Articles de revues : « Poor – Care – Italy »

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Pałucka1, Klaudia, Celina Łepecka-Klusek et Anna B. Pilewska-Kozak. « A midwife in Italy ». Pielegniarstwo XXI wieku / Nursing in the 21st Century 14, n^o 52 (30 septembre 2015) : 65–68. http://dx.doi.org/10.12923/p21w-2015-3/37.

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Introduction. Midwifery is one of the world’s oldest professions. Midwives are found in every corner of the world but the scope of their professional expertise may differ in various countries. Although there are numerous documents listing the midwife’s essential competencies, these professionals have to cope with various problems trying to upgrade their skills. A great example of that struggle could be found in Italy. This is one of the countries where midwives keep on fighting for autonomy. Theoretically, an Italian midwife is an independent health care employee, holding a university diploma and a license. In practice, most midwifes work only in hospitals. Italy is a country with the highest rate of caesarean sections in the European Union. In 2013, the rate was 36.3%. The obstetric care is dominated by gynecologists, whilst only some 3% of pregnancies is handled by midwives. This is due to the poor organization of medical care. After all, the role of a midwife is important in making the childbirth more humanized. There are some actual similarities between the professional situation of a nurse in Italy and Poland. They face similar problems when it comes to the implementation of their activities. Aim. The aim of the study was to discuss the position of midwives in Italy, with special attention paid to the legal standards, the education system and the professional independence.

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Cascella, Marco, Alessandro Vittori, Emiliano Petrucci, Franco Marinangeli, Antonino Giarratano, Cristina Cacciagrano, Emiliano Simone Tizi, Luca Miceli, Silvia Natoli et Arturo Cuomo. « Strengths and Weaknesses of Cancer Pain Management in Italy : Findings from a Nationwide SIAARTI Survey ». Healthcare 10, n^o 3 (25 février 2022) : 441. http://dx.doi.org/10.3390/healthcare10030441.

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Objectives: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. Design: This was a prospectively administered survey. Participants: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Intervention: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. Results: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seventy-five percent are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities (78%). The strengths of cancer pain management in Italy are the careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient’s quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. Conclusions: Despite several strengths, further efforts are needed to improve the care of patients suffering from cancer pain in Italy.

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Marinangeli, Franco, Annalisa Saetta et Antonio Lugini. « Current management of cancer pain in Italy : Expert opinion paper ». Open Medicine 17, n^o 1 (6 décembre 2021) : 34–45. http://dx.doi.org/10.1515/med-2021-0393.

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Abstract Introduction Chronic pain and breakthrough cancer pain (BTcP) have a high prevalence in all cancer types and cancer stages, combined with a significant physical, psychological, and economic burden. Despite efforts to improve appropriate management of cancer pain, a poor assessment and guilty undertreatment are still reported in many countries. The purpose of this expert opinion paper is to contribute to reduce and clarify these issues with a multidisciplinary perspective in order to share virtuous paths of care. Methods Common questions about cancer pain assessment and treatment were submitted to a multidisciplinary pool of Italian clinicians and the results were subsequently discussed and compared with the findings of the published literature. Conclusion Despite a dedicated law in Italy and effective treatments available, a low percentage of specialists assess pain and BTcP, defining the intensity with validated tools. Moreover, in accordance with the findings of the literature in many countries, the undertreatment of cancer pain is still prevalent. A multidisciplinary approach, more training programs for clinicians, personalised therapy drug formulations, and virtuous care pathways will be essential to improve cancer pain management.

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Eandi, Mario. « Pharmacoeconomic aspects of poor adherence to treatment in multiple sclerosis management ». Farmeconomia. Health economics and therapeutic pathways 12, n^o 3 (15 septembre 2011) : 107–17. http://dx.doi.org/10.7175/fe.v12i3.127.

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Multiple sclerosis (MS) is a chronic autoimmune disease, which affects the central nervous system and is the leading cause of chronic disability in young adults. Especially in the most common form characterized by relapses and remissions (RRMS), MS is a major burden on the NHS and society at a cost of illness per year for Italy estimated at 1.5 billion euros. The DMT (Disease-Modifying Therapies) when used continuously since the diagnosis of the disease have proved effective in reducing the risk of relapses, slowing the progression of the disease, reducing the consumption of health resources, especially hospitalizations, with a significant savings on healthcare costs. High rates of adherence have been associated with DMT not only to improved clinical performance, but also to a significant reduction in costs associated with the consumption of health resources. Because some recent studies have shown that the use of IFNβ-1a IM leads to better adherence to therapy and a significant savings in hospitalizations, outpatient visits, and also on the access to the PS, it is desirable that in Italy the use of IFNβ-1a IM will become ever greater. In this way, we can assume that we can achieve a significant saving in direct health care costs that affect the NHS, as has been observed in some foreign studies in which adherence to treatment was associated with a reduction in the average annual cost per patient between 33 and 65%.

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Bevan, Gwyn, Alice Evans et Sabina Nuti. « Reputations count : why benchmarking performance is improving health care across the world ». Health Economics, Policy and Law 14, n^o 2 (16 mars 2018) : 141–61. http://dx.doi.org/10.1017/s1744133117000561.

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AbstractThis paper explores what motivates improved health care performance. Previously, many have thought that performance would either improve via choice and competition or by relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary, but in the form of reputational effects through public reporting of benchmarking of performance. Drawing on natural experiments in Italy and the United Kingdom, we illustrate how public benchmarking can improve poor performance at the national level through ‘naming and shaming’ and enhance good performance at the sub-national level through ‘competitive benchmarking’ and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.

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MAFFI, LUCIANO, et MARCO ROCHINI. « Poor relief systems in rural Italy : the territory of the diocese of Tortona in the eighteenth century ». Continuity and Change 31, n^o 2 (12 juillet 2016) : 211–39. http://dx.doi.org/10.1017/s0268416016000242.

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AbstractThis article studies the development of poor relief in the rural areas of the diocese of Tortona in the eighteenth century, through the analysis of the parish reports written for the pastoral visits of bishops Giulio Resta and Giuseppe Lodovico Andujar in 1741 and 1743. The reports record the most important assistance activities organised by different social actors: dowries for poor girls; bread, money and clothing to distribute to the poor; but also formal support in the form of hospitals providing shelter and care for pilgrims and the sick; the monti di pietà, which loaned money and the grain stores, which provided essential loans of grain. The diocese of Tortona in the eighteenth century represents a privileged point of view for understanding how the development of poor relief in the ancien régime was influenced by the political and institutional, geographical, landowning and socio-ecomomic context. Here, a complex institutional situation, combined with a diverse geographical and socio-economic context, gave rise to a variety of poor relief systems.

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Palumbo, Rocco, Carmela Annarumma, Paola Adinolfi et Marco Musella. « The missing link to patient engagement in Italy ». Journal of Health Organization and Management 30, n^o 8 (21 novembre 2016) : 1183–203. http://dx.doi.org/10.1108/jhom-01-2016-0011.

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Purpose The purpose of this paper is to discuss the changing patterns of users’ behavior in the health care service system. Although patient engagement and health services’ co-production are understood as essential ingredients in the recipe for sustainable health systems, some determinants to patient involvement are still widely neglected by both policy makers and health care professionals. Among others, inadequate health literacy performs as a significant barrier to patient empowerment. Design/methodology/approach A survey aimed at objectively measuring health literacy-related skills was administered to a random sample of 600 Italian patients. The Italian version of the Newest Vital Sign (NVS) was used to assess the ability of the respondents to deal with written health information. Moreover, the respondents were asked to self-report their ability to navigate the health system. It was presumed that inadequate health literacy as measured by the NVS is related with impaired self-reported functional, interactive, and critical health-related competencies, paving the way for the inability and the unwillingness of patients to be involved in the health care provision. Findings About half of the sample showed inadequate health literacy. However, poor NVS scores were only slightly associated with limited self-reported functional, interactive, and critical health-related competencies. In general, patients with inadequate health-related skills were not likely to be engaged in the provision of health services. Elderly, people suffering from financial deprivation and less educated individuals were found to be at special risk of living with limited health literacy. Practical implications Limited health literacy is a common and relevant issue among people dealing with the health care service system. The impaired ability to collect, process, and use health information produces barriers to patient engagement and prevents the evolution of patients’ behavior toward health care co-production. Originality/value Health literacy is a widely overlooked issue in the Italian national health system. This paper contributes in shedding light on the determinants and effects of health literacy of Italian hospital patients. Besides, some insights on the validity of the methodological tools typically used to assess health-related skills are provided.

