A Qualitative Comparison of First and Follow-Up Visits

UIDB/00183/2020 UIDP/00183/2020 SFRH/BPD/115073/2016 PTDC/FER-FIL/28278/2017Background: Misunderstandings in medical interactions can compromise the quality of communication and affect self-management, especially in complex interactions like those in the assisted reproductive technology (ART) field. This study aimed to detect and describe misunderstandings in ART triadic visits. We compared first and follow-up visits for frequency, type, speakers, and topics leading to misunderstandings. Methods: We purposively sampled 20 triadic interactions from a corpus of 85 visits. We used a previously developed coding scheme to detect different types of misunderstandings (i.e., with strong, acceptable, and weak evidence). We analyzed also the different topics leading to strong misunderstandings (direct expressions of lack of understanding, pragmatic alternative understandings, semantic alternative understandings) to provide insights about the contents of the consultation that may need particular attention and care. Findings: We detected an overall number of 1078 misunderstandings in the 20 selected visits. First visits contained almost two-third of the misunderstandings (n = 680, 63%). First visits were particularly rich in misunderstandings with acceptable evidence (e.g., clarifications and checks for understanding), compared to follow-up visits. In first visits, doctors’ turns more frequently than couples’ turns contained misunderstandings, while in follow-up visits it was the other way around. Looking at the couple, the majority of the misunderstandings were expressed by the woman (n = 241, 22%) rather than by the man (n = 194, 18%). However, when weighting for their number of turns, 9% of the men’s turns included an expression of misunderstanding, compared to the 7% of the women’s turns. Finally, more than half of the misunderstandings with strong evidence were about history-taking and treatment-related topics, and while the history-taking ones were particularly frequent in first visits the treatment-related ones were more present in follow-up visits. Discussion: Findings indicate that first visits may deserve particular attention to avoid misunderstandings, as they are the moment where a shared understanding can be harder to reach. In particular, misunderstandings happening in first visits seem mostly related to physicians having to reconstruct the clinical history of patients, while those in the follow-up visits seem to reflect residual and unsolved doubts from the couple, especially concerning treatments.publishersversionpublishe

Psychological factors in functional hypothalamic amenorrhea: A systematic review and meta-analysis

BackgroundPsychological factors have been found to be associated with functional hypothalamic amenorrhea (FHA); however, their role in the onset or persistence of FHA is still understudied. The study aims to assess the associations of psychological factors with the presence vs the absence of FHA.MethodsA systematic literature search has been conducted across the major databases (PubMed, PsycINFO, Scopus, and Embase) to explore the psychological factors associated with FHA. The search was limited to English-written articles published from 2000 onwards. Articles were selected based on stringent inclusion/exclusion criteria. After data extraction, meta-analysis and meta-synthesis were conducted.ResultsOf 349 retrieved articles, eight studies were included. Findings indicate that the main psychological factors associated to FHA seem to be depression and eating attitudes, especially drive for thinness. FHA women present higher levels of anxiety, sleep disorders, dysfunctional attitudes, and alexithymia. The meta-analysis on drive for thinness revealed that the pooled MD across the studies was statistically significant both in the fixed 0.63 (95% CI: 0.31–0.95) and random model 0.70 (95% CI: 0.13–1.26). Likewise, as for depression, the pooled MD across the studies was statistically significant both in the fixed 0.60 (95% CI: 0.36–0.84) and random model 0.61 (95% CI: 0.20–1.01).DiscussionFindings showed the association of psychological factors and FHA and recognized their involvement in the persistence of the disorder. A multidisciplinary approach should involve a collaborative process between gynecologists, clinical psychologists, and psychiatrists, from diagnosis to treatment. Longitudinal studies should be implemented with a comparison/control group or by including clinical psychologists in the psychological assessment and study design

Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers

During the early phases of the COVID-19 pandemic, the world initially focused on measures to suppress COVID-19 transmission and protect their populations by developing vaccines and drug treatments for the most vulnerable and a host of social actions, including implementing social distancing, working from home, travel restrictions, lockdowns, and face coverings. Nearly 2 years after the initial outbreak, at the time of writing this editorial, and through research conducted as part of this Research Topic, it is clear that the mental health impacts of COVID-19 on healthcare workers (HCW) are significant. There is an urgent need to understand and address these impacts (Greenberg et al., 2020). This is particularly true given the World Health Organisation has outlined a series of mental health and psychosocial considerations aimed explicitly at HCWs (World Health Organisation, 2020). The present Research Topic on Coronavirus Disease (COVID-19) and HCWs has added to the scientific knowledge in several main areas, including barriers and enablers to healthcare delivery, understanding HCWs' mental health and well-being, resilience, coordination and communication within the workforce, and specific interventions to promote mental health and well-being

Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers.

