Antiepileptic drug use in a nursing home setting: A Retrospective study in older adults

The authors set out to examine qualitatively the use of antiepileptic drugs (AEDs) in a population of older adults in a nursing home setting, evaluating aspects such as specialist prescriptions and changes in dosage. This retrospective prevalence study was carried out in a state-funded nursing home that provides care and rehabilitation for elderly people. The first objective of the study was to determine the prevalence of AED use in this population. The second objective was to monitor AED dosage modifications during the fifteen-month study period, focusing on the safety and the tolerability of AEDs. In the period of time considered, 129 of 402 monitored patients received at least one anti-epileptic therapy. The prevalence of AED use was therefore 32%. Gabapentin was found to be the most commonly prescribed drug, with a frequency of 29%, and it was used mainly for anxiety disorders, psychosis, neuropathic pain and mood disorders

Evaluation of the burden management in a psychiatric day center: distress and recovery style

Aim: In psychiatric rehabilitation the individual treatment plan can be formulated from tools that provide a multidimensional assessment of the patient. This study aims to analyze the relationship between distress and recovery style (integration and sealing over) from the psychosis. Assuming that this relationship affects the burden management, the study has the additional target of gaining more elements to direct the formulation of more effective therapeutic / rehabilitation programs. Methods: The study was carried out in a psychiatric day center, semi-residential structure of mental health services of the National Health System in Italy. 45 patients enrolled have been evaluated by the Neuropsychiatric Inventory (NPI - Italian version) and Integration / Sealing Over Scale (ISOS - Italian version), within three months (March-June 2014). Results: In the sample, the symptoms which cause a greater distress in the health workers, in an absolute sense, are uninhibition, irritability and apathy. Moreover, the results indicate that depression and anxiety cause a greater degree of distress in sealer patients. Discussion and conclusion. Uninhibition, irritability and apathy were more burdensome for mental health workers, because they require a greater engagement in the therapeutic relationship. Anxious and depressive symptoms cause a greater degree of distress in the sealers patients, reporting lower endurance of the denial of psychosis. The data seem to prove that knowing, differentiating and deepening the different aspects of the recovery style of each patient enable us to estimate the burden management, starting from the taking in charge, and to reduce the distress and the risk of burn out of the mental health workers

Job strain and the incidence of coronary heart diseases: Does the association differ among occupational classes? A contribution from a pooled analysis of Northern Italian cohorts

Objectives To assess the association between job strain (JS) and the incidence of coronary heart disease (CHD) in North Italian employed men, adopting a stratified analysis by occupational class (OC). Methods The study was conducted on 4103 working men, CHD-free at baseline, enrolled in population-based and factory-based cohorts. Risk factor measurements and follow-up procedures were carried out adopting the WHO MONICA standardised procedures. OCs were derived from the Erikson-Goldthorpe-Portocarero classification. JS categories were defined based on overall sample medians of psychological job demand (PJD) and decision latitude (DL) derived from items of the Job Content Questionnaire, satisfying construct validity criteria. Age-adjusted and risk factors-adjusted CHD HRs were estimated from Cox models, contrasting high-strain (high PJD and low DL) versus non-high-strain categories. Results In a median follow-up of 14.6 years, 172 CHD events occurred, corresponding to a CHD incidence rate of 2.78/1000 person-years. In the overall sample, high-strain compared with non-high-strain workers evidenced a 39% excess CHD risk, not statistically significant. No association was found among managers and proprietors. Conversely, the HR of high strain versus non-high strain was 1.78 (95% CI 1.20 to 2.66) among non-manual and manual workers, with no substantial differences between them. The exclusion of the events occurring in the first 3 years of follow-up did not change the results. Adopting the quadrant-term JS groupings, among manual and non-manual workers, high-strain and active (high PJD and high DL) categories in comparison to the low strain one (low PJD and high DL) showed HRs of 2.92 and 2.47, respectively. Conclusions Our findings support the association of JS and CHD incidence among manual and non-manual workers. The non-high strain may not be the best reference category, when assessing the contribution of JS in determining CHD incidence