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Ielapi, Nicola, Davide Costa, Antonio Peluso, Carmelo Nobile, Veronica Venditti, Egidio Bevacqua, Michele Andreucci, Umberto Marcello Bracale et Raffaele Serra. « Wound Care Self-Efficacy Assessment of Italian Registered Nurses and Wound Care Education in Italian Nursing Education System : A Cross-Sectional Study ». Nursing Reports 12, n^o 3 (18 septembre 2022) : 674–84. http://dx.doi.org/10.3390/nursrep12030067.

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Wounds are a major public health challenge for nurses, and poor wound care has important implications for patients and health care systems. The aim of this study is to assess the Italian registered nurses’ (RNs) perception in the area of wound care, regarding their knowledge, tasks of care delivery, wound management, values, and attitudes, exploring also the previous specific education received during nursing education. An observational online web-based survey was used to assess learning goals and content for wound care education in undergraduate nursing education and the skills and level of self-efficacy in this area during clinical practice. The data were collected between April and May 2022. A total of 210 RNs were interviewed and divided into five national geographic areas. Northwestern RNs showed a better education about the wound care area during university courses: the rate of RNs that did not receive any training in the wound care area was lower than in other Italian geographical areas. Southern RNs presented a better knowledge about factors that expose the wound to becoming chronic, wound drains care, and the ability to assess diabetic foot. This study showed that, in Italy, education in wound care among nursing students is relatively poor, and many skills are achieved during an RN’s career in an empirical way.

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Zampino, Rosa, Nicolina Capoluongo, Adriana Boemio, Margherita Macera, Martina Vitrone, Luigi Elio Adinolfi, Pietro Filippini et al. « Effect of a Cooperation Strategy between Primary Care Physicians and Hospital Liver Units on HBV Care in Campania, Italy ». Canadian Journal of Gastroenterology and Hepatology 2018 (26 juillet 2018) : 1–6. http://dx.doi.org/10.1155/2018/5670374.

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Aims. This study is aimed at assessing the efficacy of an active search and treat strategy for HBV-infected subjects in an endemic area (Campania, Italy). To do this, we created a cooperation bundle between 24 General Practitioners (GPs) and 3 Hospital Liver Units (HLU). We assessed whether this strategy improved the detection of HBV infection in patients at risk and the overall quality of care, with the aim of reducing liver disease progression. Methods. We estimated that, among about 20,000 patients cared for by the 24 GPs, approximately 280 patients unaware of or underestimating HBV infection would be found. Identified patients were to be referred to the HLU for clinical evaluation and treatment from February 2016 for 12 months. Results. Unexpectedly, screening and enrolment were poor (48 patients only). GP workloads, patient financial difficulties, and patients' refusal were the major causes of enrolment failure according to GPs. All patients referred to HLU completed the program; most of them were HBV inactive carriers. Conclusions. This program failed to scavenge chronic HBV-infected patients in an endemic area and establish a successful clinical collaboration between GPs and HLU. Underlying reasons are diverse and call for new strategies to implement cooperation between primary care providers and hospital specialists.

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Ledda, Caterina, Flavia Carrasi, Maria Teresa Longombardo, Gianluca Paravizzini et Venerando Rapisarda. « SARS-CoV-2 Seroprevalence Post-First Wave among Primary Care Physicians in Catania (Italy) ». Tropical Medicine and Infectious Disease 6, n^o 1 (9 février 2021) : 21. http://dx.doi.org/10.3390/tropicalmed6010021.

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Family physicians or pediatricians and general practitioners (GPs) work in non-hospital settings. GPs usually visit many patients, frequently at their homes, with low potential, if any, to control the work setting. Particularly during the initial phases of the COVID-19 outbreak, they were not informed about the occurrence of SARS-CoV-2-infected patients, with inadequate information regarding the risk, a lack of suitable protective measures and, in some cases, deficient or poor accessibility to personal protective equipment (PPE). During the first wave of COVID-19, primary care physicians were on the front line and isolated the first cases of the disease. The present study aims to estimate the seroprevalence of SARS-CoV-2 in a cohort of 133 GPs working in Catania (Italy) after the first wave of COVID-19. Serological analysis revealed a low seroprevalence (3%) among GPs. The low seroprevalence highlighted in the results can be attributed to correct management of patients by GPs in the first wave. It is now hoped that mass vaccination, combined with appropriate behavior and use of PPE, can help further reduce the risk of COVID-19 disease.

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Ferrari, S., L. Malavolta, M. R. Laghezzi Ortolani, S. Mimmi et M. Rigatelli. « Home visit in mental health care : the “italian way” ». European Psychiatry 26, S2 (mars 2011) : 531. http://dx.doi.org/10.1016/s0924-9338(11)72238-6.

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IntroductionHome visits are an essential component of community mental health care for their potentials in prevention and rehabilitative interventions. In the tradition of the Italian organisation, home visits are commonly carried out by psychiatric nurses, usually case managers for patients receiving them. Poor training and scarce integration to other clinical activities are common problems addressed by mental health professionals.MethodsA written survey on attitudes, beliefs and reality of home visiting was submitted to all 95 mental health professionals working in the community mental health centres of the Modena District, North of Italy. The survey included the following sections: general information (including seniority of service); personal experience and emotions; description of “what actually happens”; opinions on training; comparison between reality and ideals.ResultsNinety-eight percent of contacted professionals responded to the questionnaire. Home visiting should be improved and better integrated according to 55% of respondents. Good integration with social services but poor planning and lack of periodical assessments of effectiveness were emphasized by respondents. Seniority of service was significantly associated to different opinions on aim (p = .043) and numbers of home visits (p = .02) as well as the specific mental health centre was strongly associated to different perceptions on quantitative load of home visits (p < .0001). Almost no perception of danger was addressed by respondents, particularly if older.ConclusionsHome visit is a powerful tool for assertive community treatments in psychiatry and should be a focus for training and research.

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Walker, M. D., K. Lykopoulos, E. McLeod, S. Cottrell et L. Christova. « Impact of brain metastases on health care costs in metastatic breast cancer : A multinational study ». Journal of Clinical Oncology 27, n^o 15_suppl (20 mai 2009) : 6555. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6555.

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6555 Background: Incidence of brain metastases (BM) are thought to be particularly high among patients with ErbB2+ (HER2+) breast cancer and have been associated with a poor survival prognosis. A previous study identified such patients as a considerable financial burden for health systems in Germany and France when compared to metastatic breast cancer (MBC) without BM. The objective of this study was to extend that analysis to estimate health care costs in Italy, Spain and the UK. Methods: Patient treatment histories, including drugs, specialist visits, procedures, inpatient stays etc, were collected retrospectively from a panel of oncologists for women with MBC across Italy, Spain and the UK, last seen by the responding oncologist during Q3-Q4 2006 or Q3-Q4 2007. To identify ErbB2+ patients they all had to have received/were receiving trastuzumab (TZ) for MBC. Patients were sampled so as to ensure the collection contained a minimum of 50 cases with BM and 200 histories overall (remainder controls). All costs within the observation period (initiation of TZ to date last seen) were calculated from a payer's perspective for patients who had developed BM and those who had not. Linear stepwise regression took into account potential confounding of time related covariates. Results: The study included 268 Italian (146 cases), 215 Spanish (126 cases) and 243 UK patients (103 cases). BM diagnosis was associated with significantly more expensive treatment histories than those patients without. Service costs such as radiotherapy and hospital visits were found to be key drivers for these differences (p<.001). Conclusions: The significantly greater cost associated with treatment of BMs in ErbB2+ MBC patients from Italy, Spain and the UK is consistent with results from identical French and German analyses. Therapies that reduce the incidence of BMs may therefore decrease the overall financial burden of ErbB2+ MBC. [Table: see text] [Table: see text]

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Valdagno, Marta, Arianna Goracci, Silvia di Volo et Andrea Fagiolini. « Telepsychiatry : new perspectives and open issues ». CNS Spectrums 19, n^o 6 (2 janvier 2014) : 479–81. http://dx.doi.org/10.1017/s1092852913000916.

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Telepsychiatry, thanks to the continuous advance of technologies, is an area with excellent prospects to become an effective tool for assistance in psychiatry. Many studies evaluated the effectiveness of telepsychiatry in different psychiatric disorders like anxiety disorders, psychotic disorders and depression. Results showed that telepsychiatry seems to be promising in anxiety and depressive disorders, especially in the maintenance phase, and also for psychotic disorders, especially for these cases with a poor compliance. We reviewed the literature to evaluate the feasibility of telepsychiatry in Italy in terms of satisfaction, costs and cultural acceptability and considering ethical and legal aspects. In Italy the development of telemedicine still presents a high level of fragmentation. A potential integration of these new types of services with the health care system is a very challenging task and poses many legal and ethical challenges. Therefore the creation of legal instruments and formal professional ethical guidelines are needed.

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Brodman, James. « Unequal in Charity ? Women and Hospitals in Medieval Catalonia ». Medieval Encounters 12, n^o 1 (2006) : 26–36. http://dx.doi.org/10.1163/157006706777502550.

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AbstractThis study asks whether charity in Catalonia had, in fact, any basis in gender, how treatment here compared with what historians have found in Italy, and what all of this says about the role that gender played within Catalan society. Late medieval Catalan charities assisted both men and women, but in different ways. Orphans, the sick, and the homeless of both genders received shelter and care, but, to some degree, males in these categories received more benefits than females. Other charity, such as assistance to poor, single women and to prostitutes, targeted females specifically and had no male counterpart. Gender considerations in the calculation of Catalan authorities seem to reflect an interest in promoting and preserving families and a social consciousness that privileged the so-called deserving poor over their marginalized sisters and brothers.

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Eandi, Mario. « Razionalizzare la spesa ospedaliera : Day-Hospital, ADI, Hospice ». Farmeconomia. Health economics and therapeutic pathways 6, n^o 2 (15 juin 2005) : 127–34. http://dx.doi.org/10.7175/fe.v6i2.830.

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In the modern age, advances in processes, technology and clinical imperatives generated an evolution of the health care organization, particularly regarding hospitals, born as generic shelter and poor house. Nowadays the availability of high technologies and the intensity of intervention on patients are the main factors to warrant the modern hospital for acute care. This evolution trend brings out the need for new models of health care, focused on people’s different request about assistance (e.g. day-hospital, day-surgery, integrated home care, hospice). The present study gives an outline of the Italian situation, which is deeply changed in the latest years. New models of heath care emerged in Italy, as it had previously in the United States and other European countries, as able to improve assistance and reduce costs: the average hospital stay decreased, while the number of day-hospital and day-surgery increased. In spite of the rise observed in the last 3-4 years, both integrated home care and hospice availability remain still limited, especially considering the high potential request of the elderly population and the oncologic patients.

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Bollini, Paola, Giovanni Muscettola, Antonella Piazza, Maurizio Puca et Gianni Tognoni. « Mental health care in Southern Italy : application of case–control methodology for the evaluation of the impact of the 1978 psychiatric reform ». Psychological Medicine 16, n^o 3 (août 1986) : 701–7. http://dx.doi.org/10.1017/s0033291700010448.

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SynopsisA survey to analyse patients' characteristics and the care delivered to them was conducted in several psychiatric facilities, covering the whole range of care offered in the public sector in two regions of Southern Italy. A case–control method of analysis was chosen, and the relative risk estimates (RR), together with their 95% confidence intervals (CI), of being in custodial facilities were computed, comparing patients treated in custodial institutions (‘cases’) with those in community-based services (‘controls’) in respect of social and clinical vairables. Factors more stongly associated with custodial treatment were: illiteracy (RR = 2·4), unmarried status (RR =2·4), a history of prolonged illness (RR = 7·6), organic diagnosis (RR = 2·6), previous custodial treatment (RR = 3·9), and expected poor social functioning (RR =2·4). The suitability and advantages of the case–control method of analysis in the field of psychiatric care evaluation are discussed.

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Cornelli, Umberto, Giovanni Belcaro, Maria Rosaria Cesarone, Martino Recchia et Roberto Cotellese. « The Second Wave of COVID-19 in Italy : What’s Going On ? » European Journal of Medical and Health Sciences 3, n^o 1 (14 janvier 2021) : 46–49. http://dx.doi.org/10.24018/ejmed.2021.3.1.638.

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Background: a second wave (W2) of COVID-19 is affecting Italy. Objective: to analyze the ratio between deaths and positive cases in two different 36-day periods of W2. Methods: data were retrieved by the Official Bulletin of the Italian Protezione Civile. The analysis was based on mobile averages. Results: The ratios deaths/positive cases in the first 35-day period form October 9th and November 13th were of 2.45 ± 0.482 and in the second 36-day period from November 14th and December 19th was 2.37 ± 0.416. There is no statistical difference between the periods (p> 0.05). The differences are significant (p<0.01) in terms of trends, since in the first period the curve is flat, while in the second is growing. Conclusions: the reason of the different trends are several, such as the starting of the colder season, the delay in providing with the common flu vaccination. the confusion about the initiative of lockdown, and the poor care for the older people.

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Leuter, Cinzia, Cristina Petrucci, Antonella Mattei, Gianpietro Tabassi et Loreto Lancia. « Ethical difficulties in nursing, educational needs and attitudes about using ethics resources ». Nursing Ethics 20, n^o 3 (27 novembre 2012) : 348–58. http://dx.doi.org/10.1177/0969733012455565.

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Ethical difficulties arise in healthcare practices. However, despite extensive research findings that demonstrate that most nurses are involved in recurrent ethical problems, institutions are not always able to effectively support nursing care professionals. The limited availability of ethics consultation services and traditional nursing training fails to meet the frequent and strong requests by health workers to support their ethical dilemmas. A questionnaire was administered to 374 nurses attending a specialist training and a lifetime learning programme in Italy. The respondents reported a high frequency of ethically sensitive situations, and they described the poor development of ethics support and a scarcity of ethics training programmes. The results suggest the importance of promoting ethics services that include consultation and ethics training. A need for systematic ethics educational activities was identified for improving the capacity of nurses to manage ethical issues in patient care.

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Costantini, Massimo, Katherine E. Sleeman, Carlo Peruselli et Irene J. Higginson. « Response and role of palliative care during the COVID-19 pandemic : A national telephone survey of hospices in Italy ». Palliative Medicine 34, n^o 7 (29 avril 2020) : 889–95. http://dx.doi.org/10.1177/0269216320920780.

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Background: Palliative care is an important component of health care in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making. Aim: To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries. Design: Cross-sectional telephone survey, in March 2020. Setting: Italian hospices, purposively sampled according to COVID-19 regional prevalence categorised as high (>25), medium (15–25) and low prevalence (<15) COVID-19 cases per 100,000 inhabitants. A brief questionnaire was developed to guide the interviews. Analysis was descriptive. Results: Seven high, five medium and four low prevalence hospices provided data. Two high prevalence hospices had experienced COVID-19 cases among both patients and staff. All hospices had implemented policy changes, and several had rapidly implemented changes in practice including transfer of staff from inpatient to community settings, change in admission criteria and daily telephone support for families. Concerns included scarcity of personal protective equipment, a lack of hospice-specific guidance on COVID-19, anxiety about needing to care for children and other relatives, and poor integration of palliative care in the acute planning response. Conclusion: The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic. Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic and ensure these services are integrated into the health care system response. Availability of personal protective equipment and setting-specific guidance is essential. Hospices may also need to be proactive in connecting with the acute pandemic response.

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De Guzman, Roselle, et Monica Malik. « Dual Challenge of Cancer and COVID-19 : Impact on Health Care and Socioeconomic Systems in Asia Pacific ». JCO Global Oncology, n^o 6 (septembre 2020) : 906–12. http://dx.doi.org/10.1200/go.20.00227.

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Coronavirus or COVID-19 is caused by severe acute respiratory syndrome coronavirus 2. The COVID-19 pandemic has resulted in social and economic disruption throughout the entire world. Each country is being challenged. Although much of the world’s focus has been on the rapid spread in Italy, Spain, and the United States, the potential impact on the world’s poor, a majority of whom are living in Asia, could be devastating. Asia has the world’s most densely populated cities, and its developing countries are facing challenges in their socioeconomic and health care systems. COVID-19 is quickly overwhelming the fragile and overstretched health systems of low- and low- to middle-income countries. With its aging population having chronic diseases and the growing burden of cancer, Asia is facing the dual challenge of controlling the spread of COVID-19 and at the same time providing and maintaining cancer care.

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Romanò, Massimo, Sabina Oldani, Valter Reina, Michele Sofia et Claudia Castiglioni. « Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy ». Healthcare 10, n^o 6 (2 juin 2022) : 1031. http://dx.doi.org/10.3390/healthcare10061031.

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Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [n = 78], heart disease [n = 55], and lung disease [n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10–20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2–3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice (n = 133), at home (n = 9), or after family-requested transfer to an emergency department (n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients.

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Addeo, Raffaele, Luca Pompella, Pasquale Vitale, Silvia Ileana Sara Fattoruso, Ilaria Di Giovanni, Francesco Perri, Michele Caraglia, Morena Fasano et Raffaele Arigliani. « The Art of Counseling in the Treatment of Head and Neck Cancer : Exploratory Investigation among Perceptions of Health Professionals in Southern Italy ». Current Oncology 29, n^o 9 (31 août 2022) : 6277–86. http://dx.doi.org/10.3390/curroncol29090493.

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(1) Background: Recurrent and/or metastatic patients with head and neck squamous cell carcinoma show a poor prognosis, which has not changed significantly in 30 years. Preserving quality of life is a primary goal for this subset of patients; (2) Methods: A group of 19 physicians working in South Italy and daily involved in head and neck cancer care took an anonymous online survey aimed at revealing the level of knowledge and the application of communication techniques in daily patient care; (3) Results: Several specialists, 18 out 19 (95%), considered that patient participation in therapeutic choices is mandatory. The main obstacles to complete and reciprocate communication still consist of lack of time and staff, but also in the need for greater organization, which goes beyond the multidisciplinary strategy already used; (4) Conclusions: A greater impulse to training and updating on issues related to counseling can improve communication between the different clinicians involved in the treatment plan.

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Ruggeri, Matteo, Carlo Drago, Chiara Cadeddu, Alessandro Armuzzi, Salvo Leone et Marco Marchetti. « The Determinants of Out-of-Pocket Expenditure in IBD Italian Patients. Results from the AMICI Survey ». International Journal of Environmental Research and Public Health 17, n^o 21 (4 novembre 2020) : 8156. http://dx.doi.org/10.3390/ijerph17218156.

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Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals’ age were in the range of 18–88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.

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Morris, Colin. « San Ranieri of Pisa : The Power and Limitations of Sanctity in Twelfth-Century Italy ». Journal of Ecclesiastical History 45, n^o 4 (octobre 1994) : 588–99. http://dx.doi.org/10.1017/s0022046900010770.

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Studies of medieval society in recent years have laid increasing stress on the effectiveness of the power of the saints. They enriched their churches, defended their possessions, created great centres at once of pilgrimage and commerce and provided for the healing of the sick and the care of the poor. The cults of the saints formed a model for secular government. Kings appeared before their people as walking reliccollections and exercised the power of healing, and patron saints (like St Mark at Venice and St Denis in France) helped to define the identity of the political communities over whose well-being they were thought to preside. Often such saints, even those whose cults were rapidly developing in the eleventh and twelfth centuries, were figures from the New Testament or from the ages of conversion: St James at Compostella, Mary Magdalen at Vézelay, and Benedict at Fleury. On occasions, however, a charismatic figure in contemporary society emerged as the centre of a healing cult and a focus for widespread devotion.

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De Palma, Rossana, Daniela Fortuna, Sarah E. Hegarty, Daniel Z. Louis, Rita Maria Melotti et Maria Luisa Moro. « Effectiveness of palliative care services : A population-based study of end-of-life care for cancer patients ». Palliative Medicine 32, n^o 8 (11 juin 2018) : 1344–52. http://dx.doi.org/10.1177/0269216318778729.

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Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) ( p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.

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Carpentieri, Gerardo, Carmen Guida et Houshmand E. Masoumi. « Multimodal Accessibility to Primary Health Services for the Elderly : A Case Study of Naples, Italy ». Sustainability 12, n^o 3 (21 janvier 2020) : 781. http://dx.doi.org/10.3390/su12030781.

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In Europe, the share of people aged 65 years and above is expected to increase exponentially, and in 2050, for the first time in human history, the number of older people will be larger than the number of children under the age of 15. Aging is associated with increased vulnerability and dependence on medical care services. For these reasons, providing access to health services to people aged 65 years and over is crucial. From the perspective of social equity, everyone should have the opportunity to access healthcare services equally, but due to economic and geographical issues, achieving this level of equity is challenging. The aim of this study was to fill the gap between scientific and actual practices using an accessibility measure to evaluate urban accessibility to primary healthcare services and to support decision-makers to better allocate resources in local restructuring of welfare policies. The accessibility measure was designed considering both the land use and the transportation components, the local healthcare supply system, and a multimodal transportation network. The methodology was applied to the city of Naples considering Local Health Agency (ASL) healthcare services to the elderly. The ASL is the largest health agency in Europe, consisting of 17 buildings serving nearly 200,000 elderly. The results show that the entire elderly neighborhood population suffers from poor accessibility to primary health services, especially in the city suburbs, and that the methodology could be effectively applied to urban planning strategies to achieve a high quality of life for elderly people. Due to poor dialogue between the authorities, this could help to improve the decision-making process through the lens of social equity.

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Patel, Priya, et Laura Lyons. « Examining the Knowledge, Awareness, and Perceptions of Palliative Care in the General Public Over Time : A Scoping Literature Review ». American Journal of Hospice and Palliative Medicine® 37, n^o 6 (5 novembre 2019) : 481–87. http://dx.doi.org/10.1177/1049909119885899.

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Background: The field of palliative care (PC) is growing as the world population ages and burden of chronic diseases increases. Thus, it is important that the general public is knowledgeable about PC and the benefits PC provides. Objective: The aim of this study is to describe the public’s knowledge, awareness, and perceptions of PC and determine whether these have changed over time. Methods: A scoping literature review was conducted from 1968 to May 2019 using PubMed, EMBASE, and MEDLINE databases. Results: Thirteen studies met inclusion criteria that originated from the United States, Canada, Scotland, Italy, New Zealand, Ireland, United Kingdom, Korea, and Sweden between years 2003 and 2019. Participants were adults and mostly younger than 64 years, women, and Caucasian. The majority of studies reported the public having poor knowledge (7/9 articles) and awareness (4/6 articles) of PC over the past 16 years. Top characteristics associated with increased levels of knowledge and/or awareness of PC included women (6/8 articles), age 40+ (6/8 articles), experience with a close friend and/or relative requiring PC (4/8 articles), and working in health-care and/or PC (4/8 articles). The most common perceptions of PC were associated with patients who have terminal illnesses and end-of-life care. Participants commonly received information about PC from the media, having a close friend or relative requiring PC, and working in a health-care setting. Conclusions: The public has poor knowledge and awareness about PC and several misperceptions exist. These findings have remained constant over time despite growth in the field of PC, which highlights the strong need for focused educational interventions.

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Maremmani, Angelo Giovanni Icro, Mirella Aglietti, Guido Intaschi et Silvia Bacciardi. « Substance Use/Dependence in Psychiatric Emergency Setting Leading to Hospitalization : Predictors of Continuity of Care ». International Journal of Environmental Research and Public Health 19, n^o 2 (11 janvier 2022) : 760. http://dx.doi.org/10.3390/ijerph19020760.

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Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering “Versilia Hospital” (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented.

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Ascari, A., S. Ferrari, M. Andreoli, M. Peggi et M. Rigatelli. « Frequent attenders at a primary care clinic : Occasional or regular abusers ? » European Psychiatry 26, S2 (mars 2011) : 1699. http://dx.doi.org/10.1016/s0924-9338(11)73403-4.

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BackgroundFrequent attendance in general practice is known for being associated with certain socio-demographical characteristics (female sex and middle-old age) and with important medical-psychiatric morbidity. Moreover, it has a high impact on workload of GPs. However, we have poor literature about long-term studies on Frequent Attenders (FAs) and persistent FAs.ObjectivesTo re-evaluate a group of patients of FAs after nine years since first assessment; to determine the existence of others FAs and possible differences between persistent and occasional FAs.MethodsConsultation of computerized data on 168 patients between 2001 and 2009; interwiew to the GP and the assistant.SettingA primary health care center in Fiorano Modenese (Modena, Northern Italy).Patients56 persistent FAs, 56 occasional FAs, 56 non FAs.Main outcome results: Twenty-eight of 40 patients (70%) evaluated in 2001 were found to be persistent FAs, most frequently older women. Medical morbidity was frequent among persistent FAs, and intermediate among occasional FAs, while psychiatric morbidity does not show important differences between the two groups; however, depression was present in 46% of persistent FAs and in 41% of occasional FAs, while somatization only in occasional FAs (10%), and not among persistent FAs. Persistent FAs received more prescriptions for all types of drugs, while among the occasional FAs the requests for a psychiatric treatment were higher.ConclusionsThe phenomenon of frequent attendance has a large amount and claims for further studies. Psychiatric morbidity between persistent and occasional FAs might have different expressions, requiring different clinical approaches to be specifically tailored.

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Amati, Rebecca, Tommaso Bellandi, Amer A. Kaissi et Annegret F. Hannawa. « Testing the Integrative Quality Care Assessment Tool (INQUAT) ». International Journal of Health Care Quality Assurance 33, n^o 1 (24 décembre 2019) : 120–44. http://dx.doi.org/10.1108/ijhcqa-03-2018-0065.

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Purpose Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers’ perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA. Design/methodology/approach Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample. Findings The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories’ subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes. Research limitations/implications The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT. Originality/value The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.

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Cvajner, Martina. « The Presentation of Self in Emigration ». ANNALS of the American Academy of Political and Social Science 642, n^o 1 (4 juin 2012) : 186–99. http://dx.doi.org/10.1177/0002716212438200.

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This article, based on five years of ethnographic fieldwork, describes the strategies for the presentation of the Self employed by Eastern European immigrant women in the Italian northeast. These middle-aged women migrated alone, are employed as live-in care workers, and often lack legal status. For them, migration is a deeply felt trauma, which they narrate as being forced upon them by the collapse of the USSR and the failures of the transition to a market economy. They perceive their life in Italy as degrading, their work is stressful and undignified, they miss their children, and they are often seen as poor mothers with questionable morals. Consequently, they seek to dilute the social stigma, presenting positive images of their selves and claiming respect from a variety of audiences. The women continuously endeavor to define their current condition as accidental and temporary and to assert their right to a better future.

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Marascio, Nadia, Angela Costantino, Stefania Taffon, Alessandra Lo Presti, Michele Equestre, Roberto Bruni, Giulio Pisani et al. « Phylogenetic and Molecular Analyses of More Prevalent HCV1b Subtype in the Calabria Region, Southern Italy ». Journal of Clinical Medicine 10, n^o 8 (13 avril 2021) : 1655. http://dx.doi.org/10.3390/jcm10081655.

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Hepatitis C virus subtype 1b (HCV1b) is still the most prevalent subtype worldwide, with massive expansion due to poor health care standards, such as blood transfusion and iatrogenic procedures. Despite safe and effective new direct antiviral agents (DAA), treatment success can depend on resistance-associated substitutions (RASs) carried in target genomic regions. Herein we investigated transmission clusters and RASs among isolates from HCV1b positive subjects in the Calabria Region. Forty-one NS5B and twenty-two NS5A sequences were obtained by Sanger sequencing. Phylogenetic analysis was performed using the maximum likelihood method and resistance substitutions were analyzed with the Geno2pheno tool. Phylogenetic analysis showed sixteen statistically supported clusters, with twelve containing Italian sequences mixed with foreign HCV1b isolates and four monophyletic clusters including only sequences from Calabria. Interestingly, HCV1b spread has been maintained by sporadic infections in geographically limited areas and by dental treatment or surgical intervention in the metropolitan area. The L159F NS5B RAS was found in 15 isolates and in particular 8/15 also showed the C316N substitution. The Y93H and L31M NS5A RASs were detected in three and one isolates, respectively. The A92T NS5A RAS was found in one isolate. Overall, frequencies of detected NS5B and NS5A RASs were 36.6% and 22.7%, respectively. For the eradication of infection, improved screening policies should be considered and the prevalence of natural RASs carried on viral strains.

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Carta, MG, A. Preti, I. Portoghese, E. Pisanu, D. Moro, M. Pintus, E. Pintus et al. « Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System ? » Clinical Practice & ; Epidemiology in Mental Health 13, n^o 1 (13 octobre 2017) : 156–67. http://dx.doi.org/10.2174/1745017901713010156.

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Background:Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.Objectives:To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.Method:Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).Results:The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e.those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.Conclusion:Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

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De Leo, Amalia, Giulia D’Adamo, Carlotta Morozzi et Caterina Gozzoli. « Taking Care of Forced Migrants Together : Strengths and Weaknesses of Interorganizational Work from the Perspective of Social Workers ». International Journal of Environmental Research and Public Health 20, n^o 2 (12 janvier 2023) : 1371. http://dx.doi.org/10.3390/ijerph20021371.

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The reception and taking care of forced migrants with mental health issues is undoubtedly a very complex task. The literature shows that reception systems are characterized by a high level of fragmentation due to poor collaboration among services that are required to respond to complex and multidimensional needs brought by forced migrants. Starting from the need to deepen what elements support or hinder the implementation of the services’ networks for the care and management of forced migrants, qualitative research was conducted within a constructivist paradigm. As the literature reveals a lack of studies considering the perspective of practitioners, we decided to explore the representations of professionals working with migrants in northern Italy in four different service areas (health and psychological well-being, reception, family, and legal areas). A total of 24 professionals (13 F and 11 M) with an average age of 42.4 years were involved in four focus groups according to the four areas. A paper–pencil content analysis was conducted following IPA guidelines. The results show strengths, weaknesses, and elements of improvement for service network implementation. The needs of forced migrants seem to be effectively met only through a service network that takes shape in the interweaving of social, organizational, group, and individual levels.

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Valcárcel-Nazco, Cristina, Yolanda Ramallo-Fariña, Renata Linertová, Juan Manuel Ramos-Goñi, Lidia García-Pérez et Pedro Serrano-Aguilar. « Health-Related Quality of Life and Perceived Burden of Informal Caregivers of Patients with Rare Diseases in Selected European Countries ». International Journal of Environmental Research and Public Health 19, n^o 13 (5 juillet 2022) : 8208. http://dx.doi.org/10.3390/ijerph19138208.

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Most of rare disease (RD) patients are assisted in their homes by their family as informal caregivers, causing a substantial burden among family members devoted to care. The role of informal caregivers has been associated with increased levels of stress, poor physical/mental health and impaired HRQOL. The present study assessed the impact on HRQOL and perceived burden of long-term informal caregiving, as well as the inter-relationships of individuals affected by different RD in six European countries, taking advantage of the data provided by the BURQOL-RD project (France, Germany, Italy, Spain, Sweden and UK). Correlation analysis was used to explore the relation between caregiver HRQOL and caregiver burden (Zarit Burden Interview). Multinomial logistic regression models were used to explore the role of explanatory variables on each domain of caregivers HRQOL measured by EQ-5D. Caregivers’ HRQOL is inversely correlated with burden of caring. Mobility dimension of EQ-5D was significantly associated with patients age, time devoted to care by secondary caregivers, patient gender and patient utility index. Patients’ age, burden scores and patient utility index significantly predict the capacity of caregivers to perform activities of daily living. Employed caregivers are less likely of reporting ‘slight problems’ in pain/discomfort dimensions than unemployed caregivers. The EQ-5D instrument is sensitive to measure differences in HRQOL between caregivers with different levels of burden of care.

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Polistena, Barbara, Donato Rigante, Ludovico Luca Sicignano, Elena Verrecchia, Raffaele Manna, Daniela d’Angela et Federico Spandonaro. « Survey about the Quality of Life of Italian Patients with Fabry Disease ». Diseases 9, n^o 4 (15 octobre 2021) : 72. http://dx.doi.org/10.3390/diseases9040072.

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Fabry disease (FD) is a genetic disease included in the group of lysosomal storage disorders, caused by X-linked deficiency of the enzyme alpha-galactosidase A. The aim of this study was to evaluate different aspects related to the quality of life (QoL) of a multicentre cohort of Italian patients with FD. An observational survey was conducted to measure health-related quality of life (HR-QoL) in FD patients using the CAPI (Computer-Assisted Personal Interview) method: 106 patients (mostly women) responded to the questionnaire. Geographically, 53.7% of patients lived in northern Italy, 18.9% in central Italy and 27.4% in southern Italy or the Islands. All data were collected through a five-dimensional EuroQoL questionnaire referring to functional aspects (mobility, personal care, routine activities) and perception of physical/mental well-being (pain or discomfort, anxiety or depression). A descriptive analysis of responses was performed; FD patients were compared in terms of QoL with subjects suffering from other chronic diseases, such as Crohn’s disease, chronic hepatitis, cirrhosis and multiple sclerosis. Difficulty in normal daily activities was reported by 47.2% of FD patients. About one third of subjects also had mobility difficulties. Feelings of loneliness and isolation were reported by 33.3% of those being 60–69 years old. Anxiety was equally reported in both oldest and youngest patients (66.7%), while depression, relational problems, fear of other people’s judgement increased along with age, reaching 66.7% in the over-70-years group. Male patients were largely troubled about the risk of physical disability, particularly those aged 60 years or over. Furthermore, FD patients had a poorer QoL than people suffering from other chronic inflammatory disorders. Our study upholds that FD patients have a poor QoL, as already known, negatively impacting psychic well-being and social activities. Our survey has also found a worse QoL in FD patients compared with other severe chronic disorders.

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Corli, Oscar, Giacomo Pellegrini, Cristina Bosetti, Luca Riva, Matteo Crippa, Emanuele Amodio et Gianlorenzo Scaccabarozzi. « Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. Results from the DEMETRA Study ». International Journal of Environmental Research and Public Health 17, n^o 22 (14 novembre 2020) : 8429. http://dx.doi.org/10.3390/ijerph17228429.

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Background: Cancer patients experience multiple symptoms throughout the course of the disease. We aimed to provide a comprehensive analysis of the symptom burden in patients with advanced cancer at admission to specialist palliative care (PC) services and seven days later to estimate the immediate impact of PC intervention. Patient and methods: The analysis was based on an observational, prospective, multicenter study (named DEMETRA) conducted in Italy on new patients accessing network specialist PC centers during the period May 2017–November 2017. The prevalence and intensity of symptoms were assessed at baseline and after seven days using three tools including the Edmonton Symptom Assessment System (ESAS). Results: Five PC centers recruited 865 cancer patients. Thirty-three different symptoms were observed at the baseline, the most frequent being asthenia (84.9%) and poor well-being (71%). The intensity of the most frequent symptoms according to ESAS ranged from 5.5 for asthenia to 3.9 for nausea. The presence and intensity of physical symptoms increased with increasing levels of anxiety and depression. After seven days, prevalence of nausea and breathlessness as well as intensity of almost all symptoms significantly decreased. Conclusions: The study confirmed the considerable symptom burden of patients with advanced cancer. PC intervention has significantly reduced the severity of symptoms, despite the patients’ advanced disease and short survival.

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Jackson, Christopher H., Francesca Grosso, Kevin Kunzmann, Alice Corbella, Maria Gramegna, Marcello Tirani, Silvana Castaldi, Danilo Cereda, Daniela De Angelis et Anne Presanis. « Trends in outcomes following COVID-19 symptom onset in Milan : a cohort study ». BMJ Open 12, n^o 3 (mars 2022) : e054859. http://dx.doi.org/10.1136/bmjopen-2021-054859.

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BackgroundFor people with symptomatic COVID-19, the relative risks of hospital admission, death without hospital admission and recovery without admission, and the times to those events, are not well understood. We describe how these quantities varied with individual characteristics, and through the first wave of the pandemic, in Milan, Italy.MethodsA cohort study of 27 598 people with known COVID-19 symptom onset date in Milan, Italy, testing positive between February and June 2020 and followed up until 17 July 2020. The probabilities of different events, and the times to events, were estimated using a mixture multistate model.ResultsThe risk of death without hospital admission was higher in March and April (for non-care home residents, 6%–8% compared with 2%–3% in other months) and substantially higher for care home residents (22%–29% in March). For all groups, the probabilities of hospitalisation decreased from February to June. The probabilities of hospitalisation also increased with age, and were higher for men, substantially lower for healthcare workers and care home residents, and higher for people with comorbidities. Times to hospitalisation and confirmed recovery also decreased throughout the first wave. Combining these results with our previously developed model for events following hospitalisation, the overall symptomatic case fatality risk was 15.8% (15.4%–16.2%).ConclusionsThe highest risks of death before hospital admission coincided with periods of severe burden on the healthcare system in Lombardy. Outcomes for care home residents were particularly poor. Outcomes improved as the first wave waned, community healthcare resources were reinforced and testing became more widely available.

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Gigantesco, Antonella, Angelo Picardi, Elvira Chiaia, Andrea Balbi et Pierluigi Morosini. « Patients’ and relatives’ satisfaction with psychiatric services in a large catchment area in Rome ». European Psychiatry 17, n^o 3 (mai 2002) : 139–47. http://dx.doi.org/10.1016/s0924-9338(02)00643-0.

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SummaryObjectiveTo assess the satisfaction of patients and their relatives with psychiatric care and to identify variables associated with any dissatisfaction.MethodsThe study was performed in a defined psychiatric catchment area in south Rome, Italy. All eligible patients and relatives who had contacts with services during a predefined period were asked to participate. Satisfaction with psychiatric services was measured with a previously validated questionnaire.ResultsA total of 890 patients were asked to participate in the study and 855 (96%) accepted. Also, 270 relatives were asked to participate and 265 (98%) agreed. The satisfaction with services expressed by outpatients and their relatives was fairly good, with the exception of poor satisfaction with information about treatment and involvement in the treatment programme. The satisfaction of inpatients and their relatives was significantly lower, with the issue of information-giving by staff appearing particularly critical. Among patients, variables associated with dissatisfaction were being an inpatient, having a diagnosis of psychosis, being in contact with services for more than 6 years, and being single. Among relatives, being female and being the relative of an inpatient were associated with dissatisfaction. For both patients and relatives, receiving inpatient care was the strongest predictor of dissatisfaction.ConclusionsThe results suggest that inpatient care, especially for psychotic patients, needs to be improved and that special attention should be devoted to inform adequately and to engage in treatment both patients and their relatives. Lack of information appears to be a crucial determinant of dissatisfaction with psychiatric care among both patients and their relatives.

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D’Addazio, Gianmaria, Manlio Santilli, Bruna Sinjari, Edit Xhajanka, Imena Rexhepi, Rocco Mangifesta et Sergio Caputi. « Access to Dental Care—A Survey from Dentists, People with Disabilities and Caregivers ». International Journal of Environmental Research and Public Health 18, n^o 4 (6 février 2021) : 1556. http://dx.doi.org/10.3390/ijerph18041556.

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The literature highlights differences in the dental conditions of people with disabilities compared with the general population. The aim of this study was to provide an overview of the dental health of people with disabilities in order to understand if their needs are met and to identify their most critical issues as per dentists. A paper and a Google Form platform were used in conducting a survey in Central Italy (the Abruzzo region), by performing an analysis on different points of view as reported by people with disabilities and dentists. The results showed that only 69.2% of dentists treat persons with disabilities. Of these, 73.5% treat less than 10 patients with physical disabilities per year. However, 54% of dentists do not treat people with cognitive impairment and a poor ability to collaborate during treatment. More than 80% of respondent dentists report that people with disabilities do not have good oral hygiene. On the other hand, 49.1% of people with disabilities (or their caregivers in cases where the patient was unable to answer) report that they rarely or never go to the dental office. Moreover, when they do go, it is mainly for emergencies. Despite this, respondents are well aware of their dental problems. However, they have difficulties in communicating their dental problems to their dentist. The 50% of dentists who treat people with cognitive impairment do not include them in follow-up, while only 20% of these patients reported being regularly recalled. This illustrates the importance of the implementation of follow-up. In addition, training courses could help clinicians to reduce this gap and create barrier-free dental offices.

