[Severe marginality in the Como area. Homelessness phenomenon and nursing care.] / La grave marginalità nel territorio del Comasco.Il fenomeno degli homeless e la presa in carico infermieristica.

Homelessness is a growing problem. These people face huge inequalities and frequent hospitalizations, often lacking social support. The condition is one of extreme poverty and affects public health care costs. The risk of mortality and morbidity is high. Together with the synergy between health care institutions and targeted policies, Third Sector Associations are fundamental. The nurse is crucial in responding to the needs of the most fragile individuals by ensuring an integrated approach to care. The Como Services for Serious Marginalization are concerned with taking charge of and satisfying the needs of homeless people through the services provided also in the current pandemic. The main exigencies that emerge are hospitality, active listening and the need for primary services. Both Italian and immigrant populations are represented. The realities involved rely on the figure of the nurse both directly and indirectly. The health inequity faced by the homeless requires special attention. The homelessness needs require an integrated service model with reorganization needed due to the ongoing pandemic. The Nurse can become central to the territorial management of frailty and social vulnerabilities.

[The need for preventive nursing care from a gender perspective at Bollate prison. An example: breast cancer.] / Il bisogno di assistenza infermieristica di natura preventiva in ottica di genere presso il Carcere di Bollate . Un esempio: il cancro della mammella.

Breast cancer is prevalent in females, accounting for 25% of the world's cancers. Prevention is strategic, and the nurse is an active part in educational and preventive programs, highlighting how the need for preventive nature is combined with gender medicine. The objective was to investigate the knowledge of breast cancer prevention among inmates of Bollate prison (Milan). 51% (52) adhered; women had an average age of 44 years (SD: 9.8), and 39% (20) were inmates from 1 to 3 years. 93% (48) knew about breast cancer prevention, 43% (26) had undergone specific preventive checkups outside of the prison, and 62% (31) had performed self-palpation. All women felt it was important to implement prevention in the prison environment. A high percentage of female inmates with an educational qualification was observed to be aware of breast cancer prevention and to have undergone screening programs in their lifetime. Emerges the strong willingness of women prisoners to be involved and the educational role of the nurse in the prison setting also from a gender perspective.

Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties.

CONTEXT: In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed. OBJECTIVES: Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties. METHODS: Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria. RESULTS: Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales. CONCLUSION: Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.

Respiratory Distress Observation Scale Italian Version: Cultural-Linguistic Validation and Psychometric Properties.

Dyspnea can be assessed using self-rating scales but, as death approaches, self-reporting becomes difficult. The validated Respiratory Distress Observation Scale measures dyspnea distress. The aim of this study was to develop the Italian version of the Respiratory Distress Observation Scale and to examine its psychometric properties. This was a cross-sectional study, analyzing cultural and linguistic validation, content validity, and psychometric properties. Eighty-nine palliative care subjects were enrolled to validate the Italian version of the Respiratory Distress Observation Scale. Patients had an average age of 74.5 (SD, 11.6) years, and 52% (n = 46) were female. Fourteen experts in palliative care evaluated the Italian Respiratory Distress Observation Scale in terms of the content validity ratio and the content validity index (CVI). The Italian Respiratory Distress Observation Scale was reported with an internal consistency (Cronbach α value) of .72 and an overall substantial interrater reliability (Cohen κ method). The Italian Respiratory Distress Observation Scale achieved a scale-level CVI of 93%, an items-level CVI of greater than 86%, and a minimum content validity ratio value of 0.71. A weak positive correlation was found between the Respiratory Distress Observation Scale and the Dyspnea Visual Analog Scale scores (0.374; P < .001). The Italian Respiratory Distress Observation Scale showed good reliability and validity for patients in palliative care. The Respiratory Distress Observation Scale measured respiratory distress in patients nearest to death.

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings.

CONTEXT: The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest. OBJECTIVES: To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer. METHODS: A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested. RESULTS: The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74-0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33-0.36, respectively). CONCLUSION: The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

[Head and neck neoplasms and palliative care, symptoms and quality of life: literature review.] / Neoplasie testa-collo e cure palliative, sintomi e qualità di vita: revisione della letteratura.

Head-neck neoplasms are the fifth most common cancer. Head-neck patients are particularly exposed to quality of life impairment due to the central anatomical-functional role of this region in primary functions such as breathing, swallowing and phonation. Many patients are already at an advanced stage of the disease at the time of diagnosis and their prognosis remains unfavourable despite new treatment options. They face daily with multiple and simultaneous symptoms. In 20% of cases the average survival is only 5 months, making it appropriate to take charge early for the important need of palliative care. The aim of this review is to deepen the knowledge concerning the neoplasms of the head-neck district, with particular reference to the symptoms and quality of life of people in advanced stage and in palliative care. The literature review was performed through CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, Scopus and Web of Science. The research identified 9 studies that met the inclusion criteria. The results of the studies showed the prevalent symptoms of dyspnea, fatigue, nutrition and oral problems, pain, insomnia, anxiety and depression. Oral nutrition could be compromised, producing weight loss and malnutrition. In such a condition, the enteral route could be necessary. The impact of the symptoms was greater for those who could not maintain adequate nutrition and was a predictor of reduced food intake, weight loss and survival. Malnutrition influenced the performance status and quality of life which seemed to remain unchanged as the end of life approached. Mucositis, dysphagia and xerostomia had a strong association. Dysphagia was related to dysphonia. A worsening of emotional distress was shown in relation to the female gender and the tumor site. Head-neck cancer had a strong impact on the quality of life. Patients considere dyspnea, dysphonia, mobility problems, anger and weakness as the most important issues. Earlier interventions could allow a partial and temporary improvement of quality of life compatible with the patient's conditions. Nursing care involves multidimensional assessment and an early individualized, symptom-driven and needs-oriented approach.