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L’articolo illustra il lavoro psicologico-clinico effettuato all’interno della “Articolazione per la Tutela della Salute Mentale in Carcere”, nuovo contesto di cura ed assistenza nato alla luce dei radicali cambiamenti attivati dal processo di superamento degli Ospedali Psichiatrici Giudiziari (OPG) e che accoglie soggetti autori di reato affetti da patologia psichiatrica, garantendone un’osservazione costante ed interventi riabilitativi ad alta intensità terapeutica. Il caso presentato, attraverso la narrazione del percorso detentivo/riabilitativo di un soggetto, iniziato con la reclusione in regime ordinario, proseguito con l’assegnazione all’OPG e con il successivo approdo presso l’Articolazione SMC (Salute Mentale in Carcere), ed esitato nel trasferimento in un contesto comunitario, mira ad essere esemplificativo della valenza trasformativa di un approccio rivolto al paziente che, nella gestione della patologia psichiatrica, superi i limiti di un assetto prevalentemente custodialistico, spesso predominante nei pregressi contesti ad essa dedicati, e dia priorità alle finalità terapeutico-riabilitative. L’article décrit le travail clinique-psychologique mené dans le « dispositif pour la protection de la santé mentale en prison » géré par les services locaux de santé de Salerne (Italie). Il s’agit d’un nouveau service de santé mentale et de traitement créé grâce aux changements radicaux apportés par la fermeture des hôpitaux psychiatriques judiciaires en Italie. Ce service accueille les criminels souffrant de pathologies psychiatriques, assurant leur contrôle régulier et des traitements de réadaptation à forte intensité thérapeutique. L’étude de cas présentée dans cet article concerne l’histoire d’une personne initialement détenue en prison, puis transférée dans un hôpital psychiatrique judiciaire et, enfin, accueillie par le « dispositif pour la protection de la santé mentale en prison ». Au terme de ce parcours, cette personne a été déplacée dans un centre résidentiel communautaire. Cette étude de cas a pour objectif d’expliquer les transformations de l’approche centrée sur le patient : de l’attitude dominante d’emprisonner à la priorité accordée à la thérapie et à la réadaptation. The article describes the clinical-psychological work carried out within the “framework for mental health protection in prisons” managed by the local health authority in Salerno (Italy). It is a new mental health care service and treatment created thanks to the radical changes due to the closure of judicial psychiatric hospitals in Italy. This service accepts criminals suffering from psychiatric pathologies, ensuring their regular monitoring and providing high intensity rehabilitation treatments. The case-study presented in this article is about the story of a person initially detained in prison, then moved to a judicial psychiatric hospital, finally hosted by the “framework for mental health protection in prison”. At the end of this path, this person was moved to a community house. This case-study aims to explain the transformation of the approach method towards the patient: from a prevailing custodial attitude to priority given to therapy and rehabilitation.

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Single serum samples were obtained during the first trimester of pregnancies with a retrospectively normal outcome ( = 150), ectopic pregnancies ( = 38) and anembryonic pregnancies ( = 78). Serial samples during the first trimester were also obtained from 43 women achieving pregnancy following successful treatment for infertility and with a retrospectively defined normal outcome. Significant variation in serum CA 125 levels in relation to gestational age was observed in pregnancies with a normal outcome ( > 0.0001). Peak serum CA 125 levels were observed at 6−7 weeks, the mean level at this gestation being 40.1 U/ml (range 31.7-50.7 U/ml) in the normal conception/normal outcome group and 36.5 U/ml (range 25.6-52.0 U/ml) in the assisted conception/normal outcome group. A rise and fall in serum CA 125 levels during the first trimester was observed in 42 of 43 assisted conceptions monitored serially, with peak levels ranging from 7 to 1398 U/ml (median 48.8 U/ml) occurring at 28−61 days (median 45 days) gestation. Mean serum CA 125 levels were higher in the anembryonic pregnancy group at 4−5 and 6−7 weeks gestation than in both normal pregnancy outcome groups ( > 0.01). [ABSTRACT FROM PUBLISHER]

Objective: To examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021., Design: Population-based study., Setting: Republic of Malta PARTICIPANTS: Between 1 January 2017 and 31 December 2021, 1090 women and pregnant people requested at-home medical abortion through one online telemedicine provider (Women on Web). Mifepristone and misoprostol were shipped to 658 women (60.4% of requests)., Main Outcome Measures: The numbers and demographics of persons to which abortion pills were shipped, their reasons for accessing abortion, and reasons for requesting medical abortion via telemedicine between January 2017 and December 2021 were analysed. Selected data were compared across different groups., Results: The number of people in Malta to whom medical abortion pills were shipped increased significantly in the 5 years analysed. Women and pregnant people requesting medical abortion were diverse with respect to age, pregnancy circumstances and reasons for seeking an abortion. More than half had existing children and over 90% reached out to Women on Web at <7 weeks. Among those completing a medical abortion, 63% did not use contraception, and in 30% there was contraception failure. The most common reasons for ordering medical abortion pills online were difficulty accessing abortion because of legal restrictions (73%) and abortion pills not being available (45%) in the country., Conclusions: Despite a complete ban on abortion, the number of women and pregnant people residing in Malta completing at-home medical abortions is considerable and has been steadily increasing., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Objectives: To compare summative anatomy examination results of Peer Assisted Learning (PAL) tutors and learners in the same undergraduate classroom., Methods: Comparative study of Year-1 medical students who did/did not serve as PAL tutors. PAL tutors gave six hours of teaching in lower limb anatomy. Percent marks for written and spotting examinations were compared between PAL tutors and PAL learners., Results: The 12 self-selected PAL tutors were not significantly different from their peers (n=191) in terms of age or nationality, but 20% were female compared to 51% of PAL learners. Except for upper limb anatomy, PAL tutors performed at the same level as their tutees in all basic science examinations taken before PAL was introduced. PAL tutors performed better (M=89.0, SD=8.2) in the lower limb examinations than PAL learners (M=79.7, SD=13.0), but these differences were only statistically significantly bigger in the subject they had taught (t (184) = 2.40, p=0.002). Overall PAL tutors performed better in all anatomy spotting exams in both pre-clinical years (Year-1: M=80.4, SD=7.4; Year-2: M=74.8, SD=3.4) compared to PAL learners (Year-1: M=75.1, SD=6.6; Year-2: M=67.2, SD=3.0; (t (1) = 4.2, p=0.07)., Conclusions: Undergraduate PAL tutors performed better than PAL learners in the subject they taught and continued to do so in all anatomy spotting exams, even after the PAL experience had ended, suggesting that actively involving anatomy students as PAL tutors should be encouraged especially among undergraduate medical students.

Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession., (© 2015 Wiley Periodicals, Inc.)

Objective: To determine circulating levels of placental protein 14 (PP14) in complications of early pregnancy., Design: Biochemical monitoring of women presenting with vaginal bleeding and/or abdominal pain., Setting: An emergency gynaecological ultrasound clinic in a London teaching hospital., Subjects: Venous blood samples were obtained from 67 women with normal pregnancy (n = 9), ectopic pregnancy (n = 26) and failed intrauterine pregnancy (n = 32). This group included anembryonic pregnancy (n = 18), missed miscarriage (n = 2), spontaneous miscarriage of a previously demonstrated live fetus (n = 6), incomplete miscarriage (n = 4), complete miscarriage (n = 1) and molar pregnancy (n = 1)., Main Outcome Measures: Serum PP14 levels in the group of women with a failed intrauterine pregnancy in relation to the normal range for PP14., Results: Eighty-one percent of women who miscarried spontaneously had normal serum PP14 levels; 81% of women with ectopic pregnancy had depressed (< 5th centile) serum PP14 levels., Conclusion: Measurements of PP14 may be useful in distinguishing spontaneous miscarriage from ectopic pregnancy, but not in the management of threatened miscarriage.

Uterine arterial blood FVWs were studied by doppler ultrasound in eight patients with large uterine fibroids who were treated with the GnRH agonist Buserelin intranasally for 4 months. At the end of treatment, reductions in the uterine and discrete fibroid volumes were associated with significant increases in the mean RI values for the uterine (P less than 0.01) and fibroid (P less than 0.001) vasculature, thus indicating reduction in blood flow.

Circulating placental [human chorionic gonadotrophin (hCG), Schwangerschafts protein 1 (SP1), pregnancy-associated plasma protein A (PAPP-A), decidual (pregnancy protein 12 (PP12), and fetal alphafetoprotein (AFP)] proteins were measured immediately before and within 1 h in 18 women undergoing diagnostic chorionic villus sampling (CVS) in the first trimester. An elevation of serum AFP levels was consistently seen, while fluctuations in excess of 10 per cent of the pre-CVS levels of SP1 and PP12 were seen in the majority of patients. Fluctuations in hCG and PAPP-A were consistently less than 10 per cent of pre-CVS values. Post-CVS changes in levels were not apparently associated with any feature of the technique, the pregnancy, or its outcome (one missed abortion). As feto-maternal haemorrhage is a common event, anti-D should be offered to rhesus-negative women undergoing CVS. In the prediction of subsequent miscarriage, only hCG and PAPP-A measurements should be considered.

Complement factors (C3, C4, C5; Factors B, H and I) were measured in maternal and fetal serum and amniotic fluid obtained from 55 women with singleton pregnancy undergoing diagnostic fetoscopy at 15 to 28 weeks gestation. Maternal serum levels were consistently 10 times higher than fetal levels which in turn were 10 times higher than levels in amniotic fluid. Spearman rank correlation analysis at weeks 20 to 22 (n = 20) revealed a statistically significant correlation between maternal and fetal levels of C3 and Factors B and I, and between maternal and amniotic fluid levels of Factors B and I. A significant increase in fetal levels of C3, C4 and Factor H, and in amniotic fluid levels of C3 and Factor B was seen in relation to advancing gestational age. These differences were not seen in maternal serum during the short interval of pregnancy studied. These data confirm earlier assumptions of fetal synthesis of complement factors, and provide normal reference ranges of complement factors in fetal blood and amniotic fluid.

624 women were referred to an emergency gynaecological ultrasound clinic with a provisional diagnosis of threatened miscarriage based on a history of amenorrhoea and vaginal bleeding with or without abdominal pain. High-resolution abdominal sector scanning was used to assess fetal size and viability, as well as uterine and placental size, to identify features which might indicate imminent fetal death. In 158 women there was no evidence of pregnancy; 60 women had an ectopic pregnancy. In the remaining 406 women ultrasound examination correctly identified the underlying cause of vaginal bleeding at first presentation in all but the 6 who subsequently aborted. 3.9% of the patients had a second empty sac and 5.4% had an intrauterine haematoma; none of these women subsequently aborted. 2 patients had early-onset oligohydramnios and spontaneous abortion occurred in both.