The COVID-19 pandemic has been a collective trauma for the world population. Psychoanalytic literature has long proposed that dreams are a key point of access for understanding the deepest ...functioning of the mind. Using the multiple code theory (Bucci, 1993) as a framework, this study aims to explore the emotional and cognitive responses of the general population to COVID-19 through their dreams. A total of 613 dreams were collected in an online survey. Linguistic measures of referential process and a cluster analysis were performed, then one-way analyses of variance explored the differences in content among dreams' clusters according to the Linguistic Inquiry and Word Count (LIWC). Analysis suggested three dream clusters: Cluster A (N = 255) defines an arousal activation; Cluster B (N = 121) defines a phase of symbolization; Cluster C (N = 237) defines a phase of reflection/reorganization. The content analysis of LIWC presents significant differences among the three clusters (p < .05): Cluster A, compared to Cluster C, included less use of the term "we," more frequent reference to others, and more frequent use of words denoting certainty; Cluster B included more words of negation and more use of both the present tense and the verb "to have"; Cluster C included less use of words referring to wishes and illusions. These results show differentiated functions of dreams in response to the pandemic experience, underlining the importance of dreams in the processing of this collective trauma.
2019年冠状病毒大流行(COVID-19)可以被认为是一种普遍的集体创伤。精神分析文献认为梦是理解心灵最深层次功能的关键。考虑到多重代码理论,本研究旨在通过梦来探索普通人群对COVID-19大流行的情感和认知反应。在线调查共收集了613个梦。对参照过程(RP)进行了语言测量和群集分析,以及单向ANOVAs,其根据语言查询和单词计数(LIWC)探索了梦境集群之间的内容差异。根据分析,从数据中出现了三个梦的集群:集群A(N = 255)定义了唤醒激活;集群B(N = 121)定义了象征阶段;集群C(N = 237) 定义了思考/重组的阶段。LIWC的内容分析在三个组别之间呈现出显著差异(p<.05):与组C相比,组A较少使用"我们",更多地使用"他人"和确定性词语;B组梦更多使用否定词、现在时使用和动词"有";组C较少使用提及愿望和幻想的词语。这些结果显示了梦在应对大流行体验方面的差异化功能,因此强调了梦在处理这种集体创伤方面的重要性。
Abstract
Aims
Since December 2015, the European/International Fibromuscular Dysplasia (FMD) Registry enrolled 1022 patients from 22 countries. We present their characteristics according to disease ...subtype, age and gender, as well as predictors of widespread disease, aneurysms and dissections.
Methods and results
All patients diagnosed with FMD (string-of-beads or focal stenosis in at least one vascular bed) based on computed tomography angiography, magnetic resonance angiography, and/or catheter-based angiography were eligible. Patients were predominantly women (82%) and Caucasians (88%). Age at diagnosis was 46 ± 16 years (12% ≥65 years old), 86% were hypertensive, 72% had multifocal, and 57% multivessel FMD. Compared to patients with multifocal FMD, patients with focal FMD were younger, more often men, had less often multivessel FMD but more revascularizations. Compared to women with FMD, men were younger, had more often focal FMD and arterial dissections. Compared to younger patients with FMD, patients ≥65 years old had more often multifocal FMD, lower estimated glomerular filtration rate and more atherosclerotic lesions. Independent predictors of multivessel FMD were age at FMD diagnosis, stroke, multifocal subtype, presence of aneurysm or dissection, and family history of FMD. Predictors of aneurysms were multivessel and multifocal FMD. Predictors of dissections were age at FMD diagnosis, male gender, stroke, and multivessel FMD.
Conclusions
The European/International FMD Registry allowed large-scale characterization of distinct profiles of patients with FMD and, more importantly, identification of a unique set of independent predictors of widespread disease, aneurysms and dissections, paving the way for targeted screening, management, and follow-up of FMD.
The strategic role of prevention in hypertension setting is well known but, with the only exception of annually events promoted by international scientific societies, no other screening campaigns are ...available. Aim of this study was to assess the feasibility of a non-physician pharmacy-based screening program and to describe the cardiovascular risk and the BP status of participating subjects.
2731 costumers participated to the screening program, answering to a questionnaire about personal cardiovascular risk and measuring their BP with an Omron HEM 1040-E. Since no threshold for hypertension diagnosis is currently available for community pharmacies BP measurements, we assessed high BP prevalence according to 3 different cut-offs (≥140/90, ≥135/85 and ≥ 130/80 mmHg) and compared normotensives and hypertensives on major cardiovascular risk factors. According to the proposed cut-offs, prevalence of hypertension was respectively of 31%, 45% and 59.5%, and it increased among younger subjects (31–65 y) when the lowest cut-offs were applied. High BP was found in a large percentage of subjects self-declared on-/not on-treatment (uncontrolled hypertensives) or normotensives (presumptive hypertensives) and among those not aware of their own BP values (presumptive hypertensives). Prevalence of CV risk factors was higher in hypertensives than in normotensives.
Our findings demonstrated that a community pharmacy-based screening is feasible and attracts the interests of many subjects, improving awareness on their BP status. The screening was also showed to be useful in order to detect potentially uncontrolled and/or suspected new hypertensives, especially among young adults, to refer to general practitioners for confirmatory diagnosis or further evaluation.
