BACKGROUND Disorders of gut-brain interaction(DGBI)are common,but knowledge about their physiopathology is still poor,nor valid tools have been used to evaluate them in childhood.AIM To develop a psycho-gastroenterolo...BACKGROUND Disorders of gut-brain interaction(DGBI)are common,but knowledge about their physiopathology is still poor,nor valid tools have been used to evaluate them in childhood.AIM To develop a psycho-gastroenterological questionnaire(PGQ)to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without DGBI.METHODS One hundred and nineteen Italian children(age 11-18)were included:28 outpatient patients with DGBI(Rome IV criteria)and 91 healthy controls.They filled the PGQ,faces pain scale revised(FPS-R),Bristol stool chart,ga-strointestinal symptoms rating scale,state-trait anxiety inventory,Toronto alexithymia scale 20,perceived self-efficacy in the management of negative emotions and expression of positive emotions(APEN-G,APEP-G),irritable bowel syndrome-quality of life questionnaire,school performances,tobacco use,early life events,degree of digital-ization.RESULTS Compared to controls,patients had more medical examinations(35%of them went to the doctor more than five times),a higher school performance(23%vs 13%,P<0.05),didn’t use tobacco(never vs 16%,P<0.05),had early life events(28%vs 1%P<0.05)and a higher percentage of pain classified as 4 in the FPS-R during the examination(14%vs 7%,P<0.05).CONCLUSION Pediatric outpatients with DGBI had a higher prevalence of early life events,a lower quality of life,more medical examinations rising health care costs,lower anxiety levels.展开更多
The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut micr...The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut microbiota and sexual health,mediated by its impact on systemic inflammation,hormonal regulation,and immune function.A balanced gut microbiota supports optimal levels of sex hormones,such as estrogen and testosterone,which are critical for sexual function and reproductive health.Additionally,gut-derived metabolites such as short-chain fatty acids contribute to maintaining mucosal barrier integrity and regulating immune responses,which are essential for protecting against infections that may impair sexual health.Conversely,dysbiosis,an imbalance in gut microbial composition,has been linked to conditions such as erectile dysfunction,polycystic ovary syndrome,and reduced libido,emphasizing its role in sexual dysfunction.Lifestyle factors,including diet,stress,and antibiotic use,can modulate the gut microbiota and,consequently,sexual health outcomes.Recent therapeutic approaches,such as probiotics,prebiotics,and fecal microbiota transplantation,offer potential for restoring gut balance and improving sexual health.This review highlights the central role of the gut microbiota in sexual health,emphasizing its importance as a target for therapeutic interventions to enhance overall well-being.展开更多
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.展开更多
Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual p...Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.展开更多
Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care.Caregivers play a crucial role in supporting individuals through this difficult journey,o...Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care.Caregivers play a crucial role in supporting individuals through this difficult journey,often balancing their own grief with the need to provide care.This paper explores the experiences of mourning and grief in hospice settings,with a focus on the emotional challenges faced by both patients and caregivers during the grieving process.Psychological support plays a crucial role at the end of life in a multidisciplinary care approach.By addressing the complex interplay between biological disease and psychological well-being,healthcare professionals can provide more comprehensive and compassionate care.A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams,ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.展开更多
In the investigation of disease dynamics, the effect of covariates on the hazard function is a major topic. Some recent smoothed estimation methods have been proposed, both frequentist and Bayesian, based on the relat...In the investigation of disease dynamics, the effect of covariates on the hazard function is a major topic. Some recent smoothed estimation methods have been proposed, both frequentist and Bayesian, based on the relationship between penalized splines and mixed models theory. These approaches are also motivated by the possibility of using automatic procedures for determining the optimal amount of smoothing. However, estimation algorithms involve an analytically intractable hazard function, and thus require ad-hoc software routines. We propose a more user-friendly alternative, consisting in regularized estimation of piecewise exponential models by Bayesian P-splines. A further facilitation is that widespread Bayesian software, such as WinBUGS, can be used. The aim is assessing the robustness of this approach with respect to different prior functions and penalties. A large dataset from breast cancer patients, where results from validated clinical studies are available, is used as a benchmark to evaluate the reliability of the estimates. A second dataset from a small case series of sarcoma patients is used for evaluating the performances of the PE model as a tool for exploratory analysis. Concerning breast cancer data, the estimates are robust with respect to priors and penalties, and consistent with clinical knowledge. Concerning soft tissue sarcoma data, the estimates of the hazard function are sensitive with respect to the prior for the smoothing parameter, whereas the estimates of regression coefficients are robust. In conclusion, Gibbs sampling results an efficient computational strategy. The issue of the sensitivity with respect to the priors concerns only the estimates of the hazard function, and seems more likely to occur when non-large case series are investigated, calling for tailored solutions.展开更多
