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Fioritti A.,AUSL Bologna | D'Alema M.,AUSL Rome H | Barone R.,AUSL Catania | Bruschetta S.,AUSL Catania
Journal of Nervous and Mental Disease | Year: 2014

Since Basaglia's pioneering work in the 1960s, programs geared to employment have been considered hallmarks of good practice in Italian community psychiatry. These programs mostly include "train and place" schemes: sheltered workshops, training placements and temporary grants with public/private employers, and social enterprises (cooperatives). Law 68/1982 on disability and work demanded a "quota of workplaces" to be reserved for citizens with disability by public and private employers, but application to the psychiatric field proved problematic. Despite large investments, outcomes in terms of competitive employment have decreased over the decades, and now, less than 10% of all attenders of these programs attain the open labor market. More recently, some "place and support" programs have been tried with promising results. Individual Placement and Support is practiced in one third of mental health centers in the Emilia-Romagna Region and in pilot programs in three more regions. It is difficult to forecast how the rapid changes brought by the current financial crisis will impact on Italy, but very likely, supported employment programs will find more space in Italian mental health services. Copyright © 2014 by Lippincott Williams & Wilkins.

Rossi G.,QUASM Italian Association on Quality and Accreditation in Mental Health | Bosio R.,AUSL of Romagna | Erlicher A.,Azienda Ospedaliera Ospedale Niguarda Ca Granda | Morganti C.,Azienda Ospedaliera Ospedale Niguarda Ca Granda | And 4 more authors.
Journal of Nervous and Mental Disease | Year: 2014

Since the radical changes in Italian mental health law in the 1970s, quality assurance models have gained consensus as the most suitable service assessment tool. In the 1990s, the whole Italian National Health System changed into a corporate model, and an accreditation system was implemented.The Italian Association for Quality and Accreditation in Mental Health (Associazione Italiana per la Qualità e l'Accreditamento in Salute Mentale [QUASM]) was founded in 1984, and since then, it offers consultation and support for Mental Health Departments and Regional Governments to help them to develop psychiatric programs, self-evaluation, educational programs, and professional peer-model accreditation. The QUASM accreditation manual has now gone through several revisions, the last in 2008. Until 2008, QUASM was successful in promoting quality and facilitating both institutional and professional accreditation. However, radical changes triggered by financial crisis have jeopardized quality assurance implementation. Nowadays, the challenge for QUASM is to maintain quality and accreditation geared to excellence against prevailing leveling trends. Copyright © 2014 by Lippincott Williams & Wilkins.

Tarantino I.,University of Palermo | Fabbri C.,AUSL Bologna | Di Mitri R.,Civico A.R.N.A.S. Hospital | Pagano N.,Humanitas Irccs | And 6 more authors.
Digestive and Liver Disease | Year: 2014

Background: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been reported to have a higher complication rate than that of solid lesions, but the real complication rate is unknown. Aim of the study was to identify the complication rate of endoscopic ultrasound-guided fine needle aspiration and related risk factors. Methods: Prospective multicenter study at four referral centres. Data were collected from January 2010 to July 2012, searching for all adverse events related to guided fine needle aspiration. All complications occurring up to day 90 were recorded. Results: 298 patients (43.9% male, mean age 63.2. ±. 15.4 years) underwent endoscopic ultrasound-guided needle aspiration of pancreatic cystic lesions. Mean size was 34.1. ±. 9. mm. Adverse events occurred in 18 patients (6%): mild complications in 12/18 (66.6%), and moderate complications in 6/18 (33.3%). Seven were immediate, 6 early, and 5 late. All resolved with medical therapy. Conclusions: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been found to be associated with a higher complication rate than for solid lesions; however, the risk rate is acceptable considering the complication grade and the important diagnostic role of the technique in the management of pancreatic cystic lesions. © 2013 Editrice Gastroenterologica Italiana S.r.l.

Gorlia T.,EORTC Headquarters | Delattre J.-Y.,La Pitie Salpetriere AP HP | Brandes A.A.,AUSL Bologna | Kros J.M.,Erasmus University Rotterdam | And 6 more authors.
European Journal of Cancer | Year: 2013

Background The prognosis of patients with anaplastic oligodendrogliomas (AOD) and oligoastrocytomas (AOA) is variable. Biomarkers might be helpful to identify more homogeneous disease subtypes and improve therapeutic index. The aim of this study is to develop new clinical, pathological and molecular prognostic models for locally diagnosed anaplastic gliomas with oligodendroglial features (AOD or AOA). Methods Data from 368 patients with AOD or AOA recruited in The European Organisation for Research and Treatment of Cancer (EORTC) trial 26951 on adjuvant PCV (Procarbazine, CCNU, Vincristine) chemotherapy in anaplastic oligodendroglial tumours were used to develop multifactor models to predict progression free survival (PFS) and overall survival (OS). Different models were compared by their percentage of explained variation (PEV). Prognostic calculators were derived from these new models. Results Treatment (for PFS only), younger age, confirmed absence of residual tumour on imaging, frontal location, good World Health Organisation (WHO) performance status, absence of endothelial abnormalities and/or necrosis, 1p/19q codeletion and Isocitrate dehydrogenase 1 (IDH1) mutation were independent factors that predicted better PFS and OS. Conclusions We identified important prognostic factors for AOD and AOA and showed that molecular markers added a major contribution to clinical and pathological factors in explaining PFS and OS. With a positive predictive value of 92% for PFS and 94% for OS, our models allow physicians to precisely identify high risk patients and aid in making therapeutic decisions. © 2013 Elsevier Ltd. All rights reserved.

Fioritti A.,AUSL Bologna | Peloso P.F.,ASL Genoa | Percudani M.,AO Garbagnate Milanese
International Journal of Mental Health | Year: 2016

Abstract: In this paper the relation between psychosocial rehabilitation and job in Italy, a theme that can be traced back to two cultural roots, that of the right to work enshrined in the Italian Constitution and that of the ergotherapy in the asylum tradition, is stressed. After 1978 the efforts to assure community psychiatry patients a job opportunity has led to the emergence of cooperatives against exclusion. The story of one of them was told in an Italian movie, in which it is possible to understand the main problems of rehabilitation through labor. In recent decades, the transformation of Italian society and the evolution of services has necessitated the evolution of cooperatives to social enterprise, which respond to a different philosophy, and a broader range of opportunities, with the introduction of new models, such as IPS. The example of two regional projects of the last years is here illustrated. © 2016, Copyright © Taylor & Francis Group, LLC.

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