•A non-physician screening program based in community pharmacies is easily feasible.•A pharmacy-based screening program is attractive for subjects, especially for young adults.•Non-physician screening programs could underline how hypertension is undiagnosed.•Non-physician screening programs could underline how BP control is unsatisfactory.•Screening programs allow to detect new presumptive hypertensives among apparently healthy individuals.
Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of ...pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old;
<0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%;
=0.003) but underwent more often renal revascularization (63% versus 40%,
<0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.
This study included 144 patients with Apparently-Treatment Resistant (ATRH) or controlled Hypertension:
Patients with ATRH were more often poorly adherent to antihypertensive treatment than ...controlled hypertensive patients.
In patients with ARTH but not patients with controlled hypertension, psychological traits were strong, independent predictors of drug adherence and severity of hypertension, over and above demographic and health-related factors.
In patients with ATRH, the tendency to somatize, i.e. expressing somatic symptoms that cannot be adequately explained by organic findings was the most potent predictor of both poor drug adherence and severity of hypertension.
These patients also often presented alterations in the expression of emotions. It may be hypothesised that subjects who have difficulties identifying and expressing emotions with words will express them by physical complaints, and, in the mid-long term, might develop overt diseases.
In addition to more classical lifestyle and drug management and irrespective of their drug adherence level, patients with ATRH may benefit in priority from psychological evaluation and interventions. However, this needs to be studied in an interventional trial in the future.
In a pilot study including 35 patients with apparently treatment-resistant hypertension (ATRH), we documented associations between psychological profile, drug adherence and severity of hypertension. The current study aims to confirm and expand our findings in a larger and more representative sample of patients with ATRH, using controlled hypertensive patients as the comparator.
Patients with ATRH were enrolled in hypertension centres from Brussels and Torino. The psychological profile was assessed using five validated questionnaires. Drug adherence was assessed by high-performance liquid chromatography-tandem mass spectrometry analysis of urine samples, and drug resistance by 24-hour ambulatory blood pressure was adjusted for drug adherence.
The study sample totalised 144 patients, including 81 ATRH and 63 controlled hypertensive patients. The mean adherence level was significantly lower in the "resistant" group (78.9% versus 92.7% in controlled patients, p-value = .022). In patients with ATRH, independent predictors of poor drug adherence were somatisation, smoking and low acceptance level of difficult situations, accounting for 41% of the variability in drug adherence. Independent predictors of severity of hypertension were somatisation, smoking, more frequent admissions to the emergency department and low acceptation, accounting for 63% of the variability in the severity of hypertension. In contrast, in patients with controlled hypertension, the single predictors of either drug adherence or severity of hypertension were the number of years of hypertension and, for the severity of hypertension, alcohol consumption, accounting for only 15-20% of the variability.
Psychological factors, mostly related to somatisation and expression of emotions are strong, independent predictors of both drug adherence and severity of hypertension in ATRH but not in controlled hypertensive patients.
Hypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated ...organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers.
A questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03).
Knowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.
•Health education among population is essential in reducing hypertension related morbidity and mortality.•Knowledge about hypertension is often unsatisfactory among population.•Poor hypertension knowledge is associated with hypertension underdiagnosis and poor blood pressure control.•Community pharmacies can represent a non-medical sanitary setting for health education and hypertension screening.
Early uncontrolled studies reported large blood pressure reductions in subjects with resistant hypertension treated with renal denervation, however these results were not confirmed in several of the ...latest publications.
The aim of the current study was to evaluate the effectiveness of RDN in controlled studies comparing RDN to either a sham procedure or to medical therapy.
Only controlled studies were included in the analysis. Both the unadjusted and control-adjusted BP changes were calculated.
We identified 11 publications of which only 3 were double-blinded RCTs with a sham control, while 8 were open label studies where the control group was treated with medical therapy. Only 2 studies assessed adherence to medical therapy with robust methodologies. Office BP reduction (- 18/8 mmHg) significantly overestimated ABPM change (- 9/- 5 mmHg), with high heterogeneity between the included studies. When the treatment effect was adjusted for the BP change in the control group, BP changes became non significant (ABPM: - 1.8 for systolic BP 95% CI - 4.5 to 0.9 and - 0.6 for diastolic BP 95% CI - 2.3 to 1.2). These results were confirmed when only the sham-controlled studies were analysed.
In spite of promising results in early reports, renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies. Lack of a sham control in most publications and heterogeneity in assessment of treatment adherence may account for part the variability reported in the studies. Renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies.
Adherence to antihypertensive therapy is critical to achieving adequate blood pressure control. About half of hypertensive patients do not take their drugs as directed and the physicians often ...underestimate this issue. Non-adherence has important public health economic implications (numbers of visits, diagnostic procedures, prescribed drugs) and, moreover, it results in increased morbidity and mortality rates. Poor adherence can have several patients and therapy related causes. Currently, multiple different direct and indirect methods to measure therapeutic adherence are available, but, in clinical practice, there is no cost-effective and simple one. Therapeutic drug monitoring (TDM), characterized by drug (or metabolites) concentration measurement in body fluids (blood or urine), is a cost-effective direct method to assess therapeutic adherence. Despite some limitations, TDM may decrease health costs, by reducing the number of visits and by identifying those patients who would undergo unnecessary invasive procedures. Moreover, TDM can be a new alternative method to identify patients with true resistant hypertension, improving the achievement of blood pressure control In this minor revision, we would assess poor therapeutic adherence in hypertensive population, analyzing the different direct and direct available methods, with emphasis on TDM.
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