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Multimedia Psychotherapy is a new form of brief psychotherapy based on narrative medicine and ethnopsychoanalytic theories, developed to help patients affected by prolonged grief disorder (ICD-11). It consists of eight sessions, during which an 'audio-video memory object' is produced by using pictures, video clips, and music chosen by the bereaved patient. The audio-video montage is focused on remembering the deceased relative and help the patient to move on. Considering initial positive results, we ran a first controlled pilot study comparing experimental and control group.We enrolled a sample of bereaved patients who were referred for prolonged grief disorder (ICD-11) by their general practitioners or psychiatrists. Patients were randomly assigned to the experimental group (n=18) or to the control group (n=18). Patients in the experimental group received psycho-pharmacological therapy and multimedia psychotherapy, while patients in the control group received psycho-pharmacological therapy and psycho-oncological support. All patients were assessed with Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Prolonged Grief-13 (PG-13) prior to beginning treatment (pre-treatment), and with PG-13 after six months from the end of the treatment (post-treatment).Patients in the experimental group (i.e., Multimedia Psychotherapy treatment) after six months performed better than patients in the control group in Criteria B, D, and E of PG-13 (i.e.: Separation Distress, Cognitive, Emotional, and Behavioral Symptoms, Functional Impairment).We will discuss our results, issues related to the screening of patients (due to possible contraindications of Multimedia Psychotherapy), and methodological limitations. Finally, we will discuss new future applications in other clinical situations.These findings suggest that multimedia psychotherapy may hold promise for the treatment of prolonged grief disorder (ICD-11).

In 2008, it was introduced by the Legislature legislation which provided the inclusion of Article 28, paragraph 1 of Legislative Decree. N. 81/2008, which stipulates for businesses and public authorities a duty to assess, among a variety of risks that could threaten the safety and health of workers (chemical, biological risk, etc) and also the work-related stress. The implementation of this decree is, therefore, specified as "work-related stress" as one of the subjects of mandatory assessment risks. The decree, then entrusted to the Permanent Consultative Commission for health and safety at work the task to "prepare the necessary information for the risk assessment of work-related stress", subsequently issued on 17/11/2010 in the form of a "methodological path which represents the minimum level of implementation of the obligation".In light of this regulatory framework, we established our pilot study, with the objective of analyzing a growing occupational discomfort. This objective has been diffused and palpable, but very difficult to define, in a sample of employees of the Judiciary Lazio Offices. The study was commissioned by Law Committee of Guarantee of Equal Opportunity Enhancement of Welfare Work and those against Discrimination (CUG) of the Judicial Offices Romans of the Court of Appeal of Rome also contributed to its realization. The data collected from the administration of two standardized questionnaires was analyzed (Questionnaire-gauge instrument INAIL and the SF-12 v1).More evidently in this pilot study, there was a serious problem in the organizational dimension, in specific, in Managerial Support. Just as it appears, the study sample is perceived "less healthy", both physically and mentally, than the Italian normative sample.Although the sample is only a part of the study population, 26% of workers of the Judicial Offices Romans, the data obtained shows however, from both a quantitative and qualitative view point, a significant occupational stress and suggests the need to broaden our search in order to find different possible solutions to improve the condition of workers and, consequently, the degree of citizens' satisfaction that caters to this delicate area of expertise.Nel 2008 è stata introdotta dal Legislatore la normativa che ha previsto l’inserimento dell’articolo 28, comma 1, D.Lgs. n. 81/2008, il quale sancisce per le imprese e per le pubbliche amministrazioni l’obbligo di valutare, tra gli svariati rischi che potrebbero minacciare la sicurezza e la salute dei lavoratori (rischio chimico, biologico, etc), anche il rischio causato dallo “stress da lavoro”. Con l’attuazione del suddetto decreto viene, dunque, specificato lo “stress da lavoro” come uno dei rischi oggetto di obbligatoria valutazione. Il citato decreto ha, poi demandato alla Commissione Consultiva permanente per la salute e la sicurezza del lavoro il compito di “elaborare le indicazioni necessarie alla valutazione del rischio stress da lavoro”, successivamente emanate il 17/11/2010 sotto forma di un “percorso metodologico che rappresenta il livello minimo di attuazione dell’obbligo”. Alla luce di questo quadro normativo prende vita il nostro studio pilota, con l’obiettivo di analizzare un disagio lavorativo sempre più diffuso e palpabile, ma molto difficile da definire, in un campione di lavoratori dipendenti degli Uffici Giudiziari del Lazio. Lo studio è stato voluto dal Comitato Unico di Garanzia per le Pari Opportunità la Valorizzazione del Benessere di chi Lavora e contro le Discriminazioni (CUG) degli Uffici Giudiziari Romani della Corte d’Appello di Roma, che ha anche contribuito alla sua realizzazione. Sono stati analizzati i dati reperiti tramite la somministrazione di due questionari standardizzati (Questionario-Strumento indicatore dell’INAIL e l’SF-12 v1). Ciò che maggiormente si evidenzia in questo studio pilota è una forte criticità nella struttura organizzativa, specificatamente nel supporto del management. Così come è emerso che il campione in studio si percepisce “meno in salute”, sia fisicamente sia mentalmente, rispetto al campione normativo italiano. Nonostante il campione rappresenti solo una parte della popolazione studiata, il 26% dei lavoratori degli Uffici Giudiziari Romani, i dati ottenuti evidenziano comunque, sia da un punto di vista quantitativo sia qualitativo, un significativo disagio lavorativo e suggeriscono la necessità di ampliare la ricerca al fine di trovare anche possibili soluzioni per migliorare la condizione dei lavoratori e, conseguentemente, il grado di soddisfazione del cittadino che si rivolge a questo delicato ambito di competenza.

