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P Morosini

Publications and source records attributed to P Morosini.

At least 19 recordsLinked to original sources
PubMed2007

Discriminant ability and criterion validity of the HoNOS in Italian psychiatric residential facilities.

BACKGROUND: The Health of the Nation Outcomes Scales (HoNOS) was developed as an inclusive and comprehensive instrument to assess patient outcomes in 4 main domains: behaviour, cognitive and physical impairment, symptoms and social functioning/context. Concerns about the reliability and validity of the HoNOS have been raised. The aim of this study was to further investigate the discriminatory ability of the HoNOS; criterion validity was also examined. SAMPLING AND METHODS: A broad sample of patients with psychotic disorders, admitted to 265 Italian residential facilities, were rated by trained research assistants and local staff on the HoNOS, Global Assessment of Functioning, Life Skills Profile, and Physical Health Index. Discriminant function analysis was used to examine the ability of the HoNOS items to correctly classify patients with positive symptoms, substantial psychosocial impairment or physical disability. The HoNOS criterion validity was also examined. RESULTS: On the whole, the pattern of correlations between the HoNOS and the other corresponding measures was consistent. However, the majority of the correlations were only moderate. In discriminant function analysis, the classification procedure correctly classified 55.7% of the patients. CONCLUSIONS: Although the HoNOS has many advantages in its brevity, it may lack sufficient discriminatory ability for certain patient groups. Further, it correlates only moderately with measures of disability and physical health status. These findings suggest that the HoNOS alone might be insufficient for routine evaluation and should probably be supplemented by additional measures.

Activities of Daily Living↗
PubMed2004

Relevance of anger and irritability in outpatients with major depressive disorder.

INTRODUCTION: Current psychiatric classification systems underestimate the part played by anger and aggressiveness in unipolar depression. This study was designed to assess the relevance of anger, irritability, aggressiveness, hostility, and psychomotor activation in major depressive disorder. METHODS: A total of 222 newly admitted consecutive outpatients with major depressive disorder (mean age 48.9 years, 64.4% females) were enrolled in the study. They had no comorbid axis I or II DSM-IV disorder, and they received no treatment with antidepressants in the preceding 2 months. They were assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. Principal component analysis was performed on SVARAD items. RESULTS: We obtained a three-factor solution accounting for 47.4% of total variance. The factors were interpreted as 'anger/irritability', 'depression', and 'anxiety', respectively. The anger/irritability dimension was clinically relevant in 23% of patients. Anger/aggressiveness was especially frequent (21.6%), whereas psychomotor activation was infrequent (0.9%). DISCUSSION: In depressive disorders, there are psychopathological dimensions other than depressed mood and anxiety that deserve greater clinical recognition and research. Our study suggests that one of these symptom clusters includes anger, irritability, aggressiveness, and hostility. The relevance of this dimension was not related to concurrent pharmacological treatment. Misdiagnosis of bipolar II disorder is also unlikely to explain our findings. Possibly, personality factors might at least partly explain the occurrence of anger and aggressiveness in several depressed patients. Attachment theory suggests that anger might also be conceived as part of the protest-despair-detachment reaction to a loss, either actual or symbolic.

Adult↗
PubMed2004

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Adolescent↗
PubMed2004

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Adolescent↗
PubMed2004

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Adolescent↗
PubMed2004

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. METHOD: The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. RESULTS: In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. CONCLUSION: The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.

Adult↗
PubMed2004

Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Adult↗
PubMed2004

Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. RESULTS: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). CONCLUSION: These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.

Adolescent↗
PubMed2002

Psychiatric disorders in Sardinian immigrants to Paris: a comparison with Parisians and Sardinians resident in Sardinia.

BACKGROUND: The aim of the present study was to compare the prevalence of ICD-10 psychiatric disorders in a community sample of subjects of Sardinian origin resident in Paris (here "immigrants"), of the general Parisian population ("Parisians") and of Sardinians resident in Sardinia ("Sardinians"). METHODS: The sample of immigrants was obtained by contacting a fifth of all households with a Sardinian surname in Paris telephone directories. The other samples have already been partially described in previous studies. All subjects were interviewed using the CIDIS, a shortened version of the structured WHO interview CIDI. RESULTS: High or very high response rates were achieved in all studies. The final sample sizes were: 153 immigrants, 2,260 Parisians and 1,040 Sardinians. Immigrants showed high rates of depressive disorders, as did Parisians, and high rates of anxiety disorders, as did Sardinians. The immigrants' offspring (second-generation immigrants) seemed to be particularly at risk for depression, drug-abuse and bulimia. Elderly Sardinians who had returned to Sardinia after a long period of emigration showed an increased risk of dysthymia. The presence of a confidential relationship had a protective effect. CONCLUSIONS: The results are consistent with previous findings which suggest a greater risk of anxiety disorders in Southern Europe and of depression in Northern European countries. Immigrants in this study seem to present a particularly unfavourable pattern of mental disorders compared to both origin and host populations. The role of social support, use of mental health services and social conditions of second-generation immigrants should be analysed in greater depth.

Adult↗
PubMed2002

Association between the engagement of relatives in a behavioural group intervention for smoking cessation and higher quit rates at 6-, 12- and 24-month follow-ups.

OBJECTIVE: To assess the effectiveness of a behavioural group intervention for smoking cessation, which included as its most original feature the recommendation to participate with a relative or close friend. METHODS: A total of 1,060 subjects entered the programme, which consisted of 9 group sessions over a period of 5 weeks. The intervention consisted of a modified version of the Five-Day Plan, the main differences being the use of behavioural therapy techniques and small group work, and the addition of 4 weekly booster sessions. About two thirds of the participants came with a relative or close friend. Long-term abstinence from smoking was assessed with follow-up telephone interviews. RESULTS: Very few subjects were lost to follow-ups (9.2% at 6 months, 9.7% at 1 year, 10.8% at 2 years). The observed quit rates were 42.6% at 6 months, 35.5% at 1 year and 32% at 2 years. When considering as smokers all subjects who were lost to follow-ups, quit rates were also satisfactory (38.7% at 6 months, 32.1% at 1 year and 28.6% at 2 years). The main predictors of a good outcome were being male, smoking less than 20 cigarettes per day, having started smoking after 18 years of age, having made previous quitting attempts, not having a history of unsuccessful participation to smoking cessation interventions and attending the sessions with a relative or close friend. DISCUSSION: Although some limitations inherent in the design of our study suggest caution in interpreting the results and in making comparisons, the long-term effectiveness of the intervention was satisfactory. The inclusion of a relative or close friend appeared useful. This simple and inexpensive strategy may deserve recommendation, though in the future it should be tested in controlled trials.

Adolescent↗
PubMed2002

Residential care in Italy. National survey of non-hospital facilities.

BACKGROUND: In Italy, where all mental hospitals have been gradually phased out since 1978, psychiatric patients requiring long-term care are being treated in non-hospital residential facilities (NHRFs). However, detailed data on these facilities are sparse. AIMS: The Progetto Residenze (PROGRES) residential care project is a three-phase study, the first phase of which aims to survey the main characteristics of all Italian NHRFs. METHOD: Structured interviews were conducted with the manager of each NHRF. RESULTS: On 31 May 2000 there were 1370 NHRFs with 17 138 beds; an average of 12.5 beds each and a rate of 2.98 beds per 10 000 inhabitants. Residential provision varied ten-fold between regions and discharge rates were very low. Most had 24-hour staffing with 1.42 patients per full-time worker. CONCLUSIONS: There is marked variability in the provision of residential places between different regions; discharge rates are generally low.

Adult↗
PubMed2002

Papnet-assisted cytological diagnosis intensifies the already marked variability among cytological laboratories.

