bluuebunny/crossref_metadata_2025_split huggingface dataset:
Capitolo 1: Il Progetto di ricerca: motivazioni e generalità metodologiche
Authors: Bezzi Roberto , Farinazzo Carla , Miragoli Paolo 
Published: July 2014

La ricerca “Pattern di trattamento e costi nei Dipartimenti di Salute Mentale della Regione Lombardia”, che per brevità chiameremo HoNOS 2, rientra nei “Programmi Speciali” ex Art. 12 DL 502/92.La ricerca intende contribuire al dibattito su possibili modalità di finanziamento della psichiatria alternative al sistema tariffario per prestazione. Essa approfondisce, in un settore specifico, un problema che riguarda l'intero sistema sanitario e che sembra non avere ancora trovato una risposta definitiva soddisfacente.Nello scorso decennio il Servizio Sanitario Nazionale è passato, attraverso due fasi di generale riordino, governate a livello nazionale dai Decreti Legislativi 502/92 e 229/99, e ha conosciuto varie leggi regionali di riordino. Siamo solo all'inizio del nuovo decennio e già si preannunciano ulteriori modifiche sulla spinta dell'evoluzione federalista dello Stato.
Capitolo 2: Strumenti della ricerca
Authors: Lora Antonio , Baj Gabriella , Monzani Emiliano , Panetta Barbara , Morghen Daniele Von 
Published: July 2014

La valutazione della gravità e dell'esito nei servizi clinici richiede strumenti specifici, che, oltre a possedere le classiche proprietà psicometriche (riproducibilità, validità, sensibilità al cambiamento, ecc.), siano anche applicabili, cioè brevi, semplici da usare e accettabili. La scala HoNOS rappresenta uno dei primi strumenti di valutazione, sviluppati in modo specifico per essere utilizzati routinariamente nei servizi di salute mentale.Nel 1993 la Research Unit del Royal College of Psychiatrists (CRU) venne incaricata dal Ministero della Sanità inglese di sviluppare uno strumento in grado di monitorare il raggiungimento degli obiettivi, individuati nel campo della salute mentale dal libro bianco governativo “The Health of The Nation“ (uno di questi era, ad esempio, il miglioramento del funzionamento sociale nei pazienti psichiatrici). Lo strumento avrebbe dovuto essere utilizzato sia a fini gestionali che clinici. A livello gestionale avrebbe dovuto, ad esempio, quantificare l' “effectiveness” del servizio, mettendola in relazione con i costi, e monitorare gli accordi stretti tra erogatori ed acquirenti di servizi. Nell'ambito clinico avrebbe dovuto misurare la gravità del quadro psicopatologico e della situazione psicosociale degli utenti, valutare l'esito degli interventi e definire il carico degli operatori.
Premessa
Authors: Martelli Pompeo 
Published: July 2014

Sono grato al dr. Benedetto Saraceno per aver accolto la richiesta del Centro Studi e Ricerche della ASL Roma E di pubblicare in Italia il rapporto realizzato dal dr. Alex Cohen per l'Organizzazione Mondiale della Sanità nell'ambito del programma Nations for Mental Health.L'autore offre in modo conciso ma puntuale una panoramica sulla condizione della salute mentale delle popolazioni indigene nel mondo.Come l'autore, chi scrive non è mosso dalla mera curiosità per gli inquieta limina delle alterità esotiche bensì dalla consapevolezza che anche nel nostro Paese sia necessario promuovere programmi interculturali di ricerca e di formazione, nonché realizzare servizi di salute pubblica e di salute mentale culturalmente sensibili.Sono ancora pochi i colleghi italiani che hanno intrapreso questo faticoso percorso (tra loro desidero ricordare il dr. Roberto Beneduce con il Centro Frantz Fanon a Torino) ed è pertanto necessario intensificare i momenti di incontro e di verifica delle nostre attività.L'approccio con persone provenienti da altre culture che chiedono assistenza ai servizi di salute mentale è sempre una circostanza problematica per l'avvio di un buon ascolto, di una eventuale presa in carico e di una adeguata relazione terapeutica.Sui fruitori dei servizi, sul loro mental health seeking behavior e sulle ragioni delle loro scelte sappiamo ancora poco; ancor meno conosciamo sull'interazione fra operatori e utenti immigrati ed in particolare sulle difficoltà che gli operatori sperimentano nel corso di questa interazione e che sono alla base di una forte richiesta di formazione.
Indicatori per la valutazione dei Dipartimenti di Salute Mentale
Authors:   Nucleo di Valutazione Progetto QUALI DSM, Regione Lazio
Published: July 2014

È un indicatore (descrittore) di struttura e in parte di processo. Esprime con un punteggio l'aderenza del Dipartimento alla normativa vigente:L.833 del 27/12/78: Istituzione del Servizio Sanitario Nazionale, art. 33, 34, 35;DPR 7/4/94: Approvazione del Progetto Obiettivo “Tutela della salute mentale”;DGR n. 159/97: Approvazione della Linee guida attuative “Progetto Obiettivo tutela della salute mentale”;DPR 14/1/97: Approvazione dell'atto di indirizzo e coordinamento alle regioni e alle provincie autonome di Trento e di Bolzano in materia di requisiti strutturali, tecnologici ed organizzativi minimi per l'esercizio delle attività sanitarie da parte delle strutture pubbliche e private.DGR n.143 3/2/98: Regolamento concernente “Istituzione, funzioni e modalità operative del Dipartimento di Salute Mentale”.Al fine della costruzione di un sistema di indicatori, sono state considerate le strutture residenziali o semiresidenziali, così come definite al punto 3.1.Ogni requisito soddisfatto vale 1 punto. Il punteggio strutturale ed organizzativo dei DSM è dato dal totale dei requisiti soddisfatti con un punteggio massimo di 24.
Population needs for mental health services. Introduction to the theme
Authors: Lehtinen Ville 
Published: July 2014

All over the world large sums of both public and private money are expended on the operation of psychiatric health care services. In most of the European countries mental health care expenditures, as well as the total health care budget, increased quite rapidly during the 80s. But in the 90s the economic recession has forced to cut down costs which has meant a decrease in mental health resources and, evidently, an increase of the unmet need for these services in the population.The problem is that the development of mental health services has been, for the most part, merely accidental and random, usually not clearly planned and based neither on real knowledge of the population needs nor on setting priorities when all needs can not be satisfied. During the period of increasing resources there was no real need for priority setting; somewhat exaggerating one can say that every emerging demand for services could be met by allocating new resources. During the recession, on the other hand, the cutting of costs have been the main goal, leading again to an unplanned development: the cuts of resources have been rather forced and panicky, not based on consideration of true population needs or the consequences of the development.
Do we still need mental hospitals?
Authors: Burti Lorenzo 
Published: July 2014

“The debate is over” claimed a heading in a newspaper on the 1991 Amsterdam WHO conference ‘Changing mental health care in the cities of Europe’: “After half a century of debate of the issue of deinstitutionalisation the question is not any more if we should close the large mental hospitals, but what follows the closure and how to develop adequate community mental health care which replaces the functions of the mental hospital” (Gersons & Burns, 1992).These ‘functions’ have actually secured the long-lasting success of the mental hospital which has been in the past and, to a certain extent, still is in a number of countries, the cornerstone of psychiatric care. It incorporates all the functions of a psychiatric system in a single, usually isolated facility, including crisis intervention, evaluation, treatment, aftercare, long-term custodial care, rehabilitation, etc. In order to phase down the mental hospital these functions have to be supplemented by newly established, discrete services disseminated in the community. The process is clearly a complex one, since it implies a transition from a system of care provided only in mental hospitals under medical direction, to one that is comprehensive in scope, community-orientated, and staffed by multidisciplinary teams.
Population needs assessment for mental health services. Prospects for the future
Authors: de Almeida José Miguel Caldas 
Published: July 2014

