Objective To investigate the long-term changes in anxiety and depressive symptoms, protective and risk factors in hospital staff during the COVID-19 pandemic. Specifically, our aims were: 1) to ...evaluate sociodemographic, work-related, and individual characteristics associated with changes in distress symptoms; 2) to explore whether and to what extent sociodemographic, work-related, and individual characteristics predict distress symptoms. Methods Two online surveys were distributed to hospital staff in six countries (Germany, Andorra, Spain, Italy, Iran, Ireland) between May–October 2020 (T1) and between February–April 2021 (T2). An international working group was established for this study, supported by the European Association of Psychosomatic Medicine. Sociodemographic characteristics, contact with COVID-19 patients, anxiety and depressive symptoms, self-compassion, sense of coherence, social support, risk perception, and health and safety at the workplace were evaluated in 611 hospital workers using self-report measures. Results Between T1 and T2, we found a significant increase in anxiety and depressive symptoms. Lower levels of self-compassion and sense of coherence over time were reported in subjects with anxiety or depressive symptoms both at T1 and T2. High levels of risk perception (T2) and low levels of self-compassion (T2), sense of coherence (T2), and social support (T1 and T2) significantly predicted anxiety or depressive symptoms at T2. Conclusion These findings point out the risk of developing and maintaining distress symptoms during the COVID-19 pandemic is associated with lower individual and work-related resources in hospital workers. Therefore, enhancing these resources may be a starting point for providing adequate psychological support interventions.
Aims: To investigate whether alexithymia is associated with cardiometabolic risk factors (RF) and increased CVD risk. Methods: A consecutive and unselected cohort of 1,170 adult blood donors (74.8% ...males, aged 46.1 ±10.0) were recruited and assessed for traditional, biochemical (homocysteine and lipoprotein-a) and lifestyle RF. Psychological factors, including alexithymia (TAS-20: 75th centile was used as threshold) and depressive symptoms (BDI-II), were concurrently assessed. We evaluated CVD risk according to Framingham risk score (FRS) and Italian NIH (National Institute of Health) CUORE risk score (CRS). Estimated 10-year CVD risk was calculated with both scores and population was subsequently divided into low-risk vs. moderate- to-high risk (FRS <10% vs. >10% and CRS <3% vs. ≥3%, respectively). Results: The prevalence of moderate-to-high risk was 13% (FRS) and 21% (CRS). The alexithymic group (N=280; 23.6%) had significantly a lower education and occupational status, as well as higher BMI, higher total and LDL cholesterol, higher lipoprotein(a), and depression score than the non-alexithymic group. Consistently, the percentage of subjects at moderate-to-high CVD risk was significantly higher in the alexithymic group for both FRS and CRS. A stepwise forward multivariate logistic regression was used to select predictors of moderate-to-high CVD risk. The results showed that alexithymia was a strong independent predictor of increased estimated CVD risk at 10 years for both FRS (OR: 2.40; 95% CI: 1.38-4.14; p=0.002) and CRS (OR: 2.11; 95% CI: 1.32-3.38; p=0.002)t after adjustment for sociodemographic and lifestyle factors, BMI, diastolic blood pressure, metabolic RF (fasting blood glucose, LDL and triglycerides), and biochemical RF. Conclusion: This large cohort study suggests that alexithymia may be considered a major psychological factor for CVD risk in healthy population. Longitudinal studies are needed for investigating the role of alexithymia in clinical outcomes (morbidity and mortality).
Aims: To investigate psychosomatic correlates of patients with psoriasis. Methods: A consecutive sample of 282 outpatients affected by chronic psoriasis (50.4 females, aged 50.1 ±12.6; median ...duration of illness 13 years) was recruited. Most patients (79.5%) were treated as usual and had comorbid diseases (metabolic, allergic, autoimmune, endocrine, inflammatory, respiratory, hematologic and neurologic problems) (54.3%). Disease severity was assessed with the Psoriasis Area Severity Index (PAS1) and showed mild activity in 26.2%, moderate activity in 33.3%, and severe activity in 15.6% of patients. Furthermore, patients were assessed for psychiatric disorders (MINI 5.0.0), psychosomatic syndromes (Diagnostic Criteria for Psychosomatic Research, DCPR), and disease-specific quality of life (Dermatology Quality of Life Index, DLQI). Results: The prevalence of any psychiatric disorders was 14.2% (mainly anxiety and mood disorders) whereas 67% of patients were found positive to at least one of the 12 DCPR psychosomatic syndromes. The most prevalent DCPR syndromes (>10%) were abnormal illness behaviour (AIB) (n=76, 27%; particularly, illness denial = 20.2%), alexithymia (n=83,29.4%), irritability (n=64,22%), somatization (n=44, 15.6%), and demoralization (n=34, 12.2%). Disease severity was not associated with MINI diagnoses while it was significantly associated with DCPR illness denial (x^sup 2^=10.01, p=.006), demoralization (x^sup 2^=9.13, p=.01), alexithymia (x^sup 2^=10.17, p=.0O6), AIB (/2=10.28, p=.006), and mostly psychosomatic severity (DCPR>1) (x^sup 2^=17.36, p<.001). A series of hierarchical regression models showed that PAS! severity was significantly predicted by quality of life at 6% and mostly by DCPR alexithymia (10% of additional explained variance) and severity (7% of additional explained variance), after adjusting forage, gender, duration of illness, medical and psychiatric comorbidity. Conclusion: Psychosomatic syndromes were associated to severity of disease more than medical and psychiatric comorbidity. Alexithymia was also a significant predictor of severity.
We aim to determine clinical risk factors for postoperative complications in preterm infants with surgical necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP).
A retrospective ...cohort study of preterm infants with surgical NEC or SIP to compare clinical factors between those with and without postoperative complications.
78/109 (71.5%) infants had any complication following surgical NEC. Adhesions (20/35, 57.1%) and wound infection (6/35, 17.1%) were the most common single surgical complications. Patients with a single surgical complication (35/66, 53%) were significantly less likely to be exposed to antenatal steroids, more frequently had a jejunostomy, needed a central line longer, and had a longer length of stay than those without any surgical complication. Infants with > 1 surgical complication (43/71, 60.5%) included mainly females, and had AKI more frequently at NEC onset, lower weight z-scores and lower weight for length z- scores at 36 weeks PMA than those without any complications.On multinomial logistic regression, antenatal steroids exposure (OR 0.23 CI 0.06, 0.84; p = 0.027) was independently associated with lower risk and jejunostomy 4.81 (1.29, 17.9) was independently associated with higher risk of developing a single complication. AKI following disease onset (OR 5.33 (1.38, 20.6), P = 0.015) was independently associated with > 1 complication in surgical NEC/SIP infants.
Infants with postoperative complications following surgical NEC were more likely to be female, have additional morbidities, and demonstrate growth failure at 36 weeks PMA than those without surgical complications. There was no difference in mortality between those with and without surgical complications.
The popularity of unicompartmental knee arthroplasty (UKA) continues to grow among orthopaedic surgeons and robotic surgery may be helpful in obtaining a precise placement of the prosthetic ...components, thanks to the meticulous intra-operative computer study for simulating the prosthetic positioning. This may lead to longer implant survivorship as well as a reduction in intermediate and long-term prosthetic complications, despite the initial greater costs than those of manual UKA. In this preliminary study, from January 2017 and October 2017, 18 patients underwent UKA with MAKO robotic system assistance and 10 patients received UKA with NAVIO robotic system assistance. The two groups were homogeneous by age, BMI, degree of osteoarthritis involvement, and postoperative program. Patients were followed both clinically (Numeric Rating Scale NRS and Knee Injury Osteoarthritis Outcome Scores KOOS) and radiographically. At the end term follow up (2 years), no significant difference was observed for NRS and KOOS as well as for clinical parameters as an active range of motion. A significant discrepancy was detected regarding the duration of the surgery and time of using the robotic system, that appeared to be longer in the NAVIO group than that of MAKO group, likely due to the specific technical aspects that characterize these two different robotic systems. The main finding of this study is that favorable clinical and radiographical results may be obtained using a robotic approach (MAKO or NAVIO) for UKA positioning at a short follow up. Due to the lack of significant clinical differences observed between the two groups of patients at end term follow up, the "concept" of a robotic approach, more than a specific patented system, may be considered the key element for improving UKA technique and it is likely that in the near future the choice of a single specific robotic system will still be a "surgeon's preference". The results of the study add scientific evidence regarding the effective improvement of UKA results using different robotic approaches. They also show possible economic sustainability of this therapeutic strategy related to the optimal patients' performance obtained at short term follow up, suggesting that the robotic assistance may really become a key element for better long-term survivorship of unicompartmental knee arthroplasty.
