Pensare un corpo a rischio: le donne e la prevenzione dei tumori femminili

Il lavoro offre una prospettiva psicodinamica sul tema della prevenzione oncologica dei tumori femminili, discutendo della possibilità, interna e fattuale per una donna, di occuparsi della propria salute. Si riflette sul dilemma prevenzione-non prevenzione articolando tra loro tre assi teorici: narcisismo di vita e narcisismo di morte; rapporto mente, corpo e affetti; sviluppo dell' identità sessuale femminile. I tre studi di ricerca qualitativa permettono di esplorare le rappresentazioni simboliche e le costruzioni di significato delle donne intorno al tema del rischio e della diagnosi precoce dei tumori al seno e alla cervice uterina. I risultati ottenuti evidenziano aspetti importanti per pensare ad efficaci interventi di sensibilizzazione rivolti alle donne

The Relationship between Healthcare Providers and Preventive Practices: Narratives on Access to Cancer Screening

: Cancer screening programs are public health interventions beneficial to early diagnoses and timely treatments. Despite the investment of health policies in this area, many people in the recommended age groups do not participate. While the literature is mainly focused on obstacles and factors enabling access to health services, a gap from the point of view of the target population concerns healthcare providers. Within the "Miriade" research-action project, this study aims to explore the dimensions that mediate the relationship between healthcare providers and preventive practices through the narrations of 52 referents and healthcare providers involved in breast, cervical and colorectal cancer screening. We conducted ad hoc narrative interviews and used theory-driven analysis based on Penchansky and Thomas' conceptualization and Saurman's integration of six dimensions of healthcare access: affordability, availability, accessibility, accommodation, acceptability and awareness. The results show that 21 thematic categories were representative of the access dimensions, and 5 thematic categories were not; thus, we have classified the latter as the dimension of affection. The results suggest trajectories through which psychological clinical intervention might be constructed concerning health, shared health decisions and access to cancer screening

Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review.

Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions

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

Maladaptive Daydreaming in an Adult Italian Population During the COVID-19 Lockdown

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming (MD, i.e., a compulsive fantasy activity associated with distress and psychological impairment), psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale (MDS-16), and Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Based on an empirically derived cut-off score, 1,082 participants (17.2%) were identified as probable maladaptive daydreamers (MDers). A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress

IMPRONTE: Breast Cancer Women: Innovative Model for Processing Traumatic Experience

The onset of early breast cancer is a traumatic experience that holds the risk of impairing the quality of life of women even years after the end of treatments. Despite medical advances to reduce the mortality rate, clinical health psychology is still researching for solutions to address the psychological impact caused. Narrative meaning-making processes of the traumatic experience are key elements to promote psychic elaboration and well-being. Narrative Research and PI studies highlight significant markers of the transformative narrative process at the end of treatment. In this case, the narrative is a re-constructive and re-elaborative device for an already passed experience. Nowadays, narrative and diachronic markers of psychic elaboration of the traumatic experience related to the medical treatment do not exist. This project aims to fill this gap. The aim is to overturn, in an innovative way, the view of the literature, studying the narrative as a device to promote a psychic elaboration process in a diachronic way to the illness experience. This agrees with an personalized healthcare. These markers, as functions of connection and narrative transformation, are clues of risk and/or resilience of the psychic elaboration process. These markers allow the construction of a diachronic map of the functioning flow of the traumatic elaboration related to breast cancer (Diachronic flow of Illness Narrative Elaboration Markers - DINEM). DINEM is a precious tool for health operators in order to orient them in supporting the different phases of oncological treatment. The identification of these markers also allows us to build a theoretical model of Narrative Processing of Traumatic Experience (NAPTE) of women with early breast cancer, which is still absent in the literature. This model will be able to positively impact the quality of life of women, hospitals, and health operators

Cancer Prevention Sense Making and Metaphors in Young Women's Invented Stories

: Despite the proven effectiveness of cancer prevention, the literature highlights numerous obstacles to the adoption of screening, even at a young age. In cancer discourse, the metaphor of war is omnipresent and reflects an imperative demand to win the war against disease. From the psychodynamic perspective, the risk of cancer forecasts an emotionally critical experience for which it is important to study mental representations concerning illness and health care. Through the creation of an invented story that offers a framework for imagination, our aim is to understand what the relationship with preventive practices in oncology means for young women and how this relationship is revealed by their metaphors. A total of 58 young women voluntarily participated in the present research, answering a narrative prompt. The stories written by the participants were analyzed using qualitative methodology to identify construct, themes and metaphors. Our findings identify four constructs: the construction of a defense: youth as protection; the attribution of blame about cancer risk; learning from experience as a prevention activator; and from inaccessibility to access to preventive practices: the creation of engagement. The construction of an invented story allows us to promote a process of prefiguration on the bodily, affective and thought planes invested in preventive practice and brings out the use of metaphors to represent cancer risk and self-care. The results allow us to think about the construction of interventions to promote engagement processes in prevention from an early age

Cancer blog narratives: the experience of under-fifty women with breast cancer during different times after diagnosis.

The recent literature shows an increase of breast cancer in women under 50, however still few are the studies which analyse the impact of the disease in this specific target age. This study aims at exploring the most prevalent topics in Italian cancer blogs of women who have received a breast cancer diagnosis before the age of 50, in order to understand their experience of illness and the characteristics of women’s narrations at different times after diagnosis (1 year, 2 years, 3 years). We collected the textual corpus of 4 Italian breast cancer blogs and performed a thematic analysis. Five themes resulted, which, after interpretation using factorial mapping, fall into 3 sense vectors: toward the thought of the experience; from the external to the internal world; breast cancer: from rigidity to mobility. The blog analysis allows to build a first step of the scientific knowledge about the traumatic specificity of this experience, showing a need for processing the emotions. This allows to think about clinical support practices tailored to this group, in order to develop a diachronic processing of the experience and the construction of a new continuity of life

Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed