Health service outpatient experience questionnarie: factor validity and reliability of a patient- centered outcome measure for outpatient settings in Italy

3PURPOSE: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course. PATIENTS AND METHODS: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach's α. Factor invariance was assessed through multigroup analyses. RESULTS: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients. CONCLUSION: The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.openopenColuccia, Anna; Ferretti, Fabio; Pozza, AndreaColuccia, Anna; Ferretti, Fabio; Pozza, Andre

La sicurezza sostenibile: l’esperienza della Toscana

Nowadays urban safety represents a very complicated theme which doesn’t need simple or simplistic solutions, but diversified answers.This work tries to analyze and present the political safety strategies adopted by Tuscany that enter the Modern Governance theory since the n.38, 16th August 2008 Regional Law, which was titled “Regional strategies in favour of Tuscan Community safety politics”. That means a new government style which, instead of the old hierarchic model, is characterized by more cooperation between the State and the non state actors inside the sphere of public and private decisions. As a consequence, the work examines the role that the different social actors will have to take up in order to achieve an aim or social safety. This last one constantly advances. At the same time the work introduces the concept of supportability, declaring the necessity to pursue a new safety idea: the supportable safety.This new safety conception can represent the liveability level which can really be realized in a certain geographic place according to both criminality level and the sense of insecurity spreading and the fear of criminality in people, in consideration of the social and economic development reached in a certain area. All this is sensibly minimizing the traditional concept of unsafety meaning as public order and security preservation. Now a new idea of liveability is growing. In it the unsafety sense is not directly linked to criminality, but it is instead linked to other factors: noise, nightnoise, pollution, urban decay, traffic (besides family and social disease). As a consequence of the new problems linked to urban safety,we cannot think to achieve our aim with criminal politic administration based on repression and prevention of crime, but on a wise politic management of quality life. The complexity of the urban safety theme justifies the distribution of this job on more social and institutional actors. Safety doesn’t only represent the most important monopoly of the Central State, but it becomes a task of the Local Government which want to govern, as well as it becomes a task of the people who want to take part of city government.Parlare di Sicurezza Urbana significa, oggi, parlare di un tema complesso, e che ha pertanto bisogno di risposte variegate e non semplici, o peggio semplicistiche. Questo lavoro intende presentare ed esaminare le politiche di Sicurezza adottate dalla Regione Toscana che, a partire dalla Legge Regionale del 16 Agosto 2001 n. 38, titolata appunto “Interventi regionali a favore delle politiche per la sicurezza della comunità toscana”, si inseriscono nella teorica della Modern Governance, intesa come nuovo stile di governo, distinto dal modello del controllo gerarchico e, invece, caratterizzato da un maggior grado di cooperazione tra lo Stato e gli attori non statuali, all’interno di reti decisionali pubblico/private. Nell’ambito di tale ottica, vengono esaminati i ruoli che i vari attori sociali dovranno ricoprire per la realizzazione di un obiettivo, la sicurezza sociale, che per sua stessa natura si caratterizza come un tema costantemente in progress. Contestualmente, viene introdotto il concetto di sostenibilità, affermando così la necessità di perseguire una nuova accezione di sicurezza, la cosiddetta Sicurezza Sostenibile.Tale nuova concezione di sicurezza può rappresentare il grado di vivibilità realisticamente realizzabile in un certo sito geografico, in considerazione sia del livello di criminalità sia della diffusione della sensazione di insicurezza e della paura di criminalità nella popolazione, e in considerazione del livello di sviluppo economico e sociale raggiunto in un determinato territorio. Si attenua così sensibilmente il tradizionale riferimento alla sicurezza intesa come mantenimento dell’ordine e della sicurezza pubblica, e si abbraccia un concetto ampio di vivibilità, in cui le cause dell’insicurezza non sono direttamente collegate alla criminalità ma ad una serie di fattori pro-duttivi del disagio del vivere urbano: rumori, schiamazzi notturni, inquinamento ambientale, degrado urbano, traffico in eccesso (oltre che problemi di disagio sociale e familiare). Questo profondo ampliamento delle problematiche insite al tema della sicurezza urbana offre lo spunto per considerare tale fenomeno, estremamente complesso, come non più governabile esclusivamente mediante la gestione delle politiche criminali fondate sulla prevenzione o repressione dei reati, bensì attraverso la sapiente gestione di una pluralità di politiche declinate sulla qualità della vita. Il carattere di complessità caratteristico della sicurezza urbana giustifica, così, la distribuzione del compito di intervento su un ventaglio di attori sociali ed istituzionali. La sicurezza non costituisce più l’esclusivo monopolio dello Stato Centrale, ma diviene impegno delle Amministrazioni locali e sovralocali che intendono governare il territorio, e compito dei cittadini che intendono partecipare del governo della città.

Sexual masochism disorder with asphyxiophilia: a deadly yet underrecognized disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury

Comparative cytogenetics in four species of Palinuridae: B chromosomes, ribosomal genes and telomeric sequences

The evolutionary pathway of Palinuridae (Crustacea, Decapoda) is still controversial, uncertain and unexplored, expecially from a karyological point of view. Here we describe the South African spiny lobster Jasus lalandii karyotype: n and 2n values, heterochromatin distribution, nucleolar organizer region (NOR) location and telomeric repeat structure and location. To compare the genomic and chromosomal organization in Palinuridae we located NORs in Panulirus regius, Palinurus gilchristi and Palinurus mauritanicus: all species showed multiple NORs. In J. lalandii NORs were located on three chromosome pairs, with interindividual polymorphism. In P. regius and in the two Palinurus species NORs were located on two chromosome pairs. In the two last species 45S ribosomal gene loci were also found on B chromosomes. In addition, the nature and location of telomeric repeats were investigated by FISH in J. lalandii, P. gilchristi, P. mauritanicus Palinurus elephas, and P. regius (Palinuridae, Achelata), and in Scyllarus arctus (Scyllaridae, Achelata): all these Achelata species showed the (TTAGG)n pentameric repeats. Furthermore, in J. lalandii these repeats occurred in all the telomeres and in some interstitial chromosomal sites, associated with NORs

Il Mini Questionario di Qualità Percepita (QQP): uno studio sulle differenze di genere

ItNel presente lavoro abbiamo analizzato le proprietà psicometriche di un questionario italiano sulla misura della qualità percepita in ambito sanitario (Mini Questionnaire of Perceived Quality; Coluccia, Ferretti, Cioffi, Lorini, in itinere). I soggetti devono rispondere a 14 domande suddivise in 4 fattori (Soddisfazione riguardo ai Medici, Infermieri, Ausiliari, Strutture dell’Ospedale). Abbiamo somministrato il test a 1600 pazienti dell’Ospedale "Le Scotte" di Siena, Facendo riferimento metodo delle equazioni strutturali, abbiamo studiato la dimensionalità del questionario usando un’analisi fattoriale confermatirva e, successivamente, abbiamo studiato le dimensioni nella variabile genere (maschi / femmine) usando un’Analisi Multi-Gruppo. I risultati non mostrano alcuna significativa differenza del genere rispetto alle dimensioni del test.EnIn the present paper we analyze the psychometric properties of an Italian questionnaire measuring perceived quality of sanitary service (Mini Questionnaire of Perceived Quality; Coluccia, Ferretti, Cioffi, Lorini, in itinere). Subjects answer 14 questions subdivided in four dimensions (i.e. Satisfaction towards Medical Doctors, Nurses, Auxiliary Staff, and Hospital Structure). We administered the questionnaire to 1600 patients in the Hospital of Siena "Le cotte". According to structural equations modeling, we studied the dimensionality of the questionnaire using confirmatory factor analysis and, later on, we studied differences in gender using Multi-sample analysis. Results does not show significant differences in gender for test dimensions

Quality of life in children and adolescents with obsessive-compulsive disorder: a systematic review and meta- analysis

Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been understudied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=−1.16, P<0.001), suggesting that individuals with OCD had lower global QOL than controls. Moderate effect sizes emerged for school (d=−0.61, P<0.01) and social QOL (d=−0.54, P<0.01), respectively, indicating worse QOL on these domains for individuals with OCD. For samples with higher OCD severity, global QOL of individuals with OCD was lower than that for controls (β=−0.02, P<0.05). For samples with lower percentages of females, global QOL of individuals with OCD was more impaired (β=0.02, P<0.001). Age was not correlated with effect sizes. Assessment and treatment should target QOL for young males suffering from more severe OCD. The small number of included studies highlighted that QOL is under-recognized. Future research should focus on additional QOL domains and compare which ones are impaired among individuals with OCD compared with other psychiatric conditions. Overall, the results pointed out the importance of addressing QOL in both practice and research on assessment and treatment of children/adolescents with this condition. © 2017 Coluccia et al

Extruded linseed and linseed oil as alternative to soybean meal and soybean oil in diets for fattening lambs

The study evaluated the effects of replacing soybean meal and soybean oil respectively with extruded linseed and linseed oil on the productive performances and meat quality traits in lambs slaughtered at 90 days. Lambs weaned at 40 days were divided into 3 groups (N.=10) fed ad libitum for 6 weeks as follows: C (control, commercial feed containing soybean meal and soybean oil); LO (feed containing linseed oil instead of soybean oil); EL (feed containing extruded linseed). Meat quality traits were evaluated on the Longissimus lumborum (Ll) and Semimembranosus (Sm) muscles. The lambs' growth performances and the slaughtering and sectioning data did not differ between groups. The redness of meat was significantly higher (P<0.05) for the LO and EL groups compared to the control for both the muscles tested. Ll meat samples of the EL group showed a greater cooking loss compared to LO (P<0.01) and to the control (P<0.05). The amount of linoleic acid in raw Ll meat samples was significantly (P<0.01) lower in both LO and EL groups with respect to control. The concentration of α-linolenic acid was significantly (P<0.01) higher in the EL group and this positively affected the total content of ω3 as well as the ω6/ω3 ratio

L'impatto della pandemia Covid-19 sulle nuove strutture psichiatrico-forensi in Italia

After the closure of Psychiatric Hospitals (OPs), in 2012 the Italian Government decided to close the High Security Psychiatric Hospitals (OPGs). Law 81/2014 established that each region would provide smaller forensic psychiatry facilities, theREMS (Residence for the Execution of the Security Measures), to accommodate socially dangerous NGRI (Not Guilty by Reason of Insanity) offenders. The main characteristic of a REMS is that it is purely therapeutic and rehabilitative in naturewhile remaining a custodial safety measure. The COVID-19 pandemic undoubtedly tested the organization of these new Italian forensic psychiatry facilities whose practices were not yet fully established, forcing them to ensure patient safety during lockdown amidst the epidemic. The Chapter V Constitutional reform which assigned each region exclusive competence for health policies in its own territory, once the prerogative of the central government, was also put to the test. To assess the impact of the pandemic on the new forensic care system in Italy, we conducted a semi-structured interview with REMS health professionals from various regions with differing levels of contagion: the Poli REMS di Castiglione delle Stiviere; the REMS of Volterra; the REMS of Carovigno and the REMS of Pisticci. The interview assessed how the rehabilitation objectiveshad been met notwithstanding the serious operational limitations consequent to COVID-19 related decisions by the authorities.Dopo la chiusura degli Ospedali Psichiatrici (OP), nel 2012 il Governo Italiano ha deciso di chiudere gli Ospedali Psichiatrici Giudiziari, gli OPG. La legge 81/2014 stabiliva che ogni regione avrebbe dovuto prevedere l’istituzione di strutture psichiatrico-forensi più piccole, le REMS (Residenze per la Esecuzione delle Misure di Sicurezza), per accogliere gli autori di reatonon imputabili, socialmente pericolosi. La caratteristica principale delle REMS è quella di avere una natura prettamente terapeutica e riabilitativa pur rimanendo una misura di sicurezza detentiva. Non c’è dubbio che la pandemia COVID-19 abbia messo alla prova l’organizzazione delle nuove strutture psichiatrico-forensi italiane, con prassi ancora non del tutto consolidate, costringendo le REMS durante il lock-down ad adoperarsi per gestire l’epidemia, garantendo al tempo stesso la sicurezza dei pazienti. In questo contesto è stata messa alla prova anche la riforma del Capitolo V della Costituzione, che assegnava a ciascuna Regione la competenza esclusiva per le politiche sanitarie del proprio territorio, un tempo prerogativa del governo centrale. Alla luce di ciò, per valutare l’impatto della pandemia sul nuovo sistema di assistenza forense in Italia, abbiamo condotto un’intervista strutturata con gli operatori sanitari delle REMS di diverse regioni con diversi livelli di diffusione della malattia: la Poli REMS di Castiglione delle Stiviere; la REMS di Volterra; la REMS di Carovigno e la REMS di Pisticci. L’intervista ha valutato come gli obiettivi riabilitativi fossero stati garantiti nonostante i gravi limiti operativi conseguenti alle decisioni delle autorità determinate dal COVID-19

