Loss of Continuity of Care in Pediatric Neurology Services during COVID-19 Lockdown: An Additional Stressor for Parents.

Background. This study aimed to investigate the consequence of the COVID 19-related lockdown on the well-being of children with neurological and neurodevelopmental disorders and the repercussion on parental stress during the period 9 March 2020-3 May 2020. Methods. A web-based survey was shared via mail with the parents of children affected by chronic neurologic disorders and neurodevelopmental disorders in the continuity of care in two Italian tertiary centers, independently by the severity of the diseases and the required frequency of controls. For each patient, they were asked to identify a single main caregiver, among the two parents, to fill in the questionnaire. Parental stress was measured via the Perceived Stress Scale (PSS). Statistical analysis was performed with IBM SPSS Statistics version 25. The differences between the clinical groups were performed with one way ANOVA. The dimensional effect of the clinical variables on outcome was evaluated by multiple linear regression analysis. Results. The survey was completed by 250 parents (response rate = 48.9 %). Sars-Cov2 infection was reported in two patients only. A total of 44.2% of the patients had completely interrupted school activities while 70% of parents underwent changes in their job modalities. Health care services were disrupted in 77% of patients. Higher PSS scores were detected in the parents of children with neurodevelopmental disorders (p = 0.035). Conclusions. The loss of continuity of care during the lockdown must be considered as a risk factor for parents caring for children with chronic neurologic diseases and neurodevelopmental disorders in further phases of the current pandemic.

Psychometric properties of a Silhouette Rating Scale assessing current and ideal body size and body dissatisfaction in adults.

PURPOSE: The study aims at validating a new pictorial tool, the Silhouette Rating Scale (SRS). It consists of a series of nine female or male silhouettes. It was created to assess current and ideal body size evaluation, and body dissatisfaction. Our aims were to test the concurrent, convergent and discriminant validity of the scale, evaluating possible gender differences. METHOD: A first sample of 754 young adults (age M = 26.10 ± 8.50, males N = 218) and a second sample of 210 young adults (age M = 21.19 ± 3.22, males = 43) completed the SRS, and other self-report measures assessing body size evaluation, disordered eating, body satisfaction, depression, emotion regulation and insomnia. RESULTS: Statistical analyses performed on the first sample largely support the concurrent validity of the scale. Results obtained from the second sample confirm its convergent validity, showing strong correlations with the Contour Drawing Rating Scale. In addition, the correlations performed between the three responses of the SRS and other measures of eating disorders, depression, insomnia and emotion regulation indicated a good discriminant validity, though some of the variables measured seem to be significantly correlated. CONCLUSIONS: The SRS is a reliable and valid tool for assessing current body size, body ideal and body dissatisfaction as compared to other widely used scales. It guarantees the universality of use thanks to the absence of details related to ethnicity or culture and at the same time, maintaining a right level of realism. Future studies will evaluate test-retest validity and its potential within clinical populations. LEVE OF EVIDENCE: V, descriptive cross sectional study.

Sex in Chemsex: Sexual Response, Motivations, and Sober Sex in a Group of Italian Men Who Have Sex With Men With Sexualized Drug Use.

