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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. Int J Environ Res Public Health 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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Floridia M, Giuliano M, Monaco M, Palmieri L, Lo Noce C, Palamara AT, Pantosti A, Brusaferro S, Onder G, Palmieri L, Agazio E, Barbariol P, Bella A, Benelli E, Bertinato L, Bocci M, Boros S, Bressi M, Calcagnini G, Canevelli M, Censi F, Ciervo A, Colaizzo E, Da Cas R, Del Manso M, Di Benedetto C, Donfrancesco C, Fabiani M, Facchiano F, Floridia M, Galati F, Giuliano M, Grisetti T, Guastadisegni C, Lega I, Lo Noce C, Maiozzi P, Manno V, Martini M, Massari M, Urdiales AM, Mattei E, Meduri C, Meli P, Menniti Ippolito F, Minelli G, Onder G, Petrone D, Pezzotti P, Pricci F, Punzo O, Quarata F, Raparelli V, Riccardo F, Rocchetto S, Sacco C, Salerno P, Sarti G, Serra D, Spila Alegiani S, Spuri M, Tallon M, Tamburo De Bella M, Tiple D, Toccaceli Blasi M, Trentin F, Unim B, Vaianella L, Vanacore N, Vescio MF, Villani ER, Weimer LE, Brusaferro S. Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021. Antimicrob Resist Infect Control 2022; 11:74. [PMID: 35598032 PMCID: PMC9123740 DOI: 10.1186/s13756-022-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.
Methods
We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.
Results
Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.
Conclusions
In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.
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Matthewman J, Tadrous M, Mansfield K, Thiruchelvam D, Redelmeier D, Cheung A, Lega I, Prieto-Alhambra D, Cunliffe L, Langan S, Drucker A. 078 Association between oral corticosteroid prescribing patterns and appropriate fracture preventive care: UK and Ontario population-based cohort studies. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Castelpietra G, Knudsen AKS, Agardh EE, Armocida B, Beghi M, Iburg KM, Logroscino G, Ma R, Starace F, Steel N, Addolorato G, Andrei CL, Andrei T, Ayuso-Mateos JL, Banach M, Bärnighausen TW, Barone-Adesi F, Bhagavathula AS, Carvalho F, Carvalho M, Chandan JS, Chattu VK, Couto RA, Cruz-Martins N, Dargan PI, Deuba K, da Silva DD, Fagbamigbe AF, Fernandes E, Ferrara P, Fischer F, Gaal PA, Gialluisi A, Haagsma JA, Haro JM, Hasan MT, Hasan SS, Hostiuc S, Iacoviello L, Iavicoli I, Jamshidi E, Jonas JB, Joo T, Jozwiak JJ, Katikireddi SV, Kauppila JH, Khan MA, Kisa A, Kisa S, Kivimäki M, Koly KN, Koyanagi A, Kumar M, Lallukka T, Langguth B, Ledda C, Lee PH, Lega I, Linehan C, Loureiro JA, Madureira-Carvalho ÁM, Martinez-Raga J, Mathur MR, McGrath JJ, Mechili EA, Mentis AFA, Mestrovic T, Miazgowski B, Mirica A, Mirijello A, Moazen B, Mohammed S, Mulita F, Nagel G, Negoi I, Negoi RI, Nwatah VE, Padron-Monedero A, Panda-Jonas S, Pardhan S, Pasovic M, Patel J, Petcu IR, Pinheiro M, Pollok RCG, Postma MJ, Rawaf DL, Rawaf S, Romero-Rodríguez E, Ronfani L, Sagoe D, Sanmarchi F, Schaub MP, Sharew NT, Shiri R, Shokraneh F, Sigfusdottir ID, Silva JP, Silva R, Socea B, Szócska M, Tabarés-Seisdedos R, Torrado M, Tovani-Palone MR, Vasankari TJ, Veroux M, Viner RM, Werdecker A, Winkler AS, Hay SI, Ferrari AJ, Naghavi M, Allebeck P, Monasta L. The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: Findings from the Global Burden of Disease Study 2019. Lancet Reg Health Eur 2022; 16:100341. [PMID: 35392452 PMCID: PMC8980870 DOI: 10.1016/j.lanepe.2022.100341] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 - 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432-912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9-412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (-29·1%;23·8-38·5). YLLs decreased in self-harm (-27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding The Bill and Melinda Gates Foundation.
