Stability of Psychiatric Diagnoses in Candidates to Liver Transplantation Referred to a Consultation-Liaison Psychiatry Service

Objective: To investigate the stability over time of the psychiatric diagnoses among candidates to liver transplantation referred to a consultation-liaison psychiatric service. Method: Descriptive study, carried out at the Consultation-Liaison Psychiatry Service (CLPS) placed at the Modena (Italy) General University Hospital. All patients waiting for liver transplantation and repeatedly referred to the CLPS were enrolled. The observation period was from 1 January 2008 to 31 December 2013. Pearson\u2019s coefficients were calculated to measure diagnostic stability (index referral vs. last referral). Results: One hundred patients were assessed (males 67%; mean age 53 \ub1 7 years old). The mean number of referrals for patients was 3 \ub1 2. The stability rate of psychiatric diagnosis was 64%. The following diagnoses or conditions were all significantly stable (i.e., all featured by r > 0.5 and p < 0.05): Adjustment disorder, depressive disorder, comorbid anxiety/depressive disorder, substance use disorder (including alcohol), absence of any disorder, and presence of any disorder. Conclusions: The good level of diagnostic stability displayed in the sample may be a function of the clinical and organizational \u201cstyle\u201d of the CLPS, namely the focus on identifying the prevailing personality traits, defensive mechanisms, and relational patterns

Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review

Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients

Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis

Aims: Lesbian, gay, bisexual, transgender and queer people (LGBTQ) are at increased risk of traumatization. This systematic review aimed to summarize data regarding the risk of post-traumatic stress disorder (PTSD) for LGBTQ people and their subgroups. Methods: Medline, Scopus, PsycINFO and EMBASE were searched until September 2022. Studies reporting a comparative estimation of PTSD among LGBTQ population and the general population (i.e., heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment, were identified. Meta-analyses were based on odds ratio (OR and 95% confidence intervals [CI]), estimated through inverse variance models with random effects. Results: The review process led to the selection of 27 studies, involving a total of 31,903 LGBTQ people and 273,842 controls, which were included in the quantitative synthesis. Overall, LGBTQ people showed an increased risk of PTSD (OR: 2.20 [95% CI: 1.85; 2.60]), although there was evidence of marked heterogeneity in the estimate (I2 = 91%). Among LGBTQ subgroups, transgender people showed the highest risk of PTSD (OR: 2.52 [95% CI: 2.22; 2.87]) followed by bisexual people (OR: 2.44 [95% CI: 1.05; 5.66]), although these comparisons are limited by the lack of data for other sexual and gender minorities, such as intersex people. Interestingly, the risk of PTSD for bisexual people was confirmed also considering lesbian and gay as control group (OR: 1.44 [95% CI: 1.07; 1.93]). The quality of the evidence was low. Conclusions: LGBTQ people are at higher risk of PTSD compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity in this at-risk population

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Effectiveness and acceptability of psycho-education group intervention for people hospitalized in psychiatric wards and nurses

Objective: To assess effectiveness and acceptability of a Psycho-education Group Intervention (PGI) on a sample of patients admitted to a Psychiatric Inpatient Unit (PIU) and on ward nurses. Methods: Case-control study. PGI was delivered according to the model of Vendittelli and colleagues (2008). Male and female patients aged 18-70 were eligible. Cases attended the PGI, while controls did not. A 5-item ad hoc Likert-scale was used to record ward atmosphere. The Italian version of the Simple Feedback Question Form for people attending Cognitive Behaviour Therapy Group (SFQF-CBTG) was administered to each patient before discharge. The primary outcome was readmission rate after 6 months from discharge, secondary outcomes were ratings of ward atmosphere by nurses and feed-back from people hospitalized. All Statistics were performed with STATA 13.1. Results: Fifty-two patients were enrolled, 17 cases and 35 controls. No significant differences emerged in the primary outcome, though compulsory readmissions were noticeable only among controls. Ratings of ward atmosphere in relation to group activities did not differ. Seventeen SFQF-CBTG were filled in. Most cases reported at discharge to have found the group "helpful", stating that "they would attend it in the future again", and "group topics were not difficult". Conclusions: No evidence emerged in favour or against effectiveness of the PGI for patients and ward nurses, though the intervention was rated as acceptable and feasible

Factors that Influence a Career Choice in Primary Care: a Mixed-methods Study among Medical Students Starting the Social Service Program in Honduras