The concept of need and the development of methods for measuring population needs represent, in a way, a new paradigm in evaluative research and planning of mental health services.As with all new paradigms, this one has arisen as a way of overcoming a conceptual crisis: the crisis that has resulted from the application of the curative and medical model to the organisation and evaluation of mental health care, and from the traditional way of planning mental health services according to factors more centred on services and staff problems than on the actual problems of the populations.As is the case with all new paradigms, the concept of needs also represents a radical change at the epistemological level. In fact, this concept integrates a new perspective on: 1. The nature and range of the problems experienced by the mentally ill (seen not only in terms of symptoms and behavioural problems but also in terms of social disability problems); 2. The interventions required to reduce or contain those problems(integrating the dimension of treatment in a more comprehensive dimension of care); 3. The principles of mental health services organisation (seen from a more community-centred perspective).
Describing mental health services: the development of a mental health census in the North-West of England
Authors: Huxley Peter 
Published: July 2014

In the United Kingdom, national policy and local service provision both direct provision towards people with a severe mental illness (NHS and Community Care Act, 1990; Department of Health, 1993, 1994). An independent report by the Mental Health Foundation (1994), a leading mental health charity, recommended that the Department of Health “promulgates a practical definition of severe mental illness (SMI) in order to concentrate attention and services on those in greatest need”.In order to assess the extent to which a provider or a purchaser has focused attention upon the SMI, definitions are being developed in most services in the UK; this will facilitate the quantification of the number and proportion of SMI in contact with services. The definitional approach uses a (variable) number of criteria to determine status as a severely mentally ill person. It is essentially categorical because the individual is placed in one of two categories, SMI or not-SMI.
Mental health services description. Prospects for the future
Authors: Kovess Vivianne 
Published: July 2014

An abundant literature has been published about mental services evaluation and was used for purpose of comparisons between services.Comparisons have mainly concerned care in the traditional psychiatric hospital based mode versus community mental health (Tansella et al., 1982; Kraudy et al., 1987; Kovess et al., 1995) or care in different areas or countries (Sytema et al., 1989).Those comparisons have to rely on crude description of services (Tansella et al., 1986) like psychiatric hospitalisation, day hospitalisation or out patient intervention. Intensive international collaboration underpinned the importance of a more precise description about services which could have extremely different components under the same label.In fact services in mental health are complex to describe to allow meaningful comparisons because they cover many different actions given by a variety of providers and grouped into various structures as:
•hospitals: specialised or general, large or small;•day hospitals and centre;•out patients clinics, crisis centres.Care could also be provided by independent workers from the diverse medical and non medical professions involved in the mental health fields in private practice settings.
Service utilisation: a pivotal measure in assessing service needs and service outcome
Authors: Ruggeri Mirella 
Published: July 2014

In past years the study of service utilization has given a great contribution to the evaluation of mental health services. Nowadays, the challenge that must be faced is to obtain from service utilization research useful knowledge for clinical practice and service planning.Psychiatric care organization should be based on coherent and comprehensive assessments of the population's morbidity and needs for care, and take into account costs and benefits of different forms of treatments in relieving mental disorders and meeting mental health needs. While the former issue has been widely studied, the last two are mostly unexplored. Specifically, there is limited amount of information available on the significance that certain patterns of service utilization, or changes in service utilization, may have for the patient, his/her relatives and the community, and on the correlation between certain characteristics of service utilization and the overall quality of care.In this perspective, service utilization must not be considered an isolated step in the patient's career; the causal link betweenneeds, use, andoutcomeof services should be identified. A full understanding of the role of service utilization in psychiatry thus necessitates taking into consideration events occurring at various steps of a person's history:step 1: a person develops a mental disorder;step 2: in certain cases this will determine a mental health service need;step 3: in certain cases the service need will determine mental health service utilization;step 4: use of mental health services will have a certain outcome.
Importance of local differences in comparing hospital and community psychiatric services
Authors: Evans Kathryn , Tyrer Peter , Gandhi Naresh , Lamont Alwyn , Harrison-Read Phil 
Published: July 2014

Most of the studies that are frequently cited as examples of effective comprehensive community care, (i.e. they reduce the demand for hospital beds without any loss in treatment efficacy (Stein & Test, 1980; Hoult & Reynolds, 1984; Muijen et al., 1992) were carried out before the introduction of the Care Programme Approach (CPA) in 1991 (Department of Health, 1990) which at present only applies to England. As the CPA derives from these earlier studies the discrepancies between hospital and community based aftercare might be expected to become less, as now all services in England are expected to include a significant community element. However, there can still be important differences between those services focusing on community care as the main priority and those in which the hospital system is paramount.The psychiatric services in the area covered by North West London Mental Health Trust (NWL Trust) represented a natural test of these two approaches as they had parallel hospital and community based teams covering the same catchment areas respectively, North Paddington, in Westminster and Brent, in outer London.At this point it is useful to provide more detailed description of the two geographical areas at the time of the study and the community and hospital based teams that were involved.
The cost of mental health services. Prospects for future research
Authors: Cabasés Juan M. 
Published: July 2014

The setting of priorities in mental health care evaluation requires considering future trends in mental health services. Three areas of change are mentioned in this paper: the development of services, the increase of the burden of illness, and reform processes in health care systems. Economic evaluation of mental health services has to consider the different roles of the agents acting in mental health care, policy-makers, companies, researchers and care professionals, and patients and their relatives.Despite the increasing work done, most mental health care interventions have either not been evaluated or have been ill evaluated. There is a sense of paucity of measurement that has to be enriched with more and better evaluative research. Some unresolved methodological issues are commented on in this paper. In particular, direct costs outside the health care sector, indirect costs and quality of life measurement are briefly analysed.
Quality development in mental health care in Europe. Recent contributions by WHO
Authors: Faria José G. Sampaio 
Published: July 2014

In 1984 all Member States of the European Region agreed on a Pan European Health Policy, popularly known as Targets for Health for All (Health for all targets, 1991).Among the 38 targets agreed, Target 31 states (table I).More recently the first meeting of national directors/officials of mental health services in the European Member States stated that “there should be greater concern about the quality of mental health care in each Member State, and mechanisms must be established to guarantee a quality service. These include:
a.encouraging mental health care professionals to develop systems to monitor the quality of care;b.independent inspection of services;c.the participation of consumers and relatives;d.improving the basic and continuing training of mental health professionals as well as their working conditions;Special attention should be paid to the quality of care provided to those with severe long-term mental disorder, the elderly, children and adolescents. Barriers to care should be avoided, particularly for people with long-term mental disabilities.”The need for quality development and evaluation differ quite significantly across the European Region as a result of the existing differences in the pattern of mental health services and priority policies to be implemented.
Community psychiatry in Europe: assessment and evaluation
Authors: Goldberg David 
Published: July 2014

It is tempting to suppose that changes in the mental illness service in one's own part of Europe are taking place elsewhere as well. The asylum era is drawing to a close, and politicians everywhere are closing mental illness beds in order to re-distribute health costs in order to pay for new treatments needing expensive technology, as well as to allow for the needs of a population that is now living longer.In an attempt to become independent of official figures, key figures with a reputation for epidemiological psychiatry were approached in each European country, and asked to complete a brief questionnaire describing the mental health services in their country. Whether this method produces figures that are more or less accurate than official government figures is a question that cannot be addressed at present.
Mesoscale assembly of chemically modified graphene into complex cellular networks
Authors: Barg Suelen , Perez Felipe Macul , Ni Na , do Vale Pereira Paula , Maher Robert C. , Garcia-Tuñon Esther , Eslava Salvador , Agnoli Stefano , Mattevi Cecilia , Saiz Eduardo 
Published: July 2014

AbstractThe widespread technological introduction of graphene beyond electronics rests on our ability to assemble this two-dimensional building block into three-dimensional structures for practical devices. To achieve this goal we need fabrication approaches that are able to provide an accurate control of chemistry and architecture from nano to macroscopic levels. Here, we describe a versatile technique to build ultralight (density ≥1 mg cm−3) cellular networks based on the use of soft templates and the controlled segregation of chemically modified graphene to liquid interfaces. These novel structures can be tuned for excellent conductivity; versatile mechanical response (elastic-brittle to elastomeric, reversible deformation, high energy absorption) and organic absorption capabilities (above 600 g per gram of material). The approach can be used to uncover the basic principles that will guide the design of practical devices that by combining unique mechanical and functional performance will generate new technological opportunities.
Poisson’s ratio of individual metal nanowires
Authors: McCarthy Eoin K. , Bellew Allen T. , Sader John E. , Boland John J. 
Published: July 2014

AbstractThe measurement of Poisson’s ratio of nanomaterials is extremely challenging. Here we report a lateral atomic force microscope experimental method to electromechanically measure the Poisson’s ratio and gauge factor of individual nanowires. Under elastic loading conditions we monitor the four-point resistance of individual metallic nanowires as a function of strain and different levels of electrical stress. We determine the gauge factor of individual wires and directly measure the Poisson’s ratio using a model that is independently validated for macroscopic wires. For macroscopic wires and nickel nanowires we find Poisson’s ratios that closely correspond to bulk values, whereas for silver nanowires significant deviations from the bulk silver value are observed. Moreover, repeated measurements on individual silver nanowires at different levels of mechanical and electrical stress yield a small spread in Poisson ratio, with a range of mean values for different wires, all of which are distinct from the bulk value.
Tofogliflozin, a sodium/glucose cotransporter 2 inhibitor, attenuates body weight gain and fat accumulation in diabetic and obese animal models
Authors: Suzuki M , Takeda M , Kito A , Fukazawa M , Yata T , Yamamoto M , Nagata T , Fukuzawa T , Yamane M , Honda K , Suzuki Y , Kawabe Y 
Published: July 2014

Abstract
Objective:
Tofogliflozin, a highly selective inhibitor of sodium/glucose cotransporter 2 (SGLT2), induces urinary glucose excretion (UGE), improves hyperglycemia and reduces body weight in patients with Type 2 diabetes (T2D). The mechanisms of tofogliflozin on body weight reduction were investigated in detail with obese and diabetic animal models.

Methods:
Diet-induced obese (DIO) rats and KKAy mice (a mouse model of diabetes with obesity) were fed diets containing tofogliflozin. Body weight, body composition, biochemical parameters and metabolic parameters were evaluated.

Results:
In DIO rats tofogliflozin was administered for 9 weeks, UGE was induced and body weight gain was attenuated. Body fat mass decreased without significant change in bone mass or lean body mass. Food consumption (FC) increased without change in energy expenditure, and deduced total calorie balance (deduced total calorie balance=FC−UGE−energy expenditure) decreased. Respiratory quotient (RQ) and plasma triglyceride (TG) level decreased, and plasma total ketone body (TKB) level increased. Moreover, plasma leptin level, adipocyte cell size and proportion of CD68-positive cells in mesenteric adipose tissue decreased. In KKAy mice, tofogliflozin was administered for 3 or 5 weeks, plasma glucose level and body weight gain decreased together with a reduction in liver weight and TG content without a reduction in body water content. Combination therapy with tofogliflozin and pioglitazone suppressed pioglitazone-induced body weight gain and reduced glycated hemoglobin level more effectively than monotherapy with either pioglitazone or tofogliflozin alone.

Conclusion:
Body weight reduction with tofogliflozin is mainly due to calorie loss with increased UGE. In addition, tofogliflozin also induces a metabolic shift from carbohydrate oxidation to fatty acid oxidation, which may lead to prevention of fat accumulation and inflammation in adipose tissue and liver. Tofogliflozin may have the potential to prevent obesity, hepatic steatosis and improve insulin resistance as well as hyperglycemia.