Family burden, emotional distress and service satisfaction in first episode psychosis. Data from the GET UP trial

Background: Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. Objective: To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. Methods: The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. Results: At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the "Tension" dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions "Relatives' Involvement" and "Professionals' Skills and Behavior." Conclusions: The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients

Instabilis Terra: Perception and Representation of Low Coastal Areas in Modern Times

Gli spazi costieri costituiscono attualmente un'area con un'elevata presenza di insediamenti ed attività economiche. La conoscenza della loro evoluzione naturale e delle trasformazioni indotte dalle attività delle società umane è un elemento importante per una corretta definizione degli interventi di tutela e sviluppo di questi spazi. La cartografia è tra le fonti più importanti per la ricostruzione delle condizioni geografiche delle coste nel passato. L'impiego di queste fonti richiede però una attenta valutazione delle loro caratteristiche come medium e delle modifiche apportate dall'evoluzione della tecnica cartografica. La cartografia del territorio italiano si presta in modo particolare a contribuire alla conoscenza sia del dinamismo naturale delle coste basse della penisola sia dell'evoluzione della presenza di insediamenti e di attività economiche. La documentazione cartografica consente soprattutto di seguire sia le fasi di avanzamento ed arretramento della linea di costa e l'evoluzione delle foci fluviali sia la crescita delle infrastrutture di comunicazione, la diffusione degli insediamenti residenziali e produttivi e le trasformazioni nelle forme di uso del suolo

Congenital granular cell epulis of newborn: importance of prenatal diagnosis

Congenital granular cell epulis is a rare benign lesion usually arising as single mass from the alveolar ridge of maxillary bone of female newborns, composed of polygonal granular cells that typically stain negative for S-100, in contrast to the adult counterpart. Larger lesions can disturb breathing and breast-feeding, requiring surgery. Prenatal diagnosis is achieved in few cases, even if this would be important for best management of delivery and therapy. Here we present a case of multiple CGCE in a female newborn discovered at birth, together with a brief review of pathogenesis, differential diagnoses and treatment implications of early diagnosis

Continuit\ue0 e aderenza terapeutica nei giovani all\u2019esordio psicotico: il modello di intervento integrato del Servizio Psichiatrico di Bolzano. [Continuity of care and therapeutic adherence in young people at psychosis onset: the integrated intervention model of the Psychiatric Service of Bolzano]

Scopo. Presentare: 1) il percorso di trasformazione del Servizio Psichiatrico di Bolzano verso un assetto organizzativo orientato a un\u2019offerta tempestiva, intensiva, specifica e multimodale per gli utenti all\u2019esordio psicotico e i loro familiari; 2) l\u2019andamento clinico e sociale nel corso di 12 mesi della coorte dei pazienti avviati al progetto \u201cInterventi Precoci\u201d. Metodi. Studio naturalistico longitudinale che valuta l\u2019andamento nel corso di 12 mesi di una coorte di pazienti al primo episodio psicotico, reclutata nell\u2019area di competenza territoriale del Servizio Psichiatrico di Bolzano e avviata al progetto \u201cInterventi Precoci\u201d. Le caratteristiche socio-demografiche, abitative e lavorative, le erogazioni delle prestazioni (intervento medico, psicoterapia, psicoeducazione familiare, intervento sociale) e i ricoveri ospedalieri sono stati ricavati dalla cartella clinica informatizzata. Stato psicopatologico e funzionamento globale sono stati valutati, rispettivamente, con la Positive and Negative Syndrome Scale (PANSS) e la Global Assesment of Functioning (GAF). Risultati. Nei primi cinque anni di attivit\ue0 del progetto (2012-2017) sono stati trattati 116 pazienti. Al follow-up (FU) a 12 mesi, l\u201983,6% risulta in carico, il 7,7% si \ue8 trasferito in altra sede e l\u20198,5% ha abbandonato il percorso. Non risultano differenze di et\ue0 e genere tra pazienti in carico e quelli che hanno interrotto il progetto. Tutti i pazienti hanno usufruito di un trattamento integrato specifico; il 16% ha inoltre usufruito di un trattamento intensivo in regime residenziale. I punteggi PANSS totale, positiva e negativa, hanno registrato una riduzione significativa dal baseline (BL) al FU; parallelamente si \ue8 assistito a un aumento significativo dei punteggi GAF. Solamente il 13,5% \ue8 andato incontro a un ricovero ospedaliero (Servizio Psichiatrico Diagnosi e Cura, SPDC) nel corso di 12 mesi. Al FU il tasso di disoccupazione si riduce del 27,1% e il numero dei pazienti con un\u2019occupazione lavorativa raddoppia rispetto al BL. Discussione e conclusioni. Il progetto \u201cInterventi Precoci\u201d \ue8 risultato in grado di fornire trattamenti integrati, multiprofessionali e tempestivi fin dalle prime fasi del disturbo, secondo quanto raccomandato dalle linee guida internazionali, promuovendo un miglioramento significativo dei pazienti sia sul piano clinico che in termini di funzionamento sociale.Aim: To report on: 1) the modification process occurred within the Psychiatric Service of Bolzano toward an early, intensive, specific and multimodal system of care for patients experiencing their first psychotic episode and their family members; 2) the 12-month clinical and social course of a sample of patients referred to the "Early Intervention Project". Methods: Longitudinal naturalist study evaluating the 12-month clinical and outcome of a cohort of first-episode psychosis patients consecutively referred to the "Early Intervention Project" implemented within the Psychiatric Service of Bolzano. Socio-demographic characteristics, housing situation and occupational status, interventions offered (medical intervention, psychotherapy, psychoeducation to family members, social intervention) and hospital admissions were drawn from electronic medical records. Levels of psychopathology and global functioning were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Global assessment of Functioning (GAF), respectively. Results: During the first five years of activity (2012-2017) 116 patients had been referred to the Project. At 12 months 83.6%were still in charge, 7.76% moved to another area, 8.5% have abandoned the intervention. No significant difference in terms of age and gender was found between patients who remained in the project and those who lost contact. All patients had received specific integrated treatment; moreover, 16% had received intensive residential care. Notably, only 13.5% have had a hospital readmission over the 12 months of intervention. The PANSS total, positive and negative scores displayed significant reduction from baseline (BL) to follow-up (FU); in parallel, increase in GAF score from BL to FU was observed. All patients employed at BL were able to keep their job at FU; 17% of all patients unemployed at baseline were employed at FU. Discussion and conclusion: The "Early Intervention Project" implemented in Bolzano was found to ensure integrated, multidisciplinary and early treatment, as defined by the most recent international guidelines, which produced significant improvement in both clinical and social outcomes in a cohort of first-episode psychosis patients