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Contoli, Benedetta, Valentina Possenti, Rosaria Gallo, Valentina Minardi et Maria Masocco. « Data from the PASSI d’Argento Surveillance System on Difficulties Met by Older Adults in Accessing Health Services in Italy as Major Risk Factor to Health Outcomes ». International Journal of Environmental Research and Public Health 19, n^o 16 (19 août 2022) : 10340. http://dx.doi.org/10.3390/ijerph191610340.

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(1) Age-friendly health systems ensure access to quality healthcare services to all people, especially older adults. (2) We used data on elderly population collected from 2016 to 2019 by the Italian ongoing surveillance system PASSI d’Argento to analyze the prevalence and associations between accessing health services and modifiable risk factors included in the 25 × 25 strategy for the burden of noncommunicable diseases with health outcomes. (3) Chronic diseases and hospitalization as descriptors of health status showed that the elderly perceived as having poor access to care and prevention incurred a higher risk of hospitalization. The association between difficulties in accessing health services and hospitalization was always the highest in terms of the adjusted prevalence ratio (aPR), regardless of the other behavioral risk factors considered, controlling each model with sociodemographic conditions. Elderly hospitalized at least once for two days or more in the last 12 months had greater risk to have problems in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75–2.17), smoking (aPR = 1.95 95% CI 1.76–2.16), alcohol use (aPR = 1.93 95% CI 1.73–2.14), hypertension (aPR = 1.92 95% CI 1.73–2.13) and diabetes (aPR = 1.91 95% CI 1.73–2.12). (4) Health policies should encompass socio-economic and living environment barriers which prevent access to care among older adults.

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Fortunato, Alexandro, Guido Giovanardi, Marta Mirabella, Domenico Di Ceglie, Anna Maria Speranza, Giorgio Caviglia et Vittorio Lingiardi. « Caring for gender diverse children and adolescents in Italy : A mixed-method investigation of clinicians’ knowledge and approach to clinical practice ». Clinical Child Psychology and Psychiatry 25, n^o 4 (5 juin 2020) : 1049–67. http://dx.doi.org/10.1177/1359104520925526.

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Introduction: In today’s Italy, gender diversity has assumed a remarkable resonance and visibility in both scientific and popular literature, which has facilitated the development of studies regarding treatments and support for children and adolescents with gender-related issues. Aim: the aim of this study was to conduct a preliminary evaluation of how Italian clinicians (psychologists and pediatricians) perceive gender variant children and adolescents, evaluating their approach to clinical practice. Methods: An online questionnaire directed to clinicians regarding their experience with, and perceptions of, gender variant children and adolescents was used for the first part of the research. In the second part of this study, Consensual Qualitative Research (CQR) methodology was applied to semi-structured interviews aimed at investigating clinicians’ approach to clinical practice. Results: Professionals reported 374 cases, including 200 children (aged 2–11 years) and 174 adolescents (aged 12–19 years); a total of 10 interviews were conducted with professionals. Conclusion: This study highlights the increase of gender variant children and adolescents seen by professionals, but also the poor awareness of Italian professionals about gender diversity and their care, as well as an absence of a network model of intervention.

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Zanobini, Patrizio, Chiara Lorini, Saverio Caini, Vieri Lastrucci, Maria Masocco, Valentina Minardi, Valentina Possenti, Giovanna Mereu, Rossella Cecconi et Guglielmo Bonaccorsi. « Health Literacy, Socioeconomic Status and Vaccination Uptake : A Study on Influenza Vaccination in a Population-Based Sample ». International Journal of Environmental Research and Public Health 19, n^o 11 (6 juin 2022) : 6925. http://dx.doi.org/10.3390/ijerph19116925.

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Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

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Cossar, Roisin. « Lay Women in the Hospitals of Late Medieval Bergamo ». Florilegium 21, n^o 1 (janvier 2004) : 43–65. http://dx.doi.org/10.3138/flor.21.005.

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Throughout Italian cities in the later Middle Ages, civic and ecclesiastical authorities consolidated small hospitals primarily designed to house the sick, poor, and other social marginals into large institutions with a mandate to provide professional medical care to the entire community. In many cities in northern Italy, hospital restructuring was accompanied by the establishment of provveditori di sanità - guardians of public health - to oversee the medical profession and prevent outbreaks of plague. These changes were preceded by several decades of reform measures designed to bring hospitals more effectively under the control of civic and ecclesiastical authorities. Traditionally, historians have presented this period of reform as the triumph of Renaissance rationality over defective, corrupt medieval institutions. Examining hospital reform through the lens of gender complicates that view by revealing that the reform of medieval hospitals was accompanied by ambivalence among authorities towards the activities of lay women who had previously lived undisturbed within the institutions. Tracing the reasons for changes to perceptions of women in hospitals forces us to redefine the effects of hospital reform at the end of the Middle Ages.

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Founti, Panayiota, Fotis Topouzis, Gábor Holló, Barbara Cvenkel, Michele Iester, Anna-Bettina Haidich, Péter Kóthy, Anneta Kiana, Despoina Kolokotroni et Ananth C. Viswanathan. « Prospective study of glaucoma referrals across Europe : are we using resources wisely ? » British Journal of Ophthalmology 102, n^o 3 (3 août 2017) : 329–37. http://dx.doi.org/10.1136/bjophthalmol-2017-310249.

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BackgroundTo investigate the outcomes of glaucoma referrals across different European countries.Methods250 patients newly referred to tertiary referral glaucoma specialist practices in the UK, Hungary, Slovenia, Italy and Greece were prospectively enrolled (50 consecutive patients per centre). Referral accuracy and predictive value of referral criteria for an intervention or further monitoring (positive predictive value) were analysed.ResultsSame-day discharges occurred in 43% (95% CI 39% to 75%) (12/28) of optometrist-initiated referrals (UK only), 37% (95% CI 30% to 45%) (59/158) of ophthalmologist-initiated referrals (all centres) and 54% (95% CI 40% to 68%) (26/48) of self-referrals (Hungary, Italy and Greece). The percentages from all referral sources were 46% (95% CI 32% to 60%) in the UK, 56% (95% CI 44% to 70%) in Hungary, 30% (95% CI 17% to 43%) in Slovenia, 22% (95% CI 11% to 34%) in Italy and 60% (95% CI 46% to 74%) in Greece (p<0.001). Overall, the referring criterion was confirmed in 54% (95% CI 45% to 63%) (64/119) for intraocular pressure (IOP) >21 mm Hg, 56% (95% CI 43% to 69%) (33/59) for a suspicious optic disc and 61% (95% CI 45% to 77%) (22/36) for a suspicious visual field, with large between-country differences (p<0.05 for all comparisons). Of all referrals, 32% (95% CI 26% to 37%) were initiated on the basis of IOP >21 mm Hg only. By combining the IOP criterion with any other referring criterion, the positive predictive value increased from 56% (95% CI 45% to 67%) to at least 89% (95% CI 68% to 100%). In the UK, a hypothetical IOP threshold of >26 mm Hg, as a requirement for IOP-only referrals, would reduce IOP-only referrals by 44%, while not missing any definite glaucoma cases.ConclusionThe accuracy of referrals was poor in the UK and the other countries. Requiring a combination of criteria and raising the IOP threshold for IOP-only referrals are needed to cut waste in clinical care.

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Pelullo, Concetta Paola, Pamela Tortoriello, Silvia Angelillo, Francesca Licata, Francesco Napolitano et Gabriella Di Giuseppe. « Assessment of Perceived Health Status and Access to Health Service during the COVID-19 Pandemic : Cross-Sectional Survey in Italy ». Vaccines 10, n^o 12 (30 novembre 2022) : 2051. http://dx.doi.org/10.3390/vaccines10122051.

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(1) Background: The aims of this survey were to assess the perceived health status and to evaluate the use of healthcare services during the pandemic period. (2) Methods: This cross-sectional survey was conducted from May to October 2021 in the Campania and Calabria regions, Southern Italy. The sample was selected among 655 subjects attending vaccination or primary care physician clinics. (3) Results: More than half (57.2%) of the respondents were female, the mean age was 49 years (range 19–97), and 61.3% had at least one chronic disease. Among the respondents, 56.3% declared that they had accessed healthcare at least once during the pandemic and, among all respondents who did not access healthcare, 23.2% gave reasons related to the COVID-19 pandemic. The two scores obtained from the Short-Form-12 Health Survey (SF-12), physical health summary (PCS) and mental health summary (MCS), had a means of 48.4 and 45.9, respectively. Among the respondents, 2.3% of respondents considered their health poor, 43.1% good and 6.4% excellent. (4) Conclusions: Our results suggest the need to ensure, in similar health emergency situations, a quick response from the National Health System so that ordinary medical assistance activities can be guaranteed in full safety, avoiding the risk of missed access or lack of assistance.

