Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation.

In Chronic Heart Failure (CHF) patients, psychological and cognitive variables and their association with treatment adherence have been extensively reported in the literature, but few are the investigations in older people. The present study aimed to evaluate the psychological, cognitive, and adherence to treatment profile of older (>65 years) CHF patients, the interrelation between these variables, and identify possible independent predictors of self-reported treatment adherence. CHF inpatients undergoing cardiac rehabilitation were assessed for: anxiety, depression, cognitive impairment, positive and negative affect, and self-reported adherence (adherence antecedents, pharmacological adherence, and non-pharmacological adherence). 100 CHF inpatients (mean age: 74.9 ± 7.1 years) were recruited. 16% of patients showed anxiety and 24.5% depressive symptoms; 4% presented cognitive decline. Cognitive functioning negatively correlated to depression, anxiety, and negative affect (p < 0.01). The adherence antecedents (disease acceptance, adaptation, knowledge, and socio-familiar support) negatively correlated to anxiety (p < 0.05), depression (p < 0.001), and negative affect (p < 0.05), while they positively correlated to positive affect (p < 0.01). Pharmacological adherence negatively correlated to anxiety and negative affect (p < 0.05). Conversely, non-pharmacological adherence and positive affect positively correlated (p < 0.05). Furthermore, depression and anxiety negatively predicted adherence antecedents (ß = -0.162, p = 0.037) and pharmacological adherence (ß = -0.171, p = 0.036), respectively. Finally, positive affect was found as an independent predictor of non-pharmacological adherence (ß = 0.133, p = 0.004). In cardiac rehabilitation, a specific psychological assessment focused on anxiety, depression, and affect can provide useful information to manage CHF older patients' care related to treatment adherence. In particular, positive affect should be targeted in future interventions to foster patients' non-pharmacological adherence.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale.

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic). Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

The Italian validation of the Communicative Effectiveness Index Questionnaire: a multicentric study.

INTRODUCTION: Common assessment tools for aphasia evaluate single language impairments but not their functional impact on patient's communication skills in daily life. The lack of tools focused on ecological aspects might affect the choice of rehabilitative trainings. The Communicative Effectiveness Index (CETI) represents an attempt to assess the communicative abilities in "ecologic" context. This study aimed to explore psychometrics properties of the Italian translation and adaptation of CETI (I-CETI). METHODS: Sixty-eight patients with aphasia due to left hemispheric stroke admitted to post-acute rehabilitation units and their relatives were included in the study. Data were collected in three different sessions. At study entry, patients were assessed for language, depression, and functional abilities, while their caregivers and speech therapists independently completed the I-CETI to assess inter-rater agreement (baseline). One week later, caregivers and speech therapists completed again I-CETI, to assess test-retest reliability (T1). Last, at discharge, patients completed again the evaluation protocol, and caregivers and speech therapists completed I-CETI (T2). RESULTS: I-CETI showed high internal validity, excellent reliability, and good correlation between scores obtained by speech therapists and caregivers. Moreover, scores of I-CETI had quite good correlations with a traditional tool to assess language, and with measures of functional independence both at study entry and at discharge. DISCUSSION: I-CETI showed good psychometric proprieties. These results allowed considering I-CETI as a reliable tool to assess effects of speech treatments on the communicative abilities in patients with aphasia. Furthermore, I-CETI might help clinicians to develop treatments more tailored on the "ecologic" difficulties of patients.

