Telemedicine, e-Health, and Digital Health Equity: A Scoping Review.

Background: With the progressive digitization of people's lives and in the specific healthcare context, the issue of equity in the healthcare domain has extended to digital environments or e-environments, assuming the connotation of "Digital Health Equity" (DHE). Telemedicine and e-Health, which represent the two main e-environments in the healthcare context, have shown great potential in the promotion of health outcomes, but there can be unintended consequences related to the risk of inequalities. In this paper, we aimed to review papers that have investigated the topic of Digital Health Equity in Telemedicine and e-Health [definition(s), advantages, barriers and risk factors, interventions]. Methods: We conducted a scoping review according to the methodological framework proposed in PRISMA-ScR guidelines on the relationship between Digital Health Equity and Telemedicine and e-Health via Scopus and Pubmed electronic databases. The following inclusion criteria were established: papers on the relationship between Digital Health Equity and Telemedicine and/or e-Health, written in English, and having no time limits. All study designs were eligible, including those that have utilized qualitative and quantitative methods, methodology, or guidelines reports, except for meta-reviews. Results: Regarding Digital Health Equity in Telemedicine and e-Health, even if there is no unique definition, there is a general agreement on the idea that it is a complex and multidimensional phenomenon. When promoting Digital Health Equity, some people may incur some risk/s of inequities and/or they may meet some obstacles. Regarding intervention, some authors have proposed a specific field/level of intervention, while other authors have discussed multidimensional interventions based on interdependence among the different levels and the mutually reinforcing effects between all of them. Conclusion: In summary, the present paper has discussed Digital Health Equity in Telemedicine and e-Health. Promoting equity of access to healthcare is a significant challenge in contemporary times and in the near future. While on the one hand, the construct "equity" applied to the health context highlights the importance of creating and sustaining the conditions to allow anyone to be able to reach (and develop) their "health potential", it also raises numerous questions on "how this can happen". An overall and integrated picture of all the variables that promote DHE is needed, taking into account the interdependence among the different levels and the mutually reinforcing effects between all of them.

Autism and Visual impairment: A First Approach to a Complex Relationship.

Since the first half of the 20th century there has been an interest in the study of the relationship between autism and autistic-like clinical features and with visual impairments. Autism Spectrum disorders are one of the more worldwide-studied neurodevelopmental disorder with an increasing prevalence in the last ten years. Visual impairment is a condition which derives from several causes (genetic, constitutional, injuries, nutritional and environmental ones). Again, it is a kind of spectrum and an overarching category, because visual impairments range from refractive errors (myopia, hyperopia, astigmatism), to amblyopia, strabismus, and to partial and total blindness. Since the first study of Keeler (1956) which described autistic-like patterns in five preschool children who were totally blind due to retinopathy of prematurity (ROP), a growing number of researchers addressed the relationship between autism and visual impairment. In this paper we focused on it, aiming to discuss on some lessons learned in this field and to discuss some open questions since the first research in this field.

The Use of Distance Learning and E-learning in Students with Learning Disabilities: A Review on the Effects and some Hint of Analysis on the Use during COVID-19 Outbreak.

Even if the use of distance learning and E-learning has a long tradition all over the world and both have been used to keep in contact with students and to provide lessons, support and learning materials, there is an open debate on the balance between advantages and disadvantages in the use of distance learning. This debate is even more central in their use to support students with Learning Disabilities (LDs), an overarching group of neurodevelopmental disorders that affect more than 5% of students. The current COVID-19 outbreak caused school closures and the massive use of E-learning all over the world and it put higher attention on the debate of the effects of E-learning. This paper aims to review papers that investigated the positive and negative effects of the use of Distance Learning and E-learning in students with LDs. We conducted a literature review on the relationship between Distance Learning, E-learning and Learning Disabilities, via Scopus, Eric and Google Scholar electronic database, according to Prisma Guidelines. The findings are summarized using a narrative, but systematic, approach. According to the data resulting from the papers, we also discuss issues to be analyzed in future research and in the use of E-learning during the current pandemic of COVID-19.

School Closure and Children in the Outbreak of COVID-19.

School closure and home confinement are two of the measures of lockdown chosen by governments and policymakers all over the world to prevent and limit the spread of the infection of COVID-19. There is still an open debate about the real effect of school closure on the reduction of risk of infection on children and the risk of infection on with other age groups (parents, grandparents and others). There is an agreement on the effect of school closure in reducing and delaying the peak of the outbreak. In this Editorial, starting from the ongoing Italian experience, we discuss direct and indirect effects of school closure on children's psychological health and learning. We also highlight the need for an "on peace time" planning of measures and strategies necessary to face the direct and indirect effect of this outbreak and other outbreaks, on children's psychological health.

Factor mixture analysis of paranoia in young people.

BACKGROUND: Paranoid thoughts are relatively common in the general population and can increase the risk of developing mental health conditions. In this study, we investigate the latent structure of paranoia in a sample of young people. METHODS: Cross-sectional survey; 243 undergraduate students (males: 44.9%) aged 24.3 years (SD 3.5). The participants completed the Green et al. Paranoid Thought Scales GPTS, a 32-item scale assessing ideas of social reference and persecution; the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Confirmatory factor analysis (CFA) was used to confirm the two-factor structure of the GPTS. Factor mixture modeling analysis (FMMA) was applied to map the best combination of factors and latent classes of paranoia. RESULTS: The GPTS showed excellent internal reliability and test-retest stability. Convergent validity was good, with stronger links with measures of ideas of reference and of suspiciousness than with other measures of psychosis-proneness. CFA showed excellent fit for the two-factor solution. FMMA retrieved a three-class solution with 176 subjects (72.5%) assigned to a baseline class, 54 (22.2%) to a "suspicious and mistrustful" class, and 13 (5.3%) to a "paranoid thinking" class. Compared to the baseline class, the other two classes had a higher risk of psychological distress and psychosis-proneness. CONCLUSIONS: The latent structure of paranoid thinking in young people appears dimensional. Although caution is advised when generalizing from studies on college students, screening for paranoid ideation in young people who complain about psychological distress might prove useful to prevent the development of severe and potentially debilitating conditions.

Quick Identification of the Risk of Psychosis: The Italian Version of the Prodromal Questionnaire-Brief.

BACKGROUND: Diagnosing people during the prodromal phase of an incipient psychosis can improve the chance of better outcome. In busy clinical settings, the ideal tool is a brief, easy-to-complete self-report questionnaire. OBJECTIVE: To test the psychometric properties of the Italian version of one of the most used screening tools for the identification of the risk of psychosis, the Prodromal Questionnaire-Brief (PQ-B). METHODS: Cross-sectional design. A convenience sample of college students was enrolled via snowball procedure (n=243; men: 45%). After understanding and signing the consent form, the participants received a booklet containing the following questionnaires: the 21-item Prodromal Questionnaire-Brief (PQ-B); the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Receiver operating characteristic (ROC) analysis was used to assess the capacity of the PQ-B to identify individuals at risk of psychosis as independently defined based on the combination of GHQ-12 and SPQ thresholds. RESULTS: The Italian version of the PQ-B revealed good internal consistency, test-retest reliability, and adequate convergent and divergent validity. The Youden method retrieved a cut-off = 7 for the PQ-B frequency score and a cut-off = 22 for the PQ-B distress score. Both PQ-B scores had a perfect (99%) negative predictive value. CONCLUSION: The PQ-B is a promising screening tool in two-stage protocols. The major advantage of the PQ-B is to exclude cases that are unlikely to be at risk of psychosis.

The role of set-shifting in auditory verbal hallucinations.

BACKGROUND: Auditory verbal hallucinations (AVHs) are a cardinal characteristic of psychosis. Recent research on the neuropsychological mechanism of AVHs has focused on source monitoring failure, but a few studies have suggested the involvement of attention, working memory, processing speed, verbal learning, memory, and executive functions. In this study we examined the neuropsychological profile of patients with AVHs, assuming that the mechanism underlying this symptom could be a dysfunction of specific cognitive domains. METHODS: A large neuropsychological battery including set-shifting, working memory, processing speed, attention, fluency, verbal learning and memory, and executive functions was administered to 90 patients with psychotic disorders and 44 healthy controls. The group of patients was divided into two groups: 46 patients with AVHs in the current episode and 44 who denied auditory hallucinations or other modalities in the current episode. AVHs were assessed with the Psychotic Symptom Rating Scales (PSYRATS); the Launay-Slade Hallucination Scale was used to measure long-term propensity to auditory verbal hallucination-like experiences (HLEs) in the sample. RESULTS: Patients showed poorer performances on all neuropsychological measures compared to the healthy controls' group. In the original dataset without missing data (n=58), patients with AVHs (n=29) presented poorer set shifting and verbal learning, higher levels of visual attention, and marginally significant poorer semantic fluency compared to patients without AVHs (n=29). In the logistic model on the multiple imputed dataset (n=90, 100 imputed datasets), lower capacity of set shifting and semantic fluency distinguished patients with AVHs from those without them. CONCLUSIONS: Patients experiencing persistent AVHs might fail to shift their attention away from the voices; poorer semantic fluency could be a secondary deficit of set-shifting failure.

Neuropsychological correlates of schizotypy: a systematic review and meta-analysis of cross-sectional studies.

INTRODUCTION: Cognitive deficits can precede the onset of psychotic episodes and predict the onset of the illness in individuals with schizotypy traits. In some studies, high levels of schizotypy were associated with impairments in memory, attention, executive functions, and verbal fluency. This review provides a more comprehensive understanding of cognitive impairments related to schizoytpy. METHODS:  A systematic review of "schizotypy and neuropsychological measures" was conducted, and it retrieved 67 studies. All papers with case-control design showing means and standard deviations from neuropsychological measures were included in a meta-analysis (n = 40). A comparison between our finding and another metaanalysis with patients with schizophrenia-spectrum disorders [Fatouros-Bergman, H., Cervenka, S., Flyckt, L., Edman, G., & Farde, L. (2014). Meta-analysis of cognitive performance in drugnaive patients with schizophrenia. Schizophrenia Research. doi: 10.1016/j.schres.2014.06.034 ] was performed to study the similarities on the MATRICS domains between the two disorders. RESULTS: We found evidence of worse functioning of verbal and visual-spatial working memory, and of language in people with schizotypy or with schizotypal traits. Working memory deficit is present in both schizotypy and schizophrenia with larger effect sizes compared to other domains. CONCLUSIONS: Working memory deficit might be a cognitive marker of the risk of psychosis. Interventions targeting cognitive deficits early may be crucial to the prevention of psychosis.

Prevalence and dimensionality of hallucination-like experiences in young adults.

BACKGROUND: The study of hallucination-like experiences (HLEs) in non-clinical populations is increasingly used to corroborate etiological models of psychosis. This method capitalizes on the absence of confounding factors that typically affect the study of hallucinations in clinical subjects. AIM: To estimate the prevalence of HLEs in young adults; validate the mutidimensionality and explore the correlates of latent HLEs clusters. METHODS: Cross-sectional survey design. The extended 16-item Launay-Slade Hallucination Scale (LSHS-E) and the 12-item General Health Questionnaire (GHQ-12) were administered to 649 Italian college students (males: 47%). Confirmatory factorial analysis was used to test multidimensionality of the LSHS-E. Hierarchical nested, progressively constrained models were used to assess configural, metric and scalar invariance of the LSHS-E. Latent class analysis was used to test the existence of different profiles of responding across the identified hallucination-proneness dimensions. RESULTS: Factor analysis showed that the four-factor model had the best fit. Factors were invariant across demographic variables and levels of psychological distress. Three latent classes were found: a large class with no HLEs (70% of participants), a multisensory HLEs class (18.8%), and a high hallucination-proneness class (11%). Among those reporting high levels of HLEs, approximately half reported scores indicative of considerable psychological distress. CONCLUSIONS: Although HLEs have a relatively high prevalence in the general population, the majority of those experiences happen in isolation and are not associated to psychological distress. Approximately half of those individuals experiencing high levels of HLEs report significant psychological distress. This may be indicative of general risk for mental health conditions rather than specific risk for psychosis.

Patterns of hand preference in Italian adolescent high-school students.

The Annett Hand Preference Questionnaire (AHPQ) is amongst the most widely used self-report measures of handedness. The psychometric properties of the AHPQ have been rarely evaluated outside the Anglo-Saxon culture where the majority of the studies on the AHPQ were done. In this study, 1,023 students (males=49.5%) from four large high schools operating in the district of Cagliari (Italy) were invited to fill in the Italian version of the AHPQ. The AHPQ was proved to measure a unidimensional latent trait, and the questionnaire was good at assessing deviation from right-handedness with high discrimination between subjects. Some items were more informative than others, and in particular the non-equivalence between the primary and the non-primary actions was confirmed by both the confirmatory factor and the item response theory analysis. The use of the rule of thumb that classifies subjects on the basis of the primary actions was supported for the distinction between consistent right- and left-handed. However, the mixed-handed group identified on the basis of the rule of thumb was not entirely consistent with the mixed-handed class predicted by the latent class analysis. Males were about twice as likely as females to be in the mixed-handed class.

Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review.

Background: With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is necessary to support health potential, to avoid that some individuals can incur in unintended inequities. In this paper, we address the complex causal process(es) that may generate risk of inequities, considering the so-called "Digital Determinants of health" (DDoH) and their relationship with determinants of health (DoH). Design and methods: We conducted a scoping review, according to methodological framework proposed in PRISMA-ScR guidelines, on the definition of DDoH (Scopus, Pubmed and Web of Science electronic databases). Inclusion criteria: papers on the definition of DDoH, no time limits, all study designs eligible. Results: There is an agreement on the link between DDoHs and "digital divide" and on their effects on a wide range of health, functioning outcomes, both as barriers and as facilitators. Authors proposed to modify or integrate with DDoHs the "Rainbow model" or other conceptual models on DoH. To promote DHE, authors suggest considering a multidimensional complex causal model, with interdependence among the different levels and the mutually reinforcing effects. Conclusion: To study DDoH and their relationship with main determinants of health could be a way to address the complex causal model in the promotion of DHE. However, as they act in a multidimensional causal context, any intervention may consider the interdependence among different involved levels, within them, and the mutually reinforcing effects. Further research is needed to gain a more complete picture of the field.

Sheehan Suicidality Tracking Scale (S-STS): reliability, convergent and discriminative validity in young Italian adults.

BACKGROUND AND PURPOSE: The Sheehan Suicidality Tracking Scale (S-STS) is a patient self-report or clinician-administered rating scale that tracks spontaneous and treatment-emergent suicidal ideation and behaviors. This study set out to evaluate the reliability, convergent and divergent validity of the S-STS in a sample of college students, a population with a high risk of completed and attempted suicide. METHODS: Cross-sectional, survey design. Participants (303 undergraduate students; males: 42%) completed several measures assessing psychological distress (General Health Questionnaire; GHQ); self-esteem (Rosenberg Self Esteem Scale; RSES); social support (Modified Social Support Survey; MOSSS); and suicidal behavior, including ideation and attempts (S-STS). RESULTS: Both internal consistency and test-retest stability were excellent for the S-STS-global score. The S-STS subscale on suicide ideation also showed good reliability, while the subscale on suicidal behavior showed some inconsistency at retest. Convergent and divergent validity of S-STS was confirmed. All S-STS items loaded on a single factor, which had an excellent fit for the unidimensional model, thus justifying the use of the S-STS as a screening tool. In a mediation model, self-esteem and social support explained 45% of the effects of psychological distress on suicide ideation and behavior as measured by the S-STS-global score. CONCLUSIONS: This study provided promising evidence on the convergent, divergent, internal consistency and test-retest stability of the Sheehan Suicidality Tracking Scale. The cross-sectional design and lack of measures of hopelessness and helplessness prevent any conclusion about the links of suicidal behavior with self-esteem and social support.

Beliefs and attitudes among Italian high school students toward people with severe mental disorders.

The negative attitudes surrounding mental disorders and their treatment are a major obstacle to the correct identification and treatment of emerging psychopathologies. The purpose of this study was to investigate mental health literacy in a large and representative sample of high school students in Italy, via a booklet containing several questionnaires delivered to 1032 teenagers. The items in the questionnaires probed knowledge about mental health and illness, stigmatization, stereotypes, behaviors, opinions, and attitudes. In general, the students had a reasonable knowledge of mental disorders and were able to distinguish these from somatic disorders. However, a large portion of the students nourished some misconceptions about mental disorders and was also rather skeptical about the effectiveness of treatment or the chance of recovery for people with severe mental disorders. Nevertheless, roughly half of the students reported being willing to provide help to someone with a mental disorder when in need. Poor mental health literacy is a major barrier to seeking help and receiving effective treatment. Young people are the ideal target of raising awareness and antistigma campaigns because they are at a higher risk for developing a psychopathology.

The "Reading the Mind in the Eyes" test: systematic review of psychometric properties and a validation study in Italy.

INTRODUCTION: The "Reading the Mind in the Eyes" test (henceforth, Eyes test) is a simple but advanced Theory of Mind test, and it is widely used across different cultures. This study assessed the reliability and construct (convergent and discriminant) validity of the Eyes test in Italy. METHODS: A sample of 18- to 32-year-old undergraduate students of both sexes (N=200, males=46%) were invited to fill in the Italian version of the Eyes test, the Empathy Quotient (EQ), the Toronto Alexithymia Scale (TAS), and the Marlowe-Crowne Social Desirability Scale (SDS). RESULTS: Internal consistency (Cronbach's alpha) was .605. Confirmatory factor analysis provided evidence for a unidimensional model, with maximal weighted internal consistency reliability=.719. Test-retest reliability for the Eyes test, as measured by intraclass correlation coefficient, was .833 (95% confidence interval=.745 to .902). Females scored significantly higher than males on both the Eyes test and the EQ, replicating earlier work. Those participants who scored lower than 30 on the EQ (n=10) also scored lower on the Eyes test than those who did not (p<.05). Eyes test scores were not related to social desirability. CONCLUSIONS: This study confirms the validity of the Eyes test. Both internal consistency and test-retest stability were good for the Italian version of the Eyes test.

Children with autism spectrum disorders and severe visual impairments: Some general principles for intervention according to the perspective of clinical psychology of disability.

In the last decades, an increasing number of researchers addressed the relationship between autism spectrum disorders (ASD) and severe visual impairment (SVI) (like blindness or very low visual acuity) and nowadays autism could be considered one of the most reported coexisting developmental disorders in children with blindness or other severe visual impairment. As ASD and SVI' signs and symptoms affect functioning and quality of life and different domains of functioning of children with this comorbidity, it is very important to support individuals and their families as soon as possible in the cycle of life and to promote specific interventions aimed to promote developmental potential of everyone with both ASD and VI, based on the unique balance between strengths, needs and abilities of everyone. Children and individuals with SVI and ASD and SVI are a very heterogeneous group, both about the areas of social interaction, communication, and behaviour, as well as about visual abilities and about all the other aspects of their neuropsychological and functional profiles that are influenced by their visual impairments itself, their ASD itself and the combination of them. In this paper, we aim to discuss some general principles useful to design and to develop specific interventions and to promote inclusion of children with ASD and SVI.

Hallucination-like experiences in the nonclinical population.

Unusual subjective experiences are relatively common in the general population and have been associated with an increased level of vulnerability to psychosis. The current study aimed to a) determine the distribution of hallucination-like experiences (HLEs) in a community sample of young adults, b) investigate their dimensional subtypes, and c) test the association of HLEs with indicators of poor mental health. Four hundred thirty-seven participants (men, 41%) completed a battery of questionnaires including the 16-item Launay-Slade Hallucination Scale (LSHS), the 12-item General Health Questionnaire (GHQ-12) and the 21-item Peters et al. Delusions Inventory (PDI). The LSHS correlated significantly with GHQ-12 and PDI. Individuals with higher levels of psychological distress were found to report higher frequencies of the HLEs compared with those in the reference range. Exploratory factor analysis of LSHS produced a four-factor solution: a) "auditory and visual HLEs," b) "multisensory HLEs," c) "intrusive thoughts," and d) "vivid daydreams." The current results provide further support for the multidimensional nature of hallucination proneness in the general population and indicate that some HLEs (particularly those related to intrusiveness of thought) are associated with a lower level of perceived well-being.

Left-handedness is statistically linked to lifetime experimentation with illicit drugs.

Handedness has been linked to an enhanced risk of alcohol abuse, while less is known about other drugs. A convenience sample of 1004 male and female Italian participants (females=58%) from the general community (18 to 65 years old: average age = 30; standard deviation = 10, median = 25) was asked about: handedness (preference in writing); lifetime use of alcohol, tobacco, and illicit drugs; levels of psychological distress, as measured by the General Health Questionnaire (GHQ); and levels of delusion proneness, as measured by the Peters et al. Delusions Inventory (PDI). Overall, 92 individuals (9.2%) were classified as left-handed, with no significant difference reported among genders. Lifetime use of illicit drugs, primarily cannabis, was reported by 20% of the sample. In a multiple logistic regression analysis, after taking into account sex, age, and caseness on GHQ and PDI, left-handed people in the sample were statistically more likely to report lifetime experimentation with heroin, ecstasy/amphetamine, and, marginally, hallucinogens, but not alcohol or tobacco. Different mechanisms might contribute to an explanation of greater lifetime experimentation with some illicit drugs among left-handed people as compared to right-handed people. However, replications with clinical samples are necessary before any definitive statements can be made.

Schizophrenia: from epidemiology to rehabilitation.

PURPOSE/OBJECTIVE: We discuss recent evidences about schizophrenia (frequency, onset, course, risk factors and genetics) and their influences to some epidemiological myths about schizophrenia diffuse between psychiatric and psychopathology clinicians. The scope is to evaluate if the new acquisitions may change the rehabilitation approaches to schizophrenia modifying the balance about the neurodevelopmental hypothesis of schizophrenia accepting that the cognitive deficits are produced by errors during the normal development of the brain (neurodevelopmental hypothesis) that remains stable in the course of illness and the neurodegenerative hypothesis according of which they derived from a degenerative process that goes on inexorably. RESEARCH METHOD/DESIGN: A review of the literature about epidemiology of schizophrenia has been performed and the contributions of some of these evidence to neurodevelopmental hypothesis and to rehabilitation has been described. RESULTS: It cannot be definitively concluded for or against the neurodevelopmental or degenerative hypothesis, but efforts in understanding basis of schizophrenia must go on. Until now, rehabilitation programs are based on the vulnerability-stress model: supposing an early deficit that go on stable during the life under favorable circumstances. So, rehabilitation approaches (as neuro-cognitive approaches, social skill training, cognitive-emotional training) are focused on the individual and micro-group coping skills, aiming to help people with schizophrenia to cope with environmental stress factors. CONCLUSIONS/IMPLICATIONS: Coping of cognitive deficits in schizophrenia may represents the starting-point for further research on schizophrenia, cohort studies and randomized trials are necessary to defined the range of effectiveness and the outcome of the treatments.

Telemedicine: Issues in the Analysis of Its Use in Elderly People and in People with Disabilities, According to the Perspective of the Clinical Psychology of Disability.

The recent COVID-19 pandemic has led to a sudden increase in the speed of the digitization process, which has affected several areas of life (public administration, schools, universities, and healthcare, and extending to so-called "digital citizenship") [...].