A structural model of well-being, spontaneity and self-efficacy: Italian validation between adolescents and young adults

Abstract Introduction: The passage from adolescence to young adulthood introduces many challenges and chances aimed at promoting independence, financial self-sufficiency, assumption of responsibilities and separation from parents. Literature shows that in the continuum between these two phases of life, many factors intervene, producing significant differentiations. Methods: This study considered three dimensions - well-being, measured through the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); spontaneity, measured through the Spontaneity Assessment Inventory-Revised (SAI-R); and self-efficacy, measured through the General Self-Efficacy scale (GSE). The study involved two groups of Italian participants: 495 adolescents, aged between 13 and 19 years, selected at a high school; and 368 young adults, aged between 18 and 30 years, recruited by snowball sampling. Results: Results of confirmatory factor analysis for each instrument in each group indicate the validity of the three instruments for both age groups. No significant differences were found between adolescents and young adults on total or subtotal scores of the CORE-OM, except for the risk factor. Conversely, the mean scores obtained with SAI-R and GSE were very different between adolescents and young adults. Conclusions: The results of path analysis show a significant mediation of spontaneity in the link between self-efficacy and all specific psychological distress domains for adolescents. Instead, there is a significant mediation of spontaneity between self-efficacy and all specific psychological distress domains except the risk domain for young adults

The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study

Background: At the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple—the baby dies and the couple’s plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief. Objective: The main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief. Methods: This longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases—a baseline and a follow-up after 6 months. Results: This protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation. Conclusions: This study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health. International Registered Report Identifier (IRRID): DERR1-10.2196/3886

Atypical presentations of thrombotic thrombocytopenic purpura in middle-aged women with recurrent cerebral macrovascular thrombosis: a case report

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Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: Data from a large database in a community setting

Aims Current guidelines strongly recommend antiplatelet therapy with aspirin plus a P2Y12 receptor inhibitor (dual therapy) for patients with acute coronary syndrome (ACS). To better understand how antiplatelet treatment is prescribed in clinical practice, the aim of this study was to provide a more detailed description of real-world patients with and without antiplatelet treatment after an ACS, their outcomes at one-year follow-up and the related integrated cost. Methods The ReS database, including more than 12 million inhabitants, was evaluated. During the accrual period ACS patients discharged alive were identified on the basis of ICD-IX-CM code. Antiplatelet drug prescriptions and healthcare costs were analysed over one-year follow-up. Results In 2014, of the 25,129 patients discharged alive after an ACS, 5796 (23%) did not receive any antiplatelet therapy during the first month after hospital discharge. Among them, 3846 (66%) subjects were prescribed an antiplatelet drug subsequently, while 7.7% did not receive any antiplatelet treatment during the whole following year. Dual therapy in the subgroup of patients undergoing a revascularization procedure ( n = 8436) was prescribed to 79.2% of cases and to 46.1% ( n = 4009) of medically managed patients. The patients not treated with an antiplatelet treatment in the first month showed the highest one-year healthcare costs, mostly due to hospital re-admissions. Conclusions This analysis of a large patient community shows that a considerable proportion of patients remained untreated with antiplatelet treatment after an ACS event. A clearer characterization of these subjects can help to improve the adherence to the current guidelines and recommendations

Stunt and basal rot of Eustoma grandiflorum and its relationship with Fusarium solani density in the soil

En cultivos comerciales de lisianthus de La Plata y alrededores (Argentina), se observó que Fusarium solani afecta al 100% de los establecimientos productivos provocando enanismo y podredumbre basal. Se realizó un ensayo para analizar la densidad de F. solani del suelo bajo el efecto de distintos tratamientos y relacionarla con la evolución de ambas patologías. Los análisis del suelo se hicieron en 3 épocas: antes del transplante (octubre), al inicio (enero) y al final (marzo) de la floración. En enero y marzo se evaluó la incidencia de cada enfermedad y se cuantificaron las plantas cosechadas. La población de F. solani no varió en las 3 épocas y se redujo significativamente con los fumigantes y el vapor. Esto determinó una incidencia del enanismo (enero) de 0 a 9,5% con los primeros y de 31,4% con el vapor. Para el testigo y los fungicidas la incidencia varió entre el 87,9 y el 100%, disminuyendo las plantas cosechadas. La podredumbre basal comenzó con el ingreso del patógeno a través de las heridas producidas por la cosecha. Ésta fue significativamente mayor con los fumigantes (90,7 a 99%) y también con el vapor (76,8%), produciéndose la mayor incidencia en marzo (15,7 a 22,2 y 10,1% respectivamente), reduciéndose el período productivo. Se destaca la importancia de disminuir la densidad de F. solani en el momento del transplante. Entre los métodos de control el Metam sodio y Dazomet podrían ser eficaces sustitutos del Bromuro de metilo, seguidos por el vapor.Fusarium solani was recorded in 100% of the commercial crops of lisianthus (Eustoma grandiflorum) located around La Plata (Argentina). The pathogen causes stunt and basal rot. A trial was carried out to analyse the F. solani soil density and its relation to the development of both diseases. Soil samples were analysed at three times: before transplant (October), at the beginning of flowering (January) and at the ending of flowering (March) of flowering. The incidence of each disease was evaluated in January and March, and the plants harvested were quantified. The soil density of F. solani was not altered during the three times for each treatment, and fumigants and steam decrease it significantly. In January the stunt incidence reached 0 to 9.5% with the fumigants and 31.4% with the steam treatment. In the control and fungicide plots, the incidence reached 87.9 to 100%, and a consequent reduction of flower production was observed. Stem rot began after the flowers were harvested as a result of pathogen entry through the wounds. The major values of harvested plants were obtained with fumigants (90.7 to 99%) and steam (76.8%), so the greatest stem rot incidence was 15.7 to 22.2 and 10.1%, respectively, in March, and the productive period was shortened. The need of reducing F. solani soil density before lisianthus transplant is emphasized. Among soil control treatments, Metham sodium and Dazomet could be effective substitutes for Methil bromide followed by steam treatment.Facultad de Ciencias Agrarias y Forestale

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial

BACKGROUND: The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) + bevacizumab (B) or CT alone. PATIENTS AND METHODS: Patients randomly received CT+B or CT alone as first-line therapy. CT consisted of either FOLFOX4 or FOLFIRI at the clinician's discretion. RESULTS: Out of the 284 patients enrolled, increased ALRI levels were associated with shorter PFS and OS (p<0.0001). At baseline, median PFS was 10.3 months (95% CI 9.4-12.0) and 8.0 months (95 % CI 6.8-8.9), and median OS was 25.2 months (95 % CI 21.3-30.2) and 18.8 months (95 % CI 16.6-21.7) for patients with low (<14) and high (≥14) ALRI levels, respectively (HR 1.43, 95% CI 1.12-1.82, p=0.004; HR=1.51, 95% CI 1.17-1.96, p<0.001). Interaction tests on ALRI levels and treatment efficacy in the CT+B and the CT groups were statistically significant for PFS (p=0.0003), but not for OS (p=0.228). CONCLUSION: Our results indicate that ALRI is a good prognostic and predictive marker for mCRC patients candidate for CT+B

Usos y funciones de la realidad virtual en la práctica clínica: reflexiones a la luz del trabajo telemático

Este artículo abre una reflexión teórica y clínica sobre la inclusión de la realidad virtual en la consulta analítica con pacientes que se encuentran en la edad evolutiva: ¿cómo utilizarla? ¿Qué función adquiere en ese momento? Incluir la realidad virtual en la psicoterapia significa transformarla en material interpretable, pero teniendo en cuenta el funcionamiento psíquico del paciente, su historia personal y la calidad de la relación de transferencia. Con el confinamiento impuesto por la emergencia COVID-19 se han antojado necesarias nuevas reflexiones acerca de estas temáticas: el setting de la psicoterapia también se ha virtualizado, lo cual ha dado vida a nuevos escenarios que ponen límites, pero que también abren puertas.A matéria propõe uma reflexão teórico-clínica sobre os usos e funções do virtual na idade evolutiva. O trabalho de psicoterapia com crianças e adolescentes levou os Autores a confrontarem-se sobre o conteúdo virtual que os pacientes trazem para a sala de análise. A fim de dar sentido a este tipo de material, se dá relevo à importância  de se referir  à especificidade do funcionamento psíquico de cada paciente, sua história, a qualidade de relação transferal. A emergência sanitária do COVID-19,  que levou terapeutas e pacientes a se reunirem online, trouxe também novos cenários interpretativos e novas formas de conduzirem as sessões.This paper proposes a theoretical-clinical reflection of the virtual worlds uses and functions in childhood and adolescence. The work of psychotherapy with children and adolescents has allowed the authors to deal with the virtual contents that patients brings  in the analysis room. In order to give meaning to this type of content, it is underlined the importance of referring to the specificities of the psychic functioning of each patient, its history, the quality of the transferal relationship.  The health emergency from Covid-19, has brought therapists and patients to meet online, and has also opened up new interpretative scenarios and new ways to stay in therapy session

PID 10050 Capacidades socioambientales para el crecimiento y desarrollo de niños con bajo peso al nacer bpn-pretérmino

La comprensión de factores determinantes de crecimiento y desarrollo durante los primeros años de vida, continúa siendo un motivo de investigaciones. Los entornos de cuidados socioambientales, desde una perspectiva ecológica, pueden constituirse en factores, que sumados a los biológicos, afecten el crecimiento en los primeros años de  la vida. El objetivo buscado fue  determinar la influencia de las capacidades socioambientales en el crecimiento y desarrollo de una población de niños con bajo peso  pretérmino hasta los 2 años de vida. La población analizada estuvo compuesta por una cohorte de 39 niños pretérminos (BPN) de un total de 58 vivos, egresados de internación media (15 días) durante  2009 796 nacimientos, 89 BPN 11,2 %, residentes en la ciudad  1918,71 gr  ± 382,5 y 34,07 ± 1,57 semanas de gestación de los cuales el 43,5 % presentaron el peso menor al percentilo (PEG): 1752,05 ± 422,22, 34,4± 1,62 EG y 56,5 % adecuados para la edad gestacional (AEG) (2047,52 ± 298,61, 33,7 ± 1,5).

Aportes para una comprensión del crecimiento y desarrollo e influencia familiar de niños escolarizados de Concepción del Uruguay

El objetivo es describir la influencia de los distintos ambientes socio familiares en el desarrollo de niños escolarizados de 5 años en Concepción del Uruguay. Material y métodos: Estudio descriptivo transversal, de 219 niños escolarizados aparentemente sanos, de 5 años ± 1 mes. Se evaluaron las áreas de desarrollo personal-social, motor fino, motor grueso y lenguaje, según Prueba Nacional de Pesquisa (PRUNAPE). Se caracterizó sospecha de trastorno en el desarrollo cuando se falla en al menos una pauta tipo A (cumplida por 90% de la población nacional para esa edad) o en más de una prueba tipo B (correspondiente al 75%). Con el uso de Tecnologías de Información Geográfica (TIG`s), se georreferenciaron los niños según desarrollo (típico/ sospechosos de retraso). Se utilizó el inventario Home Observation for Measurement of the Environment (HOME) para evaluar el ambiente familiar. Mediante un modelo bivariado se relacionó con determinantes socio ambientales (estrato socioeconómico, edad y educación materna y estimulación en el hogar. Resultados: El 24,5% de los niños serían sospechosos de retraso global de desarrollo. No se encontró significación estadística entre desarrollo y determinantes socio ambientales. Con respecto al estrato socioeconómico, por cada niño que no pasó la prueba hay tres que si pasan la prueba independientemente de la situación socioeconómica de la familia. El 64 % de los hogares cumplirían las condiciones necesarias para la estimulación en el crecimiento y desarrollo. Se destaca la asociación entre la estimulación en el hogar y el estrato socioeconómico (p<0,001). Se midió peso y longitud/estatura en los niños incluidos. Con los datos de peso, talla e Índice de Masa Corporal (IMC=peso(kg)/talla(m2)) los niños fueron incluidos en una de las siguientes categorías: Desnutridos: Bajo peso para la talla (BP/T), Exceso de peso: Sobrepeso (S) y Obesidad (O) y Normonutridos

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients