Le sfide della pedagogia medica oggi. Un’analisi SWOT della SIPeM

In modern times, the Italian Society of Medical Pedagogy (SIPeM) faces greater complexity. Over the last decades, great changes of the SIPeM goals and instruments there has been. Therefore it is necessary today a reflection on the goals reached, on the difficulties encountered and on future challenges. Procedure: a SWOT analysis of SIPeM was conducted with the members of the Direct Board and the Heads of the Local Sections. Results: 23 conceptual units were identified and divided into strength elements (5), weakness (7), opportunity (6) and risk (5). Conclusions: the analysis confirms some strategic choices made by SIPeM, such as the Green Line Project and underlines the need to define their own future goals in order to plan the resources distribution

Reliable Field Assessment of Proliferative Kidney Disease in Wild Brown Trout, Salmo trutta, Populations: When Is the Optimal Sampling Period?

Proliferative kidney disease (PKD), caused by the myxozoan parasite Tetracapsuloides bryosalmonae, is suspected to contribute to the decline of wild brown trout Salmo trutta populations. Different factors need to be taken into consideration for PKD outbreaks. Among them, water temperature appears as a main driver of the disease. To understand the epidemiology and impact of the disease on wild fish populations, reliable sampling approaches to detect the presence of T. bryosalmonae-infected fish are needed. This study aimed to characterize the seasonal variation of the prevalence of T. bryosalmonae-infected fish in brown trout populations in two small streams with differing temperature regimes between upstream and downstream sites. As water temperature is known to influence PKD manifestation in brown trout, we hypothesized that the number of T. bryosalmonae-positive fish, as well as their seasonal distribution, will vary between upper and downstream parts of the two streams. Since, in field studies, results can strongly vary across years, we extended the study over a 3-year-period. The number of infected fish and the intensity of infection were assessed by histology. The results confirmed the hypothesis of pronounced temporal- and site-related differences in the percentage of PKD-positive fish and the intensity of the infection. Comparison of water temperatures (total degree days as well as the number of days with a daily mean temperature ≥15 °C) with PKD data indicated that temperature was the driving factor for the temporal development and the intensity of the infection. A mean of 1500 degree days or 30 days with a daily mean temperature ≥15 °C was required before the infection could be detected histologically. From our findings, recommendations are derived for a water temperature-driven sampling strategy campaigns that enables the detection of PKD infection and prevalence in wild brown trout populations

Le sfide della pedagogia medica oggi. Un’analisi SWOT della SIPeM

In modern times, the Italian Society of Medical Pedagogy (SIPeM) faces greater complexity. Over the last decades, great changes of the SIPeM goals and instruments there has been. Therefore it is necessary today a reflection on the goals reached, on the difficulties encountered and on future challenges. Procedure: a SWOT analysis of SIPeM was conducted with the members of the Direct Board and the Heads of the Local Sections. Results: 23 conceptual units were identified and divided into strength elements (5), weakness (7), opportunity (6) and risk (5). Conclusions: the analysis confirms some strategic choices made by SIPeM, such as the Green Line Project and underlines the need to define their own future goals in order to plan the resources distribution

La formazione in psicoterapia: Un dipinto in chiaroscuro

La formazione in psicoterapia rappresenta oggi per molti psicologi clinici una tappa importante e quasi obbligata per completare la propria professionalità; a fronte di questa richiesta crescente sono nate numerose scuole di formazione private, riconosciute dal Ministero dell'Università, che si affiancano alle tradizionali scuole pubbliche. Per orientarsi in un panorama così complesso, uno strumento di accesso alle informazioni delle scuole dei diversi orientamenti dato dai siti web di ciascuna di esse, cui si affiancano richieste telefoniche, e-mail e il colloquio di ammissione fatto dalla scuola. La domanda che guida il presente lavoro se gli studenti-futuri utenti abbiano gli strumenti adeguati per fare una scelta consapevole, anche in ragione del grosso impegno di tempo e denaro che questa richiede. Il lavoro ha analizzato i siti web di 201 sedi principali delle scuole di specializzazione riconosciute dal MIUR, valutando la presenza di alcuni dati relativi alle caratteristiche della scuola. I siti risultano sufficientemente aggiornati; tuttavia, alcune informazioni critiche (costi, analisi personale, supervisione) sono poco chiare, rendendo spesso problematica la scelta da parte degli studenti

It's a hard knock life for some: Heterogeneity in infection life history of salmonids influences parasite disease outcomes.

Heterogeneity in immunity occurs across numerous disease systems with individuals from the same population having diverse disease outcomes. Proliferative kidney disease (PKD) caused by Tetracapsuloides bryosalmonae, is a persistent parasitic disease negatively impacting both wild and farmed salmonids. Little is known of how PKD is spread or maintained within wild susceptible populations. We investigated an aspect of fish disease that has been largely overlooked, that is, the role of the host phenotypic heterogeneity in disease outcome. We examined how host susceptibility to T. bryosalmonae infection, and the disease PKD, varied across different infection life-history stages and how it differs between naïve, re-infected and persistently infected hosts. We investigated the response to parasite exposure in host phenotypes with (a) different ages and (b) heterogeneous infection life histories. Among (a) the age phenotypes were young-of-the-year (YOY) fish and juvenile 1+ fish (fish older than one) and, for (b) juvenile 1+ infection survivors were either re-exposed or not re- exposed to the parasite and response phenotypes were assigned post-hoc dependant on infection status. In fish not re-exposed this included fish that cleared infection (CI) or had a persistent infection (PI). In fish re-exposed these included fish that were re-infected (RI), or re-exposed and uninfected (RCI). We assessed both parasite-centric (infection prevalence, parasite burden, malacospore transmission) and host-centric parameters (growth rates, disease severity, infection tolerance and the immune response). In (a), YOY fish, parasite success and disease severity were greater and differences in the immune response occurred, demonstrating an ontogenetic decline of susceptibility in older fish. In (b), in PI and RI fish, parasite success and disease severity were comparable. However, expression of several adaptive immunity markers was greater in RI fish, indicating concomitant immunity, as re-exposure did not intensify infection. We demonstrate the relevance of heterogeneity in infection life history on disease outcome and describe several distinctive features of immune ontogeny and protective immunity in this model not previously reported. The relevance of such themes on a population level requires greater research in many aquatic disease systems to generate clearer framework for understanding the spread and maintenance of aquatic pathogens

Social capital and willingness to participate in COVID-19 vaccine trials: an Italian case-control study

Background: What leads healthy people to enter in a volunteer register for clinical trials? This study aimed to investigate the relationship between the decision to volunteer in clinical trials for a COVID-19 vaccine and social capital, in a sample of healthy volunteers in Italy. Since social capital is characterized by trust, reciprocity, and social and political participation, we claim that it is key in leading individuals to actively take action to protect public health, and to take a risk for the (potential) beneft not only of themselves but for the entire community. Methods: This study was conducted through the administration of a questionnaire to healthy volunteers registered for a phase 1 clinical trial for a COVID-19 vaccine in the Unit Research Centre of ASST-Monza, in September 2020. The primary purpose of a phase 1 study is to evaluate the safety of a new drug candidate before it proceeds to further clinical studies. To approximate a case–control study, we randomly matched the 318 respondents to healthy volunteers (cases) with 318 people randomly selected by Round 9 of the European Social Survey (controls), using three variables, which we considered to be associated with the decision to volunteer: gender, age, and education level. To execute this matching procedure, we used the “ccmatch” module in STATA. Results: The fndings highlight the positive impact of social capital in the choice of healthy individuals to volunteer in COVID-19 vaccine clinical trials. Controlling for possible confounding factors, some exemplary results show that people with a high level of general trust have a greater likelihood of volunteering compared to people with low trust (OR=2.75, CI=1.58–4.77); we also found that it is more probable that volunteers are people who have actively taken action to improve things compared with people who have not (for individuals who did three or more actions: OR=7.54, CI=4.10–13.86). People who reported voting (OR=3.91, CI=1.70–8.99) and participating in social activities more than other people of their age (OR=2.89, CI=1.82–4.60) showed a higher probability to volunteer. Conclusions: Together with the adoption of urgent health measures in response to COVID-19, government policymakers should also promote social capital initiatives to encourage individuals to actively engage in actions aimed at protecting collective health. Our fndings make an empirical contribution to the research on vaccines and its intersection with social behaviour, and they provide useful insights for policymakers to manage current and future disease outbreaks and to enhance the enrolment in vaccine trials

