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Lo sviluppo sociale

Una delle elaborazioni più significative che fornisce un nuovo modello dello sviluppo sociale umano è la Teoria dell’Attaccamento di Bowlby. Storicamente la teoria dell’attaccamento si è sviluppata a partire dalla teoria psicoanalitica delle relazioni oggettuali, ed ha molto in comune specialmente con le idee di Winnicott, Fairbairn e Guntrip. Essa porta avanti queste idee in due aree principali: – il ruolo privilegiato attribuito ai legami emotivi significativi tra gli individui; – l’influenza di differenti modalità di interazione familiare nel determinare lo sviluppo del bambino. Sostanzialmente la teoria dell’attaccamento studia la natura, la finalità, l’organizzazione dei legami affettivi e i processi attraverso cui questi si costituiscono. In essa assumono un peso rilevante le esperienze reali tra un bambino e la figura che di lui si prende cura, poichè a tali esperienze è riconosciuto un ruolo fondamentale nella complessa dinamica dei meccanismi di individuazione e della conseguente costruzione di una identità personale. Nell’ambito dello sviluppo affettivo e sociale le modalità reali, concrete, con cui una madre si prende cura del suo neonato hanno un impatto cruciale, determinando il modo con cui il neonato organizzerà le proprie strategie di attaccamento nei confronti della madre ed eventualmente le generalizzerà ad altri adulti. Difatti il neonato, una volta adulto, farà riferimento a quelle stesse modalità di attaccamento che hanno costruito la sua propria esperienza, e tenderà a metterle in atto nei confronti dei propri figli. Quindi, cominciando nell’infanzia e continuando attraverso il corso della vita, la salute mentale di un individuo è vista come intimamente legata alle relazioni con le figure di attaccamento che offrono supporto emotivo e protezione. Sebbene alcune delle ispirazioni originarie di Bowlby per la teoria dell’attaccamento provenissero dalla sua esperienza come clinico, durante lo sviluppo della sua teoria egli prese spunto sia dalle sue ricerche di etologia basate sull’osservazione del comportamento animale, sia da teorizzazioni di psicologia cognitiva. Quindi descrisse il sistema comportamentale dell’attaccamento come un “sistema di controllo, evolutivamente adattivo, motivazionale e comportamentale”, che gli esseri umani condividono in vario grado con gli altri primati, e definì l’attaccamento come quella “forma di comportamento che si manifesta in una persona che consegue o mantiene una prossimità nei confronti di un’altra persona, chiaramente identificata, ritenuta in grado di affrontare il mondo in modo adeguato”. Secondo Bowlby, questo comportamento diventa molto evidente ogni volta che la persona è spaventata, affaticata o malata, e si attenua quando si ricevono conforto e cure. Altre volte il comportamento può risultare meno evidente, in ogni caso per una persona il fatto di sapere che una figura di attaccamento è disponibile e pronta a rispondere è un fatto che fornisce un forte e pervasivo senso di sicurezza, che incoraggia a dare valore alla relazione e a continuarla. Il comportamento di attaccamento è evidente soprattutto nella prima infanzia, ma può essere osservato, come già accennato, nell’ambito dell’intero ciclo di vita, specialmente nei momenti di emergenza. Sebbene si manifesti con differenti modalità, è osservabile virtualmente in tutti gli esseri umani, e per questo è considerato parte integrante della natura umana: ogni neonato difatti nasce predisposto a costruire un legame affettivo significativo nei confronti della figura di attaccamento. Quindi le relazioni di attaccamento umano sono regolate da un sistema comportamentale-motivazionale che è attivato sin dalla nascita dalla presenza concreta della figura che svolge la funzione di prendersi cura del neonato e che ha la finalità di garantire la sopravvivenza del neonato e la sua difesa dai pericoli : quindi è attivato ogni volta che vi sia un pericolo reale o supposto. Difatti questo sistema monitorizza la prossimità fisica e la disponibilità psicologica della figura di attaccamento “più forte e più saggia”, e attiva/regola il comportamento di attaccamento diretto verso quella figura. Il bambino può fiduciosamente esplorare l’ambiente con il sostegno attivo della figura caregiver, in quanto è a conoscenza del fatto che questa figura rimane presente in qualsiasi momento di necessità. Questa interazione tra il bambino e la figura che se ne prende cura è chiamato “il fenomeno della base sicura” , ed è un fenomeno centrale nella teoria dell’attaccamento. Il bambino usa il genitore come base sicura da cui partire per le sue esplorazioni: genitore e bambino restano in contatto per essere sicuri di potersi avvicinare nel caso si presenti per il piccolo un potenziale pericolo. L’aspetto cruciale dell’attaccamento nello sviluppo della specie umana è che attraverso questa relazione il bambino interiorizza quelle strategie che mantengono, nel modo più adattivo possibile, il contatto con la figura d’attaccamento. Egli “impara”, cioè, a rappresentarsi dei modelli cognitivo-affettivi del Sé e del Sé con l’altro che verranno attivati ogni qualvolta sarà necessario raggiungere la maggiore prossimità possibile con la figura di attaccamento. Queste costruzioni sono state chiamate da Bowlby Modelli operativi interni : sono di origine precocissima, e saranno molto stabili e protette nel corso dello sviluppo, formando il nucleo rappresentazionale interno del sistema di attaccamento. Anche il modo in cui la figura di attaccamento risponde ai segnali del neonato dipende dalla qualità delle esperienze di attaccamento di cui ella è portatrice a sua volta, e dal modo in cui esse si sono via via organizzate nella sua mente dando luogo appunto ai suoi Modelli operativi interni, che quindi organizzano il comportamento di attaccamento dell’adulto, interessando le sue aspettative di relazione, i suoi processi decisionali, la sua capacità di leggere correttamente i segnali comunicativi, ecc.

Risvolti applicativi

La teoria dell’attaccamento ha notevoli risvolti applicativo-professionali: sono interessanti a questo proposito gli studi longitudinali per correlare i pattern di attaccamento a comportamenti psicopatologici. Questi studi mirano sostanzialmente a valutare l’andamento della relazione tra pattern di attaccamento e psicopatologia, allo scopo di sviluppare presidi preventivi. Un ulteriore risvolto applicativo è la pratica clinica dei teorici del disturbo di regolazione affettiva, che fanno appunto riferimento alla teoria di Bowlby. Sono interessanti anche le attuali ricerche sulla relazione tra pattern di attaccamento e disturbi alimentari: ad esempio il comportamento anoressico restrittivo è solitamente associato ad uno stile di attaccamento Evitante, mentre le abbuffate compulsive vengono associate ad uno stile di attaccamento Ambivalente. In un contesto clinico, e più precisamente in ambito psicoterapeutico, un caso clinico può essere letto alla luce della teoria dell’attaccamento: in questo senso l’esplorazione dei Modelli operativi interni fornisce un importante spaccato delle modalità di funzionamento interpersonale attuale proprio perché vengono costruiti a partire da pattern ripetuti di esperienze interattive e sono intesi come rappresentazioni delle interazioni che sono state generalizzate e che formano modelli rappresentazionali relativamente fissi che l’individuo utilizza per predire il mondo e mettersi in relazione con esso. Il modello costruito nell’arco dei primi due anni di vita nella relazione con i genitori è per il bambino di enorme importanza, al punto da regolare le aspettative su come gli altri lo tratteranno e da modellare il suo comportamento nei loro confronti. Il bambino costruirà un modello mentale della madre e del suo modo di comportarsi verso di lui; costruirà un analogo modello del padre; infine un modello di sé stesso e delle sue capacità fisiche e sociali. Con il tempo, insomma, la modalità di attaccamento tende ad estendersi alle altre relazioni, e ad assumere sempre di più le caratteristiche di uno script che contiene tutte le istruzioni circa i comportamenti di attaccamento. Secondo Bowlby, in oltre, sono i pattern di comunicazione verbale e non verbale i processi per mezzo dei quali i Modelli operativi interni delle relazioni di attaccamento sicure e insicure vengono generati e mantenuti, e attraverso i quali vengono a loro volta trasmessi alla generazione successiva. Attraverso la maniera in cui i genitori abitualmente rispondono al proprio figlio, loro gli comunicano anche che lui è (o non è) meritevole di una risposta. Quei genitori che nel corso della loro infanzia hanno esperito transazioni con figure di attaccamento responsive e accettanti, sono a loro volta più pronti a rispondere alle richieste dei loro figli in modo empatico ed emotivamente supportivo. Come risultato, è più probabile che i loro bambini non solo si sentano compresi, competenti e valutati positivamente, ma anche che si vengano a trovare in una posizione più favorevole per costruirsi più funzionali modelli operanti di sè e delle proprie figure di attaccamento. Così da varie ricerche è emerso che le esperienze familiari di coloro che crescono ansiosi e timorosi non solo sono state caratterizzate dall’incertezza circa la disponibilità del supporto genitoriale, ma spesso anche gravemente distorte e confuse dalle pressioni genitoriali ad esempio esercitate sul bambino perché egli agisse come caregiver nei confronti di un genitore Analogamente le esperienze familiari di coloro che crescono stabili e fiduciosi in se stessi sono caratterizzate non solo da un costante supporto genitoriale quando questo viene richiesto, ma anche da un forte e continuo adattamento verso una crescente autonomia.

