Measurement invariance of the experiences in close relationships questionnaire across different populations

The measurement invariance of the Experiences in Close Relationships (ECR) questionnaire was investigated across four samples of non-clinical subjects (N = 222), dermatological patients (N = 458), psychiatric inpatients (N = 156), and patients with drug-resistant epilepsy (N = 101). The results provided evidence of configural, metric, and scalar invariance across groups. Overall, our findings provide further support to the reliability and validity of the ECR (AU)

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Measurement invariance of the experiences in close relationships questionnaire across different populations.

The measurement invariance of the Experiences in Close Relationships (ECR) questionnaire was investigated across four samples of non-clinical subjects (N = 222), dermatological patients (N = 458), psychiatric inpatients (N = 156), and patients with drug-resistant epilepsy (N = 101). The results provided evidence of configural, metric, and scalar invariance across groups. Overall, our findings provide further support to the reliability and validity of the ECR.

A melanoma risk score in a Brazilian population.

BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.

Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology.

OBJECTIVE: To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria. METHOD: Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis. RESULTS: Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%). CONCLUSIONS: The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.

A melanoma risk score in a Brazilian population / Um escore de risco para melanoma em uma população brasileira

BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM. .

FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenvolver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano) e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79). Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo. .

Anniversary reactions in medical patients.

The aim of this study was to explore the prevalence and characteristics of anniversary reactions (somatic symptoms occurring at the anniversary of specific events) in a large sample of 1498 medical patients from different medical settings who underwent the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), which provide definition of anniversary reactions. In 54 (3.6%) of the 1498 patients for whom anniversary reaction was identified, 61.1% had a concurrent DSM-IV diagnosis. Other syndromes related to somatization, abnormal illness behavior, irritable mood, demoralization, and alexithymia were present in 9 of 10 cases. Symptoms of the conversion syndrome were found in 6 (0.4%) patients with the SCID and in 67 (4.5%) patients with the DCPR, 20% of whom also had anniversary reaction. The results should alert physicians to enquire about the timing of symptoms in relation to meaningful personal events.

The combination of depressive symptoms and smoking shorten life expectancy among the aged.

BACKGROUND: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors. METHODS: A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality. RESULTS: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05-2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28-5.31), after controlling for potential confounders. CONCLUSIONS: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

Somatoform and psychoform dissociation among women with orgasmic and sexual pain disorders.

Since the 20th century, psychogenic female sexual dysfunctions (FSD), like some somatoform and conversion disorders, have been considered an expression of somatoform dissociation. Several studies have reported dissociative symptoms in different somatoform and conversion disorders, but limited data are available on dissociation among patients with FSD. The aim of this study was to assess somatoform and psychoform dissociation among patients with women's orgasmic disorder, dyspareunia, and vaginismus. A battery of self-administered questionnaires (Somatoform Dissociation Questionnaire, Dissociative Experiences Scale, Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised) was given to 200 gynecological outpatients to assess psychoform and somatoform dissociation and their association with FSD. A strong association between somatoform dissociation and FSD was observed (adjusted odds ratio [OR] = 5.39, 95% confidence interval [CI] = 1.15-25.32), the association between somatoform and psychoform dissociation being estimated by an adjusted OR of 4.83 (95% CI = 1.17-19.91). Our results are compatible with the idea that some forms of FSD could be regarded as somatoform dissociative disorders.

Polymorphisms of GSTM1 and GSTT1, sun exposure and the risk of melanoma: a case-control study.

Glutathione S-transferases (GSTs) are a family of enzymes that are known to play an important role in cellular protection against oxidative stress, including the oxidative stress caused by ultraviolet radiation. This study focused on the possible involvement of GSTM1 and GSTT1 polymorphisms in risk modulation of cutaneous melanoma. Within a case-control study, the presence of the null polymorphism at GSTM1 and GSTT1 was investigated in 188 cases of cutaneous melanoma and 152 controls. Information on socio-demographic characteristics, medical history, sun exposure and pigmentary characteristics were collected for all subjects. Logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (CI). An interaction was suggested between the GSTM1 and GSTT1 "null" genotype and episodes of sunburn in childhood OR of interaction (1.65, 95% CI (95% CI) 0.27-9.94). The risk of melanoma among the subset of participants who reported sunburns in childhood and who had both null variants, was nine (OR 9.16; 95% CI 1.18-70.9). The results suggest that subjects carrying both GSTM1 and GSTT1 null polymorphisms and experiencing sunburns in childhood have an extremely high risk of melanoma.

Subtyping depression in the medically ill by cluster analysis.

BACKGROUND: There is increasing awareness of the need of subtyping major depressive disorder, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing depression in the medically ill. METHODS: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 198 patients (12.7%) received a diagnosis of major depressive disorder. Data were submitted to cluster analysis. RESULTS: Two clusters were identified: depressed somatizers and irritable/anxious depression. The somatizer cluster included 58.6% of the cases and was characterized by DCPR somatization syndromes (persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, and anniversary reactions) and DCPR alexithymia. The anxious/irritable cluster had 41.4% of the total sample and included DCPR irritable mood and type A behavior and DSM-IV anxiety disorders. LIMITATIONS: The study has limitations due to its cross-sectional nature. Further, these findings require additional validation in another sample. CONCLUSIONS: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, irritable mood, type A behavior and alexithymia, as encompassed by the DCPR. Subtyping major depressive disorder may yield improved targets for psychosomatic research and treatment trials.

Reliability of self-reported information on skin cancer among elderly patients with squamous cell carcinoma.

PURPOSE: We aimed to evaluate reliability of self-reported information on skin cancer among individuals aged > 65 years with cutaneous squamous cell carcinoma (SCC). METHODS: A test-retest was performed with patients completing two questionnaires one month apart. RESULTS: Among 102 recruited patients the response rate was 97.1% (mean age 80.9 years, 74.8% men). The majority of items showed substantial agreement: history of skin cancer screening (k = 0.88), past skin cancer in general (k = 0.92), basal cell carcinoma (k = 0.75), patient delay (k = 0.64) and total delay (k = 0.86). Agreement was high also for ages > 80 years. Recall of past SCCs (k = 0.48) and sunscreen use (k = 0.38) was less accurate. CONCLUSIONS: Our study provided evidence on the reliability of patient reported skin cancer information among elderly individuals, who represent the majority of affected cases.

Somatoform and psychoform dissociation among students.

Recent evidence suggests a relationship between psychoform and somatoform dissociation both in clinical and non clinical samples. The aim of the study was to investigate the association between the two forms of dissociation among 947 university students who completed two self-administered questionnaires, the Somatoform Dissociation Questionnaire (SDQ-20) and the Dissociative Experience Scale (DES). The main result of the study was that the association between somatoform and psychoform dissociation was strong for individuals with moderate level of DES scores (O.R.=7.0), but much stronger for individuals with high level of DES scores (O.R.=18.9).

Timely diagnosis of cutaneous squamous cell carcinoma: the GP's role.

BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is the second most frequent skin cancer among Caucasians. Advanced cases determine significant tissue destruction and they can metastasize. OBJECTIVES: To evaluate the role of GPs in timely diagnosis of SCC, examining the probability of delay before the diagnosis and treatment of SCC among patients having first seen a GP compared to patients having accessed directly a dermatologist. METHODS: We included a stratified sample of 308 SCC patients treated at a referral center in Italy. Medical records were reviewed and combined with patient interviews. RESULTS: Multivariable analysis has shown that patients who have first seen a GP have a significantly lower likelihood of long patient delay [odds ratio (OR) = 0.45; 95% confidence interval (95% CI) 0.21-0.94; P = 0.04) compared to patients having accessed directly a dermatologist. Treatment delay was not associated with the specialization of the first doctor seen for the lesion (OR = 0.52; 95% CI 0.15-1.84; P = 0.31). CONCLUSION: Our findings highlight the potential role of the GP in facilitating rapid access to appropriate health care.

Delay in diagnosis and treatment of squamous cell carcinoma of the skin.

Advanced squamous cell carcinomas (SCC) of the skin can cause significant tissue destruction and may metastasize. Understanding the determinants of patient delay could help prevent advanced presentation. The purpose of the present study was to examine patient- and healthcare-related factors associated with delay before the detection and treatment of SCC. A sample of 308 patients with SCC treated at a dermatological referral centre in Italy were interviewed. Clinical data were obtained from the medical records. The highest quartile patients reported > 9 months delay between noticing the lesion and the first medical visit (defined as long patient delay). Multivariate analysis showed that SCC arising on pre-existing chronic lesions were associated with long patient delay (odds ratio = 3.17; 95% confidence interval 1.1-9.3). Controlling for confounders, the first physician's advice to remove the lesion immediately was associated with a shorter treatment delay (p < 0.001). In conclusion, our work emphasizes the importance of seeing a doctor about any change in a pre-existing lesion, particularly in light of the fact that SCC on chronic lesions are at greater risk of metastasis and recurrence.

Factors associated with large cutaneous squamous cell carcinomas.

BACKGROUND: Large cutaneous squamous cell carcinoma (SCC) is associated with a higher risk of disfigurement, local recurrence, and metastasis; however, little is known about factors associated with tumor size at diagnosis. OBJECTIVES: We sought to evaluate factors associated with SCC size, including diagnostic/treatment delay and patient and tumor characteristics. METHODS: We studied a stratified sample of 308 patients with SCC recently treated at a dermatologic referral center in Italy. Medical records were reviewed and telephone interviews conducted. Multiple logistic regression was used to examine factors associated with SCC size. RESULTS: With univariate analyses, among both invasive and in situ cases, SCC greater than 2 cm was significantly associated with male gender, tumors arising in chronic lesions, and tumors located on not easily visible sites. Long delay before surgical removal was significantly associated with large SCC size only for invasive SCC (P < .001). Among patients with invasive SCC, when controlling for age and gender, multivariate analysis showed a significantly higher likelihood of SCC greater than 2 cm with a total delay longer than 18 months before surgical removal (odds ratio=4.18; 95% confidence interval 2.45-7.13) and for tumors arising in chronic lesions (odds ratio=6.42; 95% confidence interval 3.13-13.2). LIMITATIONS: The study was cross-sectional and based on a single center. CONCLUSIONS: Long total delay in removal significantly increased the likelihood of invasive SCC greater than 2 cm. Our findings highlight the importance of early detection and treatment to prevent large invasive SCCs, which are associated with a higher risk of disfigurement, recurrence, and metastasis. Particular attention should be paid to chronic skin lesions and not easily visible body sites during physician- and patient-performed examinations.

Identifying individuals at high risk of melanoma: a simple tool.

Simple and reliable tools for identifying patients at high risk for melanoma with preventive measures have important public health implications. An individual risk score for cutaneous melanoma was constructed and externally validated. With the summary coefficients of the risk factors for cutaneous melanoma, derived from a meta-analysis, a melanoma risk score was tested in an Italian population and externally validated in a Brazilian population. Common nevi, skin and hair color, freckles, and sunburns in childhood were the variables included in the final predictive model. The discriminatory ability of the models was assessed by the receiver operating characteristic (ROC) curve. The performance of the model was also evaluated by conducting an external validation. The area under the curve (AUC) of the candidate model was 0.79 (95% confidence interval: 0.75-0.82). The same model, when applied in the Brazilian population, presented an AUC of 0.79 (95% confidence interval: 0.70-0.86). At the cut-off level of 3 and more, 89 and 80% of the melanoma cases were correctly classified as 'at risk for melanoma' in the Italian and in the Brazilian populations, respectively. The risk model is a simple tool that identifies patients for preventive measures and may be used with reasonable confidence in different populations. The risk model may help family doctors in referring patients to dermatological clinics and thus improve early diagnosis.

