Effectiveness is the gold standard of clinical research

Psychological treatments have been shown to be at least as effective (and sometime even more effective) than psychotropic medications for many psychiatric disorders, in particular anxiety disorders, depressive disorders, and personality disorders (American Psychological Association, 2013; Cuijpers, 2017). Effective psychological treatments are also cost-effective: their implementation in public mental health services is convenient in financial terms, with decades of studies consistently demonstrating a reduction in public spending for psychological health (Abbass, Kisely, Rasic, Town & Johansson, 2015). Therefore, it could be critical that psychological treatments whose efficacy is supported by strong empirical evidence can be delivered as a primary choice in public mental health services. We hope and believe that the time when a psychologist or a psychiatrist (especially if paid by the public mental health system) could provide any treatment he or she thought fit, even in the absence of any scientific evidence of its efficacy, is coming to an end. However, a recommendation should be made to be very careful in not equating the empirical support of a given treatment with the sole presence of randomized controlled trials (RCTs) that show its efficacy. This would be a mistake from both an empirical and a theoretical perspective, as it runs the risk of throwing out the baby with the bathwater. In other words, endorsing a perspective according to which a specific treatment should be promoted or rejected on the sole basis of findings from RCT studies runs the risk of putting clinical science back almost twenty years from the current more advanced understanding of the efficacy, effectiveness, and usefulness of psychotherapy (Dazzi, 2006; Dazzi, Lingiardi, & Colli, 2006; Leichsenring et al., 2016; Silberschatz, 2017)

Interaction of proteins in solution from small angle scattering: a perturbative approach

In this work, an improved methodology for studying interactions of proteins in solution by small-angle scattering, is presented. Unlike the most common approach, where the protein-protein correlation functions $g_{ij}(r)$ are approximated by their zero-density limit (i.e. the Boltzmann factor), we propose a more accurate representation of $g_{ij}(r)$ which takes into account terms up to the first order in the density expansion of the mean-force potential. This improvement is expected to be particulary effective in the case of strong protein-protein interactions at intermediate concentrations. The method is applied to analyse small angle X-ray scattering data obtained as a function of the ionic strength (from 7 to 507 mM) from acidic solutions of $\beta$-Lactoglobuline at the fixed concentration of 10 $\rm g L^{-1}$. The results are compared with those obtained using the zero-density approximation and show a significant improvement particularly in the more demanding case of low ionic strength.Comment: 12 pages, 3 figures, to appear in Biophysical Journal (April 2002) Due to an unfortunate name mismatch, the original submission contained an incorrect sourc

Intention to be vaccinated for COVID-19 among Italian nurses during the pandemic

Background: While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue. Methods: We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage. Results: A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant. Conclusions: Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses’ perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people

Diagnosi e valutazione della personalit alleanza terapeutica e scambio clinico nella ricerca in psicoterapia

Questo contributo si propone di fornire una breve rassegna delle principali linee di ricerca seguite negli ultimi anni dal gruppo coordinato da Vittorio Lingiardi. Tra queste, ci soffermeremo in particolare su: a) valutazione e diagnosi della personalità con SWAP-200 e PDM (Psychodynamic Diagnostic Manual); b) sviluppo e validazione di strumenti clinician-report per operazionalizare l'uso del PDM; c) valutazione dei meccanismi di difesa e degli stili difensivi mediante DMRS e sua versione Q sort; d) studio del processo e della relazione terapeutica (alleanza terapeutica, rotture e riparazioni dell'alleanza controtransfert); in particolare, in quest'area di ricerca, ci siamo impegnati nello sviluppo e validazione di nuovi strumenti per la valutazione dei processi di rottura e riparazione dell'alleanza (Collaborative Interaction Scale) e della qualità dell'attaccamento tra paziente e terapeuta (Patient-Therapist Attachment Q Sort); d) sviluppo della ricerca clinica e applicativa sui temi dell'identità di genere, dell'orientamento sessuale e dell'omofobia sociale e interiorizzata

Osteoporosis : economic burden of disease in Italy

Background and Objective Today, osteoporosis is the most common bone disease and an important public health problem in all developed countries. The objective of this study was to estimate the costs associated with the management and treatment of osteoporosis in order to assess the economic burden in Italy for 2017, in terms of direct medical costs and social security costs. Methods A cost of illness model was developed to estimate the average cost per year sustained by the NHS (National Health Service) and Social Security System in Italy. A systematic literature review was performed to obtain epidemiological, direct and indirect costs parameters where available. Hospitalisation costs were calculated considering the administrative database of the hospital discharge records for the period 2008-2016. Patients were enrolled in the analysis if they report the subsequent inclusion criteria: age >= 45 years and presence of osteoporosis in primary or secondary diagnosis (ICD9-CM 733.0) and/or presence of a major fracture in primary or secondary diagnosis (excluding road accidents) in the following locations: spine (codes ICD9-CM: 805;806), femur (codes ICD9-CM: 820; 821), radius and ulna (codes ICD9-CM: 813.4; 813.5), humerus (codes ICD9-CM: 812.0-812.5), pelvis (code ICD9-CM: 808), tibia and fibula (codes ICD9-CM: 823), ankle (code ICD9: 824) and ribs (codes ICD9-CM: 807.0; 807.1). Costs were estimated considering the diagnosis-related group (DRG) national tariff associated with each hospitalisation. Finally, the administrative databases of the Italian National Social Security Institute (INPS) (2009-2015) were analysed for the estimate the pension and disability costs from the social perspective. Results The model estimated an average annual economic burden of osteoporosis in Italy of euro2.2 billion. Of this cost, approximately 80% (euro1.8 billion) was associated with hospitalisations, 16% (euro351 million) for pharmacological treatments, 3% (euro71 million) for ambulatory visits, and 0.6% (euro13 million) for social security costs. The average yearly cost per patient was equal to euro8691 (euro8591 for hospitalisations). Analysing severe patients, hospitalisation costs increase to euro12,336 (+ 44% if compared to non-severe osteoporosis patients). Conclusions The analysis showed that osteoporosis represents one of the main health problems in Italy and the ability to maintain patients in a non-severe health state could decrease the economic burden from both NHS and social perspective

An analysis of the social and economic costs of breast cancer in Italy

Background: Breast cancer is the most prevalent cancer affecting women and it represents an important economic burden. The aim of this study was to estimate the socio-economic burden of breast cancer (BC) in Italy both from the National Health Service (NHS) and the government perspectives (costs borne by the social security system). Methods: The economic analysis was based on the costs incurred by the NHS from 2008 to 2016 (direct costs related to hospitalizations) and by the National Social Security Institute (INPS) from 2009 to 2015 (costs of social security benefits) for patients with breast cancer. The analysis was based on the Hospital Information System (HIS) and Disability Insurance Awards databases. For both databases, patients affected by a malignant neoplasm of the female breast, carcinoma in situ, or secondary malignant neoplasm of the breast were considered. Results: Results show that more than 75,000 women were hospitalized for breast cancer every year, with an overall cost for hospitalization of about €300 million per year. From the Social Security analysis, a number of 29,000 beneficiaries each year was estimated. Considering per patient social costs, breast cancer at the primary stage cost €8828 per year, while secondary neoplasms cost €9780, with an average total economic burden of €257 million per year. Conclusions: This analysis focused on the economic impact of breast cancer in Italy, showing that an advanced stage of the disease was associated with a higher cost

La diagnosi strutturale secondo Kernberg

Il capitolo illustra il modello del colloquio per la valutazione strutturale della personalità (intervista strutturale) elaborato da Otto Kernberg. Vengono quindi descritte le principali caratteristiche della personalità nevrotica, borderline e psicotica, come teorizzate da Kernberg, e i diversi disturbi associati alle varie organizzazioni di personalità

Genealogia dell’attaccamento.

Questo lavoro descrive il percorso biografico e intellettuale che ha portato John Bowlby a sviluppare la teoria dell'attaccamento. Ne illustra poi i concetti, le applicazioni e gli sviluppi cui è andata incontro durante la vita di Bowlby e negli anni successivi alla sua morte.The aim of thi paper is to descrive the biographic and intellectual path which leds John Bowlby to develop attachment theoer. Moreover, it describes its core concepts, their applications and the evlution of attachment theory duirng and after the life of John Bowlby

I sabotatori interni

Il volume si presenta come uno studio sistematico del concetto di "sabotatore interno", o "organizzazione patologica di personalità". Con questo concetto si intende una parte dissociata e infantile del Sé, carica di dolore e rabbia, che cerca di distruggere o sabotare le relazioni, le aspirazioni e le realizzazioni sane proprie e altrui. Nel volume vengono dapprima passati in rassegna i modelli teorici degli autori kleiniani che hanno identificato e descritto le organizzazioni patologiche di personalità, e i modelli elaborati da alcuni tra gli indipendenti britannici per spiegare fenomeni analoghi a quelli affrontati dai teorici kleiniani, a partire da Ronald Fairbairn, che ha coniato l'espressione "sabotatore interno"; viene inoltre presentato sinteticamente il modello di Janine Chasseguet-Smirgel sui nuclei perversi della personalità. Vengono poi descritti alcuni modelli nati nel contesto della svolta relazionale americana e della teoria dell'attaccamento che permettono di comprendere meglio la loro genesi e il loro sviluppo. Alla fine del testo viene presentata una possibile visione di insieme delle organizzazioni patologiche/sabotatori interni, con brevi esemplificazioni cliniche della loro fenomenologia. Il taglio storico-critico e la proposta di un modello integrato delle strutture psichiche descritte rendono il volume interessante per gli studenti di psicologia, specializzandi e psicoterapeuti di diverso orientamento teorico