Basic emotions, attachment style and psichological distress.

Recent studies have shed light on the biological foundations of Basic Emotional Systems that can be found both in animals and in human beings. The aim of our study is to reveal the associations that exist between the Basic Emotions making up part of the personality structure, the relationship-based emotional regulatory system, i.e. Attachment Style, and the influence of these on the manifestation and expression of psychological distress. Our sample consisted of 110 subjects (M = 34, F = 76) , of whom 50 suffered from a stroke and 60 suffered from bone fractures; the average age was 72.67 (SD = 11.24). Participants were administered the following questionnaires: Feeney et al.\u2019s Attachment Style Questionnaire (Fossati et al., 2003, Jour. Soc. Pers. Rel. 20(1), 55-79) in order to assess adult attachment styles; Zigmond and Snaith\u2019s Hospital Anxiety and Depression Scale (Costantini et al., 1999, Support Care Cancer. 7:121\u2013127) in order to assess the intensity of anxiety and depression; the Affective Neuroscience Personality Scales (Davis et al., 2003, Neuro-Psychoanalysis, 5(1), 57-69) in order to evaluate the Basic Emotional Systems. Notwithstanding the advanced age of the subjects, the analysis indicated the existence of a statistically significant relationship between the Attachment Style (ASQ) and the Basic Emotional Systems of the personality structure (ANPS). In particular, we found a positive correlation between Secure Attachment Style and positive emotions, while the Avoidant Attachment Style seemed to modulate only partly adaptive emotions and psychological distress (HADS)

Effect of ursodeoxycholic acid treatment on alanine aminotransferase and gamma-glutamyltranspeptidase serum levels in patients with hypertransaminasemia. Results from a double-blind controlled trial.

The ability of ursodeoxycholic acid (UDCA, 600 mg/day) to lower alanine aminotransferase (ALT) blood levels in blood donors rejected for donation because of fluctuating hypertransaminasemia was evaluated in a randomized, controlled, double-blind clinical trial vs. placebo. All subjects with ALT values at least twice the normal upper limit in at least two out of three previous checks (the last one not more than 1 month previously) were admitted to the study. Checks were carried out 1, 2 and 3 months after the admission. 59 out of 65 patients completed the study. Although all patients were asked to abstain from alcohol, more than 50% of them in both groups had basal gamma-glutamyltransferase (gamma-GT) values higher than normal. After 1 month of treatment and throughout its duration, UDCA was effective in lowering ALT in all patients (30% decrease with respect to the basal value) and, especially, in lowering gamma-GT in those patients with elevated levels (50% decrease with respect to the basal value). This decrease was significantly different from the spontaneous 10% decrease of the ALT and gamma-GT levels observed in the placebo group. 3 months after suspension of therapy a rebound of both ALT and gamma-GT to values comparable to the basal ones or even higher was found only in UDCA-treated patients. We conclude that the short-term administration of UDCA is free of hepatotoxic effects and could be useful in lowering ALT and gamma-GT serum levels. The real significance of UDCA treatment in the natural history of chronic liver diseases deserves further investigation

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

Wiki-Based Conceptual Modeling: An Experience with the Public Administration

The dematerialization of documents produced within the Public Administration (PA) represents a key contribution that Information and Communication Technology can provide towards the modernization of services within the PA. The availability of proper and precise models of the administrative procedures, and of the specific \u201centities\u201d related to these procedures, such as the documents involved in the procedures or the organizational roles performing the activities, is an important step towards both (1) the replacement of paper-based procedures with electronic-based ones, and (2) the definition of guidelines and functions needed to safely store, catalogue, manage and retrieve in an appropriate archival system the electronic documents produced within the PA. In this paper we report the experience of customizing a semantic wiki based tool (MoKi ) for the modeling of administrative procedures (processes) and their related \u201centities\u201d (ontologies). The tool has been used and evaluated by several domain experts from different Italian regions in the context of a national project. This experience, and the reported evaluation, highlight the potential and criticality of using semantic wiki-based tools for the modeling of complex domains composed of processes and ontologies in a real setting

Ursodeoxycholic acid for symptomatic primary biliary cirrhosis. Preliminary analysis of a double-blind multicenter trial. Italian Multicenter Group for the Study of UDCA in PBC.

Abstract The administration of ursodeoxycholic acid, a hydrophilic bile acid not hepatotoxic to humans, has been suggested for treatment of primary biliary cirrhosis to improve cholestasis and reduce hepatocellular damage. Efficacy of treatment has been studied mainly in patients with asymptomatic or early-stage disease. In January 1988, to establish the efficacy and safety of ursodeoxycholic acid in a population with more severe disease, we started a multicenter, double-blind, placebo-controlled trial in patients with symptomatic disease, that is, with pruritus or serum bilirubin exceeding 2 mg/dl. Forty-four patients were assigned to ursodeoxycholic acid, 500 mg daily (corresponding to about 8.7 mg/kg body weight in these patients), and 44 to a placebo. As planned at the beginning of the study, a preliminary analysis was performed when all patients had been followed for at least 6 months (33 patients up to 12 months). Pruritus, self-evaluated by the patients, and cholestyramine consumption, as recorded in a diary, decreased significantly (p < 0.01) in both groups. In patients who initially had abnormal levels, serum bilirubin decreased significantly (p < 0.05) in the ursodeoxycholic acid group compared to placebo. After 6 months the following were also significantly better in the ursodeoxycholic acid than in the placebo group: a composite weighted biochemical index taking into account the changes in serum bilirubin, alkaline phosphatase, gamma-GT and AST (p < 0.001); serum prealbumin (p < 0.05); IgG (p < 0.01) and IgM (p < 0.01) levels