Metodologie

Mary Ainsworth ha condotto una lunga serie di complesse osservazioni su gruppi di bambini, anche provenienti da diverse culture, per valutare come si comportavano in una situazione sperimentale nota come Strange SituationSi tratta di una procedura ideata appunto per studiare il comportamento di attaccamento e di esplorazione del bambino di un anno, che si svolge in un laboratorio attrezzato con giocattoli ed è costituita da una sequenza standard di otto episodi, della durata di tre minuti ciascuno, ad eccezione dell’ultimo. Di rilievo sono due fasi di separazione e due di riunificazione con la madre e la presenza o assenza di una persona estranea mentre il bambino sta con la madre o da solo. La tecnica di laboratorio della Ainsworth è a tutt’oggi la tecnica sistematica più ampiamente usata per la valutazione della qualità dell’attaccamento del bambino verso il caregiver. Durante la situazione sperimentale il bambino è esposto ad un accumulo di circostanze ansiogene, che elicitano comportamenti che normalmente spingerebbero un bambino a cercare conforto dalla madre. Come già accennato, le caratteristiche stressanti della situazione includono: la non familiarità della stanza, l’essere in presenza di un adulto estraneo e due episodi di separazione dal genitore, ciascun episodio della durata di tre minuti. Queste caratteristiche servono per innalzare i livelli di vigilanza del bambino e provocare in lui un’intensa richiesta di conforto e rassicurazione. Difatti dopo un periodo preliminare nel quale il bambino ed il genitore (generalmente la madre) giungono in una stanza, che è un ambiente ignoto al bambino, dove si trovano dei giocattoli ed un adulto estraneo, il genitore lascia due volte la stanza e due volte ritorna, in modo che per due volte il bambino rimanga nella stanza ignota ed in presenza di un adulto non familiare. Le differenze tra le diverse diadi madre-bambino si osservano dopo le due brevi separazioni, quando la madre e il bambino si riuniscono. Il modo in cui il bambino si comporta in questa situazione (separazione e ricongiunzione) è ritenuto un forte indicatore della qualità dell’attaccamento tra lui e la figura caregiver che è coinvolta nella SS. Le osservazioni relative agli esperimenti di allontanamento-riunione indicano che, a partire dall’età di 1 anno, interruzioni dell’attaccamento si sono trasformate in esperienze soggettive come scene di allontanamento di forma ben definita. I bambini si comportano in accordo con le proprie aspettative sulle intenzioni della persona che li accudisce, aspettative basate su precedenti esperienze di interruzione. Il tipo di attaccamento e lo stress causato dall’interruzione dell’attaccamento nei momenti di allontanamento si cristallizzano in caratteristiche risposte emotive nei confronti di queste interruzioni. Durante i primi esperimenti della Ainsworth, la maggior parte dei bambini era in grado di tollerare il primo allontanamento senza allarme. Al secondo o al terzo allontanamento, i bambini reagivano secondo tre modelli caratteristici, ed in base a ciò l’Autrice ha individuato tre gruppi di bambini, denotanti altrettante categorie di attaccamento: A (insicuro-evitante), B (sicuro), C (insicuro-ambivalente). Questa classificazione tende sostanzialmente a descrivere il pattern di attaccamento che riflette lo stile con cui il bambino ha organizzato il comportamento di attaccamento in base allo stile di accudimento del caregiver. Sono gli episodi di riunione a fornire una base per inferire la natura della visione che è stata interiorizzata dal bambino circa la relazione tra lui stesso e la madre: specificamente se egli può o non può fare affidamento con successo (cioè non difensivamente) sulla madre, per alleviare il proprio stato di stress, come mostrano in maniera convincente i bambini con attaccamento sicuro.

Da appunti su “Psicologo verso la professione”, di Paolo Moderato, Francesco Rovetto

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Sorveglianza integrata COVID-19: i principali dati nazionali
English (Inglese)

L’infografica web con i dati della sorveglianza integrata COVID-19 e il report esteso vengono aggiornati periodicamente su EpiCentro.

Scarica il documento “Informazioni privacy per la sorveglianza sanitaria integrata COVID-19” (pdf 477 kb).

Infografica web

Dati della Sorveglianza integrata COVID-19 in Italia
Archivio delle infografiche in italiano (11 marzo 2020- 22 giugno 2020)

Documento esteso

documento esteso “Epidemia COVID-19. Aggiornamento nazionale 20 gennaio 2021”
appendice al bollettino con il dettaglio regionale

Open data

Per approfondire i dati contenuti nella dashboard e nei bollettini settimanali della sorveglianza scarica:

il file xlsx “COVID-19 ISS open data” (aggiornamento giornaliero)
la nota metodologica “Stime della trasmissibilità di SARS-CoV-2 in Italia” (pdf 559 kb)
presentazione esplicativa del metodo per la stima degli Rt (pdf 735 kb), a cura della Fondazione Bruno Kessler, Trento
dati nazionali e script per il calcolo dell’Rt nazionale (zip 6 kb)(aggiornamento settimanale)

Rapporto ISS-ISTAT

il rapporto “Impatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente periodo gennaio-novembre 2020” (pdf 1,8 Mb) realizzato da ISS e ISTAT che presenta un’analisi della mortalità nel periodo gennaio-novembre 2020 per il complesso dei casi e per il sottoinsieme dei soggetti positivi al Covid-19 deceduti; fa inoltre il punto sulle principali caratteristiche dell’epidemia e i loro effetti sulla mortalità totale, distinguendo tra la prima (febbraio-maggio 2020) e la seconda ondata epidemica (settembre-novembre 2020).
il rapporto “Impatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente. Periodo gennaio-maggio 2020” (pdf 1,1 Mb) realizzato da ISS e ISTAT che presenta un’analisi della mortalità totale e dei soggetti positivi al COVID-19 deceduti nel mese di maggio 2020 e un aggiornamento delle analisi relative al periodo gennaio-aprile 2020, già oggetto del secondo Rapporto.
il rapporto “Impatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente primo quadrimestre 2020” (pdf 1 Mb) realizzato da ISS e ISTAT per fornire una lettura integrata dei dati epidemiologici di diffusione dell’epidemia di COVID-19 e dei dati di mortalità totale acquisiti e validati da ISTAT. Il documento presenta un’analisi della mortalità totale e dei soggetti positivi al COVID-19 deceduti nel mese di aprile 2020 e un aggiornamento delle analisi relative al periodo gennaio- marzo 2020, già oggetto del primo Rapporto.
il rapporto “Impatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente primo trimestre 2020” (pdf 1,4 Mb) realizzato da ISS e ISTAT per fornire una lettura integrata dei dati epidemiologici di diffusione dell’epidemia di COVID-19 e dei dati di mortalità totale acquisiti e validati da ISTAT.

Attenzione: Si sottolinea che i dati raccolti sono in continua fase di consolidamento e, come prevedibile in una situazione emergenziale, alcune informazioni possono risultare incomplete o posso essere oggetto di modifica da un giorno all’altro. Inoltre, soprattutto nelle Regioni/PA in cui si è verificata o si sta ancora verificando una trasmissione locale sostenuta del virus c’è la possibilità di un ritardo di alcuni giorni tra il momento della esecuzione del tampone per la diagnosi e la segnalazione sulla piattaforma dedicata.

Guida all’interpretazione dei dati

I dati pubblicati dall’ISS provengono dal Sistema di sorveglianza integrata COVID-19 in Italia e sono elaborati dall’ISS integrando i dati microbiologici ed epidemiologici forniti dal

Guida all’interpretazione dei dati

I dati pubblicati dall’ISS provengono dal Sistema di sorveglianza integrata COVID-19 in Italia e sono elaborati dall’ISS integrando i dati microbiologici ed epidemiologici forniti dalle Regioni e Provincie Autonome (PA) e dal Laboratorio nazionale di riferimento per SARS-CoV-2 dell’ISS.

Per approfondire come funziona la sorveglianza integrata COVID-19 consulta la pagina dedicata.

Tutte le Regioni/Province Autonome inviano quotidianamente all’ISS i dati relativi a tutti gli individui con infezione da SARS-CoV-2 confermata in laboratorio. L’ISS ha creato una piattaforma informatica dedicata, che consente la raccolta dei dati sia attraverso un’interfaccia web collegata alla piattaforma stessa che attraverso l’invio di un dataset.

Tutti i casi di COVID-19 diagnosticati dai laboratori di riferimento regionali e dagli altri laboratori che sono entrati più di recente a far parte ufficialmente della rete diagnostica, entrano nell’ambito della sorveglianza. Si ricorda che la definizione internazionale di caso, adottata anche dall’ISS, prevede che venga considerata come caso confermato una persona con una conferma di laboratorio del virus che causa COVID-19 a prescindere dai segni e sintomi clinici.

I dati individuali vengono aggiornati da ciascuna Regione/PA con cadenza giornaliera e hanno la peculiarità di fornire un livello di dettaglio maggiore rispetto a quello previsto in altri flussi di dati (come per esempio quello della Protezione Civile o del Ministero della Salute). Infatti sono spesso disponibili informazioni sulle patologie preesistenti e sulle condizioni cliniche in cui versano i pazienti al momento dell’inserimento dei loro dati nella piattaforma.

Come prevedibile in una situazione emergenziale, alcune informazioni possono essere temporaneamente incomplete. Ci si riferisce a questo quando si parla di informazioni “in fase di consolidamento”. In particolare, soprattutto nelle Regioni/PA in cui c’è un alto numero di contagi, di malati e di ricoverati, c’è la possibilità di un ritardo di alcuni giorni tra il momento dell’esecuzione del tampone per la diagnosi e la segnalazione sulla piattaforma dedicata.

Per i dati più recenti va usata particolare cautela, perché ci può essere un ritardo di notifica dei casi, e questo non deve essere interpretato come indice dell’andamento dell’epidemia. Per approfondire questo aspetto consulta la pagina dedicata sorveglianza integrata COVID-19.

Glossario

Definizione di caso

Secondo quanto riportato nella Circolare ministeriale 0007922-09/03/2020, la definizione di caso si basa sulle informazioni attualmente disponibili, perciò potrebbe essere rivista in base all’evoluzione della situazione epidemiologica e delle conoscenze scientifiche disponibili [3].