The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of ...disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill.
A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate.
Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization.
Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.
Puberty is a critical age for patients with Turner syndrome (TS): infertility is reported to be linked to karyotype and spontaneous puberty and menarche occur in approximately 30% of patients, ...especially in mosaicism. However, it is not always predictable considering hormonal pattern and pelvic transabdominal ultrasound scan (US).The aim of the study is to compare the accuracy of Magnetic Resonance Imaging (MRI) and US to evaluate uterine and gonads volume, to visualize the presence of follicles and to predict spontaneous puberty and menarche in girls with TS. In a retrospective study, we evaluated 19 TS patients (age: 9-16 years), who underwent transabdominal pelvic US and pelvic MRI as required by parents. We correlated pelvic imaging with karyotype, hormonal data and pubertal outcome, and we compared US resolution to MRI.MRI revealed a higher accuracy in the study of uterus and ovaries, and permitted to measure ovaries not visualized by US. Ovarian volume, the presence of follicles and the occurrence of spontaneous puberty were not related to the karyotype; spontaneous puberty started in one patient with a karyotype 45,X and in two patients with mosaicism (45,X/46,XX; 47,XXX/45, X). Ovarian follicles were relieved by MRI in patients with a spontaneous menarche and the persistence of menstrual cycles correlated with an ovarian volume corresponding to Tanner stage 3-4. We stress the role of MRI in the follow-up of TS adolescents, guide in the choice of the timing of treatment.
Summary
Aims: The role of type A behaviour in cardiovascular disease is controversial and most of the research is based on self‐rating scales. The aim of this study was to assess the prevalence of ...type A behaviour in cardiology and in other medical settings using reliable interview methods that reflect its original description.
Methods: A sample of 1398 consecutive medical patients (198 with heart transplantation, 153 with a myocardial infarction, 190 with functional gastrointestinal disorders, 104 with cancer, 545 with skin disorders and 208 referred for psychiatric consultation) was administered the Structured Clinical Interview for the DSM‐IV and the Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) which identifies 12 clusters, including type A behaviour.
Results: A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behaviour in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). Type A behaviour frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM‐IV diagnoses. Among cardiac patients, those with type A behaviour were less depressed, demoralised and worried about their illness.
Conclusions: Type A behaviour was found to occur in about a third of cases of patients with cardiovascular disease. Only in a limited number of cases was it associated with depression. It has a lifestyle connotation that may have important clinical consequences as to stress vulnerability and illness behaviour.
Background
Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept ...rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment. Aims: In this cross‐cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.
Methods
463 IBS patients, with moderate to severe symptom scores, and 192 healthy controls completed validated questionnaires about attachment, catastrophizing, negative pain beliefs and IBS‐SSS in nine locations, USA (New York, Los Angeles), Mexico, Italy (Rome, Bari), Romania, Iran, India, and China.
Key Results
Attachment anxiety and avoidance scores were significantly higher in IBS patients than in controls (p < 0.001). This was particularly true for the fearful‐avoidant attachment category, especially in China and Romania. Path analysis showed that attachment anxiety and avoidance had indirect effects on IBS‐SSS through catastrophizing (p < 0.0001) and negative pain beliefs (p = 0.005). All three psychosocial measures varied significantly depending on location.
Conclusions & Inferences
In the IBS population studied, attachment style was significantly different in IBS compared to a control population. Geographic differences in attachment, catastrophizing and negative pain beliefs were documented and their correlation with symptom severity and thus, research of psychosocial variables in IBS should take into account the location of the population studied.
This cross‐cultural study compares three psychological factors, attachment, catastrophizing, and negative pain beliefs in IBS patients living in nine geographic sites. Attachment, never studied before in IBS, was significantly different in patients vs controls and all three variables showed significant differences among sites, including their relationships with IBS symptom severity.
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