Barriers and facilitators of type 1 diabetes self-care in adolescents and young adults.

PURPOSE: This study explores the disease experience of adolescents and young adults with T1DM focusing on the barriers and facilitators that characterise their disease self-care. Self-care requires complex decision making and cooperation between patients, their families, the healthcare team, and the social support system. Personal and social factors affect self-care, and specific challenges impact adolescents and young adults, putting them at a higher risk of poor glycaemic control and more severe complications. DESIGN AND METHODS: The study uses a qualitative description approach. Twenty-two people (15 women; 10-30 years old; 2-24 years from diagnosis) were purposefully recruited through snowballing techniques. Data were collected with semi-structured interviews and analysed inductively with semantic thematic analysis. RESULTS: Four themes and nine subthemes conceptualise the patients' experience as a life-long journey that has its difficult beginning at the time of diagnosis and continues through the resolution of the initial crisis by integrating disease at the identity level and acquiring expertise. Technology and social environment act both as self-care barriers and facilitators. CONCLUSIONS: Findings highlight the importance of designing and improving technology related to diabetes accounting for patients' experiences. Second, it is imperative to work towards a de-stigmatisation of diabetes. Finally, health professionals should work with people with T1DM on the psychological aspects of the disease and identity integration. PRACTICE IMPLICATIONS: Diabetes-related technology should promote usability and acceptability while addressing visibility and device burden issues. Clinicians should pay particular attention during the transition from the paediatric to the adult centres and offer global assessments and treatment.

Mirroring, monitoring, modelling, belonging, and distancing: Psychosocial processes in an online support group of breast cancer patients.

Breast cancer patients are primary users of Internet Health Forums, virtual self-help communities where they find and share information, preoccupations, and support. Previous literature has mainly focused on analysing the contents and the outcomes of breast cancer forums' participation. In light of the Community of Practice theoretical model, our research investigated the psychosocial processes that build and shape patients' experience and participation in the forum. We conducted 16 semi-structured email interviews with breast cancer patients recruited within a well-established online community. Thematic analysis identified five processes-mirroring, monitoring, modelling, belonging, and distancing-that marked three phases of users' experience: initiation, participation, detachment. An interactive dynamic characterised the identified processes: the disease's experience was shaped by and, in turn, it crafted this virtual community. These community processes contributed to participants' empowerment at practical, informative, and emotional levels through the development of a shared repertoire of resources, stories, and ways of dealing with patients' recurring problems.

Spectral Tuning and Photoisomerization Efficiency in Push-Pull Azobenzenes: Designing Principles.

This work demonstrates how push-pull substitution can induce spectral tuning toward the visible range and improve the photoisomerization efficiency of azobenzene-based photoswitches, making them good candidates for technological and biological applications. The red-shifted bright ππ* state (S2) behaves like the lower and more productive dark nπ* (S1) state because less potential energy along the planar bending mode is available to reach higher energy unproductive nπ*/S0 crossing regions, which are responsible for the lower quantum yield of the parent compound. The stabilization of the bright ππ* state and the consequent increase in isomerization efficiency may be regulated via the strength of push-pull substituents. Finally, the torsional mechanism is recognized here as the unique productive route because structures with bending values attributable to the inversion mechanism were never detected, out of the 280 ππ* time-dependent density functional theory (RASPT2-validated) dynamics simulations.

Differentiating PNES from epileptic seizures using conversational analysis.

We applied conversation analysis in an unselected continuous series of 70 patients to discriminate patients with psychogenic nonepileptic seizures (PNES) from patients with epilepsy. Two psychologists examined the patients' recorded reports. Patients were also submitted to an extensive neuropsychological battery in order to verify whether specific cognitive deficits or mental health problems are typical of patients with PNES and whether some cognitive deficits could prevent the correct diagnosis. The results showed a good percentage of correct diagnosis, with a sensitivity of 0.795 and a specificity of 0.83, while no difference in the cognitive profile was found between patients with PNES and patients with epilepsy. The results also suggest that psychologists can apply the conversation analysis as well as linguists, which is an important finding since psychologists are employed in specialized centers, while linguists in general are not part of the team.

An Ethnographic-Discursive Approach to Parental Self-Help Groups: The Case of ADHD.

Mutual aid groups have become a common form of help in the mental health field. Although self-help groups are associated with a range of health and social benefits, they remain poorly understood in terms of the dynamics of their interactions. Adopting an ethnographic-discursive approach, we conducted a 6-month observation of the meetings of a self-help group of parents with children diagnosed with attention deficit/hyperactivity disorder (ADHD) to analyze the discursive dynamics of the interactions that characterized the group. Using a set of discursive strategies and practices, the parents promoted a homogeneity of viewpoints and experiences within the group and constructed a shared and consensual narrative to endorse a specific understanding of ADHD. The production of both homogeneity within the group and a shared narrative served to absolve parents of guilt, helped parents to signify their experience within a blaming social context, and preserved their identities as "good parents."

Orders to shoot (a camera): effects of ostracism on obedience.

Research suggests that ostracism increases susceptibility to indirect forms of social influence (e.g., conformity). Yet, no study to date has explored whether the effects of ostracism extend to the most direct form of social influence--obedience. We investigated whether ostracized individuals would be more likely to obey a direct command to do something effortful in uncomfortable conditions. Participants (N = 62) were randomly assigned to be included or ostracized in Cyberball, or assigned to a control condition. They were then approached by the experimenter and commanded to go outside when temperatures were below 30 degrees F and take 39 unique and creative photographs in the cold of winter. Ostracized participants were more likely to obey the experimenter's command to be creative when taking photographs. No differences in obedience emerged between the inclusion and the control condition. We provided evidence completing the social influence "trifecta": ostracism increases susceptibility to conformity, compliance, and now, obedience.

University Students with Current Suicidal Ideation and Perceived Changes during the COVID-19 Pandemic: A Qualitative Study.

INTRODUCTION: Mental health problems seemed to have increased among university students during the COVID-19 pandemic. To deepen our understanding of the pandemic's effects in this population, we conducted qualitative research to investigate any perceived changes in students during the pandemic, differentiating the sample based on the presence or absence of current suicidal ideation (SI). METHODS: A wide sample of Italian university students (n = 1,214) completed an online questionnaire during the COVID-19 pandemic, March 2020-June 2021. We conducted a computer-assisted content analysis of an open-ended question about the perceived changes that occurred to them during the pandemic. RESULTS: (1) Four thematic clusters were identified: "The psychological impact of the pandemic," "New ties and new loneliness," "An uncertain forethought" and "Discovering the value of relationships." (2) In subjects characterized by severe SI, the state of confinement at home was related to the most intense emotional states and worries. (3) Students with severe SI were different from the others, in particular using the lemma "panic," which was the only psychological state specifically associated with this group. CONCLUSIONS: Students with current severe SI experienced higher level of psychological distress and suffering compared to the other groups during the pandemic.

Regulating liminality: Making sense of the vegetative state and defining the limits of end-of-life action.

Persistently alive but unaware, vegetative state patients are stuck in the transition between life and death - that is, in a liminal hotspot. This condition raises complex ethical and legal dilemmas concerning end-of-life action. Drawing on social representations (SRs) and the liminality framework, our research investigated how the vegetative state was constructed within the Italian parliamentary debates discussing end-of-life bills (2009-2017). We aimed to understand (1) how political groups represented the vegetative state, (2) how they legitimised different end-of-life bills and (3) came to terms with the issue of liminal hotspots. By dialogically analysing three debates (No. of interventions = 98), we identified six themes and discursive aims allowing parliamentarians to differently represent the vegetative state and support different courses of action. In turn, we identified new features of the psycho-social processes generating SRs: the dialogical tensions between anchoring and de-anchoring. Results corroborated the idea that de-paradoxifying liminality relies on group sense-making and, thus, different political leanings differently addressed the liminality of the vegetative state. We also reveal a novel feature of dealing with liminal hotspots informing the psycho-social literature that applies when a decision needs to be taken, such as in the case of crafting a law: moving from the paradox.

The interplay between ovarian cancer and social relationships: an analysis of patients' metaphors.

OBJECTIVE: Research showed that ovarian cancer poses unique challenges to patients' care experiences and that patients' social networks could affect their care path significantly. The present study aimed to analyse the metaphors that patients used to signify the impact of the illness on their social relationships and the role of relationships in dealing with cancer. DESIGN: Following a qualitative description approach we conducted 38 semi-structured interviews with Australian (14) and Italian (24) women diagnosed at different stages of ovarian cancer. RESULTS: The analysis identified four themes bringing together the meanings expressed by participants' metaphors: Lack of comprehension and communication; Isolation, marginalisation, and self-isolation; Discrepancy between the private and public self; and Social relationships as empowerment resources. CONCLUSION: The polysemic nature of patients' metaphors captures both the empowering and especially disempowering role of social relationships in dealing with ovarian cancer. Results also show that metaphors are used to make sense of the impact of ovarian cancer on social relationships and to express different strategies for managing patients' networks.

COVID-19, people with disabilities, and the Italian government recovery: investigating the impact and promoting psychological resources to prevent future emergencies.

Introduction: Given its profound and transversal impact, the COVID-19 pandemic in 2020 marked a deep point of division in how people make sense of the world and their lives. The consequences of this event were remarkable, especially for populations already facing vulnerability, exclusion, and discrimination. In Italy, over 3 million people (5.2% of the entire population) have a disability due to health issues or severe limitations that prevent them from performing daily activities. Although the COVID-19 health emergency aggravated and amplified these problems, research and studies investigating the incidence of psychological distress and the role of psychological resources for people with disabilities in the aftermath of the pandemic are still to be implemented. For these reasons, the Department of Psychology conducted a study on behalf of the Italian Government to assess the impacts of the COVID-19 pandemic on the social, psychological, and economic wellbeing of Italians with disabilities. Methods: The aim was to assess the consequences of the pandemic on this population, especially the impacts related to the lockdowns and preventive measures, and to evaluate the protective role that could be played by psychological resources such as resilience, future orientation, and career adaptability in a Life Design perspective. With the collaboration of local, regional, and national associations for people with disability, an anonymous, online self-report questionnaire was distributed to 403 persons with disabilities in Italy. Results: Results showed a strong relationship between the levels of psychological resources and life satisfaction during the COVID-19 pandemic. Discussion: In line with studies in international literature regarding the effects of the COVID-19 pandemic on people with disabilities, this research highlights the extension of this period's impacts on this population's psychological wellbeing. Moreover, this study amplifies the urgent call for action and research in promoting Life Design psychological resources, given their positive and protective role in preserving and increasing people's wellbeing.

The discourse around usefulness, morality, risk and trust: a focus group study on prenatal genetic testing.

OBJECTIVE: This study explores the underlying values and beliefs that guide women's reasoning on prenatal genetic test (PGT) uptake, as framed by their own words, during a group discussion, in a Catholic country such as Italy. METHODS: Women's reasoning was explored by means of five focus group consisting of seven pregnant women and 13 new mothers. RESULTS: The focus group material content was analysed using the Nudist software. The discourse around PGT was rooted into four frames of reference: The usefulness dimension was used to express the positions in favour of PGT, whereas morality, risk and trust were used to express negative evaluations on such a technology. Participants advocated for themselves the choice of being tested, besides giving some credit to the partner's opinion. Moreover, participants reported little knowledge on PGT. CONCLUSION: The research shed some light on the frames of reference used by participants to build their positions on PGT uptake, confirming the public's ability to translate scientific accounts into personally meaningful information. A more complete understanding of the reasons for decisions to test would help counsellors to better communicate with women and couples, and to better assist them to make a better informed testing decision.

Conflicting representations of pain: a qualitative analysis of health care professionals' discourse.

INTRODUCTION: Studies regarding health care professionals' representations of pain indicate that doctors and nurses tend to concentrate on the organic origin of pain, and to view pain as subordinate to diagnosis and treatment of the disease; they also tend to underestimate the psychological and psychosocial components of pain, which means that they generally view the patient's subjective experience as secondary. This leads to an underestimation of pain. OBJECTIVE: The objective of this study was to analyze the representations of pain held by doctors, head nurses, and nurses in two Italian hospitals, focusing on how these representations are shaped according to the local culture in which they are constructed and negotiated. METHODS: Our study is based on a socio-constructionist approach, drawing on semi-structured, in-depth interviews with 26 health care professionals. RESULTS: The results show similarities and differences in how health care professionals construct their representations of pain. Three main issues emerged. First, the contents of these representations are strictly related to participants' job position and professional training; second, the representation of pain is significantly influenced by the values and meanings associated with the different professions; and third, there are two conflicting representations of pain, focusing on the objectivity vs the subjectivity of pain, respectively. CONCLUSIONS: To promote significant change regarding pain management within hospital organizations, it is essential to construct shared representations of the problem and its implications, particularly as regards relations with the patient. This change should take place at the educational as well as the socio-organizational level, and it should take into account ideas and proposals from the subjects involved.

Self-care is Renouncement, Routine, and Control: The Experience of Adults with Type 2 Diabetes Mellitus.

Type 2 Diabetes Mellitus can cause serious complications; it has a severe impact on the quality of life and high costs. One of the key strategies to manage diabetes is self-care, a complex multifactorial process influenced by personal, cultural, and systemic factors, that comprises self-care maintenance, self-care monitoring, and self-care management. Few patients perform adequate self-care. To deepen our understanding of patients' experiences of self-care maintenance, self-care monitoring, and self-care management, we conducted the first qualitative study on this topic. This study used Interpretive Phenomenological Analysis, informed by the Middle-range Theory of Self-care of Chronic Illness, to explore the experience and meaning of self-care maintenance, self-care monitoring, and self-care management in adults with T2DM (n = 10). Three themes were identified: self-care is renouncement, self-care is routine, and self-care is control. A cross-cutting moral pattern connects the three themes. Our findings corroborate the Middle-range Theory of Self-care of Chronic Illness in the field of diabetes self-care and could inform practitioners in understanding the experience of self-care as a complex phenomenon and in developing tailored interventions.

Quality of life in patients with primary biliary cholangitis: A cross-geographical comparison.

BACKGROUND & AIMS: Several symptoms impair the quality of life (QoL) of patients with primary biliary cholangitis (PBC). They are reported to vary significantly in different countries. Aim of our study was to explore whether there is a geographical clustering that accounts for symptoms in PBC. METHODS: Data was analysed from four cohorts of PBC patients from the UK, Spain, Japan and Italy using the PBC-27 scale. RESULTS: Overall, 569 patients from four cohorts were identified, including 515 females (90.5%) with a mean age of 61 years. The analysis provided evidence for strict factorial invariance of the scale, a robust indicator of its validity for cross-cultural research. The mean of the fatigue domain of British patients was significantly greater than that of the Japanese (p â€‹< â€‹0.05), Italian (p â€‹< â€‹0.05), and Spanish patients (p â€‹< â€‹0.001). The mean of the cognitive domain after 54 years of age, was significantly greater in the British patients than in the Japanese (p â€‹< â€‹0.05) and Spanish patients (p â€‹< â€‹0.01). However, after 69 years of age, there were not significant differences between countries. The mean of the emotion domain after 54 years of age, was greater in the British that in the Spanish (p â€‹< â€‹0.01) and Italian patients (p â€‹< â€‹0.01). CONCLUSIONS: Differences in the four countries concerning fatigue, cognitive and emotional dysfunction were found. The association of latitude and symptoms might provide new insights into the role of sun exposure, genetics and/or cultural component into disease phenotype in PBC.

Taking into account the observers' uncertainty: a graduated approach to the credibility of the patient's pain evaluation.

This article presents two experiments aiming to investigate the adoption of a graduated measure to describe credibility attribution by observers who evaluate patients' pain accounts. A total of 160 medical students were required to express a credibility judgment on the pain intensity level of hypothetical patients. We used 16 vignettes based on a factorial mixed-design. Within-participants factors were the reported pain, the presence of a physical sign, the patient's facial expression and the patient's gender, and between-groups factors were the patient's age and the geographical distribution of the patient's name. Results confirm the well-established tendency not to believe patients' self-reports and provide information regarding the evaluators' uncertainty. The findings suggest that a graduated measure is useful for assessing the degree of uncertainty of the observers and subtle effects of different factors upon the judgment of patient's pain.

'I still have difficulties feeling like a mother': The transition to motherhood of preterm infants mothers.

OBJECTIVE: The premature birth of their infant can constitute a sudden interruption of the transition to motherhood that requires a reorganisation of the process. The present study aimed to analyse the experience of the transition to motherhood of preterm infants' mothers, framing it within Stern's transition to motherhood theory. METHOD: A semi-structured interview was administered to 30 mothers during the recovery of the infant in the Neonatal Intensive Care Unit. The interview explored the experience of mothers related to pregnancy, the infant's birth and recovery. RESULTS: Thematic Analyses evidenced four interrelated themes: disconnection from the child, perception of maternal inadequacy, loss of parental role and temporal suspension. The themes showed that the mothers' experience of preterm birth not only concerns the traumatic delivery, but is also embedded in the entire process of becoming a mother within an institutional context. CONCLUSIONS: Results were connected to Stern's theory. Findings revealed difficulties for preterm mothers that could affect the development of the maternal constellation and thus their transition to motherhood. These difficulties may influence the construction of maternal identity, mother's representation of their child and the bond with their child.

[Relevance of the Di Bella case in the relationship between people and official medicine]. / Rilevanza del caso Di Bella nel rapporto tra le persone e la medicina ufficiale.

In this research, we suppose that the Di Bella case showed a separation, that is at the basis of the relation between people and the "official medicine", in an emblematic way: the separation between the reified universe--that is the scientific research with its necessary and universal rules, the medical practice, the medical and governmental institutions--and the consensual universe--the common sense, the emotions and the thoughts of people, of the patients and of their relatives. At the same time, these dynamics of the relationship between science and public opinion are framed in the context of the historical and political Italian situation of the Nineties to explain the origin and the development of the affair. Because of the priority role attributed to the mass-media in building the case, this research analyses all the articles on the Di Bella case published in Panorama and L'Espresso--two magazines chosen because they represent different cultural and political tendencies--by experimenting the integration of qualitative and quantitative methodologies. From our analysis, an ancient culture emerges, that is expressed by the stereotype of the no hope illness and by the repetition of consolidated common places: on one side the irrationality of the masses and the Italian character, on the other side the veneration for the science and the unquestionable trust in the guarantee provided by a foreign hospital or by a foreign research centre. At the same time, a positive role of the public opinion points out, which is able to get some negative sides of the reified universe and to give voice to the needs of the patients and of all common people who have to face with--or are afraid of facing with--the cancer, a prototypical illness which arouses fears and anxieties.

Attention deficit/hyperactivity disorder blame game: a study on the positioning of professionals, teachers and parents.