Caso sospetto di COVID 19 che richiede esecuzione di test diagnostico

una persona con infezione respiratoria acuta (insorgenza improvvisa di almeno uno tra i seguenti segni e sintomi: febbre, tosse e difficoltà respiratoria)
e
senza un’altra eziologia che spieghi pienamente la presentazione clinica
e
storia di viaggi o residenza in un Paese/area in cui è segnalata trasmissione locale (secondo la classificazione dell’OMS) durante i 14 giorni precedenti l’insorgenza dei sintomi
oppure
una persona con una qualsiasi infezione respiratoria acuta
e
che è stata a stretto contatto con un caso ospedale battipaglia probabile o confermato di COVID-19 nei 14 giorni precedenti l’insorgenza dei sintomi
oppure
una persona con infezione respiratoria acuta grave (febbre e almeno un segno/sintomo di malattia respiratoria – es. tosse, difficoltà respiratoria)

Guida all’interpretazione dei dati

I dati pubblicati dall’ISS provengono dal Sistema di sorveglianza integrata COVID-19 in Italia e sono elaborati dall’ISS integrando i dati microbiologici ed epidemiologici forniti dalle Regioni e Provincie Autonome (PA) e dal Laboratorio nazionale di riferimento per SARS-CoV-2 dell’ISS.

Per approfondire come funziona la sorveglianza integrata COVID-19 consulta la pagina dedicata.

Tutte le Regioni/Province Autonome inviano quotidianamente all’ISS i dati relativi a tutti gli individui con infezione da SARS-CoV-2 confermata in laboratorio. L’ISS ha creato una piattaforma informatica dedicata, che consente la raccolta dei dati sia attraverso un’interfaccia web collegata alla piattaforma stessa che attraverso l’invio di un dataset.

Tutti i casi di COVID-19 diagnosticati dai laboratori di riferimento ospedale eboli regionali e dagli altri laboratori che sono entrati più di recente a far parte ufficialmente della rete diagnostica, entrano nell’ambito della sorveglianza. Si ricorda che la definizione internazionale di caso, adottata anche dall’ISS, prevede che venga considerata come caso confermato una persona con una conferma di laboratorio del virus che causa COVID-19 a prescindere dai segni e sintomi clinici.

che richieda il ricovero ospedaliero (SARI)
e
senza un’altra eziologia che spieghi pienamente la presentazione clinica. Nell’ambito dell’assistenza primaria o nel pronto soccorso ospedaliero, tutti i pazienti con sintomatologia di infezione respiratoria acuta devono essere considerati casi sospetti se in quell’area o nel Paese è stata segnalata trasmissione locale.

Caso probabile: un caso sospetto il cui risultato del test per SARS-CoV-2 è dubbio o inconcludente utilizzando protocolli specifici di Real Time PCR per SARS-CoV-2 presso i laboratori di riferimento regionali individuati o è positivo utilizzando un test pan-coronavirus.

Caso confermato: un caso con una conferma di laboratorio per infezione da SARS-CoV-2, effettuata presso il laboratorio di riferimento nazionale dell’ISS o da laboratori regionali di riferimento che rispondano ai criteri indicati nell’Allegato 3 della Circolare, indipendentemente dai segni e dai sintomi clinici.

Definizione di decesso: Ai fini della sorveglianza l’OMS definisce un decesso per COVID-19 come un decesso risultante da una malattia clinicamente compatibile in un caso probabile o confermato di COVID-19, a meno che non vi sia una chiara causa di morte alternativa non correlabile al COVID-19 (per esempio, trauma). Non dovrebbe esserci un periodo di completa guarigione tra la malattia e il decesso.

Età mediana/Età media: Mediana e media sono due misure statistiche utilizzate in epidemiologia per riassumere le informazioni su una variabile, in questo caso, l’età. La media è calcolata sommando tutte le età degli individui e dividendola per il numero di persone incluse. L’età mediana in un set di dati è l’età che divide il set in due metà, con una metà delle età al di sotto della mediana e l’altra metà al di sopra di questo numero. In questa epidemia, in cui la distribuzione delle età dei casi COVID-19 è asimmetrica la mediana descrive meglio la variabile rispetto alla media.

