Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery

Our aim was to prospectively examine the association of psychosocial factors with adverse outcome after cardiac surgery. One hundred and eighty cardiac surgery patients were enrolled and contacted annually by mail. Depression [Beck depression inventory (BDI)], anxiety [state anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-S) and trait anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-T)] were investigated annually, social support, negative affectivity, social inhibition (SI), illness intrusiveness, self-rated health and sleeping disorders were investigated by standardized tests at the second and fifth year. The end-point was the major adverse cardiac and cerebrovascular event (MACCE) including death. Twenty-eight (15.5%) patients died by the end of the fifth year. At the end of the second and fifth years, 146 (81.1%) and 118 (65.5%) patients fulfilled the tests, respectively. At the end of the second year after adjustment for medical and perioperative factors worse self-rated health [adjusted hazard ratio (AHR): 0.67, P=0.006], sleeping disorders (AHR: 1.14, P=0.001), higher illness intrusiveness (AHR: 1.03, P=0.018), higher BDI (AHR: 1.12, P=0.001), STAI-S (AHR: 1.09, P=0.001) and higher STAI-T scores (AHR: 1.08, P=0.002) showed higher risk for MACCE. Significant individual elevation in scores of sleeping disorders, illness intrusiveness and SI were observed over the three-year period in the MACCE group. Assessment of psychosocial factors could help in identifying patients at high-risk for MACCE after cardiac surgery

Fattori che modulano i processi decisionali: uno studio sull’effetto framing

Lo studio prende in considerazione il cosiddetto “effetto framing”, definito come il contesto in cui l’individuo si trova a operare una scelta. Nello specifico, il modo in cui un problema decisionale è formulato influisce sulla percezione del punto di partenza del problema, rispetto al quale valutare i possibili esiti delle proprie azioni. Lo studio ha indagato l’entità e le caratteristiche dell’effetto framing in soggetti sani e in pazienti con esiti di grave cerebrolesione acquisita (GCA) ed ha esaminato le possibili relazioni tra tale effetto e alcuni processi cognitivi che si ritiene siano alla base dei processi decisionali. Sono state quindi valutate caratteristiche neuropsicologiche (working memory, funzioni attentive ed esecutive) e neuropsichiatriche (impulsività/disinibizione in particolare), ipotizzando che la presenza dell’effetto framing sia direttamente correlata a quella dei disturbi neuropsicologici e di personalità eventualmente presenti. Tutti i partecipanti sani che i pazienti sono stati esaminati mediante test neuropsicologici, scale cliniche e una prova computerizzata costruita ad hoc. I risultati hanno evidenziato la presenza degli effetti attesi, con un aumento di tale effetto nel gruppo dei pazienti con GCA, ponendo rilievo nella pratica clinica agli aspetti decisionali che incidono sulla qualità della loro vita e dell’intero sistema familiare. Questo è l’unico studio in cui una procedura che richiede di inibire attivamente le risposte automatiche, viene utilizzata per indagare i processi cognitivi coinvolti nell’effetto framing. In conclusione, raccolte insieme, le precedenti scoperte e i nostri primi risultati, forniscono evidenze convergenti a partire da paradigmi sperimentali differenti che supportano l’ipotesi secondo cui l’attivazione di un sistema esecutivo-analitico (caratterizzato da processi controllati, deliberati e cognitivi) possa influenzare i processi decisionali in condizione di framing

The Civic Virtue of Women in Quattrocento Florence

Fifteenth century Florence has long been viewed as the epicenter of Renaissance civilization and a cradle of civic humanism. This dissertation seeks to challenge the argument that the cardinal virtues, as described by humanists like Leonardo Bruni and Matteo Palmieri, were models of behavior that only men adhered to. Elite men and women alike embraced the same civic ideals of prudence, justice, fortitude, and temperance. Although they were not feminists advocating for social changes, women like Alessandra Strozzi, Margherita Datini, and Lucrezia Tornabuoni had a great deal of opportunity to actively support their own interests and the interests of their kin within popular cultural models of civic virtue. This, in turn, earned these women much praise at the time. By exploring interpretations of each virtue and illustrating case studies of merchant and aristocratic women\u27s activities, this dissertation points to a larger Florentine culture that set forth the path to a virtuous life for both men and women. This path challenges the historiographical clich that Florence, because of its patriarchal culture, was a particularly difficult place to be a woman. While highlighting the uniqueness of women\u27s experiences, this dissertation argues that oppression was more reflective of a woman\u27s economic position than of her sex. New interpretations of letters, prescriptive literature, and wills reveal the ways in which the humanist cultural climate affected both men and women. Seen in this light, the active engagement of both sexes in Renaissance humanist culture emerges on a larger historical canvas

