Il regret anticipato come principo regolatore della scelta

editorial reviewe

Health-related quality of life and burden of illness in adults with newly diagnosed attention-deficit/hyperactivity disorder in Sweden

Abstract Background This observational, cross-sectional, retrospective chart review aimed to identify factors determining health-related quality of life (HRQoL) in adults with newly diagnosed attention-deficit/hyperactivity disorder (ADHD) in Sweden. Methods Adult participants with a new clinical diagnosis of ADHD were enrolled from two specialist outpatient clinics in Stockholm, Sweden, from 2013 to 2015. Data extracted from patient records included demographics, clinical characteristics and comorbid psychiatric diagnoses identified using the Mini International Neuropsychiatric Interview (MINI). Depression severity was assessed using the Montgomery–Åsberg Depression Rating Scale – Self-reported (MADRS-S). The self-rated five-dimension EuroQol questionnaire (EQ-5D) was used to measure HRQoL. Predictors of EQ-5D index score were identified using multivariate linear regression adjusting for age, sex, education level, and main income source. Results The mean age of the 189 enrolled patients was 35.2 years (standard deviation [SD], 12.3), and 107 (57%) were female. Psychiatric comorbidities were present in 92 patients (49%), with anxiety and depression being the most common diagnoses. The mean EQ-5D index score was 0.63 (SD, 0.28). Low EQ-5D index scores were significantly associated with high MADRS-S scores, multiple comorbid psychiatric disorders, low educational achievement, female sex, and not having a main income derived from employment or self-employment. Conclusions These findings suggest that adults with newly diagnosed ADHD experience low HRQoL, which may often be exacerbated by psychiatric comorbidities such as anxiety and depression. Patients presenting with ADHD and psychiatric comorbidities in adulthood may require particular care and resources in the management of their ADHD

Pulmonary valve preservation during tetralogy of Fallot repair: midterm functional outcomes and risk factors for pulmonary regurgitation.

Objectives: Many centres have recently adopted pulmonary valve (PV) preservation (PVP) during tetralogy of Fallot (ToF) repair. We sought to identify the midterm functional outcomes and risk factors for pulmonary regurgitation after this procedure. Methods: All patients undergoing PVP during transatrial-transpulmonary repair for ToF with PV stenosis at our institution between January 2007 and December 2020 were reviewed. Results: Overall, 73 patients were included. At the index surgery, the body surface area was 0.31 ± 0.04 m2, the age was 4.9 ± 2.9 months and the preoperative PV z-score was -3.02 ± 1.11. At a mean follow-up of 5.3 ± 2.7 years, the fractional area change of the right ventricle (RV) was 47.1 ± 5.2%, and the tricuspid annular plane systolic excursion z-score was -3.31 ± 1.89%. The 5-year freedom from moderate/severe PV regurgitation was 61.3% [95% confidence interval (CI): 48, 73%]. There was a significant correlation between RV function and moderate/severe PR at follow-up (R2: 0.08; P = 0.03). A comparison with a group of patients undergoing a transannular patch procedure (N = 33) showed superior outcomes for patients with PVP. The preoperative PV z-score and the degree of PR at discharge were risk factors for the early development of moderate/severe PR at follow-up [hazard ratio (HR): 0.64; 95% CI: 0.48, 0.86, P = 0.01 and HR: 2.31; 95% CI: 1.00, 5.36, P = 0.04, respectively]. A preoperative PV annulus z-score ≤ -2.85 was found to be predictive for moderate/severe PR at 5 years after PVP (HR: 2.56; 95% CI: 1.31, 5.01, P = 0.002). Conclusions: A pulmonary valve preservation strategy during tetralogy of Fallot repair should always be attempted. However, a preoperative PV annulus z-score < -2.85 and moderate/severe regurgitation upon discharge are risk factors for midterm pulmonary regurgitation

Additional file 1: of Health-related quality of life and burden of illness in adults with newly diagnosed attention-deficit/hyperactivity disorder in Sweden

Table S1. Proportion of patients with missing data. (DOCX 16 kb

Why are Depressive Individuals Indecisive? Different Modes of Rumination Account for Indecision in Non-clinical Depression

Individuals with depressive symptoms tend to adopt an abstract-analytical (A-A) rather than a concrete-experiential (C-E) mode of rumination. A large body of evidence shows that this leads to many deficits that are associated with depression (Watkins in Psychol Bull 134:163–206, 2008). In two studies, the present research examined whether indecision in a non-clinical population could also result from the mode of rumination adopted. In the first study, 174 participants completed measures of depressive symptoms, rumination, decision-making styles and indecision. The results of this study showed that indecision and one dysfunctional decision-making style (hyper-vigilance) significantly correlated with A-A rumination, even when controlling for depression. In a second study, 71 participants with mild to severe depressive symptoms (MSDs) and 49 participants with no to minimal depressive symptoms were trained to adopt either an A-A or a C-E rumination mode, and subsequently requested to make 10 choices. Consistent with the results of the first study, the results of the second study showed that participants in the A-A condition took longer to make their choice compared to participants in the C-E condition, irrespective of their level of depression. Moreover, the group of participants with MSDs experienced slightly more difficulty in decision making when they were in the A-A mode than in the C-E mode. This suggests that the A-A rumination mode could be an antecedent of indecision, whereas the C-E mode predicts its reduction. These interpretations are in line with the idea that A-A rumination is maladaptive and C-E rumination is adaptive