[Emotional aspects and quality of life of patients after acoustic neuroma surgery]. / Aspetti emotivi e qualità della vita in pazienti operati di neurinoma del nervo acustico.

UNLABELLED: Acoustic neuromas are rare lesions arising in the internal auditory canal (IAC) and extending in the posterior cranial fossa. Surgical removal is the treatment of choice; peri and postoperative complications are directly related to the size of the tumour. Some Authors think the surgical treatment and related temporary or permanent neurological deficits could change the QoL and the psychological status. PURPOSE: The aim of this analysis is to ascertain if the surgical procedure could significantly worsen the QoL of this population 12 months after the discharge from surgical department. METHODS: By using a questionnaires of Quality of Life aims to evaluate the impact that the disease and the surgical procedure have on this population. SUBJECTS: We have evaluated a sample of 150 subjects one year after the surgical removal of a acoustic neuroma. Data have been collected through questionnaires the Whoqol-Brief, the BDI, the STAI Y1 and Y2 and specific item to assess effects of postoperative dysfunctions. RESULTS: Data reveal a negative effect on QoL, 94% of the subjects show lower score at Whoquol-Brief and in anxiety with scores higher than normative score sample (state-anxiety (t = 5.602 p = .000; trait-anxiety: t = 4.354 p = .000). Higher incidence of depressive disorders have not been found. CONCLUSION: Psychological support to subjects after discharge from acoustic neuroma surgical removal should be tailored to improve quality of life and for a better management of anxiety.

[Organizational climate, trust and burnout in a rehabilitation center]. / Clima organizzativo, fiducia e burnout in un centro di riabilitazione.

Today human resources are considered of fundamental importance and necessity for the success of the organizations that provide health services. The aims of the present study were: 1) to investigate the perception that rehabilitation medical staff employees have of their hospital organization, 2) to quantify their evaluation concerning organizational trust, 3) to identify eventual burnout symptoms and their relationship with perceived organizational climate and trust. The sample consisted of 131 employees, subdivided into 6 professional categories. Three questionnaires were administered to the employees. The results evidenced significant differences between the various professional groups regarding the climate perceived and trust in the organization. Administrative personnel, nurses and medical graduates revealed a greater satisfaction, responsibility and work integration than the other employee groups (p = 0.023). All the scales which measured organizational climate correlated (inversely) with those measuring burnout (p" 0.05), indicating the existence of a close relationship between a work climate perceived as collaborative (r = -0.33) and characterized by a continuous exchange of information about the hospital organization (r = -0.50), and the psychological well-being experienced by the employees. This study confirms the importance of promoting organizational strategies aimed at mutual reinforcement and support characterized by regular and constructive feedback, wherein there is a reciprocal recognition of each employee's role through a clear, open communication.

Treatment dropout in drug-addicted women: are eating disorders implicated?

A high prevalence of eating disorders among drug-addicted female patients has been noted, and it could be associated to psychopathological underlying factors. Our aim was to assess eating disorder traits in women approaching a residential program for drug addiction. We hypothesized that these traits would correlate to more general psychopathological factors, and would influence treatment relapse. A sample of 204 substance dependent women attending a residential treatment was screened for psychopathological indices, and follow-up data were obtained at the end of the treatment. Clients had a high risk for eating disorders (15%), and lifetime prevalence was even higher (20%). Disordered eating was associated to psychopathological distress, in particular harm avoidance resulted significantly lower (p=0.005), evoking higher unresponsiveness to danger. Drug addiction treatment outcome is associated to completion of defined programs, and eating disorder was a key covariable in determining treatment relapse or success (p=0.03). Clinicians should be aware of this potential co-morbidity, and concurrent treatments should be attempted, in order to prevent symptomatic shifting.

[Perception and opinions on the right of choice in medical field: what caregivers teach us on the communication]. / Percezione e opinioni sul diritto di scelta in campo medico: cosa ci insegnano i caregiver sulla comunicazione.

The aim of the present study was to analyse caregivers' perceptions and opinions concerning medical information and advance directives. Fifty-one subjects (mean age 63.07+/-12.2) were enrolled and filled in some questionnaires: the Family Strain Questionnaire (FSQ), the SF-12 and a specifically assembled questionnaire which we named Communication and Consent (CCQ). Correlations were found between FSQ factors, which refer to caregiving-related problems, and SF-12, which refers to the self-perception of mental and physical health. The subjects who resulted emotionally distressed referred to care for more critical patients and that they had not received sufficient attention by physician at the time of diagnosis. Self-determination and decision-making resulted inversely correlated to caregivers' age and education. In general, caregiver's role itself influences attitudes towards medical information and advanced directives. The study also indicates that health professionals have to pay more attention to the relationship than they use to do, trying to understand which kind of emotional sound a technical term may produce for the patients and their caregivers.

[Assessment of occupational stress among workers in rehabilitation medicine]. / Indagine sullo stress occupazionale di operatori della medicina riabilitativa.

Emerging evidence confirms the risk of distress in staff involved in the Helping Professions resulting in the possibility of reduced efficacy and efficiency of the structure which offers health services. The aim of the present study was to reveal the presence of burnout and its relationships with environmental and organizational factors of health care professionals enrolled in medical rehabilitation. 88 health care professionals underwent a psychometric assessment by filling the Organizational Checkup System Questionnaire (OCS) for measuring burnout and associated organizational factors. Data analysis demonstrated the presence of major emotional distress (p = 0.05) in the group who had an executive role (social-assistants and assistant nurses), especially regarding organization factors linked with: Overwork (p = 0.009), lack of Leadership (p = 0.01), lack of Comprehension of modifications offered by the structure (p = 0.0001) and Professional Development (p = 0.016). OCS revealed to be a sensitive psychometric instrument, especially for the identification of organizational weaknesses, which can stimulate the application of strategies to prevent the burnout syndrome and to improve coping skills.

[Management of occupational stress among patients with cardiac diseases]. / Gestione dello stress occupazionale in pazienti cardiopatici.

The object of our study was the evaluation of psycophysic condition, stress perception and coping in a sample of subject in cardiac rehabilitation. Our study recruited 48 worker patients (44 male, M = 50.5 +/- 8.8; 4 female, M = 50.8 +/- 8.7). They were submitted to: 1) cardiac evaluation and rehabilitation in DH regimen; 2) psychological assessment; 3) work's characteristic evaluation. The evaluation were made at the moment of recruitment and six month later 42 subjects went back to work after 81.8 +/- 49 days; 2 subjects had a worsening of their clinic conditions not consistent with an occupational resumption; 4 subjects didn't go back to work. In the 42 worker subjects we have find a significant decrease of anxiety (p < 0.019) and depression levels (p < 0.004); a significant improvement of Quality of Life perception in its physical (p < 0.000) and psychic aspects (p < 0.021) and an improvement about the ability to reorganize the work to better ménage stress (p < 0.012).

[Work outcome evaluation of cardiac surgery patients after rehabilitation training]. / Valutazione dell'outcome ripresa occupazionale di pazienti riabilitati cardioperati.

The aim of this study was to investigate the incidence of job resumption and the influence of clinical, psychological and functional factors in patients who underwent cardiac surgery. 859 patients were evaluated (mean age 66 +/- 9, 72% M, 28% F, 75% retired, 7% housewives and 18% still working) following admission in a Cardiac Rehabilitation Center; within 5 days of cardiac surgery. Six months after surgery, 80% of the patients resumed their previous occupation. The variables which positively influenced the latter were: a) left ventricular ejection fraction > 35% (p = 0.002), average-high education (p = 0.002), younger patients (p = 0.032), absence of complications during the 6 months post-surgery (p = 0.001), having attended frequent educational programs during the rehabilitation period (p = 0.022), a precise knowledge of the illness (p = 0.001), lack of depression (p =0.0001) and anxiety (p = 0.0001). Our data confirm, in accordance with the recent guidelines, the importance of a rehabilitative intervention which comprises physical, educational and psychological support.

[Anxiety and Depression Short Scale: norms for its use in rehabilitation]. / Scheda ansia e depressione forma ridotta: norme per l'utilizzo in ambito riabilitativo.

In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisciplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individual's problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index.

[Communication between physician and patient with chronic heart decompensation may help to reach the therapeutic objectives. How to make it efficient]. / La comunicazione tra medico e paziente con scompenso cardiaco cronico può aiutare ad ottenere gli obiettivi terapeutici. Come renderla efficace?

In the management of chronic heart failure there is increasing evidence that effective communication with the patient is an important tool in health care since it permits the achievement of therapeutic goals and the patient's satisfaction in terms of the quality of health assistance received. In fact, the variations in the communication processes relevantly influence the results in some behaviors and attitudes of the patient, such as adherence to the therapeutic prescriptions, understanding and remembering the information received, satisfaction with the medical examination and less worry. The capacity of the patient of co-administering the illness may result in a reduction in the instability due to avoidable concomitant factors, and thus reduce the heart failure morbidity and rehospitalization rate. Building up an effective doctor-patient relationship becomes an important goal to achieve, and the necessary instruments are not only instinctive or the result of experience, but can also be taught and learnt. The aim of this work was to give a contribution, which, in addition to underlining the theoretic aspects of the communicative process by means of numerous examples taken from everyday practice in patient management, is to induce reflection and to propose ways of intervention for the improvement of the therapeutic relationship between the cardiologist and the patient with heart failure.

Psychological constructs associated with emotional blood pressure response and white coat phenomenon.

Some hypertensive and non-hypertensive subjects have a striking blood pressure response to a medical environment (white coat phenomenon), although it is unlikely that its presence, degree, and duration can be routinely predicted. Despite the common observation that "anxious" patients may present with this reaction when a physician measures their blood pressure, no psychological variables have thus far been linked to white coat phenomenon in formal analyses. Ambulatory blood pressure monitoring is a useful tool to disclose the phenomenon since it allows precise evaluation of repeated blood pressure measurements outside the medical environment. To investigate the possible relationship between psychological profile and white coat phenomenon, we have planned to administer a series of psychometric tests to 120 subjects undergoing ambulatory blood pressure monitoring. The present data are derived from an analysis of the first set of 70 patients. Thirty-four subjects who presented with white coat phenomenon (defined as office blood pressure elevated by at least 15% over the mean 24-hour ambulatory blood pressure value) and 36 comparable subjects who did not have this reaction underwent a series of psychometric tests evaluating cognitive behavior, hostility, cynicism, anger, anxiety state, coping ability and strategies, and quality of life. Of the various psychometric tests, the scores of three relevant scales (healthcare-related fears, mental efficiency and behavioral disengagement) were significantly higher in the group of patients with white coat phenomenon, while in both groups, emotional instability was higher than the clinical cut-off point. There were no significant differences between the two groups regarding signs and repression of anger (anger-out and anger-in), cynicism, hostility, or anxiety state. Our data seem to indicate that the subjects most likely to show an overt blood pressure increase in the medical environment are those who evidence healthcare-related fears and emotional instability but are not necessarily anxious. They exhibit high coping skills in cognitive resolution of stressing situations (such as blood pressure measurement) but do not combine these strategies with an adequate behavioral response and do not feel that behavioral involvement is necessary for the management of their clinical condition.

Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction. Application of recursive partitioning techniques to the GISSI-2 database. Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico.

BACKGROUND: Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. METHODS AND RESULTS: In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation-RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95% confidence intervals [CI], 1.2-4.0) and Class II to the worst (HR = 3.2; 95% CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95% CI = 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. CONCLUSIONS: This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.

[Psychological characteristics of patients with infarction: results of the GISSI-2. Italian Group for the Study of Survival in Myocardial Infarction (GISSI)]. / Le caratteristiche psicologiche del paziente infartuato: risultati del GISSI-2. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto del Miocardio (GISSI).

OBJECTIVE: To provide a thorough psychological examination of patients with documented myocardial infarction (MI) enrolled in a multicenter randomized clinical trial (GISSI-2). The psychosocial variables examined include: state variables (anxiety, health-related fears, depression), psychophysical well-being in the three months preceding the acute event (depressive mood, impaired sense of well-being, perceived stress) and trait variables (Type-A Behavior (TAB), neuroticism, introversion/extroversion, social anxiety and feelings of guilt in interpersonal relationships). POPULATION AND SETTING: A total of 2705 patients (12.5% females) admitted to 166 Italian Coronary Care Units. METHODS: Patients were administered the CBA-H, a standardized questionnaire with dichotomous responses (true/false), for a total of 152-item grouped into 16 scales. For each scale, the frequency of scores above cut-off values was computed and compared to patients' clinical and sociodemographic profile. RESULTS: Over one third of all patients scored above the clinical cut-off for anxiety and health-related fears, and 15% showed a depressive pattern. Forty percent of patients reported depressive mood and a diminished sense of well-being in the past three months preceding MI, and more than half perceived themselves as stressed. About one third of the sample overtly exhibited TAB traits and half reported neuroticism scores in the clinical range. One half of our sample could be identified as extrovert, and 14% as introverted. Feelings of guilt and social anxiety were registered respectively in 40% and 12% of the sample. A worse psychological profile was associated to female gender, older age, lower education, living alone and a worse cardiac asset. CONCLUSION: The study has documented the association between clinical, sociodemographic and psychological variables in a large sample of patients with IMA. While the impact of psychological variables upon patients' clinical outcome is to be evaluated, these data may be helpful in promoting the comprehensive and effective care of IMA patients.

[Psychological, behavioral and occupational status changes after an aortocoronary bypass intervention]. / Variazioni psicologiche, comportamentali e di status professionale dopo intervento di bypass aortocoronarico.

BACKGROUND. Studies on the quality of life after coronary artery by-pass grafting (CABG) have yielded discordant results. Several studies have described psychological and social improvements while others have reported a lack of change in behavioural risk factors and return to work. There have been no reports on Italian patients, and, because of the wide range of psychological measures used in previous studies, it is difficult to draw any general conclusions. The aim of this study was to assess the psychological sequelae of CABG. METHODS. A total of 164 patients (142 men and 22 women, aged 60 years) with myocardial ischemia, completed the CBA-H Questionnaire 3-5 days before elective CABG and again after 6 months. RESULTS. State anxiety scores were lower after surgery (p < .000) as were health fears (p < .000), depression (p < .009) and life stress (p < or = .000) scores. There were also improvements in well-being (p < .003), affective relationships (p < .000) and sexual relations (p < .0007). There was a decline in behavioural risk factors, namely: smoking behaviour (p < .09), alcohol consumption (p < .002), over-eating (p < .0000) and sedentary life-style (p < .02). Clinical post-operative complications did not negatively influence patients' psychological state and return to work. Preoperative health fears (p < .04) and social anxiety (p < .02) did influence patients' return to work. CONCLUSIONS. In conclusion, psychosocial function, health state and quality of the life generally improved after elective CABG. Return to work was found to be an unreliable measure of the success of surgery. Pre- and post-operative data revealed a general denial trait which identifies patients at greater risk of cardiovascular events after CABG.

Respiratory Illness Opinion Survey: a short form for COPD patients.

Psychological assessment of respiratory patients often necessitates an understanding of their attitudes towards respiratory disease and hospitalization. The Respiratory Illness Opinion Survey (RIOS) is a 78 item questionnaire, which explores six attitude dimensions regarding respiratory illness and hospitalization, namely: 1) Optimism; 2) Specific Internal Awareness; 3) External Control; 4) Negative Staff Regard; 5) Psychological Stigma; and 6) Authoritarian Attitudes. However, as the current form of RIOS presents some limitations with regard to its length and complexity, we decided to review and shorten it with the aim of facilitating administration. Eighty eight hospitalized patients with chronic obstructive pulmonary disease (COPD) (mean age 59 yrs) completed the RIOS. Factor analyses were carried out to identify the principal components, and to verify psychometric validity. Results indicate that the RIOS can be used after being reduced to 31 items, without substantially altering its original factorial structure.

Psychophysiological stress testing in postinfarction patients. Psychological correlates of cardiovascular arousal and abnormal cardiac responses.

The psychophysiological responses to two mental stress tests (mental arithmetic and an interactive concentration task) were assessed in 168 unmedicated, male, postinfarction patients 36-69 years old. Patients also completed a standard battery of psychological tests. Psychophysiological responses were generally unrelated to age and education. Comparison of patients scoring high (more than 75%) and low (less than 25%) relative to the normal population on psychological measures indicated that heart rate and blood pressure responses to mental stress tests were significantly greater in those reporting low than in those reporting high neuroticism. The study population was subsequently divided into high, medium, and low cardiovascular responders on the basis of rate-pressure product reactions to the two stress tests. The three cardiovascular response groups did not differ in age, interval between myocardial infarction and stress testing, ejection fraction, incidence of exercise-induced ischemia, or ischemic signs during Holter monitoring. However, the high cardiovascular responders were more likely to manifest possible or definite electrocardiographic signs of ischemia or significant arrhythmia during mental stress testing than were the medium or low cardiovascular responders (50% versus 19.6% and 7%, respectively). High cardiovascular responders also reported lower levels of trait anxiety, neuroticism, psychophysiological symptoms, and depression.

[Stroop's color-word test as a mental stressor in the functional evaluation of recent myocardial infarction: comparison with arithmetic calculation]. / Il color-word test di Stroop come stressor mentale nella valutazione funzionale dell'infarto miocardico recente: confronto con il calcolo aritmetico.

To assess the power of Stroop's color-word test to induce cardiovascular arousal in cardiac patients, 10 postinfarct patients underwent Stroop's test, as well as the mental arithmetic test, which was assumed to be the gold standard. Both stressors induced significant increases in heart rate and blood pressure; the differences between these increases were not statistically significant. Stroop's test is a useful alternative to the mental arithmetic test in the study of cardiovascular responses to mental stress.

[The association of arithmetic calculation and noise as a mental stressor in the functional evaluation of recent myocardial infarction]. / L'associazione calcolo aritmetico più rumore come stressor mentale nella valutazione funzionale dell'infarto miocardico recente.

To evaluate the possible augmented power of mental arithmetic when given to the subjects during noise, 12 postinfarct patients underwent mental arithmetic in the standard way and then the same stressor with a white noise: mental arithmetic significantly increased (p less than 0.05) the heart rate, while mental arithmetic and white noise significantly increased (p less than 0.05) heart rate, systolic and mean blood pressure, as well as skin conductance. Nevertheless, the increments in heart rate, blood pressure and skin conductance induced by the two different ways of stressing did not significantly differ. Thus, adding white noise to mental arithmetic does not seem to be useful to increase the power of mental arithmetic in order to elicit cardiovascular responses.