Risultati per: Demenze: trattamento farmacologico e non farmacologico e gestione dello stress del caregiver

Introduction
Sexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women’s hazardous drinking and mental health comorbidities.

Methods and analysis
This two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders – 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study’s primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms.

Ethics and dissemination
The Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants.

Trial registration number
Registered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).

This parallel-design, double-blind, randomized clinical trial investigates if combination treatment with brexpiprazole and sertraline is efficacious, safe, and well tolerated in patients with posttraumatic stress disorder.

‘Stato gold’ nell’ambito del programma ‘Eso-Angels Awards

Introduction
Caring for a relative in the home environment is a great challenge for many informal caregivers (CGs). Caregiver counselling offers support to the CGs and can, thus, help them improve CGs’ burdensome home care situations, especially if the caregiver counsellors (CCs) have good communication skills. Motivational interviewing (MI) has the potential to further enhance the communication skills of CCs and the effectiveness of MI has been demonstrated internationally in a wide variety of contexts. However, MI has not been implemented and evaluated in the caregiver counselling context yet.

Methods and analysis
The goals of our prospective, interventional, mixed-methods study are the development, implementation and evaluation of a training course for CCs on the topic of ‘Motivational Interviewing for caregiver counselling’ in Germany. The training is specifically adapted to the caregiver counselling context and consists of an e-Learning, an on-site workshop and a voluntary follow-up support phase. Its quality and benefits will be evaluated according to Kirkpatrick’s four-level evaluation model. Measured outcomes will be participants’ satisfaction with the training (level I: reaction), MI knowledge (level II: learning), perceived use (level III: behaviour) and counselling competence, self-efficacy, social cognitions about the use of MI and perceived impact of MI (level IV: results). Primary outcome is counselling competence measured by Counsellor Activity Self-Efficacy Scale. The data will be collected at baseline (t0), after the on-site workshop (t1), after the voluntary follow-up support (t2) and 6 months after the training (t6). Quantitative data will be analysed with several repeated-measures ANOVAs and qualitative data with qualitative content analysis. Recruitment is ongoing until 31 July 2024.

Ethics and dissemination
All procedures were approved by the Ethics Committee of the Friedrich–Alexander University Erlangen–Nürnberg (project number 24–108-B). Informed consent will be obtained before participants are enrolled. Serious adverse events are not expected. Results will be published in peer-reviewed journals and presented at conferences.

Trial registration number
ISRCTN14218056.

We recently showed that a bacterial infection can break oral tolerance to food and lead to IgE-dependent mast cell activation and food-induced abdominal pain, which could constitute an important pathogenic mechanism in post-infectious irritable bowel syndrome (IBS). Here, we investigated whether similar immune mechanisms in response to psychological stress lead to food-evoked pain signaling, and thus potentially explain the pathophysiology in a larger group of patients with IBS.

Car-T da donatore contro neuroblastoma che non risponde a cure

Car-T da donatore contro neuroblastoma che non risponde a cure

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/.

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.

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 (

Ministero Salute ha assegnato finanziamento di 1,2 milioni euro

Stroke, Volume 56, Issue Suppl_1, Page ATP126-ATP126, February 1, 2025. Background:Stroke survivors face functional changes that may alter their quality of life. Although these changes are significant for the stroke survivor, they are consequential for the caregiver of the stroke patient as well. Psychological burden of stroke caregivers has been investigated, but its association with level of disability and quality of life of the stroke patient has been less studied.Objective:To determine if worse 90-day patient stroke outcomes result in greater caregiver strain and worse caregiver mental health in a multiethnic sample.Methods:Using data from the Brain Attack Surveillance in Corpus Christi project, we prospectively determined 90-day ischemic and hemorrhagic stroke outcome from 2019-2023. Patient function based on ADLs/IADLs (higher scores worse) along with patient quality of life based on SS-QOL (higher scores better) were used to measure patient outcome. Stroke caregivers’ depression was measured using the PHQ-8 (higher scores worse) and strain was measured by mCSI (higher scores worse). Generalized propensity scores (GPS) were calculated for the main exposures using caregiver and patient demographics, dyad characteristics, and clinical variables as predictors. Caregiver outcomes were modeled with linear regression, with caregiver depression and strain as main outcomes, unadjusted and adjusted for GPS.Results:During this time period, 339 strokes were identified and their caregivers subsequently interviewed. The median age of interviewed caregivers was 55, with 46% being the sole informal caregiver. A majority of the caregivers interviewed were either the spouse of the stroke patient (42.2%) or the child of the stroke patient (38.1%). In adjusted analyses, functional status for stroke patients was not associated with caregiver depression (p=0.12), higher stroke patient quality of life was strongly associated with lower odds of any depression symptoms among caregivers (p