Yoga for Anxiety Management in the Workplace

Anxiety is a potential cause of serious influence in a person\u27s daily life. This chapter is focused specifically on the effects of the work environment factors in disease development and progression. Working environments are places of significant sources of stress: they put us in connection with our duties and expectations (often not coincide with reality) and with a "forced socialization." Especially forced socialization is to be considered a main source of stress in work places, inducing negative outcomes in work and social relationships. The psychosocial risks of work places can so be defined according to design, organization and management of work as well as to social and environmental contexts that may lead to damage of physical, social and psychological domains. Stress can then be defined as a pattern of emotional, cognitive, behavioral, and physiological reactions to adverse and noxious aspects perceived as the contents of the working environment. Thanks to the beginning of psychosocial research on the working environment, the impact of some aspects of the work environment on health has become an object of study, as the interventions to mitigate it. Yoga, meditation, and mantra techniques, as described in this work (presenting others’ experiences and two of own current projects, used in a hospital workplace to control the condition of occupational stress but also in a clinical sample), showed the potential in considerably reducing anxiety and mood symptoms

Mental health services and the city: a neighbourhood-level epidemiological study

Introduction Neighbourhood composition is considered a social determinant of mental health that can be addressed by policymakers to improve outcomes. Deprived neighbourhoods typically lack resources such as leisure and park facilities but also daycare centres. However, the study of specific needs and resource distribution tailored to the clinical-demographic features of mental health service users is still in its infancy. Aim In this study, we aimed to identify discrepancies between neighbourhood resources and epidemiological composition of a representative sample of mental health service users in the large metropolitan area of Milan in Italy. Methods In a cross-sectional study design, we described neighbourhood-specific density of community services and the socio-demographic and clinical features of residents who accessed local mental health services in the same geographical areas. Data were retrieved from municipal and mental health registries and analysed at a neighbourhood level and at a higher level of neighbourhood clustering based on territory coverage of three mental health departments. Results At the neighbourhood level, no significant difference could be observed between resources of the three identified urban areas. However, a strong heterogeneity of resource localization was observed for public housing properties, social services, juvenile community homes, social aggregation spaces and day centres for disabled individuals after controlling for population density across the three areas. This heterogeneity did not match the distribution of service users or specific diagnosis-related needs across different urban districts. Non-affective psychoses were found to be more frequently diagnosed in deprived neighbourhoods, whereas anxiety disorders were most frequent in an area which incorporates relatively more affluent neighbourhoods. Further studies including a neighbourhood-level socio-economic index are needed to confirm the likelihood of these associations. Conclusion Our preliminary findings suggest a heterogeneous distribution of diagnoses across city areas, which might reflect uneven neighbourhood resources. Overall, this study highlights the need to adequately tailor neighbourhood resources to the specific mental health needs of vulnerable individuals

Protocol for a phase III RCT and economic analysis of two exercise delivery methods in men with PC on ADT

Abstract Background Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer. However, side effects of ADT often lead to reduced quality of life and physical function. Existing evidence demonstrates that exercise can ameliorate multiple treatment-related side effects for men on ADT, yet adherence rates are often low. The method of exercise delivery (e.g., supervised group in-centre vs. individual home-based) may be important from clinical and economic perspectives; however, few studies have compared different delivery models. Additionally, long-term exercise adherence and an understanding of predictors of adherence are critical to achieving sustained benefits, but such data are lacking. The primary aim of this multi-centre phase III non-inferiority randomized controlled trial is to determine whether a home-based delivery model is non-inferior to a group-based delivery model in terms of benefits in fatigue and fitness in this population. Two other key aims include examining cost-effectiveness and long-term adherence. Methods Men diagnosed with prostate cancer of any stage, starting or continuing on ADT for at least 6 months, fluent in English, and living close to a study centre are eligible. Participants complete five assessments over 12 months (baseline and every 3 months during the 6-month intervention and 6-month follow-up phases), including a fitness assessment and self-report questionnaires. Biological outcomes are collected at baseline, 6, and 12 months. A total of 200 participants will be randomized in a 1:1 fashion to supervised group training or home-based training supported by smartphones, health coaches, and Fitbit technology. Participants are asked to complete 4 to 5 exercise sessions per week, incorporating aerobic, resistance and flexibility training. Outcomes include fatigue, quality of life, fitness measures, body composition, biological outcomes, and program adherence. Cost information will be obtained using patient diary-based self-report and utilities via the EQ-5D. Discussion To disseminate publicly funded exercise programs widely, clinical efficacy and cost-effectiveness have to be demonstrated. The goals of this trial are to provide these data along with an increased understanding of adherence to exercise among men with prostate cancer receiving ADT. Trial registration The trial has been registered at clinicaltrials.gov (Registration # NCT02834416). Registration date was June 2, 2016

Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1\u2013June 30, 2018 and 2019; (b) March 1\u2013April 30, 2020 (i.e., lockdown); and (c) May 1\u2013June 30, 2020 (i.e., post-lockdown). Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p 65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44\u20130.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54\u20130.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32\u20132.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49\u20130.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01\u20131.79). Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena

Interplay between negative symptoms, time spent doing nothing, and negative emotions in patients with schizophrenia spectrum disorders: results from a 37-site study

This study evaluated the relationship between negative symptoms, daily time use (productive/non-productive activities, PA/NPA), and negative emotions in schizophrenia-spectrum disorders (SSDs): 618 individuals with SSDs (311 residential care patients [RCPs], 307 outpatients) were surveyed about socio-demographic, clinical (BPRS, BNSS) and daily time use (paper-and-pencil Time Use Survey completed twice/week) characteristics. Among them 57 RCPs and 46 outpatients, matched to 112 healthy controls, also underwent ecological monitoring of emotions (8 times/day for a week) through Experience Sampling Method (ESM). RCPs spent significantly less time in PA than outpatients. Patients with more negative symptomatology spent more time in NPA and less in PA compared to patients with milder symptoms. Higher time spent in NPA was associated with negative emotions (p < 0.001 during workdays) even when correcting for BNSS total and antipsychotic polypharmacy (p = 0.002 for workdays, p = 0.006 for Sundays). Future studies are needed to explore in more detail the relationship between negative emotions, negative symptoms, time use, and functioning in individuals with SSDs, providing opportunities for more informed and personalised clinical treatment planning and research into interactions between different motivational, saliency and behavioural aspects in individuals with SSDs

Time perspective affects daily time use and daily functioning in individuals with Schizophrenia Spectrum Disorders: Results from the multicentric DiAPAson study.

Time perspective (TP) influences various aspects of human life. We aimed to explore the associations between TP, daily time use, and levels of functioning among 620 patients (313 residential patients and 307 outpatients) with a diagnosis of Schizophrenia Spectrum Disorders (SSD) recruited from 37 different centres in Italy. The Brief Psychiatric Rating Scale and the Specific Levels of Functioning (SLOF) were used to assess psychiatric symptoms severity and levels of functioning. Daily time use was assessed using an ad hoc paper and pencil Time Use Survey. The Zimbardo Time Perspective Inventory (ZTPI) was used to assess TP. Deviation from Balanced Time Perspective (DBTP-r) was used as an indicator of temporal imbalance. The amount of time spent on non-productive activities (NPA) was positively predicted by DBTP-r (Exp(β): 1.36; p .003), and negatively predicted by the Past-Positive (Exp(β): .80; p .022), Present-Hedonistic (Exp(β): .77; p .008), and Future (Exp(β): .78; p .012) subscales. DBTP-r significantly negatively predicted SLOF outcomes (p .002), and daily time use, in particular the amount of time spent in NPA and Productive Activities (PA), mediated their association. Results suggested that rehabilitative programs for individuals with SSD should consider fostering a balanced time perspective to reduce inactivity, increase physical activity, and promote healthy daily functioning and autonomy

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders

Background: Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods: Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results: Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions: Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery