La salute detenuta: tra diritto e sicurezza”. Un’ indagine nella Casa Circondariale di Rimini.

The survey approachs the issue of health and the problem of its effective protection in a context of deprivation of liberty and coercion, which is the prison. The theoretical reflection born from the reform of the Legislative Decree 230/99 which marked the transition from an employee by the Prison Health within prison a fully integrated in the National Health Service. The comparison between an institution of health promotion and institution of punishment which may operate on the same subject held produces multiple attrits, making their relationship problematic. The work shows the daily difficulties in the management of prison health within the institution, physician-patient between different health care roles, and between the latter and prison workers. The coexistence, in fact, is not always harmonious though quite often it is common sense and the willingness of operators to reduce barriers: overcrowding, limited resources and insufficient staff make the application of the rule and therefore the right to goal a difficult to be pursued. It is designed for a scheme of semi-structured interview essay is divided into 3 sections covering: "staff and its functions", "health reform" and "health of the prisoner"; questions were directed to doctors, nurses and psychologists engaged inside the prison of Rimini with the specific aim of examining the ambivalent relationship between the demand for health care in prisons and the need for security and a clear - albeit partial - point of view. We tried to reconstruct the situation of prison health care through the perception of prison operators, capturing the problematic issues that deal on both issues is instrumental to the experience of persons detained by analyzing, in terms of operators , what happens inside of a prison institution in everyday health care.

Le cure oncologiche e la prospettiva del paziente. Revisione di letteratura e un caso di studio

Numerose ricerche indicano i modelli di cure integrate come la migliore soluzione per costruire un sistema più efficace ed efficiente nella risposta ai bisogni del paziente con tumore, spesso, però, l’integrazione è considerata da una prospettiva principalmente clinica, come l’adozione di linee guida nei percorsi della diagnosi e del trattamento assistenziale o la promozione di gruppi di lavoro per specifiche patologie, trascurando la prospettiva del paziente e la valutazione della sua esperienza nei servizi. Il presente lavoro si propone di esaminare la relazione tra l’integrazione delle cure oncologiche e l’esperienza del paziente; com'è rappresentato il suo coinvolgimento e quali siano i campi di partecipazione nel percorso oncologico, infine se sia possibile misurare l’esperienza vissuta. L’indagine è stata svolta sia attraverso la revisione e l’analisi della letteratura sia attraverso un caso di studio, condotto all'interno della Rete Oncologica di Area Vasta Romagna, tramite la somministrazione di un questionario a 310 pazienti con neoplasia al colon retto o alla mammella. Dai risultati, emerge un quadro generale positivo della relazione tra l’organizzazione a rete dei servizi oncologici e l’esperienza del paziente. In particolare, è stato possibile evidenziare quattro principali nodi organizzativi che introducono la prospettiva del paziente: “individual care provider”,“team care provider”,“mixed approach”,“continuity and quality of care”. Inoltre, è stato possibile delineare un campo semantico coerente del concetto di coinvolgimento del paziente in oncologia e individuare quattro campi di applicazione, lungo tutte le fasi del percorso: “prevenzione”, “trattamento”,“cura”,“ricerca”. Infine, è stato possibile identificare nel concetto di continuità di cura il modo in cui i singoli pazienti sperimentano l’integrazione o il coordinamento delle cure e analizzare differenti aspetti del vissuto della persona e dell’organizzazione.

SPHERA, a new Italian convection-permitting regional reanalysis: improving heavy-rainfall representation and describing hail-prone environments

Extreme weather events related to deep convection are high-impact critical phenomena whose reliable numerical simulation is still challenging. High-resolution (convection-permitting) modeling setups allow to switch off physical parameterizations accountable for substantial errors in convection representation. A new convection-permitting reanalysis over Italy (SPHERA) has been produced at ARPAE to enhance the representation and understanding of extreme weather situations. SPHERA is obtained through a dynamical downscaling of the global reanalysis ERA5 using the non-hydrostatic model COSMO at 2.2 km grid spacing over 1995-2020. This thesis aims to verify the expectations placed on SPHERA by analyzing two weather phenomena that are particularly challenging to simulate: heavy rainfall and hail. A quantitative statistical analysis over Italy during 2003-2017 for daily and hourly precipitation is presented to compare the performance of SPHERA with its driver ERA5 considering the national network of rain gauges as reference. Furthermore, two extreme precipitation events are deeply investigated. SPHERA shows a quantitative added skill over ERA5 for moderate to severe and rapid accumulations in terms of adherence to the observations, higher detailing of the spatial fields, and more precise temporal matching. These results prompted the use of SPHERA for the investigation of hailstorms, for which the combination of multiple information is crucial to reduce the substantial uncertainties permeating their understanding. A proxy for hail is developed by combining hail-favoring environmental numerical predictors with observations of ESWD hail reports and satellite overshooting top detections. The procedure is applied to the extended summer season (April-October) of 2016-2018 over the whole SPHERA spatial domain. The results indicate maximum hail likelihood over pre-Alpine regions and the northern Adriatic sea around 15 UTC in June-July, in agreement with recent European hail climatologies. The method demonstrates enhanced performance in case of severe hail occurrences and the ability to separate between ambient signatures depending on hail severity.