Il Test di Rorschach nel contesto forense: uno studio sulla genitorialità condotto su coppie in ambito di separazione e affidamento minori

The Rorschach Test in the forensic context: a study on parenting conducted on couples in separation and child custody contextfont size  PrintE-mailby Roberto Cicioni, Tommaso Caravelli, Floriana Loggia, Maria Elisa Maiolo This work aims at setting Rorschach Test in a specific forensic context, such as that of the couples involved in separation and in entrustment of minors. Authors’ intent is to arrange the foundation for a future calibration of Rorschach Test, specific to the forensic context of couples undergoing separation and child custody. The study was conducted on 150 Rorschach protocols administered to a sample of Italian separated couples and evaluated in the field of child custody; this study also aims at meeting the demand of the Technical Consultant to make use of specific diagnostic elements to the participants that are involved personally in separation and custody. Data collection shows an average profile of the appraised participants different from the profile of those who do not live this deep state of transition and stress: this can be an objective starting point on which to base assessments on parenting.The comparison of the data obtained in this study with those ones of the “national reference sample” shows differences between protocols of those participants that do the test voluntarily, with those gathered in the investigation contexts who often are characterized by low motivation to the test and by fears and anxieties which are intrinsically related to the topic of evaluation. It is definitively important for the forensic Psychodiagnostics to possess specific statistical data on which to base inferences on the parenting ability of participants, reducing the risk of subjective judgments based on common sense or only on theoretical model, not necessarily shared between consultants, which are often the basis of the occurrence of irreconcilable disputes.The sample includes protocols administered in Italy between 2001 and 2009, equally divided between males and females with average age 40 years, collected and signed using the “Scuola Romana Rorschach” method.To ensure objectivity in the marking phase, that is to ensure that every answer given by an appraised subject matches one and only one score, we used a computer program, Siglaror (Parisi &Pes, 2006), a database of more than 23,000 Rorschach interpretations marked on a statistical system and on the degree of agreement achieved by a group of experts at national level.Lo scopo di questo lavoro è di descrivere le caratteristiche quantitative di alcuni indici del Test di Rorschach, strumento molto utilizzato in ambito peritale per la valutazione degli atteggiamenti genitoriali delle coppie coinvolte nei processi di separazione e di affidamento dei minori. Lo studio è stato condotto su protocolli Rorschach somministrati a un campione di 75 coppie italiane separate e si propone di rispondere all’esigenza del Consulente Tecnico di avvalersi di dati statistici ed elementi diagnostici contestuali, ottenuti da soggetti che vivono in prima persona la separazione e l’affidamento. Il campione considerato riguarda nello specifico protocolli somministrati in tutta Italia tra il 2001 e il 2009, a soggetti con età media di 40 anni, raccolti e siglati secondo il metodo “Scuola Romana Rorschach”.Per garantire l’oggettività e l’uniformità nella fase di siglatura, ci si è avvalsi dell’ausilio del sistema informaticoSiglaror (Parisi & Pes, 2006), un database di oltre 23.000 interpretazioni Rorschach, siglate sia su base statistica sia sul grado di accordo raggiunto da un gruppo di esperti a livello nazionale (Parisi & Pes, 2006). Dai dati raccolti emerge un profilo dei periziandi differente da quello di soggetti che non vivono tale condizione di transizione e profondo stress: tale profilo può costituire un quadro di riferimento riguardo alle valutazioni sulla genitorialità. Appare evidente l’utilità per lo Psicodiagnosta forense di poter accedere a dati statistici aggiornati e specifici dai quali desumere indicazioni attendibili sulla capacità genitoriale dei periziandi, limitando valutazioni soggettive basate sul senso comune o sul proprio modello teorico di riferimento, non necessariamente condiviso dai Consulenti di parte

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Microscopic Examination of Findings Encountered during Cadaver Dissection: Malignant, Benign or Anatomic Variation?

Pathologic findings encountered during cadaver dissection provide an opportunity for integrating the preclinical basic sciences and encouraging critical thinking. The objective of this study was to determine whether it is possible to make a pathologic diagnosis of an unknown mass from an embalmed cadaver. Diagnoses would have to be based solely on gross and microscopic appearance of tissue, without clinical histories of the cadaveric donors. The tissue samples we removed from each mass were surprisingly well preserved and showed minimal autolysis. Indeed, some of the histological detail was as clear as may be found in any textbook. We were able to obtain a pathologic diagnosis for 6 cases that illustrate complications of malignant neoplasms arising in the colon, breast, ovary, and kidney. Our results emphasize the importance of integrating gross and microscopic anatomy with pathology to facilitate a comprehensive understanding of disease. This histopathology independent learning project could become an integral part of dissection-based anatomy courses, and stimulate students to become more inquisitive when they see something out of the ordinary in their cadaver

High GADA titer increases the risk of insulin requirement in LADA patients: A 7-year follow-up (NIRAD study 7)

Objective: The aim of this study was to determine whether glutamic acid decarboxylase antibody (GADA) titer and other clinical parameters could define the risk of progression to insulin therapy in latent autoimmune diabetes in adults (LADA) patients during a 7-year follow-up. Methods: This study involved 220 LADA and 430 type 2 diabetes subjects followed up for 7 years from the time of GADA screening to evaluate their progression toward insulin therapy. Kaplan-Meier curves and multivariate logistic regression analysis were performed to identify the markers capable of influencing this progression. Results: During the follow-up, the drop out was 4% in both groups. A total of 119 (56.1%) out of 212 LADA patients required insulin during the 7 years of follow-up. The Kaplan-Meier plots showed that 74/104 (71.1%) of high GADA titer required insulin compared with 45/108 (41.6%) of low GADA titer and with 86/412 (20.9%) of type 2 diabetes ( P2 and IA-2IC and zinc transporter 8 (ZnT8) positivity were also shown as the markers of faster progression (PIC positivity and sulfonylurea treatment, in the first year from diagnosis, significantly increase the progression toward insulin requirement in LADA patients

Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes

Background. Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy.Methods. Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR < 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis.Results. Mean age of the patients was 66.6 +/- 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 +/- 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase.Conclusions. In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR