Introduction
Mental healthcare represents a significant issue for the Healthcare System 1: one of the major causes is the high heterogeneity in the provision of care, due to the differences among the ...Departments of Mental Health (DMHs).
Objectives
To identify the predictors of an adequate treatment for patients with severe mental disorders (SMDs), both at an individual and structural level, the latter considering the major features of the Psychiatric Operative Units (POUs), in the Italian region Lombardy.
Methods
Healthcare Utilization Databases, collecting data on the services provided to beneficiaries of the National Health Service (NHS), have been used to retrieve data.
Patients that during 2015 were resident in Lombardy; suffered from depressive, bipolar or schizophrenic disorder; were in contact with the DMHs, have been identified.
Adequateness of treatment has been evaluated according to the Minimally Adequate Treatment (MAT) 2,3: a combination of psychiatric visits and specific pharmacological treatment, or psychotherapeutic sessions. Having received a MAT has been assessed during a one-year period.
Predictive factors have been classified into two hierarchical levels: individual (first) level and structural (second) level. At the first level, clinical and socio-demographics characteristics have been evaluated for each patient. At the second level, the organizational structure of each POU has been examined: the number of patients taken in care, number of community-care facilities, and hours worked by each class of healthcare providers (psychiatrists, nurses, psychologists, psychosocial staff
).
A log-binomial model has been used to evaluate the association between the first-level factors and having received a MAT; a multilevel log-binomial model for the second-level factors considered the hierarchical structure of data.
Results
72115 patients have been identified: 33974 (47.1%), 28407 (39.4%) and 9734 (13.5%) suffering from depressive, schizophrenic or bipolar disorder respectively; 45.4% of them (32773 patients) received a MAT.
Compared with patients affected by depression, those with bipolar or schizophrenic disorder show a higher probability of receiving a MAT (+23%, +11% respectively).
Patients living alone have a lower probability of receiving a MAT, unlike patients with a higher level of education or employment, underlining the social burden related to SMDs.
Organizational features have proven significant: centres with a higher activity volume and with more community-care facilities seem more likely to guarantee MAT. Moreover, the higher the hours worked by psychiatrists, nurses and psychologists, the higher the probability of providing MAT.
Conclusions
Patients with SMDs are still untreated in an appropriate way. Results highlight the importance of the community-care facilities, as well as of the composition of the multidisciplinary teams working there.
Disclosure of Interest
None Declared
IntroductionMental healthcare proved to have experienced a clear-cut reduction during the Covid-19 outbreak, and its responsiveness to patients’ health needs showed relevant declines. Moreover, the ...impact of the pandemic on usual outpatient healthcare has never been systematically measured with a person-level approach in analytical studies.ObjectivesTo assess how the access to, and the delivery of, recommended healthcare for patients with severe mental illness has changed during the Covid-19 pandemic.MethodsData were retrieved from the HCU of Lombardy Region (Italy), and a population-based study estimated the association between the level of epidemic restrictions (free, severe, light and moderate) and the recommended healthcare provided (outcome) to patients with schizophrenic and depressive disorders. For each disorder, prevalent and incident patients in the year 2019 were identified. These patients were then observed from 1st January 2020 to December 31, 2020. A Self-Controlled Case Series (SCCS) design was applied, and estimates were obtained with a conditional Poisson regression model. Adjustments for seasonality of medical services delivering were performed (SCC-RS design, with recruitment of a specific reference cohort in 2018, evaluated in 2019). The estimates were stratified according to gender, age and comorbidity profile of the patients included.ResultsPatients with prevalent schizophrenic disorder were 29,516 (Prevalence Rate=35.5x10’000 inhabitants, Image 1), 292 with incident disorder; patients with prevalent depressive disorder were 37,764 (PR=45.4, Image 2), 4,349 with incident disorder. The largest reductions were observed in the rate of psychosocial interventions delivery during the period of exposure to severe restrictions (IRR: 0.35; 95% CI: 0.34 - 0.36 for patients with schizophrenic disorder and 0.49; 0.45 - 0.53 for patients with depression, Image 3), compared to the pre-pandemic period. For patients with incident disorder, the largest reduction concerned the delivery of psychoeducational interventions during the period of exposure to moderate restrictions (0.19; 0.06 - 0.64 for patients with schizophrenic disorder and 0.27; 0.13 - 0.55 for patients with depressive disorder), compared to the pre-pandemic period.Image:Image 2:Image 3:ConclusionsReal-world data can be used to assess how the individual access to psychiatric recommended healthcare changed during the Covid-19 epidemic. Also, compared to the pre-pandemic period, there was a general reduction in the delivery of recommended interventions to patients with mental disorders during the pandemic period.Disclosure of InterestNone Declared
Olfactory changes are quite common in the population, causing a significant impact on the quality of life. Documentation of the olfactory function is essential for the diagnosis, treatment and ...follow-up of patients with inflammatory diseases of the upper airways, neurodegenerative diseases or viral infections. Among the different existing smell tests, the CCCRC is an inexpensive test, easy to apply, but it has not yet been evaluated on a large scale in the Brazilian population.
To validate the CCCRC smell test, after adaptation for the Brazilian population, evaluating the performance of healthy volunteers and the stability of the test in retests.
In this study, we carried out a cultural adaptation of the CCCRC test to Brazil. To validate and determine the normality scores, we applied the test to 334 healthy volunteers, aged >18 years of age. The retest was also carried out in up to four weeks on 34 additional volunteers to assess validity of the results.
When evaluating the participants’ performance, normosmia and mild hyposmia values were obtained in more than 95% of them. Women (58.4%) showed better accuracy than men (41.6%): p<0.02, and individuals over 60 years of age showed worse performance (median: 6; 75th percentile: 6.5; 25th percentile). The test and retest of the 34 volunteers demonstrated that there was agreement (ICC, intraclass correlation coefficient) considered good in the left nostril (ICC=0.65) and excellent in the right nostril (ICC=0.77) in the combined score.
The CCCRC test adapted to Brazil showed normal values, similar to the originally-described test and validations in other countries, with a high reproducibility rate. Considering the highly favorable cost-benefit ratio, the adapted CCCRC is a very useful tool for measuring olfactory function in the Brazilian population.
Alterações olfativas são bastante comuns na população, causando significativo impacto na qualidade de vida. A documentação da função olfatória é fundamental para o diagnóstico, tratamento e seguimento de pacientes que cursam com doenças inflamatórias das vias aéreas superiores, neurodegenerativas ou infecções virais. Entre os diferentes testes de olfato existentes, o CCCRC é um teste barato, de fácil aplicação, mas que ainda não foi avaliado em larga escala para a população brasileira.
Validar o teste de olfato CCCRC com adaptação para a população brasileira, avaliando o desempenho de voluntários saudáveis e a estabilidade do teste em retestes.
Nesse estudo realizamos adaptação cultural do teste CCCRC para o Brasil. Para validação e determinação dos escores de normalidade, aplicamos o teste em 334 voluntários saudáveis, com mais de 18 anos de idade. O reteste foi ainda realizado em até quatro semanas em 34 voluntários adicionais para avaliar concordância dos resultados.
Avaliando o desempenho dos participantes, valores de normosmia e hiposmia leve foram obtidos em mais de 95% deles. Mulheres (58,4%) apresentaram melhor acurácia em relação aos homens (41,6%), p<0,02; e indivíduos acima dos 60 anos apresentaram pior desempenho (mediana: 6; percentil 75: 6,5; percentil 25: 5). O teste e reteste dos 34 voluntários demonstrou que houve concordância (CCI, coeficiente de correlação intraclasse) considerada boa em narina esquerda (CCI=0,65) e excelente em narina direita (CCI=0,77) no escore combinado.
O teste CCCRC adaptado para o Brasil apresentou valores de normalidade semelhantes ao teste originalmente descrito e a validações em outros países, com alta taxa de reprodutibilidade. Considerando a relação custo-benefício altamente favorável, o CCCRC adaptado é uma ferramenta muito útil para mensuração da função olfatória na população brasileira.
In this paper, we propose a robust and low-complexity acoustic source localization technique based on time differences of arrival (TDOA), which addresses the scenario of distributed sensor networks ...in 3D environments. Network nodes are assumed to be unsynchronized, i.e., TDOAs between microphones belonging to different nodes are not available. We begin with showing how to select feasible TDOAs for each sensor node, exploiting both geometrical considerations and a characterization of the overall generalized cross correlation (GCC) shape. We then show how to localize sources in the space-range reference frame, where TDOA measurements have a clear geometrical interpretation that can be fruitfully used in the scenario of unsynchronized sensors. In this framework, in fact, the source corresponds to the apex of a hypercone passing through points described by the sole microphone positions and TDOA measurements. The localization problem is therefore approached as a hypercone fitting problem. Finally, in order to improve the robustness of the estimate, we include an outlier detection procedure based on the evaluation of the hypercone fitting residuals. A refinement of source location estimate is then performed ignoring the contributions coming from outlier measurements. A set of simulations shows the performance of individual blocks of the system, with particular focus on the effect of TDOA selection on source localization and refinement steps. Experiments on real data validate the localization algorithm in an everyday scenario, proving that good accuracy can be obtained while saving computational cost in comparison with state-of-the-art techniques.
The paper presents the results of 5 case studies on complex site effects selected within the project for the level 3 seismic microzonation of several municipalities of Central Italy damaged by the ...2016 seismic sequence. The case studies are characterized by different geological and morphological configurations: Monte San Martino is located along a hill slope, Montedinove and Arquata del Tronto villages are located at ridge top whereas Capitignano and Norcia lie in correspondence of sediment-filled valleys. Peculiarities of the sites are constituted by the presence of weathered/jointed rock mass, fault zone, shear wave velocity inversion, complex surface and buried morphologies. These factors make the definition of the subsoil model and the evaluation of the local response particularly complex and difficult to ascertain. For each site, after the discussion of the subsoil model, the results of site response numerical analyses are presented in terms of amplification factors and acceleration response spectra in selected points. The physical phenomena governing the site response have also been investigated at each site by comparing 1D and 2D numerical analyses. Implications are deduced for seismic microzonation studies in similar geological and morphological conditions.
IntroductionThe 1978 Italian reform of psychiatric services initiated the closure of psychiatric hospitals encouraging the development of community mental health. However, there is wide variability ...across regions in the amount of resources devoted to community-based psychiatric care, and the range of services provided still is cause of concern.ObjectivesTo evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).MethodsThirty-one clinical indicators concerning accessibility, appropriateness, continuity, and safety were defined and estimated using healthcare utilization (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions.ResultsA total of 70,586 prevalent patients with schizophrenia treated in 2015 were identified, of whom 1,752 were newly taken-in-care. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a general hospital psychiatric ward (GHPW); higher values were identified in new cases. In general hospitals, one-fifth of the admissions were followed by readmission within 30 days of discharge. For two- thirds of patients continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within two weeks. For cases newly taken-in-care the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent.ConclusionsThe Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.Disclosure of InterestNone Declared
Introduction
The evaluation of healthcare pathways must be considered of fundamental importance. The quality of care provided to patients with severe mental disorders (SMD) does not correspond to the ...standards set by the recommendations. Therefore, measures such as the real coverage rate of psychiatric patients’ needs (
contact coverage
), by comparing epidemiological prevalence rates and the number of patients receiving adequate care, could be a valuable resource for implementing the transition to community mental health. However, simple assessment and reporting of rates of contact with mental healthcare potentially overestimate the full expected health benefits of services. Therefore, in addition to monitor the coverage rate achieved by the services, the evaluation of the
effectiveness
of the care provided (
effective coverage
) De Silva
et al
. Int J Epidemiol 2014;43(2):341–53 is also of relevant importance.