Reliability of self-reported household pesticide use.

Household pesticide exposure has been associated with cancer risk in both adults and children. We investigated the reliability of reported lifetime household pesticide exposure through repeated administration of a standardized questionnaire. A questionnaire including detailed questions about lifetime frequency and duration of pesticide use in nonoccupational circumstances was administered on two occasions to 163 cutaneous melanoma cases and 113 controls. We investigated the agreement between the two measurements taken on average 12 months apart and studied the association between differences in the two measurements and a set of explanatory variables. According to the results of the reliability analysis, we also corrected the odds ratio estimates from the main study. The agreement for duration and frequency of use of pesticides outdoors was 89.5% (Cohen's kappa = 0.48) and 92.0% (Cohen's kappa = 0.40), respectively, whereas duration and frequency of use of pesticides indoors agreement was 75.4% (Cohen's kappa = 0.32) and 77.4% (Cohen's kappa = 0.28), respectively. The agreement was higher for duration (97.4%; Cohen's kappa = 0.72) and use of pesticides on domestic animals (86.4%; Cohen's kappa = 0.68). The corrected odds ratio showed a moderate increase with a reinforcement of the effect of pesticides. Overall, there was a good reproducibility in self-reported exposure to pesticides. This findings may reinforce earlier studies that showed that residential pesticides may cause cancer.

Skin cancer knowledge and preventive behaviors among patients with a recent history of cutaneous squamous cell carcinoma.

AIMS: To evaluate skin cancer knowledge and preventive behaviors of patients recently treated for cutaneous squamous cell carcinoma (SCC) and to examine the factors associated with the adoption of preventive behaviors. METHODS: Telephone survey on 315 SCC patients treated at a large dermatological hospital in Italy, evaluating skin cancer knowledge, sun protection and skin examination practices as well as medical recommendations received after SCC removal. RESULTS: Skin cancer knowledge was fair/low for 48.9% of the participants. Doctors were the main source of skin cancer information for 24.4% of the patients. Of the patients assessed >or=12 months after SCC removal, 32.7% reported a total skin examination after removal. Of the participants, 41.6% never/rarely used sunscreens. In a multivariate analysis, the likelihood of having complete skin examinations was associated with a doctor's advice to have an examination (odds ratio, OR = 2.29; 95% confidence interval, CI = 1.2-4.4), a higher knowledge level (OR = 2.05; 95% CI = 1.1-3.8) and past skin examinations (OR = 3.62; 95% CI = 1.9-7.0). Doctor's recommendations increased the likelihood of adopting preventive behaviors. CONCLUSIONS: We found substantial knowledge gaps and limited adoption of skin cancer prevention, highlighting the need for interventions promoting knowledge and preventive behaviors, particularly among higher-risk patients.

Toward a biopsychosocial approach to skin diseases.

A link between the mind and the skin has long been hypothesized. Indeed, some studies suggested that psychosocial factors may play a role in the pathogenesis and course of several skin diseases. Conversely, other studies suggested that psychiatric disorders and psychosocial difficulties may result as a complication of a primary skin disease. Epidemiological studies indeed found a high prevalence of psychiatric disorders among dermatological patients. This is a source of concern, because psychiatric morbidity is associated with emotional suffering, disability, lower quality of life, poorer adherence to dermatological treatment, and increased risk of self-harm. Conditions such as demoralization, health anxiety, irritable mood, type A behavior, and alexithymia were also found to be frequent in dermatological patients, and to be independently associated with greater psychological distress, lower quality of life, and poorer psychosocial functioning. Several studies also raised concerns about under-recognition and undertreatment of psychiatric disorders. This large body of findings suggests that psychosocial issues deserve more attention in everyday dermatological practice, and highlights the need for a biopsychosocial approach to the management of patients with skin disease. To this purpose, the development of efficient consultation-liaison services enabling an effective collaboration between dermatologists and mental health professionals is mandatory.