Experiences, opinions and current policies on users' choice and change of the allocated primary mental health professional: a survey among directors of community mental health centers in the Emilia-Romagna region, Italy.

BACKGROUND: The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users' requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic. METHODS: A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software. RESULTS: Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by "fixed-rota" was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users' requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users' requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful. CONCLUSIONS: In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users' request to choose/change their PHMP may be useful.

Relations between a novel, reliable, and rapid index of arterial compliance (PP-HDI) and well-established inidices of arterial blood pressure (ABP) in a sample of hypertensive elderly subjects.

Hypertension is a risk factor for a long-lasting arterial wall-remodelling leading to stiffness. The rapid method measuring the pulse pressure (PP) by means of the tool of Hypertension Diagnostic Instruments (HDI) called PP-HDI, overcomes some of the problems arising with more-time consuming methods, like ambulatory blood pressure monitoring (ABPM), and give information about the elasticity of the arterial walls. We studied the relationship between the PP-HDI, the large artery compliance (LA-C) and small artery compliance (SA-C) and few well-established indices of arterial blood pressure (ABP) in a sample of 75 hypertensive subjects, aged 65 years and over. Significant correlations between LA-C and heart rate (HR), PP-ABPM and PP-HDI were found. SA-C relates with HR and systolic blood pressure (SBP) measured in lying and standing positions. Applying a stepwise regression analysis, we found that LA-C variance stems from PP-HDI and HR, while SA-C variance stems from SBP in lying position. Receiver operator characteristic (ROC) curves for thresholds of PP showed that PP-HDI reached levels of sensitivity/specificity similar to PP-ABPM. In conclusion, surveillance of ABP through hemo-dynamic indices, in particular of SBP, is essential, nevertheless the advantage of this control is not known in an elderly population where the organ damage is already evident. PP needs necessarily an instrumental measurement. The PP-HDI result is similar in reliability with respect to PPABPM, but is more rapid and well applicable in an elderly population.

Treatment of postprandial hypotension in the elderly.

Food intake induces splanchnic vasodilation lasting for at least one hour, which can precipitate in postprandial hypotension, if systolic arterial blood pressure falls by more than 20 mmHg. Postprandial hypotension has a high prevalence in the elderly, above all in subjects receiving hypotensive drugs or in those with disorders of the autonomic nervous system. In our total case series of 567 subjects, the prevalence of postprandial hypotension evaluated by 24-hr blood pressure recording, was 14.5%, increasing to 28% in the oldest group. Since relevant cerebral ischemic symptoms may become manifest, a correct diagnosis of the disorder and both pharmacological and non-pharmacological therapeutical approaches are of great importance for the wellbeing of old patients.

Membrane lipid composition of red blood cells in liver disease: regression of spur cell anaemia after infusion of polyunsaturated phosphatidylcholine.

The morphology of red blood cells was studied in 30 patients with severe liver cirrhosis, in 10 patients with extrahepatic jaundice, and in 10 control subjects. In all the patients with extrahepatic jaundice more than 30% of red blood cells were target cells with increased resistance to osmotic lysis. In 12 patients with liver cirrhosis more than 30% of red blood cells were spur cells. The cholesterol: phospholipids (C/PL) molar ratio was 0.89 in target cells, 1.33 in spur cells, and 0.74 in normal red blood cells. The red blood cell membrane cholesterol and phospholipids exchanged with plasma lipoproteins, the lipid composition of which was studied in eight patients with spur cells; the free cholesterol: phospholipid (FC/PL) molar ratio was 0.33 (0.16 in the controls) in high density lipoproteins (HDL) and 1.40 (0.82 in the controls) in low density lipoproteins (LDL); in these patients the polyunsaturated fatty acid content was low in both phospholipids and cholesterol esters of lipoproteins. The irregular folds of the spur cells regressed when polyunsaturated lecithin was infused (2 g daily for five days) in eight patients with spur cell anaemia; the infusions decreased both C/PL ratio in RC to 0.88 and the concentration of unconjugated bilirubin (104.3 to 82.0 mumol/l (6.1 to 4.8 mg%)), whereas the activity of the plasma lecithin:cholesterol acyltransferase (LCAT) increased from 31.2 to 54.4 mumol/l/h. Polyunsaturated fatty acid content of RC lecithin increased after the infusion as it did in HDL, the FC/PL ratio of which decreased to 0.23.