Promoting the well-being of mothers with multidisciplinary psychosocial interventions in the perinatal period.

BACKGROUND: Antenatal depressive and anxiety symptoms are common and may persist over time after delivery, with negative consequences on the mothers and their children. Evidence on the efficacy of psychological and pharmacological interventions during pregnancy aimed at preventing post-partum depression is controversial. METHODS: A consecutive sample of 318 women presenting for scheduled obstetric visits during pregnancy was screened for risk factors and anxiety or depressive symptoms. Based on the screening results, women were classified into three groups at increasing risk of post-partum depression (PPD) and were offered different interventions. RESULTS: Depressive or anxiety symptoms were found in 91 (28.6%) women, 89 (28.0%) had low risk of PPD and 138 (43.4%) had no risk of PPD. The multidisciplinary psychosocial interventions offered to women with clinical symptoms were well accepted, with an uptake of 76/91 (83.5%). Thirty-three women who did not improve with psychotherapy were offered sertraline or paroxetine as a second-line treatment: 7 accepted and 26 (78.8%) refused. Eleven women already on medication at baseline continued their treatment along with the MPI. The MPI interventions had some positive effects in terms of post-partum recovery, symptom reduction, and in preventing a new onset of depression. Among the 227 non-symptomatic during pregnancy, only 5 (2.2%) developed symptoms in the post-partum period. At 12 months post-partum, 84.6% of women who were symptomatic at 2 months post-partum recovered. LIMITATIONS: Our results should be interpreted in light of important limitations, including the lack of a control group that was not offered the MPI, the lack of information on the reasons for refusal and discontinuation and on the number of psychotherapy sessions attended. CONCLUSIONS: Our findings underscore the potential usefulness of MPI in recognizing early signs or symptoms during pregnancy and the advantage of building specific interventions for preventing post-natal depression. The MPI has positive effects on women with depressive or anxiety symptoms during pregnancy, that however did not exceed significantly those observed in women who refused the intervention. Thus, in the absence of a control group, our results are preliminary and warrant confirmation and testing in future randomized clinical trials.

[O-arm navigation in spinal surgery for complex cases]. / Navegación O-arm en cirugía vertebral para casos complejos.

The intraoperative computer-assisted navigation technique has evolved and changed the way we approach certain complex cases in the vertebral pathologies. The main advantages of this technique are that it increases the accuracy of the procedure, reduces its morbidity and invasiveness, diminishes the radiation dose and improves surgical protocols. In addition to the transpedicular fixation, the navigation system is useful in a high variety of pathologies such as spinal decompression or tumor resection. In the present study, we show several cases where navigation is used intraoperatively in different pathologies and their clinical outcomes.

La técnica asistida por navegación intraoperatoria ha evolucionado y cambiado la forma de abordar ciertos casos complejos en la patología vertebral. Las principales ventajas de esta técnica consisten en aumentar la precisión de la intervención, reducir su morbilidad y carácter invasivo, disminuir la dosis de exposición radiológica y mejorar los protocolos quirúrgicos. Además de la fijación transpedicular, el sistema de navegación es útil en una alta variedad de padecimientos, como la descompresión medular o la resección tumoral. En el presente estudio mostramos varios casos donde se ha usado la navegación intraoperatoria en diferentes patologías y sus resultados clínicos.

Navegación O-arm en cirugía vertebral para casos complejos / O-ARM navigation in spinal surgery for complex cases

Resumen: La técnica asistida por navegación intraoperatoria ha evolucionado y cambiado la forma de abordar ciertos casos complejos en la patología vertebral. Las principales ventajas de esta técnica consisten en aumentar la precisión de la intervención, reducir su morbilidad y carácter invasivo, disminuir la dosis de exposición radiológica y mejorar los protocolos quirúrgicos. Además de la fijación transpedicular, el sistema de navegación es útil en una alta variedad de padecimientos, como la descompresión medular o la resección tumoral. En el presente estudio mostramos varios casos donde se ha usado la navegación intraoperatoria en diferentes patologías y sus resultados clínicos.

Abstract: The intraoperative computer-assisted navigation technique has evolved and changed the way we approach certain complex cases in the vertebral pathologies. The main advantages of this technique are that it increases the accuracy of the procedure, reduces its morbidity and invasiveness, diminishes the radiation dose and improves surgical protocols. In addition to the transpedicular fixation, the navigation system is useful in a high variety of pathologies such as spinal decompression or tumor resection. In the present study, we show several cases where navigation is used intraoperatively in different pathologies and their clinical outcomes.

Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years.

INTRODUCTION: Fractures of the carpal bones are often difficult to diagnose and treat due to the complex bone architecture of this region. Hamate fractures, particularly body fractures, are extremely uncommon. PRESENTATION OF CASE: We present a case of a coronal fracture of the hamate associated with a fracture of the base of the fourth metacarpal, which was treated by open reduction and internal fixation. DISCUSSION: Some of hamate body fractures are associated with other injuries like metacarpal fractures. Its diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. This fracture is a very rare lesion that can raise questions about their most adequate diagnostic and therapeutic approaches. CONCLUSION: After reviewing the literature, we conclude that there is a high rate of delay in the diagnosis of these lesions, probably due to their rarity and to the lack of radiological studies specifically targeting this region. Despite this, surgical treatment in its different modalities has been shown to have the best clinical and functional results.

Effects of dehydroepiandrosterone (DHEA) supplementation on hormonal, metabolic and behavioral status in patients with hypoadrenalism.

Oral DHEA administration to patients with hypoadrenalism, in addition to glucocorticoid and mineralcorticoid replacement, may improve both well-being and hormonal/metabolic parameters. Twenty patients (13 men, 7 women, 26-76 yr, 11 with Addison's disease, 9 with central hypoadrenalism) were recruited in a placebo-controlled, randomized study. Hormone levels, carbohydrate and lipid parameters, bone metabolism, body composition and psychological parameters were evaluated at baseline and after treatment with DHEA 50 mg/day or placebo for 4 months. After 4 months of DHEA administration, serum DHEAS levels raised both in men (from 0.71+/-0.18 to 8.28+/-1.66 micropmol/l, p<0.005) and in women (from 0.25+/-0.07 to 5.65+/-1.93 micromol/l, p<0.05). Only in hypoadrenal women an increase in testosterone (T; from 0.4+/-0.1 to 1.45+/-0.26 nmol/l, p<0.05) and androstenedione (A; from 0.86+/-0.34 to 2.05+/-0.29 nmol/l, p<0.05) levels was observed. In men no significant modifications in T and 17-hydroxyprogesterone (17-OHP) levels were found, whereas serum SHBG significantly decreased. As far as the metabolic parameters are concerned, only in patients with Addison's disease a significant decrease in total cholesterol and in low-density lipoproteins after 4 months of DHEA administration was found. No changes in glucose metabolism and insulin sensitivity were observed. In basal conditions, mean serum osteocalcin (OC) was normal and significantly decreased after DHEA treatment. A significant reduction in body fat mass percentage (BF%) after DHEA administration was observed. As far as well-being is concerned, DHEA replacement did not cause any relevant variation of subjective health scales and sexuality in both sexes. Our study confirms that DHEA may be beneficial for female patients with hypoadrenalism, mainly in restoring androgen levels. Concerning the health status, more sensitive and specific instruments to measure the effects of DHEA treatment could be necessary.

Psychosocial problems secondary to cancer: an Italian multicentre survey of consultation-liaison psychiatry in oncology. Italian Consultation-Liaison Group.

Data relative to consultation-liaison psychiatry (C-L) in oncology are lacking. In order to examine this area, a multicentre investigation was conducted in 17 general hospitals in Italy. All psychiatric consultation requests for cancer patients referred to C-L during a 1-year period were evaluated. Only 5% (n=217 referred patients: 114 men and 103 women) of all C-L activity were for cancer patients. Most were 'routine' consultations (72%) for current psychiatric symptoms (69%) or coping/compliance problems (12%). Previous psychological or psychiatric disorders were shown in 32% of cases. Approximately 40% of patients were not informed of their referral to C-L. The most frequent ICD-10 psychiatric diagnoses were adjustment disorders (27%) and major affective disorders (23%). Transfer to psychiatric units was low (1%). These findings indicate the need for improvement of referral criteria to C-L and closer attention to continuity of psychosocial care of cancer patients during hospitalisation and post-discharge.

A multicenter investigation of consultation-liaison psychiatry in Italy. Italian C-L Group.

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.

Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches.

A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.

Empowering women in villages: all-women village councils in Maharashtra, India.

PIP: This study examines the impact of all-women panchayats (village councils) in three small villages in Maharashtra state in India on women's well-being. Field work was conducted during 1991-93 in the villages of Yenora, Metikheda, and Vitner. In 1989 there were nine all-women village councils, which were elected owing to the efforts of a large independent farmers' organization, the Shetkari Sanghatana (SS). Findings indicate that the all-women village councils made a significant difference in women's lives. The mix of male and female leaders varied between the villages and affected the outcomes. The author argues that the strategy for empowerment is more successful than enclave strategies that focus only on a poor minority or radical feminist strategies that insist on women's action and hostility toward male involvement. The legal mandate for the panchayat as a vehicle for development was adopted in Maharashtra in 1965. However, the participation of the community in panchayats was only an assumption. In 1988-89, the 73rd Constitutional Amendment was passed to give power to panchayats and to reserve 30% of the legislative seats for women and backward castes. Prior to 1986, women were appointed, but not elected, to panchayats. During 1986-91, women's interest in local political power increased. As a result of the all-women village councils, women's attitudes toward themselves and their daughters changed in all three villages. Panchayats improved the accessibility of fuel, water, and fodder, which relieved women of their burdens and allowed girls to attend schools. Women's mobility and assets increased. The number of wife-beating incidents declined. Women gained respect in their families and in their maternal homes. Women still had dual labor roles in the labor force and at home. Two of the villages illustrated effective women's leadership. The cases illustrate the effectiveness of a broad-based strategy for women's empowerment.^ieng

Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study.

The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.

[Orodental hygiene habits in preadolescents and adolescents from 2 urban and 2 rural secondary schools]. / Estudio de hábitos de higiene bucodental en preadolescentes y adolescentes de dos colegios urbanos y dos rurales.

OBJECTIVE: Buccodental health is a problem of high prevalence, including mainly caries, malocclusion and malposition. Dental caries is the principal oral problem of childhood and adolescence. The objective of our study was to know the information, customs and attitudes in relationship to buccodental hygiene of preadolescent and adolescent students. MATERIAL AND METHODS: The design is a cross-sectional epidemiological study of two urban (n = 330 students) and two rural (n = 270 students) schools. We performed an individual interview with the students that included 27 items concerning knowledge, customs and attitudes about buccodental hygiene. RESULTS: The prevalence of caries is 24.5% in our population. We found the best buccodental hygiene in rural students and girls. The adolescents are more problematic than preadolescents. CONCLUSION: It is important to make health examinations and to have health education in school, especially concerning some pathologies with a higher prevalence such as dental caries and other buccodental diseases. The first step towards good health education is to know the reality of the problem. A higher level of sanitary education in rural schools is most likely the cause for better results in this population. The girls have more conscience of this disease. It is necessary to increase the health education about buccodental hygiene, mainly in adolescence.

Heterosexuals and HIV disease: a controlled investigation into the psychosocial factors associated with psychiatric morbidity.

The aim of the study was to evaluate the prevalence of current and past psychiatric morbidity among HIV seropositive and HIV seronegative heterosexual men and women and to identify the psychosocial factors associated with psychiatric morbidity. Twenty-four asymptomatic HIV seropositive and twenty-six HIV seronegative heterosexuals were included in the study. Outcome measures included socio-demographic data, psychiatric history, current psychological status (Zung Self-Report Anxiety Scale, Zung Self-Report Depression Scale, Symptom Check List 90-R), Social Supports and Locus of Control Scales, and information on changes in work, social, and sexual life after HIV testing. There were no significant differences between HIV seropositive heterosexuals and HIV seronegative controls on any of the outcome measures. Levels of psychiatric morbidity were generally low and similar to those expected in a general out-patient medical population. Multiple regression analyses showed that degree of social support was the only significant factor associated with psychiatric morbidity. The implications of the findings are discussed.

Experience with psoriasis in a psychosomatic dermatology clinic.

We studied 179 psoriatic patients by semistructured colloquia and psychometric tests and determined their cutaneous psycho-neurophysiological profiles by biofeedback methods. The Paykel scale for stressful events showed that 72% of psoriatics had experienced significant stressful events about one month before the appearance of the psoriasis. The Zung test for anxiety and depression showed a high level of anxiety in the psoriatic patients. 64% of the patients who were treated by BFBtraining had a decrease in their PASI index for severity and the extent of the disease and also fewer recurrences at the one-year follow-up. The results of the World Experience Inventory indicated difficulties related to body image and to relationships with others. Psoriasis influenced the sexuality of the patients. It is always difficult when one is afflicted by ill health to enjoy life and the general scores of SWL (Satisfaction with Life), were significantly lower than those of a control group.

The psychosocial impact of HIV infection in gay men, drug users and heterosexuals. Controlled investigation.

The aim of this study was to establish the prevalence of current and past psychiatric morbidity in HIV seropositive asymptomatic subjects belonging to three transmission categories (gay men, intravenous drug users, and heterosexuals) compared with that found in HIV seronegative controls from the same groups. A cross-sectional, controlled study including 279 seropositive subjects belonging to groups II and III defined by the Center for Disease Control (94 gay men, 157 intravenous drug users, and 28 heterosexuals) and 159 seronegative subjects (38 gay men, 91 intravenous drug users, and 30 heterosexuals) is reported. Outcome measures included standardised, self-report questionnaires and a semistructured interview to assess current psychopathological status and past psychiatric history. In addition, a psychiatric diagnosis according to DSM-III-R criteria Axis I and II was made in the seropositive subjects. Results showed that these subjects differed very little from the controls and that overall levels of psychiatric disturbances in both groups were low and similar to those found in other life-threatening illnesses. Furthermore, intravenous drug users, regardless of HIV serological status, had the highest levels of psychological morbidity. Psychosocial distress was associated with previous and current lifestyle, independently of HIV status.

The psychosocial impact of HIV infection in women.

The aim of the investigation was to study the prevalence of current and past psychiatric morbidity and psychosocial problems in HIV seropositive (HIV +ve) asymptomatic women. A cross-sectional controlled study including 57 HIV +ve women belonging to CDC group II and III (43 intravenous drug users and 14 non-IVDUs heterosexuals) and 23 HIV -ve women (15 intravenous drug users and 8 non-IVDUs heterosexuals) is reported. Outcome measures included, past psychiatric history, current psychological status (Zung Anxiety and Depression scales, Symptom Check List 90-Revised), Social Supports and Locus of Control Scales, and information on changes in work, social and sexual life after HIV testing. Results showed that HIV +ve women differed very little from HIV -ve controls regarding outcome measures and indeed for some variables HIV infected women had lower levels of psychological morbidity. Multiple regression analyses showed that alcohol misuse and a predominantly external locus of control accounted for the 29% of the variance of psychiatric distress (F = 9.23, p < 0.0006). The implications of the findings are discussed.

[The psychological impact of HIV infection and the "burn-out" syndrome amongst health care workers dealing with HIV seropositive and AIDS patients]. / L'impatto psicosociale dell'infezione da HIV sul personale sanitario e la sindrome del "burn-out" nel corso dell'assistenza ai pazienti sieropositivi e AIDS.

HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) health care personnel is faced with a life threatening disease and with problems concerning fear of contagion and sense of professional inadequacy in dealing with chronically and terminal patients who may be suffering from psychosocial and neuropsychiatric problems. Therefore, HIV/AIDS health care workers may develop the "burn-out syndrome" (BOS) that is characterized by emotional distress, lowered job productivity and spread of work problems to family and conjugal relationships. BOS aetiology involves individual, organizational and socio-cultural factors and its consequences may negatively affect quality of care of HIV/AIDS patients. BOS prevention includes continuing staff training and education on HIV-related issues and support groups for health workers.

Factors associated with psychological help-seeking in HIV disease.

The study was aimed at evaluating the psychosocial and psychopathological characteristics of individuals with Human Immunodeficiency Virus (HIV) infection seeking psychological help compared with a sample not seeking help. Two hundred and seventy-one HIV seropositive (HIV+ve) subjects belonging to three transmission categories (90 gay men, 154 intravenous drug users and 27 heterosexuals) who were assessed at their first clinic appointment and offered access to psychological help were studied. Subsequently, it was found that 45 (17%) took advantage of the offer of psychological help, and attended a specialist clinic, while 226 (83%) did not seek help. Stepwise logistic regression analysis was used to establish the characteristics of subjects who received psychological help. Results showed that five factors identified at the time of first clinic appointment were significantly associated with seeking psychological help subsequently: (1) having a current DSM-III-R Axis I psychiatric diagnosis; (2) being single; (3) belief of being affected by a serious physical illness (negative correlation); (4) higher level of education; and (5) no past or current history of substance misuse. The implications of the findings are discussed.