Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure.

OBJECTIVE: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units' performance measured through mortality rates and efficiency indicators. METHODS: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors' knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units' performance indicators which include patients' mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. RESULTS: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units' efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units' mortality rates (odds ratio, -8.677; 95% confidence interval, -16.654, -0.700). CONCLUSION: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.

Amygdala responses to masked and low spatial frequency fearful faces: a preliminary fMRI study in panic disorder.

Previous studies have demonstrated amygdala activation in response to fearful faces even if presented below the threshold of conscious visual perception. It has also been proposed that subcortical regions are selectively sensitive to low spatial frequency (LSF) information. However, chronic hyperarousal may reduce amygdala activation in panic disorder (PD). Our aim was to establish whether the amygdala is engaged by masked and LSF fearful faces in PD as compared to healthy subjects. Neutral faces were used as the mask stimulus. Thirteen PD patients (seven females, six males; mean age=29.1 (S.D: 5.9)) and 15 healthy volunteers (seven females, eight males; mean age=27.9 (S.D. 4.5)) underwent two passive viewing tasks during a 3T functional magnetic resonance imaging (fMRI) as follows: 1) presentation of faces with fearful versus neutral expressions (17ms) using a backward masking procedure and 2) presentation of the same faces whose spatial frequency contents had been manipulated by low-pass filtering. Level of awareness was confirmed by a forced choice fear-detection task. Whereas controls showed bilateral activation to fearful masked faces versus neutral faces, patients failed to show activation within the amygdala. LSF stimuli did not elicit amygdala response in either group, contrary to the view that LSF information plays a crucial role in the processing of facial expressions in the amygdala. Findings suggest maladaptive amygdala responses to potentially threatening visual stimuli in PD patients.

Pituitary gland volume in currently depressed and remitted depressed patients.

Major depressive disorder (MDD) has been associated with increased pituitary gland volume (PGV), which is thought to reflect stress-related dysregulation related to hypothalamic-pituitary-adrenal (HPA) axis activity. However, it is unclear whether PGV alteration reflects a "dynamic" change related to current mood instability or if it is a stable marker of illness vulnerability. In this study we investigated PGV in currently depressed patients (cMDD) (n=31), remitted depressed patients (rMDD) (n=31) and healthy controls (n=33), using 1.5 Tesla magnetic resonance imaging (MRI). The groups were matched for age and gender. We found no significant PGV, intra-cranial volume (ICV) or whole brain volume (WBV) differences between cMDD patients, rMDD patients and healthy controls. Furthermore, PGV was not correlated with clinical features of depression (e.g., age of onset; number of episodes; and scores on subscales of the Beck Depression Inventory, the Positive Affect and Negative Affect Scale, and the Mood and Anxiety Symptom Questionnaire). In conclusion, PGV does not appear to be a marker of current or past MDD in adult patients.

Comportamientos antisociales: la investigación moderna aclara errores sobre la causalidad entre enfermedad mental y conductas violentas / Antisocial behaviors: the modern research explains errors about causality between mental disease and violent behavior

El fenómeno de la violencia está en aumento en todos los países del mundo y se puede hablar de epidemia social. Su causa no es específica de un único factor: sea este biológico, social, económico o ambiental. Según los resultados de la investigación moderna los comportamientos antisociales responden a una interfactorialidad y por lo tanto se presentan de manera compleja. Podemos añadir, como ulterior confirmación cientifica, la investigación realizada sobre personas con síndromes esquizofrénicos en las ciudades de Bolonia y Bouider, que demuestran que el crimen no esta mecánicamente relacionado con la enfermedad mental. En psiquiatría el enfoque multidisciplinario permite distinguir netamente el trastorno mental de la conducta violenta. La contención del fenómeno de la violencia es sólo posible con una política de salud pública interinstitucional, multidisciplinaria e interprofesional dirigida hacia la promoción de la salud, a partir de la tutela del bienestar infantil