The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study.

OBJECTIVES: The recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two "multidisciplinary" inpatient units embedded predominantly in different paradigms - one pediatric and one psychiatric. METHODS: Qualitative analysis of 20 healthcare staff members' interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France). RESULTS: The "Complex patients" theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. "Management and its limits" describes the daily management of psychiatric symptoms in both units. "Psychiatry and Adolescent medicine: from opposition to collaboration" describes the different levels at which these disciplines work together and how this cooperation may be evolving. CONCLUSIONS: The complex entanglement intrinsic in EDs of the patients' somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.

Propofol and survival: a meta-analysis of randomized clinical trials.

BACKGROUND: One of the most commonly used hypnotics is propofol. Several studies performed in cardiac surgery suggested an increased mortality in patients receiving a propofol-based total intravenous anaesthesia. Furthermore, the possibility of infections and the 'propofol syndrome' have suggested that propofol might be dangerous. Nonetheless, propofol is widely used in different settings because of its characteristics: fast induction, rapid elimination, short duration of action, smooth recovery from anaesthesia, few adverse effects, no teratogenic effects, characteristics that have undoubtedly contributed to its popularity. The effect of propofol on survival is unknown. We decided to carry out a meta-analysis of all randomized controlled studies ever performed on propofol vs. any comparator in any clinical setting. METHODS: Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, Clinicaltrial.gov, and Cochrane Central Register of Clinical Trials by expert investigators. The following inclusion criteria were used: random allocation to treatment, comparison between propofol and any comparator in any clinical setting. RESULTS: One hundred thirty-three studies randomizing 14,516 patients were included. No differences in mortality between patients receiving propofol [349/6957 (5.0%)] vs. any comparator [340/7559 (4.5%)] were observed in the overall population [risk ratio = 1.05, 95% confidence interval (0.93 to 1.18), P = 0.5] and in several sub-analyses. CONCLUSION: Inspite of theoretical concerns, propofol has no detrimental effect on survival according to the largest meta-analysis of randomized trials ever performed on hypnotic drug.

[Silica risk in construction industry: an investigation on raw materials]. / Il rischio silice nel settore edilizia: esperienza di un'indagine sulle materie prime.

Typical construction activities like demolition, excavation and sanding can expose workers to silica, but there are few investigations carried out with the aim of evaluating the silica content in raw materials used for these activities (mortars, plasters, cement...). Our intervention has been directed in looking for free crystalline silica in samples of raw materials. We have measured the silica content in these materials comparing declared and real composition found in the products. Our intent was to obtain more information about the working activities which expose workers to free crystalline silica in construction industry and to highlight the silica presence in raw materials also when the companies don't declare it, against labeling rules based on Italian law D.lgs 65/03.

[Risk assessment method for psychosocial factors at workplace: a North-West Tuscany area project]. / Metodologia di valutazione dei rischi psicosociali in ambiente di lavoro: un progetto toscano di area vasta.

The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.

[Occupational doctors in the public prevention services and qualified occupational doctors: their roles and forms of collaboration]. / Medici del lavoro nei servizi pubblici di prevenzione e medici del lavoro competenti: ruoli e forme di collaborazione.

The occupational docters in public prevention and control services and the qualified occupational doctors who carry out functions of specialized doctors for enterprises, as well as operating according to their individual professional skills, are all part of the polydisciplinary system of collaboration that, while differing in methods, organizations and planning of their activities, have a shared aim: the safeguarding of the health and safety of the workers. The two systems have a mutual obligation to give information, foreseen also by several norms, that require common codes for evaluation and interpretation when exchanging communications, also for going beyond the simple conflictual relationship of "controller" and "controlled". In fact a shared commitment is necessary nowadays to face the lesser known and investigated risks and diseases, to promote the roles and rights of the workers, their representatives and also the employers of the micro-enterprises.

Point of view of Occupational Health Prevention Units.

The regulations pertaining to the obligation of continuation of health surveillance of workers formerly exposed to asbestos are also examined from the point of view of clinical epidemiological usefulness. The outcomes of some types of campaigns of health surveillance of formerly exposed workers organized by the SSN (National Health Service) are also examined.

Monocyte chemoattractant protein-1 induces monocyte recruitment that is associated with an increase in numbers of osteoblasts.

Monocyte chemoattractant protein-1 (MCP-1) is a member of the chemokine family of cytokines. The principal function of MCP-1 is thought to be the stimulation of monocyte recruitment. Monocyte products are potential regulators of bone cell activity. Growth factors produced by monocytes may stimulate bone formation, while cytokines such as IL-1 and IL-6 can induce bone resorption. To determine whether MCP-1 enhances recruitment of monocytes during bone healing, studies were carried out in which MCP-1 was applied to osseous sites in vivo. Changes in monocyte number were determined by immunohistochemistry using the antibody ED-1 specific for peripheral monocytic cells. The effect of MCP-1 on osteoblast number was determined by counting the number of alkaline phosphatase positive cells in close proximity to bone. For comparison, osteoblast number was also determined following stimulation with platelet-derived growth factor (PDGF)-BB plus IGF-1 in vivo. Results indicate that MCP-1 stimulated a large increase in monocyte recruitment compared to vehicle alone. An increase in monocytes induced by MCP-1 was associated with an increase in the number of osteoblasts lining the bone surface, although not to the same magnitude as a positive control, PDGF-BB, and IGF-1. These results indicate that MCP-1 induces the recruitment of monocytes to bone and suggest that the recruitment is associated with an increase in osteoblast number. This is likely to occur via indirect mechanisms, because MCP-1 did not directly enhance DNA synthesis in osteoblastic cells in vitro. Thus, activated mononuclear phagocytes may play an important role in osseous wound healing by stimulating proliferation of osteoblastic cells, presumably through the elaboration of growth factors.

[Attempt to solve technical problems involved in the re-utilization of coil filters for hemodialysis]. / Tentativo di soluzione ai problemi tecnici relativi al riuso dei filtri coil per emodialisi

The problem of the reutilization of coil filters in haemodialysis is discussed. The methodologies in current use are examined and the technical risks and inconveniences that limit any real economic advantage are pointed out. On the basis of these observations, a system of reutilization is proposed which does not call for any direct handling of the filter nor any special techniques for eliminating risks of transmitting infection, and cuts to the minimum extra work involving the use of hospital staff. The proposed equipment is illustrated in detail. It consists of a small accessory individual monitor which has opened the way to the concept of "weekly dialyser". Attention is called to the need for further research into the physiopathology of the regenerated membrane, particularly in relation to the type of filter, the number of reutilizations, and the behaviour of ultrafiltration and the various solutes.

Emergency contraception.

Emergency contraception (EC) is an effective way to prevent an unintended or unplanned pregnancy. EC is available in two forms in Canada: a progestin-only method and a combined hormonal method, also known as the Yuzpe regimen. EC has been proven to be most effective within 72 h and up to 120 h after unprotected sexual intercourse. To date, the progestin-only method is the preferred method of EC recommended to teens because it is known for higher efficacy and fewer side effects, and is, therefore, more widely accepted over the combined method. Teens should also be counselled that the progestin-only method is widely available without a doctor's prescription across Canada.

Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician.

Anorexia nervosa (AN) is a serious life-threatening illness that typically has its onset during the adolescent years. Evidence regarding the optimal treatment of AN in children and teenagers is growing; however, much remains unknown. Although current treatment approaches vary in Canada and elsewhere, the evidence to date indicates that family-based treatment (FBT) is the most effective treatment for children and teenagers with AN. A key component of the FBT model is that the parents are given the responsibility to return their child to physical health and ensure full weight restoration. An understanding of the basic principles and philosophy underlying FBT allows the physician to initiate elements of this evidence-based intervention to young patients with AN and their families.

Weekly artificial kidney: personal monitor with cartridge re-use.

Cartridge re-use is now successful in centre and home haemodialysis. The economic advantage of re-use is remarkable even in the case of a single re-use. However, hepatitis and pyrogenic reactions may follow re-use and are a source of possible contamination. The problem of storing sterilised cartridges also arises. In order to reduce the work load and simplify preparation and re-use the authors have developed a simple 'personal monitor' that permits automatic recovery of the cartridge and eliminates handling. In our unit this 'personal monitor' has been used for 14 months without complications and with considerable saving. By using the same cartridge three times for each patient, the aim of a 'weekly kidney' has been achieved.