Search Results for: Come stress e attacchi di cuore sono collegati

Currently, the only medications approved by the US Food and Drug Administration for posttraumatic stress disorder (PTSD) are the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine. But a 2022 meta-analysis of drugs used for PTSD found that about 40% of patients don’t benefit from SSRIs. However, those living with PTSD who took a combination of sertraline and the antipsychotic brexpiprazole showed greater improvements in symptoms than those who took sertraline with a placebo.

Objectives
This study aimed to determine the feasibility of recruiting, implementing and delivering an acceptance and commitment therapy (ACT) intervention for mild traumatic brain injury (mTBI) (ACTion-mTBI) within a multidisciplinary outpatient mTBI rehabilitation services. The study also aimed to conduct a preliminary investigation of group differences between ACTion-mTBI and an equivalent cognitive behavioural therapy (CBT) intervention on various outcome measures and psychological treatment targets.

Design
A two-arm quasiexperimental feasibility study.

Setting
Five mTBI rehabilitation clinics throughout New Zealand.

Intervention
Psychologists working in mTBI rehabilitation clinics throughout New Zealand were trained to deliver ACTion-mTBI or CBT. Eligible participants were assigned to either of these interventions based on the psychologist available at the clinic they were referred to. ACTion-mTBI is a five sessions intervention that incorporates all six components of the ACT model. The CBT intervention is an equivalent intervention and incorporating all four components of the CBT model. Both interventions are adapted for an mTBI context.

Primary outcome measures
The primary outcomes were related to the feasibility of ACTion-mTBI. This included recruitment, retention and treatment adherence of participants, study procedure and fidelity of treatment delivery.

Secondary outcome measures
To explore group differences between ACTion-mTBI and CBT on functional disability, postconcussion symptoms, mental health, valued living and psychological flexibility.

Results
The intervention proved feasible to implement with community-based mTBI rehabilitation services. Attrition rates were comparable between the two psychological interventions and fidelity to the treatments was high. At post-treatment, when covarying pretreatment scores, ACTion-mTBI had a significantly greater improvement in functional disability than CBT (moderate effect). ACTion-mTBI also had a significantly greater reduction in postconcussion symptoms, anxiety and stress. Promisingly, significant improvements in psychological flexibility was also found post-treatment. There were no group differences on depressive symptoms and valued living.

Conclusion
We conclude that a full clinical trial of ACTion-mTBI for individuals with mTBI is feasible and warranted.

Trial registration number
ACTRN1262100059482.

Introduction
Unpaid caregivers of people living with dementia often experience lower levels of perceived life satisfaction and higher rates of depression and anxiety compared with those caring for individuals without Alzheimer’s disease or related dementias. While research on unpaid caregiver well-being and satisfaction has primarily focused on the characteristics of people living with dementia and their dyadic relationships, it has not adequately explored the role of social networks in supporting unpaid caregiver well-being. In this study, we aim to fill this gap by taking an egocentric social network approach to understand the multiple dimensions of social relations among unpaid caregivers of people living with Alzheimer’s disease or related dementia.

Methods and analysis
We will conduct a mixed-method, 2-year exploratory study that involves a structured survey-based telephone interview in year 1 and semistructured interviews in year 2 with caregivers of PLWD recruited through community and healthcare partners. Participants will participate in 1 60-min interview in year 1 (n=100) and a 45–60 min semistructured interview in year 2 (n=75). Eligibility for caregivers includes being an unpaid caregiver, aged 40 years or older, residing and providing care in Arizona or Nevada. The survey consists of questions about caregiver and care recipient demographics, caregiver background, caregiver stress, resilience, well-being and egocentric social network data. Network composition attributes, such as tie strength, the function of the relationship and reliance on network members, will also be assessed. In year 2, qualitative semistructured interviews will supplement these quantitative measures to understand network selection, perceived network changes over time and network strength.

Ethics and dissemination
The Arizona State Institutional Review Board (00018191) approved this study. All participants will receive electronic informed consent documents to review and sign. During the initial interview, participants will be asked if they have any questions about the informed consent documents. We will confirm that participants have completed the required consent form before the start of any research activity. The findings of this study will be disseminated through peer-reviewed journal articles, academic and community presentations, and community-focused publications targeting caregivers.

Objectives
This study aims to characterise the diversity of post-COVID-19 physical and mental health outcomes, known as the post-COVID-19 condition (PCC), and the determining factors 3–6 months after acute SARS-CoV-2 infection.

Design
This is a prospective cohort study.

Setting
This study took place at the European Hospital of Marseille, France.

Participants
Participants include patients with acute COVID-19 treated as inpatients or outpatients.

Interventions
Interventions include face-to-face assessment of physical and mental health symptoms.

Main outcome measures
Main outcome measures include symptom scores and scales, as well as paraclinical elements (thoracic CT scan, pulmonary functional tests). Multiple component analysis was used to identify clinical phenotypic clusters of PCC patients, as well as their initial comorbidity groups. A multinomial regression model was used to evaluate the association between the initial comorbidities and disease severity with PCC phenotype.

Results
A total of 210 patients agreed to participate, of which 157 (75%) reported at least one symptom at the 3–6 months visit; mostly asthenia, dyspnoea, psychiatric disorders such as anxiety, depression, post-traumatic stress disorder and cognitive disorders. Four PCC clusters were recognised: (1) paucisymptomatic PCC (n=82, 39%); (2) physical sequelae PCC (n=39, 18.6%), (3) pre-existing pulmonary comorbidities PCC (n=29, 13.8%); and (4) functional somatic and/or mental symptoms PCC (n=60, 28.6%). In addition to their PCC symptoms, the patients in these clusters differed in terms of their demographic characteristics (sex), comorbidities and severity of COVID-19.

Conclusions
The four identified PCC clusters corresponded to distinct and coherent clinical and paraclinical entities, making it possible to consider adapted and personalised prognosis and therapeutic interventions.

Draicchio, ‘nei primi sei mesi del 2024 già 296 casi nel mondo’

Objectives
To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance).

Design
Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data sources
PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024.

Eligibility criteria
English-language RCTs with ≥30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes.

Data extraction and synthesis
Full-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges’ g (with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates.

Results
20 RCTs were included. Osteopathic interventions reduced depression (Hedges’ g=–0.47, 95% CI: –0.86 to –0.09, p=0.02) and increased skin conductance (Hedges’ g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges’ g=–0.61, 95% CI: –1.06 to –0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias.

Conclusions
Osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed.

Trial registration number
This meta-analysis was not formally registered, though the protocol and search strategy can be found at Open Science Framework, registration identification: https://osf.io/jrtpx/.

All’ospedale di Acireale, è il più anziano donatore

Introduction
Preterm infants born before 32 weeks of gestation are generally admitted to a neonatal intensive care unit (NICU) to receive life-saving treatment, resulting in early exposure to stressful events. Yet, NICU admission is not only stressful for the infant but can also have a long-lasting negative impact on parental mental health, who may worry about their child. Parental mental health problems might affect child development through parental behaviour and the parent–infant relationship. Simultaneously, adverse child development after preterm birth can (further) elevate parental stress and mental health problems, straining parental behaviour, the parent–infant relationship and child development. This systematic review and meta-analysis aims to examine the association between preterm-born children’s development (

Introduction
Efforts to increase engagement with diabetes prevention programmes largely focus on increasing diabetes awareness, with the logic that risk knowledge will motivate behaviour change. However, the salience of perceived risk as it relates to diabetes prevention is contested. The goal of this cross-sectional, embedded mixed-methods study was to examine the relationships between perceived risk, diabetes beliefs and prevention behaviours among adults at elevated risk of type 2 diabetes.

Methods
Data come from the Richmond Stress and Sugar Study (n=125). Diabetes beliefs (ie, internal, chance, powerful others) were assessed using the Multidimensional Health Locus of Control. Preventive behaviours (eg, changing diet, exercise, tobacco, alcohol) were measured by self-report. Perceived risk of developing diabetes was measured using a probability scale (0%–100%). Logistic and Poisson regression models quantified the relationships between beliefs, behaviours and perceived risk. Qualitative themes regarding challenges and facilitators to preventive behaviours were abstracted from open-ended questions and summarised using content analysis.

Results
Perceived risk of developing diabetes was low (median: 35% likelihood) and only 10% of participants had ever attended a prevention class. None of the diabetes belief domains were significantly associated with either engagement in preventive behaviours or perceived diabetes risk. Perceived diabetes risk was not associated with engagement in preventive behaviours; however, having a family history of diabetes was strongly related to perceived risk (OR: 3.35, 95% CI: 1.42 to 7.86). Qualitative facilitators and barriers of preventive behaviours reflected psychosocial factors (eg, determination, stress, preferences) and resources (eg, social support, time, overall health).

Conclusions
Perceptions of risk and health beliefs are not correlated with engagement in preventive behaviours among adults at clinically elevated risk of diabetes. Awareness campaigns may benefit from incorporating family health history information. Diabetes prevention programmes should address barriers beyond health beliefs to promote engagement in behaviour change.

Intervento al Bellaria di Bologna, coinvolti 50 professionisti

Intervento al Bellaria di Bologna, coinvolti 50 professionisti

This systematic review and network meta-analysis evaluates psychiatric interventions in pediatric posttraumatic stress disorder.

Objectives
To evaluate the effect of delivery hospital busyness on the postnatal condition and the perinatal mortality among small preterm infants born at ≤32+0 gestational weeks.

Design
The daily delivery volume distribution is defined as lowest 10% (‘quiet’) and highest 10% (‘busy’) delivery-volume days, and days between (80%) as optimal delivery-volume days. We analysed differences in the incidence of selected adverse outcomes between quiet and busy days compared with optimal delivery-volume days by logistic regression followed by crude (ORs) and adjusted ORs (aORs) with 99% CIs.

Setting
A population-based cohort study based on prospectively collected real-world data from five university hospitals and 21 non-tertiary-level delivery hospitals in Finland, 2006-2016.

Participants
4323 small preterm infants.

Primary outcome measures
Umbilical cord pH ≤7.05, Apgar score 0–3 points at the age of 1 min, Apgar score 0–3 points at age 5 min, birth asphyxia (International Classification of Diseases-10 code), resuscitation with intubation.

Secondary outcome measures
Perinatal mortality comprising stillbirths and early neonatal deaths (

Objectives
Population ageing and the rise in chronic diseases place continual stress on healthcare systems. Scarce resources often impede equitable access to healthcare, particularly in rural areas, resulting in prolonged waiting times and heightened risks of morbidity and mortality. Telemedicine has emerged as a promising solution, offering remote and equitable care that could potentially bridge access gaps and enhance health outcomes. This systematic review aims to quantitatively examine the impact of telemedicine implementation on waiting times, defined as the time passed from the booking of a visit for an outpatient to the administration of the service.

Design
A systematic review was conducted using studies on telemedicine interventions that specifically addressed waiting times. Bias assessment was performed with three tools: ROBINS-I (“Risk of Bias In Non-Randomized Studies of Interventions”), AXIS (“Appraisal tool for Cross-Sectional Studies”) and RoB-2 (“Risk of Bias-2”). A weighted mean approach was used to synthesise results, with medians synthesised using a median approach.

Data sources
Articles in English were retrieved from the PubMed and Scopus databases.

Eligibility criteria
Studies were excluded if they did not specifically address waiting times related to telemedicine interventions. Only studies that considered waiting times defined as the time passed from the booking of a visit for an outpatient to the administration of the service and any telemedicine intervention were included.

Data extraction and synthesis
A total of 53 records were included, encompassing 270 388 patients in both the experimental and control groups. The weighted mean reduction in waiting times was calculated, and bias was assessed. No record was evaluated to be at high risk of bias, with 69.8% of studies evaluated at low risk and 26.4% at moderate risk (3.8% were surveys). Results were synthesised using a weighted mean approach for studies reporting means, and a median approach for studies reporting medians.

Results
Overall, a weighted mean reduction of 25.4 days in waiting times was observed. Focusing on clinical specialties (n=114 042), the weighted mean reduction amounted to 34.7 days, while in surgical patients (n=156 346), telemedicine was associated with a weighted mean of 17.3 days saved.

Conclusions
The implementation of telemedicine solutions may significantly improve waiting times, potentially leading to more efficient and equitable healthcare systems.

PROSPERO registration number
CRD42023490822.

Al via CVrisk-IT in tutta Italia. Filippo Magnini testimonial

Al via CVrisk-IT in tutta Italia. Filippo Magnini testimonial