Barbara D’Avanzo

Medical history, diet and pancreatic cancer.

The relation between various aspects of medical history, selected indicator foods and the risk of pancreatic cancer was analyzed in a hospital-based case-control study conducted in Northern Italy on 247 patients with cancer of the pancreas, and 1,089 controls in hospitals for acute, nonneoplastic or digestive conditions. There was a significant association with history of pancreatitis (relative risk, RR 3.2, 95% confidence interval = 1.3-7.9), which was however reduced when the condition was first diagnosed at least 5 years previously. The point estimates were slightly, but not significantly, above unity for diabetes (RR = 1.5), gastrectomy (RR = 1.1) and cholelithiasis (RR = 1.3), and no association was found with liver disease or drug allergy. In relation to diet, there was some tendency for the risk to decrease with more frequent fruit consumption, but the results were largely inconsistent in relation to various indicators of meat, animal protein or fat intake. Although no important associations were found in this study with various aspects of medical history or diet indicators and pancreatic cancer risk, on account of the size of the dataset and the statistical power, this study contributes usefully to the debate on a common cancer whose causes are still largely undefined.

Efficacy of Couple Therapy as a Treatment for Depression: A Meta-Analysis

Data from clinical trials of couple therapy for depression have never been subjected to systematic analyses. We performed a meta-analysis of eight controlled trials involving 567 subjects. No difference was found on depressive symptoms between couple therapy and individual psychotherapy. Relationship distress was significantly reduced in the couple therapy group. Too few data are available for comparisons with drug therapy and no treatment. The findings are weakened by small sample sizes, assessments at the end of treatment or short follow-up, unclear sample representativeness, heterogeneity among studies. The mediating role of improvement in quality of couple relationships is not supported by data. However, it has not been adequately tested. Evidence on efficacy of couple therapy as a treatment for depression is inconclusive. The evidence for improvement in couple relationships may favor the choice of couple therapy when relational distress is a major problem.

Dairy Products and the Risk of Prostatic Cancer

Dietary indicators of prostatic cancer risk were analyzed in a case-control study conducted in Northern Italy on 96 histologically confirmed cases and 292 controls in hospital for acute, nonneoplastic or genital tract diseases. There was a significant trend in risk as regards frequency of milk consumption: compared with nondrinkers or occasional milk drinkers, the relative risk (RR) was 1.2 (95% confidence interval, Cl, 0.7-1.9) for 1 or 2 glasses per day and 5.0 (95% Cl 1.5-16.6) for 2 or more glasses per day. By contrast, no consistent association was observed with measures of cheese or butter intake. This might, at least in part, be attributable to the lower measurement errors for milk (which tends to be consumed in regular and uniform patterns) as compared with other dairy products. However, the interpretation of these findings is not clear, since other sources of animal fat, like eggs or meat, as well as a summary fat score, were unrelated to prostatic cancer. Although these limitations and uncertainties are substantial, this study provides further evidence that elevated milk consumption may be an indicator of prostatic cancer risk.

Mortality in long-stay patients from psychiatric hospitals in Italy - Results from the Qualyop project

Abstract.Background: Mortality in psychiatric patients both from natural and non-natural causes was reported to be markedly higher than in the general population. The effect of the psychiatric hospital (PH) closure process on mortality has nonetheless seldom been investigated. We studied mortality in a cohort of PH patients, taking into account the closure process in Italy. Methods: A total of 2915 patients from 12 PH were described in the period 1994–1996 and followed up until June 2000, and discharges and deaths were registered. Standardized mortality ratios (SMR) for natural and non-natural causes were computed on the basis of regional death rates. Results: Observed deaths were 714 vs. 291.2 expected. The all-causes SMR was 2.47 in males and 2.43 in females. The SMR was 26.92 in males and 13.75 in females for psychiatric causes, 6.84 and 7.89 for undefined causes, 9.57 and 7.27 for pneumonia, 6.38 and 7.78 for chronic obstructive respiratory disease, and 1.27 and 1.58 for ischemic heart disease. No excess was observed for all cancers in males, but the SMR was 1.50 for lung cancer in males, 2.30 for breast cancer and 1.48 for all neoplasms in females. SMR for suicide was 3.85 in males and 2.73 in females. Most SMR were higher at younger age, although the rate of absolute excess deaths was greater above age 60. The SMR for all causes was 2.66 before discharge from PH, and 2.09 after discharge. Conclusions: Mortality remained high after leaving the PH, but no increase was associated to the PH closure.

Formal and informal help-seeking for mental health problems. A survey of preferences of Italian students

Help-seeking preferences for mental health are a crucial aspect to design strategies to support adolescents in an emotionally delicate life phase. Informal help-seeking is usually preferred but little was published about preferences in different cultures, and it is not clear whether informal and formal help are mutually exclusive or whether they are part of the same overall propensity to help-seeking. In a survey of 710 students in Milan, Italy, help-seeking propensity measured through an Italian version of the General Help-Seeking Questionnaire was high, similar in males and females (mean total score 3.8, DS 0.9); few (9%) tended not to seek help. The most-preferred source of help was a friend, then father or mother, partner, psychologist and psychiatrist. 355 students (55%) reported high propensity to seek both informal and formal help; 33 (5%) would only seek formal help. Help-seeking should be promoted in itself, rather than indicating professionals and professional settings as primary sources of help.

Quality Assessment of Mental Health Care by People with Severe Mental Disorders: A Participatory Research Project

Abstract This study assessed the perceived quality of care by consumers with severe mental disorders. A questionnaire investigating service quality was developed by a consumer focus group and filled by 204 consumers. In five areas the negative evaluations exceeded or closely approximated the positive ones: choice of professionals, waiting times, information about illness and medications. All five do not refer to the outcomes of care, but to the concept of responsiveness. The results confirmed that people with severe mental disorders can give value judgments on various aspects of care. However, even in a service strongly oriented towards community care, the consumers’ needs in sensitive areas concerning choices, respect and autonomy are not met. The application of the concept of responsiveness to quality improvement may help services to meet consumers’ expectations.

Community residential facilities in mental health services: A ten-year comparison in Lombardy

Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.

Historical and Conceptual Developments of Psychosocial Rehabilitation: Beyond Illness and Disability in a Humanistic Framework

Abstract: Psychosocial rehabilitation is now coming of age and can no longer be considered as a subspecialty of psychiatry. It is therefore time to review its original foundations, past development, current status and future prospects. This paper outlines the history of psychosocial rehabilitation and its milestones: its first presentation in a textbook of psychiatry fifty years ago, the links with community care in early seventies, the conceptual framework provided by the WHO International Classification of Impairments, Disabilities and Handicaps in early eighties, the new challenges arising from the International Classification of Functioning, Disability and Health at the beginning of this century, the growth of the consumers movement and the breakthrough provided by the concepts of recovery and empowerment. The shift from a humanitarian to a humanistic standpoint can provide the foundation for an updated definition of psychosocial rehabilitation that considers social inclusion as its ultimate goal.