Views of Mental Health Professionals on Positive Changes in Service Practices and Staff-User Relationships After One Year of Covid-19 Pandemic in Italy

Abstract This study explored views of mental health services (MHS) professionals regarding positive changes in service practices and organizations, and staff-user relationships after one year of COVID19 in Italy. Professionals from a community-oriented MHS completed online the Questionnaire on MHS Transformations during the COVID-19 pandemic, a 30-item tool developed by a participatory approach and validated. Of the 184 participants, 91.8% felt it was ‘‘true/definitely true’’ that during the pandemic they had informed users on procedures to reduce contagion risks, and 82.1% stated that they had increased telephone contact with users. Sixty-nine percent of professionals reported that staff revised treatment plans according to new needs of care and 78.6% stated that they had been able to mediate between user needs and safe working procedures. Moreover, 79.4% of respondents stated that they had rediscovered the importance of gestures and habits, and 65% that they had gained strength among colleagues to face fear. Fifty-four percent of participants admitted that they had discovered unexpected personal resources in users. Overall, 59.6% of participants stated that they found some positives in the COVID-19 experience. Perceived positive changes was greater among professionals from community facilities vs. those from hospital and residential facilities. In community-oriented MHS, the pandemic offered an opportunity to change practices and rethink the meaning of relationships between people. This data may be useful in generating a more balanced understanding of COVID-19’s impact on MHS and for MHS planning in the pandemic era

Measuring adolescents' perceptions of parenting style during childhood: psychometric properties of the parenting styles and dimensions questionnaire

The paper analyzes the psychometric properties of the G1 version of the Parenting Styles and Dimensions Questionnaire, a self-report instrument designed to investigate how adolescents or adults were parented during childhood. The sample included 1451 Italian adolescents in high school. Three studies tested the scale's structure, invariance, and convergent validity. The first found slightly acceptable fit indexes for a 40-item scale measuring three factors (authoritative, authoritarian, and permissive styles); the factors presented good reliability (ρc .62-.96). Multigroup confirmative analyses found factor loadings invariant in the father version, whereas 12 items resulted not invariant in the mother version (second study). Good convergent validity was found with the Parental Bonding Index and the Parental Monitoring Scale (third study). Discussion of results is provided within the parenting styles literature

Erectile dysfunction and heart failure: the role of phosphodiesterase type 5 inhibitors

The phosphodiesterase type 5 (PDE-5) inhibitors are effective in treating erectile dysfunction (ED). ED and heart failure (HF) share similar risk factors, and commonly present together. This association has led to questions ranging from the safety and efficacy of PDE-5 inhibitors in HF patients to a possible role for this class of medication to treat HF patients with or without ED. In addition to endothelial dysfunction, there are causes of ED specific to patients with HF including low exercise tolerance, depression and HF medications. Before treating HF patients with PDE-5 inhibitors, patients should be assessed for their risk of a cardiac event during sexual activity. PDE-5 inhibitors are safe and effective in treating ED in HF patients. An improvement in erectile function by PDE-5 inhibitors was associated with an improvement in quality of life and reduction in depression. Several studies demonstrated the effect of PDE-5 inhibitors on HF per se. PDE-5 inhibitors improved endothelial dysfunction, increased exercise tolerance, decreased pulmonary vascular resistance and pulmonary artery pressure, and increased cardiac index. Several mechanisms whereby PDE-5 inhibitors improve HF have been proposed. PDE-5 inhibitors already have a role in treating primary pulmonary hypertension; however additional studies are needed to determine if they will become a standard therapy for HF patients

Nutraceutical therapies for atherosclerosis

Atherosclerosis is a chronic inflammatory disease affecting large and medium arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). Although the development of pharmacotherapies to treat CVD has contributed to a decline in cardiac mortality in the past few decades, CVD is estimated to be the cause of one-third of deaths globally. Nutraceuticals are natural nutritional compounds that are beneficial for the prevention or treatment of disease and, therefore, are a possible therapeutic avenue for the treatment of atherosclerosis. The purpose of this Review is to highlight potential nutraceuticals for use as antiatherogenic therapies with evidence from in vitro and in vivo studies. Furthermore, the current evidence from observational and randomized clinical studies into the role of nutraceuticals in preventing atherosclerosis in humans will also be discussed

Tadalafil in Primary Pulmonary Arterial Hypertension

Background: Sildenafil, a short-acting phosphodiesterase-5 inhibitor (1), is safe and may benefit patients with primary pulmonary arterial hypertension (2– 8). However, it requires many daily administrations. We describe a patient with end-stage primary pulmonary arterial hypertension who improved while taking tadalafil, a long-acting phosphodiesterase-5 inhibitor (9). Case Report: A 72-year-old woman was hospitalized for progressive cardiopulmonary failure. Five years earlier, primary pulmonary arterial hypertension was diagnosed and the patient was hospitalized for hydropic decompensation and hypoxemia. Since then, she had been receiving permanent oxygen therapy and had also taken digoxin, amlodipine, furosemide, potassium canrenoate, and acenocoumarol. At the most recent hospitalization, the patient had dyspnea (New York Heart Association class IV) and 4 pitting edema of the legs up to the thighs, which had progressed over the previous 3 months. The patient’s blood pressure was 110/70 mm Hg, her pulse was 102 beats/min, her respiratory frequency was 32 breaths/min, and her temperature was 36.8 °C. During oxygen therapy (fraction of inspired oxygen, 35%), arterial PO2 was 55 mm Hg. Electrocardiography showed sinus rhythm and right ventricular hypertrophy. Chest radiography showed cardiomegaly without signs of pulmonary edema. Doppler echocardiography showed dilation of right chambers with severe tricuspidal regurgitation and estimated peak systolic pulmonary pressure of 105 mm Hg. Chest spiral computed tomography excluded pulmonary arterial embolism. Despite administration of intravenous diuretics and optimization of oxygen therapy, the patient’s condition did not substantially improve. Epoprostenol therapy was attempted but was stopped because the patient had symptomatic arterial hypotension despite a low infusion rate. Therefore, with the patient’s informed consent, we administered tadalafil (20 mg orally every other day) in addition to background therapy. After 2 weeks of tadalafil therapy, the patient improved remarkably (New York Heart Association class III); the only untoward effect was slight arterial hypotension that promptly regressed with amlodipine withdrawal. Blood pressure was 116/66 mm Hg, pulse rate was 84 beats/min, and respiratory frequency was 20 breaths/min. Leg edema was remarkably reduced. The patient’s arterial PO2 was 70 mm Hg during oxygen therapy (fraction of inspired oxygen, 0.28%). Doppler echocardiography showed a notable reduction of the estimated peak systolic pulmonary pressure (80 mm Hg). Accordingly, doses of intravenous diuretics were progressively decreased and were administered orally. The patient was discharged and referred to outpatient care. After 6 months of tadalafil treatment, the patient’s functional status improved (New York Heart Association class II to III). Physical examination showed stable normotension, further reduction of heart rate and respiratory frequency, and disappearance of leg edema. Arterial PO2 during oxygen therapy (fraction of inspired oxygen, 0.24%) remained stably above 70 mm Hg. Doppler echocardiography showed progressive reduction of estimated peak pulmonary systolic pressure (up to 65 mm Hg). Accordingly, we reduced oral doses of diuretics and prescribed oxygen therapy only during physical activity. Table. Overall Effects of Low-Dose Steroids Based on Corticotropin Stimulation Testing Results Outcome Nonresponders (Events/Total Patients) Responders (Events/Total Patients) Control Group, % (n/n) Steroid Group, % (n/n) P Value Control Group, % (n/n) Steroid Group, % (n/n) P Value Death 63 (83/132) 51 (63/123) 0.05 57 (32/56) 49 (34/69) 0.2 Shock reversal 39 (48/123) 53 (63/118) 0.03 44 (20/45) 56 (30/54) 0.2 Letters www.annals.org 2 November 2004 Annals of Internal Medicine Volume 141 • Number 9 743 Discussion: By stabilizing guanosine 3,5-cyclic monophosphate in vascular smooth-muscle cells of the pulmonary artery, sildenafil prolongs the effect of endogenous vasodilators. Through this mechanism, it reduces mean pulmonary artery pressure and the pulmonary- to-systemic vascular resistance ratio and improves the overall ventilation–perfusion mismatch, arterial oxygenation, and functional capacity (3– 8). However, because it has a half-life of about 4 hours (1), sildenafil requires many daily administrations, which in the long term may compromise treatment adherence and may be costly. In our patient with end-stage primary pulmonary arterial hypertension, we observed that long-term treatment with tadalafil, which has a half-life of about 18 hours, was safe and greatly improved pulmonary hemodynamics and arterial oxygenation (Figure). These improvements were paralleled by a striking improvement in clinical and functional status. Besides confirming the efficacy of phosphodiesterase- 5 inhibitors in treatment of primary pulmonary arterial hypertension, this finding may alert physicians to the possibility that tadalafil may be more affordable than sildenafil. In fact, because its half-life is nearly 5-fold greater than sildenafil’s (9), tadalafil may be administered once daily or even every second day, a feature that may improve adherence and reduce treatment costs