Socio-demographic analysis of free-lance nurses in a non-institutional employment regimen.

INTRODUCTION: The free-lance nurse, not bound to rigid organizational systems, can offer personalized assistance always respecting the rights of the person and of the profession. More recent graduates have decided to undertake the nursing profession by moving towards the free-lance nursing, considering it both as a career opening and as a professional opportunity, although this option never got much attention from the researchers in the Italian nursing scene. Free-lance nursing is now considered a valuable opportunity to develop a nursing career. This market is destined to grow for different reasons, such as an increasing chronicity of health conditions of more and more ageing population and the deficits of the National Health Service (Servizio Sanitario Nazionale - SSN) in community and home care. AIM: The aim of the study was to evaluate the correlation between the development of the free-lance nursing and the Italian socio-economic context. METHODS: The design of the study was descriptive - observational. Data collection and observation was carried out from January 2018 until April 2108. For the analysis a linear regression model was adopted to quantify a cause-effect relationship between one or more independent variables and the dependent variable which interprets the phenomenon investigated. The regression carried out was descriptive to analytically express the observed reality and represent it in a plausible way. The specification model was represented as: Free-lance nurses per capita = per capita income + Out of Pocket expense per capita + waiting lists in days + number of beds per inhabitants + NHS nurses per inhabitants. RESULTS: The estimate carried out had an R of 0.813, R-square equal to 0.6612, adjusted R-square 0.540 and standard error of the estimate 1.277, highlighting a correlation between the variables adopted in the model and a p = 0.005. From the analysis of the variables used, the average per capita income (p = 0.045) and the nurses working in the National Health Service /1,000 beds (p = 0.017) were statistically significant. CONCLUSIONS: It can be stated that the free-lance nursing profession is costly for patients and therefore develops more revenue where the average per capita income grows, but the research also seems to show that, where the National Health Service has too few nurses, the private demand increases in order to satisfy healthcare needs.

LAW n.219/17: Reflecting on shared care plan.

INTRODUCTION: The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility. MATERIALS AND METHODS: This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient. RESULT: The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give. CONCLUSION: In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.

Psychobiotics Regulate the Anxiety Symptoms in Carriers of Allele A of IL-1ß Gene: A Randomized, Placebo-Controlled Clinical Trial.

BACKGROUND: Probiotic oral intake, via modulation of the microbiota-gut-brain axis, can impact brain activity, mood, and behavior; therefore, it may be beneficial against psychological distress and anxiety disorders. Inflammatory cytokines can influence the onset and progression of several neurodegenerative mood disorders, and the IL-1ß rs16944 SNP is related to high cytokine levels and potentially affects mood disorders. The aim of this study was to examine the combined effect of IL-1ß polymorphism and probiotic administration in mood disorder phenotypes in the Italian population. METHODS: 150 subjects were randomized into two different groups, probiotic oral suspension group (POSG) and placebo control group (PCG), and received the relative treatment for 12 weeks. Psychological profile assessment by Hamilton Anxiety Rating Scale (HAM-A), Body Uneasiness Test (BUT), and Symptom Checklist 90-Revised (SCL90R) was administered to all volunteers. Genotyping was performed on DNA extracted from salivary samples. RESULTS: After 12 weeks of intervention, a significant reduction of HAM-A total score was detected in the POSG (p < 0.01), compared to the PCG. Furthermore, IL-1ß carriers have moderate risk to develop anxiety (OR = 5.90), and in POSG IL-1ß carriers, we observed a reduction of HAM-A score (p = 0.02). CONCLUSIONS: Consumption of probiotics mitigates anxiety symptoms, especially in healthy adults with the minor A allele of rs16944 as a risk factor. Our results encourage the use of probiotics in anxiety disorders and suggest genetic association studies for psychobiotic-personalized therapy.

The civil liability of paediatric dentists in Italy. Trains of thought on novelties introduced by law n. 24/2017 ("Gelli-bianco" law).

AIM: This study offers an overview regarding news and main themes which have been introduced by Law n. 24/2017 (the so called "Gelli-Bianco" law) in Italy. The normative content deals with the features of civil liability for healthcare professionals. More specifically, this article is referred to the contractual and extra-contractual liability of paediatric dentists. Dentists often provide services combining healthcare and dental procedures as well as aesthetic activities. Thanks to the case law and doctrine tradition, the distinction between contracts of employment and contracts of work is clearly stated. This examination is focused on highlighting methods employed by paediatric dentists to prevent possible actions of suing for compensation.

Comparing the direct normal form and multiple scales methods through frequency detuning.

Approximate analytical methods, such as the multiple scales (MS) and direct normal form (DNF) techniques, have been used extensively for investigating nonlinear mechanical structures, due to their ability to offer insight into the system dynamics. A comparison of their accuracy has not previously been undertaken, so is addressed in this paper. This is achieved by computing the backbone curves of two systems: the single-degree-of-freedom Duffing oscillator and a non-symmetric, two-degree-of-freedom oscillator. The DNF method includes an inherent detuning, which can be physically interpreted as a series expansion about the natural frequencies of the underlying linear system and has previously been shown to increase its accuracy. In contrast, there is no such inbuilt detuning for MS, although one may be, and usually is, included. This paper investigates the use of the DNF detuning as the chosen detuning in the MS method as a way of equating the two techniques, demonstrating that the two can be made to give identical results up to ε 2 order. For the examples considered here, the resulting predictions are more accurate than those provided by the standard MS technique. Wolfram Mathematica scripts implementing these methods have been provided to be used in conjunction with this paper to illustrate their practicality.

Identifying the significance of nonlinear normal modes.

Nonlinear normal modes (NNMs) are widely used as a tool for understanding the forced responses of nonlinear systems. However, the contemporary definition of an NNM also encompasses a large number of dynamic behaviours which are not observed when a system is forced and damped. As such, only a few NNMs are required to understand the forced dynamics. This paper firstly demonstrates the complexity that may arise from the NNMs of a simple nonlinear system-highlighting the need for a method for identifying the significance of NNMs. An analytical investigation is used, alongside energy arguments, to develop an understanding of the mechanisms that relate the NNMs to the forced responses. This provides insight into which NNMs are pertinent to understanding the forced dynamics, and which may be disregarded. The NNMs are compared with simulated forced responses to verify these findings.

Out-of-unison resonance in weakly nonlinear coupled oscillators.

Resonance is an important phenomenon in vibrating systems and, in systems of nonlinear coupled oscillators, resonant interactions can occur between constituent parts of the system. In this paper, out-of-unison resonance is defined as a solution in which components of the response are 90° out-of-phase, in contrast to the in-unison responses that are normally considered. A well-known physical example of this is whirling, which can occur in a taut cable. Here, we use a normal form technique to obtain time-independent functions known as backbone curves. Considering a model of a cable, this approach is used to identify out-of-unison resonance and it is demonstrated that this corresponds to whirling. We then show how out-of-unison resonance can occur in other two degree-of-freedom nonlinear oscillators. Specifically, an in-line oscillator consisting of two masses connected by nonlinear springs-a type of system where out-of-unison resonance has not previously been identified-is shown to have specific parameter regions where out-of-unison resonance can occur. Finally, we demonstrate how the backbone curve analysis can be used to predict the responses of forced systems.