Trajectories and determinants of emergency department use among nursing home residents: a time series analysis (2012-2019)

Background Emergency department (ED) use among nursing home (NH) residents is an internationally-shared issue that is understudied in Italy. The long term care in Italy is part of the health system. This study aimed to assess trajectories of ED use among NH residents and determinants between demographic, health supply, clinical/functional factors. Methods A pooled, cross-sectional, time series analysis was performed in an Italian region in 2012/2019. The analysis measured the trend of ED user percentages associated with chronic conditions identified at NH admission. A GLM multivariate model was used to evaluate determinants of ED use. The variables collected were sex, age, assistance intensity, destination after discharge from NH, chronic conditions at NH admission, need for daily life assistance, degree of mobility, cognitive impairments, behavioural disturbances and were taken from two databases of the official Italian National Information System (FAR and C2 registries) that were combined to create a unique and anonymous code for each patient. Results A total of 37,311 residents were enrolled; 55.75% (20,800 residents) had at least one ED visit. The majority of the residents had cardiovascular (25.99%) or mental diseases (24.37%). In all pathologies, the percentage of ED users decreased and the decrease accelerated over time. These results were confirmed in the fixed effects regression model (coefficient for linear term (b = - 3.6177, p = 0, 95% CI = [- 5.124, - 2.1114]); coefficient for quadratic term = - 0.7691, p = 0.0046, 95% CI = [- 1.2953, - 0.2429]). Analysis showed an increased odds of ED visits involving males (OR = 1.27, 95% CI 1.24;1.30) and patients affected by urogenital diseases (OR = 1.16, 95% CI [1.031-1.314]). The lowest odds of ED visits were observed among subjects aged > 90 years (OR = 0.64, 95% CI [0.60-0.67]), who required assistance for their daily life activities (OR = 0.86; 95% CI = [0.82, 0.91]), or with serious cognitive disturbances (OR = 0.86; 95% CI = [0.84, 0.89]), immobile (OR = 0.93; 95% CI = [0.89, 0.96]), or without behavioural disturbances (OR = 0.92; 95% CI = [0.90, 0.94]). Conclusions The percentage of ED users has decreased, through support from the Italian disciplinary long-term care system. The demographic, clinical/functional variables associated with ED visits in this study will be helpful to develop targeted and tailored interventions to avoid unnecessary ED use

Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy

Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual’s well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people’s mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs’ hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018–2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‰ to 22.2‰). Significant hospitalization rate increases were observed both in 15–19 and in 10–14 females’ age groups in 2021. Non-significant increases were observed in all males’ age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged

Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study

Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED).Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests.Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents.Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention

Connecting psychosocial and personality characteristics with mental health outcomes. An Italian co-twin control study

Exposure to stressful life events is common, and it is linked to increased psychological issues. As most likely people respond to stressors depending on environmental and genetic factors, we assessed in a twin study the association of some personal characteristics such as resilience and self-perception with anxiety, depression and stress in the late Covid pandemic period, to verify the underlying genetic and shared familial components. With this design, the strength of the associations was compared between individual-level and intrapair-level analyses. From June 2020 to December 2021, the Italian Twin Registry conducted a three-wave longitudinal study among adult twins using validated questionnaires, and 1,763 adult twins participated in the study (mean age 46 years, 67 % females, 70 % monozygotic). A regression-based within-pair differences model was applied to control for genetic and shared environmental confounding. Results showed that anxiety was linked negatively with resilience, social support and perceived health, and positively with risk perception and hypochondria. Depression was associated negatively with resilience, social support and perceived health, and positively with financial concern and hypochondria. Stress was associated negatively with resilience and perceived health, and positively with financial concern, risk perception and hypochondria.These results suggest potential etiological effects of the above-mentioned risk factors. While our findings need to be confirmed by longitudinal studies, they propose potential etiological models for mental disorders, indicating that addressing in the clinical practice factors such as self-perception, personality traits (resilience), environmental resources (social support), and comorbid disorders (hypochondria) could have therapeutic benefits while treating certain common mental disorders

Consequences and coping strategies of nurses and registered nurses perceiving to work in an environment characterized by workplace bullying

Aim: The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method: A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results: In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion: Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication: Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities

Attitude and concerns of healthy individuals regarding post-mortem brain donation. A qualitative study on a nation-wide sample in Italy

Abstract Background Collecting post-mortem brain tissue is essential, especially from healthy “control” individuals, to advance knowledge on increasingly common neurological and mental disorders. Yet, healthy individuals, on which this study is focused, are still understudied. The aim of the study was to explore, among healthy potential brain donors and/or donors’ relatives, attitude, concerns and opinion about post-mortem brain donation (PMBD). Methods A convenience sampling of the general population (twins and their non-twin contacts) was adopted. From June 2018 to February 2019, 12 focus groups were conducted in four Italian cities: Milan, Turin, Rome and Naples, stratified according to twin and non-twin status. A qualitative content analysis was performed with both deductive and inductive approaches. Emotional interactions analysis corroborated results. Results One hundred and three individuals (49–91 yrs of age) participated. Female were 60%. Participants had scarse knowledge regarding PMBD. Factors affecting attitude towards donation were: concerns, emotions, and misconceptions about donation and research. Religion, spirituality and secular attitude were implied, as well as trust towards research and medical institutions and a high degree of uncertainty about brain death ascertainment. Family had a very multifaceted central role in decision making. A previous experience with neurodegenerative diseases seems among factors able to favour brain donation. Conclusions The study sheds light on healthy individuals’ attitudes about PMBD. Brain had a special significance for participants, and the ascertainment of brain death was a source of debate and doubt. Our findings emphasise the importance of targeted communication and thorough information to promote this kind of donation, within an ethical framework of conduct. Trust in research and health professionals emerged as an essential factor for a collaborative attitude towards donation and informed decision making in PMBD

Gender dysphoria: Quality of online information for gender reassignment surgery

Summary: An ever-increasing number of patients are using the Internet to learn about medical conditions. This study aimed to evaluate the quality of Internet-based patient information on gender reassignment surgery for people who suffer from gender dysphoria.Twenty websites identified using Google and Yahoo search engines were selected and evaluated based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items).The EQIP tool comprises 36 questions to which the answer can be “yes” or “no”. The final score for each website can be between 0 and 36. An overall score of 26 or above was considered high, because it co-related to the 72nd percentile. The average of the scores turned out to be 22.5 points, lower than our target; 7 (35%) sites were rated higher than the average and 13 (65%) were rated lower.The assessment of the websites included in the study showed a lack of information about the sequence of the medical procedures, perioperative criticalities and qualitative risks and side-effects descriptions. The overall quality of published information on gender reassignment surgery is very low. We believe that the Internet should not be used as the main source of medical information, and physicians should maintain the leadership in guiding patients affected by gender dysphoria.Level of Evidence: Level IV, case study

Table_1_Which variables and determinants influence online food delivery consumption among workers and students? Results from the DELIvery Choice In OUr Society (DELICIOUS) cross-sectional study.docx

IntroductionOnline food delivery (OFD) applications provide easy access to food, eliminating the need for cooking and meal planning. However, they predominantly promote processed and calorie-dense foods, potentially impacting diet and health. This study aimed to describe the use of OFD services in a sample of Italian workers and students, to explore potential determinants of OFD usage and to assess possible differences in use between these two categories.MethodsData were collected through an online survey (convenience sampling) distributed on social media platforms between July 12, 2022, and February 1, 2023. The sample included individuals aged 18 and above, currently residing in Italy. The sample was stratified according to worker/student status. Descriptive analyses were performed on key variables. A multivariable logistic regression analysis was conducted to assess the effects of variables on OFD usage, treated as a dichotomous variable (usage or non-usage).ResultsThis study analyzed 3,502 questionnaires (2,594 from workers and 908 from students) after excluding 323 non-student and non-worker responses. Positive associations with OFD use included higher income, remote working, smoking, elevated BMI, depression risk, and impulsive buying among workers, while being female, frequent screen-watching during meals, daily smoking, higher BMI, and impulsive buying were associated with OFD use among students. Factors negatively associated with OFD use included older age (workers and students), living in suburbs (workers and students) or in an outline town (workers), being single (workers and students), adhering to the Mediterranean diet (students), having low health literacy (students), and job dissatisfaction (workers).DiscussionOFD consumption was associated with some risky behaviors and conditions, such as high BMI or smoking, suggesting that it might be influenced by individual tendencies. Healthier habits, such as physical activity, did not significantly impact OFD usage, especially among workers. Whereas, among students, factors such as low health literacy and better eating habits were associated with less use of OFD, so that they could be more prone to use OFD in a measured way. Further research is needed to better understand potential associations between OFD and risky habits, as well as its role in promoting access to healthy food in underserved areas.</p

Additional file 1 of Attitude and concerns of healthy individuals regarding post-mortem brain donation. A qualitative study on a nation-wide sample in Italy

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