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In this European public health news, the economic crisis’ impact on health and health spending is again on the agenda. It needs an effort from the public health professionals to inform policy makers regarding the impact of their decisions on health (Ricciardi, Jakab). It also needs a continued commitment both from the professionals (Bert, van der Star) and from those beyond the field of public health (Borg). # EUPHA President’s Column {#article-title-2} During the past 2 decades, most European countries have made impressive progress in population health. This progress has, however, been uneven, and the health divide across the European region is unacceptably large. The noteworthy heterogeneity of health progress in the European population could result from intrinsic differences in resources for health care (including support for basic measures such as control of tobacco and hypertension), in willingness to take action, or in negative effects of political divisions.1 We at EUPHA argue that conditions that improve population health have to be shaped in the policy arena to suit national and regional circumstances. If so, what measures are available to policy makers in Europe to increase the success of public health policies in the face of the financial crisis and ageing populations? Examining the health status of European citizens, but also including a comparative analysis of the effectiveness of European health policy over the past decades, is a challenge for our public health community. We need to assess the health effects of different social and economic policies and the associations between health and health systems. We have also to improve our understanding of the remarkably low life expectancy in the Commonwealth of Independent States (and the related quality of health care) and better analyze migrants’ difficulties in accessing health services. In times of economic downturn, people who are disadvantaged are more affected than others. Going … more...

The aim of this study was to determine the effects of the pneumoperitoneum used in colorectal procedures on peripapillary retinal nerve fibre layer (RNFL) thickness. We also analysed the dynamics of ocular anterior segment structures. In this prospective clinical pilot study, 29 patients aged between 45 and 85 years old underwent laparoscopic surgery for selected colorectal diseases. The pneumoperitoneum induced a mean intraocular pressure (IOP) increase of 4 mmHg. Visual acuity, IOP, corneal thickness, angle opening distance (AOD) and the trabeculo-iris space area (TISA) at 500 microns and 750 microns anterior to the scleral spur, RNFL thickness and visual field were measured before and after surgery using Sloan charts, Visante™ optical coherence tomography (OCT) (Zeiss, Oberkochen, Germany), Spectralis® OCT (Heidelberg Engineering, Heidelberg, Germany) and Humphrey Visual Field System® (Zeiss, Oberkochen, Germany). Patients were categorised in two groups to understand the behaviour of IOP: in group one (n=17), patients were in Trendelenburg position; in group two (n=12), patients were in reverse Trendelenburg position. The IOP was measured during surgery by the Icare® Tonometer (Icare, Vantaa, Finland) according to a standardised protocol; the IOP was measured before and after surgery by Goldmann applanation tonometer (Haag-Streit, Koniz, Switzerland). Patients with previous diagnosis of both open or angle-closure glaucoma or anterior segment anomalies were excluded. No statistically significant differences in increase of IOP were found between the two groups (p>0.05); no statistically significant differences in RNFL thickness, visual field, AOD and TISA were found before and after surgery in all patients (p>0.05). In our study we have demonstrated that a mean IOP increase of 4 mmHg over a short period of time is safe for a healthy optic nerve. more...

Importance The prognostic significance of regression in primary melanoma has been debated for many years. There is no consensus regarding the need for sentinel lymph node (SLN) biopsy when regression is present within the primary tumor. Objective To review the evidence that regression may affect SLN status. Data Sources A systematic review was performed by searching in MEDLINE, Scopus, and the Cochrane Library from January 1, 1990, through June 2014. Study Selection All studies that reported an odds ratio (OR) or data on expected and observed cases of SLN positivity and histologic regression were included. Data Extraction and Synthesis Primary random-effects meta-analyses were used to summarize ORs of SLN positivity and histologic regression. Heterogeneity was assessed using the χ 2 test and I 2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. The methodologic quality of the studies was assessed according to the Strengthening of Reporting of Observational studies in Epidemiology (STROBE) checklist, and 2 different meta-analyses were performed based on those criteria. Main Outcomes and Measures Summary ORs of histologic regression of primary melanoma and SLN status. Results Of the 1509 citations found in the search, 94 articles were reviewed, and 14 studies comprising 10 098 patients were included in the analysis. In the combined 14 studies, patients with regression had a lower likelihood to have SLN positivity (OR, 0.56; 95% CI, 0.41-0.77) than patients without regression. On the basis of study quality, we found that patients with regression enrolled in high-quality studies had a lower likelihood to have SLN positivity (OR, 0.48; 95% CI, 0.32-0.72) compared with results of low-quality studies (OR, 0.73; 95% CI, 0.53-1.00). Examination of the funnel plot did not provide evidence of publication bias. Conclusions and Relevance The results of this analysis showed that the risk of SLN positivity was significantly lower in patients with histologic regression compared with those without. Regression may be used in these cases to make a selection of which patients should be the most appropriate for this procedure. more...

Background: Opioids e-commerce represents an important public health issue. While the literature describes this phenomenon in the USA, the studies about this topic are scarce in Europe. This review aims to describe the state of the art of the online opioids commerce and to explore the factors influencing the opioids e-commerce.Methods: Scientific literature available via four bibliographic databases (PubMed, Cochrane Collaboration, ISI Web of knowledge and Scopus) was screened on June 2012. Keywords used were “Internet and opioids”, “Online and opioids”, “Web and opioids”, “Opioid selling”, “Opioid business”, “Opioid buy”, and “Opioid sale”. After the selection, 31 articles were finally identified as meeting the inclusion criteria.Results: The online market of opioids had experienced a boom thanks to the discount prices, the poor monitoring actions, the quickness and easiness of acquiring of these drugs. Legislation on the sale of drugs online differs among the countries. We found that the opioids... more...

It is widely acknowledged that 16% to 34% of suicide attempters repeat a suicide behavior within 1-2 years after the first, “index”, attempt, and that a previous nonfatal suicide attempt is found in up to 40% of suicide deaths (Scoliers, Portzky, van Heeringen & Audenaert, 2009). Suicide attempt is defined as “a self inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die; a suicide attempt may result in no injuries, or death” (Silverman, Berman Sanddal & O’carroll, 2007). more...

Background Since antibiotic resistance has become a worldwide public health concern and is in part related to physicians’ lack of knowledge, it is essential to focus our attention on healthcare profession students. The present study aims at evaluating the knowledge and attitudes of the School of Medicine’s students towards antibiotic usage and antibiotic resistance. Methods In December 2013, a cross sectional study was conducted amongst medical, dental, nursing and other health care profession students of the School of Medicine at the University of Torino. Students of all the academic years took part in this study. Questionnaires were submitted during regular lectures (only students who attended courses on one specific day were surveyed) and the data collected was analyzed using StataMP11 statistical software. Results Overall, 1,050 students were interviewed. The response rate was 100%. Around 20% of the sample stated that antibiotics are appropriate for viral infections and 15% of the students that they stop taking those drugs when symptoms decrease. Results of the multivariate analyses showed that females were more likely than males to take antibiotics only when prescribed (OR 1.43, 95% CI 1.04–1.98). Interestingly, students with a relative working in a health-related field, as well as those who took at least one course of antibiotics in the last year, had a lower probability of taking those drugs only under prescription (OR = 0.69 95% CI: 0.49–0.97 and OR = 0.38 95% CI: 0.27–0.53, respectively). Conclusion The present paper shows how healthcare profession students do not practice what they know. Since those students will be a behavioral model for citizens and patients, it is important to generate more awareness around this issue throughout their studies. It would be advisable to introduce a specific course and training on antibiotics in the core curriculum of the School of Medicine. more...

