LIBRI DI FELICE NAVA

Il volume affronta il tema del gioco d’azzardo patologico sotto vari aspetti: vengono aggiornate le conoscenze scientifiche sulla natura del gioco e le caratteristiche che lo possono rendere una patologia; vengono proposti modelli di intervento di sensibilizzazione, prevenzione, formazione che vedono nel territorio la risorsa e il luogo di azione; vengono descritte esperienze e riflessioni di presa in carico e cura delle persone malate di GAP curate da noti professionisti italiani e stranieri.

The infectious diseases are the most prevalent illnesses in prisoners, and they have a relevant burden for the society. Several studies have shown that the screening and the treatment of the infectious diseases inside prisons may be effective in reducing their burden in the general community. The main aim of the study was to determine between 2019-2021 the incidence and the prevalence of HIV, HBV, HCV, TB and syphilis in the people inside Padua prisons. The study has demonstrated that the screening of the infectious diseases in detainees was very high, raising in 2021 in the entrant people the 100%. The research also has shown that during 2021 the most prevalent incidence of infectious diseases was for TB (16.3%), followed by HCV (11.3%), HBV (7.9%) and HIV (1.6%). Interestingly, our data has indicated how during 2021 versus the previous years the prevalence of the infectious diseases increased for HBV (41.5%), HCV (18.8%), and TB (48.1%). These data indicate as different conditions such as the geographic origin of the prisoners people or several environmental factors such as the overcrowding may influence the prevalence of the infectious disease inside prisons. The study suggests how the prisons may represent a place where may be easier the treatment of the patients affected by infectious diseases and how universal and periodic screening campaigns and facilitated treatment programs as the point of care may increase the access to care and to control the spread of infectious also in the general community.

Italy has two different public healthcare services taking in care patients with dual diagnosis: (1) the mental health services (Centri di Salute Mentale - CSM) and (2) and the drug abuse services (Servizi per le Dipendenze - Ser.D.). We collected and analyzed data regarding the frequency of the co-morbidities in Veneto Region during 2019. Our study shows that only the 1% of the patients in treatment in the mental health services and the 8.7% of those in drug abuse services are recognized as dual diagnosed subjects. In drug abuse services the most frequent substance use disorders (SUD) correlated with a psychiatric disease were the alcohol and opioids use disorders, while the most prevalent psychiatric disorders associated with a SUD were the personality disorders and the schizophrenia, schizotypal and delusional disorders. Our data indicate that the diagnosis of co-morbidity should be improved in both services and that integrated programs between the above services should be developed to improve the best practices.

Hepatitis D virus (HDV) is a public health concern for its severe medical consequences. The aim of this pilot study was to evaluate the prevalence of the main infectious disease between the detainees of the Veneto Region. The study consisted of a survey carried between the heads of the prison healthcare staff. The data showed that on 2,119 detainees the prevalence of hepatitis B (HBV) is the 6% and that the most relevant prevalence of HBV was revealed in the East Europe detainees (Ex USSR countries, Albania, Bosnia, Kosovo, Macedonia), being the 39% of all HBcAb positive subjects. The survey also revealed as the population less protected by HVB vaccination was that comes from East Europe. Moreover, the study indicates that hepatitis D diagnosis is not well known by clinician working inside prisons and that it should be improved through specific diagnostic and therapeutic procedures. Our data indicate that the prison setting may play an important and crucial role in term of public health both in intercepting patients that need of treatment and in preventing actions able to minimize the risk of infection. In prison settings screening, linkage to care and harm reduction measures should be improved in order to protect the general population from the impact of the emerging infectious diseases, including HDV.

Background Hepatitis C is a disease correlated with severe systemic consequences having elevated social and health costs. The HCV elimination is a public health concern that may be solved reaching DAAs treatment for drug users. The principal aim of this work is to evaluate the cost-benefit of a point of care for HCV treatment of drug users inside Drug abuse services (Ser.D.). Methods The study consists in a cost-benefit analysis able to evaluate the “return of health” induced by a point of care for a HCV treatment. Results The work shows that the point of care is cost-benefit in comparison with the “traditional” treatment being cost saving for the public health system. The data suggest that the cost of the point of care is corresponding to euros 593,40 while the cost of not treatment of euros 8.679,60 (due to the direct and indirect costs of the disease). Conclusions The study demonstrate the point of care is an effective model of care able to reduce the barriers of treatment and to induce a “health return” in term of cost saving for the public health systems. Indeed, the work shows how the point of care may make the elimination HCV plans sustainable for the public health agencies.

The Covid-19 emergency in prisons is a public health warming due to overcrowding, poor structural conditions,and life promiscuities.Worldwide a lot of prisoners were Sars-CoV-2 positive and in Italy several outbreaks occurred in many prisons.This paper examines, using a clinical audit, a Covid-19 outbreak occurred in an Italian prison during the spring2021.The study showed that the best measures to mitigate the outbreak negative consequences both in prisoners andin the staff are the preventive actions, the hygiene and disinfection of the common detention areas; the reductionof overcrowding; the stop of the working activities during the quarantine period.Only an improvement of living conditions inside the prisons may reduce the risk of infection among inmates.

The World Health Organization (WHO) has set up the elimination of hepatitis C virus (HCV) worldwide by 2030. The main aims of this study were to evaluate in HCV positive PWIDs: 1) the cost of patient’s journey of treated subjects; 2) the cost saving induced by HCV treatment for the public health system; 3) the potential cost for a national HCV elimination plan in drug users. We performed a non-interventional study including 1,333 PWIDs attending the Drug Abuse Units of the Public Health Service ASST Melegnano-Martesana (Milan, Italy), over one year (January–December 2017). The direct cost for the health services received by each patient during HCV treatment (excluding the cost of drug treatment) was collected using the electronic clinical database of the public health service.In the cohort of 1,333 patients we found 257 RNA HCV-positive PWIDs, 65 of which were treated. The mean health direct cost per each treated patient was € 1,418, while the mean the annual cost for each patient in waiting list for treatment was € 214. Considering that a HCV-positive PWID may infect within 3 years from infection at least 20 other new subjects, we may suppose that a HCV treatment may save about € 30,000 for the public health system. The study shows that HCV treatment in PWIDs can significantly reduce both individual and community health costs and that HCV elimination plans may be sustainable for the public health system by avoiding the enormous costs of the disease burden.

The epidemiological data suggests that people who use drugs (PWUDs) are the most important “reservoir” for the spread of HCV infection. For this reason PWUDs should be included in all HCV elimination plan as priority target for treatment.We performed an observational study in 5 Italian Drug Abuse Services (SerDs) with the main aims to determine: 1) the prevalence of HCV infection in PWUDs; 2) the most important barriers to HCV treatment.Of the about 4,000 drug users included in the study only about the 36% was tested and of them the 20% were anti HCV positive; only about the 60% of the HCV RNA positive patients were treated.The study showed several important barriers to the screening, especially when cannot used rapid tests and/or if test is not proposed periodically, and to the linkage to care, in particular when the HCV treatment cannot be given inside the SerDs.The study has also revealed as the harm reduction measures as suggested by WHO are not offered to all PWUDs. In conclusion the study suggests how inside the SerDs the barriers for HCV treatment that can be overcome with a simpler model of treatment as represented by the point of care.

This study analyzed the outcome predictors of an Internet-delivered cognitive behavior therapy (ICBT) for problem gambling, examining users’ socio-economic profile and gambling behavior. Being males and employed, the fact of playing and to have gambling problems for less than a year, preference for non strategy-based games, and high frequency of playing were found to be predictors of therapy dropout. The findings from this study, though preliminary, suggest that certain patients’ socio-economic characteristics and gambling behavior may have a bearing on the success or failure of an ICBT and that there is a need to adapt the therapy for those individuals at risk. In fact, detect at an early stage of the therapeutic relationship those patients with a greater propensity to dropout may allow the implementation of appropriate and customized approaches to reduce the difficulties to follow and complete a therapy.

I dati contenuti nella letteratura scientifica di recente pubblicazione individuano nel consumo di sostanze il fattore di rischio più importante per la trasmissione di HCV evidenziando altresì come i dipendenti da sostanze rappresentino il serbatoio più importante della malattia. Un’ altra popolazione a rischio è rappresentata dai detenuti, soprattutto perché la maggior parte di essi ha una storia di consumo di sostanze.Il trattamento della popolazione a rischio (consumatori di sostanze e detenuti) deve diventare una priorità per i sistemi sanitari sia per garantire l’equità di accesso alle cure che per raggiungere l’obiettivo di sanità pubblica di eliminazione dell’HCV.I programmi di presa in carico devono essere integrati, multidisciplinari flessibili, individuali e di prossimità, basati sulle evidenze scientifiche e diffusi omogeneamente su tutto il territorio nazionale. La presa in carico deve essere supportata da procedure e linee guida che devono comprendere anche le azioni di riduzione del danno, cosi come suggerite dall’OMS.

In carcere il dolore assume una grandezza sproporzionata e di solito non viene adeguatamente trattato. Le ragioni sono spesso dovute alla paura di prescrivere ai detenuti sostanze analgesiche oppioidi con il rischio di un uso improprio o alternativo. Lo scopo di questo studio osservazionale, condotto con 598 detenuti della Casa di Reclusione di Padova, è stato quello di identificare gli ostacoli e le barriere all’uso di farmaci analgesici oppioidi per il trattamento del dolore e trovare modalità utili per un uso razionale delle sostanze.

I giocatori problematici non sempre riconoscono la situazione critica in cui versano. Inoltre, vergogna e timore dello stigma si rivelano spesso ostacoli insormontabili che impediscono di intraprendere un trattamento formale. Ciò spiega la nascita di nuove tipologie di aiuto professionale attraverso l’utilizzo del telefono e delle tecnologie informatiche (es. helpline professionali, counselling online, siti web dedicati). Nel presente lavoro sono stati analizzati i record relativi ai soggetti che hanno iniziato un trattamento mediante la piattaforma online Giocaresponsabile.it, che offre una terapia online basata sul modello cognitivo-comportamentale (Internet-delivered cognitive behavior therapy, ICBT). Dall’esame dei profili socio-economici e dei comportamenti di gioco sia di chi ha concluso la terapia sia di coloro i quali la hanno interrotta prematuramente, emerge che determinate caratteristiche dei pazienti possono avere un peso significativo sugli esiti trattamentali. Ciò suggerisce di raffinare l’analisi sull’impatto di tali fattori in modo da ‘cucire’ con maggior precisione la terapia sulle specifiche esigenze dei pazienti.