Pharmacological treatment of pain and agitation in severe dementia and responsiveness to change of the Italian Mobilization-Observation-Behavior-Intensity-Dementia (I-MOBID2) Pain Scale: study protocol

Up to 80% of Alzheimer's disease (AD) patients in nursing homes experiences chronic pain and 97% develops fluctuant neuropsychiatric symptoms (NPS). Agitation, associated with unrelieved pain, is managed through antipsychotics and may increase the risk of death. Evidence is accumulating in favor of analgesia for a safer, effective therapy of agitation. The Italian version of Mobilization-Observation-Behavior-Intensity-Dementia, I-MOBID2, recently validated in the Italian setting, shows: good scale content validity index (0.89), high construct validity (Spearman rank-order correlation Rho = 0.748), reliable internal consistency (Cronbach's α coefficient = 0.751), good-excellent inter-rater (intraclass correlation coefficient, ICC = 0.778) and test-retest (ICC = 0.902) reliability, and good inter-rater and test-retest agreement (Cohen's K = 0.744) with 5.8 min completion time. This study intends to identify the responsiveness of the I-MOBID2 based on COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations, assessing the a priori hypotheses of (1) the efficacy of painkillers administered to severe AD patients after proper pain assessment and (2) the effect of reduction of the Cohen-Mansfield Agitation Inventory (CMAI) score and of agitation rescue medications. This protocol is approved by Calabria Region Ethics Committee protocol No. 31/2017 and follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines

Language-Related Brain Potentials in Patients With Disorders of Consciousness: A Follow-up Study to Detect “Covert” Language Disorders

Background. Language disorders may occur in patients with disorders of consciousness (DoCs), and they could interfere with the behavioral assessment of consciousness and responsiveness. Objective. In this study, we retrospectively explored whether ERP N400 was eventually associated with the presence of aphasia diagnosed in those patients who had evolved into Exit-Minimally Conscious State (E-MCS) at the clinical follow-up. Methods. In this retrospective cohort study, the ERPs elicited by an auditory sentences task were retrospectively examined in a sample of 15 DoC patients diagnosed according to the Coma Recovery Scale–Revised (CRS-R). All these 15 DoC patients underwent a (at least) 1-year clinical follow-up, which included a neuropsychological evaluation to assess language function among other cognitive functions. Ten healthy individuals also underwent the same paradigm to investigate the variability of ERPs characteristics. Results. The N400 ERP component with centroparietal topography was found in 9 of 10 healthy controls in response to the ill-formed sentences. Analysis of patients’ data revealed that (1) a significant N400 component could be detected in 64% (9 of 14 patients) of the DoC patients regardless of the type of DoC; (2) no significant N400 ERP component was retrospectively detected in those E-MCS patients who showed aphasia at the follow-up; and (3) the presence/absence of the N400-ERP component was consistent with the brain lesion side and significantly predict the recovery. Conclusion. These preliminary findings indicate that the absence of N400 was significantly associated with the presence of aphasia diagnosed at the clinical follow-up in E-MCS patients

Self-Awareness Multilevel Assessment Scale (SAMAS): psychometric analysis of inter-rater reliability

Background. Severe acquired brain injury (sABI) frequently causes impairment in selfawareness (ISA), leading to reduced patients’ compliance to treatment, worse functional outcome, and high caregiver distress. Self-awareness (SA) is a multilevel and complex function that, as such, requires a specific and effective assessment. To date, many tools are available to evaluate the declarative, but not emergent and anticipatory levels of awareness, therefore the Self-Awareness Multilevel Assessment Scale (SAMAS) was recently proposed. The new tool proved to be useful to assess SA at different levels across all domains of functioning (motor, cognitive, psycho-behavioural, etc.) because it measures not only the declarative SA, but also emergent and anticipatory levels of SA, thus overcoming some important limits of other current assessment methods.Aim. This study evaluated the inter-rater reliability (IRR) of the SAMAS.Methods. Four professionals blind to each other evaluated 12 patients with sABI. Each patient was rated by two professionals.Results. Inter-rater reliability was moderate-to-excellent, adding evidence in support of the use of SAMAS to specifically diagnose ISA after sABI.Conclusions. The SAMAS can help to better address neurorehabilitation, as it allows assessing ISA as early as possible, at all possible levels of awareness and functional domains