Validation of PARADISE 24 and Development of PARADISE-EDEN 36 in Patients with Dementia

Dementia was one of the conditions focused on in an EU (European Union) project called “PARADISE” (Psychosocial fActors Relevant to brAin DISorders in Europe) that later produced a measure called PARADISE 24, developed within the biopsychosocial model proposed in the International Classification of Functioning Disability and Health (ICF). The aims of this study are to validate PARADISE 24 on a wider sample of patients with mild to moderate dementia to expand PARADISE 24 by defining a more specific scale for dementia, by adding 18 questions specifically selected for dementia, which eventually should be reduced to 12. We enrolled 123 persons with dementia, recruited between July 2017 and July 2019 in home care and long-term care facilities, in Italy, and 80 participants were recruited in Warsaw between January and July 2012 as part of a previous cross-sectional study. The interviews with the patient and/or family were conducted by health professionals alone or as a team by using the Paradise data collection protocol. The psychometric analysis with the Rasch analysis has shown that PARADISE 24 and the selection of 18 additional condition-specific items can be expected to have good measurement properties to assess the functional state in persons with dementia

Nationwide consensus on the clinical management of treatment-resistant depression in Italy: a Delphi panel

Background: Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray. Methods: A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Stata 16.1 software was used for the analyses. Results: Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement. Conclusions: This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

Personality and gender differences in global perspective

This is the peer reviewed version of the following article: Personality and gender differences in global perspective, which has been published in final form at https://doi.org/10.1002/ijop.12265. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.© 2016 International Union of Psychological Science Men's and women's personalities appear to differ in several respects. Social role theories of development assume gender differences result primarily from perceived gender roles, gender socialization and sociostructural power differentials. As a consequence, social role theorists expect gender differences in personality to be smaller in cultures with more gender egalitarianism. Several large cross-cultural studies have generated sufficient data for evaluating these global personality predictions. Empirically, evidence suggests gender differences in most aspects of personality—Big Five traits, Dark Triad traits, self-esteem, subjective well-being, depression and values—are conspicuously larger in cultures with more egalitarian gender roles, gender socialization and sociopolitical gender equity. Similar patterns are evident when examining objectively measured attributes such as tested cognitive abilities and physical traits such as height and blood pressure. Social role theory appears inadequate for explaining some of the observed cultural variations in men's and women's personalities. Evolutionary theories regarding ecologically-evoked gender differences are described that may prove more useful in explaining global variation in human personality

Heterogeneidade e interdisciplinaridade na escola especial: a música como forma de proporcionar equilíbrio e qualidade de vida

A presente pesquisa pretende demonstrar o papel da educação musical dentro do contexto interdisciplinar da Escola para portadores de necessidades especiais, onde a problemática na questão de heterogeneidade dos alunos é constante. Este contexto coloca a educação musical como ferramenta interdisciplinar para a melhoria da qualidade de vida destes indivíduos, que implica mudança de atitude por parte do educador musical e reflexão sobre os conteúdos ministrados. A justificativa do trabalho apóia-se no novo papel da educação musical dentro da escola, pois ao ser inserida como disciplina na equipe, propõem um novo contato com os alunos, professores e equipe técnica, ressaltando problemas essenciais, e também metodologias para a aplicação da educação musical com o objetivo de inclusão social. A metodologia utilizada na pesquisa se fundamenta na antropopedagogia e na pesquisa-ação, ambas adotadas segundo as definições de André Morin, que, de forma qualitativa, apresenta como estratégias de ação, o registro reflexivo e a observação, formando uma triangulação com a interdisciplinaridade. A fundamentação teórica apóia-se em dois autores responsáveis pelo pioneirismo do estudo da interdisciplinaridade no Brasil, Hilton Japiassú e Ivani Fazenda, que traçam um paralelo entre os conceitos e os projetos disciplinares, buscando direcionar o olhar para a realização de projetos efetivamente de cunho interdisciplinar. Como conclusão a pesquisa mostra a importância da formação de grupos interdisciplinares no corpo das escolas que pretendem promover atendimento a alunos com necessidades especiais, como forma de melhorar e reduzir os efeitos no processo de inclusão para professores, alunos e demais profissionais, envolvidos, bem como, família e comunidade próxima.The following research intends to demonstrate musical education importance in the interdiciplinary context of the special necessity porters, where the problem of students' heterogeneousness is constant. This context points musical education as an interdisciplinary tool the life quality improvement of this people, what implies not only change of attitude on the part of the musical educator but also reflection on the given contents. The justification of this work has its support in the new role of the musical education at school, because as it is added as a discipline in the team, it considers a new contact with pupils, professors and the technique team, standing out essential problems, and also methodologies for the application of musical education, with the focus on social inclusion. The methodology used in the research bases itself on the antropopedagogy and on the action-research, both adopted according to Andres Morin definitions, who, qualitatively, presents the reflective register and the observation as action strategies forming a triangle with interdisciplinarity. The theoretical recital support is the job of the two beginners of interdisciplinary study in Brazil, Hilton Japiassú and Ivani Farm, who trace a parallel between the discipline concepts and projects , and focus on the accomplishment of effectively interdisciplinary jobs. As a conclusion, the research shows the importance of the formation of interdisciplinary groups at schools with intend to promote support to students with special necessities, as a form of improvement and reduce of the effects on the inclusion process for teachers, students and other professionals involved, as also the families and close communities.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

GVCs Effect of Twin Transition and Resilience on Small Firms in the Italian Setting

The aim of the paper is testing if, and the extent to which, the participation in Global Value Chains (GVCs) influences firm’s competitiveness (i.e., the “GVC effect”). The empirical results show that the participation in GVCs moderates the relationship between small firms and performance from different points of view: digital transition, green transition, and resilience. Moreover, we found that participation in GVCs is influenced by management openness, Institutional openness, and business openness

Nature-Based Solution for Reducing CO2 Levels in Museum Environments. A Phytoremediation Study for the Leonardo da Vinci’s “Last Supper

This work investigates the possibility of implementing a nature-based solution (NBS) based on the photosynthetic process of Laurus nobilis L. (common laurel), for reducing peak CO2 concentrations in an air-tight museum environment, namely the Refectory of the Santa Maria delle Grazie Church (Milan, Italy), home of Leonardo da Vinci’s painting “Last Supper”. The phytoremediation potential of laurel plants was evaluated at CO2 ≅ 1000 ppm under controlled environmental conditions. Furthermore, light-saturated net assimilation (Pnmax) was measured at two CO2 concentrations (380 and 1000 ppm) during the growing season. Steady-state gas exchanges were not affected by elevated CO2 in the short-term, while Pnmax was significantly increased, also showing higher values in spring and autumn, and a reduction during summer. Our estimated CO2 removal rates indicate that, in order to control visitors’ respiratory CO2 emissions in view of an increase in visitor numbers in the Refectory, a possible NBS in the form of an external greenhouse, connected to the HVAC system of the museum, should allocate from 58 to 112 young laurel plants, depending on their seasonal phytoremediation capacity. These results, although preliminary, allow to hypothesize the possibility of controlling CO2 indoors through a combination of traditional air-cleaning systems and a properly designed NBS, thus increasing the sustainability of air-tight museum environments