OBJECTIVE: The main objective was to assess the sensitivity, specificity and reliability of PAPNET-assisted diagnosis in comparison with conventional screening. SETTING: Seven Italian and one English University or Research Institutes, and a random sample of an other 20 Italian Laboratories of the Italian National Health Service (INHS) provided the cervical smears. METHODS: During the training phase every center examined in rotation four sets of slides for a total of 300 representative slides. Afterwards, 900 "positive" slides were added to the 3,100 slides which were collected consecutively without any selection or exclusion. The eight main centers were divided into four couples and each couple of centers examined 775 slides with the PAPNET system, "blindly" to the original diagnosis. An expert cytopathologist (M.A.) of the National Institute of Health (NIH) reassessed 40% of the slides with an original negative diagnosis to evaluate the false negative rate. Two expert NIH cytopathologists (M.A., G.M.) re-examined all slides where a disagreement had been observed between the original and one or both of the study diagnoses. The main analyses concerned the following three main categories: WNL and unsatisfactory for evaluation; ASCUS, AGUS and LSIL; HSIL and carcinoma. A special algorithm was devised to define the reference diagnosis for sensitivity and specificity assessment. RESULTS: Laboratories, even belonging to the same couple, classified as "no review" a very different proportion of slides ranging from 35% to 74%. The index of kappa agreement between the members of couples examining the same sets of slides was low or very low, ranging from 0.30 to 0.03. The sensitivity of the review classification was particularly low in some laboratories. Surprisingly, only a small correlation was observed between the sensitivity of the review classification and the proportion of slides classified as "review". The "tentative" diagnosis on PAPNET tiles of the "review" slides was almost as reliable as the microscopic diagnosis. In the overall performance, there were many significant differences among the eight laboratories. The best laboratory had a sensitivity of 95% and a specificity of 96%. At least three laboratories displayed unacceptably low sensitivity and one a very low specificity. CONCLUSION: Altogether these results seem to confirm that there are wide differences among cytological laboratories per se, and that these differences are intensified by the use of an instrument like PAPNET. The huge variation in performance may be explained by differences in basic skills and by different training, but it is difficult to understand exactly what could have been done to reduce it.

Autoanalysis↗
PubMed2001

[Hospital discharge report in patients with stroke].

When a patient who has had a stroke is discharged from hospital, the physician who will have him in his care must be informed about the patient's clinical conditions on the day of his admission and on the day of his discharge. Therefore evaluation scales (for example Barthel and Rankin scales) should be adopted to make understanding of the evolution of the disease in easier order to carry the treatments on.

Humans↗
PubMed2000

Confidential enquiry into avoidable vehicle accident deaths in the province of Modena, Italy.

The authors describe the methods and results of a kind of study confidential enquiries into avoidable deaths very rarely performed in the Mediterranean area. After assessing some quali/ quantitative evaluation criteria, an independent expert panel investigated the quality of each step in emergency health care. Information was collected by clinical and forensic reports (clinical method). Of 102 cases, 4 were avoidable deaths and 18 probably avoidable. These results, which are comparable with other similar ones found in Italy (autoptic method) and abroad, have been useful in highlighting some health care errors: in particular, in on-site care and in emergency department diagnosis and treatment. Other avoidable factors emerging were the inappropriateness of transporting severe trauma cases to a small hospital lacking proper equipment and trained staff, and the importance of staff training in first emergency care of severe trauma on ambulance. This situation had been highlighted previously and led to implementation of trauma centres. The methods implemented turned out to be quite statistically reproducible and have been used in local health care planning, especially in the rearrangement of ambulance deployment and emergency staff training.

Accidents, Traffic↗
PubMed2000

[The probability of assessing the pathogenesis of ischemic stroke. Study of 81 patients].