The gut microbiota works in unison with the host,promoting its health.In particular,it has been shown to exert protective,metabolic and structural functions.Recent evidence has revealed the influence of the gut microb...The gut microbiota works in unison with the host,promoting its health.In particular,it has been shown to exert protective,metabolic and structural functions.Recent evidence has revealed the influence of the gut microbiota on other organs such as the central nervous system,cardiovascular and the endocrine-metabolic systems and the digestive system.The study of the gut microbiota is outlining new and broader frontiers every day and holds enormous innovation potential for the medical and pharmaceutical fields.Prevention and treatment of specific women’s diseases involves the need to deepen the function of the gut as a junction organ where certain positive bacteria can be very beneficial to health.The gut microbiota is unique and dynamic at the same time,subject to external factors that can change it,and is capable of modulating itself at different stages of a woman’s life,playing an important role that arises from the intertwining of biological mechanisms between the microbiota and the female genital system.The gut microbiota could play a key role in personalized medicine.展开更多
The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stres...The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression.Both stress and depression,if not resolved over time,activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines.This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels.Since people with depression have a 60%increased risk of developing type 2diabetes(T2D)and show high levels of inflammation and low levels of BDNF,we hypothesize possible reasons that might explain why T2D,depression and dementia are often associated in the same patient.展开更多
Intimate partner violence has been recognized as a serious public health issue.Exposure to violence contributes to the genesis of,and exacerbates,mental health conditions,and existing mental health problems increase v...Intimate partner violence has been recognized as a serious public health issue.Exposure to violence contributes to the genesis of,and exacerbates,mental health conditions,and existing mental health problems increase vulnerability to partner violence,a loop that imprisons victims and perpetuates the abuse.A recently described phenomenon is when male violence against females occurs within intimate relationships during youth,and it is termed adolescent or teen dating violence.In this narrative review,factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed,along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown.Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims.Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.展开更多
BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term...BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.展开更多
Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality...Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion tha...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population.The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period.We hypothesised that pregnant women in the prepandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.AIM To compare pregnant women for anxiety,prenatal depression,psychopathology,and social support before and after the awareness of the pandemic.METHODSWe administered to women willing to participate in their 2nd-3rd trimesters of pregnancy theEdinburgh Postnatal Depression Scale(EPDS),the State-Trait Anxiety Inventory Form Y(STAI-Y),and the Symptom CheckList-90-Revised(SCL-90R);we further collected sociodemographicvariables and explored women’s social support.The comparison was cross-sectional.The firstsample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak(January 2020-February 2020)was declared,and the second sample termed COVID-19 becauseparticipants were already subjected to the COVID-19-related restrictive measures(January 2021-February 2021).Since normal distribution was not met(Shapiro-Wilk test applied),we appliednonparametric Mann-Whitney’s U-test to compare psychometric tests.Ethical standards were met.RESULTSThe nonCOVID-19 group reported higher support from partners only,while the COVID-19 groupreported multiple support(χ^(2)=9.7181;P=0.021);the nonCOVID-19 group scored higher than theCOVID-19 group only on state anxiety among psychometric scales[STAI-Y1,nonCOVID-19median=39(95%CI:39.19-51.10)vs COVID-19 median=32(95%CI:30.83-38.90);Mann-Whitney’sU=117.5,P=0.00596].Other measures did not differ meaningfully between the two groups.Scoreson the EPDS,the state and trait subscales of the STAI-Y,and most SCL-90R subscales intercorrelatedwith one another.The anxiety component of the EPDS,EPDS-3A,correlated poorlywith other measures,while it was the Global Symptom Index of the SCL-90-R that correlated moststrongly with most measures.Our results are at odds with most literature and do not confirmincreased depression and anxiety rates in pregnant women during the pandemic.CONCLUSIONThe ability of pregnant women to deal with novel generalised threats involves mobilization ofinner resources.Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.展开更多
Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2...Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women,possibly due to several contributing factors,ranging from lockdown,stay at home regulations,job losses,anxiety,and stress.Accordingly,it remains paramount to enforce proactive preventive strategies,at both the family and individual level,maintain a high level of attention to recognize all forms of violence or abuse,and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical,sexual,and emotional domains and offer a personalized care.展开更多
Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in de...Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.展开更多
Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterat...Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterations within the hepatocyte.The liver is the central organ in the metabolism of alcohol,a process that also involves other organs and tissues such as the brain,heart and muscles,but the most relevant organ is the liver.The anatomopathological alterations in the liver associated with the prolonged use of alcohol range from the simple accumulation of neutral fats in the hepatocytes,to cirrhosis and hepatocellular carcinoma.Alcohol abuse frequently leads to liver disease such as steatosis,steatohepatitis,fibrosis,cirrhosis,and tumors.Following the spread of coronavirus disease 2019(COVID-19),there was an increase in alcohol consumption,probably linked to the months of lockdown and smart working.It is known that social isolation leads to a considerable increase in stress,and it is also recognized that high levels of stress can result in an increase in alcohol intake.Cirrhotic patients or subjects with liver cancer are immunocompromised,so they may be more exposed to COVID-19 infection with a worse prognosis.This review focuses on the fact that the COVID-19 pandemic has made the emergence of alcohol-induced liver damage a major medical and social problem.展开更多
Gynecological cancers and their treatments are associated with both specific and non-specific long-term physiological effects.Cancer patients face transformations in their lifestyle,body image,role,and social interact...Gynecological cancers and their treatments are associated with both specific and non-specific long-term physiological effects.Cancer patients face transformations in their lifestyle,body image,role,and social interactions and suffer from physical,psychological,and economic problems.The mental health of cancer patients is of great importance and requires special attention,as growing evidence demonstrates its influence not only on quality of life but also on treatment com-pliance.Gynecological cancers have peculiar psychological consequences,which are linked to the specificity of the site of the neoplasia.Clinicians should be aware of the importance of protecting the psychophysical health of these patients and the fact that their physical health and quality of life also depend on the quality of their mental health.It is possible to structure targeted and effective prevention interventions and treatments to reduce psychological distress and improve the quality of life of subjects living with gynecological cancers.展开更多
Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs.There are inevitable differences in efficacy,side effects and long-term treatment response between m...Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs.There are inevitable differences in efficacy,side effects and long-term treatment response between men and women.Psychopharmacological research needs to develop adequately powered animal and human trials aimed to consider pharmacokinetics and pharmacodynamics of central nervous system drugs in both male and female subjects.Healthcare professionals have the responsibility to prescribe sex-specific psychopharmacotherapies with a priority to differentiate between men and women in order to minimize adverse drugs reactions,to maximize therapeutic effectiveness and to provide personalized management of care.展开更多
文摘BACKGROUND Disorders of gut-brain interaction(DGBI)are common,but knowledge about their physiopathology is still poor,nor valid tools have been used to evaluate them in childhood.AIM To develop a psycho-gastroenterological questionnaire(PGQ)to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without DGBI.METHODS One hundred and nineteen Italian children(age 11-18)were included:28 outpatient patients with DGBI(Rome IV criteria)and 91 healthy controls.They filled the PGQ,faces pain scale revised(FPS-R),Bristol stool chart,ga-strointestinal symptoms rating scale,state-trait anxiety inventory,Toronto alexithymia scale 20,perceived self-efficacy in the management of negative emotions and expression of positive emotions(APEN-G,APEP-G),irritable bowel syndrome-quality of life questionnaire,school performances,tobacco use,early life events,degree of digital-ization.RESULTS Compared to controls,patients had more medical examinations(35%of them went to the doctor more than five times),a higher school performance(23%vs 13%,P<0.05),didn’t use tobacco(never vs 16%,P<0.05),had early life events(28%vs 1%P<0.05)and a higher percentage of pain classified as 4 in the FPS-R during the examination(14%vs 7%,P<0.05).CONCLUSION Pediatric outpatients with DGBI had a higher prevalence of early life events,a lower quality of life,more medical examinations rising health care costs,lower anxiety levels.
