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The media and scientific literature are increasingly reporting an escalation of large carnivore attacks on humans, mainly in the so-called developed countries, such as Europe and North America. Although large carnivore populations have generally increased in developed countries, increased numbers are not solely responsible for the observed rise in the number of attacks. Of the eight bear species inhabiting the world, two (i.e. the Andean bear and the giant panda) have never been reported to attack humans, whereas the other six species have: sun bears Helarctos malayanus, sloth bears Melursus ursinus, Asiatic black bears Ursus thibetanus, American black bears Ursus americanus, brown bears Ursus arctos, and polar bears Ursus maritimus. This chapter provides insights into the causes, and as a result the prevention, of bear attacks on people. Prevention and information that can encourage appropriate human behavior when sharing the landscape with bears are of paramount importance to reduce both potentially fatal human–bear encounters and their consequences to bear conservation.
To describe the main features of the younger group of patients hospitalized (January 1st and December 31st) in the Acute Psychiatry Unit of a General Hospital in Bologna (Northern Italy), comparing their socio-demographic and clinical characteristics and their needs with those of the adult patients admitted.
Retrospective consultation of case-histories concerning 111 subjects (60.4% men) randomly selected. Chi-square and independent sample T-test used to compare 33 cases (≤21 years) and 78 controls (35-49 years).
Young-cases had a higher prevalence of parental separation (31% vs 2.7%; p< 0.001) and were more frequently adopted (18.8% vs 0%; p=0.01). Psychomotor agitation or etero/self-aggressiveness (36.4%) and personality disorders (12.1%) were the most prevalent causes of hospitalization among the younger group, whereas psychosis (32.1%), mood disorders (19.2%) and alcohol-substances dependence (11.5%) were more common in controls (p< 0.001). Presence of unfavorable life-events was two-fold higher in cases than in controls (p=0.074). In particular, quarrels with family (40%) or friends (20%) and substance abuse (13.3%) occurred especially in young individuals. In adults, mournings/separations and rejection therapy were more frequent (p=0.017).
Hospitalization's features (type, length, number of laboratory and instrumental exams) were not significantly different among the two groups, except for frequency and number of interviews and childpsychiatrists and educators’ care provided that prevailed in cases.
The young population admitted in our acute psychiatric ward has a complex sociorelational and clinical situation requiring a multi-professional management. The frequent need of care in emergent/urgent situation highlights the importance of further studies on this issue.
Even if medical and psychiatric co-morbidity often overlap, specific combined medical-psychiatric units do not exist in Italy and elderly who need urgent psychiatric care are usually admitted in the Acute Psychiatry Unit of general hospitals despite many difficulties. The aim of this study is to describe this phenomenon.
55 cases (>65 years) and 120 randomly selected controls (30-60 years), were picked-up among all patients hospitalized between 1st January-31st December 2008. Socio-demographic and clinical information were collected through the retrospective consultation of the case histories of all participants.
Cases were significantly different from controls in terms of psychiatric background, medical history and medical pharmacotherapy: mood disorders (38.2%) and positive medical histories (81.8%) prevailed among elderly as compared to adult controls (p< 0.001; p< 0.001 respectively). The use of drugs (other than psychotropic ones) was four-fold more frequent in the elderly (74.5% vs 16.6%; p< 0.001). Cases and controls used differently the service: elderly requiring more frequently medical pharmacotherapy (81.8% vs 27.5%; p< 0.001), specialist consults (38.2% vs 11.6%; p< 0.001), laboratory tests (76.4% vs 60%; p=0.04) and instrumental tests (chest radiography 9% vs 0.8%; p=0.01; brain neuroimaging 12.7% vs 2.5%; p=0.01).The multi-adjusted logistic regression analysis confirmed a different pattern of use of the acute psychiatric service for elderly as compared to adult controls.
Elderly have peculiar medical histories and distinguishing management needs, notably in the medical field. Our data suggested the need of a new clinical approach concerning combined psychiatric-medical inpatient acute units in Italy.
To evaluate the features of Frequent-Attenders (FAs) admitted to an Acute Psychiatric Unit of a general hospital in Bologna, Northern Italy.
Persons admitted between January 2008-June 2009 (N=110) were randomly selected thanks to the Hospital Information System. All participants’ admissions in the indexed period were recorded, the case-history of the first admission was reviewed gathering socio-demographic and clinical information. The International Classification of Disease (ICD-10) was used for diagnosis. FAs were defined for 3 or more admissions within 18 months (Botha et al. 2009).
Almost one out of three patients was a FA (N=34; 30.9%). The mean number of admission for each subject being 5.6±3.4 for an average length of stay of 56.2±62.1 days. In comparison to single users, FAs were more frequently men (67.6% vs. 46.1%; p=0.029), unemployed (79.4% vs. 29.2%; p< 0.001) and living in social-health facilities (29.4% vs. 9.5%; p< 0.024). FAs and common users were not different concerning compulsory/voluntary admission. Schizophrenia and other Psychotic Disorders were predominant among FAs (44.1%), followed by Substance Use and Personality Disorders (14.7%), but no differences were detectable between cases and controls in terms of discharge diagnoses. Conversely, the prevalence of concomitant organic diseases was higher in FAs (50% vs. 27.6%; p=0.020).Finally, the results of the Logistic Regression Model estimating Odds Ratios and 95% Confidence Intervals suggested that FAs had a lower insight/compliance (2.15; 2.50-29.66; p=0.001).
FAs have a higher mental-social disability. A targeted treatment might reduce the frequency of hospitalization.
Immigration to Spain is a recent but rapidly growing fenomena. The prevalence of psychiatric disorders in the immigrants relative to natives is an inconclusive theme, given that several studies have found contradictory results.
This study presents sociodemographic characteristics and the prevalence of mood disorders (detected with MINI) of 842 adults (411 Latinos and 431 Natives), attending primary care in the greater Barcelona metropolitan area.
Most of the sample was female (n=591; 70.2%), the mean age was 34.7 (±9.8) years, range 18-65. Significant (p< 0,001) differences were found between the two groups in: scholarization, housing, work status, income and percived social network.
The prevalence of actual major depresssive disorder (MDD) was 12.7% in the total sample, with a higer prevalence in the Latinos (n=68; 16.5%) than Natives (n=39; 9.0%); p=0.001 X2=10.57.There was no difference in total prevalences of other mood disorders between the two groups. Analysis -through logistic regression- of only those patients with complete data, (n=613; 307 Latinos and 306 Natives) showed that the probability of MDD was higer in Latinos than in Native patients (OR= 2.4; 95% CI= 1.5-4.0). After adjusting for gender and all the significantly different variables, the higer risk of MDD in Latinos disappeared (OR= 1.3; 95% CI= 0.7-2.4).
From these data we can conlude that the relation between immigrant status and depression is not direct but rather mediated by disadvantaged social conditions. In further similar studies social variables should be considered.
To describe the leading cause of re-hospitalization in an Acute Psychiatric Unit of a general hospital in Bologna, Northern Italy.
All repeated admissions (>3consecutive admissions in 18 months) were recorded thanks to the Hospital Informatic System. Case-history were reviewed to collect information, diagnoses were based on the ICD-10.
In the indexed period, 392 admissions were registered for 152 patients (mean age 44; 46,1% women). At least one precipitating cause was present in 64% of admissions. The most frequent were psycho-social stress such as family conflicts, parental separations, relational problems, job or economic difficulties (39%). The co-occurrence of 2+ of such factors was common (20%). Tricky situation within the psychiatric rehabilitation service (20%), low compliance to treatments (7%), alcohol/drugs abuse (7%), and low insight (3%) were the remaining associated factors. All the re-admissions of patients with poor insight or reduced compliance were due to the same cause. Poor adherence to therapies was more frequent in bipolar disorder compared with other diagnosis (17%vs7%, p<0.005). In patients affected by personality disorders the contemporary presence of 2 or more factors was needed in 40% of admissions. Patients with schizophrenia showed the most hetherogeneous pattern of precipitating factors.
Regardless of diagnoses, in almost a half of the admissions a single psycho-social stress is sufficient to lead to re-hospitalization; in personality disorders the contemporary presence of 2+ stressors is needed to overcome the capacity compensation of the patient. Low insight is frequently associated to re-admissions. Tailored treatments might reduce the frequency of re-hospitalization.
The relationship between immigration and drug abuse and its treatment is complex and poorly understood. The objective of this study is to gain insight into patterns of drug use and service access and how they are influenced by social factors and the migratory process in a population of foreign born drug users in Barcelona, Spain.
An interview protocol was developed for the study which examined drug use patterns, social and health factors, and treatment, and was administered to 118 foreign born users in harm reduction centers. 92% were male and 8% were female. 42% were from Eastern Europe, 35% were from the Magreb, 14% from the European Community, 6% from Subsaharan Africa and 3% from Latin America.
With migration opium use decreased whereas cocaine, heroin, and speedball increased, which also constitute the primary drug used by this sample. Social support was correlated with greater consumption of heroin, cocaine, and alcohol, whereas lower social stress was predictive of higher cannabis use. Hard drug use was predicted by illegal status and a lack of stable housing. Acculturation and acclturative stress were not found to be related to substance use. Treatment was positively evaluated, with no perception of lower quality of care.
Drug use patterns shift with the migratory process, and, it would appear, adapt to the dominant local ones. The unexpecting findings regarding social factors and acculturation and acculturative stress may indicate differences in the Spanish drug use context, and as such warrant further research.
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