Annali dell'Istituto Superiore di Sanità
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Development of a Brief Psychoanalytic Group therapy (BPG) and its application in an asbestos national priority contaminated site
Get PDFThe aim of the present paper is to describe the development of a Brief Psychoanalytic Group therapy for contaminated sites and its application in the National Priority Contaminated Site of Casale Monferrato. Before presenting the core of the clinical intervention, a brief examination of some clinical features encountered working with malignant mesothelioma patients and their caregivers is offered. These aspects have been pivotal elements in the construction of a psychoanalytically oriented time-limited (i.e., 12 sessions) group therapy. This model of intervention was designed by one of the Authors (AG) and is aimed at reducing the impact of living in a threatening place where both physical well-being and health are put to the test. At a psychological level, in fact, living in contaminated sites arouses death anxieties, which can deeply compromise the quality of time remaining to live together with loved ones after a fatal cancer diagnosis
Big Data. A briefing
Get PDFThe data deluge (generally referred as “Big Data”) biomedical scientists are facing in these years asks for a serious epistemological thinking in order to avoid both “data bases idolatry” and “preconceived refusal”. Starting from the evident reproducibility crisis of biomedical sciences here we sketch some hopefully useful indications for a sensible use of data mining approaches
Population screening, monitoring and surveillance for frailty: three systematic reviews and a grey literature review
Get PDFIntroduction. Little is known about programmes or interventions for the screening, monitoring and surveillance of frailty at population level. Methods. Three systematic searches and an opportunistic grey literature review from the countries participating in the ADVANTAGE Joint Action were performed. Results. Three studies reported local interventions to screen for frailty, two of them using a two-step screening and assessment method and one including monitoring activities. Another paper reviewed both providers’ and participants’ experiences of screening activities. Three on-going European projects and population-screening programmes in primary care await evaluation. An electronic Frailty Index for use with patients’ primary care records has been recently validated. No study described systematic processes for the rveillance of frailty. Conclusions. There is insufficient evidence for the effectiveness of population-level screening, monitoring and surveillance of frailty. Development and evaluation of community-based two-step programmes including those that incorporate electronic health records, particularly in primary care, are now needed
Gestational age and hospital utilization: three-years follow-up of an area-based birth cohort
Get PDFObjective: To investigate differences by gestational age in emergency department visits and re-hospitalizations during the three years following childbirth discharge. Methods: We performed a historical cohort study in Lazio Region, Italy, for infants born in 2007-2008 to resident mothers. Health administrative data were used. Analysis was performed by multinomial logistic regression. Results: Of 90,545 infants, more than 50% had at least one emergency department visit, and 18.8% at least one re-hospitalization. Relative risk ratios of both events increased by decreasing gestational age, and were higher for mothers ≤35 years of age, with low education and of Italian nationality. Residency outside the metropolitan area was associated with an increased risk of re-hospitalization and a decreased risk of emergency department visits. Conclusion: During the three years following childbirth discharge, re-hospitalizations and, to a lesser extent, emergency department use are inversely related to gestational age at birth; socio-demographic factors have an effect on the risk of infant use of hospital resources independent of gestational age.
Knowledge of HIV infection and ways of its transmission: a knowledge, attitudes, beliefs and practices (KABP) survey among a sample of students at the “Magna Graecia”, University of Catanzaro
No full textBackground. Continuous spreading of HIV infection may be due to a lack of knowledge, especially among young people. Methods. We decided to assess knowledge of HIV infection and risk factors in a sample of students at the “Magna Graecia” University of Catanzaro, using an anonymous multiple-choice questionnaire. Results. An anonymous multiple-choice questionnaire was administered in December 2015. Two hundred and sixty-six students responded (216 attending the medical school and 50 attending School of Law). Knowledge of HIV infection was scarce in a significant percentage of students who practice behaviours at risk for acquisition of HIV infection and STDs (sexually transmitted diseases) in general. Conclusion. This study shows that preventative and informative campaigns are urgently needed in earlier stage of adolescence to avoid acquisition of HIV infection and other STD
Uterus transplants and their ethical implications
Get PDFEarly experiments in womb transplants have increased interest in the possibility of performing this procedure in women who have no womb, usually for congenital reasons.The present article describes past experiments and summarises the most relevant reference documents before indicating the key ethical implications involved in womb transplants.