文摘The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut microbiota and sexual health,mediated by its impact on systemic inflammation,hormonal regulation,and immune function.A balanced gut microbiota supports optimal levels of sex hormones,such as estrogen and testosterone,which are critical for sexual function and reproductive health.Additionally,gut-derived metabolites such as short-chain fatty acids contribute to maintaining mucosal barrier integrity and regulating immune responses,which are essential for protecting against infections that may impair sexual health.Conversely,dysbiosis,an imbalance in gut microbial composition,has been linked to conditions such as erectile dysfunction,polycystic ovary syndrome,and reduced libido,emphasizing its role in sexual dysfunction.Lifestyle factors,including diet,stress,and antibiotic use,can modulate the gut microbiota and,consequently,sexual health outcomes.Recent therapeutic approaches,such as probiotics,prebiotics,and fecal microbiota transplantation,offer potential for restoring gut balance and improving sexual health.This review highlights the central role of the gut microbiota in sexual health,emphasizing its importance as a target for therapeutic interventions to enhance overall well-being.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
文摘Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.
文摘Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care.Caregivers play a crucial role in supporting individuals through this difficult journey,often balancing their own grief with the need to provide care.This paper explores the experiences of mourning and grief in hospice settings,with a focus on the emotional challenges faced by both patients and caregivers during the grieving process.Psychological support plays a crucial role at the end of life in a multidisciplinary care approach.By addressing the complex interplay between biological disease and psychological well-being,healthcare professionals can provide more comprehensive and compassionate care.A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams,ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.
文摘In the investigation of disease dynamics, the effect of covariates on the hazard function is a major topic. Some recent smoothed estimation methods have been proposed, both frequentist and Bayesian, based on the relationship between penalized splines and mixed models theory. These approaches are also motivated by the possibility of using automatic procedures for determining the optimal amount of smoothing. However, estimation algorithms involve an analytically intractable hazard function, and thus require ad-hoc software routines. We propose a more user-friendly alternative, consisting in regularized estimation of piecewise exponential models by Bayesian P-splines. A further facilitation is that widespread Bayesian software, such as WinBUGS, can be used. The aim is assessing the robustness of this approach with respect to different prior functions and penalties. A large dataset from breast cancer patients, where results from validated clinical studies are available, is used as a benchmark to evaluate the reliability of the estimates. A second dataset from a small case series of sarcoma patients is used for evaluating the performances of the PE model as a tool for exploratory analysis. Concerning breast cancer data, the estimates are robust with respect to priors and penalties, and consistent with clinical knowledge. Concerning soft tissue sarcoma data, the estimates of the hazard function are sensitive with respect to the prior for the smoothing parameter, whereas the estimates of regression coefficients are robust. In conclusion, Gibbs sampling results an efficient computational strategy. The issue of the sensitivity with respect to the priors concerns only the estimates of the hazard function, and seems more likely to occur when non-large case series are investigated, calling for tailored solutions.
文摘The gut microbiota works in unison with the host,promoting its health.In particular,it has been shown to exert protective,metabolic and structural functions.Recent evidence has revealed the influence of the gut microbiota on other organs such as the central nervous system,cardiovascular and the endocrine-metabolic systems and the digestive system.The study of the gut microbiota is outlining new and broader frontiers every day and holds enormous innovation potential for the medical and pharmaceutical fields.Prevention and treatment of specific women’s diseases involves the need to deepen the function of the gut as a junction organ where certain positive bacteria can be very beneficial to health.The gut microbiota is unique and dynamic at the same time,subject to external factors that can change it,and is capable of modulating itself at different stages of a woman’s life,playing an important role that arises from the intertwining of biological mechanisms between the microbiota and the female genital system.The gut microbiota could play a key role in personalized medicine.
文摘The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression.Both stress and depression,if not resolved over time,activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines.This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels.Since people with depression have a 60%increased risk of developing type 2diabetes(T2D)and show high levels of inflammation and low levels of BDNF,we hypothesize possible reasons that might explain why T2D,depression and dementia are often associated in the same patient.
文摘Intimate partner violence has been recognized as a serious public health issue.Exposure to violence contributes to the genesis of,and exacerbates,mental health conditions,and existing mental health problems increase vulnerability to partner violence,a loop that imprisons victims and perpetuates the abuse.A recently described phenomenon is when male violence against females occurs within intimate relationships during youth,and it is termed adolescent or teen dating violence.In this narrative review,factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed,along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown.Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims.Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.
文摘BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.
文摘Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population.The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period.We hypothesised that pregnant women in the prepandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.AIM To compare pregnant women for anxiety,prenatal depression,psychopathology,and social support before and after the awareness of the pandemic.METHODSWe administered to women willing to participate in their 2nd-3rd trimesters of pregnancy theEdinburgh Postnatal Depression Scale(EPDS),the State-Trait Anxiety Inventory Form Y(STAI-Y),and the Symptom CheckList-90-Revised(SCL-90R);we further collected sociodemographicvariables and explored women’s social support.The comparison was cross-sectional.The firstsample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak(January 2020-February 2020)was declared,and the second sample termed COVID-19 becauseparticipants were already subjected to the COVID-19-related restrictive measures(January 2021-February 2021).Since normal distribution was not met(Shapiro-Wilk test applied),we appliednonparametric Mann-Whitney’s U-test to compare psychometric tests.Ethical standards were met.RESULTSThe nonCOVID-19 group reported higher support from partners only,while the COVID-19 groupreported multiple support(χ^(2)=9.7181;P=0.021);the nonCOVID-19 group scored higher than theCOVID-19 group only on state anxiety among psychometric scales[STAI-Y1,nonCOVID-19median=39(95%CI:39.19-51.10)vs COVID-19 median=32(95%CI:30.83-38.90);Mann-Whitney’sU=117.5,P=0.00596].Other measures did not differ meaningfully between the two groups.Scoreson the EPDS,the state and trait subscales of the STAI-Y,and most SCL-90R subscales intercorrelatedwith one another.The anxiety component of the EPDS,EPDS-3A,correlated poorlywith other measures,while it was the Global Symptom Index of the SCL-90-R that correlated moststrongly with most measures.Our results are at odds with most literature and do not confirmincreased depression and anxiety rates in pregnant women during the pandemic.CONCLUSIONThe ability of pregnant women to deal with novel generalised threats involves mobilization ofinner resources.Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.
文摘Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women,possibly due to several contributing factors,ranging from lockdown,stay at home regulations,job losses,anxiety,and stress.Accordingly,it remains paramount to enforce proactive preventive strategies,at both the family and individual level,maintain a high level of attention to recognize all forms of violence or abuse,and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical,sexual,and emotional domains and offer a personalized care.
文摘Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.
文摘Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterations within the hepatocyte.The liver is the central organ in the metabolism of alcohol,a process that also involves other organs and tissues such as the brain,heart and muscles,but the most relevant organ is the liver.The anatomopathological alterations in the liver associated with the prolonged use of alcohol range from the simple accumulation of neutral fats in the hepatocytes,to cirrhosis and hepatocellular carcinoma.Alcohol abuse frequently leads to liver disease such as steatosis,steatohepatitis,fibrosis,cirrhosis,and tumors.Following the spread of coronavirus disease 2019(COVID-19),there was an increase in alcohol consumption,probably linked to the months of lockdown and smart working.It is known that social isolation leads to a considerable increase in stress,and it is also recognized that high levels of stress can result in an increase in alcohol intake.Cirrhotic patients or subjects with liver cancer are immunocompromised,so they may be more exposed to COVID-19 infection with a worse prognosis.This review focuses on the fact that the COVID-19 pandemic has made the emergence of alcohol-induced liver damage a major medical and social problem.
文摘Gynecological cancers and their treatments are associated with both specific and non-specific long-term physiological effects.Cancer patients face transformations in their lifestyle,body image,role,and social interactions and suffer from physical,psychological,and economic problems.The mental health of cancer patients is of great importance and requires special attention,as growing evidence demonstrates its influence not only on quality of life but also on treatment com-pliance.Gynecological cancers have peculiar psychological consequences,which are linked to the specificity of the site of the neoplasia.Clinicians should be aware of the importance of protecting the psychophysical health of these patients and the fact that their physical health and quality of life also depend on the quality of their mental health.It is possible to structure targeted and effective prevention interventions and treatments to reduce psychological distress and improve the quality of life of subjects living with gynecological cancers.
文摘Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs.There are inevitable differences in efficacy,side effects and long-term treatment response between men and women.Psychopharmacological research needs to develop adequately powered animal and human trials aimed to consider pharmacokinetics and pharmacodynamics of central nervous system drugs in both male and female subjects.Healthcare professionals have the responsibility to prescribe sex-specific psychopharmacotherapies with a priority to differentiate between men and women in order to minimize adverse drugs reactions,to maximize therapeutic effectiveness and to provide personalized management of care.