Recurrent primary endobronchial fetal rhabdomyoma: a case report and literature review

Fetal rhabdomyoma is an extremely rare benign rhabdomyoblastic tumor with myotube-like differentiation, mainly arising on mucosal surfaces of the head and neck region of both children and young patients, almost invariably definitively treated with surgical excision. Herein the case of a male adult suffering from a recurrent fetal rhabdomyoma primary involving the bronchial structures is reported, along with a detailed literature review. This is the first fetal rhabdomyoma described to originate in such a localization; furthermore, an 11-year interval period between the first lesion and the recurrent one has never been reported

3D Surveying of Underground Built Heritage: Opportunities and Challenges of Mobile Technologies

Among the existing Cultural Heritage settings, Underground Built Heritage (UBH) represents a peculiar case. The scarce or lack of knowledge and documentation of these spaces frequently limits their proper management, exploitation, and valorization. When mapping these environments for documentation purposes, the primary need is to achieve a complete, reliable, and adequate representation of the built spaces and their geometry. Terrestrial laser scanners were widely employed for this task, although the procedure is generally time-consuming and often lacks color information. Mobile Mapping Systems (MMSs) are nowadays fascinating and promising technologies for mapping underground structures, speeding up acquisition times. In this paper, mapping experiences (with two commercial tools and an in-house prototype) in UBH settings are presented, testing the different handheld mobile solutions to guarantee an accurate and reliable 3D digitization. Tests were performed in the selected case study of Camerano Caves (Italy), characterized by volumetric complexity, poor lighting conditions, and difficult accessibility. The aim of this research activity is not only to show the differences in the technological instruments used for 3D surveying, but rather to argue over the pros and cons of the systems, providing the community with best practices and rules for 3D data collection with handheld mobile systems. The experiments deliver promising results when compared with TLS data

3D surveying of underground built heritage: Opportunities and challenges of mobile technologies

Among the existing Cultural Heritage settings, Underground Built Heritage (UBH) represents a peculiar case. The scarce or lack of knowledge and documentation of these spaces frequently limits their proper management, exploitation, and valorization. When mapping these environments for documentation purposes, the primary need is to achieve a complete, reliable, and adequate representation of the built spaces and their geometry. Terrestrial laser scanners were widely employed for this task, although the procedure is generally time‐consuming and often lacks color information. Mobile Mapping Systems (MMSs) are nowadays fascinating and promising technologies for mapping underground structures, speeding up acquisition times. In this paper, mapping experiences (with two commercial tools and an in‐house prototype) in UBH settings are presented, testing the different handheld mobile solutions to guarantee an accurate and reliable 3D digitization. Tests were performed in the selected case study of Camerano Caves (Italy), characterized by volumetric complexity, poor lighting conditions, and difficult accessibility. The aim of this research activity is not only to show the differences in the technological instruments used for 3D surveying, but rather to argue over the pros and cons of the systems, providing the community with best practices and rules for 3D data collection with handheld mobile systems. The experiments deliver promising results when compared with TLS data

HLA-G expression in melanomas

Human leukocyte antigen G (HLA-G) is a non-classical HLA class I molecule involved in inducing tolerance at the feto-maternal interface and in escape of immune response by tumor cells. The aim of the study is to review the published literature on the expression of HLA-G in malignant melanomas and its clinicopathological and prognostic correlates