Effectiveness and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a 52-week real-life study in an Italian cohort.

BACKGROUND: Secukinumab has shown high efficacy in randomized controlled trials in both ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Here, we investigated its real-life effectiveness and tolerability in a cohort of AS and PsA patients. METHODS: We retrospectively analyzed medical records of outpatients with AS or PsA treated with secukinumab between December 2017 and December 2019. ASDAS-CRP and DAS28-CRP scores were used to measure axial and peripheral disease activity in AS and PsA, respectively. Data were collected at baseline and after 8, 24, and 52 weeks of treatment. RESULTS: Eighty-five adult patients with active disease (29 with AS and 56 with PsA; 23 males and 62 females) were treated. Overall, mean disease duration was 6.7 years and biologic-naïve patients were 85%. Significant reductions in ASDAS-CRP and DAS28-CRP were observed at all time-points. Body weight (in AS) and disease activity status at baseline (particularly in PsA) significantly affected disease activity changes. ASDAS-defined inactive disease and DAS28-defined remission were achieved in comparable proportions between AS and PsA patients, at both 24 weeks (45% and 46%) and 52 weeks (65.5% and 68%, respectively); male sex was found an independent predictor of positive response (OR 5.16, P = 0.027). After 52 weeks, achievement of at least low disease activity and drug retention were observed in 75% of patients. Secukinumab was well-tolerated and only mild injection-site reactions were recorded in 4 patients. CONCLUSION: In a real-world setting, secukinumab confirmed great effectiveness and safety in both AS and PsA patients. The influence of gender on treatment response deserves further attention.

'This is the last episode': the association between problematic binge-watching and loneliness, emotion regulation, and sleep-related factors in poor sleepers.

Evidence on the relation between binge-watching and sleep quality is still scarce and inconsistent and none has taken into account both the healthy and pathological dimensions of the phenomenon. This study aimed at filling this gap by investigating both aspects in healthy participants with high and low sleep quality. Further, we aimed at identifying sociodemographic, psychological and sleep-related determinants of problematic binge-watching in poor sleepers. We first conducted independent comparisons between good (n = 253) and poor sleepers (n = 209) on different binge-watching symptoms and motives, assessed through 'Binge-watching Engagement and Symptoms' and 'Watching TV Series Motives' questionnaires, respectively. Then, we focused on the problematic aspects of binge-watching in poor sleepers, investigating the role of emotion regulation, loneliness, and sleep-related factors using hierarchical multiple regressions. Comparisons between the two groups revealed a greater extent of binge-watching behaviour (t = -2.80, p = 0.005) and greater use of this practise to cope with negative emotions (t = -4.17, p < 0.001) in poor sleepers. In addition, hierarchical multiple regressions showed that gender (ß = -0.166, p = 0.008), alcohol consumption (ß = -0.135, p = 0.035), emotional dysregulation (ß = 0.260, p = 0.001; ß = 0.298, p < 0.001), feelings of loneliness (ß = 0.159, p = 0.029; ß = 0.199, p = 0.003), and daytime sleepiness (ß = 0.149, p = 0.016) are significant determinants of problematic binge-watching in this population. In addition to showing for the first time the relationship between sleep quality and different aspects of binge-watching, our findings indicate that emotional dysregulation, feelings of loneliness, and daytime sleepiness play a key role in determining problematic binge-watching in poor sleepers, possibly due to the existence of a pathological vicious circle between these factors in poor sleepers.

Effectiveness and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a 52-week real-life study in an Italian cohort

Abstract Background Secukinumab has shown high efficacy in randomized controlled trials in both ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Here, we investigated its real-life effectiveness and tolerability in a cohort of AS and PsA patients. Methods We retrospectively analyzed medical records of outpatients with AS or PsA treated with secukinumab between December 2017 and December 2019. ASDAS-CRP and DAS28-CRP scores were used to measure axial and peripheral disease activity in AS and PsA, respectively. Data were collected at baseline and after 8, 24, and 52 weeks of treatment. Results Eighty-five adult patients with active disease (29 with AS and 56 with PsA; 23 males and 62 females) were treated. Overall, mean disease duration was 6.7 years and biologic-naïve patients were 85%. Significant reductions in ASDAS-CRP and DAS28-CRP were observed at all time-points. Body weight (in AS) and disease activity status at baseline (particularly in PsA) significantly affected disease activity changes. ASDAS-defined inactive disease and DAS28-defined remission were achieved in comparable proportions between AS and PsA patients, at both 24 weeks (45% and 46%) and 52 weeks (65.5% and 68%, respectively); male sex was found an independent predictor of positive response (OR 5.16, P = 0.027). After 52 weeks, achievement of at least low disease activity and drug retention were observed in 75% of patients. Secukinumab was well-tolerated and only mild injection-site reactions were recorded in 4 patients. Conclusion In a real-world setting, secukinumab confirmed great effectiveness and safety in both AS and PsA patients. The influence of gender on treatment response deserves further attention.

Longitudinal associations between stress and sleep disturbances during COVID-19.

The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8-10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (ß = 0.203; p < 0.001), even after controlling for baseline sleep disturbances. Results remained significant even after controlling for the effects of covariates including age, sex, depression and anxiety symptoms, and referring to psychological services (ß = 0.179; p < 0.05). Findings confirm the high prevalence of stress symptoms during the COVID-19 pandemic and provide first longitudinal evidence for the effects of perceived stress on sleep disturbances during the pandemic.

Dreams and Nightmares during the First and Second Wave of the COVID-19 Infection: A Longitudinal Study.

Recent literature shows that the Coronovirus-19 (COVID-19) pandemic has provoked significant changes in dreaming. The current study intends to provide an update about dream variable changes during the second wave of COVID-19. A total of 611 participants completed a web survey from December 2020 to January 2021. Statistical comparisons showed that subjects had lower dream-recall frequency, nightmare frequency, lucid-dream frequency, emotional intensity, and nightmare distress during the second than the first wave of the pandemic. Dreams had a higher negative tone during the second than first wave. We revealed significant differences concerning post-traumatic growth, sleep-related post-traumatic stress disorder (PTSD) symptoms and sleep measures between groups obtained as a function of the changes in the oneiric frequency between the first and second waves. We also found significant correlations between qualitative/emotional dream features and COVID-19-related factors (job change, forced quarantine, having COVID-19 infected relatives/friends, or asking for mental health help). Overall, we found that the second wave affected fewer quantitative features of dream activity and there was less emotional intensity. Moreover, we confirmed the relationship between nightmares and the high risk of PTSD when subjects were grouped as a function of the increasing/decreasing frequency. Finally, our findings are partly coherent with the continuity hypothesis between oneiric and waking experiences.

Dreaming during lockdown: a quali-quantitative analysis of the Italian population dreams during the first COVID-19 pandemic wave.

This study aims to explore the emotional experiences related to the lockdown during the first pandemic wave, analysing the dreams of the Italian population. Through an online survey spread throughout the country, participants completed the Depression Anxiety Stress Scale-21 (DASS-21), the Resilience Scale (RS) and were asked to narrate a dream they had during the lockdown. The dreams were qualitatively analysed through the thematic content analysis. Logistic regression analyses were then conducted to verify the relationship among the categories that emerged and between these categories and the DASS-21 and RS scores. In the dreams 8 categories were identified (Places, Characters, Relationships, Actions, Danger, Death, Processes, and Emotions) composed of specific sub-categories, which seem to compose a sort of narrative structure of the dream. Some sub-categories were found to be predictor of depression and resilience or with exposure to COVID-19. Dreams can be a valid tool both to understand the experiences of the population during the pandemic and to evaluate those at risk of developing distress in clinical practice.

Psychometric properties of the Sleep Hygiene Index in a large Italian community sample.

OBJECTIVE/BACKGROUND: Poor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach. PATIENTS/METHODS: Participants (n = 6276; M = 33.62, SD = 13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables. RESULTS AND CONCLUSIONS: CFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω = 0.752). Test-retest reliability at 8-10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice.

The Relationship between Psychological Distress during the Second Wave Lockdown of COVID-19 and Emotional Eating in Italian Young Adults: The Mediating Role of Emotional Dysregulation.

This cross-sectional study aims to investigate the impact of psychological distress experienced during the second wave of the COVID-19 pandemic on emotional eating and to assess the mediating role of emotional dysregulation in a sample of Italian young adults (20-35). A total of 437 participants provided demographical data and were assessed using the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire. Correlational analyses were performed to assess the relationship between continuous variables, while ANOVA was conducted to detect differences between males and females for emotional eating. To assess whether demographic and clinical data predicted emotional eating, hierarchical linear regression was performed. Then, a mediation analysis was conducted to assess whether emotional dysregulation was a mediator between psychological distress and emotional eating. Emotional eating was associated with psychological distress and emotional dysregulation. Moreover, higher levels of emotional eating were found in females than in males. Predictors of emotional eating were sex, psychological distress, and emotional dysregulation. Mediation analyses showed that the indirect effect of psychological distress on emotional eating through emotional dysregulation was significant (b = 0.0069; SE = 0.0024; CI = 0.0024-0.0118), confirming that the relationship between psychological distress and emotional eating was mediated by emotional dysregulation, controlling for sex. The model explained 26.8% (R2 = 0.2680) of the variance. These findings may help to plan and develop psychological interventions aimed at addressing emotional eating in young adults by targeting emotional dysregulation.