The Maugeri daily activity profile: a tool to assess physical activity in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) report reduced physical activity (PA). There are only few tools available to assess PA and sedentary behavior in these patients, and none of them aims to differentiate between sedentary and active patterns. The aim of the study was to evaluate an easy tool to profile daily activity time in a cohort of patients with COPD, compared to healthy subjects; the study was set at the Istituti Clinici Scientifici Maugeri (ICS), IRCCS of Tradate and Lumezzane, Italy, and at the Ente Ospedaliero Cantonale Novaggio, Switzerland (Italian Speaking). The populations were inpatients with COPD, healthy subjects. The items of the Maugeri Daily Activity (MaDA) profile were chosen based on literature, interviews with patients and health professionals. Time spent during sleep (ST), when awake (AT), active (ACT) or in sedentary behavior (SET) were recorded. Lung function tests, arterial blood gases, the modified Medical Research Council (mMRC), the six-minute walking distance test (6MWD), the COPD Assessment Test (CAT), and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index were also assessed in patients. Sixty patients with COPD and 60 healthy controls filled in the questionnaire. As compared to controls, patients showed longer AT and SET. Active time of patients was significantly correlated with mMRC, CAT, Bode Index and 6MWD, but not with demographics, anthropometrics or stages of disease. Using this tool, we found that patients with COPD spent longer time awake and in sedentary behavior. The MaDA may be useful to evaluate PA in patients with COPD.

Predictors of Mortality in Patients with COPD and Chronic Respiratory Failure: The Quality-of-Life Evaluation and Survival Study (QuESS): A Three-Year Study.

UNLABELLED: Previous studies sought to identify survival or outcome predictors in patients with COPD and chronic respiratory failure, but their findings are inconsistent. We identified mortality-associated factors in a prospective study in 21 centers in 7 countries. Follow-up data were available in 221 patients on home mechanical ventilation and/or long-term oxygen therapy. MEASUREMENTS: diagnosis, co-morbidities, medication, oxygen therapy, mechanical ventilation, pulmonary function, arterial blood gases, exercise performance were recorded. Health status was assessed using the COPD-specific SGRQ and the respiratory-failure-specific MRF26 questionnaires. Date and cause of death were recorded in those who died. Overall mortality was 19.5%. The commonest causes of death were related to the underlying respiratory diseases. At baseline, patients who subsequently died were older than survivors (p = 0.03), had a lower forced vital capacity (p = 0.03), a higher use of oxygen at rest (p = 0.003) and a worse health status (SGRQ and MRF26, both p = 0.02). Longitudinal analyses over a follow-up period of 3 years showed higher median survival times in patients with use of oxygen at rest less than 1.75 l/min and with a better health status. In contrast, an increase from baseline levels of 1 liter in O2 flow at rest, 1 unit in SGRQ or MRF26, or 1 year increase in age resulted in an increase of mortality of 68%, 2.4%, 1.3%, and 6%, respectively. In conclusion, the need for oxygen at rest, and health status assessment seems to be the strongest predictors of mortality in COPD patients with chronic respiratory failure.

Measurement of change in health status with Rasch models.

BACKGROUND: The traditional approach to the measurement of change presents important drawbacks (no information at individual level, ordinal scores, variance of the measurement instrument across time points), which Rasch models overcome. The article aims to illustrate the features of the measurement of change with Rasch models. METHODS: To illustrate the measurement of change using Rasch models, the quantitative data of a longitudinal study of heart-surgery patients (N = 98) were used. The scale "Perception of Positive Change" was used as an example of measurement instrument. All patients underwent cardiac rehabilitation, individual psychological intervention, and educational intervention. Nineteen patients also attended progressive muscle relaxation group trainings. The scale was administered before and after the interventions. Three Rasch approaches were used. Two separate analyses were run on the data from the two time points to test the invariance of the instrument. An analysis was run on the stacked data from both time points to measure change in a common frame of reference. Results of the latter analysis were compared with those of an analysis that removed the influence of local dependency on patient measures. Statistics t, χ(2) and F were used for comparing the patient and item measures estimated in the Rasch analyses (a-priori α = .05). Infit, Outfit, R and item Strata were used for investigating Rasch model fit, reliability, and validity of the instrument. RESULTS: Data of all 98 patients were included in the analyses. The instrument was reliable, valid, and substantively unidimensional (Infit, Outfit < 2 for all items, R = .84, item Strata range = 3.93-6.07). Changes in the functioning of the instrument occurred across the two time, which prevented the use of the two separate analyses to unambiguously measure change. Local dependency had a negligible effect on patient measures (p ≥ .8674). Thirteen patients improved, whereas 3 worsened. The patients who attended the relaxation group trainings did not report greater improvement than those who did not (p = .1007). CONCLUSIONS: Rasch models represent a valid framework for the measurement of change and a useful complement to traditional approaches.

Cognitive behavioral group intervention for Alzheimer caregivers.

Long-term caregiving of patients with Alzheimer disease (AD) frequently induces a relevant distress enhanced by inadequate coping strategies. This study aimed to explore the impact of cognitive and behavioral therapy (CBT) group intervention on AD patients' caregivers. In particular, reduction in caregivers' global care needs and in anxiety and depression has been investigated. About 100 caregivers were divided into the following groups: CBT group intervention, self-help manual, and control have been enrolled in the study. CBT group intervention seems to be more effective than the other 2 conditions in reducing caregivers' anxiety. Furthermore, only caregivers of the CBT group showed significant needs related to reduction in care. The proposed treatment could be the core of a more structured and systematic intervention for AD patients' caregivers in Italy.

[Discriminating capacity of the MASI-R questionnaire in the perception of work-stress]. / Validità discriminante del MASI-R nella percezione di stress lavoro-correlato.

INTRODUCTION: Workplace mobbing represents a severe type of occupational stress. The aim of this study is to evaluate the discriminant validity of the Maugeri Stress Index-Revised questionnaire (MASI-R) for the perceived work stress assessment. METHODS: A total of 105 patients were enrolled at the Occupational Medicine Uinit of our Institute for mobbing-related issues; they were compared to a control group matched for age, sex and professional category. Work stress perception was assessed in both samples using the self-report questionnaire MASI-R, which is the Maugeri Stress Index short form. RESULTS: Workers who perceived exposure to mobbing scored significantly lower compared to the control group in the four MASI-R scales (p < 0.001) and in the two visual analogue scales measuring job satisfaction (p < 0.001) and life satisfaction (p < 0.001). Further analyses have identified the items which significant discriminate between the two groups of workers. CONCLUSIONS: These findings show a good discriminant validity of the MASI-R questionnaire: workers who perceived exposure to workplace mobbing reveal higher work stress levels compared to the control group in all aspects measured.

Cognitive and emotional factors affecting avoidable decision-making delay in acute myocardial infarction male adults.

BACKGROUND: To study the potentially avoidable decision-making delay in acute myocardial infarction (AMI) adults male with different psychological characteristics a nationwide multicentre study was conducted in Italy by the 118 Coronary Care Units (CCUs). METHOD: 929 AMI patients consecutively presented to the CCU in a conscious condition less than two hours, 2-6 hours, 6-12 hours, and more than 12 hours after symptom onset and completing the Disease Distress Questionnaire (DDQ) were enrolled in a multicentre case-control study. The DDQ collects information regarding the decision time to seek help, and includes a set of items assessing psychological factors and pain-related symptoms. The relationship between the perceived threat and the delay due to decision-making was evaluated by means of a multivariate model using LISREL 8 structural equation modelling. RESULTS: The delay significantly correlated with perceived threat, which was mainly related to somatic awareness. It was only slightly related to pain and was not associated with any of the other variables. Perceived threat was also related to psychological upset, fear and health worries, the first of which was considerably influenced by emotional instability. CONCLUSION: Somatic awareness is the main dimension affecting perceived threat, but subjective pain intensity affects the delay both directly and indirectly. The core of the model is the relationship between perceived threat and the delay due to decision-making. The importance of subjective pain intensity is well documented, but it is still not clear how subjective and objective pain interact.

Measuring pandemic-related anxiety and confidence in care in chronic patients using the Psychological Consequences of a Pandemic Event (PCPE) questionnaire.

The COVID-19 pandemic has determined a considerable increase in psychological distress worldwide. Compared with the general population, patients with chronic conditions experience higher stress levels due to the increased risk of worse health outcomes from COVID-19 infection. Worries and fear of contagion could cause them to avoid going to their health facilities for medical examinations, which results in higher risks of morbidity and mortality. The present study aimed to develop and validate the Psychological Consequences of a Pandemic Event (PCPE) self-report questionnaire, and to assess the psychological effects of exposure to a pandemic on mood and on treatment adherence appropriate for patients with chronic diseases. Data were analysed with Rasch analysis after an Exploratory Factor Analysis and a Confirmatory Factor Analysis. We identified a final set of 10 items, divided into two independent factors labelled "pandemic-related anxiety" and "confidence in care". Finally, we transformed the raw scores of both factors into two interval scales (two rulers) that met the requirements of the fundamental measurement. The PCPE questionnaire has demonstrated to be a short and easy-to-administer measure, with valid and reliable psychometric properties, capable of assessing pandemic-related anxiety and confidence in care in patients with chronic clinical conditions.

[EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. / L'EuroQol-5D (EQ-5D): uno strumento per la misura della qualità della vita.

The aim of this paper was to provide a detailed description of the EuroQol- 5 Dimension (EQ-5D) useful for those member of staff in rehabilitation setting who wish to use it properly. EQ-5D is an instrument which evaluates the generic quality of life developed in Europe and widely used. The EQ-5D descriptive system is a preference-based HRQL measure with one question for each of the five dimensions that include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The answers given to ED-5D permit to find 243 unique health states or can be converted into EQ-5D index an utility scores anchored at 0 for death and 1 for perfect health. The EQ-5D questionnaire also includes a Visual Analog Scale (VAS), by which respondents can report their perceived health status with a grade ranging from 0 (the worst possible health status) to 100 (the best possible health status). Finally the specific utility (in clinical and research setting) of each one of them is discussed.

[Measuring change in rehabilitative cardiology: reliability of a short questionnaire to assess an outcome]. / Valutazione psicologica del cambiamento in cardiologia riabilitativa: validazione di un questionario a forma breve per la valutazione di esito.

UNLABELLED: The present Italian health planning demands the use of tools, care and treatments useful for the National Health Service, but with empirical effectiveness scientifically sustained. Aim of the present paper is to verify the validity, the reliability and the responsiveness of the factor "Perception of positive change" (named Schedule C) in cardiovascular rehabilitation. METHOD: The reliability of the Schedule C of the CBA VE has been examined comparing the mean scores obtained from each item at the entry and just before the discharge through the t-Student for paired sample. To assess the concurrent validity we used the AD Short Scale to measure anxiety and depression. 100 patients who underwent cardiac surgery were enrolled during hospitalization for a Cardiac Rehabilitation Programme. Cronbach's alpha was used to assess internal consistency of each item. RESULTS: Each item of the Schedule C demonstrated good internal consistency (Cronbach Alpha > .88) and elevated correlations item-total for each item. The strong correlation of anxiety and depression scores with the Schedule C points out appropriate concurrent validation. CONCLUSIONS: We believe that the Schedule C of the CBA VE is endowed with suitable metric validity and then useful as outcome evaluation in cardiovascular rehabilitation settings.

[A comparison of three health-related quality of life measures in COPD patients]. / Una comparazione di tre misure di qualità di vita legate allo stato di salute in pazienti BPCO.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is one of the most disabling diseases today, and a good assessment of Health Related Quality of Life (HRQoL) allows the clinicians to identify the critical areas where is possible to cure in order to improve the well-being of the patient. OBJECTIVE: The aim of this study was to compare different questionnaires used for the evaluation of HRQoL, in order to assess their psychometric properties and their abilities to discriminate the different severity levels of COPD. METHODS: This research was conducted using the Medical Research Council (MRC) dyspnoea scale for grading the degree of a patient's breathlessness, St. George's Respiratory Questionnaire (SGRQ), Italian Health Status Questionnaire (IHSQ) and Maugeri Respiratory Failure-26 (MRF-26) were filled by 102 patients affected by COPD. RESULTS: We observed high internal and external correlations between the instruments, showing a good level of internal consistency. Results did not show any correlations between medical and psychological evaluation, in particular a lack of correlation (r = 0.321) between GOLD categorization and the evaluation of dyspnoea made by patients (MRC scale). Even the correlations between GOLD categorization, SGRQ (r = 0.226), MRF-26 (r = 0.237) and IHSQ (r = 0.239) did not show any correlations. The evaluation of discriminating properties of questionnaires had shown, for all the instruments, a good discrimination between higher levels, but more difficulties in the discrimination of lower levels (not only in MRC scale, but even in GOLD classification). CONCLUSIONS: The study confirms the high psychometric properties of the psychological instruments used in Italy to examine Health Related Quality of Life (HRQoL) indexes. It is observed that there isn't a direct correlation between severity of illness and self-perceived quality of life, so we can conclude that the construct of "quality of life" is more connected with self-perceived disability (dyspnoea and obstruct activities), than with the medical parameters. We can consider worthy of a psychological and clinical close examination the patients that are included in the first two GOLD categories, in case that they report scores connected with a high sense of limitation of Quality of Life. In short, clinicians have to distinguish and consider the concepts of physical health and HRQoL, composed by the multiple psychological factors that influenced the self-perceived well-being.

[The Maugeri Stress Index: a questionnaire to assess work-related psychological stress]. / Il Maugeri Stress Index questionnaire per la valutazione dello stress lavoro correlato.

INTRODUCTION: The European directives concerning the evaluation of work-related stress were absorbed into Italian law by means of Legislative Decree No. 81 of 9 April 2008. AIMS: To develop a new questionnaire to assess the impact of work-related psychological distress and to validate it by testing its factorial structure, its content, its construct and discriminant validity. METHODS: After critically reviewing the literature, we generated an initial item set to identify the items to be used in a preliminary version of the questionnaire, and then used a focus group to test the comprehensibility of the items. The questionnaire was administered to 329 subjects working in state and private organisation and a small sample of 29 subjects complaining of vexation at work. RESULTS: The Maugeri Stress Index (MSI) is reliable (Cronbach alpha: 0.93). Factorial analysis indicated five factors: Well-being, Adaptation, Support, Irritability and Avoidance. The total and subscale scores were significantly different when comparing subjects with and without vexation at work. CONCLUSION: The MSI has a multi-factorial structure, good internal reliability and sufficient discriminant power.

A revised short version of the depression questionnaire.

BACKGROUND: The Depression Questionnaire (QD) is an instrument designed to measure depression in an inpatient-rehabilitation setting. This study proposes a reduced version of the original 24-item QD, to make it better suited to the characteristics of patients in this setting. METHODS: The study population consisted of 801 individuals admitted to cardiac rehabilitation (564 males and 237 females) who had validly completed the original version of the QD. Data were analyzed first through confirmatory factor analysis and then using logistic models. RESULTS: Factor analysis of QD-24 items form, confirmed the plausibility of the monofactorial solution, both for males and females. Factor analysis combined with clinical observation suggested the possibility of reducing the QD to 17 items. Two further items were eliminated through use of simple logistic models. We thus obtained a shortened 15-item version of the QD (QD-R) that maintains a good index of separation (0.80), that is, good capacity to discriminate between individuals with different levels of depression, and a good item-trait interaction (chi(2)153=165.37, P>0.05). A second confirmatory factor analysis applied to the 15-item monofactorial model confirmed the validity of this shortened version of the instrument. The QD-R scores significantly correlated with metres walked during the 6 minute walking test (r=-0.316; P<0.01). CONCLUSION: Combined use of confirmatory factor analysis and simple logistic models together with observations drawn from clinical experience constitutes a valid method for shortening a questionnaire while at the same time maintaining, if not improving, its psychometric properties. The QD-R, seems adequate to how much is required in rehabilitation to point out the outcome, in case of variation of depression, easily to fill in by the debilitated individual or elderly, mainly because some item excessively influenced by the pathology or the hospital context were removed.

Prolonged grief and depression in caregivers of patients in vegetative state.

PRIMARY OBJECTIVE: Several studies have shown that the symptoms of grief are different from symptoms of depression among bereaved family members. The present study is an attempt to replicate these findings among caregivers of patients in a vegetative state. METHODS AND PROCEDURES: Forty-five caregivers of 41 patients in vegetative or minimally conscious state in-hospital for long-term care. The questionnaire Prolonged Grief 12 (PG-12) assessed the presence of Prolonged Grief Disorder; the Depression Questionnaire (DQ) assessed the presence of a clinically significant depressive state. MAIN OUTCOMES AND RESULTS: Three conditions of psychiatric illness emerged: Prolonged Grief Disorder only (n = 9; 20%), depression only (n = 7; 15.5%) and Prolonged Grief Disorder together with depression (n = 7; 15.5%). There was no association (V = 0.203) between diagnosis of Prolonged Grief Disorder and the presence of a clinically significant depressive state. Caregiver's syndromal-level grief was associated with patients' young age (p = 0.028) and with younger age of caregiver (p = 0.029). Caregiver's syndromal-level depression was associated with less time from the event (p = 0.003). CONCLUSIONS: Caregiver's grief symptoms are distinct from their depressive symptoms among family members and each disorder has distinct risk factors.

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation.

BACKGROUND: The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population. PURPOSE: To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients' functional status. METHODS: This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke's Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE). RESULTS: 100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT. CONCLUSIONS: Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.

Cognitive and metacognitive factors among alcohol-dependent patients during a residential rehabilitation program: a pilot study.

PURPOSE: The aims of this pilot study were to examine cognitive factors (brooding and craving) together with positive/negative metacognitive beliefs about alcohol during a residential program for alcohol addiction and to explore relationships with psychological variables at discharge, with the scope of identifying predictive factors of psychological outcome and patients at greatest risk of relapse. METHODS: Thirty patients underwent a brief semistructured interview on admission to a 28-day rehabilitation program for alcohol addiction, and completed at admission and discharge the following five self-report questionnaires: 1) brooding (Brooding subscale of Ruminative Response Scale [B-RRS]), 2) craving (Penn Alcohol Craving Scale [PACS]), 3) positive beliefs about alcohol use (Positive Alcohol Metacognitions Scale [PAMS]), 4) negative beliefs about alcohol use (Negative Alcohol Metacognitions Scale [NAMS]), and 5) the psychophysical state of health (Cognitive Behavioral Assessment - Outcome Evaluation [CBA-OE]). RESULTS: Significant changes were found between admission and discharge in CBA-OE, B-RRS, and PACS. Brooding at admission was a significant predictor of post-treatment psychological variables of "anxiety", "depression", and "psychological distress", whereas craving at admission was a good predictor of "perception of positive change" at discharge. CONCLUSION: Our results confirm the importance of brooding in mood regulation and its role in the development and maintenance of problem drinking. In addition, craving was negatively associated with the perception of positive change in the post-treatment outcomes and was a predictor of this psychological variable, which includes features related to the individual's resilience and strength. The changes in metacognitive beliefs regarding alcohol use were not statistically significant, but we found a reduction in positive metacognitions and an increase in negative alcohol-related beliefs; future studies are needed to further explore this issue.

The Maugeri Stress Index - reduced form: a questionnaire for job stress assessment.

INTRODUCTION AND OBJECTIVES: A multidimensional self-report questionnaire to evaluate job-related stress factors is presented. The questionnaire, called Maugeri Stress Index - reduced form (MASI-R), aims to assess the impact of job strain on a team or on a single worker by considering four domains: wellness, resilience, perception of social support, and reactions to stressful situations. MATERIAL AND METHODS: The reliability of a first longer version (47 items) of the questionnaire was evaluated by an internal consistency analysis and a confirmatory factor analysis. An item reduction procedure was implemented to obtain a short form of the instrument, and the psychometric properties of the resulting instrument were evaluated using the Rasch measurement model. RESULTS: A total of 14 items from the initial pool were deleted because they were not productive for measurement. The analysis of internal consistency led to the exclusion of eight items, while the analysis performed using structural equation models led to the exclusion of another six items. According to the Rasch model, item properties and the reliability of the instruments appear good, especially for the scales for wellness and resilience. In contrast, the scales for perception of social support and negative coping styles show a lower internal consistency. CONCLUSIONS: The Maugeri Stress Index - reduced form provides a reliable and valid measure, useful for early identification of stress levels in workers or in a team along the eustress-vadistress continuum.