Sindrome di alienazione genitoriale (PAS) e abuso sessuale intrafamiliare: criteri di differenziazione e matrici comuni

The aim of this work is discussing a very important problem that may emerge as a spin-off of the Parental Alienation Syndrome in the context of the child custody diputes after marital separation: the false sexual abuse allegations. More and more frequently we can observe, in fact, judiciary cases with a typical development: a parent is accused of abuse and cruelty to his/her child and the judge provides his/her removal, interrupting his/her relationship with the child; the long investigating and judiciary course doesn’t confirm the accusation but, in the meantime, the parentchild relationship is irremediably damaged. Therefore it’s very important differentiating correctly between bona fide abuse allegations and the accusations resulting from Parental Alienation Syndrome: for this purpose Gardner (1999) presents a long list of criteria referring both to minors’ behavioural patterns and to parents’ psychological characteristics, behaviours and family history. When really abused by the refused parent, children generally exhibit symptoms seen in the Post-traumatic Stress Disorder (A.P.A., 2001) and aren’t likely to exhibit the typical manifestations of PAS. With regard to parents, alienating parents are typically uncooperative with examiners and their reports aren’t very credible; they need to provide continually “refresher courses” in order to remind their children of the abuse experienced; they’re overprotective of their children from the alienated parent, even in protected contexts; their accusations of alleged abuse emerge only after the separation. Parents of children who are genuinely abused, instead, let their children rember spontaneously the abuse experienced; they recognize the risk of an attenuation of the child’s bond with the abuser parent and most often they do everything in their power to restore it in protected conditions; their accusations of child abuse date back long before the separation. Targeted parents in PAS are generally credible in their reports and very much concerned for the physical and financial well-being of the family; in these cases the abuse accusations regard only the children, not the other family members. Abuser parents are, on the contrary, uncredible in their affirmations, not very or not at all concerned for the physical and financial well-being of the family; they’re inclined to impulsivity, acting-out of anger and paranoia; in these cases the abuse accusations extend also to the other family members. It’s finnaly proposed an interesting reading (Villa, 2006) of the psychic dynamics acting in the families from which rises an accusation of alleged abuse, observing that Parental Alienation Syndrome, incestual relations and incest cases have the same psychodynamic origins: they take rise from family relations that are primitive and concrete, narcissistic and excluding, typical of “pre-oedipical” conditions, in which there’s no space for the symbolic and its representations.Il presente lavoro intende affrontare un fenomeno di particolare rilevanza che può emergere, nel contesto delle dispute tra genitori separati per l’affidamento dei figli, in qualità di derivato o effetto della Sindrome di Alienazione Genitoriale: le false accuse di abuso sessuale intrafamiliare. Si assiste, infatti, sempre più di frequente a vicende giudiziarie che seguono un iter caratteristico: un genitore viene accusato di abusi o gravi maltrattamenti ai danni del figlio e viene allontanato, sospendendo ogni relazione con il bambino; il lungo percorso investigativo e giudiziario non conferma la denuncia ma, nel frattempo, il rapporto genitore-figlio è compromesso irrimediabilmente. Si desume, dunque, l’importanza di un’accurata differenziazione tra accuse bona fide di abuso e denunce frutto di una PAS: a tale scopo Gardner (1999) fornisce un lungo elenco di criteri che fanno riferimento sia ai pattern comportamentali dei minori che alle caratteristiche psicologiche, agli atteggiamenti e alla storia familiare dei genitori. In caso di abuso realmente subito dal genitore rifiutato, i sintomi dei figli rientrano solitamente nell’area del Disturbo Post-traumatico da Stress (A.P.A., 2001), e difficilmente si riscontrano le manifestazioni tipiche della PAS. Quanto alle figure parentali, solitamente i genitori alienanti sono poco collaborativi nel sottoporsi a valutazioni, poco attendibili nei loro resoconti, bisognosi di fare continue “iniezioni di richiamo” per ricordare ai figli i maltrattamenti subiti, premurosi nel proteggere i figli dal genitore bersaglio, anche in contesti protetti; denunciano, inoltre, i presunti abusi solo dopo la separazione. I genitori di minori realmente abusati, invece, lasciano che i figli ricordino spontaneamente gli abusi subiti, riconoscono il rischio dell’indebolimento del rapporto tra il genitore abusante ed i figli e fanno di tutto per ripristinarlo in condizioni protette; la denuncia degli abusi risale, infine, ad un periodo di molto precedente alla separazione. I genitori bersaglio della PAS, abitualmente, sono attendibili nei loro resoconti; si sono sempre preoccupati del benessere familiare; le denunce di abuso mosse loro riguardano solo i figli, non gli altri familiari. I genitori realmente abusanti, al contrario, sono poco attendibili nei loro resoconti, poco o affatto interessati al benessere della famiglia, tendono all’impulsività, all’esplosione violenta della rabbia e alla paranoia; la denuncia di abuso si estende, in questi casi, anche ad altri membri della famiglia. Viene, infine, offerta un’interessante lettura (Villa, 2006) delle dinamiche psichiche profonde operanti nelle famiglie da cui nasce la denuncia di sospetto abuso, osservando come la Sindrome di Alienazione Genitoriale, le relazioni incestuose e i casi di incesto condividano una stessa matrice psicodinamica che affonda le sue radici in relazioni familiari primitive e concrete, narcisistiche ed esclusive, proprie di condizioni “pre-edipiche”, in cui non c’è spazio per il simbolico e le sue rappresentazioni

Le conflittualità nelle separazioni coniugali: aspetti psicopatologici e rischi per i minori

This article examines the complex situations caused by ex-partners’ difficulties in “mentalizing” the distress of their separation and their tendency to “act it out” with interminable struggles which perpetuate destructive behaviours and which increase their own grief, as well as that of their children. The minors involved have a higher probability of emotional and behavioral maladjustment because they are involved in relationships which interfere in their psychic development (e.g. conflicts of loyalty, difficulties in the parent-child relationship, inversion of roles between parents and children), and in more serious cases, they are exposed to psychological abuse. Described here are the various forms of psychic hardships that the family separated by conflict may assume: described by some authors as downright “syndromes”, they represent the changing face of a pathological family dynamic of which each member plays his role and has his own good reasons for standing in the way of the dramatic changes which he faces. G. Giordano defines “parental mobbing” as the collection of hostile and persecutory behaviours started by a separated parent against the other with the aim of preventing him or her from exercising their role as a parent by means of devaluing and destroying the relationship with the child. This may include sabotaging visitations; marginalizing the decision making processes; use of threats; campaigns of denigration; familial and social elegitimization. I.D. Turkat describes mothers (“Malicious Mother Syndrome”) who, although they are free of other mental disorders and seem to have a good relationship with their children, exhibit damaging behaviours toward the exhusband with the intention of impeding a normal and affectionate relationship with his children. This behaviour may include true violations of the law, or excessive legal actions in order to burden the ex-spouse. G.L. Rowles speaks of the “Disenfranchised Father Syndrome” as a disorder of fathers who are partially or totally “paralyzed” by the distress of separation. They can do nothing to avoid it, and try to fight on in order to remain present in the lives of their children. But after having struggled in vain to stand up for their legal rights, they finally come to realize that they have been delegitimized in their parental role. Symptoms include those of depression, and those of Post traumatic Stress Disorder. Of great interest are the studies of R. Gardner on “Parental Alienation Syndrome” (PAS), a pathology which arises primarily from the context of child custody disputes. Its principle manifestation is the child’s seemingly motiveless refusal to maintain his or her relationship with the non-custodial parent, accompanied by an exacerbated and unjustified campaign of denigration; the latter being the result of direct and indirect programming on the part of the alienating parent, as well as the active and personal contribution of the child in question. The “singular relationship” which results between the minor and the parent deliberately aims to exclude the other, and in more serious cases, may represent a clear and powerful mental health risk factor for the child.Il presente lavoro prende in esame le complesse problematiche legate alla difficile “mentalizzazione” del disagio da separazione da parte degli ex-coniugi e alla tendenza ad “agirlo” attraverso interminabili “battaglie” che non fanno altro che perpetuare all’infinito comportamenti distruttivi e cronicizzati il proprio malessere e, soprattutto, quello dei figli. Coinvolti in processi relazionali disfunzionali per il loro sviluppo psichico (conflitti di lealtà, genitorializzazione, inversione di ruoli) ed esposti, nei casi più gravi, al rischio di abuso psicologico, i minori hanno elevate probabilità di andare incontro a disadattamento sul piano emotivo e comportamentale. Vengono, infine, descritte le variegate forme che il disagio psichico della famiglia separata conflittuale può assumere: definite da vari autori come vere e proprie “sindromi”, esse rappresentano i volti cangianti di una dinamica familiare patologica in cui tutti i membri della famiglia giocano il proprio ruolo ed hanno le loro buone ragioni per opporsi al cambiamento drammatico che li attraversa. G. Giordano definisce “mobbing genitoriale” l’insieme di comportamenti ostili e persecutori messi in atto da un genitore separato nei confronti dell’altro allo scopo di impedirgli l’esercizio della propria genitorialità, svilendo e distruggendo la sua relazione con il figlio: sabotaggi delle frequentazioni, emarginazione dai processi decisionali, minacce, campagne di denigrazione, delegittimazione familiare e sociale. I.D.Turkat descrive madri (“Sindrome della Madre Malevola”) che, pur rimanendo esenti da altre psicopatologie accertabili e mantenendo con i figli (almeno in apparenza) un efficace rapporto di accudimento, attuano nei confronti dell’ex-marito un comportamento lesivo, teso ad impedirgli un normale ed affettuoso rapporto con i figli. L’alterazione della condotta può comprendere vere e proprie violazioni della legge, oppure può trasformarsi in un eccesso di azioni legali con cui vessare l’ex-coniuge. G. L. Rowles parla di “Sindrome del Padre Interdetto” a proposto di padri parzialmente o del tutto paralizzati dalla sofferenza della separazione: essi non possono far nulla per evitarla, cercano di lottare per rimanere presenti nella vita dei figli ma, dopo aver tentato inutilmente di far valere i loro diritti in campo giuridico, si rendono conto di essere delegittimati nel loro ruolo genitoriale. La loro sintomatologia è costituita da sintomi depressivi e del disturbo posttraumatico da stress. Di grande interesse, infine, gli studi di R. Gardner sulla “Sindrome di Alienazione Genitoriale” (PAS), patologia relazionale che insorge essenzialmente nel contesto delle controversie per l’affidamento dei figli. La sua principale manifestazione consiste nel rifiuto immotivato del figlio a mantenere rapporti con il genitore non affidatario, accompagnato da un’esacerbata ed ingiustificata campagna di denigrazione: quest’ultima è frutto della programmazione diretta e indiretta da parte del genitore alienante e del contributo attivo e personale del figlio. La “relazione singolare” che viene così a configurarsi tra il minore e uno dei due genitori è deliberatamente mirata all’esclusione dell’altro e, nei casi più gravi, può rappresentare un potente e diretto fattore di rischio per la salute mentale del minore