Objectives
To measure the gap between contact and
effective coverage
of mental healthcare, i.e., the
effectiveness
of interventions provided by services for the treatment of SMD in preventing an exacerbation of psychiatric symptoms.
Methods
Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly taken-in-care cases of depression, schizophrenia, bipolar, and personality disorder were included. A variant of the self-controlled case series method was used to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contacts with the outpatient service, psychosocial interventions, and psychotherapies) and relapse episodes (mental illness emergency hospital admissions).
Results
11,500 relapses occurred. Relapse risk was reduced (
Figure
) during periods covered by (i)
psychotherapy
for patients with depression (IRR 0.67; 95% CI, 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii)
psychosocial interventions
for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99) and bipolar disorder (0.55; 0.36 to 0.84), (iii)
pharmacotherapy
for those with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic mental healthcare, in the absence of psychosocial/psychotherapeutic interventions, did not affect the risk of relapse.
Image:
Conclusions
Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study ascertained the gap between utilization of mental healthcare and
effective coverage
, showing that
real-world
data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.
Disclosure of Interest
None Declared
The Seismic Microzonation of level 3 (SM3) is nowadays a world-wide accepted tool for the mitigation of seismic risk. The SM3 is a complex process involving different disciplines ranging from Geology ...and Applied Seismology to Structural and Geotechnical Engineering. The outcome of a SM3 is presented on a zoning map in terms of a selected ground shaking intensity parameter and susceptibility to main ground instability (soil liquefaction, settlements, landslides, fault ruptures). In an advanced SM3 study for a given area, four main interdisciplinary steps can be recognized: (1) definition of the reference input motions, (2) construction of the subsoil model, (3) performing of numerical analyses and computing of amplification factors, (4) identification of zones with different geotechnical hazard potential and drawing up of the SM3 map. After the 2016–2017 Central Italy seismic sequence, intensive studies have been performed to obtain SM3 maps in 137 municipalities most damaged by the earthquakes. The aim of these studies has been to obtain a clear background on site effects to perform a correct reconstruction of the municipalities. In the paper, main results and critical issues of the above-mentioned steps of SM3 procedure are discussed together with some remarks on the use of SM3 output in supporting seismic design for reconstruction.
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•Co and Co/Ru-based catalysts with 5%wt. Co, 10%wt. Co and 0.4%wt. Ru supported on SiO2 for the Fischer-Tropsch process have been synthesized by Flame Spray Pyrolysis (FSP).•5wt% of ...Co sample did not show any activity toward the FT synthesis while 10%wt of Co and 10%wt of Co − 0.4%wt of Ru samples are suitable catalysts for GTL process.•10%wt sample showed a great stability in function of TOS at T=250°C in terms of reactants conversion and products selectivity.•Products selectivity to CO2, CH4, light hydrocarbons (<C7) and heavy hydrocarbons (>C7) remains essentially unchanged at different temperatures.
Flame spray pyrolysis (FSP) is an innovative and scalable technique, used to synthesize monometallic and bimetallic Co-Ru catalysts with 5%wt. Co, 10%wt. Co and 0.4%wt. Ru supported on SiO2 active in the Gas-to-Liquids (GTL)-Fischer-Tropsch (FT) process, which converts syngas to hydrocarbons. The catalysts were characterized by TEM, FE-SEM-EDX, TPR, XRD and N2 adsorption/desorption. All the three samples have been tested in a fixed bed FT-bench scale plant. Results demonstrated that the 5%wt. Co catalyst was not active toward FT synthesis, while samples containing 10% wt. Co and 10% wt. Co - 0.4% wt. Ru were suitable candidates for the GTL-FT process. With an increase in temperature, the CO conversion increased, the product selectivity remained unchanged, and the 10%wt. Co catalyst showed higher stability as a function of time-on-stream (TOS) with respect to traditionally prepared materials. The addition of 0.4%wt. of Ru improved the performance in terms of CO conversion and C2+ yield.
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