Annali dell'Istituto Superiore di Sanità
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Suicidal behaviour and non-suicidal self-injury in children and adolescents seen at an Italian paediatric emergency department
Get PDFIntroduction: Increasing rates of non-fatal self-harm amongst adolescents represent growing concern. The objective of the study is to describe non-fatal self-harm – including suicidal behaviour (SB), suicidal ideation (SI) and non-suicidal self-injury (NSSI) – observed at an Italian paediatric emergency department (ED).Methods: Retrospective analysis of the clinical records of patients admitted to ED from 2011 to 2016, who underwent child psychiatry consultation (CPc). We analyzed: rates of CPc for SB, SI and NSSI; risk factors for SB and SI in patients admitted to the hospital’s Child Psychiatry Unit after a CPc; and, correlations between NSSI and SB/SI.Results: The rate of CPc for SB, SI and NSSI switched from 7.7% in 2011 to 19% in 2016, with a statistically significant increase over the years (p< 0.001), a 2.2:1 female/male ratio, and an average age of 15.5±1.8 years. SB consisted mainly in drug poisoning (53%), with a significant prevalence in female. Mood disorder was identified in 82.5% of patients hospitalized for SB or SI. Substance abuse was more frequently found in patients admitted for SB when compared to the SI group. Almost half (48%) of the patients admitted for SB or SI reported a current or lifelong history of NSSI. In patients admitted for SB or SI, 3 factors were significantly and independently associated with NSSI: being female, substance abuse, and more severe depressive symptoms.Conclusions: Between 2011 and 2016, there was a significant growing need for CP consultations for suicidal behaviours, mainly in female adolescents. The subjects admitted for SI or SB, who also presented NSSI, were mainly substance abusers, and presented with more severe depressive symptoms
Schiavonia Hospital response to COVID-19 outbreak: a first single-center experience
Get PDFOn February 21st 2020, Schiavonia Hospital (SH) detected the first 2 cases of COVID-19 in Veneto Region. As a result of the underlying concomitant spread of infection, in two months SH had to rearrange the clinical services in terms of structural changes to the building, management of spaces, human resources and supplies, in order to continue providing optimal care to the patients and staff safety. The aim of this article is to describe how SH was able to adjust its services coping with the epidemiological stages of the pandemic.Three phases can be therefore identified. The first, after initial cases’ identification, characterized by the hospital isolation. In the second phase the hospital reopened, the facility was divided into two unmatching areas, named COVID-19 and COVID-free, to prevent intra-hospital contamination. The last phase was characterized by the re-assessment of the facility as the largest COVID Hospital in Veneto, draining exclusively COVID-19 patients from the surrounding areas
New mode of care. Value and limit of the person-centered care planning for people with mental disability
Get PDFRiassunto L\u27enorme aumento delle persone con disabilità mentali e intellettuali in tutto il mondo e la capacità di difesa raggiunta da questi pazienti, culminata nella Convenzione sui diritti delle persone con disabilità (CRPD), hanno comportato cambiamenti nel modo in cui i relativi affari servizi Pubblici. In particolare, negli ultimi decenni, molti paesi hanno esaminato come fornire una persona con disabilità un funzionamento sociale accettabile, migliorare il benessere, secondo i principi di equità, solidarietà e partecipazione. È nato un nuovo modello politico e socio-sanitario, chiamato "welfare community", gli utenti sono protagonistidel loro progetto sanitario e le risorse messe in atto assumono un carattere di investimento sulla comunità e il suo sviluppo economico. La personalizzazione dei servizi sociali e sanitari è anche garantita in molti paesi come una "nuova modalità di cura", necessaria in forme diverse a seconda dell\u27aspetto finanziario e dei destinatari. Il presente articolo è una rassegna narrativa che esamina e sintetizza la ricerca internazionale e il materiale non di ricerca per esaminare le diverse strategie di implementazione della personalizzazione in diversi paesi,con particolare attenzione all\u27Italia, nel tentativo di fornire chiarezza concettuale su questo argomento in termini di opportunità e insidie
Rehabilitation strategies for low anterior resection syndrome. A systematic review
Get PDFObjective. To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery for colorectal cancer.Methods. We have search in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health and Scopus databases. Studies selected were limited to those including only patient undergone low rectal resection with sphincter preservation and with pre-post assessment with a LARS score. Five articles fit the criteria.Results. The percutaneous tibial nerve stimulation demonstrated moderate results and sacral nerve stimulation was found to be the best treatment with greater symptom improvement. Only one study considered sexual and urinary problems in the outcomes assessment.Conclusions. In clinical practice patients should evaluate with the LARS and other score for evaluation of urinary and sexual problems. Future research must be implemented with higher quality studies to identify the least invasive and most effective treatment/s.