Risk adjusted mortality after hip replacement surgery. A retrospective study
Get PDFIntroduction: Hip replacement (HR) operations are increasing. Short term mortality is an indicator of quality; few studies include risk adjustment models to predict HR outcomes. We evaluated in-hospital and 30-day mortality in hospitalized patients for HR and compared the performance of two risk adjustment algorithms. Materials and methods: A retrospective cohort study on hospital discharge records of patients undergoing HR from 2000 to 2005 in Tuscany Region, Italy, applied All-Patient Refined Diagnosis Related Groups (APR-DRG) and Elixhauser Index (EI) risk adjustment models to predict outcomes. Logistic regression was used to analyse the performance of the two models; C statistic (C) was used to define their discriminating ability. Results: 25,850 hospital discharge records were studied. In-hospital and 30-day crude mortality were 1.3% and 3%, respectively. Female gender was a significant (p<0.001) protective factor under both models and had the following Odds Ratios (OR): 0.64 for in-hospital and 0.51 for 30-day mortality using APR-DRG and 0.55 and 0.48, respectively, with EI. Among EI comorbidities, heart failure and liver disease were associated with in-hospital (OR 9.29 and 5.60; p<0.001) and 30-day (OR 6.36 and 3.26; p<0.001) mortality. Increasing age and APR-DRG risk class were predictive of all the outcomes. Discriminating ability for in-hospital and 30-day mortality was reasonable with EI (C 0.79 and 0.68) and good with APR-DRG (C 0.86 and 0.82). Conclusions: Our study found that gender, age, EI comorbidities and APR-DRG risk of death are predictive factors of in-hospital and 30-day mortality outcomes in patients undergoing HR. At least one risk adjustment algorithm should always be implemented in patient management
Eating episode frequency and fruit and vegetable consumption among Italian university students
Get PDFObjective: To analyze breakfast consumption, regularity of meals, fruit and vegetable consumption in the Italian University Student population on a national level.Design: Descriptive analysis evaluating data taken from the “Sportello Salute Giovani” questionnaire.Participants: 12.000 university students who self-administered a confidential survey. 8292 questionnaires were analyzed.Variables measured: Age; sex; self-reported economic status; BMI; number of breakfast and portions of vegetables and portions of fruit usually consumed per week; number of eating episodes per day; intended weight loss.Analysis: Descriptive and logistic regression analyses were conducted. Gender and age differences were tested by Chi2 and Mann-Whitney tests.Results: 15.8% of males and 26.3% of females declared to consume at least one portion of fruit every day. Similar results were found for vegetable consumption. Age does not influence fruit or vegetables consumption, frequency of eating episodes or breakfast habit. Both a regular breakfast and a higher number of eating episodes are significantly associated both with a higher frequency of fruit and vegetables intake.Conclusions and implications: This study underlines the need to promote nutritional education campaigns to increase adherence to nutritional guidelines
Clinical ethics and the role of clinical ethics committees: proposals for a revival
Get PDFThe issue addressed in the paper published by the Italian National Bioethics Committee (NBC) entitled “Clinical ethics committees”, is highly significant for many reasons. One of these is the fact that the ethics committees charged with assessing clinical trials have so much responsibility and such a heavy work-load that they have little time available for other tasks such as engaging directly with patients “at the bedside”, as a result of which the role of committees responsible for assessing clinical cases is especially important. According to the NBC, the opinions of clinical ethics committees should be formulated jointly and are non-binding. The NBC offers practical proposals not only for the Italian context. While the Italian National Institute of Health (Istituto Superiore di Sanità – ISS) is not involved directly in treating patients, its role in providing guidance is crucial to the national health service and it has always paid special attention to these issues