BACKGROUND: Most studies on chemsex focus on the health risks associated with the practice, whereas less attention has been paid to the perception of sexual gratification in men who have sex with men (MSM) who use these substances. AIM: The purpose of this study was to explore the effects of chemsex substances on sexual response, motivations to engage in chemsex and the relationship with sober sex. METHODS: Thirty-one Italian cisgender MSM involved in sexualized drug use were interviewed and transcripts were thematically analyzed. OUTCOMES: An ad hoc grid exploring sociodemographic data, chemsex sexual experience, motives, and relationships with sober sex was used during telephone-based interviews. RESULTS: Participants showed significant individual differences in how chems may affect their sexual experience. The most reported effects were an increase in sexual desire and subjective arousal, access to higher disinhibition, possible erection and ejaculation difficulties, significant extension of the sexual experience duration, and an intensified perception of intimacy and pleasure. All the positive outcomes of substances on sex creates a great curiosity around chemsex, which is among the primary motives to engage in chemsex for the first time. Over time, other motives may emerge, also connected to substance abuse and craving. Some men reported to be motivated by their partners and friends and to use chemsex to cope with depressive mood/anxiety symptoms, stress and sexual problems. Many differences were reported between chemsex and sober sex. Chemsex seems to embody the idea of transgressive and exciting sex, while sober sex is outlined as a more intimate encounter, that can be significantly affected by performance anxiety. CLINICAL TRANSLATION: These results offer some new perspectives that may add interesting information to the literature and be fundamental for future prevention and harm-reduction projects. STRENGTHS & LIMITATIONS: Although this study is based on a small group of Italian MSM and the interviews were not audio-recorded, transcripts were consistent with scientific literature that considers it important to pay attention to the positive links between sex and substance use. CONCLUSION: The promotion of safer sexual behavior should contemplate an in-depth discussion and recognition of both pleasurable and distressing aspects of chemsex sexual experience, its motivations over time and perceived differences with sober sex. Nimbi FM, Rosati F, Esposito RM, et al. Sex in Chemsex: Sexual Response, Motivations, and Sober Sex in a Group of Italian Men Who Have Sex With Men With Sexualized Drug Use. J Sex Med 2021;18:1955-1969.

Implementation of Psychodynamic Multifamily Groups for Severe Mental Illness: A Recovery-Oriented Approach.

Background: Among Family-Based Services for the treatment of severe mental illnesses, multi-family models gained particular attention, given the potential usefulness of mutual feed-back, motivation and encouragement among families. Methods: The Psychodynamic Multi-Family Group Model has been proposed since 1997 in some Community Mental Health Services in Rome. Since 2011 multifamily groups are held weekly in all the six Districts of the Department of Mental Health that serves a population of more than one million people, and data have been collected since 2015 in three Districts. A total of 794 individuals attended the meetings in the period 2015-2019. Results: Eighty-six percent of those who started, attended more than one meeting. The mean of occurrences of participation among patients was 18.6, among mothers 25.6 and among fathers 21.6. The 794 participants belonged to 439 family units, among which 180 comprised only the patient, 76 only parent(s) or other close person(s), and 183 comprised parent(s) or close person(s) with the patient. Patients participating alone were older than those of families who participated as a whole. Families including the patient showed the longest duration of attendance and the highest prevalence of a diagnosis of schizophrenia in the index patient. Families who had been attending the multifamily groups since a long time maintained a high rate of attendance. Conclusions: Multifamily groups represent a setting where patients can meet with other people and professionals in a free still structured way, and with not strictly therapeutic objectives. The high number of patients who attended alone suggests that such participation corresponds to a self-perceived need of open and free setting facilitating sharing of problems and solutions. The good tenure of the interventions, the high participation, and the feasibility in the long-term suggest that multifamily groups can be implemented in the mental health services of a large city, are sustainable over many years, and can represent a valuable resource for many patients and families.

Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment.

Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.

Chemsex in Italy: Experiences of Men Who Have Sex With Men Consuming Illicit Drugs to Enhance and Prolong Their Sexual Activity.

BACKGROUND: Chemsex is a novel phenomenon referring to the consumption of illicit drugs to facilitate, enhance, and prolong the sexual experience in men who have sex with men (MSM). AIM: The present study aims to investigate contexts, patterns of substance use, first chemsex experience, and harm reduction in a group of MSM practicing chemsex in Italy. METHODS: Thirty MSM involved in chemsex activities were interviewed between February and July 2019. OUTCOMES: The interviews were conducted using an ad hoc grid exploring general characteristics of Italian chemsex, patterns of substance use, first chemsex experience, and harm reduction opinions. RESULTS: Chemsex in Italy showed important peculiarities and patterns because of sociocultural background. Chemsex was mainly reported in private venues within couple and group sexual activities. Most participants attended chemsex sessions about 1-2 times per month often concurring with men-only club events. Freebase cocaine emerged among the most relevant substances consumed together with gamma-hydroxybutyrate/gamma-butyrolactone, crystal methamphetamine, and mephedrone. A rare use of injected substances compared with other European Union countries was shown. Given the high prevalence of erectile problems, a large use of phosphodiesterase type 5 inhibitors was reported, and noncoital sexual activities were usually preferred (eg, oral sex, fist fucking). The first chemsex experiences were usually accessed by geolocation-based dating apps and sexual partners and were generally described as positive experiences, with some negative consequences at the end of the session (dysphoric mental states, guilt, craving). Taking part in international gay events seems to favor the first experience of chemsex for some participants. Moreover, some MSM practiced chemsex only abroad or in other cities in Italy so as not to be recognized as chem users in their daily environment. CLINICAL TRANSLATION: Implications for ad hoc harm reduction programs are discussed. STRENGTHS & LIMITATIONS: Despite the methodological limitations due to participants' number and the absence of interviews audio recording, results highlighted some relevant characteristics of chemsex in Italy, such as freebase cocaine use, attitudes regarding slamming, geographical movements, and secrecy. CONCLUSION: The results revealed a need for greater scientific and public attention on chemsex to act with the most specific and effective prevention and harm reduction tools. Nimbi FM, Rosati F, Esposito RM, et al. Chemsex in Italy: Experiences of Men Who Have Sex With Men Consuming Illicit Drugs to Enhance and Prolong Their Sexual Activity. J Sex Med 2020;17:1875-1884.

Eating disorder symptoms and the 2 × 2 model of perfectionism: mixed perfectionism is the most maladaptive combination.

PURPOSE: The 2 × 2 model of perfectionism (Gaudreau and Thompson in Personal Individ Diff 48:532-537, 2010) represents an important addition to the perfectionism literature, but so far has not been studied in relation with disordered eating. METHOD: Using the 2 × 2 model as analytic framework, this study examined responses from a convenience sample of 716 participants aged 19-68 years (71% female) investigating how self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) predicted individual differences in eating disorder symptoms, additionally controlling for body mass index, gender, and age. RESULTS: Results showed a significant SOP × SPP interaction indicating that the combination of high SOP and high SPP-called "mixed perfectionism"-was associated with the highest levels of eating disorder symptoms. CONCLUSIONS: The findings demonstrate the utility of the 2 × 2 model of perfectionism as an analytic framework for examining perfectionism and disordered eating. Moreover, they suggest that mixed perfectionism is the most maladaptive form of perfectionism when it comes to disordered eating, such that having high levels of SPP combined with high levels of SOP represents the most maladaptive combination of perfectionism in terms of risk of eating disorder. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Perfectionism and eating disorder symptoms in female university students: the central role of perfectionistic self-presentation.

PURPOSE: Numerous studies have found perfectionism to show positive relations with eating disorder symptoms, but so far no study has examined whether perfectionistic self-presentation can explain these relations or whether the relations are the same for different eating disorder symptom groups. METHODS: A sample of 393 female university students completed self-report measures of perfectionism (self-oriented perfectionism, socially prescribed perfectionism), perfectionistic self-presentation (perfectionistic self-promotion, nondisplay of imperfection, nondisclosure of imperfection), and three eating disorder symptom groups (dieting, bulimia, oral control). In addition, students reported their weight and height so that their body mass index (BMI) could be computed. RESULTS: Results of multiple regression analyses controlling for BMI indicated that socially prescribed perfectionism positively predicted all three symptom groups, whereas self-oriented perfectionism positively predicted dieting only. Moreover, perfectionistic self-presentation explained the positive relations that perfectionism showed with dieting and oral control, but not with bulimia. Further analyses indicated that all three aspects of perfectionistic self-presentation positively predicted dieting, whereas only nondisclosure of imperfection positively predicted bulimia and oral control. Overall, perfectionistic self-presentation explained 10.4-23.5 % of variance in eating disorder symptoms, whereas perfectionism explained 7.9-12.1 %. CONCLUSIONS: The findings suggest that perfectionistic self-presentation explains why perfectionistic women show higher levels of eating disorder symptoms, particularly dieting. Thus, perfectionistic self-presentation appears to play a central role in the relations of perfectionism and disordered eating and may warrant closer attention in theory, research, and treatment of eating and weight disorders.