Internal structure and psychometric properties of Diabetes Distress Scale for Type 1 Diabetes.

Diabetes-related distress (DD) refers to the worries and concerns about the nature and complications of Type 1 diabetes (T1D) and the frustration with the burdens of its management. Research suggests that sources of DD among people with T1D differ from those among Type 2. Many adults with T1D experience difficulties that are often unrecognised, unaddressed and mismanaged. The Diabetes Distress Scale for Type 1 diabetes (T1-DDS), is a newly developed instrument that is used to identify the specific sources of DD, exclusively for adults with T1D. The aim of the study was to examine the factorial structure of T1-DDS in Greek population and to evaluate its psychometric properties for use in research and clinical practice. A sample of 102 adults with type 1 diabetes, aged 38.85 (±10.08) years, females 63%, BMI 21.45 (±5.84) kg/m2, diabetes duration 21.35 (±13.73) years, HbA1c 7.5% (±1.2;58 mmol/mol) completed the translated T1-DDS. Exploratory factor analysis (EFA) and confirmatory (CFA) factor analysis were used to investigate the factor structure of the scale. Reliability was explored by internal consistency. Convergent validity was assessed through correlations with measures of psychological distress and diabetes status variables. Differential validity was assessed on the basis of known-group comparisons, with expected differences in distress for gender and age. Confirmatory factor analysis provided a low fit for the 7-factor model. Exploratory factor analysis supported a conceptually justifiable 5-factor model in the Greek sample. Internal consistencies of all five factors ranged from α=0.76 to 0.89. As expected, all factors were correlated with psychological distress [(r=0.510, p<0.01) for the total scale]. Management distress was positively correlated with HbA1c (r=0.397, p<0.01) and BMI (r=0.296, p<0.01), and Family/Friends distress was negatively correlated with duration of diabetes (r=-0.298, p<0.01). Further analyses showed that men exhibited higher score in relations to the social context of diabetes management (t=2.164, p<0.05 for Negative Social Perceptions), (t=2.572, p<0.05 for Family/Friends distress), and younger participants reported significantly higher distress in relation to reactions from friends and family (t=2.106, p<0.05). The Greek version of T1-DDS is a valid and reliable measure of diabetes-related distress that can be used in clinical practice to address personal needs and direct targeted interventions.

Psychometric properties and factor structure of the Greek version of Reflective Functioning Questionnaire.

The ability to mentalize, namely to understand, interpret and effectively communicate the mental state of self and others is considered important in self-organisation and affect regulation. The aim of the present study was to provide data on the validation process of Reflective Functioning Questionnaire (RFQ), a recently developed measure of mentalizing, in order to evaluate its use in research and in clinical practice for Greek populations. A total of 219 participants (102 people with type 1 diabetes and 117 healthy individuals) completed the RFQ. A principal component analysis supported the 2-factor model (RF certainty for mental states and RF uncertainty for mental states) in both samples. Internal consistencies of both subscales were satisfactory (α=0.80 for RF certainty and α=0.79 for RF uncertainty). Relationships with validity measures of psychological distress, empathy and emotional intelligence provided further support for the psychometric properties of the scale. As expected, there were positive associations between the degree of certainty concerning mental states and emotional intelligence (r=0.390, p<0.01), as well as empathy (r=0.292, p<0.01) in general population. Conversely, negative associations were found between the degree of certainty about mental states and psychological distress in the diabetes group (r=-0.470, p<0.01) and in general population (r=0.320, p<0.01). A reverse pattern of associations was observed between the degree of uncertainty about mental states and emotional intelligence (r=-0.265, p<0.01) in general population, as well as psychological distress in both the diabetes group (r=0.590, p<0.01) and in general population (r=0.330, p<0.01). Also, as expected, there were differences across age groups, with older participants reporting a more balanced reflective functioning - with higher certainty levels in the diabetes group (t=-2.133, p>0.05) and the healthy participants (t=-2.738, p>0.05) and lower uncertainty levels in the diabetes group (t=-2.480, p>0.05) and the healthy participants (t=-2.779, p>0.05). The data collected so far support the reliability and validity of the measure that can be used in research to address mentalizing impairments. However, further research is needed to evaluate its consistency thought time with a test-retest analysis, and to evidence its factorial structure with a confirmatory factor analysis. In addition, it is of primary importance to extend the validity testing of RFQ in clinical populations to further support its use in clinical practice.

Prevalence of women's worries, anxiety, and depression during pregnancy in a public hospital setting in Greece.

Many studies have examined the prevalence and risk factors of postnatal depression. However, only a few studies have explored the prevalence of anxiety and depressive symptoms in pregnancy. The aim of this study was to investigate the prevalence of worries, antenatal anxiety (AA), and antenatal depression (AD). The sample of this study consisted of 163 pregnant women with gestational age from 11 to 26 weeks. Worries were measured with Cambridge Worry Scale (CWS), anxiety was measured with State-Trait Anxiety Inventory (STAI), and depression was measured with Center for Epidemiologic Studies-Depression scale (CES-D). Depressive symptoms were found in 32.7% of the participants and 44.4% had STAI scores indicating anxiety symptoms of clinical significance. The mean score for total CWS was 26 (SD = 12.3). It is noteworthy that the most important worries in the study sample were "the possibility of something going wrong with the baby", "giving birth", and "financial problems". The prevalence of antenatal anxiety and depression identified in this study is of concern. Screening for antenatal anxiety and depressive symptoms with validated instruments is crucial.

Sudden presentation of intracranial meningioma after elective general anesthesia.

A case of "silent" intracranial meningioma unmasked by narcosis is described. The diagnosis was made because of the patient's failure to wake up after elective general anesthesia for orthopaedic surgery. Factors leading to this complication and its management are discussed. Early computed tomography scan and antiedema therapy are strongly suggested for these patients.

Neuropsychological and neurophysiological evaluation after anterior communicating artery (ACoA) aneurysm surgery.

BACKGROUND: We evaluated high cerebral functions 6 months after surgery for bleeding ACoA aneurysms comparing neurophysiological and neuropsycological tests. METHODS: Twelve patients were chosen among a series of cases operated on in the first 48 hours after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade I or II. We excluded patients over 65 years, or with intracranial haematomas, intraventricular haemorrhage, hydrocephalus, or with multiple or giant aneurysms. All of them underwent neurophysiological evaluation with recording and mapping of long latency (P300) auditory and visual event-related potentials (ERPs) and a neuropsychological assessment for memory, intelligence, frontal lobe functions and language. RESULTS: Neuropsychological assessment: All patients were severely damaged on phonemic fluency. In a first group (group A: 3 cases) tests were all in a normal range. In a second (group B: 3 cases) the tests showed severe impairment on learning and long term memory. In a third (group C: 6 cases) tests showed memory and "frontal lobe" deficits. Neurophysiological assessment: The whole group of patients showed significant delay in ERPs recordings compared to controls. ERPs of patients in group A and B showed no significant differences from controls, while being significantly delayed in 5 patients out of 6 of group C. CONCLUSIONS: All patients had difficulties in the phonemic task in which a notable cognitive effort is necessary, while intelligence, short term memory, attention and language were within normal limits. Patients in group C showed severe frontal lobe type cognitive impairment. Those ones in groups A and B did not present cognitive derangements (A) or only memory and learning impairment (B). ERPs may be an objective parameter in the follow-up of cases with cognitive impairment, even if neurophysiological tests cannot be replaced.

[Therapeutic decisions and grading of subarachnoid hemorrhage]. / Scelte terapeutiche e grading nell'ESA.

Early admission and medical treatment can improve prognosis in patients with subarachnoid hemorrhage (SAH). In our Centre in 10 years, 595 patients with SAH have been treated: 422 were admitted within 24 hours (71%) and 498 (84%) within 72 hours. 374 underwent surgical treatment: 283 within 48 hours and 91 underwent late surgery. Thirty-three patients underwent emergency surgery for intracranial hematomas, with a mortality rate of 30%. One hundred eighty-one patients in Hunt-Hess grade I-II underwent early surgery. Mortality rate was 7%. Mortality rate for rebleeding, when surgery was delayed was more than 10%. Patients in Hunt-Hess grade III underwent early surgery in the majority of cases (68 out of 111). Only in 52% of cases surgical result was good. Thirty-four out of 108 in grade IV-V underwent early surgery, with a mortality rate of 45%. The analysis of general results shows that early surgery improves prognosis in Hunt-Hess grade III patients. Also patients in Hunt-Hess grade III-IV-V can take advantage of early surgery. Old age, arterial hypertension and angiographical vasospasm do not worsen prognosis even in patients operated on early. Endovascular treatment even in acute phase has improved results especially in cases of certain aneurysms types such as posterior circulation aneurysms.

[Pharmacologic therapy of subarachnoid hemorrhage]. / Terapia farmacologica dell'emorragia subaracnoidea.

Medical treatment of subarachnoid haemorrhage, is focused on the prevention of rebleeding and vasospasm, of damages of oxitading products, and on the improvement of general conditions of the patient. Some authors consider use of antifibrinolytic usefull to reduce the risk of rebleeding, but the percentage of hydrocephalus and ischemia are increased. In our Centre combination of nimodipine-cloricromene and hemodilution is used for the prevention of vasospasm. We report conclusions about 216 patients in I-II-III grade of Hunt-Hess scale, treated before 48 hours from SAH. We obtained only 8% postspasm ischemias, with no neurological deficit, and only 23% of increased cerebral blood flow revealed by transcranial Doppler. Cloricromene is used only after aneurysm is occlused. It presents different action mechanisms. It is an inhibitor of platelet activation and aggregation, of cyclooxygenase and lipooxygenase activity, so reducing thromboxanes ratio. Phospholipase A2 inhibition it's possible but not demonstrated. It also interferes with phosphoinositoles path and so with proteinkinase C activity, and reduces hemostatic thrombotic balance activation and leukocyte endothelial adhesion and activation. It reduces, finally, the release of free radicals, cytokines inflammation amplyfing. The reduced damage to the endothelium allows the releasing of vasodilatatory agents like NO.