Emotion, rationality, and social identity: a theoretical-methodological proposal for a cognitive approach.

Humberto Maturana's biology of cognition and the studies of neuroscientist Antonio Damasio have proposed theories that indicate the role of emotion in cognitive processes. Emotion lies at the basis of any behavior. An emotional transition defines a transition from one domain of actions to the other, while emotions shared in human interaction define collective domains of action and thus also social identity. In this case, they may give rise to operational coherences within the same domain of action which is recognized as "rationality". The transition from one operational coherence to another within the same rationality does not therefore entail an emotional transition. This article uses this theoretical framework to propose an interpretation of the phenomenon of social identity and distinguishes social identities based only on emotions from those related to operational coherence. We call the former type of social identity "ontological", while the latter is referred to as "formal". To empirically prove the theoretical proposal of the article, the concept of metacontrast found in social self-categorization theory and its quantification elaborated by Alberto Voci are used. According to the social self-categorization theory, the greater the distance between two groups' visions of the world, the greater the metacontrast between them. Using our model, metacontrast must thus be greater for ontological social identity and less for formal social identity. Our hypothesis was confirmed by the data. This outcome allows huge applications of the methodology proposed, as exemplified in the final considerations.

EaRly-start ExerciSe training afTer acute hemodynAmic decompensation in patients with chRonic hearT failure (RE-START). A multicenter, randomized, controlled trial on short-term feasibility and impact on functional capacity, symptoms and neurohumoral activation .

RE-START is a multicenter, randomized, prospective, open, controlled trial aiming to evaluate the feasibility and the short- and medium-term effects of an early-start AET program on functional capacity, symptoms and neurohormonal activation in chronic heart failure (CHF) patients with recent acute hemodynamic decompensation. Study endpoints will be: 1) safety of and compliance to AET; 2) effects of AET on i) functional capacity, ii) patient-reported symptoms and iii) AET-induced changes in beta-adrenergic receptor signaling and circulating angiogenetic and inflammatory markers. Two-hundred patients, randomized 1:1 to training (TR) or control (C), will be enrolled. Inclusion criteria: 1) history of systolic CHF for at least 6 months, with ongoing acute decompensation with need of intravenous diuretic and/or vasodilator therapy; 2) proBNP > 1000 pg/mI at admission. Exclusion criteria: 1) ongoing cardiogenic shock; 2) need of intravenous inotropic therapy; 3) creatinine > 2.5 mg/dl at admission. After a 72-hour run-in period, TR will undergo the following 12-day early-start AET protocol: days 1-2: active/passive mobilization (2 sessions/day, each 30 minutes duration); days 3-4: as days 1-2 + unloaded bedside cycle ergometer (3 sessions/day, each 5-10 minutes duration); days 5-8: as days 1-2 + unloaded bedside cycle ergometer (3 sessions/day, each 15-20 minutes duration); days 9-12: as days 1-2 + bedside cycle ergometer at 10-20 W (3 sessions/day, each 15-20 minutes duration). During the same period, C will undergo the same activity protocol as in days 1-2 for TR. All patients will undergo a 6-min WT at day 1, 6, 12 and 30 and echocardiogram, patient-reported symptoms on 7-point Likert scale and measurement of lymphocyte G protein coupled receptor kinase, VEGF, angiopoietin, TNF alfa, IL-1, IL-6 and eNOS levels at day 1, 12 and 30.

Non-vitamin K oral anticoagulant use in the elderly: a prospective real-world study - data from the REGIstry of patients on Non-vitamin K oral Anticoagulants (REGINA).

PURPOSE: Numerous studies on thromboembolic prevention for non-valvular atrial fibrillation (NVAF) have shown either equal or better efficacy and safety of non-vitamin K oral anticoagulants (NOACs) compared to warfarin, even for patients aged ≥75 years. Data on elderly patients, in particular, octogenarians, are lacking. Paradoxically, this population is the one with the highest risk of bleeding and stroke with a worse prognosis. This study aims to describe safety and effectiveness of NOACs in an elderly comorbid population. PATIENTS AND METHODS: REGIstry of patients on Non-vitamin K oral Anticoagulants (REGINA) is a prospective observational study enrolling consecutive NVAF patients started on NOACs and followed up to 1 year (at 1, 6, 12 months). The primary endpoint was the incidence rate of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). The secondary endpoints were the incidence of 1) stroke or systemic embolism, 2) hospitalization, 3) death, and 4) drug-related adverse events. RESULTS: We enrolled 227 patients aged 81.6±6.1 years (range 67-95 years; ≥80 years in 59.4%). The median CHA2DS2-VASc was 5 (IQR 4-5) and HAS-BLED was 4 (IQR 3-5). The estimated glomerular filtration rate was 59.27±24.12 mL/min. During follow-up, only 10 MB and 23 CRNMB occurred, with a total incidence of 4.4% (95% CI: 1.7%-7.17%) and 5.7% (95% CI: 2.68%-8.72%), respectively. There were 2 cerebral ischemic events, with a total incidence of 0.88% (95% CI: 0.84%-0.92%), 23 NOAC-related hospitalizations, no NOAC-related deaths, and 4 minor drug-related adverse effects. CONCLUSION: In a population of aged and clinically complex patients, mainly octogenarians, NOACs were safe and effective.

[Epidemiology without numbers: nurses tell their perception, and the management strategies, of the behavioral problems of the elderly]. / Una epidemiologia senza numeri: gli infermieri raccontano la loro percezione-gestione dei disturbi comportamentali dell'anziano.

OBJECTIVES: To assess the practicability of caring strategies which rely on the subjective resources and insights of nursing personnel in the management of behavioral problems of the elderly. METHODS: Following the indications of a training session, the nurses in charge of a residential geriatric department have been invited to express, through brief written accounts, their point of view on: 1. the definition(s) of behavioral problems; 2. the strategies adopted before or with or in the place of psychotropic drugs; 3. the experience gained from significative responses to non-pharmacological treatments. RESULTS: All the narratives by individual participants are reported to document, through the variability of their languages, concepts, interventions, the need as well as the possibilities of caring behaviors, where listening attitudes are practiced, thus allowing also a better awareness of original role opportunities. CONCLUSIONS: Narrative practices can usefully be incorporated into caring duties and contexts, and represent an important training tool, specifically relevant for the grey areas of medicine.

Effects of an Outpatient Service Rehabilitation Programme in Patients Affected by Pulmonary Arterial Hypertension: An Observational Study.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease characterised by a severe impairment of functional status and quality of life (QoL). Use of rehabilitative programmes may help to improve outcomes. The aim of this pre/post test case series was to evaluate the impact of a training program, including sessions of aerobic and resistance exercise, inspiratory muscle reinforcement, slow breathing, relaxation, and psychological support, on functional outcomes. METHODS: Fifteen patients affected by PAH, in World Health Organization (WHO) Functional Class (FC) II or III and in stable clinical condition, were included in a 4-week cardiorespiratory training programme conducted in outpatient service. Patients were tested during a routine control visit (T0), one month later at the beginning of the training programme (T1), and at study end (T2). Between T0 and T1, patients continued their normal activities and therapies. At each step, patients underwent respiratory and functional evaluation by spirometry, 6-minute walk test (6-MWT), maximal cardiopulmonary exercise testing (CPET), echocardiography, and levels of brain natriuretic peptide (BNP). QoL was also assessed at T1 and T2 using the Hospital Anxiety and Depression Scale and the EuroQoL-5D questionnaire. The primary endpoint was the effect of training on peak oxygen consumption (peak V̇O2). RESULTS: There were no significant differences in BNP levels, or in any of the respiratory or echocardiographic parameters measured, between T0 and T1. Between T1 and T2, significant improvements were recorded in QoL (HADS-Anxiety mean change 3.5 ± 3.3 and HADS-Depression mean change 1.6 ± 2.0, all p < 0.01). Significant improvements were also observed in functional capacity with distance walked at 6-MWT increasing from 455 ± 115 to 487 ± 120 (+8%, p < 0.01), workload (WR) of CPET increased of 22% (from 73 ± 22 to 87 ± 21 watt, p < 0.001), peak V̇O2 increasing from 17.3 ± 4.2 to 19.9 ± 4.5 mL/kg/min (p < 0.001) and pulse O2 increasing from 7.8 ± 1.8 to 8.8 ± 2.4 mL/beat (p < 0.01). No adverse events or deterioration in clinical status were observed during the training sessions. CONCLUSION: Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.

Angiostrongylus vasorum in 20 dogs in the province of Chieti, Italy.

After a case of Angiostrongylus vasorum (canine lungworm) was diagnosed in the province of Chieti (Italy) in early 2008, parasitological research was conducted to investigate the presence of the parasite in dogs in the area. A total of 178 dogs, 56 carcasses and 122 stool samples were examined between January and September 2008. The carcasses were examined for the presence of adult parasites in the right ventricle and pulmonary artery, and larval forms in the internal organ and brain tissues. The faeces were inspected for larval form L1 using three diagnostic methods that are currently used to test for endoparasites and larvae of bronchopulmonary strongyles. A total of 20 cases of canine angiostrongylosis were diagnosed (8.9%), with adult parasites being identified in 5 dogs, and L1 larvae in another 15. The anatomo-pathological examination of the carcasses of the dogs infested with adult nematodes revealed pneumonia, pleurisy, reddish foam in the trachea, effusion of serohaemorrhagic fluid in the thoracic cavity and enlarged mediastinic and mesenteric lymph nodes. Histological examination of the tissues showed serious, similar syndromes with lesions caused by colonisation of the kidneys, lymph nodes and brain by the parasites. Given the large number of cases confirmed in relation to the period of study (9 months), it is essential to include angiostrongylosis among the differential diagnoses made in clinical and post-mortem examinations of dogs in the province of Chieti and in the neighbouring areas.