A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Shalom: da comunit\ue0 terapeutica a comunit\ue0 di vita

Risultati di una ricerca condotta dall'Universit\ue0 Pontificia Salesiana riguardante la Comunit\ue0 terapeutica Shalom di Palazzolo sull'Oglio (BS

Clinical relevance of small-bowel findings detected by wireless capsule endoscopy

Objective. Capsule endoscopy is becoming known as a valid tool for identifying sources of obscure gastrointestinal (GI) bleeding. Fewer data are available about its clinical value for other indications. Material and methods. Sixty patients ( 31 F, mean age 47 years, range 14 - 80 years) with no signs of overt GI bleeding were investigated by Given M2A video capsule for suspected small-bowel disease. The main clinical features were: iron deficient anemia ( 20), abdominal pain ( 12), chronic diarrhea ( 9), malabsorption and weight loss ( 7), Crohn's disease ( CD) ( 5), and familial adenomatous polyposis ( 3). Three patients underwent wireless endoscopy for suspected GI neoplasm and one for portal thrombosis. Results. Complete vision of the small bowel was achieved in 55 patients. No small-bowel lesions were identified in 17 patients, but 5 of them had gastric abnormalities. Small-bowel abnormality was found in 38 patients. Lesions compatible with CD were found in 14 patients, diffuse or patchy enteropathy in 7 and polyps in 6. Actively bleeding lesions were detected in 6 patients and potential bleeding sources in 5. Capsule endoscopy had an overall diagnostic yield of 62%. In particular, three small-bowel malignancies were detected and 9 patients received a better definition of their already-known pathology. However, further endoscopies were needed in 10 patients to obtain a diagnosis. One patient, diagnosed with ileal CD, underwent surgery, as the capsule remained trapped in a stricture. Conclusions. Wireless endoscopy effectively visualizes small-bowel abnormalities even though more accurate selection of the patients is needed in order to optimize its diagnostic efficacy

Risk factors for non-adherence to medication in inflammatory bowel disease patients

Background: Inflammatory bowel diseases are chronic conditions requiring medication throughout life to treat the disease and control the risk of relapse and colorectal cancer. Adherence to prescribed drugs is therefore crucial to their management. Aim: To identify determinants and potential risk factors of non-adherence in inflammatory bowel disease patients. Methods: An anonymous 24-item questionnaire (available online as Supplementary material) was administered to 485 out-patients attending a tertiary referral centre. Results: Sixty-one per cent of the patients reportedly adhered to their treatment. No differences emerged between inflammatory bowel disease and socio-demographic characteristics other than age, non-adherence being significantly associated with cases under 40 years (43% vs. 34%, P = 0.041). The most common reasons for non-adherence vs. adherence were forgetfulness (61% vs. 44%, P = 0.000), disease remission (25% vs. 10%, P = 0.000), recent diagnosis (24% vs. 15%, P = 0.000) and full-time employment (55% vs. 26%, P = 0.000). Oral therapy was associated with a significantly better adherence than rectal therapy (60% vs. 32%, P = 0.001). Communication affects patient adherence: a significant interaction was found for adherence and patients <40 years who had a good relationship with their doctors. Conclusions: Risk factors for non-adherence are younger age, busy working life, recent diagnosis and disease remission. Good communication with the doctor might improve adherence