Annali dell'Istituto superiore di sanita最新文献

Introduction: The pandemic significantly affected mental health, leading to a reorganization of services. This study examines changes in Italy's Departments of Mental Health (DMHs), comparing surveys from 2021 (during COVID-19) and 2023 (post-pandemic).

Methods: The two surveys involved 19 Italian DMHs and covered variables related to mental health care (number of centres, available staff, services provided and intervention methods).

Results: Between 2021 and 2023, services show structural stability with a solid territorial network. Organizational changes point to greater flexibility and customization, with a stronger semi-residential hospital offer. Human resources give mixed signals: psychologists and health care social workers are increasing, while social workers and psychiatric rehabilitation technicians are decreasing. Clinically, hospitalizations in General Hospital Psychiatric Units (GHPUs), Emergency Department (ED) visits, and self-harm cases are rising, while psychiatric and psychological visits decline. Remote nursing and psychosocial interventions are increasing. The growth in first psychological consultations and users taken into care suggests a gradual return to in-person access and partial pre-pandemic normality.

Conclusions: The data substantiate the need for continuous attention and adequate support to address post-pandemic mental distress, highlighting the importance of reorganizing services to effectively respond to the new needs of the population.

Introduction: The implementation of an innovative psychoeducational group intervention in Italian general hospital psychiatric units started in the years 2000-2001 in two Italian regions. The aim of this contribution is to describe the intervention method and the experience of its application, its spread, the results of evaluation studies and its evolution.

Method: The methodology is qualitative/quantitative. The qualitative approach concerns the description of the prevalent clusters of topics in the most used intervention modules. The quantitative approach concerns the analysis of indicators used in the evaluation studies carried out since 2000-2001.

Results: Over time, three topics of the intervention have remained constant: "What happened before the crisis"; "Stress-vulnerability-coping model"; "Psychotropic drugs: shared decisions". Other topics have been introduced based on the patients' preferences: "Psychophysical well-being", "Awareness", "Emotions-thoughts-behaviors connection", "Problem-solving" and "Stigma". The intervention has been applied over time in 15% of Italian psychiatric wards with positive results (main result: decrease in readmissions and restraints).

Discussion: Two main topics are discussed: a) the advantages and obstacles in applying the intervention; b) the need for addressing also the issues of substance dependence and antisocial personality.

Background: Accurate estimation of vaccine effectiveness (VE) in real-world settings is essential for guiding immunization strategies, especially in older populations. However, observational studies are prone to bias due to confounding factors, and the choice of statistical method can significantly influence VE estimates.

Materials and methods: We compared the performance of a multivariable Cox proportional hazards model with seven propensity score (PS)-based models to estimate the relative vaccine effectiveness (rVE) of the bivalent Original/Omicron BA.4-5 mRNA vaccine as a second or third booster, compared to a first mRNA booster received ≥120 days earlier. Data from 11,879,461 individuals aged ≥60 in Italy (April-June 2023) were analyzed.

Results: All models produced consistent rVE estimates, with values ranging from 16.4% to 22.1%. Over time, booster effectiveness declined, with the reference model showing a drop in rVE from 45.6% (15-60 days) to 14.3% (181-265 days). PS-based methods improved covariate balance but did not outperform the Cox model in terms of precision or interpretability.

Conclusions: In large, relatively balanced datasets, traditional multivariable models remain a robust and reliable choice for estimating VE. While PS-based methods offer theoretical advantages, their practical benefit may be limited when confounding is well controlled.

Background: Disulfiram, acamprosate (ACM), naltrexone, and nalmefene are medications currently approved for the treatment of Alcohol Use Disorder (AUD). Baclofen and sodium oxybate (SO) have been approved for the treatment of AUD and alcohol withdrawal syndrome in France and Italy, respectively. However, concerning the effectiveness of combined therapies for AUD, data from the current literature are contrasting.

Aims: To investigate the outcomes of combined therapy of SO and ACM for the maintenance of alcohol abstinence.

Methods: A sample of 48 AUD patients consecutively enrolled and treated with SO (50-100 mg/kg of body weight, t.i.d.) plus ACM (666 mg three times daily; with dosage reduced in patients with body weight <60 kg) was observed for 12 weeks.

Results: At the 3-month visit, continuous abstinence from alcohol was maintained by 34 patients (70.8%). Fifteen patients (31.3%) reported side effects like nausea, dizziness, and abdominal pain, with no significant differences between abstinent and not abstinent patients.

Conclusion: SO plus ACM may be an effective and safe pharmacological combination for maintaining alcohol abstinence in AUD patients. Future ad hoc clinical trials are needed to test this therapeutic association for AUD treatment.