Prevalence of and risk factors for binge eating behaviour in 6930 adults starting a weight loss or maintenance programme

Objective: Conflicting data are available on the prevalence of binge eating behaviour (BE) in individuals seeking to lose or maintain weight. The present study aimed to estimate the prevalence of and the risk factors for BE in a large sample of men and women starting a weight loss or maintenance programme. Design: Cross-sectional study. BE was defined as a Binge Eating Scale (BES) score 6518. The State-Trait Anxiety Inventory and the Italian Depression Questionnaire were used to assess anxiety and depression. Besides sex, age and BMI, marital status, educational level, smoking and physical activity were evaluated as potential risk factors for BE. Uni- and multivariable Poisson working regression models were used to estimate prevalence ratios (PR) and marginal probabilities. Setting: Nutritional research centre. Subjects: Adults (n 6930; 72 % women) with a median age of 46 years (range 18\u201381 years) were consecutively studied. Results: BE prevalence in the pooled sample was 17 %. At multivariable analysis, being a woman (PR=2\ub770), smoking (PR=1\ub715) and increasing BMI (PR=1\ub705 for 1 kg/m2 increase) were risk factors for BE. On the contrary, being older (PR=0\ub799 for 1-year increase), performing physical activity (PR=0\ub789) and being married (PR=0\ub788) were protective factors for BE. Anxiety and depression were more common in subjects with BE. Conclusions: BE is common in individuals seeking to lose or maintain weight. The prevalence of BE is higher in young obese women. However, BE is present also in men, elders and normal-weight subjects

Do fish get wasted? Assessing the influence of effluents on parasitic infection of wild fish

Many ecosystems are influenced simultaneously by multiple stressors. One important environmental stressor is aquatic pollution via wastewater treatment plant (WWTP) effluents. WWTP effluents may contribute to eutrophication or contain anthropogenic contaminants that directly and/or indirectly influence aquatic wildlife. Both eutrophication and exposure to anthropogenic contaminants may affect the dynamics of fish-parasite systems. With this in mind, we studied the impact of WWTP effluents on infection of brown trout by the parasite Tetracapsuloides bryosalmonae, the causative agent of proliferative kidney disease (PKD). PKD is associated with the long-term decline of wild brown trout (Salmo trutta) populations in Switzerland. We investigated PKD infection of brown trout at two adjacent sites (≈400 m apart) of a Swiss river. The sites are similar in terms of ecology except that one site receives WWTP effluents. We evaluated the hypothesis that fish inhabiting the effluent site will show greater susceptibility to PKD in terms of prevalence and disease outcome. We assessed susceptibility by (i) infection prevalence, (ii) parasite intensity, (iii) host health in terms of pathology, and (iv) estimated apparent survival rate. At different time points during the study, significant differences between sites concerning all measured parameters were found, thus providing evidence of the influence of effluents on parasitic infection of fish in our study system. However, from these findings we cannot determine if the effluent has a direct influence on the fish host via altering its ability to manage the parasite, or indirectly on the parasite or the invertebrate host via increasing bryozoa (the invertebrate host) reproduction. On a final note, the WWTP adhered to all national guidelines and the effluent only resulted in a minor water quality reduction assessed via standardized methods in this study. Thus, we provide evidence that even a subtle decrease in water quality, resulting in small-scale pollution can have consequences for wildlife

Effects of eHealth interventions on stress reduction and mental health promotion in healthcare professionals: a systematic review

Aims: To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; ‘third-wave’ psychotherapies vs. other types). Background: Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access. Design: A systematic review of quantitative studies. Methods: A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools. Results: The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents (‘third-wave’ psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 ‘third wave’ psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found. Conclusion: The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and ‘third-wave’ psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions