La rappresentazione del rapporto tra utenti e sistema sanitario: I modelli culturali dei medici di medicina generale - The representation of the relationship between users and healthcare system: Cultural models of general practitioners

The present research study explores the emotional and symbolic representation of the Italian healthcare system and specifically of general medical services reported by a group of Italian general practitioners. General medicine is recently affected by a structural change which could be sustained also by a cultural revolution, however this revolution seems to be oriented to expected values without a clear methodology which promotes and accompanies this cultural change. The present study deals with the lack of practices due to these unrealized expected values and assumes that for intervening it is necessary knowing the existing culture before thinking to change it. Interviews to 36 general practitioners were analyzed by Emotional Text Analysis (AET). Results highlight a factorial space characterized by five clusters. According to respondents’ perspective, healthcare problems refer to two large issues characterized by powerlessness of general practitioners to intervene. On the one hand, there is health emergency, dealt with by first aid and emergency medicine. On the other hand, there is chronicity, especially affecting the elderly, which is dealt with by other workers (nurses, private family assistants, social workers) who care patients at home and replace physicians. The general practitioners’ work is difficult because of many different reasons; but the central theme is the lack of absolute power – based on morality and consciousness – which leads to the perception of catastrophic consequences for medical profession and the physician-patient relationship. Often, general practitioners are in their offices and are not able to go to patients’ home, therefore they cannot create care relationships based on trust and dependence which allow useful and trustworthy interventions. In sum, the core theme emerging from data refers to the general practitioners’ perceived lack of personal and trust-based relationships with patients

La relazione che organizza il contesto sanitario: domanda dell’utenza e risposta dei servizi sanitari, nel territorio e nell’ospedale - The relationship which organizes the healthcare context: users’ demand and response of healthcare services, in the territory and the hospital

Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three s tudies: the first study regarded the citizens’expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners onthe health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leavingthe possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the othe

Diagnostic and therapeutic path of breast cancer: Effectiveness, appropriateness, and costs â Results from the DOCMa study

none8noopenGiovagnoli, Maria Rosaria; Bonifacino, Adriana; Neglia, Cosimo; Benvenuto, Marco; Sambati, Francesco Vincenzo; Giolli, Lorenzo; Giovagnoli, Alessandra; Piscitelli, PriscoGiovagnoli, Maria Rosaria; Bonifacino, Adriana; Neglia, Cosimo; Benvenuto, Marco; Sambati, Francesco Vincenzo; Giolli, Lorenzo; Giovagnoli, Alessandra; Piscitelli, Prisc

L’Islam e la sua rappresentazione nella cultura italiana

Different groups of citizens from Latium region, distributed by gender and age, and belonging to the medium-high socio-economic-cultural class, were asked in 2002, 2004 and 2005 to express what was coming to their mind, their associations and fantasies about Islam and islamic populations. The data were processed with the Emotional Text Analysis. The results of these three research studies are presented, which show a progressive accentuation of the pejorative stereotypes towards the islamic populations

La cultura locale di Roma e delle sue periferie urbane nella rappresentazione dei resti archeologici - The local culture of Rome and its urban suburbs in the representation of the archaeological remains

Nel presente lavoro viene proposta l’analisi della relazione come luogo del problema che caratterizza l’intervento psicologico clinico quale alternativa alla diagnosi. Tre esempi clinici aiutano a cogliere come la relazione sia il luogo del problema che s’intende affrontare; sia con il lavoro d’assistenza in ambito familiare, che scolastico o sociale. La funzione psicologica può cambiare radicalmente il lavoro assistenziale, mutando obiettivi inutili e obsoleti in interventi efficaci. Ciò è possibile se l’intervento cambia il proprio obiettivo, spostandolo dalla singola persona disabile o problematica, alla relazione entro la quale l’intervento si contestualizza.The research, carried out within a project research of national interest (PRIN) directed by archaeologist Professor Clementina Panella, has the purpose to detect the local culture of inhabitants of the center and the outskirts of Rome, paying attention to the archaeological remains and their cultural contribution. Three components of local culture emerged in this research; all of them are reported to a cultural context that people feel as organized by the pursuit of power and the enhancement of the mass media as factors that give notoriety and popularity then power. One of the three cultural repertoires, characterized by young participants and residents in the outskirts of Rome, enhances the archaeological remains as components of a fun culture. The fun, in combination with culture, is experienced as an effective alternative to the power and the pursuit of powe

Validation of the italian version of the behavioral inhibition questionnaire (Biq) for preschool children

Behavioral Inhibition (BI) is a temperamental trait characterized by fear and wariness in reaction to new and unfamiliar stimuli, both social and non-social. BI has been recognized as possible forerunner of anxiety disorders, especially social anxiety and phobia; therefore, its assessment is clinically relevant. The present study aimed to examine the psychometric properties of the Italian adaptation of the Behavioral Inhibition Questionnaire (BIQ), which measures BI in preschool children. The BIQ was completed by 417 Italian parents (230 mothers, 187 fathers) of 270 preschoolers aged 3–5. Confirmatory factor analysis showed a good internal validity: the factorial structure was corresponding to the original six-factor version. Results showed excellent internal consistency, significant item-total correlations, good inter-rater reliability, convergent validity (by correlating the BIQ with the Italian Questionnaires of Temperament-QUIT, the Anxiety-Shy Conner’s Scale and the Laboratory Temperament Assessment Battery) and discriminant validity (i.e., no correlation with Conners’ ADHD scale). Significant correlations emerged between BI indexes and total BIQ scores of parents and maternal (but not paternal) versions of the questionnaire. Altogether, the results are promising and consistent with previous validation studies, suggesting the BIQ as a reliable and valid measure for evaluating parents’ perception of BI in Italian preschoolers

Myocardial extracellular volume fraction to differentiate healthy from cardiomyopathic myocardium using dual-source dual-energy CT

Objective: To evaluate the feasibility of dual-energy CT (DECT)-based iodine quantification to estimate myocardial extracellular volume (ECV) fraction in patients with and without cardiomyopathy (CM), as well as to assess its ability to distinguish healthy myocardial tissue from cardiomyopathic, with the goal of defining a threshold ECV value for disease detection. Methods: Ten subjects free of heart disease and 60 patients with CM (mean age 66.4 ± 9.4; 59 males and 11 females; 40 ischemic and 20 non-ischemic CM) underwent late iodine enhanced DECT imaging. Myocardial iodine maps were obtained using 3-material decomposition. ECV of the left ventricle was estimated from hematocrit levels and the iodine maps using the AHA 16-segment model. Receiver operating characteristic curve analysis was performed, with corresponding area under the curve, along with Youden's index assessment, to establish a threshold for CM detection. Results: The median ECV for healthy myocardium, non-ischemic CM, and ischemic CM were 25.4% (22.9–27.3), 38.3% (33.7–43.0), and 36.9% (32.4–41.1), respectively. Healthy myocardium showed significantly lower ECV values compared to ischemic and non-ischemic CM (p 29.5% would indicate the presence of CM in the myocardium (sensitivity = 90.3; specificity = 90.3); the AUC for this criterion was 0.950 (p < 0.001). Conclusion: The findings of this study resulted in a statistically significant distinction between healthy myocardium and CM ECVs. This led to the establishment of a promising threshold ECV value that could facilitate the differentiation between healthy and diseased myocardium, and highlights the potential of this DECT methodology to detect cardiomyopathic tissue

XMM-Newton survey of the Local Group galaxy M 33

In an XMM-Newton raster observation of the bright Local Group spiral galaxy M 33 we study the population of X-ray sources (X-ray binaries, supernova remnants) down to a 0.2--4.5 keV luminosity of 10^35 erg/s -- more than a factor of 10 deeper than earlier ROSAT observations. EPIC hardness ratios and optical and radio information are used to distinguish between different source classes. The survey detects 408 sources in an area of 0.80 square degree. We correlate these newly detected sources with earlier M 33 X-ray catalogues and information from optical, infra-red and radio wavelengths. As M 33 sources we detect 21 supernova remnants (SNR) and 23 SNR candidates, 5 super-soft sources, and 2 X-ray binaries (XRBs). There are 267 sources classified as hard, which may either be XRBs or Crab-like SNRs in M 33 or background AGN. The 44 confirmed and candidate SNRs more than double the number of X-ray detected SNRs in M 33. 16 of these are proposed as SNR candidates from the X-ray data for the first time. On the other hand, there are several sources not connected to M 33: five foreground stars, 30 foreground star candidates, 12 active galactic nucleus candidates, one background galaxy and one background galaxy candidate. Extrapolating from deep field observations we would expect 175 to 210 background sources in this field. This indicates that about half of the sources detected are sources within M 33.Comment: 14 pages, 6 figures, accepted for publication in A&A, the images of Figs. 1,2,3,4,6 are available in jpg format, a full version of the paper is available at ftp://ftp.xray.mpe.mpg.de/people/fwh/docs/M33_AA0068.p

Neuropsychological predictors of quality of life in focal epilepsy

Spontaneous complaints of outpatients with focal epilepsy often stress the relationship between cognitive deficits and Quality of Life (QOL). Consequently, the aim of the present study was to find the best neuropsychological predictors of QOL in individuals with focal epilepsy, in order to guide their ambulatory health care. A sample of 71 Portuguese patients was studied: 40 female, 47 married, with a mean age of 37.48 years (S.D. = 11.79, 16–62), mean education of 7.93 (S.D. = 4.05, 3–17), and focal epilepsy of moderate severity. A Socio-demographic and Clinical Questionnaire, the SF-36 v1, the Cognitive Functioning Scale from the ESI-55, a Seizure Control scale (items from the Liverpool Seizure Severity Scale), and several neuropsychological tests were used. Semantic Fluency was the only predictor of Physical Functioning, Role Functioning – Physical, and Mental Health; I.A. Test predicted Bodily Pain; and AttentiveMatrices predicted General Health, Vitality, and Role Functioning – Emotional. The Mental Component of the SF-36 v1 was predicted by Attentive Matrices, and the Physical Component was predicted by Semantic Fluency. Cognitive Functioning was predicted by the Token Test. Social Functioning and Seizure Control presented no statistically significant correlation with the neuropsychological indicators used. These results underscore the importance of cognitive performance to the QOL of individuals with focal epilepsy, supporting the systematic screening of cognitive performance in this population. Additionally, they suggest cognitive rehabilitation has the potential to improve these individuals’ QOL