The Effect of Abuse History on Adolescent Patients with Feeding and Eating Disorders Treated through Psychodynamic Therapy: Comorbidities and Outcome.

OBJECTIVES: The first aim of our study was to compare the characteristics and comorbidities of patients with eating disorders between those who suffered from a childhood abuse and those who did not. Our second aim was to analyze the differences in the outcome of the psychodynamic therapy between abused and not abused patients. METHODS: Twenty-six adolescent patients with eating disorders were assessed. Adolescent were evaluated by a single expert psychiatrist by checklists and questionnaires: EDI 3, SCL 90, BIS11, Dissociative Experiences Scale, Global Assessment of Functioning, SCID II, and CTQ-Self control (SF). According to the results of CTQ-SF (cut-off\u2009 65\u20098), patients were divided into two groups: those who had experienced a history of abuse and those who had not. They underwent a psychodynamic psychotherapy and were assessed again after 12\u2009months. RESULTS: Eleven patients (42.3%) had a history of abuse according to CTQ score. No significant differences were found in abused and not abused patients in their demographic, clinical, and comorbid characteristics (sex, age, type of eating disorder, comorbid impulse control, personality, and addictive disorders). Abused patients showed a significantly higher score in many scale. The psychotherapeutic intervention in patients with a history of abuse resulted only in a significant decrease in symptom checklist-90 (SCL-90) psychoticism dimension (p\u2009<\u20090.05), whereas in patients with no history of abuse a significant decrease was found for SCL-90 somatization, obsessive-compulsive and phobic anxiety dimensions, the SCL-90 Global Severity Index, the Eating Disorder Inventory-3 interceptive deficits, and the dissociative experience scale. CONCLUSION: Regarding the first aim of our study, we proved that history of abuse is not significantly related to patient comorbidities. Regarding our second aim, history of abuse was related to patient improvement only for psychotic symptoms; whereas patients who had not experienced an abuse improved in a variety of symptoms. Thus, abuse history can be considered as a negative prognostic factor for patients with eating disorders undergoing dynamic psychotherapy. However, this psychotherapy may have a role in preventing early psychotic disorders in patients with and without an history of abuse

Closing the gap: a multi-stakeholder initiative of health promotion in 20 suburban Roman districts

Issue In the last decade the economic crisis, in addition to urban, demographic and ethnic changes, led to an important reduction in preventive services access and social-healthcare pathways, impacting more on disadvantage groups, especially elderly and frail people. In a complex city such as Rome, where over 65 population with average income less than 11.000 \u20aca year is 28,6%, social isolation and related health issues represent a focal question. In order to strengthen health promotion and prevention in elderly, a multi-stakeholder project has started in Parishes of 20 socially disadvantaged Roman districts. Description of the problem To assess social and health needs of the elderly, a counselling service composed by a psychologist, a social assistant and local volunteers, trained in health determinants and empathy skills, has been set up in each Parish. A Mobile Health Unit (MHU) with a general practitioner and a nurse offer free medical visits focused on nutrition, cardiovascular diseases, diabetes and active ageing. A functional network among counselling services in Parishes, the Vicariatus Urbis, MHU team and district\u2019s services has been structured in order to address user\u2019s needs. Health promotion meetings have also been proposed in the Parishes to empower, enable and increase elderly health literacy. Previous informed consent, data about user\u2019s social-health status are collected in order to provide a better assessment and support. Results From February 2017, MHU provided more than 120 medical visits and an average of 10 elders per week in each Parish require counselling services. MHU\u2019s users have a mean age of 70 \ub1 10.3 SD (68.6% female and 31.4% male), 51% living with relatives and 30% alone. Lessons First results suggest that the project has correctly identified latent social and health needs of elderly people living in suburban areas trying to close the gap between ease/dis-ease condition. Follow-up data analysis will assess the project\u2019s effectiveness. Key messages: Focused social inclusion and health promotion programs have to be implemented on disadvantaged groups living in suburban districts, especially elderly living alone or in a margined condition. Multi-stakeholder network can be considered a driver to support health promotion and reduce inequalities in access to healthcare

Development and validation of a questionnaire to assess Unaccompanied Migrant Minors' needs (AEGIS-Q)

Background: While many studies focus on specific aspects of Unaccompanied Migrant Minors' (UMMs) health, especially mental well-being, there is a lack of tools comprehensively assessing their needs. To fill this gap, we developed and validated a questionnaire to thoroughly assess unAccompaniEd miGrant mInorS' physical, psychological, legal, spiritual, social and educational needs (AEGIS-Q). Methods: This work consisted of three stages. The first one involved an extensive literature review. Given the results of the review, a first draft of the questionnaire was developed and submitted to a panel of experts for validation (Delphi method-second stage). During the third stage, the final version of the questionnaire was pilot-tested in a sample of 18 UMMs. Results: The questionnaire, drafted based on the results of the review, consisted of sections covering personal data, migration profile, physical health needs and access to healthcare, psychological needs, legal needs, spiritual needs and educational and social needs of UMMs. After two Delphi rounds, the final version of the questionnaire, consisting of 83 questions, was structured. The pilot study had a response rate of 89-100%. We found substantial reliability for most of the sections in the questionnaire, including physical health (\u3b1=0.652), legal (\u3b1=0.781), and educational and social (\u3b1=0.614) needs. The questions regarding psychological needs had very high reliability (\u3b1=0.860). Conclusions: The questionnaire offers a useful sharable tool to assess and monitor UMMs' needs, helping the reception system to better know and meet their needs and implement the taking in charge

