Lorenzo Montali

A short version of a HRQoL questionnaire for Italian and Japanese patients with Primary Biliary Cirrhosis

BACKGROUNDnThe available self-report questionnaire for the quality of life in patients with primary biliary cirrhosis (PBC-40) is currently validated only in the British population but it lacks an evaluation of its dimensionality.nnnAIMSnTo validate the Italian and Japanese versions of PBC-40 and to assess the dimensionality of the original structure of PBC-40 by a confirmatory factor analysis. PBC-40 was translated to Italian and Japanese using the forward-backward method and then reviewed in focus groups in the framework of a large multicentric study.nnnMETHODSnA sample of 290 patients with PBC (125 Italian and 165 Japanese) was administered two questionnaires previously validated for PBC-specific (PBC-40) and general quality of life (SF-36).nnnRESULTSnThe confirmatory model failed to fit adequately the original hypothesized structure. A principal component analysis led to a seven-factor structure, with exclusion of 13 items characterized by lower load; PBC-27 questionnaire was the final instrument. The validity of the PBC-27 was supported by its strong correlation with the SF-36 scores.nnnCONCLUSIONnWe here propose an alternative structure of the quality of life questionnaire for PBC, namely PBC-27, which appears to be effective in detecting the impact of PBC on quality of life in Italian and Japanese patients.

The discourse around usefulness, morality, risk and trust: a focus group study on prenatal genetic testing

This study explores the underlying values and beliefs that guide womens reasoning on prenatal genetic test (PGT) uptake, as framed by their own words, during a group discussion, in a Catholic country such as Italy.

Conflicting Representations of Pain: A Qualitative Analysis of Health Care Professionals’ Discourse

INTRODUCTIONnStudies regarding health care professionals representations of pain indicate that doctors and nurses tend to concentrate on the organic origin of pain, and to view pain as subordinate to diagnosis and treatment of the disease; they also tend to underestimate the psychological and psychosocial components of pain, which means that they generally view the patients subjective experience as secondary. This leads to an underestimation of pain.nnnOBJECTIVEnThe objective of this study was to analyze the representations of pain held by doctors, head nurses, and nurses in two Italian hospitals, focusing on how these representations are shaped according to the local culture in which they are constructed and negotiated.nnnMETHODSnOur study is based on a socio-constructionist approach, drawing on semi-structured, in-depth interviews with 26 health care professionals.nnnRESULTSnThe results show similarities and differences in how health care professionals construct their representations of pain. Three main issues emerged. First, the contents of these representations are strictly related to participants job position and professional training; second, the representation of pain is significantly influenced by the values and meanings associated with the different professions; and third, there are two conflicting representations of pain, focusing on the objectivity vs the subjectivity of pain, respectively.nnnCONCLUSIONSnTo promote significant change regarding pain management within hospital organizations, it is essential to construct shared representations of the problem and its implications, particularly as regards relations with the patient. This change should take place at the educational as well as the socio-organizational level, and it should take into account ideas and proposals from the subjects involved.

'It's as if PBC didn't exist': the illness experience of women affected by primary biliary cirrhosis.

This study investigates the illness experience of women who are affected by primary biliary cirrhosis (PBC), a rare chronic liver disease which mostly affects women. Despite the fact that PBC is medically recognised, it shares many characteristics with other chronic and controversial conditions which may lead to delegitimation of the patients experience of illness, impacting on the construction of the patients self-identity. Twenty three women took part in semi-structured interviews. Data were analysed using interpretative phenomenological analysis and the analysis identified three themes that are interrelated and characterised by a dynamic of normalisation. The first theme, the delegitimation of womens experience, implies denial of patients’ sick-role, trivialisation of fatigue and lack of consideration of patients’ needs. The second theme, PBC as a challenge to womens social identity refers to how patients face delegitimation and manage the illnesss consequences for relationships and social roles. The third theme, the need for biographical continuity, focuses on how patients construct their ill identities as a consequence of both the delegitimation and the challenges posed by PBC. Results are discussed in a gender perspective, highlighting how delegitimation and identity construction processes are influenced by womens social roles and conditions.

Teorie e pratiche nella gestione del dolore: una ricerca sulle rappresentazioni dei medici

Theories and practices in pain management: A research on doctors’ representations - Pain is a symptom often associated with disease, but several studies indicate that hospital pain management continues to be inadequate. This fact seems to depend on representations of the problem and professional practices which are not likely to change. The purpose of this qualitative study, conducted in two hospitals in the north of Italy, is to analyze pain representations held by doctors, and their implications with respect to the practices adopted in assessment and treatment of pain. The results - expressed by the interviewees - indicate three meanings connected to different professional practices: pain is represented as a clinical cue, as a request for help and for attention and as a symptom to be treated. These different meanings are explained in relation to the bipolar nature of pain representation’s nucleus which seems to be structured around the dialectic between subjective and objective pain. Key words: pain, pain-free hospital, doctors, social representations, qualitative research, content analysis Parole chiave: dolore, ospedale senza dolore, medici, rappresentazioni sociali, ricerca qualitativa, analisi del contenuto.

Italian Teachers' Knowledge and Perception of Attention Deficit Hyperactivity Disorder (ADHD).

Teachers perceptions of attention deficit hyperactivity disorder (ADHD) can influence the diagnostic rates of the disorder and the management of children in schools. This study investigated the knowledge and perceptions of ADHD in a sample of 589 Italian primary school teachers using a self-report questionnaire that included the ADHD perceptions questionnaire (Norvilitis & Fang, 2005) and the ADHD knowledge scale (Jerome, Gordon, & Hustler, 1994). The results showed that Italian teachers had a moderate level of knowledge, that their perceptions of ADHD were ambivalent, that their teaching experience was not positively correlated with their perceptions and knowledge of ADHD, and that receiving specialized information about ADHD had a limited influence on their perceptions. These findings suggest that perceptions are more than a matter of knowledge and should be addressed with regard to deep cultural values and representations. The educational and psychological implications of these results are discussed; particular attention is given to the importance of understanding the social context of ADHD and taking into consideration the teachers perceptions of ADHD in the organization of training. Future research should address the role of childrens gender in influencing perceptions of ADHD as well as the perceptions of parents and siblings.