Numero decessi/letalità: Il tasso di letalità di una malattia è il numero di persone che sono morte a causa della malattia diviso per il numero totale di persone ammalate di quella malattia. Questo è diverso dal tasso di mortalità, che è il numero di persone che sono morte a causa della malattia diviso per la popolazione totale.

Asintomatici: Una persona trovata positiva al test perSARS-CoV-2 senza segni o sintomi apparenti di malattia.

Pauci sintomatici: Una persona trovata positiva al test per SARS-CoV-2 con sintomi lievi (ad esempio malessere generale, lieve rialzo della temperatura corporea, stanchezza, ecc.).

Lievi: Una persona trovata positiva al test per SARS-CoV-2 con chiari segni e sintomi di malattia (malattia respiratoria) ma non abbastanza gravi da richiedere il ricovero ospedaliero.

Severi: Una persona trovata positiva al test per SARS-CoV-2 con chiari segni e sintomi di malattia (malattia respiratoria) abbastanza gravi da richiedere il ricovero ospedaliero.

Critici: Una persona risultata positiva al test per SARS-CoV-2 con chiari segni e sintomi di malattia (ad esempio, malattia respiratoria) e abbastanza gr

COVID-19, la malattia da nuovo coronavirusIl 30 gennaio 2020 l’OMS ha dichiarato che il focolaio internazionale da nuovo coronavirus, identificato il 9gennaio e denominato successivamente SARS-CoV-2, è un’emergenza di sanità pubblica di rilevanza interna-zionale (Public Health Emergency of International Concern – PHEIC),4 e subito dopo anche il Consiglio deiMinistri ha le bolle eboli dichiarato lo stato di emergenza sanitaria anche in Italia.5Le parole chiave dell’epidemia secondo l’Istituto Superiore di Sanità6Focolaio epidemico Si parla di focolaio epidemico quando una malattia infettiva provoca un aumentonel numero di casi rispetto a quanto atteso all’interno di una comunità o di una regione ben circoscritta.Per individuare l’origine di un focolaio è necessario attivare un’indagine epidemiologica dell’infezionetracciando una mappa degli spostamenti delle persone colpite.Epidemia Con il termine epidemia si intende la manifestazione frequente e localizzata, ma limitata neltempo, di una malattia infettiva, con una trasmissione diffusa del virus. L’epidemia si verifica quando unsoggetto ammalato contagia più di una persona e il numero dei casi di malattia aumenta rapidamente inbreve tempo. L’infezione si diffonde, dunque, in una popolazione costituita da un numero sufficiente disoggetti suscettibili.Pandemia La pandemia è la diffusione di una malattia in più continenti o comunque in vaste aree delmondo. L’OMS definisce cinque fasi di una pandemia: in ordine la fase interpandemica, la fase di allerta,la fase pandemica, la fase di transizione prima di ritornare alla fase interpandemica. La fase pandemica ècaratterizzata da una trasmissione alla maggior parte della popolazione.Soggetto “asintomatico” È un soggetto che, nonostante sia affetto da una malattia, non presenta alcunsintomo apparente. Esiste un periodo chiamato “incubazione” in cui una malattia infettiva è già presentesenza mostrare alcun sintomo: l’incubazione è quindi “asintomatica” e termina quando il paziente avvertei primi sintomi, momento in cui la malattia da “asintomatica” diventa “sintomatica”. Una malattia può ri-manere asintomatica per periodi brevi o lunghi; alcune malattie possono rimanere asintomatiche persempre. La presenza di pazienti asintomatici affetti da coronavirus sembra possibile anche nel caso delSARS-CoV-2, tuttavia, secondo l’OMS, le persone sintomatiche sono attualmente la causa più frequente didiffusione del virus. Quarantena È un periodo di isolamento e di osservazione di durata variabile al quale vengono sottopo-ste persone che potrebbero portare con sé germi responsabili di malattie infettive. L’origine del terminequarantena si riferisce alla durata originaria di quaranta giorni, che in passato si applicava rigorosamentesoprattutto a chi proveniva dal mare. Oggi, il tempo indicato per la quarantena è stato ridotto e varia aseconda delle varie malattie infettive, in particolare relativamente al periodo d’incubazione identificatoper quella malattia infettiva. Per il coronavirus la misura della quarantena, con sorveglianza attiva, è sta-ta fissata a quattordici giorni, e si applica agli individui che abbiano avuto contatti stretti con casi confer-mati di malattia infettiva diffusiva COVID-19,