Valutazione dell\u2019attivit\ue0 di un\u2019area afferente all\u2019unit\ue0 operativa complessa \u2013 igiene ospedaliera di un policlinico universitario: analisi e risultati preliminari

INTRODUZIONE: In ambito ospedaliero, la sicurezza riveste un obiettivo di primaria importanza e deve essere perseguita tramite sorveglianza e controllo ambientale. A tal fine, l\u2019Unit\ue0 Operativa Complessa (UOC) Igiene Ospedaliera della Fondazione Policlinico Universitario A Gemelli (FPG) agisce come organo tecnico di verifica e consulenza della Direzione Sanitaria e si avvale dell\u2019attivit\ue0 integrata di expertise mediche e sanitarie in 6 aree (A- Acque, B-Alimenti, C- Ambienti Controllati, D-Prodotti e Procedure obbligatoriamente sterili, E-Expertise-Education-Evidence, M-Microclima). Scopo dello studio \ue8 valutare attivit\ue0 e prodotti dell\u2019Area D quale stima indiretta della sicurezza dei pazienti. MATERIALI E METODI: All\u2019Area D afferiscono 6 procedure, ognuna volta al controllo di una matrice obbligatoriamente sterile: colliri e altre preparazioni farmaceutiche -D1, unit\ue0 di emocomponenti -D2, sacche per nutrizioni parenterali -D3, macchine sterilizzatrici -D4, radiofarmaci -D5 e mediafill test -D6. La periodicit\ue0 delle verifiche \ue8 programmata secondo leggi di riferimento, Farmacopea Ufficiale, linee guida. Le Procedure esitano nella produzione di Pareri igienico-sanitari: ordinario (PO), verifica dell\u2019ordinario (PVO), conformit\ue0 (PC), verifica di conformit\ue0 (PVC). Il parere d\u2019allerta (PA), generato a seguito di risultati preliminari non conformi all\u2019atteso, pu\uf2 determinare l\u2019attivazione di Focus Group al fine di stabilire e adottare misure correttive tempestive volte al ripristino delle condizioni di sicurezza. RISULTATI: Le Procedure sono state applicate 42 volte nel 2015 e 51 nel 2016 (+21.4%) esitando in: 64% PO e PVO, 36% PC (2015); 67% PO e PVO e 33% PC (2016) e nessun PVC nel biennio considerato. Nello stesso periodo vi \ue8 stata una riduzione del 53% di PA e un incremento del 43% e del 38% nell\u2019utilizzo delle Procedure D4 e D6 rispettivamente. CONCLUSIONI: Lo studio evidenzia un aumento d\u2019utilizzo di Procedure dovuto a una maggiore attenzione posta alla sorveglianza igienico-sanitaria da parte della FPG e una riduzione del numero di allerte, esitando in una maggior sicurezza ambientale per pazienti, visitatori e operatori. Lo studio riassume i risultati nel breve periodo e sar\ue0 utile monitorare l\u2019andamento nel tempo estendendo la valutazione anche alle altre Aree di intervento della UOC

Smoke exposure and cardio-metabolic profile in youth with type 1 diabetes

Abstract Background To evaluate the relationship between smoking and metabolic parameters in patients affected by type 1 diabetes (T1D). Patients and methods We enrolled 104 children and young adults (50 females and 54 males) with T1D (aged 16.4 ± 8.6 years). The subjects were divided into three groups according to their smoking habits: no smoking (NS), passive smoking (PS), active smoking (AS). The physical examination of the participants included nutritional status assessment by anthropometry and pubertal stage according to Marshall and Tanner as well as blood pressure measurement. In all patients, metabolic blood assays including fasting blood glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured. Insulin resistance was determined by glucose disposal rate (eGDR). Physical activity was also recorded. Results Significant differences in biochemical and functional parameters among the three groups were demonstrated, in particular for systolic (p = 0.002) and diastolic pressure (p = 0.02) and eGDR (p = 0.039). No differences in daily insulin dose (p = 0.75) and glycated hemoglobin (p = 0.39) were observed. AS group had significantly higher blood pressure (p < 0.05) and lower eGDR (p ≤ 0.001) compared to NS and PS. Significant difference was also detected between PS and NS in systolic and diastolic (p = 0.02) pressure and eGDR (p = 0.01). In a multivariable model adjusted for age, gender, BMI and physical activity, smoking habits did not maintain any independent association with metabolic parameters. Conclusion This is the first study in a Mediterranean population, looking at tobacco smoke and cardio-metabolic factors in youth with T1D. The relationship between smoking and unfavorable metabolic profile was demonstrated. On the basis of these findings, smoking tobacco should be considered an important modifiable risk factor for young patients with diabetes mellitus, highlighting the need for intensified smoking prevention and cessation programs