Attaccamento e clinica riabilitativa: pazienti con esiti di ictus e familiari di riferimento.

Una stretta relazione lega attaccamento, malattia, e disagio psicologico: il pattern di attaccamento influisce su: percezione dei sintomi, ricerca di assistenza sanitaria (Ciechanowsky, 2002), vulnerabilit\ue0 alla malattia, comportamento di malattia (Maunder e Hunter, 2001) e modo di affrontare crisi e nuovi adattamenti manifestati dal paziente. Soggetti sicuri, con schemi di S\ue9 e degli atri positivi, hanno una migliore capacit\ue0 di resilience rispetto agli insicuri (Bartholomew e Horowitz, 1991). Nella clinica riabilitativa, il familiare di riferimento svolge un ruolo attivo e partecipa dei processi mentali del paziente. Esistono diverse modalit\ue0 di caregiving (Feeney, 1996): soggetti con stile sicuro tendono ad essere pi\uf9 empatici, responsivi e attivi nel fornire aiuto degli insicuri. Ci si propone di indagare con appositi strumenti psicometrici lo stile di attaccamento, il disagio psichico, il recupero funzionale e le loro relazioni, in pazienti con esiti di ictus ospedalizzati e relativi familiari di riferimento rispetto ad un gruppo di controllo costituito da pazienti con esiti di frattura e loro familiari di riferimento. Si ipotizza che i soggetti con stile di attaccamento sicuro presentino livelli di disagio psicologico inferiori rispetto a quelli con stile insicuro, e livelli di indipendenza funzionale maggiori; inoltre, si ipotizza che una relazione in cui paziente e familiare manifestano strategie di attaccamento sicuro sia correlata ad un esito migliore del ricovero rispetto a quelli con stile insicuro; infine possono esserci differenze tra pazienti con lesioni all\u2019emisfero destro, sinistro e con i pazienti ortopedici. I risultati preliminari ottenuti sembrano confermare la maggior parte delle ipotesi formulate. Bartholomew, K., Horowitz, L.M. (1991). Journal of Personality and Social Psychology, 61, pp. 226-244. Ciechanowsky, P.S., Walker, E.A., Katon, W.J., Russo, J.E. (2002). Psychosomatic Medicine, 64, pp. 660-667. Feeney, JA. (1996). Personal Relationships, 3, pp. 401-416 Maunder, R.G., Hunter, J.J. (2001) Psychosomatic Medicine, 63, pp. 556-567

Attachment styles and clinical rehabilitation: stroke patients and their caregivers

In the practice of clinical rehabilitation, the caregiver plays an active and participating role in the patient’s mental processes. Moreover, the attachment style of the caregiver is associated with a particular type of care (Feeney, 1996). Caregivers with a secure style tend to be empathic and to actively offer assistance, while those with an insecure style exhibit different types of non-responsive caregiving, depending on their particular type of insecurity. We hypothesise that subjects with a secure attachment style will exhibit lower levels of psychological distress and higher levels of functional independence compared to those with an insecure style. We further expect that a relationship between patient and caregiver characterised by secure attachment strategies will be correlated with a more positive outcome of recovery compared to relationships based on an insecure style. Finally, differences may be found between patients with lesions of the right hemisphere, those with lesions of the left hemisphere and orthopaedic patients. Description of the sample: The study excludes patients with severe cognitive deficits. The sample consists of 35 stroke patients (M = 66%, F = 34%; average age = 69 with SD = 9.7; married = 66%) and 30 patients with fractures (M = 27%, F = 73%; average age = 75 with SD = 9.3; married = 50%), as well as the patients’ caregivers. In the neurological patients, the cerebral lesion is located in the right hemisphere in 60% of the cases, while most of the strokes are ischaemic in nature (66%). A share of 70% of the patients with right-hemisphere lesions exhibits modifications in cognitive functioning (neglect: 38%). Among the patients with lesions of the left hemisphere, around 60% show alterations in the cognitive profile (aphasia: 43%). A share of 50% of the orthopaedic patients (74% of the cases with femoral fractures) exhibits modifications of the cognitive profile. The caregivers of the post-stroke patients (spouse: 43%, son or daughter: 46%) are more frequently women (57%) with an average age of 53; 74% are married. Men and women are equally represented among the caregivers of the orthopaedic patients (spouse: 47%, son or daughter 50%); these caregivers have an average age of 61, and 80% are married. Tools and methodology: The HAD (Hospital Anxiety and Depression scale by Zigmond and Snaith, 1983), with separate subscales for anxiety and depression, was used to assess the psychological distress of the patients on admission and on discharge. The patients’ level of functional independence was also tested on admission and discharge by means of the FIM scale (Functional Independence Measurement, by Dodds et al., 1993). The CES-D scale (Center of Epidemiologic Studies Depression scale, by Radloff, 1977 in the Italian form validated by Fava, 1982) was used to measure the presence and degree of depression in the caregivers, likewise on admission and discharge. The attachment style of both patients and caregivers was identified using RQ (Relationship Questionnaire by Bartholomew and Horowitz, 1991) and ASQ (Attachment Style Questionnaire by Feeney, 1996 in the Italian version validated by Fossati et al., 2003). The ASQ evaluates attachment style according to five key factors: “confidence discomfort with closeness”, “need for approval”, preoccupation with relationships” and “relationships as secondary”. The preliminary findings appear to confirm most of the hypotheses formulated above

A revision of the genus Europicardium

The cardiid genus Europicardium Popov, 1977 was introduced for a small group of Cenozoic species from Europe, but remained almost unknown in the western literature until about 15 years ago, and its type species, Cardium multicostatum Brocchi, 1814, continued to be cited mainly as Trachycardium multicostatum. Many records are available for this species from the Miocene of Europe, but most are based on several distinct, often misidentified species. In the present revision, based on museum material, the taxonomy of Europicardium is discussed and the identity of its type species is fixed. Seven species are assigned to Europicardium: E. multicostatum (Brocchi, 1814), E. miorotundatum (Sacco, 1899) (lectotype designated), E. miocaudatum (Sacco, 1899), E. polycolpatum (Cossmann & Peyrot, 1912), E. pseudomulticostatum (Zhizhchenko, 1934), E. badeniense (Kokay, 1996) and E. hoernesi sp. nov. from the middle Miocene of Austria. However, literature records and museum material suggest the occurrence of additional species and the need for further investigation. The oldest record of Europicardium is from the early Miocene of the Aquitaine Basin, from where the genus likely spread into the Mediterranean and throughout the Paratethys. Europicardium reached a maximum diversity in the early middle Miocene (Badenian) of the Paratethys, probably in relation to the Miocene Climatic Optimum, and also with the complex and variable palaeogeography of the Paratethys, which promoted differentiation and diversity. Europicardium disappeared from the Paratethys when it became a freshwater basin in the late Miocene, and from the Mediterranean due to the Messinian Salinity Crisis. The last European species was E. multicostatum, which arrived in the Mediterranean from the adjacent Atlantic with the post-Messinian recolonization, and became extinct in the Pleistocene due to climatic deterioration. At the present day, Europicardium occurs in the tropical waters of West Africa, with three specie