Additive manufacturing of reconstruction devices for maxillofacial surgery: design and accuracy assessment of a mandibular plate prototype
Get PDFAdditive manufacturing (AM) presents unique opportunities for medical applications and in particular in maxillofacial surgery for developing patient specific implants. The quality assessment of additive manufactured products is an essential aspect for the real introduction in health services. In this framework, the purpose of the present study is to investigate the possibility of developing prototypes of mandibular plates as preoperative surgical planning models, by verification of design, analysis of internal structure integrity and evaluation of the effects of variables involved in AM processes. A PolyJet threedimensional (3D) printing system is used in the study due to its very fine resolution. The computer aided design (CAD) models of the implants were converted to stereolithography (STL) file formats in different STL conversion resolutions and then printed using commercial prototyping polymers to observe the effect of model resolution. Finite element analysis (FEA) was conducted to study the capability of the designed mandibular plate to support the involved biomechanical loads. Micro-computed tomography (micro-CT) analysis was performed to verify the dimensions and the internal defects of the printed objects, considering that the presence of defects can affect the quality and compromise the final performance. Results were analyzed to understand the effect of the 3D printing process flow conditions on the obtained prototypes. Relative error in reference to the CAD models mainly evidenced the difference in resolution due to STL files and the effect of the design. No anomalies and defects were detected inside the evaluated samples
A qualitative study of family carers views on how end-of-life communication contributes to palliative-oriented care in nursing home
Get PDFBackground: Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the process by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.Methods: A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.Results: End-of-life communication contributed to palliative-oriented care by: a) improving knowledge of family carers’ preferences; b) promoting family carers understanding about their relative’s health conditions, prognosis, and treatment available; c) fostering shared decision-making between healthcare professionals and residents/family carers; and d) improving knowledge of residents’ preferences. Conclusion: Clear and in-depth communication provides insight into residents’ and family carers’ preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making.
Neurophysiological monitoring in neonatal abstinence syndrome from cocaine
Get PDFIntroduction. Neonatal abstinence syndrome (NAS) in a newborn is a result of thesudden discontinuation of exposure to psychotropic drugs abused by the mother duringpregnancy. Since forty decades, the standardized Finnegan Neonatal Abstinence ScoringTool (FNAST) documents the infant withdrawal, and initiate the appropriate treatmentregimen, when elevated scored are reported. Whereas FNAST is successfully applied foropioids NAS, in case of other psychotropic drugs and especially cocaine, the tool is notalways efficacious or predictive.Methods. Continuous v-Electroencephalography (vEEG) provides particularly usefulinformation about brain cortical functioning and evaluation of background activity innormal newborns. vEEG allows to properly study and identify clinical manifestationsas physiological motor paroxysms, that disappear from birth to infant age in correlationwith the neurological development. Due to its feature to be a non-invasive tool continuousvEEG monitoring could be used to describe some clinical manifestations and assessif they can be correlated to possible injuries in critical neonates as those exposed in uteroto psychoactive drugs presenting NAS.Results. An example for the potential use of such methodology is discussed in a caseof NAS due to prenatal exposure to cocaine as a complementary tool for the evaluationof behavioural state and clinical and neurological signs in newborns in utero exposed topsychoactive drugs, excluding epileptic phenomena.Discussion. Video-EEG recording could be considered an important and objective toolthat allows the evaluation of behavioural state and clinical and neurological signs in newbornsin utero exposed to psychoactive drugs and the neurophysiological definition ofsigns and symptoms, which cannot be evaluated by FNAST such as startles and its variabilityduring subsequent days after birth, subclinical seizures or brain injuries
Network of services facilitating and supporting job placement for people with autism spectrum disorders. The experience of the ASL Piacenza, Italy
Get PDFAbstractThe Mental Health Department of Piacenza has recently activated a special programfor persons diagnosed with autism spectrum disorders (ASD). The Program engages anumber of stakeholders: the users, their families, social and psychiatric services as wellas specific associations for autism. The program is aimed to grant a complete and individualizedassistance to people with ASD and it is especially focused on the transitionto adulthood. In this period, it is necessary to build the “life project” in order to improvefunctioning and quality of life of users. The elective areas of the individual plan have todeal on how to reach autonomy in daily living and related skills, obtaining and maintaininga job, as well as starting and reinforcing significant relationships. This paper is especiallyfocused on job placement for people with ASD