In recent decades, Italy has become a desirable destination for immigrants. It should be noted that the organization of mental health services in Italy strongly relies on outpatient services, while the psychiatric wards usually accommodate patients in acute phases of their disorder. Nonetheless, migrants’ first contact often happen in a psychiatry ward when they are in a severe and acute psychopathological condition. The research was performed in the Emergency Department (ED) of the Maggiore della Carità Hospital, Novara, Italy. We collected data about 3781 consecutive patients, 3247 Italian natives and 421 migrants, assessed in the ER of the Maggiore della Carità Hospital, and referred to psychiatric assessment after ER triage. From 1st January 2006 to 31st December 2007, only data for migrant patients were available. From 1st January 2008 to 31st December 2015, data were available for all consecutive patients assessed in the ER. An experienced psychiatrist assessed patients with a clinical interview, including the assessment of suicidal intent, suicidal behaviors and attempts. The psychiatrist filled in for each patient a data sheet, reporting demographic data and clinical features. The high frequency of substance use disorders was higher in the migrant population than in the native one. The request for psychiatric consultation for self-injury behaviors was more frequent in migrants and also suicide attempts were more common. Nonetheless, being a migrant was not a predictor of suicide attempt in our sample.Several differences were found between migrants and natives in socio-demographic, clinical and treatment variables. Clinical implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

IntroductionChildhood trauma, especially sexual abuse, is associated with an increased risk of suicidal behavior. However, studies also show that according to the stress-vulnerability model, not all individual exposed to this kind of trauma exhibit suicidal behaviors as some protective factors could diminish the aforementioned risk, such as personality factors. Resilience might be one such a protective factor. Furthermore, there has been growing evidence to support the role of impulsive and aggressive behavior in the risk of suicide.ObjectivesTo compare suicide attempters to non-suicide attempters (patients admitted for any other reason) for as far as psychological features and childhood trauma. To verify the role of resilience and coping strategies as protective factor for suicide attempt, mitigating the risk of an individual who has experienced childhood trauma.MethodsWe recruited patients referred to the inpatient and outpatient facilities of psychiatry ward of “Maggiore della Carità” hospital in Novara during the period November 2015–December 2016. We included all patients from 18 to 65 years with a psychiatric disorder that met DSM–5 diagnostic criteria. For the analysis, we divided patients into two subgroups according to the presence/absence of suicidal behaviors. The assessment included: Resilience Scale for Adult (RSA), Brief cope, Rosenberg Self-esteem Scale (RSES), childhood trauma questionnaire (CTQ), temperament and character inventory (TCI).Results and discussionAlthough, the recruitment is still ongoing preliminary results seem to confirm the role of resilience and coping strategies as protective factor mitigating the risk of an individual who has experienced childhood trauma from making a suicide attempt.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

Background: We performed a systematic review and proportion meta-analysis in order to investigate the prevalence and the adverse effects of the self-medication among the teenagers. Methods: We selected observational studies published from January 1990 until January 2014 that examined the use of self-medication in the adolescents (aged from 13 to 18 years). Keywords used on PubMed, ISI Web of Knowledge and Scopus were ‘self medication’, ‘adolescent*’, ‘self prescription’, ‘over the counter preparations’ and ‘self administration’. Results: Finally, 15 articles met the inclusion criteria, for a total of 143 213 subjects involved. Overall, 50% of adolescents use to take drugs without consulting a physician. Further analyses stratified by number of drugs used demonstrated that in the studies reporting that adolescents use more than one type of drug the prevalence rises up to 63%. Only one study reported the possible adverse effects related to the inappropriate use of drugs, which were experienced by 31.1% of the females and 19.6% of the males. Conclusions: Self-medication use among adolescents is a widespread phenomenon. It would be advisable to give more attention on this public health concern and to promote initiatives, such as mass media campaigns and governmental actions, in order to make the citizens more aware to the risks related to the consumption of drugs without medical consultation. Further studies on adverse effects are urgently needed. more...

Issue/Problem The situation of humanitarian emergency affecting Sicily and the difficulties highlighted by the media in the reception of migrants have made this topic interesting for carrying out the validation of guidelines for Health Impact Assessment (HIA) introduced in 2013. In particular, the HIA regional working team, in collaboration with the National Agency for Regional Health Services, wanted to investigate the potential health impacts of the reorganization of non-medical support initiatives aimed at … more...

Background The threat of antibiotic resistance has become a worldwide public health concern, with a substantial economic and clinical burden. In this regard, the World Health Organization estimated that this problem leads, in the European hospitals, to an excess of mortality of 25 000 people every year. Antibiotic misuse, mainly related to physicians’ lack of knowledge and wrong prescribing behaviour, is one of the leading cause of antibiotic resistance. On account of this, it is essential to focus the … more...

Nowadays, the development of antibiotic resistance represents one of the most important issues of the global public health. The incorrect use of antimicrobial drugs is recognized as one of the leading causes of antibiotic resistance. Therefore, a better understanding of the existing pieces of evidence pertaining knowledge and attitudes about antibiotic and antibiotic resistance in the general population worldwide is advisable.A systematic review and proportion meta-analyses were performed through PubMed and Scopus scientific databases. Cross-sectional studies published from January 2000 to November 2013 and investigating knowledge about antibiotic use and antibiotic resistance were included.Overall, 26 studies have been selected for the systematic review, and 24 of these were included in the meta-analyses. A lack of knowledge about antibiotics was detected. In particular, 33.7% (95%CI 25.2-42.8) of the sample did not know that antibiotics can treat bacterial infections, and 53.9% (95%CI 41.6-66.0) of them did not know that antibiotics are not useful against viruses. Besides, although 59.4% (95%CI 45.7-72.4) of the sample was aware of antibiotic resistance, 26.9% (95%CI 16.6-38.7) of them did not know that misuse of antibiotics can lead to this problem. Finally, 47.1% (95%CI 36.1-58.2) of the subjects stop taking antibiotics when they start feeling better.It would be necessary to strengthen educational initiatives in the community and to push physicians to correctly inform patients in order to make them aware of the importance of a correct behavior concerning antibiotic consumption. more...

IntroductionThe level of express emotion (EE) is a measure of the attitude of close relatives towards a patient and include dimensions as critical comments, hostility and emotional over-involvement. Anger and impulsivity may lead to self-injurious and aggressive behaviours, and often represent an obstacle to treatment.AimsTo compare anger expression, impulsivity and expressed emotion in ED and SCHZ, and to explore the different level of caregivers’ EE in the two groups.MethodsTwenty-five female with ED diagnosis and 25 patients with schizophrenia, were recruited at the Psychiatry Ward and outpatient Service of AOU – Novara, during one year period. Patient's assessment included Global Assessment of Functioning (GAF), Structured Clinical Interview (SCID 1-2), Level of Expressed Emotion Scale (LEE), Paykel scale, State and Trait Anxiety Inventory (STAY 1-2), State-Trait Anger Expression Inventory (STAXY), Barratt Impulsiveness Scale (BIS-11).ResultsLevels of anxiety (both state and trait) are higher in the ED group than in SCHZ. As far as the STAXY is concerned, SCHZ patients score higher than ED ones on control over anger, while general index of anger expression was higher in ED patients. We did not find significant differences in EE between two groups, except for the patient's emotional response of the patient to the disease, which was greater among SCHZ. Both SCHZ and ED patients scored higher on the LEE, Paykel and STAY than their caregivers.ConclusionsSCHZ and ED patients show different patterns of anxiety and anger, but similar profile as far as EE is concerned. Implications for treatment will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

Communication via mobile phones has become an essential tool for health professionals. The latest generation of smartphones is comparable to computers, allowing the development of new applications in health field. This paper aims to describe the use of smartphones by health professionals and patients in the field of health promotion. We conducted a bibliographic search through Pubmed. Then, research results were analyzed critically in order to select the best experiences available. All searches were carried out on November 2012 and were not limited by date. Each item from the initial search was reviewed independently by members of the project team. Initial search returned 472 items with PubMed. After the removal of duplicates, 406 items were reviewed by all the members of the project team and 21 articles were identified as specifically centered on health promotion. In the nutrition field there are applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies, while about physical activity many applications suggest exercises with measurement of sports statistics. Some applications deal with lifestyles suggestions and tips. Finally, some positive experiences are reported in the prevention of falls in elderly and of sexually-transmitted diseases. Smartphones are transforming the ways of communication but the lack of monitoring of contents, the digital divide, the confidentiality of data, the exclusion of the health professional from the management of patient, are the main risks related to their use. more...

In a commentary by Louise Boyle and Sofia Ribeiro, the authors urge on the importance of young professional networks in public health to train them on leadership competencies in a vibrant, international and multidisciplinary atmosphere.1 The Young Forum Gastein initiative is proposed then by the authors as an important tool and network to interact with high-level European health experts. In the past 20 years, giant strides have been made in terms of integration among citizens from different European countries, and new challenges for health sector are continuously arising, such as societal changes, patient-centred care, globalization, more assertive and informed patients.2 These challenges are particularly true considering how the economic crisis and increasing budgetary constraints have put additional pressures on health systems, with consequent reduced health spending in several countries.3 It is important, therefore, that the future public health professionals will be ready to deal with these evolving dares. As promoted in Health 2020 … more...

Background: Important changes have occurred in radiological departments (RDs) over the past 30 years. The procedures have become more complex and the number of patients has increased. This scenario could have important implications for public health and infection control but, to date, the scientific literature has dealt little with matters relating to microbiological monitoring in RDs. Purpose: To examine the level of microbiological contamination in the main RDs of Turin, a city in northern Italy, in order to analyze the presence of a possible biological risk. Material and Methods: We analyzed data from 12 RDs. Samples were taken from X-ray tubes, control panels, radiographic cassettes, and imaging plates. We used the French guidelines “Standards NF S 90--351” in order to obtain the threshold values of reference. Through a questionnaire we investigated the use of personal protective equipment by the chiefs of the RDs. Results: We found values out of limits in 41.7% of the X-ray tubes sampled, in 91.7% of the control panels and imaging plates, while only 8% of the radiographic cassettes were contaminated. A total of 58.3% of RDs reported values above the threshold for three out of four samples. In 16.7% of the RDs only one surface presented acceptable values. Conclusion: Healthcare-associated infections are a cogent issue for the RDs, and knowledge of how to prevent them is increasingly required by health professionals. This study is meant to be a first analysis of the issue that highlights the need of further investigations, maybe with a more detailed monitoring through the characterization of the microbial species involved. Moreover, the development of shared and maybe official standards for the evaluation of microbiological contamination in RDs is strongly suggested. more...

Noroviruses are recognized as the leading cause of human acute viral gastroenteritis worldwide. The rate of outbreaks on cruise ships has grown significantly in recent years. Given the potentially harmful consequences of outbreaks for passengers and crewmembers and the subsequently high costs for cruise companies, disease outbreaks on cruise ships represent a serious public health issue. The aim of our study was to systematically review published studies related to Norovirus outbreaks on commercial cruise ships. We searched the PubMed and Scopus scientific databases. We included eligible studies published from January 1990 to July 2013 that were written in English and described infectious episodes involving at least two passengers and/or crewmembers on a commercial cruise ship. As a result, 15 studies and seven reviews met the inclusion criteria, describing a total of 127 outbreaks. The majority of the cases were reported in Europe and the USA, affecting more...

Background Currently, smokers in Italy are around 11 million: of them 43.5% are women. From January 2005 is into force the Law No 3 of January 2003 (the so called Sirchia Law named after the Health Ministry who promoted it) that banned smoking in all indoor public places. The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. Methods Based on a national survey conducted by the National … more...

Objectives The goal of this study was to describe and analyse interventions performed in the emergency department (ED) of an Italian hospital with the aim of humanising the patient care pathway. The actions taken are described and the changes analysed to determine whether they resulted in an increased level of patient satisfaction. Methods An observational study was conducted between October 2010 and March 2011. The data were collected via a telephone questionnaire administered to patients who were admitted to the ED before and after humanisation interventions. The respondents were questioned about their general condition and their level of satisfaction. Results The study population included 297 patients (158 before and 139 after the interventions). The highest overall patient satisfaction after the interventions was highly correlated with the humanisation interventions and not with other factors such as gender, age, educational level or the severity code triage. Specifically, in patients who went to the ED after the changes had been made, there was a greater level of satisfaction regarding comfort in the waiting room, waiting time for the first visit and the privacy experienced during the triage. Conclusion The results demonstrate that the interventions implemented in this study, designed to humanise the ED, improved overall patient satisfaction. Interventions may be taken to reduce the depersonalisation of patients in the emergency room. more...

The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification.We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n = 285) or endovascular repair (n = 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications.The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P = .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04 mg/dL; P .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P = .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P = .01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P = .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage 1.AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability. more...

Background Only few studies with small experimental samples investigated the impact of psychoactive substances on driving performance. We conducted a multicenter international cross-sectional study to evaluate the correlation between alcohol use and driving-related skill as measured by brake reaction time (RT). Methods Before and after the entrance into randomly selected recreational sites from six European countries, all subjects aged 16-35 years, owning a driver license, were asked to compile a structured socio-demographic questionnaire and measure RT (SimuNomad3 driving simulator), breath alcohol concentration (BAC; Drager Alcoltest), and drug use (Oratect III saliva test, only at the exit). Mixed regression modeling was used to evaluate the independent association between RT and alcohol concentration or drug use. Results Before the entrance into the recreational site, 4534 subjects completed all assessments and composed the final sample. Their mean age was 23.1 ± 4.2y; 68.3% were males; 54.7% had BAC > 0 g/L (assumed alcoholics); 7.5% declared illegal drug assumption (mostly cannabis). After the exit, 3019 also completed the second assessment: 71.7% showed BAC > 0 g/L. Controlling for age, gender, educational level, occupation, driver license years, and drug use, BAC was positively associated with RT, achieving significance, however, only when BAC was higher than 0.49 g/L. Significant interaction terms were found between BAC and female gender or drug use, with highest RTs (> 1 sec.) recorded among drug users with BAC > = 1 g/L. Conclusions This field study confirms previous experimental data on the negative impact of alcohol use on driving-related skill, supporting regulations and educational campaigns aimed at discouraging driving after consumption of psychoactive substances. more...

Background Recent international sources have described how the rapid expansion of the Internet has precipitated an increase in its use by the general population to search for medical information. Most studies on e-health use investigated either through the prevalence of such use and the social and income patterns of users in selected populations, or the psychological consequences and satisfaction experienced by patients with particular diseases. Few studies have been carried out in Europe that have tried to identify the behavioral consequences of Internet use for health-related purposes in the general population. The aims of this study are to provide information about the prevalence of Internet use for health-related purposes in Italy according to demographic and socio-cultural features, to investigate the impact of the information found on health-related behaviors and choices and to analyze any differences based on health condition, self-rated health and relationships with health professionals and facilities. Methods A multicenter survey was designed within six representative Italian cities. Data were collected through a validated questionnaire administered in hospital laboratories by physicians. Respondents were questioned about their generic condition, their use of the Internet and their health behaviors and choices related to Internet use. Data were analyzed using descriptive statistics and logistic regression to assess any differences by socio-demographic and health-related variables. Results The sample included 3018 individuals between the ages of 18 and 65 years. Approximately 65% of respondents reported using the Internet, and 57% of them reported using it to search for health-related information. The main reasons for search on the Internet were faster access and a greater amount of information. People using the Internet more for health-related purposes were younger, female and affected by chronic diseases. Conclusions A large number of Internet users search for health information and subsequently modify their health behaviors and relationships with their medical providers. This may suggest a strong public health impact with consequences in all European countries, and it would be prudent to plan educational and prevention programs. However, it could be important to investigate the quality of health-related websites to protect and inform users. more...

IntroductionResilience is a dynamic, context- and time-specific process that refers to positive adaptation or ability to maintain or regain mental health despite experiencing adversity. Pathways to resilience include biological, psychological, social and dispositional attributes. In mood disorders, resilience may influence frequency of relapse, severity of episodes and response to treatment.AimsTo evaluate resilience as well as personality features, coping abilities, self-esteem and quality of life in a sample of mood disorder patients.MethodsWe recruited mood disorder patients at the Psychiatry institute AOU Maggiore della Carità, Novara. Socio-demographic data were gathered and patients filled in the following self-administered scales: Resilience Scale for Adult (RSA), Brief Cope, Rosenberg Self-Esteem Scale (RSES), Paykel list of stressful events, Temperamental and Character Inventory (TCI), Quality of life (SF-36).ResultsWe collected data from 61 patients. Statistical analysis was performed by calculating the Pearson Correlation Coefficient between the RSA and the other tests. We observed a positive correlation between RSA and coping “Emotion” and coping “Problem”. A negative correlation was found between RSA and coping “Avoidance”. Resilience was also positively related to self-esteem and physical, mental and general health. As far as personality traits are concerned, resilience was positively correlated with Reward dependence, persistence, self transcendence, self directedness and cooperativeness.ConclusionsSince higher resilience levels are related with better physical and mental health, constructive coping and self-esteem, strategies aimed at enhancing resilience could improve treatment and quality of life in patients with mood disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

