Attachment forerunners, dyadic sensitivity and development of the child in families with a preterm born baby

Objective: The aim of this study is to explore attachment forerunners and dyadic sensitivity in the family with preterm born child. Methods: 89 families, 35 with preterm born children ( 2500 gr.) were studied from 3 months to 1 year corrected age (267 total subjects). Mother-child and father-child couples were subjected to CARE-Index and both parents to DAS, CES-D and STAI Y-2. The child\u2019s psychomotor development was assessed by Bayley Scales. Results: The mothers of preterm children presented high risk interactive behaviors at CARE-Index (low scores at Dyadic Sensitivity Scale, p = .000), high anxiety (p = .003) and depression (p = .03). Preterm fathers presented low scores at Dyadic Sensitivity Scale (p = .000) and high anxiety (p = .024). In interaction, attachment forerunners suggest an insecure attachment in preterm mothers (p = .001) and fathers (p = .000) and in preterm children in the interaction with the mother (p = .028). These risk factors were correlated, in both parents, with low performance of the child at Bayley Scales (p =.04). Fathers of preterm children presented also a negative perception of the child and an unsatisfied perception of the hospital care. Conclusions: The results show in the preterm family that 40% of mothers and 75% of fathers are in high risk area suggested by CARE-Index. In these cases, insecure attachment forerunners, low dyadic sensitivity and psychological difficulties (couple conflicts, anxiety, depression) seem to influence the psychomotor development of the preterm child

L’influenza dell’attaccamento e della sensibilità diadica genitorialesullo sviluppo psicomotorio del bambino nato pretermine

Lo scopo di questa ricerca è studiare i precursori dell’attaccamento e la sensibilità diadica genitoriale nelle famiglie con bambino nato pretermine. Sono state considerate 110 famiglie delle quali 55 con figli nati pretermine ( peso alla nascita < 1500 gr.) per un totale di 330 soggetti valutati durante i primi sei mesi di età corretta del bambino. Le diadi madre-bambino e padre-bambino sono state sottoposte al CARE-Index, una procedura videoregistrata per la valutazione dei precursori dell’attaccamento; ad entrambi i genitori sono stati somministrati CES-D, per la valutazione della depressione e STAI Y-2, per la valutazione dell’ansia di tratto. Lo sviluppo psicomotorio dei neonati è stato valutato tramite le scale Bayley. Rispetto ai controlli, nelle madri dei bambini pretermine sono stati evidenziati bassi punteggi di Sensibilità Diadica al CARE-Index (p=.025) ed elevati livelli di ansia (p=.026). Nei padri sono stati riscontrati bassi punteggi di Sensibilità Diadica (p=.004) e alti livelli di sintomi depressivi (p=.003). Nelle famiglie pretermine i precursori dell’attaccamento sono più frequentemente di tipo insicuro nelle madri (p=.000) e nei padri (p=.000), mentre nei neonati solo nell’interazione con la madre (p=012). Questi fattori sono risultati associati a minori punteggi alle scale Bayley (p=.000). Nelle madri dei neonati pretermine si riscontrano frequenti difficoltà con la famiglia di origine, nei padri una percezione negativa del proprio bambino e una maggiore insoddisfazione per l’assistenza ricevuta. Questi risultati evidenziano che il 40% delle madri e il 75% dei padri dei bambini nati pretermine rientra nella fascia ad alto rischio del CARE-Index (che richiede un trattamento psicologico e/o farmacologico). In tali casi, la scarsa sensibilità diadica, i precursori di attaccamento insicuro e le difficoltà psicologiche dei genitori sembrano influenzare lo sviluppo psicomotorio del bambino

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p &lt; 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

I gruppi di autoaiuto come tecnica di intervento nei disturbi del comportamento alimentare.

Lo studio ha valutato la diffusione sul territorio italiano dei gruppi di auto-aiuto come tecnica di intervento per i Disturbi del Comportamento Alimentare (DCA). Metodo: è stata condotta un’indagine telefonica su 90 Centri Ospedalieri, Cliniche Private e Associazioni per il trattamento dei DCA dalla quale è emerso che solo 9 strutture utilizzavano dei gruppi di self-help. I 19 facilitatori contattati hanno compilato un questionario appositamente approntato focalizzato su: a) origine dei gruppi; b) caratteristiche dei conduttori; c) tipologie dei disturbi; d) modello teorico; e) organizzazione; f) argomenti trattati e difficoltà; g) collaborazione con enti pubblici o privati; h) dimissioni o abbandono; i) follow-up. Sono state raccolte informazioni sulle seguenti tematiche: a) caratteristiche e formazione dell’helper; b) finalità e scopi; c) stili di comunicazione; d) leadership e dinamiche. Risultati: i gruppi sono costituiti da 5 a 14 persone, prevalentemente di sesso femminile e di età dai 14 ai 70 anni. Ogni incontro dura mediamente 90 minuti con frequenza settimanale. La comunicazione è descritta come libera ed empatica con una leadership democratica. Lo scopo è la riduzione della sintomatologia attraverso l’informazione e la condivisione delle esperienze. Gli elementi caratterizzanti sono: la presenza di un helper, lo sviluppo di un senso di appartenenza, la fiducia e il gruppo come sostegno emotivo. Quasi l’80% dei gruppi collabora con il sistema sanitario pubblico. Conclusioni: in Italia, i gruppi di auto-aiuto sono utilizzati raramente nel trattamento dei DCA, ma possono risultare una metodologia utile all’interno di protocolli terapeutici più complessi

Home visiting come sostegno alla genitorialit\ue0 in famiglie con nati pretermine.

Negli ultimi anni si \ue8 riscontrata sempre pi\uf9 la necessit\ue0 di pianificare trattamenti medici e psicologici che includano la promozione della salute e il miglioramento delle competenze individuali, al fine di ridurre i fattori di rischio e di aumentare quelli di protezione. Nell\u2019ambito degli interventi preventivi rivolti alla famiglia, la maggior efficacia sembra essere garantita dal sostegno alla relazione genitore-bambino (Cassiba, Van IJzendoorn, 2005). Abbiamo svolto uno studio pilota basata su una tecnica di Home Visiting psicologico diretta a rafforzare la qualit\ue0 della relazione genitore-bambino nato pretermine (peso alla nascita &lt; 1500gr). L\u2019intervento si \ue8 svolto a domicilio basandosi teoricamente sul costrutto di attaccamento e sulla tecnica dell\u2019Infant Observation. Sono stati trattati 10 genitori di et\ue0 compresa tra i 30 e i 40 anni, di cui 7 madri con una storia di disagio psicologico antecedente alla gravidanza (disturbo alimentare, 2 casi, attacchi di panico, 2 casi, depressione, 3 casi). L\u2019esperienza di Home Visiting \ue8 stata presentata come la continuazione del percorso di sostegno psicologico fornito dall\u2019U.O. di TIN ed \ue8 iniziata la settimana seguente la dimissione del nato pretermine e terminata al sesto mese di et\ue0 corretta del bambino. Le visite domiciliari sono state effettuate dalla psicologa del reparto che in 5 casi ha effettuato colloqui con la triade madre-padre-bambino e, negli altri 5 casi, colloqui con la diade madre-bambino. Durante la visita, la coppia ha avuto la possibilit\ue0 di condividere i vissuti relativi la nascita pretermine, entrare in contatto con i sentimenti propri e del partner, esprimere ansie e paure rispetto allo sviluppo del figlio e l\u2019incertezza sulle proprie capacit\ue0 genitoriali. Nel corso dell\u2019incontro, la psicologa ha osservato il comportamento del bambino e ha attirato l\u2019attenzione dei genitori sulle modalit\ue0 utilizzate dal neonato per entrare in relazione con loro, al fine di promuovere un sentimento empatico di identificazione. Tali interventi sembrano promuovere una relazione pi\uf9 sensibile tra madre e figlio. La focalizzazione sulla triade, inoltre, sembra favorire un maggiore alleanza di coppia e una migliore capacit\ue0 genitoriale di comprensione dei bisogni del bambino