Introduction: Individuals affected by lymphedema, both primary and secondary, experience a significant reduction in quality of life and functional capacity. However, the impact of lymphedema on occupational life, specifically on return-to-work processes, remains largely unexplored.

Objectives: This study explores the psychosocial, occupational, and health-related challenges experienced by individuals with lymphedema, with a focus on work reintegration.

Methods: A mixed-method approach was adopted through the development of an online survey, which included both standardized psychometric scales and open-ended questions.

Results: The mediation analysis confirmed that return to work self-efficacy serves as a key mechanism through which optimism contributes to job satisfaction. Qualitative findings highlight the need for multilevel and systemic interventions. From an individual perspective, targeted self-efficacy training programs for workers with lymphedema appear crucial.

Conclusions: Considering a community and an organizational perspective, it is essential to implement training initiatives for healthcare professionals aimed at improving their knowledge and awareness of lymphedema.

Background: The fear of having contracted HIV or another sexually transmitted infection (STI), even in the absence of significant risk factors, is a globally observed phenomenon across diverse cultural, social, and healthcare settings. Helplines serve as a valuable observatory for this pattern, often described as "worried well" (WW). This study investigates the WW phenomenon with the objective of assessing whether the COVID-19 pandemic has acted as a compounding factor in its intensification.

Methods: AIDS and STIs Helpline of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) extracted data from a structured database and analyzed patterns related to callers' concerns.

Results: Between 2018 and 2023, 4,703 calls were analysed, showing how WWs represent 8.1% of all users and questions asked by WWs accounted for 7.8% of the total number of questions received by the AIDS and STIs Helpline.

Conclusions: While the COVID-19 pandemic may have contributed to an intensification of the WW phenomenon, its origins are more deeply rooted in factors such as psychological distress and limited health literacy.

Introduction: Witnessed domestic violence is a widespread yet underrecognized form of childhood trauma, with serious consequences for the emotional, behavioral, and physical development of children and adolescents. In Italy, nearly half of domestic violence incidents occur in the presence of children, yet standardized tools for identifying affected minors remain scarce.

Objectives: This study presents the EpiCHILD assessment tool, designed to support the early identification of psychophysical vulnerabilities in children exposed to domestic violence and to guide targeted prevention and care strategies.

Methods: Developed within the ESMiVA study, EpiCHILD is a multidimensional electronic questionnaire composed of nine sections, incorporating validated instruments for PTSD (ITQ-CA), depression (CDI-2), and psychosocial functioning (SDQ-Ita). Administered by trained professionals in clinical and social service settings, the tool is GDPR-compliant and allows for flexible, child-centered use.

Conclusions: EpiCHILD enables systematic screening and early detection of children at risk due to violence exposure. It standardizes data collection across sectors and lays the groundwork for future research on the biological impact of trauma, including potential epigenetic markers, representing an innovative contribution to precision prevention in child mental health.

Background: Person-centred care is central to global and European Union (EU) dementia strategies. This Italian study evaluates compliance of integrated care pathways (ICPs) with the National Guidance for People with Dementia (NGICPD).

Methods: ICPs obtained from national and official sources evaluated using a 43-item NGICPD-based checklist across three domains: framework, elements, and development.

Results: Thirty-nine ICPs were analysed. Fourteen of 21 regions and 30 of 110 Local Health Authorities developed an ICP. Mean scores were 23.5±7.9 for regional and 23.1±5.0 for LHA ICPs, showing low compliance with the NGICPD.

Conclusions: The study assessed national and regional ICPs for dissemination, guideline alignment, and implementation gaps, emphasizing the need for improved monitoring through key quality indicators.

Background: From 11.7% to 31.5% of the population in Western countries has tattoos. Given the potential health implications, it is important to obtain reliable estimates of the prevalence of the tattooed population.

Objective: To estimate the prevalence of tattoos in the general population and among younger age groups worldwide, and the settings in which tattoos are performed.

Methods: We conducted a literature review by searching MEDLINE, Scopus, and Web of Science for relevant articles published between January 1, 2000, and September 17, 2025. Studies were included if they reported data on the prevalence of tattoos and/or the settings in which tattooing occurred, drawn from the general population or specific age groups and students.

Results: From the 7,921 potential articles identified, 86 were included in our review. We found a global prevalence ranging from 0.18% to 63.9% (from 5.2% to 35.3% in developed countries), with a significantly increasing trend. The data revealed a higher tattoo prevalence among younger individuals. In Western countries, from 64% to 93.9% of the samples got their tattoos in authorized parlours.

Conclusions: The data demonstrate a clear increase in tattooing worldwide. This represents a matter of concern from a public health perspective, as it is likely to be accompanied by a corresponding increase in health risks and requests for tattoo removal.