IntroductionStudies conducted on Italian samples suggested that 70% of self-harms referred to the emergency room (ER) were suicide attempts. Suicide attempts are associated with societal, relationship and individual risk factors, which vary with age and gender, occur in combination, and may change over time. We conducted a previous study on a sample of psychiatric consultations in ER from 2008 to 2011. We observed that female gender, a permanent job and being in the warmer months of the year were risk factors for suicide attempts.AimTo update knowledge about risk factors for attempted suicide analyzing a larger sample of ER psychiatric consultations.MethodsDeterminants of emergency room visits for psychiatric reasons were studied prospectively in a period of 8 years, from 2008 to 2015 at the “Maggiore della Carità” Hospital in Novara. The psychiatric assessment of patients was performed by experienced psychiatrists with a clinical interview. For each patient, a data sheet was filled in order to gather demographic and clinical features. Comparison of qualitative data was performed by means of the Chi2 test while differences between groups for continuous variables were assessed through a t-test. Statistical significance was set at P ≤ 0.05. A multivariate analysis was performed using logistic regression in order to assess the potential predictors of attempted suicide. Results are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).ConclusionsWe have collected data from more than 500 psychiatric consultations for attempted suicide. Data collection and statistical analyses are still ongoing. Implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

IntroductionAccording to Durkheim's theory, suicide attempts increase during periods of rapid economic changes and decrease again when stability is achieved, due to the social integration in the community guaranteed by occupational status. Since 2009 in Europe, it was observed an increase in the suicide rates, in line with the increase of unemployment. Although unemployment is considered a risk factor for suicide, it was observed a noticeable increase in suicide rates among Italian employed men during the last years, probably related to the specific economic scenario and to emerging difficulties in keeping an income to adequately maintain one's own family standard of living.AimTo study attempted suicides with a specific focus and attention on the current Italian economic scenario.MethodsDeterminants of emergency room visits for psychiatric reasons in patients aged > 16 years were studied prospectively from 2008 to 2015 at the AOU Maggiore della Carità Hospital, Novara, Italy. Each patient was assessed by an experienced psychiatrist with a clinical interview and socio-demographic and clinical features were gathered. Statistical significance was set at P ≤ 0.05.ResultsPreliminary results suggest an increase in suicide attempts according to the rise of the unemployment rate in Novara. Although in absolute figures most attempters are unemployed, it seems that suicide attempts are more frequent in the group of employed subjects, which includes also people under redundancy fund. This subgroup may be considered halfway between employed and unemployed attempters.ConclusionsData collection and statistical analyses are still ongoing. Implications for clinical practice will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...

IntroductionDual diagnosis (DD) is the coexistence of a Psychiatric Disorder (PD), and Substance Use Disorder (SUD). The increase of DD observed in recent years has caused serious problems to both public and private services organization.AimsOur aim is to assess the prevalence and features (including clinical and sociodemographic ones) of DD over a decade, comparing the period 2003–2004 and 2013–2014.MethodsWe performed a retrospective study retrieving the medical records of DD patients at their first admission to the Psychiatry Ward AOU “Maggiore della Carità”, Novara, Italy. Sociodemographic and clinical features were recorded. The two groups of patients (2003–2004 vs. 2013–2014) were compared.ResultsIn both periods DD patients are usually Italian male, aged 19–40, single. They have usually attended middle school, live with parents, have two or more brothers and/or sisters but no kids. DD patients in 2003–2004 and 2013–2014 showed differences as far as employment and diagnosis are concerned. The first were more frequently employed than the latter: moreover the 2003–2004 patients were more frequently diagnosed with a personality disorder while the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods, as well.ConclusionsThe identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors which may be the target of prevention and treatment approaches.Disclosure of interestThe authors have not supplied their declaration of competing interest. more...