LA "NASCITA" DELLA FAMIGLIA ADOTTIVA: SVILUPPO PSICOSOCIALE DEI BAMBINI E BENESSERE GENITORIALE. UNO STUDIO LONGITUDINALE

Il presente progetto di ricerca nasce dalla collaborazione tra il mondo accademico e il mondo dei servizi che si occupano di adozione e ha l’obiettivo di progettare e applicare un protocollo di accompagnamento delle famiglie nel primo anno post-adozione. Il primo contributo della tesi è dedicato alla presentazione dettagliata del protocollo, in termini di finalità, obiettivi, metodo e, grazie a uno studio di caso singolo, si mettono in evidenza le ricadute operative dell’applicazione del protocollo stesso nell’intervento con le famiglie. Il secondo contributo offre, invece, una panoramica della situazione all’arrivo dei bambini in famiglia: lo studio si pone l’obiettivo di valutare il benessere dei bambini, considerando il peso delle esperienze vissute prima dell’adozione, e il benessere di madri e padri, con un approfondimento specifico sulla dimensione dello stress genitoriale. Il disegno di ricerca longitudinale ha, poi, consentito di tracciare i percorsi di cambiamento cui le famiglie vanno incontro e a cui sono dedicati i successivi contributi. Si sono valutati sia il recupero dei bambini, con un’attenzione specifica all’area dello sviluppo cognitivo e agli aspetti socio-emotivi legati alle performance intellettive, nonché l’andamento del benessere genitoriale. In particolare, lo studio che chiude l’elaborato di tesi discute la specifica modalità con cui le madri e i padri adottivi sembrano affrontare la transizione genitoriale, in analogia o meno a quanto accade nelle famiglie biologiche: è stata rivolta specifica attenzione alla dimensione della qualità della relazione coniugale e del supporto sociale, ancora largamente inesplorate nel panorama della ricerca nazionale e internazionale.The research project was promoted by the Athenaeum Center for Family Studies and Research with the cooperation of the public adoption agency “Il Cerchio” Centro Adozioni ASL Milano 1, and it was aimed at developing and applying a research protocol for the agency’s first year post-adoption practice. In the first study of the thesis the research protocol was presented, in terms of finalities, aims, method, and practical implications for the intervention with adoptive families through a single-case study. The second study documented the situation at children’s arrival into the new family and it was aimed at investigating children’s wellbeing, taking into account their pre-adoptive experiences, and parents’ wellbeing, especially focusing the attention on parental stress. The next two studies presented the longitudinal data about families’ changes during the first year post-adoption. Children’s recovery in the area of social, emotional, and cognitive development, and parents’ wellbeing were evaluated. In particular the last study discussed the specific way adoptive mothers and fathers cope with the transition to parenthood, comparing with biological families’ experiences, especially on marital relationship and social support, two dimensions still not largely explored in the field of national and international research

predictors of parenting stress during early adoptive parenthood

Parenting stress has a crucial influence on the parent-child relationship, the functioning of the family, and the development of children. Few studies have examined parenting stress in adoptive families during early parenthood, and fewer still have considered this issue in association with the quality of both couple and social relationships. The current study was intended to investigate predictors of parenting stress in a community sample of 56 adoptive parents from Italy, for a total of 112 participants. Our goals were to: 1) evaluate parenting stress among adoptive parents during the first post-adoption year, and 2) identify whether and to what extent parenting stress can be predicted by certain characteristics of the child (gender, age at adoption, years of institutionalisation, presence/absence of disease on arrival, emotional and behavioural difficulties), of parents' individual well-being (e.g., the presence of depressive symptoms), of relationships within the couple (sexual satisfaction, tenderness between partners, quarrelling) and with the social context (real and potential social support). In the analyses parents' gender effect and intercorrelations between the partners were taken into account. Results of multiple regression analysis and relative weight analysis highlighted the great importance of children's age at adoption and their emotional and behavioural difficulties in predicting both mothers' and fathers' stress, but also the contribution of the couple relationship quality as a protective factor that could reduce the level of parenting stress

Bullying victimization among internationally adopted adolescents: Psychosocial adjustment and moderating factors

Bullying constitutes a serious risk factor for the psychosocial adjustment of young people in both the general population and minority groups. Among minorities, international adoptees are likely to show a specific vulnerability to the experience of being bullied, moderated by specific risk and protective factors. This study aimed to investigate the association between adoptees’ experience of bullying victimization and their psychosocial adjustment, and to explore the moderating role of adoptive identity and reflected minority categorization. An online, anonymous self-report questionnaire was completed by 140 adolescents (13–17 years), who were internationally adopted by Italian families. Findings showed that being victimized was associated with higher levels of emotional and behavioral difficulties, but that the strength of this relation varied according to the levels of adoptive identity and reflected minority categorization. Specifically, victimization was found to have a more detrimental and negative impact on psychological adjustment for adoptees who were highly identified with the adoptive group, and reported to be less perceived by others as members of the minority group. Results are discussed in relation to recommendations for further research as well as for professionals working with internationally adopted adolescents.publishedVersio

Real-life monocentric experience of venetoclax-based regimens for acute myeloid leukemia

IntroductionCombination of venetoclax and hypomethylating agents (HMAs) has become a standard of care in acute myeloid leukemia (AML) aged >75 years or who have comorbidities that preclude intensive induction chemotherapy.MethodsWe conducted a monocentric retrospective analysis on adult patients affected by treatment-naïve AML not eligible for standard induction therapy or refractory/relapsed (R/R) AML treated with venetoclax combinations outside clinical trials. Venetoclax was administered at the dose of 400 mg/daily after a short ramp-up and reduced in case of concomitant CYP3A4 inhibitors.ResultsSixty consecutive AML were identified. Twenty-three patients (38%) were affected by treatment-naïve AML and 37 (62%) by R/R AML. Median age was 70 years. Among R/R AML 30% had received a prior allogeneic stem cell transplantation (allo-HSCT). In combination with venetoclax, 50 patients (83%) received azacitidine. Antifungal prophylaxis was performed in 33 patients (55%).Overall response rate was 60%, with 53% of complete remission (CR; 78% for treatment-naïve and 49% for R/R, p 0.017). Median overall survival was 130 days for R/R patients and 269 days for treatment-naïve patients; median event free survival was 145 days for R/R cohort and 199 days for treatment-naïve AML.Measurable residual disease was negative in 26% of evaluable patients in CR/CR with incomplete hematologic recovery after 2 cycles and in 50% after 4 cycles, with no significant association with survival.Eleven patients (18%) received an allo-HSCT after venetoclax combinations. Most common grade 3/4 adverse events were infectious (51% of the patients), or hematological without infections (25% of the patients). Use of CYP3A4 inhibitors was associated with a trend to shorter cytopenias and with a lower rate of infections. Invasive fungal infections were less frequent among patients receiving azole prophylaxis (6% vs 26%; p 0.0659).DiscussionVenetoclax-based regimens are a viable option for AML considered not eligible for standard induction therapy and a valid rescue therapy in the R/R setting.Azole prophylaxis did not significantly affect response and it was associated with a lower rate of invasive fungal infections. Despite a limited number of patients, the association of venetoclax and HMAs proved to be also a feasible bridging therapy to transplantation

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders

Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combi-nation with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholestea-toma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions. Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients. © Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale

Bullying victimization among internationally adopted adolescents: Psychosocial adjustment and moderating factors

Bullying constitutes a serious risk factor for the psychosocial adjustment of young people in both the general population and minority groups. Among minorities, international adoptees are likely to show a specific vulnerability to the experience of being bullied, moderated by specific risk and protective factors. This study aimed to investigate the association between adoptees’ experience of bullying victimization and their psychosocial adjustment, and to explore the moderating role of adoptive identity and reflected minority categorization. An online, anonymous self-report questionnaire was completed by 140 adolescents (13–17 years), who were internationally adopted by Italian families. Findings showed that being victimized was associated with higher levels of emotional and behavioral difficulties, but that the strength of this relation varied according to the levels of adoptive identity and reflected minority categorization. Specifically, victimization was found to have a more detrimental and negative impact on psychological adjustment for adoptees who were highly identified with the adoptive group, and reported to be less perceived by others as members of the minority group. Results are discussed in relation to recommendations for further research as well as for professionals working with internationally adopted adolescents

Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol

Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required

The Comprehensive Facial Injury (CFI) Score Is an Early Predictor of the Management for Mild, Moderate and Severe Facial Trauma

Identifying groups of patients with homogeneous characteristics and comparable outcomes improves clinical activity, patients’ management, and scientific research. This study aims to define mild, moderate, and severe facial trauma by validating two cut-off values of the Comprehensive Facial Injury (CFI) score and describing their foreseeable clinical needs to create a useful guide in patient management, starting from the first evaluation. The individual CFI score, overall surgical time, and length of hospitalization are calculated for a sample of 1400 facial-injured patients. Receiver Operating Characteristic (ROC) analysis and the corresponding Area Under the Curve (AUC) is tested, and a CFI score ≥4 is selected to discriminate patients undergoing surgical management under general anesthesia (Positive Predictive Value, PPV of 91.4%), while a CFI score ≥10 is selected to identify patients undergoing major surgical procedures (Negative Predictive Value, NPV of 91.7%). These results are enhanced by the consensual trend of Length of Stay outcome. The use of the CFI score allows us to distinguish between the “Mild facial trauma” with a low risk of hospitalization for surgical treatment, the “Moderate facial trauma” with a high probability of surgical treatment, and the “Severe facial trauma” that requires long-lasting surgery and hospital stay, with an increased incidence of Intensive Care Unit admission

Il primo anno post-adozione: esiti di benessere familiare

Many studies have documented that adopted children, despite the initial delays, showed significant recovery over time in all the main developmental areas; longitudinal studies focused on adoptive parents and on their well-being\u2019s trajectories over time are limited and inconsistent. The present study is aimed at partially filling this gap, evaluating children\u2019s well-being (emotional, behavioural, and attachment difficulties) and parents\u2019 well-being (depression, parenting stress, couple satisfaction, and social support) during the first postadoption year (T1=within 2 months after children\u2019s arrival in the family and T2=a year after children\u2019s arrival). In all the analyses mothers\u2019 and fathers\u2019 perceptions were compared. Participants were 56 families, for a total of 112 parents and 65 children (7 adoptions of siblings). This study showed globally a positive situation at children\u2019s arrival in the family, more continuity than change during the first post-adoption year, and highlighted the presence of many adoptive couples\u2019 resources: low levels of parenting stress and depression, a strong couple relationship, together with a perception of the child as not problematic