Conversion to secondary progressive multiple sclerosis: patient awareness and needs. results from an online survey in Italy and Germany

Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders.Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified.Methods: Participants were consenting adults with SPMS since <= 5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs.Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001).Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients).All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany.Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders.Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method.Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders.Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders

Su alcune recenti proposte di identificazione di centri antichi della Sicilia

Manni Eugenio. Su alcune recenti proposte di identificazione di centri antichi della Sicilia. In: L'Italie préromaine et la Rome républicaine. I. Mélanges offerts à Jacques Heurgon. Rome : École Française de Rome, 1976. pp. 605-617. (Publications de l'École française de Rome, 27

Hommage à la mémoire de Jean Bérard

Manni Eugenio. Hommage à la mémoire de Jean Bérard. In: Bulletin de l'Association Guillaume Budé, n°1, mars 1977. pp. 79-89

Su alcune recenti proposte di identificazione di centri antichi della Sicilia

Manni Eugenio. Su alcune recenti proposte di identificazione di centri antichi della Sicilia. In: L'Italie préromaine et la Rome républicaine. I. Mélanges offerts à Jacques Heurgon. Rome : École Française de Rome, 1976. pp. 605-617. (Publications de l'École française de Rome, 27

Ippi di Regio, un "logografo" da ricostruire

Manni Eugenio. Ippi di Regio, un "logografo" da ricostruire. In: Mélanges Pierre Lévêque. Tome 2 : Anthropologie et société. Besançon : Université de Franche-Comté, 1989. pp. 331-336. (Annales littéraires de l'Université de Besançon, 377

Sémites et Grecs en Sicile jusqu'au Ve siècle avant J.-C

Manni Eugenio. Sémites et Grecs en Sicile jusqu'au Ve siècle avant J.-C. In: Bulletin de l'Association Guillaume Budé, n°1, mars 1974. pp. 63-84

Hommage à la mémoire de Jean Bérard

Manni Eugenio. Hommage à la mémoire de Jean Bérard. In: Bulletin de l'Association Guillaume Budé, n°1, mars 1977. pp. 79-89

Ippi di Regio, un "logografo" da ricostruire

Manni Eugenio. Ippi di Regio, un "logografo" da ricostruire. In: Mélanges Pierre Lévêque. Tome 2 : Anthropologie et société. Besançon : Université de Franche-Comté, 1989. pp. 331-336. (Annales littéraires de l'Université de Besançon, 377