From Europe PMC via Jisc Publications RouterHistory: ppub 2022-01-01, epub 2022-04-18Publication status: Publishe

Failure of the anticoagulant therapy and psychological distress : Still far from a bridge

Background: The procoagulant stress response reflects part of a beneficial adaptation of the organism to environmental threats, but a protracted procoagulant state generates a thrombotic risk. Atrial fibrillation (AF) is the most common arrhythmia in the general population. Patients with AF have a higher risk of thromboembolic events and stroke, therefore they are treated with long-term oral anticoagulant (OAC) therapy. The aim of this study is to evaluate if there is any association between psychological distress and clinically unexplained variations of the International Normalized Ratio (INR), that is the index used to monitor both thromboembolic and bleeding risk in the case of patients under OAC therapy. Methods: Fifty-eight patients (men = 27; women = 31; mean age = 74.98) were recruited. The sample was divided according to the recognition (or not) of the reason why the INR was subtherapeutic ( < 2) and classified as "Known Reasons" (KR = 32.8%) and "Unknown Reasons" (UR = 67.2%). Psychological assessment included the following dimensions: symptoms of anxiety and depression, perceived stress, emotional regulation strategies, and alexithymia. Results: Considering Mann-Whitney test results, no significant difference was found in the scores of anxiety, depression, stress, and emotional regulation strategies. With regard to alexithymia, UR patients are characterized by a moderate tendency to an outward-oriented thinking (r = 0.25). Conclusion: A clear role for the detected psychological factors in determining abnormal INR range in patients under OAC therapy could not be found. Further studies are needed to support our findings, if possible exploring factors other than psychological distress and the related emotion regulation strategies

Covid-19 older hospitalized patients: Three clinical-psychological patterns

Background and aims. The COVID-19 outbreak is a far-reaching health crisis and a significant psychological stressor. COVID-19 patients experience an unknown and life-threatening condition that ex-poses them to strict social distancing, physical discomfort, medication side effects, long hospitalization, stigmatization and fear of death. Older people seem to be particularly vulnerable to the current pandemic from both a physical and a psychological point of view. The present article aims to describe different psychological reactions in older hospitalized COVID-19 patients encountered by the clinical psychology Unit of one of northern Italy most hit hospitals. Three prototypical clinical cases will be described and discussed. Insights about different attitudes towards the illness will be offered. Conclusions. Auto-biographical narration among older hospitalized COVID-19 patients has positive effect. Hospital psychologist can support patients in the process of disease acceptance

Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers

From Frontiers via Jisc Publications RouterHistory: collection 2022, received 2022-03-25, accepted 2022-03-31, epub 2022-04-18Publication status: Publishe

\u2018Engage me in taking care of my heart\u2019: a grounded theory study on patient\u2013cardiologist relationship in the hospital management of heart failure.

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Pandemic nightmares: effects on dream activity of the COVID-19 lockdown in Italy

COVID-19 has critically impacted the world. Recent works have found substantial changes in sleep and mental health during the COVID-19 pandemic. Dreams could give us crucial information about people's well-being, so here we have directly investigated the consequences of lockdown on the oneiric activity in a large Italian sample: 5,988 adults completed a web-survey during lockdown. We investigated sociodemographic and COVID-19-related information, sleep quality (by the Medical Outcomes Study-Sleep Scale), mental health (by the Depression, Anxiety, and Stress Scales), dream and nightmare frequency, and related emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our sample and a population-based sample revealed that Italians are having more frequent nightmares and dreams during the pandemic. A multiple logistic regression model showed the predictors of high dream recall (young age, female gender, not having children, sleep duration) and high nightmare frequency (young age, female gender, modification of napping, sleep duration, intrasleep wakefulness, sleep problem index, anxiety, depression). Moreover, we found higher emotional features of dream activity in workers who have stopped working, in people who have relatives/friends infected by or who have died from COVID-19 and in subjects who have changed their sleep habits. Our findings point to the fact that the predictors of high dream recall and nightmares are consistent with the continuity between sleep mentation and daily experiences. According to the arousal-retrieval model, we found that poor sleep predicts a high nightmare frequency. We suggest monitoring dream changes during the epidemic, and also considering the implications for clinical treatment and prevention of mental and sleep disorders

Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy

Background: Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown. Methods: By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10–1st phase to May 4–2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study–sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales–21 Items (DASS- 21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis. Results: A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep–wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression. Conclusion: This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID- 19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak