Geographic and socioeconomic variation of sodium and potassium intake in Italy : results from the MINISAL-GIRCSI programme

Objectives To assess geographic and socioeconomic gradients in sodium and potassium intake in Italy. Setting Cross-sectional survey in Italy. Participants 3857 men and women, aged 39–79 years, randomly sampled in 20 regions (as part of a National cardiovascular survey of 8714 men and women). Primary outcome measures Participants’ dietary sodium and potassium intakes were measured by 24 h urinary sodium and potassium excretions. 2 indicators measured socioeconomic status: education and occupation. Bayesian geoadditive models were used to assess spatial and socioeconomic patterns of sodium and potassium intakes accounting for sociodemographic, anthropometric and behavioural confounders. Results There was a significant north-south pattern of sodium excretion in Italy. Participants living in southern Italy (eg, Calabria, Basilicata and Puglia >180 mmol/24 h) had a significantly higher sodium excretion than elsewhere (eg, Val d'Aosta and Trentino-Alto Adige <140 mmol/24 h; p<0.001). There was a linear association between occupation and sodium excretion (p<0.001). When compared with occupation I (top managerial), occupations III and IV had a 6.5% higher sodium excretion (coefficients: 0.054 (90% credible levels 0.014, 0.093) and 0.064 (0.024, 0.104), respectively). A similar relationship was found between educational attainment and sodium excretion (p<0.0001). When compared with those with a university degree, participants with primary and junior school education had a 5.9% higher urinary sodium (coefficients: 0.074 (0.031, 0.116) and 0.038 (0.001, 0.075), respectively). The socioeconomic gradient explained the spatial variation. Potassium excretion was higher in central regions and in some southern regions. Those in occupation V (low-skill workers) showed a 3% lower potassium excretion compared with those in occupation I. However, the socioeconomic gradient only partially explained the spatial variation. Conclusions Salt intake in Italy is significantly higher in less advantaged social groups. This gradient is independent of confounders and explains the geographical variation

Application of the seven-factor-model of personality to an Italian preschool sample

OBJECTIVE: Advances in dimensional assessment of children in healthy and clinical populations has renewed interest in the study of temperament. Cloninger's Temperament and Character Inventory (TCI) has shown high reliability and internal consistency. Adult and adolescent versions have been translated into a number of languages and validated in cross-cultural studies worldwide. To date only one preschool-TCI-based study has been conducted in early infancy with teachers as observers. The present study is aimed to test an Italian Preschool version of the Temperament and Character Inventory (PsTCI). This is the first replication and the first validation study of TCI on preschoolers with parents as observers. METHODS: 395 preschool children, recruited from pediatric communities and day-care centres throughout Italy, participated in the study. Parents of each child enrolled in the study and completed a PsTCI about the child. Standard psychometric tests of reliability and validation were performed. RESULTS: Exploratory factor analyses demonstrated the presence of distinct domains for temperament and character. TCI dimensions had good internal consistency with Cronbach's alpha ranging values (|0.60|-|0.81|). Gender differences were found for Harm Avoidance (β=-0.186; p≤0.001) and Self-Directedness (β=-0.216; p≤0.01), and accounted for 5-35arm-38-702- of the observed variance. CONCLUSION: The present work suggests the psychological complexity of Cloninger's model and confirms its application in pre-school children from diverse environmental and cultural backgrounds. The results confirm that Cloninger's instrument for temperament and character evaluations can also be used with different observers and highlight the importance of considering cultural and demographic differences in the assessment of temperament and character in preschoolers

Are some cases of sleep paralysis an expression of a dissociative condition? Dramatic resolution of sleep paralysis in an adolescent after administration of aripiprazole

Recurrent isolated sleep paralysis (SP) is characterized by an inability to perform voluntary movements at sleep onset (hypnagogic) or at sleep offset (hypnopompic) in the absence of a diagnosis of narcolepsy. Consciousness is preserved with full recall of the event. An episode of sleep paralysis lasts seconds to minutes and usually resolves spontaneously. Other features of sleep paralysis may include auditory and visual hallucinations, a sense of pressure on the chest, and high prevalence of depression which has led to the hypothesis that it is an atypical symptom of depression. This hypothesis is supported by studies showing that specific antidepressants can relieve the symptoms of SP [1]. An early study reported three cases of isolated sleep paralysis controlled by L-tryptophan with or without amitriptyline (both increased CNS 5- hydroxytryptamine [5-HT] availability) while imipramine showed no efficacy because it predominantly affects norepinephrine reuptake [2]. We report the case study of a 15 year old girl with sleep paralysis and dissociative disorder successfully treated with aripiprazole

The Relationship between Personality and Depression in Expectant Parents

Several studies assessed the relationship between depression and dimensions of temperament/character using the Cloninger's model of personality and the TCI-R. The aim of this study is clarify the relation between depression and personality in men and women who are expecting a baby. The Temperament and Character Inventory—Revised Form and the Beck Depression Inventory were administered to 65 pregnant women and 37 husbands during the last quarter of pregnancy. ANOVAs showed that pregnant women had higher levels of depression, reward dependence, and self-transcendence than the expectant fathers. Hierarchical Multiple Regression Analysis in the pregnant women group showed that harm avoidance and self-directedness were significant predictors of the level of depression. In the expectant fathers, only self-directedness was a significant predictor of depression. Low TCI-R self-directedness is a strong predictor of depression in expectant parents during pregnancy regardless of gender, and high TCI-R harm avoidance is an additional predictor of depression in expectant mothers

Could treatment of iron deficiency both improve ADHD and reduce cardiovascular risk during treatment with ADHD drugs?

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood-onset neuropsychiatric conditions. Despite extensive research, the etiopathophysiological factors underlying ADHD are not completely understood. It has been suggested that iron deficiency may contribute to ADHD symptoms severity. Whereas evidence from studies based on serum ferritin measures, a marker of peripheral iron status, is somewhat mixed, preliminary recent evidence suggests a deficiency of brain iron in individuals with ADHD. Therefore, it has been proposed that either a deficiency of peripheral iron or a dysfunction of the blood–brain barrier, in the presence of normal peripheral iron levels, may contribute to low brain iron levels, which, in turn, would increase the risk for ADHD symptoms in a subgroup of individuals with this disorder. It has also been found that individuals with ADHD may be at increased risk of severe cardiovascular events during treatment with ADHD drugs, although the extent to which this occurs in ADHD patients compared to non-ADHD individuals is still matter of investigation. Since iron depletion has been recently reported as a risk factor for adverse prognosis in heart failure, iron deficiency might contribute both to ADHD symptoms severity before treatment and to increased risk of severe cardiovascular events during treatment with ADHD drugs in a selected subgroup of patients. Therefore, we hypothesize that the effective treatment of iron deficiency might lead both to improvement of ADHD symptoms severity and to a decrease of the risk of cardiovascular events during treatment with ADHD drugs. If empirical studies confirm this hypothesis, the clinician would be advised to systematically check iron status and effectively treat iron deficiency before starting a pharmacological treatment with ADHD drugs

Might the temperament be a bias in clinical study on attention-deficit hyperactivity disorder (ADHD)? Novelty seeking dimension as a core feature of ADHD

Some clinical studies on attention deficit hyperactivity disorder (ADHD) have been found to overlap those of studies on personality, particularly those on the Novelty Seeking trait (NS) as measured by the Junior Temperament and Character Inventory (JTCI). The aim of this study was to evaluate the potential role of NS in clinical research on ADHD. We enroled 146 ADHD children (125 boys; mean age¼9.61, S. D.¼2.50) and 223 age- and gender-matched control children (178 boys; mean age¼9.41, S.D.¼2.30). All the parents filled in the JTCI for the evaluation of personality according to Cloninger's model. An exploratory factor analysis differentiated the NS items that concern “Impulsivity” (NS1) from those that concern other features (NS2). Multivariate Analysis of Variance (MANOVAs) revealed significant differences between ADHD children and non-ADHD children in temperamental dimensions: the scores of ADHD children were higher than those of non-ADHD children in Total NS, NS1-Impulsivity and NS2. Our results show that the NS dimension of the JTCI in ADHD children is higher than in non-ADHD children, even when a correction is made for impulsivity items. This finding suggests that the NS trait plays a central role in ADHD diagnosis even when items referred to impulsivity are removed from the NS scale