Health service outpatient experience questionnarie: factor validity and reliability of a patient- centered outcome measure for outpatient settings in Italy

3PURPOSE: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course. PATIENTS AND METHODS: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach's α. Factor invariance was assessed through multigroup analyses. RESULTS: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients. CONCLUSION: The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.openopenColuccia, Anna; Ferretti, Fabio; Pozza, AndreaColuccia, Anna; Ferretti, Fabio; Pozza, Andre

Sexual masochism disorder with asphyxiophilia: a deadly yet underrecognized disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury

Seismic risk assessment of a new RC-framed skin technology for integrated retrofitting interventions on existing buildings

A RC-framed-skin technology for the integrated seismic and thermal retrofitting interventions on existing buildings, recently proposed by some of the authors, is thoroughly investigated. By means of numerical analyses, its effectiveness and suitability within the framework of seismic risk class assessment is proved. The system is composed of a RC-framed structure with an external reinforced plaster layer that does not offer a structural contribution to the capacity of the system in ultimate conditions, but which can be effective by increasing the lateral stiffness in serviceability conditions. The system is realized from the outside of the existing building so guaranteeing limited invasiveness of the intervention and preventing the interruption of the building use by their occupants. An existing RC building, representative of a typical example of the Italian building stock, is analyzed as a case study, and its seismic risk class upgrade, obtained by the proposed strengthening intervention, is assessed by non-linear static analysis. The numerical models are developed within the OpenSees framework. The Expected Annual Loss (EAL) parameter, together with the Life Safety Index (LS-I), are chosen as synthetic measures that include both aspects related to Ultimate Limit state (ULS) and Serviceability Limit State (SLS) conditions. The risk class accounting for or disregarding the contribution of the external reinforced plaster are finally compared

Quality of life in children and adolescents with obsessive-compulsive disorder: a systematic review and meta- analysis

Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been understudied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=−1.16, P<0.001), suggesting that individuals with OCD had lower global QOL than controls. Moderate effect sizes emerged for school (d=−0.61, P<0.01) and social QOL (d=−0.54, P<0.01), respectively, indicating worse QOL on these domains for individuals with OCD. For samples with higher OCD severity, global QOL of individuals with OCD was lower than that for controls (β=−0.02, P<0.05). For samples with lower percentages of females, global QOL of individuals with OCD was more impaired (β=0.02, P<0.001). Age was not correlated with effect sizes. Assessment and treatment should target QOL for young males suffering from more severe OCD. The small number of included studies highlighted that QOL is under-recognized. Future research should focus on additional QOL domains and compare which ones are impaired among individuals with OCD compared with other psychiatric conditions. Overall, the results pointed out the importance of addressing QOL in both practice and research on assessment and treatment of children/adolescents with this condition. © 2017 Coluccia et al

L'impatto della pandemia Covid-19 sulle nuove strutture psichiatrico-forensi in Italia

After the closure of Psychiatric Hospitals (OPs), in 2012 the Italian Government decided to close the High Security Psychiatric Hospitals (OPGs). Law 81/2014 established that each region would provide smaller forensic psychiatry facilities, theREMS (Residence for the Execution of the Security Measures), to accommodate socially dangerous NGRI (Not Guilty by Reason of Insanity) offenders. The main characteristic of a REMS is that it is purely therapeutic and rehabilitative in naturewhile remaining a custodial safety measure. The COVID-19 pandemic undoubtedly tested the organization of these new Italian forensic psychiatry facilities whose practices were not yet fully established, forcing them to ensure patient safety during lockdown amidst the epidemic. The Chapter V Constitutional reform which assigned each region exclusive competence for health policies in its own territory, once the prerogative of the central government, was also put to the test. To assess the impact of the pandemic on the new forensic care system in Italy, we conducted a semi-structured interview with REMS health professionals from various regions with differing levels of contagion: the Poli REMS di Castiglione delle Stiviere; the REMS of Volterra; the REMS of Carovigno and the REMS of Pisticci. The interview assessed how the rehabilitation objectiveshad been met notwithstanding the serious operational limitations consequent to COVID-19 related decisions by the authorities.Dopo la chiusura degli Ospedali Psichiatrici (OP), nel 2012 il Governo Italiano ha deciso di chiudere gli Ospedali Psichiatrici Giudiziari, gli OPG. La legge 81/2014 stabiliva che ogni regione avrebbe dovuto prevedere l’istituzione di strutture psichiatrico-forensi più piccole, le REMS (Residenze per la Esecuzione delle Misure di Sicurezza), per accogliere gli autori di reatonon imputabili, socialmente pericolosi. La caratteristica principale delle REMS è quella di avere una natura prettamente terapeutica e riabilitativa pur rimanendo una misura di sicurezza detentiva. Non c’è dubbio che la pandemia COVID-19 abbia messo alla prova l’organizzazione delle nuove strutture psichiatrico-forensi italiane, con prassi ancora non del tutto consolidate, costringendo le REMS durante il lock-down ad adoperarsi per gestire l’epidemia, garantendo al tempo stesso la sicurezza dei pazienti. In questo contesto è stata messa alla prova anche la riforma del Capitolo V della Costituzione, che assegnava a ciascuna Regione la competenza esclusiva per le politiche sanitarie del proprio territorio, un tempo prerogativa del governo centrale. Alla luce di ciò, per valutare l’impatto della pandemia sul nuovo sistema di assistenza forense in Italia, abbiamo condotto un’intervista strutturata con gli operatori sanitari delle REMS di diverse regioni con diversi livelli di diffusione della malattia: la Poli REMS di Castiglione delle Stiviere; la REMS di Volterra; la REMS di Carovigno e la REMS di Pisticci. L’intervista ha valutato come gli obiettivi riabilitativi fossero stati garantiti nonostante i gravi limiti operativi conseguenti alle decisioni delle autorità determinate dal COVID-19

Molecular Evolution and Phylogeography of Co-circulating IHNV and VHSV in Italy

Infectious haematopoietic necrosis virus (IHNV) and viral haemorrhagic septicaemia virus (VHSV) are the most important viral pathogens impacting rainbow trout farming. These viruses are persistent in Italy, where they are responsible for severe disease outbreaks (epizootics) that affect the profitability of the trout industry. Despite the importance of IHNV and VHSV, little is known about their evolution at a local scale, although this is likely to be important for virus eradication and control. To address this issue we performed a detailed molecular evolutionary and epidemiological analysis of IHNV and VHSV in trout farms from northern Italy. Full-length glycoprotein gene sequences of a selection of VHSV (n=108) and IHNV (n=89) strains were obtained. This revealed that Italian VHSV strains belong to sublineages Ia1 and Ia2 of genotype Ia and are distributed into 7 genetic clusters. In contrast, all Italian IHNV isolates fell within genogroup E, for which only a single genetic cluster was identified. More striking was that IHNV has evolved more rapidly than VHSV (mean rates of 11 and 7.3 × 10-4 nucleotide substitutions per site, per year, respectively), indicating that these viruses exhibit fundamentally different evolutionary dynamics. The time to the most recent common ancestor of both IHNV and VHSV was consistent with the first reports of these pathogens in Italy. By combining sequence data with epidemiological information it was possible to identify different patterns of virus spread among trout farms, in which adjacent facilities can be infected by either genetically similar or different viruses, and farms located in different water catchments can be infected by identical strains. Overall, these findings highlight the importance of combining molecular and epidemiological information to identify the determinants of IHN and VHS spread, and to provide data that is central to future surveillance strategies and possibly control

Drinking wine to "get high": the influence of awareness of the negative effects among young adults.

Introduction In a group of university students, the current study investigated the relationship between drinking wine to get high and the awareness about its characteristics, composition, positive and negative effects on health. Methods Through a web-based survey, 1685 students at the University of Siena completed a self-report questionnaire to assess consumption behaviours, knowledge about wine and the awareness about its effects. Results Seventy-three percent reported drinking wine. Males were more frequently wine consumers (p = 0.037). Among the students who reported drinking, 69.3% engaged this habit during the weekend. Almost 12% reported drinking wine to get high. Drinking wine to get high correlated with the consideration of its consumption: using this beverage to get high was strongly associated with considering wine like other spirits (p = 0.033). Conclusions Older age, female gender, and considering wine as a part of the diet were found to be protective factors against wine drinking-to get high. In contrast with some literature, awareness of the negative effects correlated with higher propensity to use wine to get high. Potential interpretations and limitations are addressed

Victimization and sentimental relationships during COVID-19 pandemic : Vittimizzazione e relazioni sentimentali durante la pandemia da COVID-19

Covid-19 pandemic has been hard for all of us. Isolation and social distancing, particularly, have damage the quality of interpersonal relationships. Starting from these considerations the authors questioned what is the impact of the sanitary emergency on the sentimental relationships. Considering that this aspect was already present in the scientific literatures, the authors have narrowed it down to victimization which had not yet appeared in these terms.So, the aim of this study is to evaluate, inside the adult population, if the couples sentimental relationships are different between victimized and not. At last was evaluated if the anxiety, depression and stress moderate the relationship with the victimization.La pandemia da Covid-19 ha messo ognuno di noi a dura prova. L’isolamento e il distanziamento sociale, in particolar modo, hanno minato la qualità delle relazioni interpersonali. Partendo da queste considerazioni gli autori si sono interrogati rispetto a quale potesse essere stato l’impatto dell’emergenza sanitaria sulla qualità delle relazioni sentimentali. Dato che questo aspetto era già presente a vari livelli della letteratura scientifica gli autori hanno ristretto il loro campo di considerazione al fenomeno della vittimizzazione che ancora non era comparsa in questi termini. Quindi l’obiettivo principale dello studio risulta essere quello di valutare, all’interno della popolazione adulta, se le relazioni sentimentali di coppia sono diverse fra soggetti vittimizzati e non vittimizzati. Infine è stato valutato se i sintomi di ansia, depressione e stress fungono da moderatori fra relazione e vittimizzazione

Mismatch repair gene defects in sporadic colorectal cancer enhance immune surveillance

Background: There is evidence that colorectal cancers (CRC) with DNA mismatch repair deficiency (MMR-D) are associated with a better prognosis than the generality of large bowel malignancies. Since an active immune surveillance process has been demonstrated to influence CRC outcome, we investigated whether MMR-D can enhance the immune response in CRC. Patients and Methods: A group of 113 consecutive patients operated for CRC (42 stage I or II and 71 with stage III or IV) was retrospectively analyzed. The expression of MMR genes (MSH2, MLH1, MSH6 and PSM2) and co-stimulatory molecule CD80 was assessed by tissue microarray immunohistochemistry. In addition, tumor infiltrating mononuclear cells (TIMC) and T cell subpopulations (CD4, CD8, T-bet and FoxP-3) were quantified. The effect of specific siRNA (siMSH2, siMLH1, siMSH6 and siPSM2) transfection in HT29 on CD80 expression was quantified by flow cytometry. Non parametric statistics and survival analysis were used. Results: Patients with MMR-D showed a higher T-bet/CD4 ratio (p = 0.02), a higher rate of CD80 expression and CD8 lymphocyte infiltration compared to those with no MMR-D. Moreover, in the MMR-D group, the Treg marker FoxP-3 was not expressed (p = 0.05). MMR-D patients with stage I or II and T-bet expression had a significant better survival (p = 0.009). Silencing of MSH2, MLH1 and MSH6, but not PSM2, significantly increased the rate of CD80+ HT29 cells (p = 0.007, p = 0.023 and p = 0.015, respectively). Conclusions: CRC with MMR-D showed a higher CD80 expression, and CD8+ and Th1 T-cell infiltration. In vitro silencing of MSH2, MLH1 and MSH6 significantly increased CD80+ cell rate. These results suggest an enhanced immune surveillance mechanism in presence of MMR-D