COVID-19 infection may lead to acute respiratory distress syndrome (CARDS) where severe gas exchange derangements may be associated, at least in the early stages, only with minor pulmonary ...infiltrates. This may suggest that the shunt associated to the gasless lung parenchyma is not sufficient to explain CARDS hypoxemia. We designed an algorithm (Vent
Q
), based on the same conceptual grounds described by J.B. West in 1969. We set 498 ventilation-perfusion (V
/Q) compartments and, after calculating their blood composition (PO
, PCO
, and pH), we randomly chose 10
combinations of five parameters controlling a bimodal distribution of blood flow. The solutions were accepted if the predicted PaO
and PaCO
were within 10% of the patient's values. We assumed that the shunt fraction equaled the fraction of non-aerated lung tissue at the CT quantitative analysis. Five critically-ill patients later deceased were studied. The PaO
/FiO
was 91.1 ± 18.6 mmHg and PaCO
69.0 ± 16.1 mmHg. Cardiac output was 9.58 ± 0.99 L/min. The fraction of non-aerated tissue was 0.33 ± 0.06. The model showed that a large fraction of the blood flow was likely distributed in regions with very low V
/Q (Q
= 0.06 ± 0.02) and a smaller fraction in regions with moderately high V
/Q. Overall LogSD, Q was 1.66 ± 0.14, suggestive of high V
/Q inequality. Our data suggest that shunt alone cannot completely account for the observed hypoxemia and a significant V
/Q inequality must be present in COVID-19. The high cardiac output and the extensive microthrombosis later found in the autopsy further support the hypothesis of a pathological perfusion of non/poorly ventilated lung tissue.
Hypothesizing that the non-aerated lung fraction as evaluated by the quantitative analysis of the lung computed tomography (CT) equals shunt (V
/Q = 0), we used a computational approach to estimate the magnitude of the ventilation-perfusion inequality in severe COVID-19. The results show that a severe hyperperfusion of poorly ventilated lung region is likely the cause of the observed hypoxemia. The extensive microthrombosis or abnormal vasodilation of the pulmonary circulation may represent the pathophysiological mechanism of such V
/Q distribution.
People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with ...severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users.
This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done.
At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement.
SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
Abstract
Introduction
Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences ...in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS).
Methods
Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests.
Results
Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS).
Conclusions
Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.
In being aware that some factors (i.e. increasing pollution levels, Urban Heat Island (UHI), extreme climate events) threaten the quality of life in cities, this paper intends to study the ...Atmospheric UHI phenomenon in Bari, a Mediterranean coastal city in Southern Italy. An experimental investigation at the micro-scale was conducted to study and quantify the UHI effect by considering several spots in the city to understand how the urban and physical characteristics of these areas modify air temperatures and lead to different UHI configurations. Air temperature data provided by fixed weather stations were first compared to assess the UHI distribution and its daily, monthly, seasonal and annual intensity in five years (from 2014 to 2018) to draw local climate information, and then compared with the relevant national standard. The study has shown that urban characteristics are crucial to the way the UHI phenomenon manifests itself. UHI reaches its maximum intensity in summer and during night-time. The areas with higher density (station 2—Local Climate Zone (LCZ) 2) record high values of UHI intensity both during daytime (4.0 °C) and night-time (4.2 °C). Areas with lower density (station 3—LCZ 5) show high values of UHI during daytime (up to 4.8 °C) and lower values of UHI intensity during night-time (up to 2.8 °C). It has also been confirmed that sea breezes—particularly noticeable in the coastal area—can mitigate temperatures and change the configuration of the UHI. Finally, by analysing the frequency distribution of current and future weather scenarios, up to additional 4 °C of increase of urban air temperature is expected, further increasing the current treats to urban liveability.
Abstract
Background
Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is ...a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD.
Methods
Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared.
Results
Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (
p
= 0.140) and functioning (
p
= 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (
p
= 0.016) and better QoL (
p
= 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care.
Conclusions
Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.