Immigrati di seconda generazione in Toscana: valutazione sperimentale di un modello teorico

The following article is part of the discussion about immigration, and it takes into specific consideration the integration phenomenon of the so-called “second generations” of young immigrants. Supported by a research performed throughout the High School Institutes in the Region of Tuscany, this study is aimed at evaluating the trustworthiness and factorial reliability of the assessment model, which has been used to produce the questionnaire administered to the students. In order to assess the reliability and factorial structure of our measurement scales, as well as to better define the role of several theoretical factors (Integration, Relationship with School, Socialization in Groups and Values / Prejudices) assumed for the assessment of the degree of integration between foreign and Italian students, the data analysis was carried out through the use of Structural Equation Modeling. This kind of an approach allows us not only to reduce a certain theoretical complexity, but also to identify and formalize causative relationships between the variables, through the analysis of indexes related to the adaptive effectiveness of data in the model. The outcomes obtained from this study support not only the factorial reliability of the tool – as well as the effectiveness of measurement scales for several factors (INT, RS, VP, SG) – but they also confirm the leading role played by school in producing positive processes for the integration of new generations of immigrants.Lo studio qui presentato spende il proprio interesse alla riflessione sulle tematiche dell’immigrazione ed in particolare dell’integrazione delle c.d. “seconde generazioni”. Partendo da una ricerca svolta negli istituti di istruzione secondaria superiore della Regione Toscana, la ricerca si propone di valutare l’attendibilità e l’affidabilità fattoriale del modello di analisi utilizzato per la costruzione questionario somministrato agli studenti. Al fine di verificare la fedeltà e la struttura fattoriale delle scale di misura utilizzate ed il ruolo dei diversi fattori teorici ipotizzati (Integrazione, Rapporto con la scuola, Socializzazione nei gruppi e Valori/Pregiudizi) nella valutazione del grado di integrazione tra studenti stranieri e studenti italiani, l’analisi dei dati è stata condotta attraverso l’uso dei modelli di equazioni strutturali.Tale approccio consente la riduzione della complessità teorica, l'identificazione e la formalizzazione dei nessi causali tra le variabili attraverso l’analisi degli indici relativi alla bontà di adattamento dei dati al modello.I risultati ottenuti, oltre all’affidabilità fattoriale dello strumento e alla bontà delle scale riferite ai diversi fattori (INT, RS, VP, SG), hanno confermato il ruolo primario dell’istituzione scolastica nella costruzione di processi favorevoli all’integrazione delle nuove generazioni di immigrat