Health Professionals Working with Persons with Alzheimer's. Reflections for New Training Courses

AbstractHealth professionals working with a person suffering from Alzheimer's disease have to face with considerable communicational and relational difficulties. Therefore, training programs focused on the cognitive or medical aspects of the disease may not be sufficient to deal with the complexity of this condition. Starting from the contributions of Kitwood (1997) and the approach of Bender (2003), this study aims to discuss an alternative paradigm to dementia-care, providing suggestions about the daily care work of health professionals. Some expressive and narrative activities are presented in order to facilitate an effective relationship between operators and patients

A new minimally invasive technique for the repair of diastasis recti: a pilot study

BACKGROUND: Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is>2cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa's technique that combines Rives-Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis.METHODS: It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath.RESULTS: Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms.CONCLUSIONS: This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique

The effect on mental health of retiring during the economic crisis

This paper investigates the causal impact of retirement on late life depression, a growing concern for public health as major depressive disorders are the second leading cause of disability. We shed light on the role of economic conditions in shaping the effect of retirement on mental health by exploiting the time and regional variation in the severity of the economic crisis across ten European countries over the 2004-2013 period. We use data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) and address the potential endogeneity of retirement decision to mental health by applying a fixed-effect instrumental variable approach. Results indicate that retirement improves mental health of men, but not of women. This effect is stronger for those men working in regions that are severely hit by the economic crisis and in blue-collar jobs. These findings may be explained by the worsening of working conditions and the rise in job insecurity stemming from the economic downturn: In these circumstances, the exit from the labor force is perceived as a relief

Blunt Trauma Associated With Bilateral Diaphragmatic Rupture. A Case Report

Background: A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma.Case Presentation: We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital.Conclusions: Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons

Measurement error in occupational coding: an analysis on SHARE data

This article studies the potential measurement errors when coding occupational data. The quality of occupational data is important but often neglected. We recoded open-ended questions on occupation for last and current job in the Dutch SHARE data, using the CASCOT ex-post coding software. The disagreement rate, defined as the percentage of observations coded differently in SHARE and CASCOT, is high even when compared at ISCO 1-digit level (33.7% for last job and 40% for current job). This finding is striking, considering our conservative approach to exclude vague and incomplete answers. The level of miscoding should thus be considered as a lower bound of the “true” miscoding. This highlights the complexity of occupational coding and suggests that measurement error due to miscoding should be taken into account when making statistical analysis or writing econometric models. We tested whether the measurement error is random or correlated to individual or job-related characteristics, and we found that the measurement error is indeed more evident in ISCO-88 groups 1 and 3 and is more pronounced for higher educated individuals and males. These groups may be sorted in occupations that are intrinsically more difficult to be classified, or education and gender may affect the way people describe their jobs

Measuring and Detecting Errors in Occupational Coding: an Analysis of SHARE Data

This article studies coding errors in occupational data, as the quality of this data is important but often neglected. In particular, we recoded open-ended questions on occupation for last and current job in the Dutch sample of the “Survey of Health, Ageing and Retirement in Europe” (SHARE) using a high-quality software program for ex-post coding (CASCOT software). Taking CASCOT coding as our benchmark, our results suggest that the incidence of coding errors in SHARE is high, even when the comparison is made at the level of one-digit occupational codes (28% for last job and 30% for current job). This finding highlights the complexity of occupational coding and suggests that processing errors due to miscoding should be taken into account when undertaking statistical analyses or writing econometric models. Our analysis suggests strategies to alleviate such coding errors, and we propose a set of equations that can predict error. These equations may complement coding software and improve the quality of occupational coding.This article studies coding errors in occupational data, as the quality of this data is important but often neglected. In particular, we recoded open-ended questions on occupation for last and current job in the Dutch sample of the "Survey of Health, Ageing and Retirement in Europe" (SHARE) using a high-quality software program for ex-post coding (CASCOT software). Taking CASCOT coding as our benchmark, our results suggest that the incidence of coding errors in SHARE is high, even when the comparison is made at the level of one-digit occupational codes (28% for last job and 30% for current job). This finding highlights the complexity of occupational coding and suggests that processing errors due to miscoding should be taken into account when undertaking statistical analyses or writing econometric models. Our analysis suggests strategies to alleviate such coding errors, and we propose a set of equations that can predict error. These equations may complement coding software and improve the quality of occupational coding

Distal Pancreatectomy with Celiac Axis Resection: Systematic Review and Meta-Analysis

Background: Major vascular invasion represents one of the most frequent reasons to consider pancreatic adenocarcinomas unresectable, although in the last decades, demolitive surgeries such as distal pancreatectomy with celiac axis resection (DP-CAR) have become a therapeutical option. Methods: A meta-analysis of studies comparing DP-CAR and standard DP in patients with pancreatic adenocarcinoma was conducted. Moreover, a systematic review of studies analyzing oncological, postoperative and survival outcomes of DP-CAR was conducted. Results: Twenty-four articles were selected for the systematic review, whereas eleven were selected for the meta-analysis, for a total of 1077 patients. Survival outcomes between the two groups were similar in terms of 1 year overall survival (OS) (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.34 to 1.31, p = 0.24). Patients who received DP-CAR were more likely to have T4 tumors (OR 28.45, 95% CI 10.46 to 77.37, p < 0.00001) and positive margins (R+) (OR 2.28, 95% CI 1.24 to 4.17, p = 0.008). Overall complications (OR, 1.72, 95% CI, 1.15 to 2.58, p = 0.008) were more frequent in the DP-CAR group, whereas rates of pancreatic fistula (OR 1.16, 95% CI 0.81 to 1.65, p = 0.41) were similar. Conclusions: DP-CAR was not associated with higher mortality compared to standard DP; however, overall morbidity was higher. Celiac axis involvement should no longer be considered a strict contraindication to surgery in patients with locally advanced pancreatic adenocarcinoma. Considering the different baseline tumor characteristics, DP-CAR may need to be compared with palliative therapies instead of standard DP