Epidemia o pandemia?Un’epidemia è definita come “la presenza di più casi rispetto all’atteso di una particolare malattia in una de-terminate area, o in uno specifico gruppo di persone in un determinato periodo di tempo”1-3 e può essere do-vuta all’emergenza di un nuovo agente patogeno o a mutazioni genetiche di un agente già esistente, che guardia medica lorendono più virulento oppure anche alla recente introduzione di un agente in un ambiente dove non era pre-sente prima, talvolta insieme anche a una diversa suscettibilità della risposta dell’ospite o a nuove modalitàdi contagio. Si parla invece di pandemia quando “un’epidemia si diffonde a più continenti o in tutto il mondo”. Primadell’influenza da H1N1 del 2009 la definizione teneva conto anche della gravità della malattia che dovevacausare “numeri molto alti di morti e malati”. Attualmente la differenza tra pandemia ed epidemia segue soloun criterio di diffusione geografica, anche se psicologicamente una pandemia è percepita dall’opinione pub-blica come più grave di un’epidemia.

COVID-19, la malattia da nuovo coronavirusIntroduzionePunti chiave●Premessa●Epidemia o pandemia?●Dove informarsiIn sintesiLa diffusione del nuovo coronavirus SARS-CoV-2 è in continua evoluzione, i dati siaccavallano e spesso sono fonte di fake news e informazioni del tutto incontrollate.Questo dossier vuole fare chiarezza usando solo informazioni evidence-based. Sono disponibili comunque online fonti autorevoli e aggiornate in tempo reale perseguire l’andamento della epidemia/pandemia.Il nuovo coronavirus SARS-CoV-2 ha rapidamente conquistato le prime pagine di giornali, telegiornali, sitiweb. Le informazioni scientifiche date sono spesso prive di fondamento o provengono da fonti inattendibili.E’ quindi necessario fare chiarezza, in un quadro in continua evoluzione.PremessaLe epidemie e le pandemie (qualunque esse siano) sono importanti minacce per la vita e la salute e richiedo-no grandi sforzi per essere contenute e rese meno gravi. Le difficoltà nella loro gestione dipendono da molte-plici fattori, a partire dalla imprevedibilità e mutabilità che le caratterizza, per arrivare all’indispensabilità dicoordinamenti internazionali e nazionali, specie nell’attuale situazione di globalizzazione e di interconnessio-ne rapida di persone e merci. Una ulteriore difficoltà consiste nel fornire informazioni tempestive, compren-sibili e il più possibile accurate sia agli operatori sanitari sia alla popolazione generale, mantenendo sufficien-temente alto il livello di consapevolezza per poter individuare precocemente casi sospetti o accertati, senzatuttavia suscitare allarmismi.Anche la confutazione covid di notizie false e non suffragate da fonti attendibiliè molto importante per evitare ulte-riori danni personali, sociali ed economici: l’ansia e in alcuni casi la psicosi, frutto di notizie incontrollate eallarmistiche, possono provocare discriminazioni totalmente ingiustificate di interi gruppi di popolazione,anche soltanto per l’appartenenza etnica e danneggiare settori economici importanti (come il turismo, il com-mercio e la ristorazione).Inoltre, l’eccesso di “prevenzione inutile” può sovraccaricare e intasare i servizi sanitari, indurre costi sanitariinutili (per esempio mascherine protettive, esami diagnostici non indicati, visite non necessarie), sottraendoimportanti risorse.Sono invece da favorire tutti quei comportamenti individuali e sociali non medicalizzanti e a costo minimo onullo, utili anche per prevenire e mitigare altre patologie e per rafforzare la coesione e il supporto sociale epsicologico, anch’essi fon

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