Heart rate variability, serum cortisol levels and temperament in a sample of workers exposed to occupational stress: a preliminary report.

Work-related stress is an emerging risk for psychiatric occupational disorders including Adjustment Disorders (AD). The aim of this study was to investigate in workers exposed to occupational stress suffering from AD about putative indices of stress and mental health resilience such as serum cortisol (seC) levels, Heart Rate Variability (HRV) and affective temperaments. We consecutively recruited 15 male and 15 female AD patients between workers evaluated for occupational stress at an Italian Occupational Medicine Unit. SeC levels were measured by specific immunoassay. HRV indices were recorded using Task Force® Monitor system (CNSystems, Graz, Austria). Specific questionnaires were used to measure perceived and occupational stress, psychopathological symptoms and temperament. Women presented higher levels of occupational stress, higher High-Frequency HRV (HF-HRV) and lower Low-Frequency HRV (LF-HRV) than men. SeC levels were positively correlated with LF-HRV values and negatively with HF-HRV values. The LF/HF ratio resulted to be inversely correlated with the score of Harm Avoidance temperament dimension and directly with the score of Reward Dependence temperament dimension. In conclusion, in AD patients exposed to occupational stress high seC levels and reward dependence appear to be associated with a pattern of HRV reflecting less mental health resilience.

Affective temperament and mood spectrum symptoms in workers suffering from work-related stress disorders.

INTRODUCTION: Adjustment Disorders (AD) which develop in response to work-related stressors represent a model of psychiatric occupational disease. Major Depressive Episodes (MDE) although often associated to work-related stressors are unlikely recognized by insurance institutes as occupational diseases. Affective temperament and mood spectrum symptoms are possible factors of vulnerability to stress. The aim of this study was to investigate if temperaments and mood spectrum symptoms had a different distribution among workers exposed to occupational stress and suffering from different psychiatric disorders (AD, MDE). METHODS: 156 AD and 97 MDE patients were recruited and evaluated with scales for perceived stress (PSM) and work-related stress (JCQ), for psychopathological symptoms (BDI-II, SAS), for affective temperament (TEMPS-A[P]) and for lifetime mood spectrum symptoms (MOODS-SR). Group comparisons and correlation analyses between variables were performed by parametric or non-parametric statistical tests according to variables distribution. RESULTS: The diagnostic groups did not differ for perceived and occupational stress levels. MDE patients reported significantly higher BDI-II score and MOODS-SR scores than AD ones. The hyperthymic temperament was significantly more frequent in AD than in MDE group. The hyperthymic score, differently from other dimensions of temperament and from mood spectrum components, negatively correlated or did not correlate with psychopathological symptoms severity and perceived stress levels. LIMITATIONS: Predictive limitation because of cross-sectional design. CONCLUSIONS: The hyperthymic temperament as opposed to lifetime subtreshold mood symptoms appears to be more represented in patients suffering from occupational AD than in MDE ones. Acknowledging vulnerability factors to job stress could support clinicians in occupational diseases prevention and management.

Do Autistic Traits Correlate with Post-Traumatic Stress and Mood Spectrum Symptoms among Workers Complaining of Occupational Stress?

The adult autism subthreshold spectrum model appears to be a useful tool for detecting possible vulnerability factors in order to develop mental disorders in the contest of work-related stress. The aim of the present study is to analyze the relationship between autism, mood, and post-traumatic spectrum in a cohort of subjects complaining of work-related stress before the COVID-19 pandemic. The authors carried out a retrospective investigation of both medical records and self-assessment tools of a sample of subjects evaluated at the Occupational Health Department of a University hospital in central Italy. Data showed significant correlations between the AdAS spectrum, TALS-SR, and MOODS total and domain scores. A multiple linear regression evidenced that both the AdAS spectrum and TAL-SR significantly predict the MOODS scores. In particular, mediation analysis showed both a direct and indirect, mediated by TALS-SR, effect of the AdAS Spectrum on the MOODS-SR. These results corroborate the role of autistic traits in influencing the traumatic impact of work-related stress and the development of mood spectrum symptoms.

Irritable Bowel Syndrome prevalence and work ability in a sample of healthcare workers exposed to occupational stress.

OBJECTIVE: Occupational stress represents a significant precipitating factor in different diseases but its role in Irritable Bowel Syndrome (IBS) needs to be clarified. The present cross-sectional study aimed at investigating the prevalence of IBS diagnosis in a sample of health workers and exploring the potential relationships between IBS, work-related stress levels and work ability. METHODS: 653 health workers undergoing periodical occupational health surveillance at the Occupational and Preventive Medicine Unit of a major University Hospital in central Italy, were consecutively recruited and screened for IBS diagnosis, according to ROMA IV criteria. The rating scales IBS Severity Scoring System (IBS-SSS), Demand-Control-Support Questionnaire (DCSQ) and Work Ability Index (WAI) were used to assess respectively IBS severity, occupational stress and work ability levels. RESULTS: IBS prevalence in the sample was 16.8%. Participants suffering from IBS were characterized by a higher prevalence of psychiatric diagnosis and sleep disturbances, higher levels of job strain and isostrain as well as by lower levels of work ability compared to non affected subjects. Moreover, the severity of IBS correlated positively with occupational stress and both were negatively associated with work ability. CONCLUSIONS: The present results suggest the need for preventive, organizational and management strategies at workplace aimed at protecting the health and well-being but also productivity of the worker with IBS.

Work and social functioning in frontline healthcare workers during the covid-19 pandemic in Italy: role of acute post-traumatic stress, depressive and anxiety symptoms.

BACKGROUND: Evidence highlights healthcare workers (HCWs) facing outbreaks, particularly the ongoing covid-19 pandemic, are at increased risk of negative mental health outcomes, particularly post-traumatic stress symptoms (PTSS), anxiety and depression. Data from previous outbreaks highlighted the risk for a negative impact on HCWs' social and occupational functioning, but scant data have investigated this issue in the framework of the covid-19 pandemic. A number of effective interventions have been proposed to support mental health and well-being of HCWs in emerging infectious outbreaks, but it is important to acknowledge the differential impact of mental disorders on different dimensions of functioning. METHODS: The study explored the associations between work and social functioning and PTSS, depression and anxiety in a sample of 265 frontline HCWs employed at a major university hospital in Italy (Pisa), facing the first period of the covid-19 pandemic. Individuals were assessed by means of the Impact of Event Scale-Revised (IES-R) for PTSS, the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the General Anxiety Disorder-7 Item (GAD-7) for anxiety symptoms and the Work and Social Adjustment Scale (WSAS) to assess work and social functioning. RESULTS: Higher levels of functioning impairment were found among individuals with moderate to severe acute PTSS, depressive and anxiety symptoms with respect to those without. Acute PTSS and depressive symptoms were predictive factors of impairment in each domain of functioning analyzed. Anxiety symptoms were associated with impairment in both work and home management activities. Frontline activity was associated with impairment in both private and social leisure activities. CONCLUSIONS: Long-term perspective studies are warranted to better investigate the psychopathological burden on HCWs' work and social functioning and to promote adequate intervention strategies.

Validation of the Italian version of the peritraumatic distress inventory: validity, reliability and factor analysis in a sample of healthcare workers.

Background: Peritraumatic distress as assessed by the Peritraumatic Distress Inventory (PDI), has been consistently shown to predict the development of Posttraumatic Stress Disorder (PTSD) after the exposure to a potentially traumatizing event. Objective: The present study aims to validate the Italian version of the PDI in a sample of Healthcare Workers (HCWs) exposed to COVID-19 related potentially traumatizing events. Method: N = 265 HCWs who repeatedly experienced the deaths of patients during COVID-19 emergency in Italy, were enrolled from the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy). They completed the PDI, Impact Event Scale - revised (IES-R) and the reactions to losses or upsetting events Trauma and Loss Spectrum - Self Report (TALS-SR) domain. Results: Internal consistency was good with a Cronbach's alpha coefficient was .874. The PDI correlated strongly with measures that was conceptually close (TALS-SR reactions to losses or upsetting events domain; r = .723, p < .001). Participants who scored above the cut-off for PTSD reported significantly higher PDI scores than those who did not (6.47 ± 5.25 vs. 19.11 ± 8.291, p < 0.001). The one-month test-retest reliability (n = 21) was excellent (ICC = .997). Finally, factor analyses revealed that the PDI exhibited a single-factor structure. Conclusions: the Italian version of the PDI showed good psychometric proprieties and may be used to detect those at risk for developing PTSD.

Antecedentes: Se ha demostrado sistemáticamente que el distrés peritraumático, evaluado por el Inventario de Distrés Peritraumático (PDI), predice el desarrollo del Trastorno de Estrés Postraumático (TEPT) después de la exposición a un evento potencialmente traumático.Objetivo: El presente estudio tiene por objeto validar la versión italiana del PDI en una muestra de Trabajadores de la Salud (TSP) expuestos a eventos potencialmente traumatizantes relacionados con COVID-19.Método: N=265 trabajadores de la salud que experimentaron repetidamente la muerte de pacientes durante la emergencia de COVID-19 en Italia, fueron enrolados en la Azienda Ospedaliero-Universitaria Pisana (Pisa, Italia). Completaron el PDI, Escala de Evento de Impacto - revisada (IES-R) y el Trauma y Espectro de Pérdidas- Auto reporte, dominio de las reacciones a las pérdidas o eventos perturbadores (TALS-SR).Resultados: La consistencia interna fue buena con un coeficiente alfa de Cronbach de 0,874. El PDI se correlacionó fuertemente con medidas que eran conceptualmente cercanas, (dominio de las reacciones a las pérdidas o eventos perturbadores TALS-SR; r=.723, p<.001). Los participantes que puntuaron por encima del límite para el TEPT reportaron puntuaciones de PDI significativamente más altas que los que no lo hicieron (6,47±5,25 vs. 19,11±8,291, p<0,001). La confiabilidad del test de un mes (n=21) fue excelente (ICC=.997). Finalmente, los análisis factoriales revelaron que el PDI exhibía una estructura de un solo factor.Conclusiones: la versión italiana del PDI mostró buenas propiedades psicométricas y puede ser usada para detectar a aquellos en riesgo de desarrollar TEPT.

Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19.

The COVID-19 outbreak has been associated with significant occupational stressors and challenges for healthcare workers (HCWs) including the risk of exposure to SARS-CoV-2. Many reports from all over the world have already found that HCWs have significant levels of self-reported anxiety, depression and even symptoms of post-traumatic stress disorder. Therefore, supporting mental health of HCWs is a crucial part of the public health response to the COVID-19 pandemic. The aim of the present review is to ascertain the interventions put in place worldwide in reducing stress in HCWs during the COVID-19 outbreak. We evidenced how only few countries have published specific psychological support intervention protocols for HCWs. All programs were developed in university associated hospitals and highlighted the importance of multidisciplinary collaboration. All of them had as their purpose to manage the psychosocial challenges to HCW's during the pandemic in order to prevent mental health problems.Whether one program offers distinct benefit compared to the others cannot be known given the heterogeneity of the protocols and the lack of a rigorous protocol and clinical outcomes. Further research is crucial to find out the best ways to support the resilience and mental well-being of HCWs.

Post-traumatic stress symptoms in an Italian cohort of subjects complaining occupational stress.

OBJECTIVE: Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms. The main aim of this investigation is to better understand the impact of post-traumatic stress symptomatology, using a specific self-assessment questionnaire, in subjects experiencing occupational stress with the rationale to address the variegated symptoms expressed by this particular population in a post-traumatic dimensional perspective. METHODS: Authors collected socio-demographic, occupational, and clinical data. They utilized Trauma and Loss Spectrum Self Report (TALS-SR), a questionnaire investigating post-traumatic stress symptoms. The population size was 345 subjects who presented at the Occupational Health Department of a university hospital over a 3 years period (2016-2018). RESULTS: Data analysis revealed 33.9% of subjects who met post-traumatic stress disorder (PTSD) criteria. Gender distribution of this set was (36.4% female, 31% male). A family history or personal history of mental disorders were related to higher scores in almost all TALS-SR domains and were related, respectively, to higher scores of criterion B "intrusion symptoms" (P = .014), criterion D "negative alterations in cognitions and mood" (P = .023), and criterion E "arousal" (P = .033) of PTSD. Differences in TALS-SR scores also emerged based on age and gender. CONCLUSIONS: PTSD symptoms manifest at a significant level in those who experience work-related stress. Personal background of individuals, both in terms of family and personal history for mental disorders, seems to increase their vulnerability to develop post-traumatic stress symptoms. This study suggests the importance of evaluating occupational stress from a post-traumatic stress perspective also at an early stage.

Sudden and persistent dysphonia within the framework of COVID-19: The case report of a nurse.

In December 2019, clusters of atypical pneumonia with unknown etiology emerged in the city of Wuhan in China. In early January 2020, the Center for Disease Control in China announced that it was identified a new coronavirus, first tentatively named 2019-nCoV and officially named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. On February 11, 2020 the WHO identified the disease caused by SARS-CoV-2 as COVID-19 (COronaVIrus Disease-19 based on the year of appearance). Although only a few months have passed since the beginning of this pandemic, numerous studies, case reports, reviews by leading international scientific and medical journals have been published. However, given the unpredictability of virus behaviour and the still limited knowledge about it, many aspects of the infection are still little known. A recent epidemiological study has shown the presence of dysphonia in some patients with COVID-19, with a minority reporting aphonia during the clinical course of the disease. This case study draws attention on a 50-year-old female nurse presented with a history of fatigue resulting from minor exertion and persistent dysphonia at the Occupational Health Department of a major University Hospital in central Italy. The patient had a history of COVID-19 infection, which lasted about two months with pulmonary and extrapulmonary symptoms. After two RT-PCR negativities for SARS-CoV-2, dysphonia and fatigue due to minor exertionpersisted. The patient, following the persistence of the symptomatology, was subject to numerous specialist examinations, which showed no organic alterations. Based on her clinical and instrumental history, we hypothesized a psychogenetic dysphonia related to COVID-19. This case report highlights the importance of personalized medicine with long-term follow-up and rubustpsychological support in patients who tested positive for COVID-19 and in particular in the categories at greatest risk of both contagion and adverse physical and mental outcomes like health care workers.

Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (Covid-19).

The novel coronavirus disease 2019 (COVID-19) is a global pandemic spreading worldwide, and Italy represented the first European country involved. Healthcare workers (HCWs) facing COVID-19 pandemic represented an at-risk population for new psychosocial COVID-19 strain and consequent mental health symptoms. The aim of the present study was to identify the possible impact of working contextual and personal variables (age, gender, working position, years of experience, proximity to infected patients) on professional quality of life, represented by compassion satisfaction (CS), burnout, and secondary traumatization (ST), in HCWs facing COVID-19 emergency. Further, two multivariable linear regression analyses were fitted to explore the association of mental health selected outcomes, anxiety and depression, with some personal and working characteristics that are COVID-19-related. A sample of 265 HCWs of a major university hospital in central Italy was consecutively recruited at the outpatient service of the Occupational Health Department during the acute phase of COVID-19 pandemic. HCWs were assessed by Professional Quality of Life-5 (ProQOL-5), the Nine-Item Patient Health Questionnaire (PHQ-9), and the Seven-Item Generalized Anxiety Disorder scale (GAD-7) to evaluate, respectively, CS, burnout, ST, and symptoms of depression and anxiety. Females showed higher ST than males, while frontline staff and healthcare assistants reported higher CS rather than second-line staff and physicians, respectively. Burnout and ST, besides some work or personal variables, were associated to depressive or anxiety scores. The COVID-19 pandemic represents a new working challenge for HCWs and intervention strategies to prevent burnout and ST to reduce the risk of adverse mental health outcomes are needed.

Mental disability management within occupational health surveillance.

INTRODUCTION: The management of workers with mental disability is a current topic of great interest. The aim of the article is to report the experience of managing cases of employees with mental disabilities in an Italian university hospital and to describe the preventive measures adopted and the therapeutic programs carried out. METHODS: A group of 100 workers suffering from psychiatric disorders has been included in a medical surveillance program lasting at least 6 months. The workers were followed up within a protocol that included psychiatric visits, psychotherapeutic interventions, visits by the occupational physician and medico-legal evaluations. Evaluation scales of disease severity and treatment efficacy (CGI) and overall functioning (GAF) were administered at the baseline and after 6 months of follow-up. RESULTS: The sample was mainly composed of nurses (44%) and nursing assistants (24%) and the most commonly diagnosed disorders were mood and anxiety disorders. Participation in the medical surveillance program with the implementation of specific therapeutic strategies and organizational interventions resulted in a statistically significant reduction in the severity of the disease and an improvement in overall functioning and made it possible to keep the job and place of work in almost all cases. DISCUSSION: The results of this experience allow us to affirm that the integration of skills is a valid tool both for the multidisciplinary diagnostic assessment and for the monitoring and management of workers with mental disability under periodic health surveillance.

Plasma Brain-Derived Neurotrophic Factor (BDNF) and serum cortisol levels in a sample of workers exposed to occupational stress and suffering from Adjustment Disorders.

INTRODUCTION: Decreased plasma BDNF (pBDNF) levels have been proposed as a biomarker in illness phases of mood disorders. Serum cortisol (seC) levels are an index of energy mobilization and stress. The aim of this cross-sectional study was to evaluate pBDNF and seC levels in workers exposed to occupational stress and suffering from Adjustment Disorders (AD) compared to healthy workers. METHODS: Plasma BDNF and seC levels were measured by means of specific immunoassays in 64 AD patients and 38 healthy controls. Perceived and occupational stress was evaluated in patients and controls using the Psychological Stress Measure (PSM) and the Job Content Questionnaire (JCQ). Psychopatological symptoms in patients were assessed using specific rating scales. RESULTS: Plasma BDNF levels resulted significantly higher in patients than in controls, whereas no significant differences were found for seC levels. In patients but not in controls pBDNF levels showed a significant positive correlation with seC levels. Perceived stress levels were positively correlated with all psychopatological rating scales scores. CONCLUSIONS: BDNF could play a key role in the pathophysiology of stress-related disorders and its peripheral levels elevation could contribute to protect neurons under stress. Further research is needed focusing on biomarkers for stress-related disorders as a potential tool for the diagnosis and prevention of occupational diseases.

Disruption of sleep-wake continuum in myotonic dystrophy type 1: Beyond conventional sleep staging.

Sleep disruption and excessive daytime sleepiness are well recognised symptoms in myotonic dystrophy type 1 (DM1), where a central dysfunction of sleep-wake regulation may play a pivotal role. Few studies evaluated sleep macrostructure in DM1, but none investigated more refined sleep variables. Eight DM1 patients (6 male, aged 20-50 years) and 10 healthy controls (7 male, aged 22-67 years) underwent nocturnal polysomnography and multiple sleep latency test. Sleep stages and events were scored according to standard criteria; sleep microstructure was analyzed through cyclic alternating pattern. Relative and absolute delta powers were computed for whole non REM and each non REM period. DM1 patients showed increased REM sleep and decreased N2. N3, although not significantly, was increased. Three patients, but no controls, had sleep-onset REM period in nocturnal sleep. DM1 patients showed slower delta power dissipation across the night, and increased sleep instability (CAP rate). Multiple sleep latency tests showed shorter sleep latencies, five patients presenting at least one sleep-onset REM period and, when including also night sleep, two sleep-onset REM periods. Our data confirm a narcoleptic-like phenotype in DM1 with a prominent REM sleep dysregulation, that may account for daytime sleepiness, together with increased sleep instability and impaired delta power dissipation that seem peculiar of the disease.

A mobile app for patients with Pompe disease and its possible clinical applications.

In recent years, the potential of smart technology to provide innovative solutions for disease management has raised high expectations for patients' and healthcare professionals' community. We developed a mobile app, called AIGkit, specifically designed for adult patients with Pompe disease, with the aim to help them manage the burden of illness-related factors, and also to provide clinicians with continuous tracking of each patient in real-time and ambient conditions of everyday life. We present the AIGkit as an innovative approach exploiting cutting-edge technology to improve quality of care and research into neuromuscular disorders.

Relationship between neuropsychological impairment and grey and white matter changes in adult-onset myotonic dystrophy type 1.

Myotonic dystrophy type 1 (DM1) has a wide phenotypic spectrum and potentially may affect central nervous system with mild to severe involvement. Our aim was to investigate grey matter (GM) and white matter (WM) structural alterations in a sample of adult-onset DM1 patients and to evaluate relationship with clinical and cognitive variables. Thirty DM1 patients underwent neuropsychological investigation and 3T-MRI protocol. GM and WM changes were evaluated calculating brain parenchymal fraction (BPF), voxel-based morphometry (VBM), white matter lesion load (LL% and Fazekas scale) and tract based spatial statistical (TBSS). Patients showed main impairment in tests exploring executive and mnesic domains with visuo-spatial involvement, significantly related to BPF. VBM revealed clusters of widespread GM reduction and TBSS revealed areas of decreased fractional anisotropy (FA) and increased radial diffusivity (RD), mean diffusivity (MD) and axial diffusivity (AD) in patients compared to a group of matched healthy controls. Multiple regression analyses showed areas of significant negative relationship between left temporal atrophy and verbal memory, between RD and mnesic and visuo-spatial cognitive domains, and between AD and verbal memory. TBSS results indicate that the involvement of normal appearance WM, beyond the signal changes detected with conventional MR imaging (Fazekas scale and LL%), was associated with neuropsychological deficit. These data suggest that disrupted complex neuronal networks can underlie cognitive-behavioural dysfunctions in DM1.

Disease awareness in myotonic dystrophy type 1: an observational cross-sectional study.

BACKGROUND: Myotonic dystrophy type 1 (Steinert's disease or DM1), the most common form of autosomal dominant muscular dystrophy in adults, is a multisystem disorder, affecting skeletal muscle as well as eyes, heart, gastrointestinal tract, endocrine system, and central nervous system, finally responsible of increasing disabilities and secondary social consequences. To date, DM1-related brain involvement represents a challenging field of research. It is well known that DM1 patients frequently present neuropsychological disturbances and psychiatric comorbidities among which reduced awareness of disease burden and its progression, also defined as anosognosia, is common in clinical practice, this leading to secondary misattribution of symptoms, delay in timely diagnostic procedures and low compliance to treatment. METHODS: Here we present an observational cross sectional study in which disease-related cognitive dysfunctions and quality of life were assessed by a protocol finally designed to estimate the prevalence of disease awareness in a sample of 65 adult-onset DM1 patients. RESULTS: Our analysis showed that in DM1 patients several cognitive functions, including executive and mnesic domains with visuo-spatial involvement, were affected. The assessment of anosognosia revealed that a high percentage (51.6%) of DM1 subjects was disease unaware. The reduced illness awareness occurs across different physical and life domains, and it appears more prominent in Activities and Independence domains investigated by the Individualized Neuromuscular Quality Of Life (INQoL) questionnaire. Moreover, the unawareness resulted significantly related (at p <0.05 and p < 0.01) to the performance failure in cognitive tests, specifically in the domains of visuo-spatial memory, cognitive flexibility and conceptualization. CONCLUSIONS: The obtained data confirm, by a systematic analysis, what's the common clinical perceiving of disease unawareness in Steinert's disease, this related to the already known cognitive-behavioural impairment of frontal type in affected patients. We believe that a deep knowledge of this aspect will be useful for medical practice in the management of patients with DM1, also for guidance in occupational and social interventions, definition of outcome measures and in preparation of trial readiness.

Work-related stress disorders: variability in clinical expression and pitfalls in psychiatric diagnosis.

BACKGROUND: Putative occupational stress-related psychiatric disorders are Adjustment Disorders (AD) and Post-Traumatic Stress Disorder (PTSD). Mood Disorders (MD) are not excluded but are unlikely to be identified as occupational diseases. The differential diagnosis between AD and MD is not easy and is based on strict categorical criteria. OBJECTIVES: The aim of this study  was to explore differences in personality and mood spectrum symptoms among workers investigated for occupational stress suffering from AD or MD. METHODS: Sixty-two patients with AD and 43 with MD were recruited and evaluated by means of rating scales for psychosocial occupational risk and work-related stress (WHS, CDL, OSQ), for sleep disturbances (PSQI), for personality disorders (SCID-II) and for mood spectrum symptoms (MOODS-SR). RESULTS: The diagnostic groups did not differ for WHS, OSQ and PSQI scores. The duration of exposure to stressful/adversative work situations was significantly higher in the MD group (p=0.03). Positive family psychiatric history (p=0.005), personality disorders (p=0.009) and pathological personality traits (p<0.0001) were significantly more frequent in the MD group. The MOODS-SR questionnaire total score (p=0.019) and the manic component score (p=0.001) but not the depressive score were significantly higher in the MD group. CONCLUSIONS: The present study suggests that  positive family psychiatric history, pathological personality traits and  spectrum manic symptoms represent markers of vulnerability and low resilience for workers exposed to occupational stress. These characteristics could weaken the etiological relationship between work-related stress and an initial  major depressive episode when it is under investigation as a possible occupational disease.

Hard ways towards adulthood: the transition phase in young people with myotonic dystrophy.

Myotonic dystrophy type 1 (DM1), also called Steinert's disease, is a genetic multisystem disorder that has raised, in the last years, high interest because of the high variable clinical spectrum and related disability. Children with myotonic dystrophy are affected by behavioural problems and intellectual disability, finally impacting on their degree of engagement in family, work and social activities. The transition phase, representing the process of moving from adolescence to adulthood, can be severely affected by growing up with a neuromuscular disorder, with significant impact on patient's and families' quality of life. Although conceptual models of health assistance for individual with genetic disorders have already been proposed the burden for the patient and his family is still relevant. Therefore to afford this critical condition it would be suitable to plan proper educational and psychosocial programs, identifying areas of unmet needs and targeted health objectives that ensure the right support to DM1 population.

System consolidation of spatial memories in mice: effects of enriched environment.

Environmental enrichment (EE) is known to enhance learning and memory. Declarative memories are thought to undergo a first rapid and local consolidation process, followed by a prolonged process of system consolidation, which consist in a time-dependent gradual reorganization of brain regions supporting remote memory storage and crucial for the formation of enduring memories. At present, it is not known whether EE can affect the process of declarative memory system consolidation. We characterized the time course of hippocampal and cortical activation following recall of progressively more remote spatial memories. Wild-type mice either exposed to EE for 40 days or left in standard environment were subjected to spatial learning in the Morris water maze and to the probe test 1, 10, 20, 30, and 50 days after learning. Following the probe test, regional expression of the inducible immediate early gene c-Fos was mapped by immunohistochemistry, as an indicator of neuronal activity. We found that activation of the medial prefrontal cortex (mPFC), suggested to have a privileged role in processing remote spatial memories, was evident at shorter time intervals after learning in EE mice; in addition, EE induced the progressive activation of a distributed cortical network not activated in non-EE mice. This suggests that EE not only accelerates the process of mPFC recruitment but also recruits additional cortical areas into the network supporting remote spatial memories.