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Heterogeneity of the Departments of Mental Health in the Veneto Region ten years after the National Plan 1994-96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project
- Antonio Lasalvia, Bruno Gentile, Mirella Ruggeri, Alessandro Marcolin, Flavio Nosè, Lodovico Cappellari, Dario Lamonaca, Emanuele Toniolo, Claudio Busana, Antonio Campedelli, Giancarlo Cuccato, Andrea Danieli, Fabio De Nardi, Vincenzo De Nardo, Ernesto Destro, Gerardo Favaretto, Silvio Frazzingaro, Mario Giacopuzzi, Paolo Pristinger, Giuseppe Pullia, Sandro Rodighiero, Paolo Tito, Francesco Aprile, Stylianos Nicolaou, Giuseppe Coppola, Nicola Garzotto, Umberto Gottardi, Ermanna Lazzarin, Giuseppe Migliorini, Luigi Pavan, Fabrizio Ramaciotti, Paolo Roveroni, Salvatore Russo, Pierpaolo Urbani, Michele Tansella
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 16 / Issue 1 / March 2007
- Published online by Cambridge University Press:
- 18 May 2011, pp. 59-70
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- Article
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Aims - This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health (“Progetto Obiettivo 1994-1996”) ten years after its launch. Methods - The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. Results - CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. Conclusions - A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.
Declaration of Interest: The study has been supported by the Regione del Veneto, Giunta Regionale, Ricerca Sanitaria Finalizzata 2004, Venezia, Italia (grant to Professor M. Ruggeri).
74 - Aseptic Meningitis Syndrome
- from Part X - Clinical Syndromes – Neurologic System
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- By Burt R. Meyers, Mt. Sinai School of Medicine, Mirella Salvatore, Mt. Sinai School of Medicine
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 513-520
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- Chapter
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Summary
Aseptic meningitis syndrome is associated with symptoms, signs, and laboratory evidence of meningeal inflammation with spinal fluid findings that suggest a viral or noninfectious origin. Clinically, patients present with headache, nausea, meningismus, and photophobia, symptoms that are also common in patients with bacterial meningitis. A stiff neck, with or without a Brudzinski or Kernig sign, may be observed. Patients usually appear nontoxic but may have changes in mental status, including irritability. Other signs of possible viral infection may include pharyngitis, adenopathy, morbilliform rash, and evidence of systemic viral infection, including myalgia, fatigue, and anorexia. There are usually no signs of vascular instability, and the course is often self-limiting.
Aseptic meningitis is a syndrome of multiple etiologies, both infectious and noninfectious (Table 74.1). Infections are usually of viral origin but also may be due to mycobacteria, fungi, rickettsiae, and parasites. Group B coxsackieviruses (mostly serotypes 2 through 5) and echoviruses (mostly serotypes 4, 6, 9, 11, 16, and 30) are responsible for more than 90% of cases of viral meningitis. Herpes virus, arboviruses, lymphocytic choriomeningitis virus (LCM), Lyme disease, leptospirosis, and acute human immunodeficiency virus (HIV) are the etiologic agents that make up most of the remaining infectious cases. Noninfectious causes include drug reactions, collagen-vascular diseases (ie, lupus erythematosus granulomatous arteritis), sarcoidosis, cerebral vascular lesions, epidermal cysts, meningeal carcinomatosis, serum sickness, and nonfocal lesions of the central nervous system (CNS). Specific syndromes (ie, Mollaret's meningitis, Still's disease) may produce a similar clinical picture.