Open-ended design : local re-appropriations through imperfection

Design for Sustainability (DfS) focuses on wicked problems that cannot be modelled in reductionist ways. Furthermore, when bottom-up local interventions prove to have positive effects in their context, they remain hard to spread and might face failure if transferred the other contexts. Here, a research through-design approach is present-ed for highlighting a new paradigm, that questions the very nature of both design process and outcomes. Specifically, Open-ended Design (OeD) is introduced pursuing the creation of unfinished and ever-evolving outcomes (im-perfect by intention), embracing the out-of control local instances. In this approach balance between openness and over-design is sought, to facilitate both the global diffusion of design outcomes and their local re-appropriation. The aim of the research is to highlight existing connections between OeD and DfS, listing its values and limitations through some reported cases. In conclusion, designers might start designing for emergent aspects of the designed solutions, supporting multiple local re-appropriations

The role of re-appropriation in open design : a case study on how openness in higher education for industrial design engineering can trigger global discussions on the theme of urban gardening

This case study explores the opportunities for students of Industrial Design Engineering to engage with direct and indirect stakeholders by making their design process and results into open-ended Designed Solutions. The reported case study involved 47 students during a two-weeks intensive course on the topic of urban gardening. Observations were collected during three distinctive phases: the co-design phase, the creation of an Open Design and the sharing of these design solutions on the online platform Instructables.com. The open sharing of local solutions triggered more global discussions, based on several types of feedbacks: from simple questions to reference to existing works and from suggestions to critiques. Also some examples of re-appropriation of the designed solutions were reported. These feedbacks show the possibilities for students to have a global vision on their local solutions, confronting them with a wider and more diverse audience. The case study shows on the other hand the difficulty in keeping students engaged in this global discussion, considering how after a few weeks the online discussions dropped to an almost complete silence. It is also impossible with such online platforms to follow the re-appropriation cycles, losing the possibility of exploring the new local context were the replication / modification of the designed product occurred. The course’s focus on Open Design is interesting both under the design and educational points of view. It implies a deep change in the teaching approach and learning attitude of students, allowing unknown peers to take part of the design process and fostering a global discussion starting from unique and local solutions

Mapping the selection, availability, price and affordability of essential medicines for mental health conditions at a global level

Aims: To provide a cross-country analysis of selection, availability, prices and affordability of essential medicines for mental health conditions, aiming to identify areas for improvement. Methods: We used the World Health Organization (WHO) online repository of national essential medicines lists (EMLs) to extract information on the inclusion of essential psychotropic medicines within each country's EML. Data on psychotropic medicine availability, price and affordability were obtained from the Health Action International global database. Additional information on country availability, prices and affordability of essential medicines for mental disorders was identified by searching, up to January 2021, PubMed/Medline, CINAHIL, Scopus and the WHO Regional Databases. We summarised and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors, and by country income groups. Results: A total of 112 national EMLs were analysed, and data on psychotropic medicine availability, price and affordability were obtained from 87 surveys. While some WHO essential psychotropic medicines, such as chlorpromazine, haloperidol, amitriptyline, carbamazepine and diazepam, were selected by most national lists, irrespective of the country income level, other essential medicines, such as risperidone or clozapine, were included by most national lists in high-income countries, but only by a minority of lists in low-income countries. Up to 40% of low-income countries did not include medicines that have been in the WHO list for decades, such as long-acting fluphenazine, lithium carbonate and clomipramine. The availability of generic and originator psychotropic medicines in the public sector was below 50% for all medicines, with low-income countries showing rates lower than the overall average. Analysis of price data revealed that procurement prices were lower than patient prices in the public sector, and medicines in the private sector were associated with the highest prices. In low-income countries, the average patient price for amitriptyline and fluoxetine was three times the international unit reference price, while the average patient price for diazepam was ten times the international unit reference price. Affordability was higher in the public than the private sector, and in high-income than low-income countries. Conclusion: Access to medicines for mental health conditions is an ongoing challenge for health systems worldwide, and no countries can claim to be fully aligned with the general principle of providing full access to essential psychotropic medicines. Low availability and high costs are major barriers to the use of and adherence to essential psychotropic medicines, particularly in low-and middle-income countries

Long-acting antipsychotics: patient\u2019s features and prescribing attitudes in Italy. Findings from the cross-sectional phase of an observational, longitudinal, multicenter study.

Scientific background. Long-acting injectable antipsychotics (LAIs) are considered one of the most important tools for ensuring medication adherence in people with chronic psychosis. In recent times many authors promoted an earlier and broader use of LAIs, considering not only their efficacy in preventing non-adherence (and therefore relapses), but also their potential role in simplifying the daily medication routine, ultimately ameliorating patient\u2019s quality of life. On this background, this study aims at describing how this new perspective influenced prescribing pattern in Community Psychiatry Services, with a specific interest in comparing first- and second-generation antipsychotics. Methods. The STAR Network \u201cDepot\u201d Study is an observational, longitudinal, multicenter study involving 35 Italian Community Psychiatry Services. Adult patients initiating a new LAI were recruited over a 12-months period and assessed for relevant socio-demographic and clinical features (employing also validated rating scales) at baseline, after 6 and 12 months. Descriptive statistics and a stepped multivariate logistic model accounting for the inter-center variability were employed. Results. Only results from the recruitment (or cross-sectional) phase will be discussed here. Four-hundred-fifty-one patients, mostly males over their 30s, were recruited. Patients were heterogeneously distributed between higher and lower levels of education, social functioning, overall symptom profiles and medication adherence. Beside schizophrenia, also bipolar disorders, personality disorders and mental organic conditions were well represented. Paliperidone and aripiprazole were the most frequently prescribed medications. Analyses showed that, compared to first-generation LAIs, second-generation LAIs were more likely to be prescribed to younger, employed patients, with higher affective symptoms, a diagnosis different from schizophrenia or bipolar disorder, and fewer previous LAI prescriptions. Discussion. LAIs are prescribed to heterogeneous populations of patients, often even off-label. The advocated paradigm shift is under way in clinical practice, although it appears to be largely limited to second-generation LAIs

Esketamine for treatment resistant depression: a trick of smoke and mirrors?

Abstract In March 2019, the US Food and Drug Administration (FDA) approved a nasal spray formulation of esketamine for the treatment of resistant depression in adults. Esketamine is the S-enantiomer of ketamine, an FDA-approved anaesthetic, known to cause dissociation and, occasionally, hallucinations. While ketamine has not been approved for depression in the USA or in any other country, it has been used off-label in cases of severe depression. This commentary critically reviewed the evidence on esketamine submitted to the FDA, aiming to draw implications for clinical practice, research and regulatory science

Calling for policy actions to increase access to long-acting antipsychotics in low-income and middle-income countries

Schizophrenia-spectrum disorders are associated with substantial impairment and disability. Lack of treatment adherence is a major issue, especially in low- and middle-income countries (LMICs). Despite growing evidence supporting second-generation long-acting antipsychotics (LAIs) as an effective strategy to ensure continued maintenance treatment in schizophrenia, access to these technologies has been very limited in constrained-resource settings. Including second-generation LAIs in national and international essential medicines lists and evidence-based guidelines, promoting public health-oriented patent pooling and extending their availability to primary health care settings, are key actions that should urgently be implemented to increase access to long-acting technologies. Implementing these policy actions can pragmatically improve treatment adherence, ultimately tackling schizophrenia-related impairment and disability in LMICs, which can be regarded as a global health priority

Crossroads of methodological choices in research synthesis: insights from two network meta-analyses on preventing relapse in schizophrenia

In recent years, network meta-analyses have been increasingly carried out to inform clinical guidelines and policy. This approach is under constant development, and a broad consensus on how to carry out several of its methodological and statistical steps is still lacking. Therefore, different working groups might often make different methodological choices based on their clinical and research experience, with possible advantages and shortcomings. In this contribution, we will critically assess two network meta-analyses on the topic of pharmacological prevention of relapse in schizophrenia, carried out by two different research groups. We will highlight the implications of different methodological choices on the analysis results and their clinical-epidemiological interpretation. Moreover, we will discuss some of the most relevant technical issues of network meta-analyses for which there is not a broad methodological agreement, including the assessment of transitivity

Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries

[no abstract available