Il gioco d'azzardo patologico

Il gioco d’azzardo rappresenta la più antica e studiata tra le dipendenze senza droga. Presente sin dalle epoche più antiche, negli anni è stato oggetto di numerose ricerche e di svariati modelli interpretativi (di matrice neurobiologica, psicodinamica, ecc.) rivolti alla conoscenza del gioco – anche nella sua variante tecnologica – come dipendenza comportamentale (con le caratteristiche condizioni di craving, tolleranza, assuefazione, astinenza), all’eziopatogenesi, alla comprensione della personalità del giocatore, con attenzione al giocatore adolescente. Vengono proposti, in particolare, l’inquadramento diagnostico del DSM IV, alcuni spunti interpretativi di matrice psicodinamica, il modello di Robert Custer, nonché alcuni tra gli studi più importanti condotti sull’argomento quali sono gli studi di Blaszczynski e Nower

CLINICIAN-PATIENT RELATIONSHIP AND ADHERENCE TO TREATMENT

PATIENT'S ADHERENCE TO TREATMENT IS STRONGLY RELATED TO CLINICIAN'S ABILITY.ROLE OF EMPATHY, OF COMMUNICATION'S SKILLS ARE NOT INVESTIGATED ENOUGH, EVEN IF ACCORDING TO PATIENT'S OPINION THESE ABILITY ARE MORE IMPORTANT OF TECHNICAL SKILLS

A Cross-Sectional Survey on Burnout Prevalence and Profile in the Sicilian Population of Ambulance Driver-Rescuers

Introduction: Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings. Hypothesis: This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample. Methods: This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data. Results: The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout. Conclusions: These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered

Quality of life, alexithymia, and defence mechanisms in patients affected by breast cancer across different stages of illness

Objectives: The aim of this study was to evaluate the effect of alexithymia and defence mechanisms on the quality of life of patients affected by breast cancer at different stages of the disease. Methods A convenience sample of 110 patients with breast cancer was involved in the study: 41 were receiving adjuvant chemotherapyafter surgery, 29 had disease-free survival in follow-up and 40 were receiving chemotherapy for metastatic disease. Quality of life, alexithymia and defence mechanisms were assessed using the following instruments: EORTC QLQ-C30-BR23, Toronto Alexithymia Scale (TAS-20) and Defense Mechanism Inventory (DMI). Results Compared to the other groups, patients receiving chemotherapy for metastatic disease reported poorer quality of life in several domains, more severe cancer-related and treatment-related symptoms and higher levels of alexithymia. When the effect of other potential predictors was taken into account, TAS-20 difficulty in identifying feelings was significantly related to all the EORTC functional subscale. Conclusion: This study underlined the relevance of difficulty in emotional processing and defence mechanisms in modulating psychological adjustment in women affected by breast cancer, suggesting that these might be potential targets of psychological intervention for this population

SESAR EXPLORATORY RESEARCH SAPIENT PROJECT OVERVIEW

The SESAR (Single European Sky ATM Research) Exploratory Research project called SAPIENT (Satellite and terrestrial architectures improving performance, security and safety in ATM) is a program of the SESAR Joint Undertaking under the European Union’s Horizon 2020 research and innovation programme under grant agreement 699328 [1][2]. It aims at defining Satellite and Terrestrial Architectures improving performance security and Safety in ATM (Air Traffic Management) through new and innovative functionalities for future CNS (Communication, Navigation and Surveillance) and ATM systems and future European RPAS (Remotely Piloted Air System) C2/C3 satellite Data Link (DL) for governmental initiatives (C2 states for Command and Control, while C3 states Command, Control and Communications). In this context it has been defined SAPIENT which is a novel cost-effective and performance-efficient system solution for aeronautical communications, aimed at adapting and optimizing the capacity and safety performance of aeronautical communication applications, e.g. CPDLC (Controller-Pilot Data Link Communications) and ADS-C (Automatic Dependent Surveillance – Contract), in view of the estimated ‘status’ of air ground ATM SoL (Safety of Life) terrestrial and satellite datalinks over actual flown trajectories. To meet these targets, SAPIENT exploits the information on actual 4D aircraft trajectories – in terms of dynamic position in space and time – and performance data of ATM Air Ground Datalinks, produced by aircraft and other elements of the ATM Communication Infrastructure [3]. The innovative aspects addressed in the SAPIENT Project are related to the TAS-I patent “System for Aeronautical Safety of Life Applications Providing Adaptation of Services and Communication Resources for Maximized Safety and Capacity Performance” [4] . Significant references for the ATM Datalink aspects are the activities undergong in SESAR on VDL2 (VHF Digital Link Mode 2) [5] and other new generation digital datalinks and in ESA on Iris [7]. The SAPIENT solution is a multilink/data link monitor and control system. It is aimed at providing information on the aircraft perception of the operational layout goodness in order to correct or operate more effectively with respect to the ATM communication goals. The main objectives are: - Support the multilink function during the selection of the optimal data link; - Foresee retroaction on the in-use data link, and change the resources during the flight, according to information obtained through it and according to the information collected from the other SAPIENT system actors; - Retroact on multilink function in order to change the priority between data links (i.e. need of load balancing in a common coverage area with traffic hot spots). The use of the SAPIENT system is expected to positively impact: - The efficiency of the data-links management in a multilink environment, resulting in less resources needed by ATM communication system elements, with main focus on effective and efficient use of RF spectrum The Communication issues in the ATM air/ground links minimizing the need of tactical interventions from ATC (Air Traffic Control) and pilots to de-conflict situations - Communication issues in the RPAS C3 satellite DL minimizing the use of RPAS safety procedure that will limit the execution of the RPAS missions - The Air Navigation Service providing a cost saving obtained by improving the Air navigation Service productivity and the frequency band usage The aim of this paper is to present the SAPIENT reference architecture and system boundaries, the SAPIENT protocol and the main SAPIENT simulation result