Time Waits for No One: Longitudinal Study on the Effects of an Anti-Stigma Seminar on the Psychology Student Population.

The primary aim is to describe the changes in the knowledge of mental health conditions, the attitudes toward the mentally ill, and the intended behaviour towards people with mental illness among the entire student population of the third year of a degree course in Psychology. A total of 570 students attended a seminar on stigma towards mental illness and were invited to complete an online survey which collected data on sociodemographic characteristics and three validated questionnaires evaluating different aspects of stigma at three different time points (pre-intervention, post-intervention, and at one year follow up). A total of 253 students (44.39%) completed the questionnaires at t0, t1, and t2. The mean age of the sample was 23.7 (SD = ±5.89), and 86.96% (n = 220) were females. Between t0 and t1, a statistically significant improvement was observed for all three outcomes, while the intended behaviour outcome was no longer significant between t1 and t2 (Z = -0.70; p = 0.48). Females and who participated live at the seminar maintained a significant knowledge of mental illness and a better attitude toward community mental health care. The effects of the seminar focused on reducing stigma tended to diminish over time at one year follow-up, particular in relation to intended behaviour.

Giving a voice to cataplectic experience: recollections from patients with narcolepsy type 1.

STUDY OBJECTIVES: The objective of this study was to assess the narratives from the recalled accounts of cataplexy attacks of patients with narcolepsy type 1 (NT1). METHODS: Twenty-two drug-naive adult patients meeting the International Classification of Sleep Disorders criteria for the diagnosis of NT1 referring to the Narcolepsy Center of the University of Bologna in the year 2017 underwent a semistructured interview focusing on their personal experiences during the cataplectic attacks. Verbatim transcripts were analyzed by thematic analysis of elementary contexts using T-LAB software. RESULTS: The thematic analysis performed on the entire body text showed 3 clusters that explained 36.2%, 34.1%, and 29.7% of the variance, respectively: a cluster related to situations that trigger attacks of cataplexy, a cluster to bodily sensations, and another control strategies during episodes. The thematic content highlighted a tendency to disregard emotional experiences, thus affecting the ability to name, recognize, and regulate critical emotions. CONCLUSIONS: The study showed that patients with NT1 spoke of their cataplectic attacks in terms of self-reported bodily experiences, trigger situations, and their management. Therefore, patients may have developed strategies of symptom management focused on emotion avoidance and/or inhibition.

Effect of oxybuprocaine eye drops on corneal volume and thickness measurements.

PURPOSE: To investigate the effect of oxybuprocaine eye drops on corneal volume (CV) and corneal thickness measurements. METHODS: Central corneal thickness (CCT), corneal thinnest point (CTP), and CV of 78 eyes of 78 healthy volunteers were measured with Pentacam, before and 5 min after the administration of oxybuprocaine eye drops. The fellow non-anesthetized eyes were used as control. RESULTS: Before topical anesthesia, the mean CCT was 546.76 ± 35.3 µm, after anesthesia, it was 547.76 ± 36.56 µm (p = 0.86). In the fellow eyes, the first mean CCT was 548.82 ± 35.2 µm and the second was 547.55 ± 35.9 µm (p = 0.82). The mean CTP before anesthesia was 543.99 ± 35.23 µm, after it was 544.89 ± 36.3 µm (p = 0.88). In the fellow eyes, the first mean CTP was 544.15 ± 35.35 µm and the second was 542.81 ± 36 µm (p = 0.81). Before topical anesthesia, the mean CV was 60.55 ± 3.84 mm, after it was 60.66 ± 3.97 mm (p = 0.86). In the fellow eyes, the first mean CV was 60.93 ± 3.87 mm and the second was 60.73 ± 4 mm (p = 0.75). CONCLUSIONS: Oxybuprocaine eye drops do not appear to induce a significant corneal swelling and do not affect the measurements when comparing CCT measured with optical or ultrasound devices.

Reliability of the IOLMaster in measuring corneal power changes after hyperopic photorefractive keratectomy.

PURPOSE: To test the accuracy of the IOLMaster (Carl Zeiss Meditec) in detecting corneal power changes after hyperopic photorefractive keratectomy (PRK). METHODS: Forty-five consecutive eyes that underwent hyperopic PRK with the SCHWIND ESIRIS excimer laser, ranging from +0.75 to +7.00 diopters (D) (mean: +3.84±1.56 D), were analyzed. Data included pre- and postoperative (1, 3, and 6 months) fogging refraction and automated keratometry (K). Statistical analysis was performed to determine the correlation between the changes in refraction at the corneal plane and the changes in keratometry. RESULTS: The mean difference between the changes in refraction and the measured corneal changes was +0.27±1.19 D (range: -1.91 to +4.28 D) (P=.18) at 1 month; +0.56±0.97 D (range: -1.00 to +2.96 D) (P=.006) at 3 months; and +0.67±0.80 D (range: -0.73 to +2.31 D) (P=.00002) at 6 months. Based on these results, we suggest using the regression formula found at 6-month follow-up (y=0.8074 x + 0.092) to better calculate the effective corneal power. Comparison between the data obtained with IOLMaster measurements and equivalent K readings from the Holladay report obtained with the Pentacam (Oculus Optikgeräte GmbH) shows good agreement (R(2)=0.9). CONCLUSIONS: Automated keratometry provided by the IOLMaster underestimates the effective refractive changes after hyperopic PRK, and a correcting factor is needed to calculate the corneal power in these cases.

Corneal thickness and endothelial cell characteristics in patients with myotonic dystrophy.

PURPOSE: To compare the characteristics of the endothelial cells of patients with myotonic dystrophy and those of normal subjects to determine if thicker corneas in patients with myotonic dystrophy are the result of their having abnormal endothelial cells leading to corneal edema. DESIGN: Prospective, comparative case series. PARTICIPANTS: Fifty-two eyes of patients with myotonic dystrophy and 52 eyes of normal age- and gender-matched subjects. METHODS: Central corneal thickness (CCT) and endothelial cell counts and shape were measured with an SP 3000P specular microscope (Topcon, Tokyo, Japan) in patients with myotonic dystrophy and were compared with those of age- and gender-matched healthy subjects. MAIN OUTCOME MEASURES: Central corneal thickness, endothelial cell counts, pleomorphism, and coefficient of variation (CoV). RESULTS: In patients with myotonic dystrophy, the mean+/-standard deviation CCT measurement was 533+/-38 microm; the mean+/-standard deviation cell count was 2601+/-365 cell/mm(2); and the mean+/-standard deviation CoV was 23.3+/-4.4 (P<0.001). The mean+/-standard deviation pleomorphism was 64.4+/-8.4%. In healthy subjects, the mean+/-standard deviation CCT measurement was 514+/-27 microm (P = 0.002); the mean+/-standard deviation cell count was 2649+/-363 cell/mm(2) (P = 0.48); the mean+/-standard deviation CoV was 27.6+/-5.5 (P<0.001); and the mean+/-standard deviation pleomorphism was 61.1+/-8.6% (P = 0.04). CONCLUSIONS: Thicker corneas found in patients with myotonic dystrophy are not related to endothelial number or appearance as assessed in this study.

Corneal parameters and difference between goldmann applanation tonometry and dynamic contour tonometry in normal eyes.

PURPOSE: To compare the difference between 2 methods of measuring the intraocular pressure (IOP), namely, Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) and to study the relationship with the corneal parameters in patients with no glaucoma signs. METHODS: One hundred and eighteen eyes of 118 healthy subjects from 20 to 77 years of age underwent IOP measurements with DCT and GAT, central corneal thickness, and corneal volume measurements with Pentacam Scheimpflug camera. Pentacam examination has been performed first, then DCT and, after 10 minutes, GAT measurements. RESULTS: The measurements with GAT ranged between 11 and 22 mm Hg (m=15.49+/-2.43 mm Hg), the measurements with DCT ranged between 10.5 and 25.1 mm Hg (m=17.59+/-2.9 mm Hg). DCT showed a statistically significant (P<0.0001) higher IOP measurement compared with GAT. A relation between differences in IOP with central corneal thickness and corneal volume was found, whereas no relation was found with corneal radius and age. CONCLUSIONS: Our results show a discrete correlation between GAT and DCT measurements, but DCT showed slightly higher values of IOP. If DCT should be considered the gold standard, higher values of IOP could still be considered normal. These 2 devices cannot to be used interchangeably.

Comparison of central corneal thickness measured with Orbscan and Pentacam.

PURPOSE: To compare central corneal thickness measurements obtained with Orbscan II using the acoustic equivalent correction factor (CF) and Pentacam in eyes screened for refractive surgery. METHODS: Central corneal thickness in 91 eyes of 51 volunteers with a spherical equivalent refraction ranging from -17.00 to +5.50 diopters (D) (mean: -3.75+/-4.19 D) was measured with both Orbscan II (CF) and Pentacam prior to refractive surgery. RESULTS: Central comeal thickness measurements ranged from 438 to 610 microm with Orbscan II (CF) and from 472 to 634 microm with Pentacam. The differences between Pentacam and Orbscan II (CF) measurements ranged from -43 to +52 microm (mean: -13.98+/-14.79 microm); these differences were statistically significant (P<.0001). No correlation was found between the difference in central corneal thickness and refractive error. CONCLUSIONS: These results suggest measurements obtained with the Orbscan II (CF) are thinner than those obtained with the Pentacam. Further studies are needed to determine which instrument is more accurate in measuring central corneal thickness.