Classificazione, diagnosi ed ICD-10. I - Principi generali e considerazioni critiche

Scopo - Discutere i principali problemi teorico-pratici connessi alia classificazione in campo medico e psichiatrico, e presentare la struttura generale della decima revisione della Classificazione Internazionale delle Malattie (ICD-10), entrata ufficialmente in vigore dal gennaio del 1993. Risultati - Sono dapprima discussi i fondamenti epistemologici della classificazione, le varie strategic classificatorie adottate in campo medico e psichiatrico ed i principali modelli classificatori esistenti. Sono quindi analizzati i problemi relativi alia attendibilità ed alia validità delle diagnosi psichiatriche, e vengono descritte le strategic che possono essere impiegate per migliorarle. Infine sono discussi i principi che hanno informato ia stesura dell' ICD-10 ed i field trials effettuati al fine di preparare il testo finale delle direttive diagnostiche. Conclusioni - La classificazione in psichiatria rappresenta un passaggio obbligato e necessario per rendere possibile la sistematizzazione delle nuove conoscenze e la comunicazione tra operatori, ricercatori ed utenti. La decima revisione dell' ICD rappresenta lo sforzo più ampio sinora compiuto in campo psichiatrico al fine di predisporre un sistema classificatorio rigoroso che, nel contempo, sintetizzi approcci e culture psichiatriche differenziat

Classificazione, diagnosi ed ICD-10. II - Le sindromi schizofreniche

Scopo: Presentare un breve profilo storico relativo ai numerosi tentativi di classificazione dei disturbi schizofrenici succedutisi dal secolo scorso ad oggi e descrivere le principali caratteristiche della classificazione ICD-10 della schizofrenia e dei disturbi ad essa correlati, le principali novità introdotte in essa rispetto all'ICD-9 ed infine le principali similarità e differenze ravvisabili tra la classificazione della WHO ed il DSM-III-R. Risultati - Il concetto di schizofrenia si é venuto definendo attraverso i contributi di autori di rilievo storico, quali Kraepelin, Bleuler e Schneider. Nella definizione dei criteri diagnostici per la schizofrenia, I'ICD-10 ha ripreso i principali criteri schneideriani relativamente ai sintomi patognomonici per questo disturbo, mentre ha ridimensionato, rispetto al DSM-III-R, Pimportanza del criterio longitudinale kraepeliniano relativo al decorso adottando una durata minima di un mese per la diagnosi e prospettando la possibilità di una prognosi non necessariamente sfavorevole. Conclusioni - Nel complesso, nell'ICD-10 si tende ad un ampliamento del concetto di schizofrenia, rispetto ad altri sistemi diagnostici più restrittivi, mentre l'enfasi posta sui sin- tomi schneideriani controbilancia questa tendenza e restringe i criteri di inclusion

Classificazione, diagnosi ed ICD-10. III - Le sindromi affettive

Scopo - Presentare un breve profilo storico sui termini nosografici e sui principali modelli di classificazione dei disturbi affettivi descrivendo le caratteristiche più importanti della loro classificazione secondo l'ICD-10, le principali novita introdotte in essa rispetto all'ICD-9 ed infine alcune similarità e differenze tra la classificazione ICD-10 ed il DSM-III-R. Risultati - DalFanalisi della struttura della classificazione di questi disturbi nelFICD-10 emerge con chiarezza la difficoltà di arrivare ad una sistemazione nosografica esauriente sulla base delle conoscenze attuali. L'ICD-10, comunque, ha segnato un significativo progresso rispetto all'ICD-9, ed ha, al tempo stesso incorporato molti degli orientamenti riscontrabili nel DSM-III-R. Conclusioni - L'ICD-10 ha proposto un modello di classificazione che cerca di operare una sintesi tra tradizioni e scuole diverse, e di valorizzare nel contempo, per quanto possibile, i risultati emersi dalle ricerche di queste ultime 2 decad

Construct validity and psychosocial correlates of the Italian version of the 21-item Medical Interview Satisfaction Scale in primary care

BackgroundSatisfaction with the medical interview has been rarely explored in primary care outside the UK, despite evidence suggesting that a trustful doctor-patient relationship is a key ingredient to facilitate treatment adherence and relief from illness-related distress.AimsThe aims of this study are to analyse the construct validity of the Italian version of the Medical Interview Satisfaction Scale (MISS-21) and its correlations with two outcome measures, the Inventory of Depressive Symptomatology - Self-Report and World Health Organization Quality Of Life Brief Version, in patients with mild-to-moderate depression, recruited in primary care practices.MethodThe factor structure underlying the MISS-21 was investigated with principal component analysis, and the internal consistency of the factors was evaluated with Cronbach's alpha. Network analysis was used to investigate the interrelationships among items. The importance of individual items in the network structure was determined with centrality analyses. Correlations of MISS-21 scores with changes in depression and quality of life were analysed with Spearman's correlation coefficient.ResultsThe MISS-21 proved to have a robust four-dimensional factor structure. Cronbach's alpha for the factors ranged from 0.77 to 0.93, suggesting good to excellent internal consistency. The four factors identified were positively correlated with improvement in depressive symptoms and three quality-of-life domains.ConclusionsThe MISS-21 has sound psychometric properties, and comprises four factors related to clinical outcomes, which makes it suitable for clinical and research applications. The central items in the network should be considered as possible targets for quality improvement interventions in primary care

Italian psychiatry – 25 years of change

Italian psychiatry is probably more debated than known in the international arena. Law 180 of 1978, which introduced a radical community psychiatry system, has drawn worldwide attention and debate, with comments ranging from the enthusiastic to the frankly disparaging (Mosher, 1982; Jones et al, 1991). More recently, this interest was marked by a well-attended symposium 'Lessons Learned from Italian Reforms in Psychiatry' held at the 2003 annual meeting of the Royal College of Psychiatrists in Edinburgh

Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge

<p>Abstract</p> <p>Background</p> <p>The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements.</p> <p>Methods</p> <p>All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed.</p> <p>Results</p> <p>No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge.</p> <p>Conclusion</p> <p>Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.</p

Time-clustering of wave storms in the Mediterranean Sea

In this contribution we identify storm time-clustering in the Mediterranean Sea through a comprehensive analysis of the Allan Factor. This parameter is evaluated from long time series of wave height provided by oceanographic buoy measurements and hindcast re-analysis of the whole basin, spanning the period 1979-2014 and characterized by a horizontal resolution of about 0.1 degree in longitude and latitude and a temporal sampling of one hour (Mentaschi et al., 2015). The nature of the processes highlighted by the AF and the spatial distribution of the parameter are both investigated. Results reveal that the Allan Factor follows different curves at two distinct time scales. The range of time scales between 12 hrs to 50 days is characterised by a departure from the Poisson distribution. For timescales above 50 days, a cyclic Poisson process is identified. The spatial distribution of the Allan Factor reveals that the clustering at smaller time scales is present in the North-West of the Mediterranean, while seasonality is observed in the whole basin. This analysis is believed to be important to assess the local increased flood and coastal erosion risks due to storm clustering

Pyridostigmine in pediatric Intestinal pseudo-obstruction. case report of a 2-year old girl and literature review

Pediatric chronic intestinal pseudo-obstruction is a rare disorder characterized by a severe impairment of gastrointestinal motility leading to intestinal obstruction symptoms in the absence of mechanical causes. The diagnosis is usually clinical and diagnostic work is usually aimed to rule out mechanical obstruction and to identify any underlying diseases. Treatment is challenging and requires a multidisciplinary effort. In this manuscript we describe the youngest child successfully treated with the orally administrable, longacting, reversible anti-cholinesterase drug, pyridostigmine. Like other drugs belonging to cholinesterase inhibitors, pyridostigmine enhances gut motility by increasing acetylcholine availability in the enteric nervous system and neuro-muscular junctions. Based on the direct evidence from the reported case, we reviewed the current literature on the use of pyridostigmine in severe pediatric dysmotility focusing on intestinal pseudo-obstruction. The overall data emerged from the few published studies suggest that pyridostigmine is an effective and usually well tolerated therapeutic options for patients with intestinal pseudo-obstruction. More specifically, the main results obtained by pyridostigmine included marked reduction of abdominal distension, reduced need of parenteral nutrition, and improvement of oral feeding. The present case and review on pyridostigmine pave the way for eagerly awaited future randomized controlled studies testing the efficacy of cholinesterase inhibitors in pediatric severe gut dysmotility

Surrogate modeling of the aeroacoustics of an NM80 wind turbine

Wind turbines play a major role in the European Green Deal for clean energy transition. Noise is a critical aspect among open technological issues, as it determines the possibility of onshore installations near inhabited places and the possible detrimental effects on wildlife when offshore. This paper assesses the accuracy of different approaches to predicting the sound pressure level (SPL) of a wind turbine. The 2.75 MW Neg Micon NM80 horizontal axis wind turbine (HWAT) was simulated in OpenFOAM, modeling the turbine with the actuator line method (ALM) implemented in the turbinesFoam library. Two different inflow conditions were considered: a stationary inflow with a typical atmospheric boundary layer profile and a time-dependent inflow derived from a precursor channel with fully turbulent conditions. The surrogate model for noise prediction used for this work is based on the synthetic/surrogate acoustics models (SAMs) of Amiet and Brooks-Pope-Marcolini (BPM). This approach allows for blade motion modeling and the prediction of the SPL of the URANS postprocessing results. The SPL spectrum obtained was then compared to the results from the other aeroacoustic solvers of IEA Task 39 participants, showing the best performance in the fully turbulent case. The results demonstrate that coupling between the ALM and surrogate acoustics provides more accurate results than the blade element momentum (BEM) approach

Breaking Symmetry Rules Enhance the Options for Stereoselective Propene Polymerization Catalysis

An example of breaking "Ewen's symmetry rule" for olefin catalysis polymerization is proposed by DFT calculations. Catalyst precursors with Cs symmetry are suggested to promote the isotactic propene polymerization by a modification of the active site geometry obtained via coordination with AlH-alkyl species in solution. The origin of stereocontrol in olefin polymerization is due to a dual mechanism dictated by the chiral catalyst. These findings may expand the toolbox for promoting stereoselective olefin polymerization by transition metal catalysts