Attention deficit/hyperactivity disorder is currently the most debated childhood psychiatric diagnosis. Given the circulation of competing perspectives about the 'real' causes of children's behaviour and the 'best' way to treat them, we aim to analyse the interactions of the central social actors' discourses about attention deficit/hyperactivity disorder children within the Italian context. Adopting a multi-method approach, we focus on the polyphonic chorus of voices surrounding the child, studying the discourses of mental health professionals, teachers and parents. These actors are representative of three contexts that are deeply engaged with attention deficit/hyperactivity disorder: medical institutions, schools and families. Our theoretical and methodological approach integrates positioning theory, the Bakhtinian notion of dialogical thinking and discourse analysis to study stakeholders' reflexive and interactive positioning in terms of the attribution of rights, duties, responsibilities and power issues. The results show that mutual blame is a constitutive element of relational dynamics among the key adults surrounding attention deficit/hyperactivity disorder children. We argue that these conflicting relationships are not merely related to the debate regarding the validity of the attention deficit/hyperactivity disorder diagnosis. Rather, the mutual blame centres on questions of compliance, recognition of authority and morality. Through the blame game, adults negotiate their own and others' subjectivity in ways that simultaneously (re)produce power relationships and resistance efforts.

The influence of anchoring on pain judgment.

CONTEXT: Research on decision making suggests that a wide range of spontaneous processes may influence medical judgment. OBJECTIVES: We considered an easily accessible strategy, anchoring and insufficient adjustment, which might contribute to health care professionals' miscalibration of patients' pain. METHODS: A sample (n=423) of physicians, nurses, medical students, and nursing students participated in a computerized task that showed 16 vignettes featuring fictitious patients reporting headache. In the experimental condition, participants were asked to evaluate the severity of the patient's pain before and after knowing the patient's rating. In the control condition, participants were shown all information about the patient at the same time and were required to make judgments in a single stage. RESULTS: When participants could express an initial impression before knowing the patient's rating, they fully anchored to their initial impressions in almost half of the responses. Moreover, even among those who revised their initial impression, the extent of the revision was often insufficient. Greater anchoring was associated with patients' ratings that were higher than the participants' initial impression. Finally, we provided evidence that anchoring increased pain miscalibration. We discuss our findings in terms of their contribution to the understanding of the cognitive processes involved in pain assessment. CONCLUSION: When estimating patients' pain intensity, observers are driven by anchoring, a rule of thumb that might have pernicious consequences in terms of unwarranted overreliance on initial impressions and insufficient revision in light of relevant disconfirming evidence. Taking this heuristic into account might foster accurate pain assessment and treatment.

Gender effects in pain detection: speed and accuracy in decoding female and male pain expressions.

The ability to detect facial expressions of pain is crucial in eliciting prosocial behaviors towards the individual experiencing pain. Previous studies have shown that the sufferers' gender can affect the observers' explicit judgment of the pain face, thus suggesting its possible influence on pain decoding. The present study investigates whether the sufferer's gender affects the observer's reflexive or implicit detection of facial expression of pain. More specifically, we used implicit measures to test whether observers detect pained expression more quickly or accurately on male or female faces. In three experimental studies, we devised a set of stimuli using computer-generated faces. In Experiment 1, prototypical female and male avatars with different facial expressions (pain, anger, disgust, and neutral) were displayed, while subjects' (N=34) accuracy and speed at identifying the expressions were recorded. In Experiment 2, participants (N=56) watched videos of the avatars displaying dynamic expressions and had to quickly and accurately identify each expression. In Experiment 3, participants (N=38) were shown an androgynous avatar face showing different expressions and were asked to identify the face as either female or male. Overall, we found that the target's gender affected the observer's reflexive decoding of the facial expression of pain. Specifically, the results showed that participants, regardless of their gender, were slower and less accurate in recognizing pain expressions (but not other expressions) on female faces. Furthermore, androgynous faces displaying pained expressions were more likely to be categorized as male than female. Several potential explanations are discussed.