The relationship between health care users’ demand and the health care system’s response: a research on change observed in the health care system, in the hospital and in the territory

The present research study aims at exploring the representation of the health service within a group of hospital physicians and nurses. The objective is to identify how the symbolic dynamic of hospital workers shapes their own praxis. The texts of interviews with 25 hospital workers have been subjected to Emotional Text Analysis (ETA). Five clusters emerge from the analysis where the topic of giving life and avoiding death is central and where the hospital assumes a thaumaturgical and basically omnipotent role. This is in conflict with recognizing the limitations of therapy. Only in the background the culture of curing the patients appears, characterized by aggressive reactivity towards the crisis which leads patients to emergency intervention because crises are ascribed to deviances frommedical prescription. Emergency intervention is ultimately the kind of intervention which the hospital believes it is capable to provide. Another problem is the lack of filters provided by bureaucratized general practitioners, whose cooperation would be essential, but who are supposed to have no longer the necessary relationship with their patients

La relazione che organizza il contesto sanitario: domanda dell’utenza e risposta dei servizi sanitari, nel territorio e nell’ospedale - The relationship which organizes the healthcare context: users’ demand and response of healthcare services, in the territory and the hospital

Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three s tudies: the first study regarded the citizens’expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners onthe health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leavingthe possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the othe

Timing of Pituitary Stalk Assessment in Langerhans Cell Histiocytosis: "When" Is Sometimes More Important than "What"

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Perusinis II. Fall: Der Alzheimer Patient R.M. Geschichte, Genealogie und Genetik eines psychiatriehistorischen Falls

1.American Journal of Alzheimer`s Disease and Other Dementias: 2010; 25:189-192 100th anniversary of PERUSINI`S SECOND CASE: PATIENT RM and his KINDRED Im Jahre 1907 wurde der Münchener Korbmacher RM als ,,Zweifelhafter Fall“ in der damals ,,Königlich Psychiatrischen Klinik“ in München behandelt. Die diesbezüglich 1909 von Alzheimers Assistenten Gaetano Perusini publizierte Kasuistik siedelt den offensichtlichen Symptomausbruch im Jahr 1899 an. Dieser gemutmaßte extrem frühe Krankheitsbeginn (38.Lebensjahr des RM) sowie Perusinis familienanamnestischer Hinweis ,,ein Bruder desselben soll nicht recht gescheut sein“ erforderte intensive Recherche zu Geschichte und Genealogie dieses psychiatriehistorischen Falls, um das eventuelle Vorliegen einer heredofamiliären Form von Morbus Alzheimer mit Beginn im frühen Lebensalter zu diskutieren. Detaillierte Untersuchungen über acht Generationen konnten zwar psychiatrische Auffälligkeiten im Stammbaum des Probanden aufzeigen, aber keinen Nachweis einer autosomal-dominanten Form der “Early-Onset Alzheimer`s Disease“ erbringen. 2.Nervenheilkunde: 2010; 29:850-852 Alzheimer und Perusini: Patient RM und sein Stammbaum 1773-2009 Die ersten vier Fälle der Alzheimerschen Krankheit wurden in Alzheimers histopathologischem Laboratorium von dem italienischen Neuropathologen Gaetano Perusini untersucht. Das Weiterverfolgen von Perusinis Hinweis zur auffälligen Psychopathologie des Bruders des RM zeigt noch 1923 die identische differentialdiagnostische Überlegung „Arteriosklerose“ wie bereits 1907 beim Probanden selbst. Das Nachvollziehen der damals angewandten relevanten Untersuchungsmethoden zur Sicherung der Verdachtsdiagnose „Progressive Paralyse“ weist erhebliche Ungenauigkeiten in der Dokumentation auf, so dass verschiedene Differentialdiagnosen zu diskutieren sind. Kurz vor ihrem Tod konnte eine APOE-Genotypisierung der gemäß nervenärztlicher Diagnose an dementiellem Syndrom erkrankten Enkeltochter von Perusinis II.Fall durchgeführt werden. Die Genotypisierung konnte das Vorliegen einer autosomal-dominanten Form des Morbus Alzheimer mit frühem Beginn nicht belegen. 3.Nervenarzt: 2011; 82:363-368 La malattia di Alzheimer-Perusini: Zum 100. Jahrestag der Publikation Gaetano Perusinis Die Arbeit zielt ab auf Honorierung der Verdienste des Wissenschaftlers Gaetano Perusini (1879-1915). Durch seine genau ein Jahrhundert zurückliegende Veröffentlichung ,,Über klinisch und histologisch eigenartige psychische Erkrankungen des späteren Lebensalters“ kann er als Wegbereiter für das moderne Konzept des altersunspezifischen Beginns der Alzheimerschen Krankheit gelten. Gaetano Perusini arbeitete wissenschaftlich zusammen mit Ugo Cerletti, Alois Alzheimer, Franz Nissl sowie Emil Kraepelin und war beteiligt an der Herausgabe der ,,Folia Neurobiologica“. In seinem persönlichen Schicksal spiegelt sich die Tragik des 1.Weltkrieges: An den Folgen seiner Verwundung durch einen Granatsplitter verstarb Gaetano Perusini im Alter von nur 36 Jahren

Theoretical Approaches and Key Concepts in Medical Anthropology

The theoretical views and ideas offered in the following pages – which are quite long in order to offer a through explanation of the vast and diverse medical and anthropological literature we have available – regard specific concepts and paradigms that will be useful in order to create a solid framework for the ethnographic material we have gathered

Fibromatosis of the Plantar Fascia: Diagnosis and Indications For Surgical Treatment

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection

Quality of life measurements for patients with chronic suppurative otitis media: Italian adaptation of "Chronic Ear Survey". La misura della qualità della vita in pazienti con otite media suppurativa cronica: adattamento in italiano del “Chronic Ear Survey”

Il Chronic Ear Survey (CES) è una misura specifica della Qualità della Vita (QoL) nei pazienti affetti da Otite Media Suppurativa Cronica (CSOM). È un questionario composto da 13 domande che indagano frequenza, durata e severità dei sintomi associati a questa malattia. Il CES genera tre sottoscale con rispettivo punteggio che riguardano limitazioni nelle attività fisiche e sociali, sintomi e trattamento medico. Attraverso le risposte ottenute dai pazienti è possibile ricavare un punteggio che va da 0 a 100; il punteggio più alto indica una QoL migliore, mentre quello più basso indica una QoL peggiore. Il questionario è stato creato in lingua inglese. Lo scopo del lavoro è di validare in lingua italiana il CES. La traduzione è stata condotta seguendo le linee guida internazionali. La versione italiana del CES (CES-I) è stata proposta a 54 pazienti con CSOM. Nello stesso tempo, è stato somministrato a tutti i pazienti anche il questionario SF-36. Un modello trasversale è stato usato per esaminare la consistenza interna (Cronbach alpha) e la validità esterna (coefficiente di Pearson). Per confermare la validità esterna del CES-I è stato poi analizzato il test di correlazione di Pearson considerando il punteggio totale, le singole sottoscale del CES e le 8 scale dello Short Form Health Survey (SF-36). Il coefficiente di Cronbach è stato pari a 0.737. Il coefficiente di correlazione interno ha dato un risultato pari a 0.737 (95% CI: 0.600-0.835, p < 0.001) di media e 0.412 (95% CI: 0.237-0.559, p < 0.001) per le singole misure. Sulla base dei nostri risultati il questionario CES-I è risultato essere concorde con l’originale in lingua inglese e può essere considerato uno strumento adeguato per valutare la Qualità della Vita nei pazienti con CSOM di lingua italianaThe chronic ear survey (CES) is a sensitive and disease specific quality of life (QoL) measurement tool in patients with chronic suppurative otitis media (CSOM). It is a 13-item survey that evaluates the frequency, duration and severity of problems associated with this disease. It is composed of three subscales that describe activity restrictions, symptoms and medical resource utilisation. Based on patient's answers, it is possible to obtain a score resulting in a scale ranging from 0 to 100; the highest indicates the best health, while the lowest denotes poor health. The questionnaire was originally created in English. The aim of this study is to validate the CES questionnaire in Italian (CES-I). Translation was made following international guidelines. The application follows the stages of translation from English to Italian and linguistic adaptation, and grammatical and idiomatic equivalence review. The CES-I and the Short Form Health Survey 36 (SF-36) questionnaires were administered to 54 patients with CSOM. A cross-sectional design was used to examine the internal consistency (Cronbach's alpha) and concurrent validity (Pearson's product moment correlation). To confirm the external validity of CES-I, Pearson correlation coefficient, considering the total score and single subscales of CES and the 8 scales of the SF-36, was calculated. Cronbach's alpha coefficient for internal consistency was 0.737. The intraclass correlation coefficient, measured through mixed effects, was 0.737 (95% CI: 0.600-0.835, p < 0.001) for average measures and 0.412 (95% CI: 0.273-0.559, p < 0.001) for individual measures. According to our results, CES-I is a reliable tool for evaluation of QoL in patients with CSOM among the Italian-speaking population

La rappresentazione del rapporto tra utenti e sistema sanitario: I modelli culturali dei medici di medicina generale - The representation of the relationship between users and healthcare system: Cultural models of general practitioners

The present research study explores the emotional and symbolic representation of the Italian healthcare system and specifically of general medical services reported by a group of Italian general practitioners. General medicine is recently affected by a structural change which could be sustained also by a cultural revolution, however this revolution seems to be oriented to expected values without a clear methodology which promotes and accompanies this cultural change. The present study deals with the lack of practices due to these unrealized expected values and assumes that for intervening it is necessary knowing the existing culture before thinking to change it. Interviews to 36 general practitioners were analyzed by Emotional Text Analysis (AET). Results highlight a factorial space characterized by five clusters. According to respondents’ perspective, healthcare problems refer to two large issues characterized by powerlessness of general practitioners to intervene. On the one hand, there is health emergency, dealt with by first aid and emergency medicine. On the other hand, there is chronicity, especially affecting the elderly, which is dealt with by other workers (nurses, private family assistants, social workers) who care patients at home and replace physicians. The general practitioners’ work is difficult because of many different reasons; but the central theme is the lack of absolute power – based on morality and consciousness – which leads to the perception of catastrophic consequences for medical profession and the physician-patient relationship. Often, general practitioners are in their offices and are not able to go to patients’ home, therefore they cannot create care relationships based on trust and dependence which allow useful and trustworthy interventions. In sum, the core theme emerging from data refers to the general practitioners’ perceived lack of personal and trust-based relationships with patients

La "Malattia dell'anima" negli scrittori cristiani d'Africa

La definizione tradizionale di malattia dell'anima deriva dalla riflessione medico-filosofica antica sulla psicopatologia. Come ha messo in luce Jackie Pigeaud nel suo studio sulla "malattia dell'anima", l'espressione è "un'analogia" originata dalla supposizione che l'anima, come il corpo, possa essere affetta dalla malattia. La presa di coscienza medica e filosofica, nonché la constatazione dell'interazione tra corpo e anima hanno fatto sì che la medicina e l'etica collaborassero a fornire interpretazioni e spiegazioni di quel complesso fenomeno che rientra propriamente nel territorio della psicopatologia. Nell'ambito della cultura cristiana l'approccio al problema della malattia dell'anima non ha interessato soltanto la medicina e l'etica, ma ha investito anche la sfera della teologia e della catechesi. Perciò, in questo contributo si cercherà di analizzare l'evoluzione e l'arricchimento di questa tematica nella letteratura cristiana, limitando l'indagine a Tertulliano e Cipriano, attivi nella grande metropoli di Cartagine nel II e III secolo