No abstract

This study aimed to measure the prevalence of Problematic Internet Use (PIU) among high school students and to identify factors associated with PIU underlining gender differences. The students filled a self-administered, anonymous questionnaire collecting information on demographic characteristics and patterns of Internet use. Multiple logistic regression analysis was performed to identify factors associated with PIU in the overall sample and by gender. Twenty-five schools and 2022 students participated in the survey. Prevalence of PIU was 14.2% among males and 10.1% among females. Males 15-year-olds and females 14-year-olds had the highest PIU prevalence that progressively lowered with age among females. Only 13.5% of pupils declared parents controlled their Internet use. The sensation of feeling lonely, the frequency of use, the number of hours of connection, and visiting pornographic websites were associated with the risk of PIU in both genders. Attending vocational schools, the activities of chatting and file downloading, and the location of use at Internet point among males, and younger age among females were associated with PIU, whilst information searching was protective among females. PIU could become a public health problem in the next years. The physical and mental health consequences should be studied.

BackgroundClinical pathways (CPs) are used to improve the outcomes of acute stroke, but their use in stroke care is questionable, because the evidence on their effectiveness is still inconclusive. The objective of this study was to evaluate whether CPs improve the outcomes and the quality of care provided to patients after acute ischemic stroke.MethodsThis was a multicentre cluster-randomized trial, in which 14 hospitals were randomized to the CP arm or to the non intervention/usual care (UC) arm. Healthcare workers in the CP arm received 3 days of training in quality improvement of CPs and in use of a standardized package including information on evidence-based key interventions and indicators. Healthcare workers in the usual-care arm followed their standard procedures. The teams in the CP arm developed their CPs over a 6-month period. The primary end point was mortality. Secondary end points were: use of diagnostic and therapeutic procedures, implementation of organized care, length of stay, re-admission and institutionalization rates after discharge, dependency levels, and complication rates.ResultsCompared with the patients in the UC arm, the patients in the CP arm had a significantly lower risk of mortality at 7 days (OR = 0.10; 95% CI 0.01 to 0.95) and significantly lower rates of adverse functional outcomes, expressed as the odds of not returning to pre-stroke functioning in their daily life (OR = 0.42; 95 CI 0.18 to 0.98). There was no significant effect on 30-day mortality. Compared with the UC arm, the hospital diagnostic and therapeutic procedures were performed more appropriately in the CP arm, and the evidence-based key interventions and organized care were more applied in the CP arm.ConclusionsCPs can significantly improve the outcomes of patients with ischemic patients with stroke, indicating better application of evidence-based key interventions and of diagnostic and therapeutic procedures. This study tested a new hypothesis and provided evidence on how CPs can work.Trial registrationClinicalTrials.gov ID: [NCT00673491].

We read with great interest the article by Saposnik et al regarding the escalating levels of access to in-hospital care and stroke mortality. 1 Many authors agree that the management of the patients in stroke care units has been the most substantial advance in stroke care; however, the mechanism by which the stroke care unit management improves outcomes remains uncertain. 2 Therefore, in their article Saposnik et al argued that the stroke unit admission does not automatically imply receiving comprehensive care and appropriate interventions, and they analyzed the impact of the organized care in stroke mortality. We suggest that this issue should be further analyzed.We conducted an observational study to this purpose. Retrospective data were collected with standard report forms from the medical records of 253 consecutive patients admitted for ischemic strokes in 29 Italian hospitals in June 2004. Patients with hemorrhagic strokes and transient ischemic attacks were excluded. Stroke in-hospital mortality was selected as the primary outcome and dependency at discharge measured using the Functional Independence Measure as the secondary outcome. We described patient outcomes according to gender, comorbidities (based on their Charlson-Deyo index patients were categorized as having 0 to 1 or Ͼ1 comorbidities), medical complications (at least one complication), admission in stroke unit (yes or no), access to organized care (based on organized care index as having 0 to 1 or Ͼ1 score), management by a stroke team (yes or no), team clinical expertise (level of knowledge of the evidence) and use of antithrombotic drugs (antiplatelet or anticoagulant during the stay).2 and Fisher exact test were used for categorical variables. Differences in the rate of in-hospital deaths and of independency at discharge according to each variable under study were also evaluated at individual level using randomeffects logistic regression.Overall in-hospital stroke mortality was 19.76%. In detail we observed the following unadjusted odds ratios ( In conclusion, we think that our data adds further evidence in favor of the argument that stroke patients are best served by a comprehensive and specialized inpatient care and not by individual interventions. This kind of approach could be defined as a complex intervention in which a number of separate elements are essential to the proper functioning of the intervention but the "active ingredient" that is effective is difficult to specify. 3 In fact, the management of patients affected by stroke involves the expertise of several professionals, which can result in poor coordination or inefficiencies in patient treatment, and organized care can significantly improve the outcomes of these patients. However, the active ingredient of organized care still remains unclear, and further studies focused on the evaluation of complex interventions are needed to help to understand which mechanisms within the organization can really improve the quality of stroke care. DisclosuresNone.

results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment.