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1.  The Italian SEME Surveillance System of Severe Mental Disorders Presenting to Community Mental Health Services 
Mental health is recognized worldwide as a major public health priority for the twenty-first century. Different actions are needed, including developing or strengthening national mental health information systems, based on standardized indicators that allow national and international monitoring. In 2008, the national Centre for Disease prevention and Control of the Italian Ministry of Health and the Mental Health Unit of the Italian National Institute of Health (INIH) jointly launched a mental health information system named SEME (an Italian acronym meaning ‘mental health epidemiological surveillance’) based upon data collected from trained psychiatrists working in 22 selected sentinel community mental health centers distributed across Italy and covering a total population of 1,941,853 inhabitants, in order to collect and report site-level information on first-contact patients suffering from specific severe mental disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, bipolar I disorder, anorexia nervosa, major depressive episode with psychotic symptoms or suicide attempt). Strengths of the system are the high reliability of diagnoses and the use of a web-based technique for data collection with data entry forms designed for ease of completion. During the first year of implementation of this system, a total of 343 first-contact patients met criteria for one of the severe mental disorders under surveillance. As the system includes standardized instruments to measure psychiatric symptoms and psychosocial functioning, it may facilitate health services research based on longitudinal measurements aimed at evaluating the continuity of psychiatric care and the effectiveness of innovative therapeutic and rehabilitative programs.
doi:10.2174/1745017901208010007
PMCID: PMC3293155  PMID: 22435071
Community mental health services; first-contact patients; incidence; sentinel surveillance; severe mental disorders.
2.  Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge 
BMC Public Health  2009;9:306.
Background
The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements.
Methods
All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed.
Results
No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge.
Conclusion
Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.
doi:10.1186/1471-2458-9-306
PMCID: PMC2746213  PMID: 19698136
3.  Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview – Short Form (CIDI-SF) for assessing mental disorders 
Background
The Composite International Diagnostic Interview – Short Form consists of short form scales for evaluating psychiatric disorders. Also for this version training of the interviewer is required. Moreover, the confidentiality could be not adequately protected.
This study focuses on the preliminary validation of a brief self-completed questionnaire which originates from the CIDI-SF.
Sampling and Methods
A preliminary version was assessed for content and face validity. An intermediate version was evaluated for test-retest reliability. The final version of the questionnaire was evaluated for factor exploratory analysis, and internal consistency.
Results
After the modifications by the focus groups, the questionnaire included 29 initial probe questions and 56 secondary questions. The test retest reliability weighted Kappas were acceptable to excellent for the vast majority of questions. Factor analysis revealed six factors explaining 53.6% of total variance. Cronbach's alpha was 0.89 for the questionnaire and 0.89, 0.67, 0.71, 0.71, 0.49, and 0.67, for the six factors respectively.
Conclusion
The questionnaire has satisfactory reliability, and internal consistency, and might be efficient for using in community research and clinical practice. In the future, the questionnaire could be further validated (i.e., concurrent validity, discriminant validity).
doi:10.1186/1745-0179-4-8
PMCID: PMC2329624  PMID: 18402667
4.  A new self-report questionnaire called "ABC" to evaluate in a clinical practice the aid perceived from services by relatives, needs and family burden of severe mental illness 
Objective
To describe: a) a self-report questionnaire of 34 item, developed by a Family Association of Psychiatric Patients in collaboration with two psychiatrists to evaluate by key-relative in a clinical practice the perceived quality of mental health services, the needs and family burden; b) the methodology of validation.
Methods
It has been studied (a) the Face Validity by two focus groups of 10 relatives for each group, (b) the concurrent validity of family burden items comparing the ABC with QPF, a widely used questionnaire, in 6 Italian mental health centres on a sample of key-relatives, (c) the discriminant validity comparing three different samples of key-relatives of patients with psychiatric illness, Alzheimer or cancer. The internal consistency of items for assessing relatives' opinions on the quality of care has been evaluated by Chronbach' s α. The test-retest has been evaluated on a sample of 20 key-relatives.
Results
The results indicate a fairly good performance of the questionnaire in this preliminary but almost complete phase of validation. The time to fill in it has been estimated in a 7 minutes average.
Conclusion
It is possible by this self-report questionnaire to evaluate in a clinical routine setting and in a very short time three important problems for relatives and professionals: opinions and needs of relatives, and objective and subjective family burden of severe mental illness.
doi:10.1186/1745-0179-3-15
PMCID: PMC2031885  PMID: 17877813
5.  Effectiveness of cognitive-behavioural group therapy for inpatients 
Objective
To measure the effectiveness of manualized cognitive-behavioural group therapy (CBGT) when it is integrated into the routine care on a general hospital psychiatric inpatient unit.
Methods
A pre-post design is used to measure the "process", "results" and "outcome" indicators in the year before CBGT was introduced (2001) in contrast to the subsequent two years (2002, 2003). Readmission to hospital, compulsory admissions, ward atmosphere (i.e. the use of physical restraint, episodes of violent behaviour) and patients' satisfaction were assessed.
Results
90% of all inpatients in the years 2002–2003 attended the group therapy. In the years after CBGT was introduced the rate of readmission declined from 38% to 27% and 24% (p < .04), compulsory admissions were reduced from 17% to 4% (p < .03), the ward atmosphere and patients' satisfaction were both excellent (p < .01).
Conclusion
It is probable that the improvements observed were attributable to the group therapy. These results and those observed in an earlier study are promising and further investigations of this approach are indicated.
doi:10.1186/1745-0179-2-16
PMCID: PMC1552055  PMID: 16859548
6.  Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial 
Background
Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices.
The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi – in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia.
Method
Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores.
Results
31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning.
Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study).
Conclusion
The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated.
doi:10.1186/1745-0179-2-5
PMCID: PMC1501010  PMID: 16584543

Results 1-6 (6)