No abstract

Objectives The history of electroconvulsive therapy (ECT) spans eight decades, over which period this method of treatment has been modernized. At the same time, however, the conflict between acceptance and rejection of ECT therapy remains unresolved today. This ambivalence is particularly noticeable in Italy, where the number of uses of ECT has been declining for several years. The aim of the present study is to examine the distribution and use of ECT in Italy today in comparison to 2009 and to analyze the factors that have influenced this downward development. Methods A cross-sectional study using a standardized Italian-language questionnaire was conducted in 2017 to investigate the dissemination and practice of ECT in Italy. The study was addressed to all public and private hospitals providing ECT as a treatment. Results Of the 145 mental health facilities in Italy, only 9 offered ECT. A total of 293 patients were treated with ECT within 1 year (mainly for depression). Rates for 3-year treatments in the centers yielded an uneven picture: 4 centers showed an increase in cases and just as many a decline. A north-south divide existed in terms of geographical distribution: centers were mainly located in the north in 2017. Conclusions The study shows that the dissemination and use of ECT have reached a historical low in Italy. It further documents the extent to which the use of ECT declined after 2009. Three factors that have accompanied this development are discussed. If this downward trend is to be reversed, it will be necessary to develop a new approach so as to engender a perception of ECT as a viable treatment option.

Violence has serious physical, psychological, and sociocultural consequences. 7 One would imagine that these consequences would be universally considered as morally unacceptable. However, in 2019, the US Government threatened to refuse signing a UN resolution denouncing rape as a war crime if it included any mention of reproductive health. 8 To move forward, we now need to determine what still needs to be done to achieve more gender equity and how to get it done!We know that education is a core component of preventing violence and should begin at a young age for both genders. 9 However, the male default bias again means that education will remain insufficient if we do not acknowledge that rules promoting gender equity have historically been made by men. These rules have often implicitly promoted so-called manly values that include violence and power. Women have sometimes tried to adopt these values hoping that they can thereby break through the glass ceiling. We now need to set values and rules that promote better lives with more collaborative objectives, and address issues socially. Parity needs to become the norm, emphasizing that it is not men's rights here and women's rights there, but equal rights and equity for all.

Background Increasing life expectancy is associated with a growing number of people living in nursing homes, while the availability of outpatient medical care, especially from family doctors, is stagnating in this sector. Consequently, numerous and often avoidable, low-threshold hospitalizations of nursing home residents are observed. This results in unnecessary use of resources such as emergency services and emergency rooms as well as in potential health risks to the nursing home residents related to hospitalization. This study aims to improve this healthcare gap by implementing an intersectoral telemedicine approach. Methods Twenty-five nursing homes are participating and provided with telemedical equipment to perform teleconsultations. Additionally, an early warning system and a digital patient record system are implemented. Telephysicians based at RWTH Aachen University Hospital are ready to support the nursing homes around the clock if the family doctor or an emergency service practice is not available in time. Mobile non-physician practice assistants from the telemedicine centre can be dispatched to perform delegable medical activities. General practitioners and the medical emergency practices also have access to the telemedical infrastructure and the non-physician practice assistants. Discussion Optimal@NRW adds a telemedicine component to standard care — combining elements of outpatient and inpatient health care as well as emergency service practices — to enable timely medical consultation for nursing home residents in case of the development of an acute medical condition. In addition to optimized medical care, the goal is to reduce unnecessary hospital admissions. The intersectoral approach allows for the appropriate use of resources to match the individually needed medical treatment. Trial registration ClinicalTrials.govNCT04879537. Registered on May 10, 2021

Although most reasons for the persistently low autopsy rate are primarily structural and motivational, some normative implications relating to these aspects remain.