TO THE EDITORS: We read with great interest the article by Semprini et al 1 concluding that semen washing with intrauterine insemination (SW-IUI) appears to be a safe and effective method for achieving pregnancy in human immunodeficiency virus (HIV)-discordant couples in which the man is HIV infected. However, the authors did not discuss some of the problems that render SW-IUI not practicable for most couples in developed countries, and the current debate on different options. SW-IUI is cumbersome and costly, per-cycle live birth rate is 13%, and for a significant number of couples, the wish of parenthood remained unaccomplished due to the technical and financial hurdles associated with the method. Approximately 30% of couples evaluated in Milan, Italy, and St Gallen, Switzerland, did not start the insemination process after initial counseling and another 30% subsequently withdrew after a number of failed cycles. Moreover, almost half of the couples who did not conceive with artificial insemination attempted spontaneous conception through unprotected intercourse, exposing the woman to HIV transmission, and at least 1 infection occurred. 1,2

Background To investigate perceptions and attitude to prescribe Pre-Exposure Prophylaxis (PrEP) among HIV specialists. Methods A questionnaire developed through a Focus Group and literature review was administered to a convenience sample of HIV specialists during educational courses in two Regions and an online survey in February-May 2012. Participants were classified as having a positive or negative attitude according to their willingness to prescribe PrEP. Demographic and working information, experience with HIV-infected patients, information and provision of antiretrovirals to uninfected persons, self-reported knowledge, perceptions and concerns regarding PrEP were assessed. The association between a different attitude towards PrEP prescription and selected characteristics was assessed through univariate and multivariate regression analysis. Results Of 311 specialists, 70% would prescribe PrEP, mainly to serodiscordant partners (64%) but also to people at ongoing, high risk of HIV infection (56%); 66% advocated public support of costs. A negative attitude towards PrEP was significantly associated with lack of provision of information on, and prescription of, antiretroviral post-exposure prophylaxis; specialists with a negative attitude believed behavioural interventions to be more effective than PrEP and were more concerned about toxicity. Overall, 90% of specialists disagreed regarding a lack of time for engaging in prevention counselling and PrEP monitoring; 79% would welcome formal guidelines, while those with a negative attitude did not consider this advisable. Conclusions Although conflicting attitudes appear evident, most specialists seem to be willing, with guidance from normative bodies, to promote PrEP within multiple prevention strategies among vulnerable populations. More scientific evidence regarding effectiveness could overcome resistance.

Background The application of serological methods in HIV/AIDS routine surveillance systems to identify persons with recently acquired HIV infection has been proposed as a tool which may provide an accurate description of the current transmission patterns of HIV. Using the information about recent infection it is possible to estimate HIV incidence, according to the model proposed by Karon et al. in 2008, that accounts for the effect of testing practices on the number of persons detected as recently infected. Methods We used data from HIV/AIDS surveillance in the period 2004-2008 to identify newly diagnosed persons. These were classified with recent/non-recent infection on the basis of an avidity index result, or laboratory evidence of recently acquired infection (i.e., previous documented negative HIV test within 6 months; or presence of HIV RNA or p24 antigen with simultaneous negative/indeterminate HIV antibody test). Multiple imputation was used to impute missing information. The incidence estimate was obtained as the number of persons detected as recently infected divided by the estimated probability of detection. Estimates were stratified by calendar year, transmission category, gender and nationality. Results During the period considered 3,633 new HIV diagnoses were reported to the regional surveillance system. Applying the model, we estimated that in 2004-2008 there were 5,465 new infections (95%CI: 4,538-6,461); stratifying by transmission category, the estimated number of infections was 2,599 among heterosexual contacts, 2,208 among men-who-have-sex-with-men, and 763 among injecting-drug-users. In 2008 there were 952 (625-1,229) new HIV infections (incidence of 19.9 per 100,000 person-years). In 2008, for men-who-have-sex-with-men (691 per 100,000 person-years) and injecting drug users (577 per 100,000 person-years) the incidence remained comparatively high with respect to the general population, although a decreasing pattern during 2004-2008 was observed for injecting-drug-users. Conclusions These estimates suggest that the transmission of HIV infection in Lazio remains frequent and men-who-have-sex-with men and injecting-drug-users are still greatly affected although the majority of new infections occurs among heterosexual individuals.

We assessed the safety and efficacy of reconstructive therapy with facial fillers for the treatment of HIV-associated facial lipoatrophy (FLA) through a randomized, controlled, open-label single-center study. A total of 134 HIV-infected patients with severe FLA were randomly assigned to receive immediate (67 patients) or delayed (67 patients) facial injections of poly-l-lactic acid (PLA) or polyacrylamide gel (PAIG). Outcome measures included changes in physician and patient FLA severity scale, adverse events, and changes in health-related quality of life (HRQoL) and anxiety using validated measures. The mean average study follow-up was 27 weeks for the immediate and 25 weeks for the delayed subjects. Adverse events were mild and resolved after a mean of 4 days. Compared to patients randomized to the delayed treatment group, patients assigned to the immediate treatment group had significantly lower physician-rated (0.0 versus -3.0; p0.0001) and patient-rated (0.1 versus -1.8; p0.0001) FLA severity scores. By contrast, measures exploring HRQoL and anxiety did not show any significant difference between patients randomized to the immediate and deferred groups. Reconstructive therapy with facial fillers was effective and safe and led to significant improvements in FLA severity. However, no significant gains in HRQoL, relational and psychological consequences of body changes, and anxiety-related concerns were observed. Studies should be performed to identify patients who could maximally benefit from filling interventions for FLA.

Gli adolescenti, nel passaggio all’età adulta, attraversano un processo identitario che necessita di un reciproco riconoscimento fra giovane e società. Chi accompagna il giovane in questo percorso?Secondo Donati, la famiglia e le associazioni sono mediatori privilegiati fra individuo e società. La famiglia, capitale sociale primario incentrato su fiducia primaria e relazioni finalizzate al bene comune, favorisce l’associazionismo, capitale sociale secondario, basato su fiducia secondaria e reciprocità sociale indirizzate alla sfera pubblica.Essenziale è dunque la relazione fra interno ed esterno: una famiglia prosociale, cioè caratterizzata da apertura, scambio, condivisione e solidarietà, sa aprirsi alla società condividendone l’onere del processo educativo. Il giovane viene così supportato, nella sua transizione, dalla famiglia d’origine e dalla società.Attualmente, però, questa fase di passaggio risulta prolungata da un mancato dialogo in famiglia e tra famiglia e istituzioni (scuola, chiesa...), elemento imprescindibile per risolvere quel blocco identitario nel quale il giovane rimane oggi intrappolato.