1,721,004 research outputs found
SELF-DETERMINED SENSE OF HOPELESSNESS IN COPD – A GROUNDED THEORY STUDY
No full textSelf-determined sense of hopelessness in COPD – a Grounded Theory study
Introduction: Living with Chronic Obstructive Pulmonary Disease (COPD) is a struggling experience, with a negative impact both on the physical and psychological well-being of those affected.
Aim: The main aim was to develop a theoretical account of the perception and expectation patterns of COPD patients, considering their severity levels.
Methods: This Grounded Theory study, conducted at the U.O.C. Cardio Respiratory Rehabilitation Unit of the IRCCS Fondazione Don Carlo Gnocchi in Milan (Italy), involved 20 participants with COPD who underwent semi-structured face-to-face interviews about their experience and expectations of the disease. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. Moreover, a visual tool exploring their symptoms and the Pictorial Representation of Illness and Self-measure (PRISM) were administered. Clinical data have been also considered. Analysis was conducted through NVivo (version 12).
Results: Theoretical saturation of substantive codes was achieved with 20 interviews [Males=13 (65%)]. The participants’ mean age and the forced expiratory volume in 1 second were 68,18 (SD=7,17) years and 66 (SD=6,14) percent of predicted, respectively.
The core category was “hopelessness”. COPD was perceived as a serious threat to one’s daily activities, and interests. The most described symptoms were shortness of breath, sleep disturbances, and fatigue, resulting in depressive symptoms often linked to avoidance and a reduction in the motivation to undertake more challenging activities. In general, patients demonstrated some difficulties to project themselves into the future; negative illness expectations, linked to the sense of responsibility due to cigarette smoking, emerged in most cases, especially in patients with severe COPD. Feeling supported and hopeful about the effectiveness of treatment seems to have a positive influence on patients’ coping styles.
Discussion: This study confirmed how COPD limits patients' quality of life, increasing their general rejection of life. Investigating perceptions of their condition and focusing on their expectations might be useful to introduce personalized therapeutic interventions, where patients are the real experts of their disease
Illness Perceptions, Cognitions, and Beliefs on COPD Patients’ Adherence to Treatment – A Systematic Review
Full text linkBackground: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. Besides its irreversibility, COPD is a treatable condition, and patients would strongly benefit from being adherent to their treatments. However, almost half of them are non-adherent, and, according to several recent studies, the way the patient perceives the disease might influence this variable.
Aim: This systematic review provided a synthesis of studies about the relationships between illness perceptions (IP), cognitions, beliefs, and adherence in COPD.
Methods: English language publications were searched in PubMed, Medline, Scopus, ResearchGate, PsycINFO, and Cochrane Library databases from November 2022 to February 2023, following PRISMA guidelines. The reference lists of eligible studies were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently.
Results: A total of 14 studies were included. Adherence to treatment in COPD is confirmed to be low, using both self-report questionnaires and objective assessment systems. Most studies concluded that COPD is perceived as a moderate threat destined to last forever, even if many participants referred to little disease knowledge. This perception did not change between adherent and nonadherent groups. Those who considered more necessary to take their medicines and had a caregiver were more adherent and less concerned about their future. On the other side, forgetfulness, lack of trust in medications, and difficulties in understanding how to take them were perceived as the main causes of non-adherence. Other predictors of non-adherence, like depression, low self-efficacy, and severity of disease were confirmed.
Conclusion: The systematic review highlights the variability of the relationship between IP, cognitions and beliefs, and COPD treatment adherence. A new level of awareness of the relationship between patients’ subjective point of view and treatment adherence may inform future treatment options and promote a more personalized intervention
Living beyond loss: a qualitative investigation of caregivers' experiences after the death of their relatives with amyotrophic lateral sclerosis
No full textBackground: Caregivers of Amyotrophic Lateral Sclerosis (ALS) patients experience varying psychological responses following the patient's death, including sadness, loneliness, guilt, and a loss of purpose. Objectives: This research aims to investigate the caregiver journey experienced from the time of diagnosis to the loss of a care recipient, with a specific focus on understanding the factors that contribute to improved coping with bereavement. Methods: The present study used the Interpretative Phenomenological Approach (IPA) to qualitatively explore the accounts of 41 Italian bereaved caregivers of people affected by ALS (Mean Age = 59.78; Female: 60.98%; Male: 39.02%). Results: Results revealed 5 overarching themes representing 5 macro areas that emerged from the analysis of the interviews ("Caregiver's perception of his/her life", "Caregiver's feelings", "Caregiver's life after patient's death", "Caregiver's disease description", "Caregiver's help resources"), these were further defined based on 12 main themes, which were, in turn, articulated into 30 subthemes. The transition from life before ALS ("a peaceful landscape") to caregiver life (compared to the color "black") was a "shock", during which caregivers had to change their needs. However, life after the person living with ALS' death was both characterized by a sense of "re-birth" and "emptiness", and a general need for "psychological assistance" and "social support". Conclusions: Results emphasize the need to improve the psychological support offered to caregivers of person living with ALS after the patient's death, tailoring it to the specificity of the condition, to meet their emotional needs, reduce isolation and help them cope with practical challenges and plans
THE APPLICATION OF A BRIEF MINDFULNESS INTERVENTION IN PEOPLE WITH SEVERE COVID-19
No full textIntroduction: The practice of mindfulness, formalised in the structuring of well-known protocols such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT), have proven to be very effective in reducing stress related to chronic conditions (Cherkin et al., 2016; Johns et al., 2015) and of depression (Hilton et al, 2017; Schumer, Lindsay, & David Creswell, 2018). However, these protocols generally require a high level of engagement for participants, which is why, in the present exploratory study, we opted to evaluate the implementation of a shor and less intensive Mindfulness-based protocol, but which showed good results on health-related outcomes, even with a single session (Howarth, Smith, Perkins-Porras, & Ussher, 2019).
The overall objective of this exploratory study was to develop and evaluate the implementation of a short-term, Mindfulness-based intervention conducted in telemedicine, compared with usual care alone, on the symptoms associated with Post Traumatic Stress Disorder Stress Disorder (PTSD) of persons who have previously tested positive for COVID-19, admitted to a resuscitation and/or intensive care unit and then in pulmonary rehabilitation following negativization.
Methods: The present pilot randomised controlled trial compared the impact of a Mindfulness-based brief intervention conducted in telemedicine (n = 20) for a period of 5-6 sessions of 45 minutes each, for a total commitment of 3 weeks, to a wait-list control (n = 20), involving people who have been previously tested positive for COVID-19, admitted to intensive care or reanimation and subsequently in respiratory rehabilitation following negativization. The General Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Impact of Event Scale (IES), Perceived Stress Scale (PSS), State Shame and Guilt Scale-8, Peritraumatic Perceptions of Fear and life threat, Psychological General Wellbeing Index (PGWBI), respiratory functions, oxygen saturation, haemogasanalysis were detected at baseline, 3 weeks, and 3 months. Descriptive analyses were conducted with respect to clinical and socio-demographic variables, as well as
the primary and secondary outcomes. All statistical analyses were conducted according to an intentionto-treat system. In addition, using linear mixed models, intra- and inter-group comparisons were carried out on the primary and secondary outcome indices. The analyses were considered statistically significant for p<.005. Moreover, semi-structured interviews conducted according to the Interpretative Phenomenological Analysis (IPA) approach detected the participants' emotional experiences, expectations, and beliefs about their experience of illness. Themes that emerged and recurring themes during the course and interviews were analysed from a qualitative point of view, distinguishing the data emerged from the participants' interviews and those from the carers. Results: This pilot study found that the Experimental Group pursued improvements in terms of symptoms related to Post Traumatic Stress Disorder (PTSD) and the secondary outcomes outlined above over the course of the three surveys. Furthermore, with regard to the parameters pertaining to respiratory function, spirometry and arterial and venous haematochemical examinations, these were not inferior to those achieved by the Control Group. From the qualitative analysis part, it was possible to detect the presence of descriptive, linguistic, and conceptual comments. Relevant was the theme of contact with death and the emotional experiences associated with it, which emerged in different keys in both patients and caregivers. It is also useful to note the reported progressive change of perspective on how the patient deals with the remaining symptoms of COVID-19 during the proposed sessions. Conclusion: This study showed the potential of an affordable and widely accessible Mindfulness-based brief intervention in clinical practice, offering a view of hospital-territory continuity following the acute phase of COVID-19 disease
INTERVENTI DI TRATTAMENTO DEL CRAVING NELLE DIPENDENZE DA SOSTANZE E COMPORTAMENTI MEDIANTE TDCS
No full textIntroduzione
Negli ultimi anni la ricerca neuroscientifica ha dedica
to crescente attenzione all’utilizzo di tecniche di neu
romodulazione non invasiva per il trattamento dei
disturbi da addiction. Tra queste, la stimolazione tran
scranica a corrente diretta (tDCS) rappresenta una
metodica promettente, in grado di modulare l’eccitabi
lità corticale e l’attività dei circuiti fronto-striatali
implicati nei processi di ricompensa, controllo degli
impulsi e regolazione del craving.
La dipendenza da gioco d’azzardo patologico e quella
da cocaina condividono numerosi aspetti neurobiologi
ci e clinici: entrambe sono caratterizzate da disregola
zione del sistema dopaminergico mesolimbico, altera
zioni della corteccia prefrontale dorsolaterale (DLPFC)
e difficoltà nel controllo degli impulsi. Queste somi
glianze hanno spinto la comunità scientifica a indaga
re se approcci di neuromodulazione, già studiati nei
disturbi da uso di sostanze, possano essere efficaci
anche nelle dipendenze comportamentali.
I
primi studi sull’applicazione della tDCS in questi
ambiti suggeriscono che la stimolazione di specifiche
aree prefrontali possa ridurre il craving, migliorare le
capacità decisionali e modulare i meccanismi neuroco
gnitivi alla base della perdita di controllo. Sebbene i
dati siano ancora preliminari, la tDCS potrebbe rappre
sentare un valido complemento ai trattamenti psicote
rapeutici e farmacologici tradizionali, offrendo nuove
prospettive di intervento in patologie caratterizzate da
elevata cronicità e ricadute. Scopo
Il progetto pilota esplora la fattibilità del trattamento
con tDCS in un servizio ambulatoriale e valuta l’effica
cia della stimolazione su craving, impulsività, tono
dell’umore, qualità del sonno e ricadute post tratta
mento su gamblers e cocainomani.
Partecipanti
Il campione è formato da 13 partecipanti in carico al
SerD VCO, dei quali 7 con diagnosi di Disturbo da Gioco
d’azzardo Patologico e 6 con diagnosi di Disturbo da
uso di cocaina.
Tra i criteri di inclusione: diagnosi di dipendenza pato
logica secondo i criteri del DSM 5, dipendenza attiva
(eventuale remissione non superiore a tre mesi) e pos
sibilmente un minimo di risorse sociali con presenza di
un eventuale caregiver che possa seguire il paziente
nelle fasi di somministrazione della stimolazione.
I criteri di esclusione sono la minore età, gravidanza,
presenza di impianti metallici come pacemaker, comor
bilità con patologia psichiatrica in fase di scompenso
e comorbilità con altre dipendenze.
I soggetti selezionati sono stati valutati dallo specia
lista Neurologo per escludere quadri clinici incompati
bili con la partecipazione al trattamento.
Strumenti
Somministrazione dei questionari: VAS per frequenza
ed intensità del craving (punteggi da 0 a 10), SCL90
(Derogatis L. R., 1994), BIS11 (Fossati et al. 2001),
BDI (Beck et al. 1996) immediatamente prima della
stimolazione (T0), al termine della stimolazione (T1) e
90 giorni dopo la fine del trattamento (T2).
Le ricadute sono state verificate mediante drug test e
colloquio per il gruppo dei cocainomani e mediante
colloquio per i giocatori.
Protocollo tDCS
La tDCS è una tecnica di neuromodulazione non inva
siva e indolore, annoverabile tra le tecniche di non
invasive brain stimulation – NIBS
• Montaggio: DLPFC destro (anodo) / DLPFC sinistro
(catodo)
• Corrente: 2 mA
• Durata: 20 minuti per sessione
• Programmazione: 12 sessioni in 2 settimane (es. 5
sessioni la prima settimana + 5 la seconda, più 2 nella
settimana finale)
• Note di applicazione:- Elettrodi posizionati secondo il sistema EEG 10–20
(F4 per l’anodo, F3 per il catodo).- Spugne imbevute di soluzione salina, superficie 25
35 cm2, per mantenere la densità di corrente entro
limiti sicuri (~0,057–0,08 mA/cm2).- Screening di sicurezza prima di ogni sessione (con
troindicazioni: epilessia, impianti metallici/elettronici,
problemi dermatologici, ecc.).
Protocollo CBT (concomitante alla tDCS. • Pre-sessione (5 min): - Esercizio di immaginazione guidata focalizzato su
risorse personali positive e trigger abituali. - Obiettivo: attivare reti neurali/emotive pertinenti
prima della stimolazione.
• Durante la tDCS (20 min): - Pratica strutturata di mindfulness (body scan o
attenzione al respiro). - Esercizi di ristrutturazione cognitiva su pensieri
disfunzionali, tramite domande socratiche. - Opzione: alternare blocchi brevi di mindfulness ed
esercizi di reframing per mantenere alta l’attenzione.
• Post-sessione (5–10 min): - Breve riflessione + journaling: intuizioni chiave,
cambiamenti nello stato emotivo, trasformazioni
cognitive. - Il terapeuta annota i progressi e pianifica il focus
della sessione successiva.
Razionale dell’integrazione
• Stimolazione anodica del DLPFC destro: aumenta l’ec
citabilità dei circuiti che supportano controllo cogniti
vo, regolazione emotiva e ristrutturazione adattiva.
• Stimolazione catodica del DLPFC sinistro: può ridurre
la tendenza alla ruminazione negativa.
• CBT durante la stimolazione: sfrutta le finestre di
neuroplasticità, rafforzando nuovi schemi cognitivi ed
emotivi.
• Immaginazione guidata iniziale: assicura che l’ap
prendimento potenziato dalla tDCS si consolidi attorno
a contenuti personali significativi.
Analisi dei dati
Abbiamo messo a confronto i risultati dei test al T0 e
T2 mediante Anova e t-test a campioni indipendenti. Il
confronto è stato fatto in un primo tempo con tutto il
campione e poi con i gruppi patologia distinti.
Risultati
Il t-test a campioni indipendenti sui punteggi della
VAS Intensity ha mostrato una differenza statistica
mente significativa tra T0 e T2, t (22) = 2.24, p = .036.
I valori medi indicano che l’intensità percepita del sin
tomo era maggiore a T0 (M = 5.92, DS = 2.64) rispetto
a T2 (M = 3.33, DS = 2.99), con una differenza media
di 2.58 punti. La dimensione dell’effetto risulta elevata
(d di Cohen = 0.91), suggerendo che la riduzione del
l’intensità nel tempo è non solo statisticamente signi
ficativa ma anche clinicamente rilevante.
L’analisi della varianza a due vie sui punteggi della VAS
Intensity ha evidenziato un effetto principale signifi
cativo del tempo, F (1,20) = 4.93, p = .038, η2p =
.198, indicando una riduzione significativa dell’inten
sità percepita dal T0 al T2. Nel complesso, i risultati
indicano un miglioramento generalizzato e statistica
mente significativo dell’intensità percepita del craving
nel tempo, indipendentemente dal gruppo di apparte
nenza.
Il t-test a campioni indipendenti condotto sui punteg
gi della VAS Frequency non ha mostrato una differenza
statisticamente significativa tra T0 e T2, t (22) = 1.89,
p = .072. I valori medi suggeriscono comunque una
riduzione della frequenza percepita del sintomo nel
tempo, passando da M = 4.67 (DS = 2.81) a T0 a M =
2.67 (DS = 2.35) a T2, con una differenza di circa 2
punti. La dimensione dell’effetto è risultata moderata
alta (d di Cohen = 0.77), indicando che, pur in assenza
di significatività statistica, l’ampiezza della riduzione
potrebbe avere una rilevanza clinica. Le verifiche dei
presupposti hanno mostrato che né la normalità
(Shapiro-Wilk, p = .117) né l’omogeneità delle varianze
(Levene, p = .387) risultano violate, per cui l’analisi è
affidabile.
Per quanto riguarda le ricadute, due cocainomani e tre
giocatori non ne hanno avute, pari al 38% del campione.
Non sono emerse differenze significative nei punteggi
di BDI e nelle scale SCL90 di ossessione-compulsione e
sonno tra T0 e T2, nemmeno considerando separata
mente i due gruppi patologia. Anche per quanto riguar
da i punteggi di impulsività motoria, attentiva e da
non pianificazioni misurati tramite il questionario
BIS11 non si rilevano differenze staticamente signifi
cative.
Conclusione
Il presente progetto pilota ha mostrato come l’integra
zione di tDCS e trattamento riabilitativo specialistico
possa rappresentare un approccio promettente per la
riduzione del craving nei pazienti con dipendenza da
gioco d’azzardo patologico e da cocaina. I risultati evi
denziano una significativa riduzione dell’intensità per
cepita del craving tra l’inizio e la fine del trattamento,
con un effetto non solo statisticamente rilevante ma
anche clinicamente significativo. Sebbene la frequenza
del craving non abbia raggiunto la significatività sta
tistica, la diminuzione osservata suggerisce comunque
una possibile rilevanza clinica che merita ulteriori
approfondimenti.
La stabilità dei punteggi relativi all’umore, all’impulsi
vità e ad altre dimensioni psicopatologiche indica che
l’effetto del trattamento si concentra prevalentemente
sulla regolazione del craving, lasciando aperta la pos
sibilità che interventi più prolungati possano produrre
benefici più estesi. Inoltre, il 38% del campione non
ha riportato ricadute nei tre mesi successivi, dato che,
pur limitato numericamente, offre un segnale incorag
giante sulla tenuta dell’intervento nel tempo.
Nel complesso, i dati raccolti supportano l’ipotesi che
la neuromodulazione con tDCS, soprattutto se associa
ta a strategie psicoterapeutiche mirate, possa costitui
re un utile complemento ai trattamenti tradizionali. La
complessità dell’intervento valutativo dei pazienti ha
rallentato il processo di reclutamento dei pazienti stes
si. Campioni più numerosi, follow-up a lungo termine e
protocolli comparativi potrebbero confermare la soli
dità e la generalizzabilità di questi risultati preliminari
Non-Invasive Ventilation (NIV) in people affected by COVID-19 pneumonia: evaluation between acute and rehabilitation settings
No full textBackground: Using Non-Invasive Ventilation (NIV) in an acute setting for COVID-19-related acute hypoxic respiratory failure (AHRF) can be a stressful and anxiety-inducing experience for patients in the Respiratory and Intensive Care Units (RICU and ICU).
Aims and objectives: This study aimed to investigate the presence of anxiety, symptoms related to Post Traumatic Stress Disorder (PTSD), psychological distress, and depression about the perception of one's disease state in people with COVID-19-related AHRF undergoing NIV during their stay at RICU/ICU and after rehabilitation.
Methods: Fifty-two people with COVID-19 (M=66.9; SD=9.17) were evaluated during hospitalization in the RICU/ICU, and at 6 months, after rehabilitation, for symptoms of anxiety, psychological distress, Post Traumatic Stress Disorder (PTSD), and depression, in relation to the perceived severity of illness and NIV’s usage.
Results: Patients with COVID-19 experienced increased fear and anxiety due to the severity of their illness and the uncertainty surrounding the disease in the acute setting. The need for NIV indicated more severe COVID-19 disease, which significantly increased fear and anxiety [(t(14)= 2.79, p=.014] compared to the remission period, leading to feelings of loss of control and a decreased psychological well-being [(t(17)= 2.35, p=.031]. Resilience significantly improved over time [(t(16)= -4.78, p<.001].
Conclusions: Healthcare professionals need to supply more attention and support, such as offering reassurance, providing information, and addressing any concerns or fears
Dyadic Adjustment, Illness Perception, and Depression in Sleep Quality and CPAP Adherence in Couples with OSAS
No full textPoletti, Valentina, Università Cattolica del Sacro Cuore, Ital
The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature
No full textIntroduction Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it. Purpose of Review The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients? Methods A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship. Results As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet). Conclusion The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well
Designing Lentiviral Vectors for Gene Therapy of Genetic Diseases
Full text linkLentiviral vectors are the most frequently used tool to stably transfer and express genes in the context of gene therapy for monogenic diseases. The vast majority of clinical applications involves an ex vivo modality whereby lentiviral vectors are used to transduce autologous somatic cells, obtained from patients and re-delivered to patients after transduction. Examples are hematopoietic stem cells used in gene therapy for hematological or neurometabolic diseases or T cells for immunotherapy of cancer. We review the design and use of lentiviral vectors in gene therapy of monogenic diseases, with a focus on controlling gene expression by transcriptional or post-transcriptional mechanisms in the context of vectors that have already entered a clinical development phase
Prostaglandin E2 as transduction enhancer affects competitive engraftment of human hematopoietic stem and progenitor cells
Full text linkEx vivo gene therapy (GT) is a promising treatment for inherited genetic diseases. An ideal transduction protocol should determine high gene marking in long-term self-renewing hematopoietic stem cells (HSCs), preserving their repopulation potential during in vitro manipulation. In the context of the improvement of a clinically applicable transduction protocol, we tested prostaglandin E2 (PGE2) as a transduction enhancer (TE). The addition of PGE2 shortly before transduction of human CD34+ cells determined a significant transduction increase in the in vitro cell progeny paralleled by a significant reduction of their clonogenic potential. This effect increased with the duration of PGE2 exposure and correlated with an increase of CXCR4 expression. Blockage of CXCR4 with AMD3100 (plerixafor, Mozobil) did not affect transduction efficiency but partially rescued CD34+ clonogenic impairment in vitro. Once transplanted in vivo in a competitive repopulation assay, human CD34+ cells transduced with PGE2 contributed significantly less than cells transduced with a standard protocol to the repopulation of recipient mice, indicating a relative repopulation disadvantage of the PGE2-treated CD34+ cells and a counter-selection for the PGE2-treated cell progeny in vivo. In conclusion, our data indicate the need for risk/benefit evaluations in the use of PGE2 as a TE for clinical protocols of GT
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