Medical students are not choosing primary care careers. This project was a mixed-method study aimed to identify factors that influence the decisions of Honduran medical students to choose a career in primary care. The study included a survey questionnaire applied to 234 last-year medical students and semi structured interviews to eight key informants. Career choice favors medical specialties. PC careers were the preferred career choice for 8.1% of students. Relationships between “sex” and “location where student lived” by specialty categories were statistically significant (P= 0.011 and 0.042). There were more male respondents preferring PC (8.8%); students who preferred PC came mainly from urban backgrounds (62.6%). The perceived monthly salary of specialties other than primary care was significantly higher than those of GPs, FPs and Pediatricians (p<0.001). Participants considered “making a difference”, income, teaching, prestige, and challenging work as the most important factors that influence career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P=<0.05). Factor “patient-based care” was statistically significant (P=0.006) for selecting PC. Rationales behind the preference of a specialty appear to be based on a combination of ambition and prestige on one hand, and on personal and altruistic considerations on the other. There are several factors distinctive to medical students in Honduras: future work option, availability of specialties, and social factors including violence. A facilitator for PC selection in Honduras is the type of resources needed to practice a specialty. Social service participants from urban background who prefer primary care are mostly influenced by rural work and practice in ambulatory settings, while respondents with a rural background who prefer specialties are influenced by the possibility of making a positive difference in people´s lives. The study is a component of a strategy to strengthen primary care in the country that includes a public policy for strengthening PC workforce in Honduras. The results will be shared with Secretary of Health national authorities, including the Direction for Development of Human Resources, the National Council of Human Resources for Health, and academic authorities from UNAH. Policy advocacy is part of the plan for change.Doctor of Public Healt

Valutazione del rischio, sorveglianza sanitaria, monitoraggio biologico e promozione della salute sul luogo di lavoro: focus sulla relazione tra migranti, lavoro e salute

Over the last 50 years, the migratory phenomenon has progressively grown, reaching 281 million of international migrants in 2020. In the same year, 8.6 million third-country nationals were employed in the European labor market (4.6% of the total population in working age) and, in particular, migrants represented about 12% of workers. Italy hosts an estimated resident migrant population of about 5 million, which is the 8.5% of total residents. This population is recognized as one of the most vulnerable in society and frequently performs the so-called 3D jobs - dangerous, dirty, demanding / degrading. The Italian Insurer Institute (INAIL) described 564049 accident reports and 1221 fatal outcomes reports in 2021, charged by foreign workers in 18% and 15.2% of cases, respectively; considering occupational diseases, 55288 were reported in the same year, almost 8% of which charged by foreign workers. According to the National Institute of Statistics, in 2016 the incidence rate ratio of occupational accidents was higher in foreign population compared to Italians (3.3% vs 2.8%) and in 2020 it was higher in the construction sector (3.3% vs 1.9%) and in healthcare (4.5% vs 2.9%). The scientific literature reports a greater risk of injury and a significant prevalence of occupational accidents and diseases in migrant workers compared to native. Some studies, for example, reported a higher incidence rate ratio (1.57, 95% CI 1.50-1.65) and a relative risk of fatal injury of 4.4 in migrant workers compared to native workers. In the agricultural sector, especially, where the phenomenon of labor exploitation, illegal hiring and occupational damage is particularly spread, focusing the attention on finding and reporting and preventing this condition is therefore essential. Migrant workers are also particularly exposed to the risk of infection and worse clinical outcomes from Sars-Cov-2, due to different factors, such as inadequate standards of their social conditions, fewer opportunities in access the health system and the employment mainly in essential works. Some Authors report higher ORs in Blacks, Native Americans and Hispanic individuals (respectively 2.47, 5.82, 3.11) compared to the White race considering hospitalization and death and a mortality ratio of 1.42 versus 1.28 in male foreigners versus natives. Nonetheless, subjects belonging to minor ethnic groups appear to be under-represented in vaccination studies. Furthermore, a suboptimal vaccination coverage compared to the host country general population was highlighted (70.9% in White race versus 36.8% in Black race) and a high hesitation rate towards the vaccine against COVID-19 in ethnical minorities. Moreover, it is strong the need to fill the gaps in risk assessment, health surveillance data, information and training, and to improve the access to health services and plan preventive interventions. Our study is part of the European project "FARm", developed in the responsible agriculture supply chain and the Asylum, Migration and Integration Fund, aimed at the finding and reporting of conditions of vulnerability, exploitation and irregularities for the population at risk. It is carried out by the development of an original experimental approach, made up of shared outreach activities, through trained operators and mobile units, allowing to intercept the addressees inside and outside the workplace, to early identify distress markers and spread health promotion interventions. The sequence of project activities started with a context analysis using various sources of interception to access the "cases", whose data were acquired through an “ad hoc” questionnaire (97 items), which allowed the analysis of sanitary and non-sanitary indicators. Information material was produced and spread and periodic reports, dissemination initiatives and final reports were carried out. The population examined was mainly composed of males (96%), especially coming from Asia (51%); in most cases (66%) the migration was motivated by the search for a job. Any educational qualification was achieved in 13.21% of subjects, while 9% earned a University Degree or Diploma; approximately 89% is familiar with Italian language. A residence permit was held in 77% of cases. The general health was good for over 80% of the participants, while 17% of them reported a condition of more or less serious sufferings. 51% of the respondents reported to be affected by at least one pathology, with a higher prevalence of osteo-muscular diseases concerning spine and upper limbs (32 and 17%, respectively). 81.13% of interviewees said they were satisfied with the work performed. Periodic health surveillance was adopted in 75% of cases and 9 out of 10 workers received training about the use of PPE. It is a matter of concern that only 5.66% of the workers are aware of the term "caporalato", while 25% said they had been a victim of exploitation with consequences on mental and physical health. This project is a first step which provided a new useful method in order to acquiring more reliable data, identifying criticalities in prevention systems, characterizing intervention priorities, monitoring the risk of accidents, developing good practices, improving risk perception, identifying new tools for managing related problems, implementing scientific knowledge

Feature Papers "Age-Friendly Cities & Communities: State of the Art and Future Perspectives"

The "Age-Friendly Cities & Communities: States of the Art and Future Perspectives" publication presents contemporary, innovative, and insightful narratives, debates, and frameworks based on an international collection of papers from scholars spanning the fields of gerontology, social sciences, architecture, computer science, and gerontechnology. This extensive collection of papers aims to move the narrative and debates forward in this interdisciplinary field of age-friendly cities and communities

The role of the sociocultural context in explaining variance in incidence of psychosis and higher rates of disorder in minorities.

Over the past few decades, epidemiological evidence has accrued to establish variance in psychosis risk across both geographical locations and demographic characteristics such as the excess risk in migrants and their descendants. Yet, the causes of this variation in rates between places and ethnic groups are still unclear, and I aimed to address this in this thesis. I conducted a systematic review and meta-analyses to synthesise existing literature on psychosis incidence in the six countries included in the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study: England, The Netherlands, Spain, France, Italy and Brazil. I subsequently analysed data from two parts of the EU-GEI study: a 17-centre service-based incidence study of psychosis, and a case-control arm utilising community volunteers. In the latter, I aimed to explain excess risk in ethnic and religious minorities using a theoretical sociocultural distance model I developed using literature from the social sciences. Here, I proposed that culturally distant minorities were particularly at risk of social exclusion, and this outsider experience led to increased psychosocial disempowerment (a lack of control over one’s life), which increased psychosis risk. I also explored if this model could explain any excess risk in those with increased genetic African ancestry in England. Incidence varied substantially between the studies included in the systematic review, although methodological differences could not be excluded as an explanation. The EU-GEI incidence study confirmed substantial variation by place, and demonstrated a higher incidence in ethnic minorities and for young men, as well as in areas characterised by a low percentage of owner-occupied housing. The sociocultural distance model could explain most of the excess psychosis risk in ethnic minorities, although some excess risk remained, particularly in the Black ethnic group. Social and cultural distance appeared to be more important predictors than psychosocial disempowerment, suggesting that chronic social injustices rather than acute stress play an important role. This model did not explain excess risk in religious minorities: those following any religion retained an excess risk. It could explain the excess risk in those with increased genetic African ancestry, although this was a small, exploratory sample and this will need replicating in larger studies. This thesis demonstrated, for the first time, that excess risk in ethnic minorities could be explained by the sociocultural distance model. Overall, the findings from this thesis confirm substantial variation in psychosis risk by person and place, and suggest that the social reality of the environment plays a crucial role in explaining this.My PhD position was jointly funded by The European Community's Seventh Framework Programme (grant agreement HEALTH-F2-2010-241909) and by the National Institute of Health Research Collaboration of Leadership in Applied Health Research and Care East of England

Migrants presenting with suicidal behaviours at the A&E department in Modena

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