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Caruso, Michele, Vincenzo Adamo, Paolo Tralongo, Dario Giuffrida, Vittorio Gebbia, Vita Leonardi, Hector J. Soto Parra et al. « Retrast : Retreatment after adjuvant trastuzumab—Our regional southern Italy experience. » Journal of Clinical Oncology 31, n^o 15_suppl (20 mai 2013) : e11526-e11526. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e11526.

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e11526 Background: Trastuzumab (T) is the standard of care for pts with HER2+ve BC. Relapse after adj T remains a rare event. Since the large use of T in adj setting, becomes crucial to evaluate advantages of retreatment with T for pts who relapsed after treatment in early stage. There is still lack of clinical evidence and poor data from CT to say that there is a benefit in T re-exposure after relapse following adj T. Methods: Since Jun 2006 and Dec 2011, we reviewed pts with early BC treated with T in adj therapy, relapsed and re-treated with T in first line therapy, in 10 departments of medical oncology in Sicily. We aimed to study feasibility, responses and treatment outcome. Results: 62 pts with HER2+ve fulfilled the criteria for this analysis and 47 were evaluated. Pts had a median age of 53 ys (29-79). ER/PgR-ve cases were 16 (34 %). Ki67 was > 20% in 34 pts (74%). 31 pts (64%) had >3 nodes+ve. All the pts received adj therapy with anthra+/-taxane. 55% of pts had >2 metastatic sites. 12 (25,5%) pts were revalued for HER2: 10 pts confirmed 3+ and two pts 2+ were FISH+. Median time from diagnosis to relapse was 25 mos (7 – 36). Median time from last dose of T to relapse was 10 ms (2 – 35). 33 (70,2%) pts and 14 pts (29,8%) had early (< 12 ms) and late progression (≥ 12 ms) respectively after adj T. First line of therapy was T in combination with mono/polychemotherapy in 42 pts (89,3%) and 5 pts (10,6%) respectively. 27 pts (57,4%) had objective responses (CR 5, PR 22) and 7 pts (14,8%) stable disease. 13 pts (27,6%) had progression: all of these pts had early progressive disease after adj T, 9 pts (69,2%) had Ki67>20%, 5 pts (38,4%) were ER/PgR-ve and 8 pts (61,5%) ER/PgR+ve. Median TTP was 4 mos (range 2-7). Median TTP for early and late relapses pts were respectively 3,7 and 4,8 mos, (p = 0,4). Median OS from relapse to death was 23 mos (r 12 – 37). LVSD G1 (EF < 60-50%) was observed only in 7 pts (14%). Conclusions: Our data confirm the feasibility and safety of treatment with T after adj T therapy and is active for a disease control rate in 72,4% of cases. These results demonstrate that relapses after adj T occurred early (<12 ms) in 70% of pts. However pts with primary resistance (27,6%) should be well categorized using biomolecular markers to receive up-front drugs that overcome the resistance to T.

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Gigantesco, Antonella, Gabriella Palumbo, Loredana Cena, Laura Camoni, Alice Trainini, Alberto Stefana et Fiorino Mirabella. « The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy ». PLOS ONE 16, n^o 11 (29 novembre 2021) : e0260596. http://dx.doi.org/10.1371/journal.pone.0260596.

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Background The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women. Methods A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated. Main findings During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68). Conclusion Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.

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Garrido-Cumbrera, M., H. Marzo-Ortega, L. Christen, L. Carmona, J. Correa-Fernández, S. Sanz-Gómez, E. Mateus et al. « AB0675 COUNTRY COMPARISON ON THE IMPACT OF THE COVID-19 PANDEMIC ON PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1) ». Annals of the Rheumatic Diseases 80, Suppl 1 (19 mai 2021) : 1369–70. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2372.

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Background:The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs).Objectives:The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables.Results:1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1).Conclusion:The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.Table 1.Bivariate analysis between European countries (N=1,800, unless specified)Mean ± SD or n (%)UKn: 558Spainn: 464Francen: 229Greecen: 57Cyprusn: 101Italyn: 127Portugaln: 264- Inflammatory arthritis1509 (91.2)402 (86.6)147 (64.2)33 (57.9)57 (56.4)89 (70.1)120 (45.5)- Fibromyalgia53 (9.5)14 (3.0)26 (11.4)14 (24.6)28 (27.7)53 (41.7)124 (47.0)- Connective tissue disease236 (6.5)15 (3.2)13 (5.7)25 (43.9)33 (32.7)30 (23.6)61 (23.1)- Osteoarthritis140 (25.1)29 (6.3)102 (44.5)0 (0.0)8 (7.9)15 (11.8)13 (4.9)- Osteoporosis50 (9.0)3 (0.6)20 (8.7)2 (3.5)9 (8.9)18 (14.2)12 (4.5)- Vasculitis39 (1.6)1 (0.2)6 (2.6)3 (5.3)3 (3.0)5 (3.9)9 (3.4)- Sapho (only France)15 (6.6)Smoking, More than before.N= 55616 (10.3)48 (37.8)22 (24.7)8 (23.5)9 (32.1)8 (20.5)26 (31.0)Alcohol consumption, More than before. N= 1,08599 (36.3)48 (10.3)27 (27.0)4 (7.0)4 (4.0)4 (13.3)11 (18.3)Unable to meet rheumatologist. N= 72283 (48.8)186 (82.3)27 (30.3)18 (64.3)22 (51.2)9 (31.0)77 (56.2)Access to primary care. N= 68987 (76.3)65 (67.7)32 (76.2)14 (60.9)17 (60.7)65 (51.6)117 (45.0)Change in health status, Much worse or worse. N=1,786214 (38.4)245 (53.3)98 (43.0)24 (42.9)38 (38.4)78 (61.9)135 (51.9)WHO-5. Poor well-being (≤50).N= 1,777292 (52.5)303 (66.9)100 (43.9)21 (37.5)46 (46.5)30 (23.8)78 (30.1)Risk of anxiety. N= 1,769241 (43.6)309 (68.5)118 (52.0)31 (55.4)61 (62.2)78 (61.9)175 (67.8)Risk of depression. N= 1,769186 (33.6)232 (51.4)101 (44.5)31 (55.4)54 (55.1)69 (54.8)138 (53.8)Note: all relations were significant at the 0.001 level. 1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

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Brunori, Luisa, Giorgio Magnani et Chiara Bleve. « Microcredito e salute mentale ». RIVISTA SPERIMENTALE DI FRENIATRIA, n^o 2 (août 2009) : 127–41. http://dx.doi.org/10.3280/rsf2009-002007.

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- Micro-credit, a Bengali invention of Professor Muhammad Yunus, is an innovative practice of credit, based on very small loans, given to people traditionally ignored by the banking system. These loans allow people to open small businesses or to support their current activities. Micro-credit is a tool that develops the potentials of marginal people and encourages autonomy. It represents a parallel welfare policy that holds back human passivity, supports self-recovery, and reprocesses the social dimension of relationship, the internal/external dialectic between individual and group. Micro-credit involves the "poorest of the poor", the people traditionally excluded from the banking system, because considered "not includable", or simply "not trustworthy" enough. This paper describes micro-credit practices, adopted by the mental health service of Carpi (a small town in northern Italy). The basic aim of this service is to counter the idea that people with psychiatric disorders, as the poor, are not worthy of trust, nor of receiving financial loans. Micro-credit enhances autonomy, initiative and shared responsibility. It is a basic tool of active citizenship. It represents an alternative model of welfare and of coconstructed care: a collaborative model built with different stakeholders. It is an important tool to keep in check public costs by promoting self-esteem and quality of life, by bringing people to become more autonomous and less dependent on services.Parole Chiave: microcredito, fiducia, gruppo, gruppoanalisi, riabilitazione, beni relazionali, salute mentale.Key Words: micro-credit, trust, group, group analysis, rehabilitation, relational goods, mental health.

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