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Copyright of Actualizaciones en Osteología is the property of Asociacion Argentina de Osteologia y Metabolismo Mineral and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A reliable and valid global staging scale has been lacking within dementia care. Objective: To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. Methods: The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. Results: Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. Conclusion: The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed. [ABSTRACT FROM AUTHOR]

The article discusses a multicenter study that aims to examine the current pathways to psychiatric care in Italy. Details on the methods of the study and its results are offered. The results show that a greater proportion of patients are first seen in private settings or directly reach mental health centers although general practitioners and hospital doctors are still the main referral point for mental health care.

Background: Psychiatry has been affected by the 'Brain Drain' phenomenon for decades, with professionals usually migrating from lower- to higher-income countries. Whilst Italy faces a decreasing Psychiatric workforce in the near future, little is known about the factors that influence migration of Psychiatry trainees in Italy., Aim: To explore the migration tendencies of Psychiatry trainees training in Italy., Methods: A cross-sectional survey was disseminated to Psychiatry trainees in Italy., Results: The vast majority (84.2%) of the trainees had 'ever' considered leaving Italy, and more than half (60.4%) considered leaving the country 'now'. Only a quarter (25.3%) had taken 'practical steps' towards migration. Male trainees were more likely to have 'ever' considered leaving Italy. Trainees without children were more likely to have 'ever' considered leaving and more likely to consider leaving 'now'. More southern Italian trainees were considering leaving the country 'now' compared to those from the centre-north. 'Academic' and 'work' reasons were the two most cited factors given both as a reason for wanting to leave Italy and as conditions that should be improved in the country. The main reason cited to remain in the country was personal., Conclusions: Several Psychiatry trainees in Italy consider migration as a possibility, mainly driven by work and academic reasons. The main factor keeping trainees in Italy was personal reasons. Highlighting the reasons why trainees leave is crucial to facing these issues and either finding ways to encourage trainees to remain or finding other solutions for the medical shortage.

Objective: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care., Methods: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant., Results: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care., Conclusions: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally., (© 2019 John Wiley & Sons, Ltd.)

Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.

Primary hyperparathyroidism may have different characteristics. One is the asymptomatic form. This is a mild variant of hypercalcemic hyperparathyroidism, characterized by a calcemia not greater than 1 mg/dl above the upper limit of the method, a high intact parathyroid hormone (iPTH), absence of renal stones, renal function impairement, and osteoporosis, less than 50 years of age, and less than 400 mg/day calciuria. It is not a surgical entity, but its evolution may require it. Twenty-four postmenopausal women, all older than 50 years, with a diagnosis of asymptomatic hyperparathyroidism, were studied. Clinical manifestations, densitometric changes, biochemical parameters and bone remodeling were analyzed and the results were compared with the classic and normocalcemic variants of the disease. Diagnostic criteria were established and observed that only 2 (8.3%) of patients, during a follow up of 44 ± 12 months, had need for a parathyroidectomy. In conclusion, the asymptomatic primary hyperparathyroidism is a benign disorder, of periodic clinical follow-up, which rarely may require surgery.

Objectives: Workplace violence is a common risk for mental health professionals, and psychiatrists often encounter it in a variety of settings. The aim of this study was to estimate the prevalence and features of violent episodes toward psychiatrists in various mental healthcare system settings., Methods: All psychiatrists from the Region of Puglia (Apulia) were contacted (N=285) via email and were administered an on-line standardized questionnaire., Results: The response rate by psychiatrists was 57%. The main types of violence revealed were "threats" and "verbal aggression" and, of particular importance, "stalking". Female psychiatrists seemed to be at a higher risk of becoming victims of workplace violence, especially as regards verbal abuse (OR: 2.7, 95% CI: 1.2-6.5, c2 6.7, p=0.0095) and reported more serious psychological consequences with need for rest after the episode of aggression., Conclusions: Our data confirm that mental health workers, particularly psychiatrists, are healthcare professionals at high risk for workplace violence. Future implementation of preventive strategies with the aim of reducing aggressive episodes towards psychiatrists should be a high priority for managers and policy-makers operating in the Italian healthcare sector.

Introduction: Major depressive disorder is a disabling illness that involves affect and cognition of a person, negatively influencing social and work functioning. Cognitive deficits are often present in depression, although they are often believed to be secondary to typical depressive symptoms., Aim: A detailed literature review has been carried out to assess the cognitive deficits identified in people with major depressive disorder and identify specific assessment tools used for their evaluation., Methods: Using key-words, we selected papers published on Embase and PubMed/Medline, with a particular reference to those published in the last five years., Results: The literature review confirmed that cognitive deficits are one of the most important causes of social disfunctioning in patients with major depressive disorder. Cognitive deficits can be observed already in the first depressive episode. Assessment tools for cognitive deficits are scarcely used in clinical practice., Conclusion: There is a need to identify cognitive deficits in people with major depressive disorder and their relation with social and work functioning, quality of life and risk of relapse as well as to assess the effects of therapeutic intervention on cognitive performance. To achieve this purpose, it is important to use appropriate and sensitive tools for the assessment of cognitive deficits.

Aims: The European Federation of Psychiatric Trainees (EFPT), founded in London in 1992, is an independent international federation of psychiatric trainees' national associations. The EFPT is engaged in several actions in order to pursue its general aims to promote high standards of quality of psychiatric training and promote the collaboration and networking between European psychiatric trainees., Methods: Member associations constitute the general assembly that meets annually during the European Forum of Psychiatric Trainees. During the Forum, working groups are created and the activities for the next year are planned., Results: Regular activities of the EFPT include the production of statements expressing the standpoint of trainees on educational issues, the conduction of research projects, the creation of new national trainees' associations, the facilitation of networking among European psychiatric trainees and the organization an annual meeting (EFPT Forum). The last EFPT Forum has been organized in Sorrento (Italy) on May 2012. Psychiatric trainees from 37 European countries have registered to this event., Discussion: EFPT activities constitute a opportunity for psychiatric trainees to directly participate in the improvement of their psychiatric training and to establish a network with European colleagues that will contribute to their professonal development.