81 patients with ischemic stroke were studied in order to assess the pathogenesis, the accuracy of the pathogenetic diagnosis and the relationship between pathogenesis and infarct site. The pathogenetic mechanisms were grouped according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system. TOAST system settles five pathogenetic diagnosis: 1) Large artery atherosclerosis (LM); 2) Cardioembolism (CE); 3) Small artery occlusion (SAO); 4) Other etiologies (SOE); 5) Undetermined pathogenesis. As regards the site, the patients were divided into the following groups: Posterior Circulation Infarcts (POCI) 8.6%, Total Anterior Circulation Infarcts (TACI) 19.8%, Partial Anterior Circulation Infarcts (PACI) 29.6%, Lacunar Anterior Circulation Infarcts (LACI) 30.9%, Multiple Site Infarcts 11.1%. A probable or certain diagnosis was issued only in 33.3%. The diagnosis was not complete in 22.2%. That was due either to the severe clinical status or the patient and his relatives' refusal. Most of the incomplete diagnosis occurred in TACI patients. The undetermined pathogenesis due to absent clues occurred in 18.5%. CE often brought about TACI, whereas LM was likely to provoke PACI. SOE, like systemic hypotension, brought about Multiple Site Infarcts. Unfortunately assessing the pathogenetic diagnosis is still a controversial issue and TOAST method itself is not satisfactory as an overall classification system.

Adult↗
PubMed2000

[Evaluation of the workload resulting from iatrogenic pathology in a medical ward in a regional hospital].

OBJECTIVES: 1) To estimate the burden to diagnose and treat iatrogenic disorders out of all the activities of a referral hospital's medical ward. 2) To investigate about the main causes making the iatrogenic disorders arouse. DESIGN AND SUBJECTS: The entire series of iatrogenic disorder bearing patients (in- and out-), treated in the Institute of Medical Pathology of Ancona throughout a period of two years, were studied retrospectively. The low therapeutic index treatments (i.e. antiproliferative drugs, therapies under emergency, surgical amputations) were ruled out. The data to address the objectives were gathered. RESULTS AND CONCLUSIONS: 1) Highly probable iatrogenic disorders were diagnosed in 84/1620 patients (5.2%). 2) For this task 108/2763 medical performances were carried out (3.9%); 3) iatrogenic disorders were Slight in 20 (24%), Moderate in 44 (52%) and Severe in 20 (24%) patients. 4) Some facilitaters (poor monitoring of adverse drug reactions, primary disease incorrect treatment, poor accuracy of primary disease diagnosis, incoordination among therapists) were detected in 32, 25, 14, and 7%. 5) The most commonly occurring facilitaters were detected more frequently in Severe rather than Non Severe iatrogenic disorder bearing patients. 6) Severe iatrogenic disorders and the serious consequences of them, such as death and permanent serious harm, occur more often, when there are combinations of facilitaters; 7) Costs were minor in 69% and major in 31%.

Hospital Units↗
PubMed1999

[The treatment of stroke in internal medicine wards or in an intensive care unit?].

The mortality and complication rates have been studied in a series of 92 patients with stroke, who have been treated in a general medicine ward in central Italy. The data have been compared and discussed in relationship with analogous parameters reported about some series from north-European stroke units (SU) and general medicine wards (RMG). The mortality rates have been 11% over the first 7 days and 18% over the first 30 days. In a series of patients from northern Europe these parameters have been 12 and 19%. In severe prognosis patients the complication rate has been 83%, whereas in the series from northern Europe it has been estimated 97%. The infectious diseases have been complicating stroke in 21% of the patients. This rate is as high as in SU's, but lower than in RMG (49%). In the over 65 patients the mean hospital stay has been 19 days versus 24 in the SU. The percentage of the patients dismissed home has been higher than in the SU and in the RMG. Taking into consideration only the above-mentioned short term parameters and the acute phase management, the SU do not apparently have any advantage in comparison to the general medicine ward in central Italy which has been considered for this study.

Aged↗