In recent years, there has been a significant change in the type of patients referred to memory clinics, characterized by an increase in mildly symptomatic individuals and potentially even healthy people at risk of cognitive decline due to Alzheimer's disease and other neurodegenerative diseases in this context. Additionally, there is growing interest in developing health services focused on brain health throughout the lifespan, particularly within a primary prevention framework. This effort has led to proposing dedicated "brain health services" for dementia risk reduction. However, in the context of cognitive disorders, distinguishing between primary and secondary prevention poses significant challenges, particularly in identifying individuals within the general population who may exhibit subtle cognitive decline or early-stage neurodegeneration. We propose seven key dimensions for assessing "brain health": cognitive reserve along with social and functional status, cognitive decline, mood and sleep disorders, general dementia risk factors, geriatric syndromes in older adults, structural brain damage, and neurodegenerative proteinopathies. Together, these dimensions form a comprehensive "brain health chart". We review the known evidence for each dimension's role in assessing brain health, emphasizing approaches that can be applied in a community setting. We believe that by identifying broadly applicable assessment methods for these dimensions, the development of personalized strategies for maintaining brain health could be facilitated.

Objectives:The present study aimed to identify factors that affect healthcare workers' (HCWs) vaccine hesitancy and the subsequent changes in psychological well-being. Study design:800 employees (207 M; 14 aged ≤ 25; 145 aged 26-35; 381 aged 36-55; 260 aged > 55 years) were recruited from the San Martino Hospital during the first months 2021. Methods:HCWs were asked to fill in an online survey assessing (a) demographics, (b) having contracted COVID-19 infection, (c) vaccination history (against COVID-19 and influenza), (d) expected changes in psychological well-being, (e) vaccine hesitancy and (f) factors leading to a decision about the vaccine (Information Trust, Information Seeking, Fear for the Self, and Sense of Responsibility). Results:We found that, in vaccinated HCW, years of employment and adherence to the influenza vaccine indirectly affected vaccine hesitancy. These effects were mediated by HCWs' sense of responsibility and information trust. Moreover, while information trust promoted positive changes in psychological well-being, vaccine hesitancy negatively affected it. Conclusions:The present study consistently points to the crucial role of trusting information and having a sense of responsibility on vaccine hesitancy and, consequently, on psychological well-being. We discuss the practical implications for public health of these findings. In the conclusions, we suggest short-term and long-term strategies for improving vaccine adherence.

Background: SOMI (Stages of Objective Memory Impairment) is a novel classification that identifies six stages of memory decline in Alzheimer's Disease (AD) using the Free and Cued Selective Reminding Test (FCSRT). However, the relationship between SOMI stages and brain metabolism remains unexplored. This study aims to investigate the metabolic correlates of SOMI stages using FDG-PET in Mild Cognitive Impairment due to AD (MCI-AD) and early AD patients.Methods: One hundred twenty-nine-patients (99 aMCI-AD and 30 AD), and 42 healthy controls (HCs) (MMSE = 29.2 +/- .8; age:69.1 +/- 8.6 years; education:10.7 +/- 3.8 years) who underwent an extensive neuropsychological battery including FCSRT and brain FDG-PET were enrolled. According to their clinical relevance and available sample sizes, SOMI-4 (N = 24 subjects; MMSE score:26.6 +/- 2.6: age:75.4 +/- 3.2; education:9.9 +/- 4.5) and SOMI-5 groups (N = 97; MMSE:25.3 +/- 2.6; age:73.9 +/- 5.8; education:9.4 +/- 4.1) were investigated.Results: Compared to HCs, SOMI-4 showed hypometabolism in the precuneus, medial temporal gyrus bilaterally, right pecuneus and angular gyrus. SOMI-5 exhibited broader hypometabolism, extending to the left posterior cingulate and medial frontal gyrus bilaterally. The conjunction analysis revealed overlapping areas in the precuneus, medial temporal gyrus bilaterally, and in the right angular gyrus and cuneus. The disjunction analysis identified SOMI-5 specific hypometabolism encompassing left inferior temporal gyrus, uncus and parahippocampal gyrus, and medial frontal gyrus bilaterally (p < .001, p-value (FWE) < .05).Discussion: SOMI-4 relates to posterior hypometabolism, while SOMI-5 to more extensive hypometabolism further encompassing frontal cortices, suggesting SOMI as a biologically relevant classification system of memory decline.Conclusion: Memory decline staged with SOMI is associated with hypometabolism spreading in amnesic MCI-AD/AD, suggesting its usefulness as a clinical marker of increasing neurodegeneration.

