The use of the Distress Thermometer and the Hospital Anxiety and Depression Scale for screening of anxiety and depression in Italian women newly diagnosed with breast cancer.

PURPOSE: Distress is a factor that can adversely affect quality of life in breast cancer patients. A rapid and non-invasive tool to accurately detect distress is therefore important. The aims of the study were (1) to describe the women's experiences after having received a breast cancer diagnosis and while awaiting primary surgery, in terms of anxiety and depression, (2) to evaluate the use of the Distress Thermometer (DT) in newly diagnosed breast cancer patients, and (3) to define an optimal cutoff score for the DT for this population. METHOD: This study involved 436 newly diagnosed patients in the pre-surgery phase. Consent forms and questionnaires were delivered by nurses during the pre-surgery check-ups, in the time between the 4 weeks post-diagnosis and the 2 weeks before surgery. Receiver operating characteristic analysis was used to evaluate the diagnostic accuracy of the DT compared to the Hospital Anxiety and Depression Scale (HADS) and to define an optimal cutoff score for the DT in this specific population. RESULTS: The results showed that the DT is a fast, easy, and well-accepted screening tool in the Italian context of women newly diagnosed with breast cancer, performing well in relation to the HADS. The proposed cutoff score for DT screening in the clinical setting is 4 versus 5. CONCLUSION: The DT is recommended as a first step in screening, always followed by a more detailed evaluation of psychological functioning.

Stalking in nursing profession: behavior, consequences, coping strategies and gender difference.

BACKGROUND: The literature analysis has shown the risk of victimization in nursing professions. To date, very few studies have focused on the behavioral differences characterizing the stalking campaign, the consequences (physical and emotive), and the coping strategies adopted by victims (male and female nurses). OBJECTIVES: The aim of this work was to compare the victimization experience of men and women working as nurses in public hospitals. METHODS: 2.154 nurses were asked to fill a self-administered questionnaire and 765 (35.5%) filled it. Victims were 221 (29.8%), 172 (77.8%) female and 49 (22.2%) male. RESULTS: Findings show that the stalker is generally a man in the case of a female victim (76.2%) and a woman in the case of a male victim (71.4%). For both, the stalker is in most cases an acquaintance (for female victims=37.8%; for male victims=36.7%) who stalked for about one year. Stalking behavior causes in male nurses more physical symptoms (sleep and weakness disorders, respectively χ2=4.62, p=.024 and χ2=4.14, p=.043) than in female nurses. Female nurses (who cope by increasing social contact with friends and relatives and by talking to a psychologist) experienced more sadness (χ2=15.67, p=.000) and paranoia (χ2=10.07, p=.002) than male nurses. CONCLUSIONS: Possible strategies for preventing the phenomenon are discussed, highlighting the percentage (8.2% among female victims, 5.8% among male victims) of those who have reported to the police.

Italian nurses' experience of stalking: a questionnaire survey.

A literature analysis shows that nurses are at greater risk of being stalked both by ex-partners and acquaintances (such as colleagues and patients) and by unknown stalkers. The aim of this study was to explore Italian nurses' experience of stalking. A copy of the Italian modified version of the Networking for Surviving Stalking (NSS) Questionnaire on Stalking, Beck Depression Inventory (BDI), and State Trait Inventory (STAI) Y1-Y2 scales were distributed to 2,000 nurses working in 4 Italian state hospitals. There were 765 nurses who returned the questionnaire (38.4%), 107 of whom had been victims (14.0%). On average, victims had been stalked for more than 12 months by an acquaintance (41.1%), whose behavior included unwanted communications, following, control, and threatening behavior. The coping strategies used most involved offensive and interactional tactics. Stalking has both emotional and physical consequences for victims, although depression levels were not as high as we expected (BDI M = 11.05, SD = 8.84; STAI Y1 M = 42.11, SD = 11.75; STAIY2 M = 44.04, SD = 12.90). The need to adopt legal, organizational, and individual strategies is also discussed.

Emotional Distress, Self-Management Skills, and Expectations Among Adolescents and Young Adult Childhood Cancer Survivors in Transition from Pediatric to Adult Care: A Brief Report.

The transition from pediatric to adult care poses several emotional and personal challenges to adolescents and young adult (AYA) childhood cancer survivors (CCSs), which need attention to avoid the risk of nonadherence and medical dropout. This brief report describes the condition of AYA-CCSs at the moment of transition in terms of emotional state, personal autonomy, and expectations regarding future care. The results provide insights for clinicians dealing with survivorship care, to enhance AYA-CCSs emotional resilience and to support them in being in charge of their health, thus facilitating their transition to adulthood.

Sexual Harassment in the Workplace: Consequences and Perceived Self-Efficacy in Women and Men Witnesses and Non-Witnesses.

Despite the numerous advances made in Italy over the years in the study of sexual harassment in the workplace (SHW), research has focused exclusively on victims, perpetrators, and their relationships, and not on the consequences that the experience of sexual harassment can produce in witnesses. The present study aims to address this gap by examining how the indirect experience of SHW, in conjunction with variables such as gender, age, self-efficacy, and coping strategies, affects the mental health status of witnesses of SHW. A sample of 724 employees completed a questionnaire that included a modified version of the Sexual Experience Questionnaire (SEQ), the Oldenburg Burnout Inventory (OLBI), the General Health Questionnaire (GHQ), the Satisfaction With Life Scale (SWLS), and the Emotional Self-Efficacy Scale (RESE). Of the group, 321 participants reported witnessing sexual harassment in the workplace (28.2% of women and 16.2% of men). Results show that witnesses were younger than participants who described themselves as non-witnesses. Results also show that women and men who were witnesses were more likely to suffer the emotional and psychological consequences of the experience than non-witnesses. In addition, female witnesses expressed more positive emotions than men, which enabled them to manage their anxiety and emotional states when triggered in response to sexual harassment in the workplace. Finally, a significant association was found between perceptions of mental health and age, gender, experience with SHW, and self-efficacy strategies. The findings underscore the importance of sexual harassment intervention in the workplace, women and men who witness sexual harassment suffer vicarious experiences, psychological impact, exhaustion, disengagement, and negative feelings.

Work Placement and Job Satisfaction in Long-Term Childhood Cancer Survivors: The Impact of Late Effects.

Late effects of cancer and its treatments during childhood or adolescence can impact work placement and increase the risk of unemployment. The aim of this study is to describe the work placement and the perceived job and economic satisfaction of long-term childhood cancer survivors (CCS). Jobs have been categorized according to the International Standard Classification of Occupations version 08 (ISCO-08), and satisfaction has been evaluated through the Satisfaction Profile (SAT-P). Out of 240 CCS (female = 98) included: 53 were students, 46 were unemployed and 141 were employed. Within unemployed survivors, 89.13% were affected by late effects (n = 41). The presence of at least one severe late effect was significantly associated with the probability of unemployment (OR 3.21; 95% CI 1.13−9.12, p < 0.050), and having any late effect was inversely related to the level of satisfaction of the financial situation of unemployed CCS (b −35.47; 95% CI −59.19, −11.74, p = 0.004). Our results showed that being a survivor with severe comorbidities has a significantly negative impact on occupation and worsens the perception of satisfaction of economic situations. Routinary follow-up care of CCS should include the surveillance of socioeconomic development and provide interventions, helping them to reach jobs suitable for their health.

Characteristics of the stalking campaign: Consequences and coping strategies for men and women that report their victimization to police.

The study analysed cases reported to police by men and women who were victims of stalking. The objective was to describe the characteristics of the stalking campaigns experienced by men and women, their consequences, and the coping strategies adopted by the victims, as they are recorded in police case files. All the information was collected in three cities in the Northwest of Italy. Analyses were performed on 271 files classified by police officers as cases of stalking, reported by men (87, 32.1%) and women (184, 67.9%). The study revealed that men tended to let the stalking campaign last for a longer time than women before turning to the police. Procrastination had some consequences, especially in the emotional sphere, that affected the victim's wellbeing. Moreover, the coping strategies used by men victims were not effective and even risked to hamper the work of the police officers intervening and investigating on the case.

Geriatric ward hospitalization reduced incidence delirium among older medical inpatients.

OBJECTIVES: Most strategies for delirium prevention in older hospitalized patients are common good clinical geriatric care. We investigated whether acute geriatric ward (AGW) hospitalization, compared with acute general medical ward (AGMW) hospitalization,is associated with reduced incident delirium in older medical inpatients. DESIGN: prospective observational study. SETTING: a tertiary care, university hospital in Torino. PARTICIPANTS: consecutive medical patients 70 years or older admitted from the emergency department to an AGW and to an AGMW were included. MEASUREMENTS: Baseline measures included demography, functional and psychocognitive status, comorbidity, physiological and clinical severity of acute illness. Incident delirium was evaluated by qualified psychiatrists according to the Confusion Assessment Method and the Delirium Rating Scale. RESULTS: Delirium occurred in 8 of 121 patients admitted to AGW (6.6%) and in 20 of 131 patients admitted to AGMW (15.2%). After adjustment for significant differences in baseline covariates between groups, AGW hospitalization remained independently associated with less incident delirium (relative risk 0.90, 95% confidence interval: 0.024-0.331, p <0.001). In a multivariable logistic model with delirium incidence as independent variable, AGW hospitalization was independently associated with lower delirium incidence (relative risk 0.039, 95% confidence interval: 0.007-0.214, p <0.001), whereas greater cognitive impairment (p <0.001), higher Acute Physiology and Chronic Health Evaluation II score (p 0.001) and recent stressful events (p <0.001) were associated with increased delirium incidence. CONCLUSION: AGW hospitalization is associated with less incident delirium among older medical inpatients. Despite inherent limitations of observational studies, these hypothesis-generating findings add to previous evidence of potential benefit in delirium prevention from geriatric consultation in several hospital settings.

Physical Practice and Wellness Courses Reduce Distress and Improve Wellbeing in Police Officers.

BACKGROUND: The aim of this work was to evaluate a course to reduce distress in an Italian police force. Based on the findings from the first investigations on this population, courses to improve the ability to manage distress were tailored by management. Several free courses were proposed, including physical efficiency (e.g., total body conditioning) and wellness (e.g., autogenic training) classes. The goal of this research was to evaluate the courses and their impact on the perceived distress and general health of the participants, as well as the effectiveness in increasing the use of adaptive coping strategies. METHODS: A descriptive investigation was conducted involving a sample of 105 police officers before (time 1) and after (time 2) they had participated in the courses. RESULTS: Findings confirmed both physical and wellness courses affected, in participants, the perceived distress, thereby increasing the perception of wellbeing. The participants expressed having mental health benefits, the use of adaptive coping strategies increased, while the maladaptive coping strategies decreased. CONCLUSION: This study confirms that these courses could effectively reduce the risk of chronic disease, a consequence of persistent exposure to distress.

Mobbing (bullying at work) in Italy: characteristics of successful court cases.

BACKGROUND: Mobbing (bullying at work) refers to a form of psychological harassment that occurs in the workplace, in which the victim must be systematically and continuously persecuted for a long period of time. The aim of this work is to analyze the court judgments related to mobbing. METHODS: The data, collected from a website that included judgments from an Italian court, were analyzed according to the literature, identifying the type of victims, consequences, methods of harassment, type of mobbers, and compensation decided by the court. RESULTS: A total of 35 court sentences were analyzed. The findings showed that the duration of the mobbing campaign was on average 1.5 years and that the frequency of harassment was every day in most cases. In the majority of cases (17, 48.6%) the mobbing occurred in a private company. The gender of the victims who reported the mobbing experience was predominantly female (19, 54.3%), and on average, the victims were 44.54 years of age. The victims were classified as captives (12, 34.3%), scapegoats (8, 22.9%), ambitious (8, 22.9%), passives (5, 14.3%) and hypochondriacs (2, 5.7%). The mobbers were predominantly men (25, 71.4%) and on average 53.20 years of age. They were classified as casual (12, 34.3%), sadists (11, 31.4%), instigators (8, 22.9%) and choleric (4, 11.4%). The witnesses were described in the majority of cases as active, while the asymmetry of power was vertical. On average, the victims suffered 4.9 types of harassment, and the most cited consequences were anxiety disorder and physical symptoms. The motives for beginning the mobbing campaign were principally related to difficulties in relationships. The compensation imposed by the court ranged from less than 20,000 to more than 70,000 euros. CONCLUSIONS: The sentences analyzed showed that for different types of victims, there are behaviors, motives and consequences that are linked to different types of perpetrators.

Organizational and Occupational Stressors, Their Consequences and Coping Strategies: A Questionnaire Survey among Italian Patrol Police Officers.

Background: Traditionally, workers employed in police forces have been found to be exposed to a high risk of distress. Several studies reported that the main stressors were associated more with organizational aspects, whilst other researchers underlined that the main stressor were associated more with operational issues. The aim of this research was to investigate operational and organizational stressors, their consequences also in terms of anxiety and the coping strategies adopted. Methods: We compared Patrol Police Officers working in the Operational Service (Outdoor Patrol Officers) and those in the Interior Department (Indoor Patrol Officers) in the same Municipal Police force. Results: The results revealed that both Outdoor Patrol Officers and Interior Patrol Officers suffered from organizational and occupational stressor. Outdoor Patrol Officers appeared more willing to use different coping strategies, whereas Indoor Patrol Officers used avoidance strategies. This allows Outdoor Patrol Officers to explore new responses and approaches to deal with situations which-owing to the type of work-it is impossible to change. Outdoor Patrol Officers appeared better equipped to change their attitude to work than Indoor Patrol Officers. Conclusion: Interventions on both organizational and operational stressors would improve the quality of Patrol Police Officers' working life and have positive repercussions on the service offered to the general public.

Psychological Impact of Stalking on Male and Female Health Care Professional Victims of Stalking and Domestic Violence.

The aim of this work was to investigate stalking experiences in a sample of Health Care Professionals, or HCPs, who experienced domestic violence in their previous relationships with an intimate romantic or non-romantic who had become their stalkers. A comparison between males and females was made to highlight the differences among the genders. The findings showed that, for the most part, the victims experienced stalking by a stalker that was not of the same gender. Moreover, the nature of the relationship was romantic, for the most part, for both female and male subjects, suggesting that the principal motivation of stalking is the disruption of an intimate relationship. Regarding domestic violence, females described the phenomenon from a different perspective, indicating verbal, physical, and sexual abuse, while males indicated only verbal abuse. Females tended to amplify, more than the males, depression, and state and trait anxiety. Even if all symptoms were expressed in both females and males, the males exhibited a lack of confidence in their bodies, and the emotional literacy made the expression of distress more difficult. At the same time, the expression of anxiety presented in the women permitted them to become progressively less victimized over time; depression and anxiety allow the recognition of these symptoms as signs of distress and to intervene to reduce them.

Health Care Professionals as Victims of Stalking: Characteristics of the Stalking Campaign, Consequences, and Motivation in Italy.

Stalking is a phenomenon characterized by a set of repetitive behaviors, intrusive surveillance, control, communication, and search of contact with a victim who is afraid and/or worried and/or annoyed by such unwanted attention. Literature analysis shows that Health Care Professionals (HCPs) are at greater risk of being stalked than the general population. As described by Mullen, Pathé, Purcell, and Stuart, stalkers may have different motives: relational rejection, an infatuation, an inability to express their own emotions and recognize those of others, or a desire for revenge. The aim of this study was to explore stalkers' motivation as perceived by their victims, characteristics of stalking campaigns, and consequences. A copy of the Italian modified version of The Network for Surviving Stalking (NSS) Questionnaire on Stalking, the Beck Depression Inventory (BDI) and the State Trait Inventory (STAI) Y1-Y2 scales were distributed in six Italian state hospitals. Participants included 1,842 HCPs, 256 (13.9%) of which had been victims. The majority of victims reported that stalkers were Rejected (96, 37.5%), Intimacy seekers (41, 16%), Incompetent suitors (60, 23.4%), and/or Resentful (43, 16.8%; χ2 = 163.3, p = .001). Stalking campaigns were characterized by several behaviors, principally contact (by telephone calls, text message) and following. The stalking campaign caused in victims both physical and emotional consequences, the most frequent being weight changes, sleep disorders, weakness, apprehension, anger, and fear. The most used coping strategies were moving away and moving toward, the less used was moving inward. Intervention programs and preventive measures (both individual and organizational) for HCP victims and those who could be considered at risk are also discussed.

Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey.

BACKGROUND: Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. PATIENTS AND METHODS: A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. RESULTS: Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. CONCLUSION: SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.

Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients.

OBJECTIVES: To assess the level of pain intensity at which patients feel the impetus to ask for a breakthrough cancer pain (BTcP) medication, and level of pain intensity at which patients consider they have achieved acceptable pain control after receiving a BTcP medication. METHODS: A consecutive sample of patients who were receiving oral morphine equivalents equal to or more than 60 mg daily, and were prescribed rapid onset opioids for the management of episodes of BTcP, were included in the study. Focused educational activities regarding BTcP and numerical scales were established during hospital admission. At discharge patients were interviewed to find out what was the pain intensity level which gave the impetus to take the BTcP medication, what was the pain intensity for acceptable pain control after a BTcP medication had been given, and which factors prevented the patient calling for BTcP medication. A brief COPE (coping orientation to problems experienced) questionnaire was also administered. RESULTS: Fifty-two patients were recruited for this study. The meaningful pain intensity for asking for a BTcP medication was 7.1; 77% of patients had a pain intensity of 7-8 on a numerical scale of 0-10. The meaningful pain intensity for adequate analgesia after a BTcP medication was 3.5. Similarly, 77% of patients had a pain intensity of 3-4. There was no relationship with the variables examined. Concerns by patients about the use of BTcP medications were minimal. CONCLUSION: The meaningful BTcP intensity and pain intensity expected after BTcP medication can be useful in selecting patients in studies of BTcP. The principal limitation of this study was the specific setting of an acute unit with specific features and the relatively low number of patients. This observation should be followed up by further surveys with a larger number of patients and different settings.

Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer.

BACKGROUND: Head and neck tumors and their treatments negatively affect speech, swallowing, body image, and quality of life (QOL). The purpose of this study was to allow us to evaluate the impact of flap reconstructive surgery with adjuvant radiotherapy (RT) on QOL and psychological functioning. METHODS: Thirty-six of 153 consecutive patients surgically treated for carcinoma of the oral cavity received adjuvant RT. Late effects of RT and psycho-oncological assessment were performed. RESULTS: In more than 50% of the cases examined, moderate to severe late toxicity was observed, regarding subcutaneous tissues, salivary function, dysphagia, and taste impairment. Patients with severe dysphagia showed higher levels of depression and anxiety (p < .05). Dysphagia and taste impairment were seen to be associated with lower global health and QOL. The Draw a Person Test (DAP) showed severe problems in self-perceived body image in 33% of the sample. CONCLUSION: Dysphagia and taste impairment are associated with QOL and depression; our data suggest a different evaluation between self-reported and clinician-rating scales. DAP is a provocative tool that merits further research.

Styles of coping with cancer: the Italian version of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale.

Mental adjustment to cancer has been explored in a large body of the literature by using the Mental Adjustment to Cancer (MAC) scale. Problems in the factor structure of the scale and the need for refining the instrument have determined the development of the Mini-MAC. The aim of this study was to validate, according to a test-oriented approach, the Italian version of the Mini-MAC. Four hundred and thirty cancer patients in five centres in Northern Italy completed the Mini-MAC and the Brief Symptom Inventory (BSI). A subgroup of 153 patients filled out the instruments again within 3 months of the first assessment. The five original subscales (Fighting Spirit, Hopeless, Fatalism, Anxious Preoccupation and Cognitive Avoidance) showed acceptable levels of reliability (Cronbach alpha coefficients ranging from 0.55 to 0.80) although alphas were lower for the scales Fighting Spirit and Fatalism. Factor analysis (Varimax rotation) identified the same five factors with minor variations from the original version. Again, alpha coefficients were less robust for the factors Fighting Sprit and Fatalism. Hopeless and Anxious Preoccupation were significantly related to all the BSI psychological stress symptoms, including the Global Stress Index (GSI). Test-retest reliability showed no differences in the sub-scales scores between assessments.