Validation of the Italian version of the Burn Specific Health Scale-Brief

Introduction A growing awareness of psychological and functional impairment due to burns have led to the development of specific instruments to evaluate Quality of Life in this population, such as the Burn Specific Health Scale - Brief (BSHS-B), whose psychometric properties have been consistently verified. The aim of this study was to translate the BSHS-B into Italian and to investigate its reliability and validity. Methods Translation procedures were carried out according to accepted standards. Internal reliability was assessed using Cronbach's alpha coefficient. Concurrent validity was evaluated through correlations between the BSHS-B and the Short-Form 36 Health Survey (SF-36), the Self-report Clinical Inventory (SCL-90), and the Body Uneasiness Test (BUT). Results The overall Cronbach's alpha value for the scale was 0.887. Significant correlations were found between the Italian BSHS-B domains, the SF-36 subscales (Spearman's rho: 0.184-0.414), and several SCL-90 subscales (Spearman's rho: -0.173 to -0.477). Furthermore, the affect and relationship domain and the skin domain of the BSHS-B negatively correlated with the compulsive self-monitoring and depersonalization subscales of the BUT. Conclusion The Italian translation of BSHS-B has shown satisfactory internal consistency, criterion validity, and convergent validity, supporting its application in routine clinical practice as well as in international studies. © 2013 Elsevier Ltd and ISBI

Borderline Personality in Patients with Poly-Diagnoses Treated for a Bipolar Disorder

Some patients with dysphoria, explosive behaviour, or suicidal ideation, may receive a diagnosis of, and treatment for Bipolar Disorder (BD) and, not infrequently. The coexistence of these two diagnoses has been explained in different ways. Some authors include the BPD in the bipolar spectrum; others are sceptical about the existence of real comorbidity, suggesting a misdiagnosis. This study aimed to assess the personality of this group of poly-diagnosed patients (PolyD) and hypothesised they had a pathological borderline organisation. Via the administration of the Schedler Westen Assessment Procedure (SWAP-200), we compared PolyD patients with those suffering from BPD or BD only. We performed two different MANCOVAs to test PolyD, BPD and BD patients’ differences in PD-factors, Q-traits and age. The sample comprised 45 patients (Mean age=43.3, SD=15.7; Females 57.7%, N=26). BD patients (N=15) did not present any personality disorder, they had a higher functioning and Obsessive Q-traits, and a lower Histrionic PD-factor than both PolyD (N=20) and BPD (N=10) patients. Compared to PolyD patients, BD had inferior PD-Borderline, PD-Antisocial factor and Dependent-Masochistic Q-traits, but there were no other differences with BPD patients. PolyD did not differ from BPD patients in any of the PD-factors and Q-traits. Our results suggest that PolyD patients are different from BD patients and propose to consider the pathological borderline personality as a central core of their disease

The impact of healthy lifestyles on academic achievement among Italian adolescents

We evaluated the association between healthy lifestyles and academic achievement in a sample of 373 adolescent Italian students.Specifically, we investigated on the association between use of illegal drugs, habits to practice a regular physical, typology ofdiet, levels of social support, levels of self-esteem, level of Internet use, perceived stress and amount of sleep and academicachievement. Academic performance was positively correlated with good diet, perceived social support, and self-esteem. Astatistically significant difference emerged between students with high versus low correct grade point averages in relation tolifetime and current use of illegal drugs. Last, academic performance was negatively correlated with Internet use, perceived stress,and bad diet. A multiple regression analysis was conducted in order to predict academic achievement based on good diet, physicalactivity, self-esteem, sleep hours, perceived stress, problematic Internet use, perceived social support, and lifetime substance usewhile controlling for age, gender, and years of education. As expected, healthy lifestyles behaviors were highlighted as asignificant predictor in academic achievement. Specifically, it was showed that a good diet as well as nonproblematic Internetuse significantly predicted academic success. Moreover, it was found that gender did not moderate the relationship between thosepredictors and academic achievement. The results of our study show that to practice healthy lifestyle behaviors is a relevant factorfor a better performance at school, at least in our sample