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Affiliation(s)
- Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Region Friuli Venezia Giulia, Italy
| | | | - Emilie E. Agardh
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | | | | | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy
| | - Rui Ma
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Fabrizio Starace
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - Nicholas Steel
- Department of Primary Care and Public Health, University of East Anglia, Norwich, UK
- Public Health England, London, UK
| | | | | | - Tudorel Andrei
- Department of Statistics and Econometrics Bucharest Carol Davila University of Economic Studies, Bucharest, Romania
| | - Jose L Ayuso-Mateos
- CIBERSAM, Institute of Health Carlos III, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid (Autonomous University of Madrid), Madrid, Spain
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Felix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Márcia Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vijay Kumar Chattu
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
- Independent Consultant, Athens, Greece
| | - Rosa A.S. Couto
- Department of Chemical Sciences, University of Porto, Porto, Portugal
| | - Natália Cruz-Martins
- Department of Medicine (Prof N Cruz-Martins PhD), University of Porto, Porto, Portugal
- Department of Health Sciences Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Famalicão, Portugal
| | - Paul I. Dargan
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Keshab Deuba
- National Centre for AIDS and STD Control, Save the Children, Kathmandu, Nepal
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Adeniyi Francis Fagbamigbe
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Population and Behavioural Sciences, University of St Andrews, St Andrews, UK
| | - Eduarda Fernandes
- Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
| | - Pietro Ferrara
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
| | - Peter Andras Gaal
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Târgu-Mureş, Romania
| | | | - Juanita A. Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Josep Maria Haro
- Research Unit, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain
| | - M. Tasdik Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Syed Shahzad Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elham Jamshidi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehram, Iran
- Division of Pulmonary Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jost B. Jonas
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | - Tamas Joo
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | | | - Joonas H. Kauppila
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Surgery Research Unit, University of Oulu, Oulu, Finland
| | - Moien A.B. Khan
- Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates
- Primary Care Department, NHS North West London, London, UK
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Mika Kivimäki
- Department of Epidemiology and Public Health University College London, London, UK
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kamrun Nahar Koly
- Health System and Population Studies Divisions, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Center for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ai Koyanagi
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Manasi Kumar
- Division of Psychology and Language Sciences, University College London, London, UK
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Caterina Ledda
- Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paul H. Lee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Insitute of Health, Rome, Italy
| | - Christine Linehan
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Joana A. Loureiro
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE) University of Porto, Porto, Portugal
- School of Health, Polytechnic Institute of Porto, Portugal
| | - Áurea M Madureira-Carvalho
- Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
- Institute for Research and Advanced Training in Health Sciences and Technologies, Instituto Universitário de Ciências da Saúde (University Institute of Health Sciences), Gandra, Portugal
| | - Jose Martinez-Raga
- Psychiatry Department, Hospital Universitario Doctor Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Manu Raj Mathur
- Health Policy Research Public Health Foundation of India, Gurugram, India
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - John J. McGrath
- Queensland Brain Institute, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Enkeleint A. Mechili
- Department of Healthcare, University of Vlora, Vlora city, Albania
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | | | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Andreea Mirica
- Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
| | - Antonio Mirijello
- Department of Medical Sciences IRCCS Casa Sollievo della Sofferenza General Hospital, San Giovanni Rotondo, Italy
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
- Medical School, University of Thessaly, Larissa, Greece
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry Ulm University, Ulm, Germany
| | - Ionut Negoi
- Department of General Surgery Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy and Embryology Romania, Bucharest, Romania
- Cardio-Aid, Bucharest, Romania
| | - Vincent Ebuka Nwatah
- Department of Pediatrics, National Hospital, Abuja, Nigeria
- Department of International Public Health, University of Liverpool, Liverpool, UK
| | | | | | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Maja Pasovic
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jay Patel
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ionela-Roxana Petcu
- Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
| | - Marina Pinheiro
- Department of Chemistry, University of Porto, Porto, Portugal
| | | | - Maarten J. Postma
- University Medical Center Groningen, School of Economics and Business University of Groningen, Groningen, Netherlands
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training Imperial College London, London, UK
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- University College London Hospitals, London, UK
- Academic Public Health England, London, UK
| | - Esperanza Romero-Rodríguez
- Clinical and Epidemiological Research in Primary Care (GICEAP), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Dominic Sagoe
- Department of Psychosocial Science University of Bergen, Bergen, Norway
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction University of Zürich, Zurich, Switzerland
| | - Nigussie Tadesse Sharew
- Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE) University of Groningen, Groningen, Netherlands
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Farhad Shokraneh
- London Institute for Healthcare Engineering, King's College London, London, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Health and Behavior Studies, Columbia University, New York, NY, USA
| | - João Pedro Silva
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Renata Silva
- Department of Biological Sciences, University of Porto, Porto, Portugal
| | - Bogdan Socea
- Surgery, "Sf. Pantelimon" Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Miklós Szócska
- Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Marco Torrado
- Psychiatry and Medical Psychology Department, University of Lisbon, Lisbon, Portugal
- Child and Adolescent Mental Health Services (CAMHS), Hospital Garcia de Orta, Almada, Portugal
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
- Modestum LTD, London, UK
| | - Tommi Juhani Vasankari
- UKK Institute, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Russell M. Viner
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrea Werdecker
- Demographic Change and Aging Research Area, Federal Institute for Population Research, Wiesbaden, Germany
| | - Andrea Sylvia Winkler
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alize J. Ferrari
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- School of Public Health (A J Ferrari PhD), The University of Queensland, Brisbane, QLD, Australia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Peter Allebeck
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
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Lega I, Pelletier JF, Caroppo E. Editorial: Long term psychiatric care and COVID-19. Front Psychiatry 2022; 13:979360. [PMID: 36016981 PMCID: PMC9396268 DOI: 10.3389/fpsyt.2022.979360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Emanuele Caroppo
- Department of Mental Health, Roma 2 Local Health Authority, Rome, Italy
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Lauria L, Bortolus R, Battilomo S, Lega I, Pizzi E, Tamburini C, Donati S. [Analysis of the activities of the network of the Family Care Centres to relaunch their role: main results of the 2017 CCM Project]. Epidemiol Prev 2021; 45:331-342. [PMID: 34738455 DOI: 10.19191/ep21.5.a001.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION in 2017, the Italian Ministry of Health funded the project "Analysis of the activities of the network of the Family Care Centers (FCCs) to relaunch their role" aimed at updating the state of the art of the national FCCs. The project was coordinated by the Italian National Institute of Health (INIH). The present paper focuses on a selection of the project's results. OBJECTIVES to describe some characteristics of the regional and Local Health Unit governance of the FCCs, and the care offered by the FCCs in different fields of activity. DESIGN online census survey on three organizational levels of the FCCs: regional governance, coordination at the Local Health Unit level, and at the single FCC level. Data were collected through dedicated web forms via a national network of reference professionals. SETTING AND PARTICIPANTS all the Italian Regions and Autonomous Provinces, 207 Local Health Unit coordinators, and 1,859 FCC's professionals were involved. Nineteen Regions (response rate: 100%), 183 coordinators (response rate: 88.4%), and 1,557 FCCs professionals (response rate: 83.7%) participated in the survey. RESULTS the project found a lack of FCCs and of FCCs health professionals throughout the country compared to the national reference standards for these services, and a great interregional variability in the FCCs governance. Women's health according to a life-course approach is the centre of the FCCs activities, although assistance modalities differ by geographic area. CONCLUSIONS to relaunch the FCCs role, it is urgent to strengthen their network throughout the country, their multidisciplinary teams, and their integration with other social and health services.
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Affiliation(s)
- Laura Lauria
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma
| | - Renata Bortolus
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma
| | - Serena Battilomo
- Direzione generale della digitalizzazione, del sistema informativo sanitario e della statistica, Ministero della salute, Roma
| | - Ilaria Lega
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma;
| | - Enrica Pizzi
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma
| | - Cristina Tamburini
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma
| | - Serena Donati
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma
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Lega I, Nisticò L, Palmieri L, Caroppo E, Lo Noce C, Donfrancesco C, Vanacore N, Scattoni ML, Picardi A, Gigantesco A, Brusaferro S, Onder G. Psychiatric disorders among hospitalized patients deceased with COVID-19 in Italy. EClinicalMedicine 2021; 35:100854. [PMID: 33907730 PMCID: PMC8062162 DOI: 10.1016/j.eclinm.2021.100854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND there is concern about the increased risk for SARS-CoV-2 infection, COVID-19 severe outcomes and disparity of care among patients with a psychiatric disorder (PD). Based on the Italian COVID-19 death surveillance, which collects data from all the hospitals throughout the country, we aimed to describe clinical features and care pathway of patients dying with COVID-19 and a preceding diagnosis of a PD. METHODS in this cross-sectional study, the characteristics of a representative sample of patients, who have died with COVID-19 in Italian hospitals between February 21st and August 3rd 2020, were drawn from medical charts, described and analysed by multinomial logistic regression according to the recorded psychiatric diagnosis: no PD, severe PD (SPD) (i.e. schizophrenia and other psychotic disorders, bipolar and related disorders), common mental disorder (CMD) (i.e. depression without psychotic features, anxiety disorders). FINDINGS the 4020 COVID-19 deaths included in the study took place in 365 hospitals across Italy. Out of the 4020 deceased patients, 84 (2•1%) had a previous SPD, 177 (4.4%) a CMD. The mean age at death was 78.0 (95%CI 77.6-78.3) years among patients without a PD, 71.8 (95%CI 69.3-72.0) among those with an SPD, 79.5 (95%CI 78.0-81.1) in individuals with a CMD. 2253 (61.2%) patients without a PD, 62 (73.8%) with an SPD, and 136 (78.2%) with a CMD were diagnosed with three or more non-psychiatric comorbidities.When we adjusted for clinically relevant variables, including hospital of death, we found that SPD patients died at a younger age than those without a PD (adjusted OR per 1 year increment 0.96; 95% CI 0.94-0.98). Women were significantly more represented among CMD patients compared to patients without previous psychiatric history (aOR 1.56; 95% CI 1.05-2.32). Hospital admission from long-term care facilities (LTCFs) was strongly associated with having an SPD (aOR 9.02; 95% CI 4.99-16.3) or a CMD (aOR 2.09; 95% CI 1.19-3.66). Comorbidity burden, fever, admission to intensive care and time from symptoms' onset to nasopharyngeal swab did not result significantly associated with an SPD or with a CMD in comparison to those without any PD. INTERPRETATION even where equal treatment is in place, the vulnerability of patients with a PD may reduce their chance of recovering from COVID-19. The promotion of personalised therapeutic projects aimed at including people with PD in the community rather than in non-psychiatric LTCFs should be prioritised.
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Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
- Corresponding author.
| | - Lorenza Nisticò
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Roma 2 Local Health Unit, Via Maria Brighenti, 23, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Antonella Gigantesco
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Silvio Brusaferro
- Office of the President, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy
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Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One 2021; 16:e0250373. [PMID: 33891629 PMCID: PMC8064507 DOI: 10.1371/journal.pone.0250373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- * E-mail:
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - for the ItOSS working group
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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Lauria L, Lega I, Pizzi E, Donati S. [Family Care Centres for health protection and promotion of individuals and communities: a reflection at the time of the Coronavirus]. Epidemiol Prev 2021; 44:374-379. [PMID: 33412832 DOI: 10.19191/ep20.5-6.s2.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
THE CONTEXT: among the community health services representing a resource to face the COVID-19 emergency, there are the Family Care Centres (FCCs). A national study coordinated by the Italian National Institute of Health (ISS) and funded by the Italian Ministry of Health, recently described their activities and needs, highlighting a large interregional variability in the number of centres and staff availability. Ante and post-natal care, cervical cancer screening and actions addressed at teenagers are the FCCs strategic activities. THE CF IN FRONT OF COVID-19: despite the need to limit the offer of care to the services that cannot be postponed during the lockdown, many FCCs have been exemplary in promptly reorganizing activities in the new context. The paper presents a selection of experiences carried out from March to June 2020 by some FCCs in different Italian Regions concerning FCCs strategic activities. CONCLUSIONS: the combined reading of some of the results of the ISS study and of the activities implemented during the COVID-19 pandemic offers a measure of the ability of the FCCs to respond to the needs of the community and to adapt to change. These services based on an innovative health model deserve enhancement and support.
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Affiliation(s)
- Laura Lauria
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma;
| | - Ilaria Lega
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma
| | - Enrica Pizzi
- Centro nazionale per la prevenzione delle malattie e la Promozione della salute, Istituto superiore di sanità, Roma
| | - Serena Donati
- Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma
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Caroppo E, De Lellis P, Lega I, Candelori A, Pedacchia D, Pellegrini A, Sonnino R, Venturiello V, Ruiz Marìn M, Porfiri M. Unequal effects of the national lockdown on mental and social health in Italy. Ann Ist Super Sanita 2020; 56:497-501. [PMID: 33346177 DOI: 10.4415/ann_20_04_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the exception of a few countries that chose a different approach, the worldwide reaction to the COVID-19 pandemic was a (longer or shorter) period of national lockdown. While the economic consequences of shutting down national economies were immediately evident, the sociopsychiatric implications of the social confinement of the entire population remain hidden and not fully understood. Italy has been the first European country to be severely impacted by the COVID-19 pandemic, to which it responded through strict lockdown measurements. The results of a timely survey on mental and social health, carried out by students and teachers of a middle school in Rome, might help identify the most vulnerable groups of the population. This evidence could be crucial in conceiving and enacting targeted public health policies to mitigate the consequences of the pandemic on mental health and to prevent intolerance to containment measures in some population segments, which could hamper worldwide efforts in the fight against COVID-19.
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Affiliation(s)
| | - Pietro De Lellis
- Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ilaria Lega
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Antonella Candelori
- Scuola Media Michelangelo Buonarroti, Istituto Comprensivo Regina Elena, Rome, Italy
| | - Daniela Pedacchia
- Scuola Media Michelangelo Buonarroti, Istituto Comprensivo Regina Elena, Rome, Italy
| | - Alida Pellegrini
- Scuola Media Michelangelo Buonarroti, Istituto Comprensivo Regina Elena, Rome, Italy
| | - Rossella Sonnino
- Scuola Media Michelangelo Buonarroti, Istituto Comprensivo Regina Elena, Rome, Italy
| | - Virginia Venturiello
- Scuola Media Michelangelo Buonarroti, Istituto Comprensivo Regina Elena, Rome, Italy
| | - Manuel Ruiz Marìn
- Department of Quantitative Methods, Law and Modern Languages, Technical University of Cartagena, Cartagena, Murcia, Spain
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, USA
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Donati S, Maraschini A, Dell'Oro S, Lega I, D'Aloja P. The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System. Ann Ist Super Sanita 2020; 55:363-370. [PMID: 31850864 DOI: 10.4415/ann_19_04_10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries. METHODS All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death. FINDINGS A total of 106 maternal deaths among 1 455 545 live births have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes. CONCLUSIONS A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for preventing avoidable maternal deaths.
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Affiliation(s)
- Serena Donati
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Alice Maraschini
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Dell'Oro
- Dipartimento di Ostetricia e Ginecologia, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Ilaria Lega
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Aloja
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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Lega I, Maraschini A, D'Aloja P, Andreozzi S, Spettoli D, Giangreco M, Vichi M, Loghi M, Donati S. Maternal suicide in Italy. Arch Womens Ment Health 2020; 23:199-206. [PMID: 31104119 DOI: 10.1007/s00737-019-00977-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1 year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006-2012. The suicide rate was 1.18 per 100,000 after giving birth (n = 2,876,193), 2.77 after an induced abortion (n = 650,549) and 2.90 after a miscarriage (n = 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.
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Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Silvia Andreozzi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Daniela Spettoli
- SaPeRiDoC -Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, Bologna, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Monica Vichi
- Service of Statistics, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Marzia Loghi
- Integrated System for Health, Social Assistance, Welfare and Justice - Directorate for Social Statistics and Population Census - ISTAT, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
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Grussu P, Lega I, Quatraro RM, Donati S. Perinatal mental health around the world: priorities for research and service development in Italy – CORRIGENDUM. BJPsych Int 2020; 19:80. [PMID: 36287791 PMCID: PMC9540789 DOI: 10.1192/bji.2020.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Grussu P, Lega I, Quatraro RM, Donati S. Perinatal mental health around the world: priorities for research and service development in Italy. BJPsych Int 2020; 17:8-10. [PMID: 34287421 PMCID: PMC8277529 DOI: 10.1192/bji.2019.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/23/2019] [Indexed: 12/03/2022] Open
Abstract
In Italy, most studies on perinatal mental health and initiatives aimed at improving the early detection and management of perinatal mental disorders have been carried out at the local level. National population-based studies are lacking. A study of pregnant women, recruited and diagnosed by a university hospital, found a 12.4% prevalence of minor and major depression during pregnancy, and a prevalence of 9.6% in the postpartum period. In a population-based surveillance system, covering 77% of national births, suicide was identified to be one of the main causes of maternal death within the first year after birth, yet half of those who were known to have a high suicide risk during the postpartum period had not been referred to a mental health service. The value of recognising depressive or anxiety symptoms early, during pregnancy, has been emphasised by recent research and should be linked to multi-professional psychosocial interventions. Since 2017, the Italian public primary care services that are dedicated to pregnancy assistance (Family Care Centres) have been tasked to provide free psychological assessment to pregnant and postpartum women. Action is now needed in order to improve access to Italian Family Care Centres for pregnant women and to develop an integrated care model involving obstetric and mental health services.
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Affiliation(s)
- Pietro Grussu
- Family Service Unit, South Padua District, AULSS 6 Euganea, Regione Veneto, National Health Service, Italy.
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Heath, Italy
| | - Rosa Maria Quatraro
- Hospital Psychology, Obstetrics and Gynaecology Unit, AULSS 8 Berica, Regione Veneto, National Health Service, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Heath, Italy
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D'Aloja P, Maraschini A, Lega I, Andreozzi S, Sampaolo L, Valetto MR, Dri P, Donati S. Acceptance of e-Learning Programs for Maternity Health Care Professionals Implemented by the Italian Obstetric Surveillance System. J Contin Educ Health Prof 2020; 40:289-292. [PMID: 33284182 DOI: 10.1097/ceh.0000000000000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Distance learning efficacy on physician performances and patient health outcomes has been demonstrated. This study explored the participation and evaluation of CME e-learning courses for Italian health care professionals addressing leading causes of maternal mortality identified by the Italian Obstetric Surveillance System (ItOSS) at the Italian National Health Institute, namely postpartum hemorrhage and pregnancy hypertensive disorders. METHODS A model for two online free 12-hour case-based training courses was used. Data on participants were collected, anonymized, and transferred to the Italian National Health Institute for later analysis. Participants were requested to sign an online informed consent form. RESULTS Twenty-one thousand five hundred thirty-two health care professionals enrolled to the courses from 2014 to 2017 as follows: midwives (14,187, 65.9%); obstetricians (3,716, 17.2%); anesthesiologists (1,896, 8.8%); and other medical specialists (1,733, 8.0%). Overall, 85% of participants acquired CME credits. Participants' satisfaction on quality, efficacy, and relevance was very high. DISCUSSION ItOSS courses were able to reach a substantial number of different professional profiles involved in perinatal care all over the country; ItOSS courses can be considered an effective way to spread evidence-based good clinical practices. Nevertheless, further studies are needed to verify the improvement in professional health care skills and patient outcomes.
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Affiliation(s)
- Paola D'Aloja
- Dr. D'Aloja: Senior Researcher,National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Maraschini: Senior Researcher, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Lega: Senior Researcher, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Ms. Andreozzi: Grafic Designer, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Ms. Sampaolo: Information Specialist, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Valetto: Science Journalist, Zadig, Scientific Publisher, Milan, Italy;Dr. Dri: Chief Director, Zadig, Scientific Publisher, Milan, Italy: Dr. Donati: Head of Department, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy
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Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Dell'Oro S, Donati S. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. Acta Obstet Gynecol Scand 2019; 99:274-282. [PMID: 31520414 DOI: 10.1111/aogs.13727] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage. MATERIAL AND METHODS A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. RESULTS The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13-5.96), assisted reproductive technology (RR 5.99, 95% CI 4.42-8.11) multiple pregnancy (RR 5.03, 95% CI 3.57-7.09) and maternal age ≥35 years (RR 2.69, 95% CI 2.25-3.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died. CONCLUSIONS The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.
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Affiliation(s)
- Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Stefania Dell'Oro
- Department of Obstetrics and Gynecology, Foundation MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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Donati S, Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Manno V. In response to "missed opportunities and potentially misleading results in maternal mortality study". Acta Obstet Gynecol Scand 2019; 98:128-129. [PMID: 30288726 DOI: 10.1111/aogs.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 02/17/2024]
Affiliation(s)
- Serena Donati
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Statistics Service, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
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Picardi A, Gigantesco A, Tarolla E, Stoppioni V, Cerbo R, Cremonte M, Alessandri G, Lega I, Nardocci F. Parental Burden and its Correlates in Families of Children with Autism Spectrum Disorder: A Multicentre Study with Two Comparison Groups. Clin Pract Epidemiol Ment Health 2018; 14:143-176. [PMID: 30158998 PMCID: PMC6080067 DOI: 10.2174/1745017901814010143] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions. OBJECTIVE This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child's characteristics, and parents' coping resources and strategies. METHODS The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child's clinical characteristics and parents' caregiving burden, psychological distress, coping resources and strategies were assessed. RESULTS The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies. CONCLUSION This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.
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Affiliation(s)
- Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome. Italy
| | - Antonella Gigantesco
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome. Italy
| | | | - Vera Stoppioni
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Marche Nord Hospital, Fano, Italy
| | - Renato Cerbo
- Child Neuropsychiatry Unit and Centre for Neurodevelopmental Disorders, Pescara, Italy
| | - Maurizio Cremonte
- Neurological and Psychiatric Child Unit, Pediatric Department, Alessandria Hospital, Alessandria, Italy
| | | | - Ilaria Lega
- Women’s Health Unit, National Centre of Epidemiology Surveillance and Health Promotion, Italian National Institute of Health, Rome. Italy
| | - Franco Nardocci
- Italian Society for Child and Adolescent Neuropsychiatry, Italy
- Italian Autism Foundation, Rome, Italy
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Donati S, Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Manno V. Maternal mortality in Italy: Results and perspectives of record-linkage analysis. Acta Obstet Gynecol Scand 2018; 97:1317-1324. [DOI: 10.1111/aogs.13415] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Serena Donati
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | | | - Valerio Manno
- Statistics Service; Italian National Institute of Health-Istituto Superiore di Sanità; Rome Italy
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Ventura M, Maraschini A, D'Aloja P, Kirchmayer U, Lega I, Davoli M, Donati S. Drug prescribing during pregnancy in a central region of Italy, 2008-2012. BMC Public Health 2018; 18:623. [PMID: 29764430 PMCID: PMC5952470 DOI: 10.1186/s12889-018-5545-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/04/2018] [Indexed: 02/07/2023] Open
Abstract
Background Drug consumption during pregnancy is a matter of concern, especially regarding drugs known or suspected to be teratogens. Little is known about drug use in pregnant women in Italy. The present study is aimed at examining the prevalence, and to detect potential inappropriateness of drug prescribing among pregnant women in Latium, a region of central Italy. Methods This retrospective study was conducted on a cohort of women aged 18-45 years who delivered between 2008 and 2012 in public hospitals. Women were enrolled through the Regional Birth Register. After linking the regional Health Information Systems and the Regional Drug Claims Register, women’s clinical data and prescribed medications were analyzed. Italian Medicine Agency (AIFA) and US Food and Drug Administration (FDA) evidence were used to investigate inappropriate prescribing and teratogenic risk. Results Excluding vitamins and minerals, 80.6% (n = 153,079) of the women were prescribed at least one drug during pregnancy, with an average of 4.6 medications per pregnancy. Drugs for blood and hematopoietic organs were the most commonly prescribed (53.0%,), followed by anti-infectives for systemic use (50.7%). Among the inappropriate prescriptions, progestogen supplementation was given in 20.1% of pregnancies; teratogen drugs were prescribed in 0.8%, mostly angiotensin co-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (0.3%). Conclusions In Latium, drugs are widely used in pregnancy. Prescriptions of inappropriate drugs are observed in more than a fifth of pregnancies, and teratogens are still used, despite their known risk. Continuous updates of information provided to practitioners and an increased availability of information to women might reduce inappropriate prescribing.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Alice Maraschini
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Paola D'Aloja
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Ilaria Lega
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Serena Donati
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
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Di Lorito C, Castelletti L, Lega I, Gualco B, Scarpa F, Vӧllm B. The closing of forensic psychiatric hospitals in Italy: Determinants, current status and future perspectives. A scoping review. Int J Law Psychiatry 2017; 55:54-63. [PMID: 29157512 DOI: 10.1016/j.ijlp.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/14/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Italy is the only country in the world to have closed forensic psychiatric hospitals and converted to fully-residential services. The international interest around this reform has not been matched by research. This scoping review aims to report the determinants of the reform, the most updated information on how the system operates, its benefits and its challenges. We further aim to discuss the implications for policy, research and practice. METHODS 1. Selection of relevant sources through electronic search on four databases, Google, relevant printed materials and personal communication with practitioners currently working in REMS. 2. Study quality monitoring. 3. Data extraction onto NVivo 4. Data synthesis through content analysis. RESULTS 43 papers were selected for inclusion in our review. Two main themes were identified: 1. Historical chronology of the closure of forensic psychiatric hospitals; 2. The current model of residential forensic psychiatric care. CONCLUSIONS The closing down of Italian forensic psychiatric hospitals represented a fundamental step for human rights. Further work is required to improve the current service, including potential reforming of the penal code, improved referral/admission processes and consistent monitoring to reduce service inequality across regions. Further research is crucial to test the effectiveness of the Italian model of care against traditional ones.
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Affiliation(s)
- Claudio Di Lorito
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2TU, United Kingdom.
| | | | - Ilaria Lega
- Italian National Institute of Health, Viale Regina Elena 299 - 00161, Rome, Italy
| | - Barbara Gualco
- Department of Health Sciences, University of Firenze, Largo Brambilla 3, 50134 Firenze, Italy
| | - Franco Scarpa
- Local Health Unit Centre of Toscana, Viale della Piazzuola 56, 50133 Firenze, Italy
| | - Birgit Vӧllm
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2TU, United Kingdom
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D'Aloja P, Lega I, Maraschini A, Donati S. [WHO GLOSS: a global study to promote the reduction of preventable maternal and neonatal deaths related to sepsis.]. Recenti Prog Med 2017; 108:363-365. [PMID: 28901344 DOI: 10.1701/2745.27987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The study aims to promote the reduction of preventable maternal and neonatal deaths related to sepsis worldwide. To achieve this goal, the study will test new WHO criteria for early identification of maternal sepsis across both low and high resource settings, describe and analyze the frequency and outcomes of suspected or confirmed maternal sepsis for mothers and infants. Additionally, in the European participating countries, the study will describe the patterns of anti-microbial usage amongst women with suspected maternal sepsis, explore migration status amongst women with possible severe maternal infection and describe any variations in their management.
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Affiliation(s)
- Paola D'Aloja
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Roma
| | - Ilaria Lega
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Roma
| | - Alice Maraschini
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Roma
| | - Serena Donati
- Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Roma
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Maraschini A, D'Aloja P, Lega I, Buoncristiano M, Kirchmayer U, Ventura M, Donati S. Do Italian pregnant women use periconceptional folate supplementation? Ann Ist Super Sanita 2017; 53:118-124. [PMID: 28617257 DOI: 10.4415/ann_17_02_07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Deficiency of folic acid (FA) has been identified as a risk factor for neural tube defects (NTDs) as well as other congenital anomalies. Thus, periconceptional folate supplementation is recommended for all women planning to get pregnant. METHODS We conducted a KAP (knowledge, attitude, practice) survey to investigate the use of FA and its appropriateness. The survey included a sample of 562 women who delivered in the Lazio region between 2013 and 2014. Two logistic regression analyses were performed to evaluate the association between the characteristics of participating women and both the information received on FA intake and its use. RESULTS The prevalence of periconceptional FA assumption was 19.4% although 82.2% of the interviewed women had planned their pregnancies. CONCLUSIONS It shows that more periconceptional counseling is needed to increase women's awareness on the opportunity of FA supplementation.
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Affiliation(s)
- Alice Maraschini
- Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Aloja
- Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Lega
- Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Marta Buoncristiano
- Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Ursula Kirchmayer
- Dipartimento di Epidemiologia, Servizio Sanitario Regione Lazio, Rome, Italy
| | - Martina Ventura
- Dipartimento di Epidemiologia, Servizio Sanitario Regione Lazio, Rome, Italy
| | - Serena Donati
- Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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Picardi A, Lega I, Tarsitani L, Caredda M, Matteucci G, Zerella MP, Miglio R, Gigantesco A, Cerbo M, Gaddini A, Spandonaro F, Biondi M. A randomised controlled trial of the effectiveness of a program for early detection and treatment of depression in primary care. J Affect Disord 2016; 198:96-101. [PMID: 27015158 DOI: 10.1016/j.jad.2016.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/13/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE There is considerable uncertainty about whether depression screening programs in primary care may improve outcomes and what specific features of such programs may contribute to success. We tested the effectiveness of a program involving substantial commitment from local mental health services. METHODS Prospective, randomised, patient- and evaluator-masked, parallel-group, controlled study. Participants were recruited in several urban primary care practices where they completed the PC-SAD screener and WHOQOL-Bref. Those who screened positive and did not report suicidal ideation (N=115) were randomised to an intervention group (communication of the result and offer of psychiatric evaluation and treatment free of charge; N=56) or a control group (no feedback on test result for 3 months; N=59). After 3 months, 100 patients agreed to a follow-up telephone interview including the administration of the PC-SAD5 and WHOQOL-Bref. RESULTS Depression severity and quality of life improved significantly in both groups. Intent-to-treat analysis showed no effect of the intervention. As only 37% of patients randomised to the intervention group actually contacted the study outpatient clinic, we performed a per-protocol analysis to determine whether the intervention, if delivered as planned, had been effective. This analysis revealed a significant positive effect of the intervention on severity of depressive symptoms, and on response and remission rate. Complier average causal effect analysis yielded similar results. CONCLUSION Due to the relatively small sample size, our findings should be regarded as preliminary and have limited generalizability. They suggest that there are considerable barriers on the part of many patients to the implementation of depression screening programs in primary care. While such programs can be effective, they should be designed based on the understanding of patients' perspectives.
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Affiliation(s)
- A Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - I Lega
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - L Tarsitani
- Department of Psychiatric Sciences and Psychological Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - M Caredda
- Department of Psychiatric Sciences and Psychological Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - G Matteucci
- Department of Psychiatric Sciences and Psychological Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - M P Zerella
- Department of Psychiatric Sciences and Psychological Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - R Miglio
- Department of Statistics, University of Bologna, Italy
| | - A Gigantesco
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - M Cerbo
- National Agency for Regional Health Services, Rome, Italy
| | - A Gaddini
- Agency for Public Health, Lazio Region, Italy
| | | | - M Biondi
- Department of Psychiatric Sciences and Psychological Medicine, 'Sapienza' University of Rome, Rome, Italy
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Affiliation(s)
- Serena Donati
- National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy.
| | - Alice Maraschini
- National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy
| | - Vittorio Basevi
- Centro di documentazione sulla salute perinatale e riproduttiva, Regione Emilia-Romagna, Bologna, Italy
| | - Marta Buoncristiano
- National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy
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Han K, Pintilie M, Lipscombe L, Lega I, Milosevic M, Fyles T. Metformin Use Is Associated With Lower Cervical Cancer–Specific Mortality. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Picardi A, Adler DA, Rogers WH, Lega I, Zerella MP, Matteucci G, Tarsitani L, Caredda M, Gigantesco A, Biondi M. Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care. Clin Pract Epidemiol Ment Health 2013; 9:164-70. [PMID: 24155771 PMCID: PMC3804886 DOI: 10.2174/1745017901309010164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 07/26/2013] [Accepted: 08/07/2013] [Indexed: 11/26/2022]
Abstract
Background: Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care. Methods: A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results: Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions: While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.
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Affiliation(s)
- Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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Gigantesco A, Lega I. [Occupational stress and mental health]. Epidemiol Prev 2013; 37:67-73. [PMID: 23585436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One fifth of workers reports experiencing stress in the work environment in Europe. A number of studies show that psychosocial stressors in the workplace are associated with adverse physical and mental health outcomes, including symptoms of anxiety and depression. The present paper: briefly describes the characteristics of occupational stress and the main psychosocial stressful risk factors in the work environment; reports the main results of studies on psychosocial risk factors in the work environment as risk factor for common mental disorders; presents findings from an Italian study aimed at assessing prevalence of common mental disorders and workplace psychosocial stressors in a sample of hospital employees; provides the "Working conditions Questionnaire", a validated self-administered instrument to assess perceived stress in the workplace; this questionnaire includes the assessment of organizational justice.
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Affiliation(s)
- Antonella Gigantesco
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma.
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Gigantesco A, Lega I, Picardi A. The Italian SEME Surveillance System of Severe Mental Disorders Presenting to Community Mental Health Services. Clin Pract Epidemiol Ment Health 2012; 8:7-11. [PMID: 22435071 PMCID: PMC3293155 DOI: 10.2174/1745017901208010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/30/2011] [Accepted: 10/30/2011] [Indexed: 11/24/2022]
Abstract
Mental health is recognized worldwide as a major public health priority for the twenty-first century. Different actions are needed, including developing or strengthening national mental health information systems, based on standardized indicators that allow national and international monitoring. In 2008, the national Centre for Disease prevention and Control of the Italian Ministry of Health and the Mental Health Unit of the Italian National Institute of Health (INIH) jointly launched a mental health information system named SEME (an Italian acronym meaning ‘mental health epidemiological surveillance’) based upon data collected from trained psychiatrists working in 22 selected sentinel community mental health centers distributed across Italy and covering a total population of 1,941,853 inhabitants, in order to collect and report site-level information on first-contact patients suffering from specific severe mental disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, bipolar I disorder, anorexia nervosa, major depressive episode with psychotic symptoms or suicide attempt). Strengths of the system are the high reliability of diagnoses and the use of a web-based technique for data collection with data entry forms designed for ease of completion. During the first year of implementation of this system, a total of 343 first-contact patients met criteria for one of the severe mental disorders under surveillance. As the system includes standardized instruments to measure psychiatric symptoms and psychosocial functioning, it may facilitate health services research based on longitudinal measurements aimed at evaluating the continuity of psychiatric care and the effectiveness of innovative therapeutic and rehabilitative programs.
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Affiliation(s)
- Antonella Gigantesco
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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Picardi A, Adler DA, Chang H, Lega I, Gigantesco A, Pasquini P, Matteucci G, Zerella MP, Caredda M, Tarsitani L, Biondi M, Rogers WH. Development and preliminary validation of the PC-SAD5, a screener-derived short depression severity measure. J Eur Acad Dermatol Venereol 2011; 26:165-71. [PMID: 21395694 DOI: 10.1111/j.1468-3083.2011.04022.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of depressive disorders is high among patients with skin disease. The PC-SAD is a 37-item self-administered depression screening questionnaire that has been validated in dermatological patients. OBJECTIVE The aim of this study was to develop and validate a brief depression severity instrument derived from the PC-SAD that can be used to assess severity and monitor ongoing clinical course. METHODS Two patient samples participated in the study: 72 adult dermatological inpatients and 73 adults attending six primary care practices. Psychiatric assessment included the Structured Clinical Interview for DSM-IV and an 18-item version of the PC-SAD; moreover, dermatological patients completed the Patient Health Questionnaire depression scale (PHQ-9), while primary care patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS). A subset of five PC-SAD items showing the best psychometric properties were selected, and the reliability and validity of the resulting instrument (PC-SAD5) were examined. RESULTS The PC-SAD5 showed satisfactory internal consistency in both samples. There was a high correlation between PC-SAD5 and PHQ-9 and MADRS scores. Multiple regression analysis revealed a gradient of PC-SAD5 scores from patients with no mental disorder, those with milder forms of depression, to those with Major Depressive Disorder. Similar results were observed for the 18-item version of the PC-SAD. CONCLUSION The availability of valid and reliable continuous measures of depression severity derived from the PC-SAD extends its field of application from depression screening to use as a follow-up measure of depression severity in routine clinical practice. A validated very short instrument such as the PC-SAD5 may have substantial clinical value.
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Affiliation(s)
- A Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
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Gigantesco A, Masocco M, Picardi A, Lega I, Conti S, Vichi M. Hospitalization for anorexia nervosa in Italy. Riv Psichiatr 2010; 45:154-162. [PMID: 20718262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study provides: a) rates of hospitalization for anorexia nervosa (AN) in Italy in 2004-2005 period; b) an estimate of the incidence of moderate to severe hospitalized AN in the same period among persons aged 10-19 years. METHOD 9863 hospital discharges of patients aged 10-59 years with a diagnosis of AN (ICD9CM code 307.1) were extrapolated from the Italian Hospital Discharges Database. Patients aged 10-19 years, first admitted in 2004-2005, never hospitalized for AN in 2001-2003, were assumed to be a reasonable proxy of incident cases. RESULTS Crude rate of AN associated hospitalization was 24.2 per 100,000 person-years among women and 1.6 per 100,000 person-years among men. Estimated incidence rate of AN was 22.8 per 100,000 among women compared with 2.0 per 100,000 among men in the 10-19 years age group. DISCUSSION This study provides, for the first time, nationwide incidence estimates of AN in Italy.
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Affiliation(s)
- Antonella Gigantesco
- Center of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
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Picardi A, Porcelli P, Pasquini P, Fassone G, Mazzotti E, Lega I, Ramieri L, Sagoni E, Abeni D, Tiago A, Fava GA. Integration of Multiple Criteria for Psychosomatic Assessment of Dermatological Patients. Psychosomatics 2006; 47:122-8. [PMID: 16508023 DOI: 10.1176/appi.psy.47.2.122] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Psychological distress has been frequently reported in the setting of skin disorders. The Diagnostic Criteria for Psychosomatic Research (DCPR) have been found to yield valuable integrative information, in addition to DSM-IV nosology, in a variety of medical diseases. The aim of this study was to verify whether this integration could also be helpful in dermatology. A consecutive series of 539 inpatients with various skin conditions was evaluated by means of structured interviews for DSM-IV and DCPR diagnoses. The prevalence of DSM-IV conditions was 38% (mostly depressive disorders and anxiety disorders), whereas that of DCPR clusters (mostly demoralization and somatization secondary to psychopathology) was 48%. Overall, DCPR diagnoses were significantly more frequent than DSM-IV categories, regardless of the presence or absence of a psychiatric disorder. Psychological assessment of patients with skin diseases needs to incorporate both clinical (DSM-IV) and subclinical (DCPR) methods of classification. The health status of these patients can be improved if their psychological problems are appropriately assessed and recognized.
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Troisi A, Di Lorenzo G, Lega I, Tesauro M, Bertoli A, Leo R, Iantorno M, Pecchioli C, Rizza S, Turriziani M, Lauro R, Siracusano A. Plasma ghrelin in anorexia, bulimia, and binge-eating disorder: relations with eating patterns and circulating concentrations of cortisol and thyroid hormones. Neuroendocrinology 2005; 81:259-66. [PMID: 16131812 DOI: 10.1159/000087923] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 07/03/2005] [Indexed: 11/19/2022]
Abstract
The present study was designed to investigate the relations between plasma ghrelin concentrations, eating patterns, and circulating concentrations of cortisol and thyroid hormones in women with anorexia nervosa, bulimia nervosa, and binge-eating disorder. The patterns of disordered eating behavior were assessed using the Eating Attitudes Test (EAT-26) and the Bulimia Test-Revised (BULIT-R). In women with eating disorders, but not in healthy control women, plasma ghrelin concentrations were negatively correlated with body mass index (BMI) and plasma concentrations of thyreotropin (TSH), free T3 and free T4, and positively correlated with plasma concentrations of cortisol. The ghrelin concentrations of women with binge-eating and purging behavior were significantly lower than those of women with anorexia nervosa, restricting type, and there was a negative relation between the frequency and severity of binge-eating and purging behavior, as measured by the BULIT-R total score, and ghrelin concentrations. In a multivariate regression model controlling for the confounding effects of body mass index (BMI) and age, higher ghrelin concentrations were correlated with lower BULIT-R total scores. The results of this study did not confirm the hypothesis advanced in previous studies that ghrelin concentrations are higher in patients with binge-eating/purging forms of eating disorders. Based on these data, we suggest that, in women with eating disorders, ghrelin concentrations best reflect nutritional status rather than specific patterns of disordered eating behavior.
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Affiliation(s)
- Alfonso Troisi
- Department of Neurosciences, University of Rome Tor Vergata, Rome, Italy.
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Picardi A, Abeni D, Mazzotti E, Fassone G, Lega I, Ramieri L, Sagoni E, Tiago A, Pasquini P. Screening for psychiatric disorders in patients with skin diseases: a performance study of the 12-item General Health Questionnaire. J Psychosom Res 2004; 57:219-23. [PMID: 15507245 DOI: 10.1016/s0022-3999(03)00619-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 10/28/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although psychiatric disorders are frequent among dermatological patients, no study has formally assessed the performance of any psychiatric screening questionnaire in dermatological practice. This study tested the ability of the 12-item General Health Questionnaire (GHQ-12) to identify psychiatric morbidity in dermatological patients. METHODS A sample of 521 adult inpatients (81% of all eligible patients) completed the GHQ-12 and were administered the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) by a trained mental health professional masked to GHQ-12 score. RESULTS The Receiver Operating Characteristic (ROC) analysis showed that GHQ-12 possesses substantial discriminatory ability (area under the curve=0.70). The best balance between sensitivity (68%) and specificity (64%) was found at the GHQ-12 cutoff score of 3/4. This threshold gave a likelihood ratio for a positive or negative result of 1.90 and 0.50, respectively. CONCLUSION The performance of GHQ-12 was reasonably good for a self-administered questionnaire requiring only a few minutes to be completed and scored. Its routine use might increase recognition of psychiatric disorders in dermatological patients and contribute to improve patients' outcome.
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Affiliation(s)
- Angelo Picardi
- Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, Via dei Monti di Creta 104-00167 Rome, Italy.
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