Background and aims. Elders’ abuse is a matter of growing public and heath care concern. So far, the real magnitude of the problem is unexplored, especially in frail patients with dementia who experience communicating problems. Self-report screening tools for abuse limited their diagnostic accuracy in persons with dementia. Starting from this background, here we aimed at comparing the diagnostic accuracy of Elder Assessment Instrument (EAI) and the Indicator of Abuse (IOA) tools to assess elders’ abuse in real world older adults with dementia or communication impairment at in hospital admittance and to preliminary explore the potential abusive home environment. Methods. This is an observational prospective study on 70 consecutive patients aged 75 years and more, with mostly dementia of Alzheimer’s type admitted at the Geriatric clinic of the IRCCS Policlinico San Martino Hospital of Genoa, Italy. All patients received psychogeriatric assessment. The size of home environment was assessed, including caregiver’ age, cohabitation, and average economic income.Results. EAI tool showed a good diagnostic accuracy compared with IOA (AUC 0.83) (95% CI: 0.73-0.95); sensitivity of 78.6%; specificity of 76.8%) and a cut off score of 45 for EAI was also identified for the detection of elder’s abuse risk. Conclusions. This is the first report to compare the diagnostic accuracy of two observational tools for elders abuse in dementia or communication impairment. Moreover, the identification of a specific cut off score for EAI screening tool may contribute to the earlier identification of a potential abuse in such a highly vulnerable population, with potential implications in this neglected field.

Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health.

Background. The risk of disease transmission from nonstandard risk donors (NSRDs) is low, and outcomes are similar or better relative to transplants performed with standard criteria donors. However, NSRDs have posed new ethical challenges to the informed consent (IC) process. Based on the shared decision-making model, coinciding with the 3 main timings of the IC process ([1] pretransplant assessments and waiting list registration, [2] time on the waiting list, and [3] time of the organ offer), we put forward a model (3-T Model) to summarize the knowledge on IC for NSRDs and to deliver conceptual and practical support to transplant providers on this emergent issue. Methods. We searched PubMed and analyzed data from our area to provide evidence and ethical arguments to promote standardization of the timing of patient information, degree of patient participation, and disclosure of donor risk factors throughout the 3 stages of the time continuum leading to the potential acceptance of NSRDs. Results. Each of the 3 timings carries special ethical significance and entails well-defined duties for transplant providers relative to patient involvement and information of the benefits and risks associated with NSRDs. Based on our framework, experience, and interpretation of the literature, we put forward a list of recommendations to combine standardization (ie, timing, content, and degree of patient participation) and individualization of IC. Conclusions. The 3-T Model may enable the prevention of physicians’ arbitrariness and the promotion of patient-centered care. Future studies will assess the effectiveness of the 3-T Model in transplant clinical practice.

Kidney transplantation is a serious event that involves profound psychological, relational and social changes both for the patient and his family context. Assessment of personality profile, awareness of disease, family and social support of the patient candidate for kidney transplantation are necessary because factors not adequately considered, can influence the success of the transplant and alter the psychological stability of the patient. The present study aims to provide a systematic review of the literature of the last twelve years (2006–2018), focusing in particular on patient’s readiness level and illness management and on possible psychopathology. Sixty-two studies were examined. Based on the Downs and Black checklist, most studies (n = 32) were of high quality; 15 of which related to lifestyle, health education, and therapeutic adherence in post-renal transplantation, 17 studies concerned the possible existence of psychopathology and cognitive impairment of renal deceased transplanted subjects. The literature used has shown that the population of kidney transplant patients is exposed to a high risk of psychiatric disorders with repercussions on the quality of life and the risk of rejection. Therefore, an adequate pre-transplant psychosocial assessment is necessary, which allows a more in-depth knowledge of the candidate to plan coping strategies and possible post-transplant psychotherapy.

Kidney transplantation is a serious event that involves profound psychological, relational and social changes both for the patient and his family context. Assessment of personality profile, awareness of disease, family and social support of the patient candidate for kidney transplantation are necessary because factors not adequately considered, can influence the success of the transplant and alter the psychological stability of the patient. The present study aims to provide a systematic review of the literature of the last twelve years (2006-2018), focusing in particular on patient's readiness level and illness management and on possible psychopathology. Sixty-two studies were examined. Based on the Downs and Black checklist, most studies (n = 32) were of high quality; 15 of which related to lifestyle, health education, and therapeutic adherence in post-renal transplantation, 17 studies concerned the possible existence of psychopathology and cognitive impairment of renal deceased transplanted subjects. The literature used has shown that the population of kidney transplant patients is exposed to a high risk of psychiatric disorders with repercussions on the quality of life and the risk of rejection. Therefore, an adequate pre-transplant psychosocial assessment is necessary, which allows a more in-depth knowledge of the candidate to plan coping strategies and possible post-transplant psychotherapy.