Reliability and validity of the Italian version of the 14-item resilience scale

Background: In recent years resilience has gained clinical relevance in sociological, psychological, and medical disciplines, and a lot of scales measuring resilience have been developed and have been utilized in the western countries. The aim of the study was to assess the psychometric properties of the Italian version of the 14-item Resilience Scale (RS-14), by describing its validity and reliability. As agreed with the authors of the original English version of the RS-14, it was translated into Italian. Then the standard procedure for back-translation was followed. Methods: In total, 150 participants among the nursing and professional education students of the University of Insubria of Varese and health workers of the \u201cASST dei Sette Laghi-Ospedale di Circolo\u201d of Varese were enrolled. The responses to the questionnaires were collected only from the students and the health workers between the ages of 18 and 65 years who gave their consent to participate in the study from April to September 2015. A subsample of 26 students and health workers was retested on the RS-14, 5 weeks after the first assessment. The questionnaires were handed out to 214 people, and 150 sets of questionnaires (70%) were returned, of which eight were subsequently removed because \uf03e60% of the answers were missing. In order to ensure anonymity, every completed questionnaire was identified only via a code. Results: No significant differences were found between the mean values of the resilience scores between women (76.1) and men (76.3), with unpaired t-test \uf03d\uf020-0.08 and P\uf03d0.93. Similarly, no difference between resilience scores were found between mean age group of 18-25 years (75.3) and 26-65 years (78.7), with t-test \uf03d\uf0201.6. The overall Cronbach\u2019s alpha of the RS-14 is 0.88, P\uf03d0.10. The RS-14 is negatively correlated with the Beck Depression Inventory-Primary Care Version and the 12-item General Health Questionnaire and positively correlated with the World Health Organization Quality of Life-Brief Version. The test-retest reliability, assessed on the 26 subjects 5 weeks after the first evaluation, highlighted an intraclass correlation coefficient value equal to 0.65. Factor analysis retains three factors, and it considers the factor loadings \uf03e0.40: RS-14-06 (\u2018I am determined\u2019) is loaded on all the factors and RS-14-12 (\u2018In an emergency, I am someone people can generally rely on\u2019) is not loaded on any factor. Conclusion: This study demonstrates that the Italian RS-14 has psychometric properties with a good level of internal consistency (Cronbach\u2019s alpha \uf03d\uf0200.88), an adequate concurrent validity, verified by relationships with the other scales and as it was expected from literature, and an acceptable test-retest reliability

Resilience in older adults: influence of the admission in nursing home and psychopathology

Objective: The resilience is the ability to face and overcome the adversities of life. The first aim of the study is to explore this construct referring to ageing. The characteristics of resilience were assessed in older adults, the additional endpoint is to focus on the role of institutionalization in nursing home and on the influence of chronic psychiatric illness. Method: 197 patients (aged 65 and over) have been enrolled in the observational cross-sectional study. The sample was composed by 91 subjects who lived at home (Community-dwelling, group I), 56 subjects who lived in a nursing home (Nursing-home, group II) and 50 subjects who lived in a nursing home, suffering from psychiatric disorders (Psychogeriatric division, group III). The resilience was evaluated through the Resilience Scale (RS) and the Connor-Davidson Resilience Scale (CD-RISC). Results: The mean total score of RS decreased from the group I to the group III (55.4, 49.8 and 46.6, respectively). Moreover, using pairwise comparison among groups, significant differences between the group I and the group II (5.6, p<0.0001) and between the group I and the group III (8.8, p<0.0001) were found. In the CD-RISC total score, significant differences among the three groups (p<0.0001) were observed, with a decrease of the mean values from the group I to the group III (66.2, 62.4 and 56.4, respectively). The pairwise comparison showed significant differences between the group III and the group I (p<0.0001) and between the group III and the group II (p=0.03). Conclusion: The first aim of the study to explore the construct of resilience in reference to ageing both as a dispositional resource and as an environment adjusted strategy of adaptation has been reached: the characteristics of resilience were assessed in older adults. Moreover, the second endpoint has been achieved too as the data showed that resilience skills of older adults are compromised both by institutionalization and by concurrent diagnosis of psychiatric disorder

Influence of sleep disturbances on age at onset and long-term incidence of major cardiovascular events: The MONICA-Brianza and PAMELA cohort studies

Objective: We examined the prospective associations of sleep disturbances and sleep duration with the long-term incidence of major cardiovascular disease (CVD) events, in a large cohort of Italian adult men. Methods: A total of 2277 men aged 35-74 years of age and CVD free at baseline from the MONICA-Brianza and PAMELA population-based cohorts were followed up for a median of 17 years, for first coronary heart disease (CHD) or ischemic stroke events (fatal or nonfatal; n =293). Sleep disturbances, based on the Jenkins Sleep Questionnaire, were categorized as none/some, moderate, or severe. Sleep durations were 646 hours (short), seven to eight hours, and 659 hours (long) per night. Results: At baseline, 855 men (38%) either reported sleep disturbances or were short or long sleepers. The presence of severe sleep disturbances increased the risk of first CVD (hazard ratio [HR]=1.80, 95% confidence interval [CI]=1.07-3.03) and CHD events (HR=1.97, 95% CI=1.09-3.56), in particular from the age of 48 years onward. In comparison to men sleeping seven to eight hours, long sleepers experienced a higher CVD risk (HR=1.56, 95% CI=1.10-2.22), due mainly to ischemic strokes, and starting at older ages ( 6560 years). A joint effect between disturbed sleep and short sleep duration on CVD and CHD events was also observed. Adjustments for physical activity and depression did not substantially modify these associations. Conclusion: Severe sleep disturbances and long sleep duration were associated with specific CVD endpoints and age at onset, potentially suggesting distinct underlying mechanisms. A short questionnaire discriminating different levels of sleep disturbances and sleep duration should be routinely adopted in CVD prevention programs to identify men at increased risk for early-onset events

Impact of bone marrow fibrosis grade in post-polycythemia vera and post-essential thrombocythemia myelofibrosis: A study of the MYSEC group

status: publishe