.4% came from nursing homes (NH), and 55.5% were self-referred (SR). The SR group had a higher adjusted odds ratio (aOR) for non-urgent conditions (1.98 CI 1.85-2.12), but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59), and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 €) than for those referred by PCPs (mean = 138.14 € ± SD 101.17 €) or NH (mean = 143.48 € ± SD 95.28 €). CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.
Cancer incidence was investigated in an area which has been affected by the illegal practices of dumping hazardous waste and setting fire to mismanaged waste. For the 35 municipalities of this area that are served by a Cancer Registry, municipal standardized incidence ratios (SIR) and hierarchical Bayesian estimators (BIR) were computed. Moreover, municipal spatial clustering and a Poisson regression by municipality index of waste-related exposure were performed for 10 cancer types. Increased municipality SIRs were found for some cancer types. The BIRs confirmed the increases for liver cancer in two municipalities. Statistically significant clusters were detected for liver, lung, leukaemia and soft tissue sarcomas. In the regression analysis, testis cancer showed significant trend with the index of waste-related exposure (RR = 1.18).
È stata investigata l'incidenza oncologica in un'area interessata da pratiche illegali di smaltimento e di combustione incontrollata di rifiuti. Per i 35 comuni di quest'area serviti da un Registro Tumori sono stati calcolati i rapporti standardizzati di incidenza (standardized incidence ratios, SIR) e gli stimatori bayesiani (BIR). Per 10 sedi tumorali sono state eseguite, inoltre, analisi di cluster spaziali e di regressione con un indice municipale di esposizione a rifiuti. SIR in eccesso sono stati osservati per diverse sedi tumorali; i BIR hanno confermato gli eccessi di tumore epatico in due comuni. I tumori epatici e polmonari, le leucemie e i sarcomi dei tessuti molli hanno mostrato cluster significativi. Nell'analisi di regressione il tumore del testicolo ha mostrato un trend in eccesso significativo (RR = 1,18).