BACKGROUND:The amount of time spent in dialysis waiting for a renal transplantation significantly affects its outcome. Hence, the timely planning of patients' transplant evaluation is crucial. According to data from the Nord Italia Transplant program (NITp), the average waiting time between the beginning of dialysis and the admission to the regional transplant waiting list in Lombardy is 20.2 months.METHODS:A multicenter cross-sectional study was conducted in order to identify the causes of these delays and find solutions. Two questionnaires were administered to the directors of 47 Nephrology Units and to 106 patients undergoing dialysis in Lombardy respectively, during their first visit for admission to the transplant waiting list.RESULTS:The comparative analysis of the results revealed that both patients (52%) and directors (75%) consider the time required for registering to the waiting list too long. Patients judge information about the transplant to be insufficient, especially regarding the pre-emptive option (63% of patients declare that they had not been informed about this opportunity). Patients report a significantly longer time for the completion of pre-transplantation tests (more than 1 year in 23% of the cases) compared to that indicated by the directors.CONCLUSIONS:The study confirmed the necessity of providing better and more timely information to patients regarding the different kidney transplantation options and highlighted the importance of creating target-oriented and dedicated pathways in all hospitals.

INTRODUCTION:An increase in the rate of non-fatal violence events, from 20.65/10,000 in 2012 to 22.81/10,000 in 2014, was observed at the IRCCS Ospedale Policlinico San Martino in Genoa.OBJECTIVES:To analyze the incidence and outcome of the phenomenon of violence, by identifying the type of aggressive event and the ward in which it occurred, assuming that the occurrence is evenly distributed and not only limited to the psychiatric or to the emergency department. The age and sex of both attackers and victims of aggression were also analyzed.METHODS:Retrospective analysis: study of injury trends related to episodes of violence between 2012 and 2015, incidence compared to other injuries and evaluation of the direct costs. Observational staff surveys with a questionnaire based on the Overt Aggression Scale and statistical data analysis.RESULTS:Following the aggressions, 36 injuries were identified over the study period (2012-2015), resulting in 431 days of absence from work. The direct estimated costs were € 64,170. The observational surveys of each ward showed a high concentration of events. Reports were received from 34 out of the 76 evaluated wards. Seventy-five percent of the reports concerned only four operative units: emergency room, intermediate care, psychiatry and geriatrics. Sixty-one percent of the questionnaires were filled out by nurses, 23% by support staff and the remaining 16% was provided by physicians and coordinators.CONCLUSIONS:Violence against healthcare workers is a well-known problem; action is required on the scheduling of activities, improvement of communication paths with users and the training of operators.

OBJECTIVE:There is strong evidence that many patients with chronic diseases have difficulties to adhere to the medical regimens. As to transplantation, nonadherence to the prescribed medical regimen has repeatedly been found to predict morbidity and mortality, both in adults and in children. Many instruments are available in order to assess nonadherence to immunosuppressive medication, whereas only few are available on behavioural components. Aim of the study was to present the Adherence Schedule in Transplantation (ASiT, in its three versions: ASiT-A, Adults; ASiT-PA, Proxy Adult and ASiT-PC, Proxy Child) that evaluates the Cognitive Relational Antecedents of adherence to treatment and the Self-efficacy in disease management in patients before and after transplantation.METHOD:(1) Review and construct analysis of the already existing adherence Schedules, on the basis of literature review and clinical experience; (2) Construction of the ASiT in its three versions from an adaptation of the already existing adherence Schedules; (3) Administration of the ASiT to pre and post transplant recipients followed by a semi-structured interview in order to discuss with the patients pros and cons; (4) ASiT correction on the basis of patients' comments; (5) Translation in English by a bilingual English mother tongue.RESULTS:On the whole 56 Schedules were administered to pre and post transplant (liver, heart, lung and kidney) recipients and their proxy and resulted to have good construct validity, were easily administered and were well accepted by patients.CONCLUSIONS:As to research the ASiT could cover a wide range of nonadherence sources. Within a clinical context our Schedule could be a not time consuming tool useful in favouring the communication about adherence and able to enhance patients' personal limits and resources.

The usage of a computerized system to organize data and ease the activity procedures of liver transplantation is useful in clinical transplantation. Preliminary cognitive research on systems of clinical transplantation database concerning medical reports was performed to verify their development level. The survey highlighted that, so far, there has been no experimentation that can be applied to a medical report type devoted to liver transplantation. Regulations in force substantially point out that the medical report ought to contain all items that have to be taken into account in handling the patient from pretransplantation to follow-up. The Department of Transplantation of Genoa chose its medical report model for liver transplantation. The medical report model included the following items: personal data; case history; diagnosis; initial examination for prelisting; fitness for transplantation; assistance context; clinical data including subjective, objective, and instrumental parameters; pharmacological therapies; informed consent, evaluation of fitness; nursing data; counseling and clinical evaluations according to protocols and guidelines of the national transplantation centers. If the computing is well trained, it is supposed to help maintain a whole data view provided it is supplied information in an adequate way. Immediate clinical procedural advantages and useful scientific observations may be obtained from a high-quality database. In fact, all functions have to be applied to specific clinical, administrative needs to be remotely shared and conveniently integrated with each other to make the liver transplantation medical report an easy and handy instrument for inputting and handling data. It must be a precise, complete instrument that may be accessible in real time from any site connected with the intranet network, be unchangeable, and be protected to ensure certification and forensic medicine value.