Biopsy of liver metastasis for women with breast cancer: Impact on survival

Abstract Background Biopsy of metastatic site of disease can influence treatment decisions, but its impact on survival remains uncertain. Patients and methods One-hundred patients with first metachronous liver metastases (LM) from breast cancer (BC) who underwent liver biopsy between 1999 and 2009 were identified. One-hundred matched control patients with LM from BC and no biopsy were selected. Results Liver biopsy had no statistically significant impact on survival when comparing biopsied patients to controls [HR 0.82 (95% CI 0.58–1.16)]. Patients with early metastasis (within 3 years) undergoing liver biopsy had a better survival [HR 0.60 (95% CI 0.38–0.97)] compared to those who did not. Liver biopsy had no statistically significant impact on survival in patients with late LM (after 3 years) [HR 1.09 (95% CI 0.69–1.74)]. We observed that 18 out of 100 biopsied patients (18.0%) had a conversion of predictive factors which allowed adjusting for therapy, specifically new expression of ER ( n = 5), overexpression of HER2 ( n = 12) or both ( n = 1). Fourteen out of 18 (77.8%) received anti-HER2 treatment for the first time at the time of metastasis and 3 others (16.7%) received hormone therapy. Those 18 patients showed a better survival compared to the other 82 biopsied patients [HR 0.55 (95% CI 0.28–1.10)] and compared to the 13 biopsied patients with disappearance of features which predicted responsiveness to a given treatment [HR 0.19 (95% CI 0.06–0.62)]. Conclusions Liver biopsy can impact survival of patients with early metastases from BC. Discordance between primary and distant lesions can offer the patients new treatment options

First real-world data on universal respiratory syncytial virus prophylaxis with Nirsevimab in infants

Respiratory syncytial virus (RSV) predominantly affects young children, with a peak incidence in temperate regions of the northern hemisphere from October to May. Children under 24 months of age are particularly vulnerable because of the immaturity of their lungs and immune systems, which often leads to severe respiratory infections. The World Health Organization (WHO) recognizes RSV as a global health priority. Recently, Nirsevimab, a long-acting mAb, was authorised to prevent RSV in infants. Our narrative review brings together the field effectiveness data of Nirsevimab available in the literature, highlighting the strengths and weaknesses of the published studies and the prevention opportunities represented by the new preparation. All studies reviewed provide evidence for the effectiveness of immunisation with Nirsevimab in real-world settings, beyond the controlled conditions of clinical trials, and highlight its safety and feasibility. Nirsevimab significantly reduces RSV hospitalisations and ICU admissions. High coverage and high efficacy of immunisation have been reported, although supply issues and variability in studies present challenges. Continued research and surveillance are critical to understanding the long-term effectiveness of Nirsevimab. Overall, available data provide valuable insights into the efficacy, safety, and impact of immunisation with Nirsevimab in preventing severe RSV infections in infants, highlighting its potential to reduce the burden of RSV-related hospitalisations and improve paediatric health outcomes

Utility of neutrophil-to-lymphocyte ratio to identify long-term survivors among HCC patients treated with sorafenib

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Validation and refinement of PROSASH model using the neutrophil‐to‐lymphocyte ratio in patients with HCC receiving sorafenib

AbstractThe recently developed PROSASH model is proving to be a useful tool in risk‐group discrimination in hepatocellular carcinoma (HCC) patients treated with sorafenib. Several studies highlighted that the neutrophil‐to‐lymphocyte ratio (NLR) is one of the most important predictors of survival in HCC patients treated with sorafenib. The aims of the present study were to validate the PROSASH model and determine whether the incorporation of inflammatory markers can improve risk stratification. This study included 438 patients. According to the four categories of the PROSASH model, median overall survival (OS) was 20.0, 14.9, 8.5 and 3.0 months respectively (P < .001). The Harrell's c for this categorized model was 0.621. NLR (cut‐off 3) stratified OS in each of the PROSASH categories. After reclassification, median OS was 21.0, 15.1, 8.2 and 4.1 months (P < .001). The Harrell's c increased from 0.621 to 0.673 (P = .001). Integrating NLR into the PROSASH model allowed a more accurate classification of the patients in the risk groups

Evaluation of humoral and cellular response to four vaccines against COVID-19 in different age groups: A longitudinal study

To date there has been limited head-to-head evaluation of immune responses to different types of COVID-19 vaccines. A real-world population-based longitudinal study was designed with the aim to define the magnitude and duration of immunity induced by each of four different COVID-19 vaccines available in Italy at the time of this study. Overall, 2497 individuals were enrolled at time of their first vaccination (T0). Vaccine-specific antibody responses induced over time by Comirnaty, Spikevax, Vaxzevria, Janssen Ad26.COV2.S and heterologous vaccination were compared up to six months after immunization. On a subset of Comirnaty vaccinees, serology data were correlated with the ability to neutralize a reference SARS-CoV-2 B strain, as well as Delta AY.4 and Omicron BA.1. The frequency of SARS-CoV-2-specific CD4+ T cells, CD8+ T cells, and memory B cells induced by the four different vaccines was assessed six months after the immunization. We found that mRNA vaccines are stronger inducer of anti-Spike IgG and B-memory cell responses. Humoral immune responses are lower in frail elderly subjects. Neutralization of the Delta AY.4 and Omicron BA.1 variants is severely impaired, especially in older individuals. Most vaccinees display a vaccine-specific T-cell memory six months after the vaccination. By describing the immunological response during the first phase of COVID-19 vaccination campaign in different cohorts and considering several aspects of the immunological response, this study allowed to collect key information that could facilitate the implementation of effective prevention and control measures against SARS-CoV-2

Consumption of energy drinks among Italian University students : a cross-sectional multicenter study

Purpose The aim of the study was to evaluate the caffeinated Energy Drinks (EDs) consumption among a large sample of Italian undergraduates and its association with some of the major lifestyle risk factors. Methods Students attending twelve public Italian universities were involved between October 2021 and May 2022. Information on socio-demographic characteristics, ED consumption, and on health-related behaviors of participants was collected by the use of a web-based questionnaire. Results A total of 2165 students participated in the study and 15.2% of them reported having used caffeinated EDs in the last six months, mainly once a month (41.5%). In comparison with non-users, ED users showed a higher proportion of males (p &lt; 0.001) and a higher father’s educational level (p = 0.003), came mainly from Northern universities (p = 0.004) and life sciences degree courses (p &lt; 0.001). Besides, ED users reported higher BMI values (p = 0.003), more particular dietary regimens (p &lt; 0.001), higher levels of weekly moderate–vigorous physical activity (p &lt; 0.001) and participation in sports (p &lt; 0.001) and in team sports (p = 0.003), and higher proportion of smokers (p &lt; 0.001) and alcohol drinkers (p = 0.005). ED use was negatively related with female gender (OR 0.546; 95% CI 0.374–0.798), the Mediterranean diet (OR 0.587; 95% CI 0.362–0.951) and coming from the center of Italy (OR 0.500; 95% CI 0.275–0.909) and positively associated with tobacco smoke (OR 1.712; 95% CI 1.176–2.492) and participation in a team sport (OR 1.686; 95% CI 1.051–2.707). Conclusion These findings could encourage figures engaged in education to increase the students’ awareness on this issue in order to prevent the excessive use of EDs and associated unhealthy behaviors, especially in the most interested subgroups