Objective
Italian residential facilities (RFs) aim to promote human rights and recovery for individuals with severe mental disorders. Italian RFs can be distinguished into five main types: ...high‐intensity rehabilitation (RF1), medium‐intensity rehabilitation (RF2), medium‐level support (RF3.1), high‐level support (RF3.2), low‐level support (RF3.3). This study aimed to assess the effectiveness of Italian RFs in achieving functional autonomy while upholding human rights and recovery.
Methods
Data on socio‐demographics, clinical information, patient and staff assessments of functional autonomy, types of interventions, and RF performance in various domains were collected in a pilot study with a cross‐sectional design. Descriptive and inferential analyses were conducted.
Results
Twelve RFs and 113 patients participated, with varying proportions in each RF type. RF1 patients were the oldest (p < 0.001) with the lowest functional autonomy (p < 0.001), while RF2 patients were the youngest (p < 0.001) with the lowest hospitalization rate (p < 0.001). RF3.1 patients had the highest employment rate (p = 0.024), while RF3.2 had the lowest employment rate (p = 0.024) and the longest service contact (p < 0.001). RF3.3 users had the highest functional autonomy (p < 0.001). The highest functional autonomy was in self‐care which received the highest focus in objectives and interventions. Patients rated their functional autonomy higher than professionals (p < 0.001). RFs excelled in the “human rights” and “social interface” domains but performed poorly in “recovery‐based practice,” with RF1 having the lowest performance and RF3.3 the highest.
Conclusions
This pilot study suggests that Italian RFs generally aligne with their mission and human rights principles, but personalizing interventions and implementing recovery‐oriented practices face challenges.
Highlights
Residential facilities (RFs) are not merely housing solutions but aim to help residents to be integrated into the community, and carry out significant activities in daily life.
The risk of perpetuating human rights violations and neglecting the recovery ethos remains a significant challenge in RFs.
Italian RFs generally align with their mission and human rights principles.
Challenges in Italian RFs include difficulties in personalizing interventions and implementing recovery‐oriented practices.
Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The ...Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM.
As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted.
The staff rated a higher number of total and met needs than service users (
< 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (
= 0.106) and information (
= 0.100) needs, while a moderate agreement was found in accommodation (
= 0.484), food (
= 0.406), childcare (
= 0.530), physical health (
= 0.470), telephone (
= 0.458) and transport (
= 0.425) needs. Older age (-0.15;
< 0.01), longer SSD diagnosis (-0.16;
< 0.01), higher collaboration (-0.16;
< 0.01) and lower symptomatology (-0.16;
< 0.01) decreased the number of unmet needs, while being a female (0.27;
< 0.05) and a shorter length of stay in an RF (0.54;
< 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology.
Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.
•Light touch stabilized quiet balance in both AP and ML sway directions.•Light touch led to more stable postural responses to unanticipated perturbations.•Effects of light touch did interact with ...vision availability.•Similar effects of light touch between healthy and post-stroke individuals.
Cerebral damage provoked by stroke may lead to deficits of quiet balance control and of the recovery of body equilibrium following an unanticipated postural perturbation. In this investigation we aimed to evaluate the effect of light touch (LT) of an earth-fixed surface on balance stability in individuals with post-stroke hemiparesis, taking performance of age-matched healthy participants as reference. Evaluations were made in conditions of full and no visual information. Analysis of quiet balance showed that LT induced higher balance stability, with reduced amplitude and velocity of postural sway. Evaluation of the effect of LT on automatic postural responses was made in the task of recovering body equilibrium following a mechanical perturbation of balance leading to fast forward body sway. Results showed that LT led to reduced amplitude of center of mass displacement following the perturbation, in addition to reduced amplitude and velocity of center of pressure under the feet, and lower activation of the lower legs muscles. Those effects of LT were observed in both the post-stroke and control groups, and did not interact with vision availability. Our results indicated then that individuals who suffered a cerebral stroke can stabilize perturbed and non-perturbed postural responses by lightly touching a stable surface to a similar extent of healthy older individuals.
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