The association between violence against women and chronic pain: a systematic review and meta-analysis.

Violence against women is a phenomenon that involves at least 35% of women worldwide. Violence can be sexual, physical, and/or psychological, perpetrated by the partner, another family member, or a stranger. Violence is a public health problem because its consequences include higher morbidity, higher mortality, and short and long-term physical and psychological health diseases. Most studies prove an association between any type of violence and some chronic pain diagnoses but no one has done a complete collection of this evidence. This systematic review and meta-analysis aimed to evaluate whether this association is statistically significant, including the largest number of studies. Through the inclusion of 37 articles, the association has been demonstrated. Compared with no history of violence, women who did experience violence showed 2 times greater odds of developing chronic pain. The impact of violence was significant also on fibromyalgia separately, but not on pelvic pain.PROSPERO registrationPROSPERO CRD42023425477.

Online Romance Scams: Relational Dynamics and Psychological Characteristics of the Victims and Scammers. A Scoping Review.

BACKGROUND: Digital communication technologies can overcome physical, social and psychological barriers in building romantic relationships. Online romance scams are a modern form of fraud that has spread in Western societies along with the development of social media and dating apps. Through a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic. There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases. OBJECTIVES: This paper presents a scoping review of the quantitative and qualitative evidence on this issue, focusing on epidemiological aspects, relational dynamics, and the psychological characteristics of victims and scammers. METHODS: A literature scoping review was conducted using electronic databases and descriptors. Studies were included if they had analyzed the phenomenon in any population or the relationship dynamics characterizing it through whatsoever typology of design. Scoping reviews are a form of knowledge synthesis, which incorporates a range of study designs and wide eligibility criteria to comprehensively summarize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities. RESULTS: Twelve studies were included. Sixty-three percent of social media users and 3% of the general population report having been a victim at least once. Some psychological variables appear to be associated with the risk of being scammed, such as female gender, middle-age, higher levels of neuroticism, tendencies to the romantic idealization of affective relations, sensation seeking, impulsiveness and susceptibility to addiction. We analyse literature limitations and future directions. CONCLUSION: Since this emerging phenomenon is still largely unrecognized, understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention/intervention strategies to be developed.

Post-traumatic Stress Disorder in Prisoners' Offspring: A Systematic Review and Meta-analysis.

BACKGROUND: Parental incarceration can produce serious effects on the offspring's mental health. The presence of Post-Traumatic Stress Disorder (PTSD) in prisoners' offspring is understudied and the few literature data showed heterogeneous evidence, with some studies suggesting that about 25% of prisoners' offspring have PTSD and other reporting much lower prevalence rates around 2-3%. There is no systematic review and meta-analysis about PTSD in prisoners' offspring. OBJECTIVES: The present systematic review and meta-analysis aimed to provide a first quantitative synthesis of the prevalence of the PTSD diagnosis in prisoners' offspring. Moderator variables of the effect sizes were assessed, including offspring's and parents' gender, offspring's generational cohort (children/adolescents versus adults), reasons for parental incarceration (political/war versus crime), and country type (Western versus Non-Western countries). METHODS: A systematic review and a meta-analysis were conducted according to the PRISMA guidelines. Studies were included if they assessed the presence of a PTSD diagnosis in child, adolescent or adult offspring of prisoners through a diagnostic classification system, a clinician-administered interview or a self-report questionnaire, if they reported data necessary to calculate the effect sizes or the authors were available to provide them. Studies might have been based upon any design except review, single-case, case series, and case reports. Outcomes might have been measured at any time after parental incarceration. Parental imprisonment was defined as any kind of custodial confinement of a parent by the criminal justice system, including being held as a prisoner of war or for political reasons.Independent reviewers searched published/unpublished studies through electronic databases and additional sources and extracted the data. A random-effect meta-analysis was carried out by calculating the effect sizes as event rates. Heterogeneity was examined by the I2 and the Q statistics. Moderators were assessed through meta-regressions. RESULTS: Six studies (2512 participants) were included. Fifteen percent of prisoners' offspring had PTSD, as shown by a significant mean effect size of 0.14 without evidence of publication bias (95% CI: 0.081 - 0.249, p< 0.001). There were no significant differences on the mean effect sizes between the studies on adults and those on children/adolescents [Q(1) = 0.00, p = .999], between the studies on parents incarcerated for political/war reasons and those for crime [Q(1) = 0.00, p = .979], and between the studies conducted in Western and non-Western countries [Q(1) = 0.854, p = .355]. While offspring's gender was not related to the effect sizes [ß = -0.01, 95% CI: -0.02 - 0.02, p = .452], parents' gender was significantly and positively associated with the effect sizes suggesting that in studies with higher percentages of incarcerated mothers, the prevalence of offspring's PTSD was higher [ß = 0.01, 95% CI: 0.0 - 0.01, p = .019]. CONCLUSION: PTSD is a serious mental health condition among prisoners' offspring, particularly when mothers are incarcerated. The present findings point out the importance of thorough assessment and timely intervention/prevention strategies implemented by professionals of mental health settings and detention systems. The cross-sectional design of the studies does not allow causal conclusions to be drawn about the effect of parental incarceration as a risk factor for PTSD. Other variables related to parental incarceration may explain these findings. This limitation points out the importance of further longitudinal research.

A comparison of physical comorbidities in patients with posttraumatic stress disorder developed after a terrorist attack or other traumatic event.

No study investigated whether the presence of specific medical comorbidities is associated with the type of traumatic event, in particular with terrorist attack (TA). In a group of subjects with posttraumatic stress disorder (PTSD), the current study investigated the association between the types of traumatic event (TA vs. other traumatic event [OTE]) and medical comorbidities, controlling for sex and PTSD duration. The Mini International Neuropsychiatric Interview, the Clinician-Administered PTSD Scale, and the Davidson Trauma Scale were administered to 84 subjects diagnosed with PTSD. Thirty-nine were victims of TA and 45 victims of OTE. TA was associated with higher prevalence of neoplasms (ß = 2.60, p = 0.02). Females were more protected than males from circulatory system comorbidities (ß = 1.47, p = 0.04), while PTSD duration was associated with higher prevalence of such comorbidities (ß = 0.005, p = 0.01). Females showed a higher prevalence of neoplasms than males (ß = 2.50, p = 0.02). Female sex was protective against metabolic syndrome (ß = -1.79, p = 0.02). Patients with PTSD due to TA and female patients should be considered for their higher prevalence of neoplasms, while male patients and those with higher symptom duration should be monitored for circulatory disease and metabolic syndrome. Symptom duration might be associated with circulatory and metabolic disease. Implications for tailored and timely psychopharmacological and psychotherapeutic intervention for PTSD are discussed focusing on these specific medical comorbidities.

Urban safety and psychological distress during the pandemic: the results of a longitudinal study.

Introduction: In the last decades, a large body of literature has explored the topic of perceived safety and fear of crime in urban environments. The effects of psychological factors on such feelings have been studied, but rarely using prospective studies, and never when these factors intercept a worldwide dramatic event like the pandemic. This research aimed to analyze the variations of the feelings of urban safety during the pandemic, the role of resiliency and the effect of psychological stressors such as anxiety, stress, and depression. Methods: During 2019 and 2022, before and after the pandemic, a face-to-face interview was administered to the same group of 195 participants. The PUSAS scale was used to measure unsafety, the ER89-R to assess for resiliency, the DASS-21 to collect data about the general distress (anxiety, stress and depression), and the CAS scale was used to evaluate the specific coronavirus anxiety. Structural equation models were applied to test a theoretical framework grounded on the relationships between these measures. Results: The research findings showed decreased feelings of unsafety across the pandemic, consistent with the literature. The positive effect of ego-resiliency was significant but only for its interaction with data collected before the pandemic, whilst stress and anxiety impacted unsafety in 2022 through different pathways. None of the symptoms of general distress influenced the concern about crime and sense of vulnerability, as the feelings of unsafety were found independent from the variations of the specific coronavirus anxiety. Discussion: Although the research findings did not confirm the impact of coronavirus, they presented some facets that disconfirm what the literature reported about the relationships between psychological distress and fear of crime. Implications about measurement issues are discussed.

The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review.

Violent situations are unfortunately very frequent in women and children all over the world. These experiences have long-term consequences for adult physical and psychological health. One of the most reported is chronic pain, defined in various sub-diagnoses and present in all types of violence. Unfortunately, the etiology of this condition is not clear and neither are the predisposing factors. The aim of this scoping review is to examine the literature trends about the probable risk factors of chronic pain in violence victims. Considering a bio-psycho-social model, it is possible to hypothesize the presence of all these aspects. The results will be discussed in the present article.

The incidence of vestibular neuritis in Italy.

Objective: This study aims to estimate the incidence of Vestibular neuritis (VN) in three different districts in Italy, its epidemiological features, and the prevalence of comorbidities associated with it. Methods: An observational prospective study of 198 patients referred to ENT departments in Siena, Grosseto, and Cuneo was carried out over a 2-year period. Each patient underwent a complete otoneurologic examination in the first 48 h from the onset of symptoms and a brain MRI in the early stages of the disease. The follow-up lasted for 1 year. Results: The total VN incidence rate of the three municipalities was 48.497 (95% CI: 48.395-48.598) and its standardized value was 53.564 (95% CI: 53.463-53.666). The total VN incidence rate for the whole sample (municipality and district of the three centers) was 18.218 (95% CI: 18.164-18.272), and its standardized value was 20.185 (95% CI: 20.129-20.241). A significant difference was highlighted between patients living in the city compared to those living in the surrounding area (p < 0.000), this may be due to the ease of reaching the otoneurological referral center. Conclusion: The total incidence rate for the three municipalities was 48.497. This result is higher than previously reported studies.

Health-Related Quality of Life in pre-dialysis patients with chronic kidney disease: the role of Big-Five personality traits and illness denial.

BACKGROUND: Health-Related Quality of Life (HRQoL) in patients with chronic kidney disease (CKD) is significantly affected, regardless of the stage of the disease, as regards the physical, psychological and social functioning dimension. Big-Five personality traits can affect patients' HRQoL and willingness to take treatment options. Illness denial consists of denial of negative emotions, resistance to change and conscious avoidance. Poorer HRQoL can predict a higher risk of hospitalization and mortality, and broadly a worse adjustment to the dialytic therapy. Thus, a clearer knowledge of the psychological variables associated with a worse HRQoL in the predialysis stage might improve the intervention planning. No study investigated illness denial and personality traits simultaneously. We investigated the role of illness denial and Big-Five personality traits in the domains of HRQoL in predialysis patients with CKD. METHODS: One hundred adults (mean age: 75.87 years) with CKD participated. The Kidney Disease Quality of Life Short form, the Italian version of Ten Item Personality Inventory Revised, the Illness Denial Questionnaire, and the State-Trait Anxiety Inventory Form-Y were administered. RESULTS: Illness denial was associated with increased HRQoL related to symptoms/problems, effect and burden of CKD and cognitive functions domains, and it was a predictor of higher HRQoL in the last three domains mentioned above. Extraversion was related to better work status and sexual function; agreeableness was linked to elevated cognitive function, quality of social interaction and sexual function; conscientiousness was related to better sexual function; neuroticism was linked to improved cognitive and sexual functions; in the end, openness to experience was related to fewer symptoms and problems. CONCLUSIONS: This is the first study which simultaneously assessed Big-Five personality traits and illness denial in different domains of HRQoL of CKD patients. Personalised psychological interventions aimed at improving HRQoL in this population might focus on specific illness denial processes and personality traits.

Mobile opportunity against stress: Open study protocol on the effectiveness of a mobile platform for stress self-management in the post-pandemic era.

Mobile health platforms have shown promise in the management of various mental health conditions (including stress, anxiety, and depression) and cognitive behavioral strategies emerged as a popular and effective option offered by the platforms. This paper presents the protocol of a study aimed to test the effectiveness of a mobile platform that uses cognitive-behavioral strategies for stress self-management in the Tuscany region (Italy). The mobile app is adapted to the specific needs of each vulnerable population for which it is designed: young and older people, healthcare professionals, entrepreneurs. The app will be evaluated on the following outcomes: (i) perceived susceptibility and severity of the pandemic situation, perceived benefits, and costs of preventive health behaviors, (ii) knowledge about Covid-19 preventive behaviors and negative consequences of social distancing, (iii) stress and psychopathological symptoms (i.e., anxiety, depression, and post-traumatic stress symptoms) and cognitive distortions. If successful, we expect that the platform could give various groups clinical benefits by providing symptom self-monitoring and early intervention, consolidating the number of mental health programs available, and decreasing barriers to treatment-seeking. This population-level approach has the potential to improve mental health outcomes in pandemic periods for many people.

Neuroticism and Conscientiousness Moderate the Effect of Oral Medication Beliefs on Adherence of People with Mental Illness during the Pandemic.

BACKGROUND: After the declaration of the pandemic status in several countries, the continuity of face-to-face visits in psychiatric facilities has been delayed or even interrupted to reduce viral spread. Little is known about the personality factors associated with medication beliefs and adherence amongst individuals with mental illness during the COVID-19 pandemic. This brief report describes a preliminary naturalistic longitudinal study that explored whether the Big Five personality traits prospectively moderate the effects of medication beliefs on changes in adherence during the pandemic for a group of outpatients with psychosis or bipolar disorder. METHODS: Thirteen outpatients undergoing routine face-to-face follow-up assessments during the pandemic were included (41 observations overall) and completed the Revised Italian Version of the Ten-Item Personality Inventory, the Beliefs about Medicines Questionnaire, the Morisky Medication Adherence Scale-8-item and the Beck Depression Inventory-II. RESULTS: Participants had stronger concerns about their psychiatric medications rather than beliefs about their necessity, and adherence to medications was generally low. Participants who had more necessity beliefs than concerns had better adherence to medications. People scoring higher in Conscientiousness and Neuroticism traits and more concerned about the medication side effects had poorer adherence. CONCLUSIONS: These preliminary data suggest the importance of a careful assessment of the adherence to medications amongst people with psychosis/bipolar disorder during the pandemic. Interventions aimed to improve adherence might focus on patients' medication beliefs and their Conscientiousness and Neuroticism personality traits.

Influence of age on sperm characteristics evaluated by light and electron microscopies.

The impact of male aging on male fertility has only recently become of interest to the scientific community. This study aims to assess the relationship between age and fertility among a sample of men, considering the individual and pathological characteristics. In this retrospective study data of semen analysis and medical history of 1294 Italian male patients were considered. Semen analysis was performed by light microscopy and transmission electron microscopy mathematically elaborated. A generalized linear model was used to explore the influence of male age on semen quality, considering as confounders wine consumption, smoking habits, presence of varicocele, consanguinity and positive semen bacteriological analysis and urethral swab. The mean age of the participants was 36.41 ± 6.379. Male aging without impact of confounders was correlated with a decrease in sperm concentration and motility and an increased in sperm necrosis. Sperm concentration and progressive motility were negatively related to the presence of confounders as wine consumption (sperm motility), urogenital infection (sperm concentration and motility), varicocele (sperm concentration) and consanguinity (sperm motility). Urogenital infection, varicocele and consanguinity positively correlated with sperm necrosis. The most important finding was the observation of a negative effect of male aging on sperm parameters such as concentration, motility, and viability. It is possible to hypothesize age-dependent changes of testicular environment, probably related to reactive oxygen species production. The demonstration, in a large sample of patients, that aging influences sperm quality strongly motivates further research focused on the mechanisms involved in this phenomenon and its effects on offspring fitness.

Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender.

PURPOSE: Posttraumatic stress disorder (PTSD) includes different symptoms: re-experiencing, avoidance of reminders and numbing, and hyperarousal. Although questionnaires are widely used, clinician-administered interviews provide a more comprehensive exploration of symptoms. Few studies examined the convergence between clinician-rated and patient-reported general severity and symptoms, with mixed findings. We explored the association between clinician-rated and patient-reported general severity and symptoms and the moderator role of gender in PTSD patients referred to a specialized outpatient service. DESIGN AND METHODS: The Clinician-Administered PTSD Scale and Davidson Trauma Scale were administered to 56 patients. FINDINGS: Patients classified by clinicians as with higher avoidance/numbing symptoms and women classified with higher hyperarousal symptoms reported higher general severity. PRACTICE IMPLICATIONS: The assessment of the patients reporting high severity should focus on hyperarousal, particularly for women.

DSM-5 personality trait facets amongst child molesters: an exploratory comparison with other types of offenders.

BACKGROUND: DSM-5 provided a dimensional model of personality disorders which may be more clinically informative for the assessment and management of prisoners than a categorical one, as diagnoses of personality disorders alone cannot explain the type of violence. The role of DSM-5 personality facets is however understudied in child molesters, and no study compared these clinical features between individuals who have committed sex crime against children and those who have committed other types of crime. The present study compared DSM-5 personality trait facets between prisoners who had committed sex crime against children, prisoners who had committed property crime (i.e., robbery, fraud) and those who had committed crime against the person (i.e., homicide, assault or violence not implying a sexual element). A further aim was to explore which facets were associated with sex crime against children as compared with the other types of crime, controlling for socio-demographics (age, gender), psychiatric comorbidity (presence of any psychiatric diagnoses) and general psychopathy traits. METHODS: One hundred sixty-seven prisoners participated (91 had committed sex crime against children, 25 property crime, and 51 committed a crime against the person) and completed the Personality Inventory for the DSM-5 and the Psychopathy Checklist-Revised. RESULTS: Prisoners who had committed sex crime against children reported higher Restricted Affectivity traits than those who had committed property crime and crime against the person and higher Irresponsibility traits than those who had committed property crime. The results of a multinomial logistic regression analysis showed that on the one hand being a man, having a higher age, and the presence of a psychiatric comorbidity were more likely to be related to sex crime than property crime, on the other hand higher Irresponsibility personality traits, being a man, and the presence of a psychiatric comorbidity were more likely to be related to sex crime against children than crime against the person. CONCLUSIONS: The Irresponsibility facet might be specific to child molesters and can differentiate this group from offenders who have committed other crime types. This facet might be considered a key target of a tailored assessment and treatment planning during clinical practice with child molesters.

Non-intimate Relationships and Psychopathic Interpersonal and Affective Deficits as Risk Factors for Criminal Career: A Comparison Between Sex Offenders and Other Offenders.

Sex-offenders are at risk of criminal recidivism. For the treatment to be truly effective, it must be individualized. For this purpose, an accurate assessment should focus on criminological, psychological, and psychopathological features. The present study compared sex offenders with other offenders on historical experiences (i.e., problems with violence, anti-social behaviors, problems with personal relationships, problems with substance use, traumatic experiences, and parenting style). In addition, given the association between life events and psychopathy, we explored whether the relation between life events and crime type (sexual crime vs. other types of crime) might be moderated by psychopathy traits (interpersonal and affective deficits and antisocial behavior). Eighty-eight sex offenders (76% of whom child molesters) and 102 other offenders were included. The Historical, Clinical and Risk Management - 20 item Version 3 (HCR-20V3) and Psychopathy Checklist-Revised (PCL-R) were administered. The scores of the HCR-20V3 Historical scale items were computed to assess life events. The scores of the PCL-R factors, F1 Interpersonal affective deficits and F2 Antisocial behavior, were recorded. The presence of a history of problems with non-intimate relationships was the only significant risk factor for sexual crime compared with other crimes. Interpersonal and affective deficits provided an increased likelihood of being sex offenders as compared with other offenders when problems with non-intimate relationships were possibly/partially or certainly present.

Post-Traumatic Stress Disorder Secondary to Manic Episodes with Hypersexuality in Bipolar Disorder: A Case Study of Forensic Psychotherapy.

Post-traumatic stress disorder (PTSD) can arise as a secondary condition to a primary bipolar disorder, an aspect which may be overlooked by clinicians and thus may contribute to the exacerbation of the bipolar disorder itself. The occurrence of manic symptoms can have a traumatic impact on a patient unaware of her/his diagnosis, especially during symptom remission. The present work describes a clinical case of a woman with type-1 bipolar disorder and PTSD secondary to previous manic episodes characterized by hypersexuality. This clinical case is characterized by the fact that the patient had not received an adequate psycho-educational intervention making her aware of bipolar symptoms and helping her to elaborate the trauma of hypersexuality experienced after remission. The psychodiagnostic and psychotherapeutic assessment procedures are described and the forensic psychiatric implications related to the importance of timely and evidence-based intervention on this comorbidity are discussed. Identification of the primary pathology may be complicated by behaviours provoked by the psychiatric symptoms which put these patients at risk of becoming victims of abuse. Therefore, it is necessary to correctly understand these dynamics in order to promptly provide the patient with the correct therapeutic pathways.

Evaluation of the Health Education Impact Questionnaire (heiQ), a Self-Management Skill Assessment Tool, in Italian Chronic Patients.

BACKGROUND: The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes). METHODS: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed. RESULTS: A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches. CONCLUSION: The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.

Do patients with chronic low-back pain experience a loss of health-related quality of life? A protocol for a systematic review and meta-analysis.

INTRODUCTION: Health-related quality of life in chronic low back pain (LBP) is an important issue since various individual factors such as perceived loss of autonomy, inability to continue daily life and anxiety can contribute to maintenance or deterioration of this condition. Health-related quality of life is also important because it can predict the probability of recovery or recrudescence over time. In the literature, there is no systematic review on this topic. The present paper describes a protocol of the first systematic review and meta-analysis aimed at summarising the data on health-related quality of life in patients with chronic LBP compared with healthy controls. Gender, age and comorbidity of psychiatric disorders (mood or anxiety disorders) will be explored as moderators. Studies will be included if they used a case-control design comparing adults with chronic LBP to healthy controls on health-related quality of life through validated interviews/questionnaires. METHODS AND ANALYSIS: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review and meta-analysis will be conducted from 10th to 17th January 2020. Independent reviewers will search published/unpublished studies through electronic databases (Scopus, PubMed, EMBASE and the Cochrane Library) and additional sources, will extract the data and assess the methodological quality through the Newcastle-Ottawa Scale. Random-effect meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Publication bias will be assessed and moderators of the effect sizes will be investigated through weighted least squares meta-regression.The knowledge whether health-related quality of life is better or worse as a function of some individual characteristics may suggest personalised care pathways according to a precision medicine approach. ETHICS AND DISSEMINATION: The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42019131749.

A New System for Assessing Visual Disability Using a Digital Visor.

BACKGROUND: Considering the lack of universally accepted visual requirements for driving and for defining various grades of visual disability, the aim of this study is to propose a new method that provides a numerical score resulting from a combined assessment of the visual field and visual acuity loss obtained using a digital technology visor. METHODS: This study presents a new system for calculating the percentage of visual disability by combining binocular visual acuity and binocular visual field assessments. A new Global Vision Evaluation System digital technology visor uses standardized, reproducible criteria to produce well-defined, numerically expressed test results. Through a specific algorithm, the device produces a numerical value expressing the percentage of visual disability. RESULTS: Eighty-six subjects with various types of visual impairment underwent visual acuity and visual field test examinations carried out employing both traditional methods and the new digital visor. The two methods provided homogeneously similar results regarding the positioning of the subjects on the visual disability scale. CONCLUSIONS: The new digital visor seems to be a valid method to ensure that visual disability assessments are more homogeneous and reliable, and that, consequently, the resources available for this purpose are more fairly distributed.

Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators.

BACKGROUND: Lumbar spinal stenosis (LSS) is a common degenerative spine disease associated with a strong impairment in various quality of life areas, particularly the ability to perform work-related activity. Depression is a condition frequently associated. There is no comprehensive review on quality of life and objective functional impairment in LSS. This paper presents the protocol of the first systematic review and meta-analysis summarising evidence about quality of life and functional impairment in patients with LSS compared with healthy controls. Comorbid depressive disorders, age, gender, LSS duration, disability, pain severity and study methodological quality will be investigated as moderators. METHODS: The protocol is reported according to PRISMA-P guidelines. Studies will be included if they were conducted on patients aged 18 years old or older with primary LSS and if they reported data on differences in the levels of quality of life or objective functional impairment between patients with LSS and healthy controls. Independent reviewers will search published/unpublished studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Heterogeneity will be examined by the I2 and the Q statistics. Moderators will be investigated through meta-regression. CONCLUSIONS: A summary of the evidence on quality of life and functional impairment in LSS may suggest clinical and occupational health medicine strategies aimed to timely detect and prevent these outcomes. Higher percentages of patients with LSS with depression may be expected to be related to poorer quality of life. Depressive comorbidity might impact negatively on quality of life because it is associated with dysfunctional coping, disability and psychophysiological symptoms. ETHICS AND DISSEMINATION: The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. REVIEW REGISTRATION: CRD42019132209.