Heart Rate Fractality Disruption as a Footprint of Subthreshold Depressive Symptoms in a Healthy Population.

Objective: Psychopathology (and depression in particular) is a cardiovascular risk factor independent from any co-occurring pathology. This link is traced back to the mind-heart-body connection, whose underlying mechanisms are still not completely known. To study psychopathology in relation to the heart, it is necessary to observe the autonomic nervous system, which mediates among the parts of that connection. Its gold standard of evaluation is the study of heart rate variability (HRV). To investigate whether any association exists between the HRV parameters and sub-threshold depressive symptoms in a sample of healthy subjects. Method: In this cross-sectional study, two short-term HRV recordings (5 min - supine and sitting) have been analyzed in 77 healthy subjects. Here we adopted a three-fold approach to evaluate HRV: a set of scores belonging to the time domain; to the frequency domain (high, low, and very low frequencies) and a set of 'nonlinear' parameters. The PHQ-9 (Patient Health Questionnaire-9) scale was used to detect depressive symptoms. Results: Depressive symptoms were associated only with a parameter from the non-linear approach and specifically the long-term fluctuations of fractal dimensions (DFA-α2). This association remained significant even after controlling for age, gender, BMI (Body-Mass-Index), arterial hypertension, anti-hypertensive drugs, dyslipidemia, and smoking habits. Moreover, the DFA-α2 was not affected by the baroreflex (postural change), unlike other autonomic markers. Conclusions: Fractal analysis of HRV (DFA-α2) allows then to predict depressive symptoms below the diagnostic threshold in healthy subjects regardless of their health status. DFA-α2 may be considered as an imprint of subclinical depression on the heart rhythm.

Dante Alighieri (1265-1321): an "infernal" endocrinological observation.

The year 2021 marks the 700th anniversary of Dante's death. Is it appropriate to celebrate this anniversary in a journal of endocrinology? The answer is yes-the motivation for this being found in the giants that Dante, in his Divine Comedy, places around the well that divides Circle 8 from Circle 9 of Hell. The "Supreme Poet" describes one of the giants (Nimrod, a Biblical character) as having a large and elongated face with a body of gargantuan proportions. Such a description immediately calls to mind the characteristics of acromegalic prognathism, the huge stature being the most pathognomonic aspect. Is it possible that the sharp eye of Dante had observed such a feature in people affected by actual gigantism?

Second Line Volunteering in Lombardy Covid-19 Emergency as a Perspective on Medical Education and Psychological Distress.

OBJECTIVE: Healthcare personnel across Italy were called to arms during COVID-19 emergency beginning March 2020. Despite their medical training, not all of them were able to fight in first line. Volunteering for COVID-19 Lombardy ICU Network Coordination Centre (C19-LINCC) was an opportunity to volunteer without being under biological threat: a smart-working in direct phone contact with the ICUs. Our aim was to investigate if second line volunteering during the COVID-19 outbreak had an impact on stress levels and whether medical training could mitigate them, along with personality factors, namely psychological flexibility. METHOD: Volunteers of the C19-LINCC self-rated their own medical education related to SARS-CoV-2 and psychological response to the emergency. The questionnaire included five psychological scales (PSS, IES, MBI, AAQ-II, GHQ-12) addressing burnout, stress, general health, attention, cognitive fusion, and psychological flexibility. RESULTS: Psychological distress (GHQ p≤0,0001) and perception of personal achievement (MBI_p≤0,0001) change whether the subject is a volunteer or not, while perception of medical education does not have a significant impact between the two groups. No differences were found in acceptance, mindfulness, and psychological flexibility skills, however they inversely correlated with stress, burnout, and anxiety levels. CONCLUSIONS: During this period of mandatory lockdown, trained and in-training doctors showed to benefit from this smart home-based volunteering in the C19-LINCC. In addition to volunteering, psychological flexibility, mindfulness, and acceptance skills can act as protective factors. Potentially, these are soft skills that could be added to medical education.