Dysfunctional coping is related to impaired skin-related quality of life and psychological distress in patients with neurofibromatosis type 1 with major skin involvement.

BACKGROUND: Low skin-related quality of life (QoL) is usually associated with low levels of self-confidence and self-esteem and with high levels of anxiety and depression symptoms. The way patients cope with a physical disease impacts significantly on their psychosocial adjustment to the disorder and on their emotional functioning. OBJECTIVES: To explore how coping strategies, skin-related QoL, psychological distress and self-esteem interact in a sample of individuals with neurofibromatosis type 1 (NF1). METHODS: Seventy-two adult patients with NF1 completed the following questionnaires: Coping Orientation to Problem Experiences (COPE), Skindex-29, Padua Skin-Related QoL questionnaire (PSRQ), State-Trait Anxiety Inventory-X2 form (STAI-X2), Depression Questionnaire (DQ) and Rosenberg Self-Esteem Scale (RSES). The k-modes algorithm was used to identify clusters of patients based on four variables: sex, NF1 severity, number and distribution of cutaneous neurofibromas. Individuals in different clusters were compared with regard to their scores; correlations between scores were analysed within each cluster. RESULTS: Two main clusters were identified: individuals in Cluster 1 had a larger number and more widespread distribution of neurofibromas compared with Cluster 2. Patients in Cluster 1 scored higher only on several PSRQ and Skindex-29 scales. Among patients in Cluster 1, the COPE 'avoidance strategies' scale was significantly correlated with the PSRQ 'physical distress and impairments' scale, the Skindex-29 'physical symptoms' and 'functioning' scales, the STAI-X2, the DQ and the RSES. CONCLUSIONS: Patients with major skin involvement have reduced skin-related QoL. Among them, current findings tentatively suggest that the higher the use of dysfunctional coping, the more impaired are QoL, psychological distress and self-esteem. What's already known about this topic? Neurofibromatosis type 1 (NF1) can affect the quality of life (QoL) in adolescent and adult patients. Low skin-related QoL is usually associated with low levels of self-confidence and self-esteem and with high levels of anxiety and depression symptoms. Questionnaires evaluating skin-related QoL, anxiety, depression, self-esteem and coping are available. What does this study add? Patients with a large number and a widespread distribution of cutaneous neurofibromas have reduced skin-related QoL compared with patients with minor skin involvement. The newly developed Padua Skin-Related QoL questionnaire allows the simultaneous evaluation of discomfort and comfort skin-related QoL dimensions in patients with NF1. Among patients with major skin involvement, the higher the use of dysfunctional coping, the more impaired are skin-related QoL, psychological distress and self-esteem. Our data suggest that patients with NF1 with major skin involvement who endorse dysfunctional beliefs about their own coping abilities might benefit from psychological counselling and coping skills treatments aiming to both improve perceived self-efficacy and learn more adaptive coping strategies.

Neural correlates of observation of disgusting images in subjects with first episode psychosis and post-traumatic stress disorder.

The aim of this study was to analyze neural responses to disgusting images in individuals with first episode psychosis and post-traumatic stress disorder (PTSD). Although anhedonia is a common symptom in both disorders we expected that they would be associated with different neurophysiological abnormalities and patterns of activation. We recruited three groups of participants: 13 individuals with first episode psychosis, 10 individuals with PTSD who had survived the April 2009 L’Aquila earthquake and 25 healthy controls matched for age and education. All individuals participated in a functional imaging experiment in which they watched six alternating blocks of disgusting and scrambled images whilst undergoing scanning with a General Electric 1.5T whole-body scanner. We estimated individuals'’ beta-weights, extracting 22 clusters corresponding to 22 significant areas. Findings were consistent with other neuroimaging studies; the active areas (i.e. amygdala, insula, inferior and medial frontal gyrus) have consistently been associated with emotional experiences. Statistical analysis revealed important group differences in intensity and direction (positive or negative) of signal from baseline during disgusting condition. Although these results are preliminary they show that functional neuroimaging techniques may make a valuable contribution to differential diagnosis of first episode psychosis and PTSD.

Functional measurement in consumer evaluation of market products

Understanding which product attributes influence the most consumer evaluation is central in marketing research. In particular, comprehension of niche market has become of fundamental importance to survive in modern open markets. Functional measurement techniques have been shown to be useful in identifying the cognitive rules underlying the integration of different product attributes. Based on this rationale, an analysis on footwear and shoe market was carried out. Potential buyers of a target product were presented with different profiles created by manipulating design, brand and price, and their preferences were recorded. Functional measurement and cluster analysis techniques were employed to identify patterns in cognitive behavior (AU)

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Averaging models: parameters estimation with the R-Average procedure

The Functional Measurement approach, proposed within the theoretical framework of Information Integration Theory (Anderson, 1981, 1982), can be a useful multi-attribute analysis tool. Compared to the majority of statistical models, the averaging model can account for interaction effects without adding complexity. The R-Average method (Vidotto & Vicentini, 2007) can be used to estimate the parameters of these models. By the use of multiple information criteria in the model selection procedure, R-Average allows for the identification of the best subset of parameters that account for the data. After a review of the general method, we present an implementation of the procedure in the framework of R-project, followed by some experiments using a Monte Carlo method(AU)

Initial conditions in the averaging cognitive model

The initial state parameters s0 and w0 are intricate issues of the averaging cognitive models in Information Integration Theory. Usually they are defined as a measure of prior information (Anderson, 1981; 1982) but there are no general rules to deal with them. In fact, there is no agreement as to their treatment except in specific situations such as linear models where they can be merged with the arbitrary zero inter-response scale C0. We present some considerations on their meaning and usefulness in the Functional Measurement approach, starting from different points of view. Furthermore, we suggest a method to deal with their complexity both within each single trial of a factorial design, and between the overall trials of an experiment(AU)

Quality of life impact as outcome in burns patients.

PURPOSE: Severe burns have not only physical but also psychological consequences both during and after hospitalisation. By identifying the mainly impaired areas of a patient's quality of life (QoL), specific psychological support programmes can be provided. The assessment of subjectively perceived QoL impairment can also provide an indicator of the outcome of the medical and psychological treatment. METHOD: This study used the Sickness Impact Profile (SIP) to investigate QoL in 30 burned patients after discharge and again three months' later. RESULTS: At the first assessment, both the physical and psychological dimensions were significantly impaired, although there was an improvement at the 3-month follow-up, particularly in the physical dimension. Data suggest that there are QoL areas that appear to be compromised in burn patients. Even after hospital discharge, the burn injury causes major limitations that extend well beyond the physical area and involve emotional, social and relational aspects. Nevertheless, most of the categories in the physical dimension tend to improve during follow-up and, three months after the first administration, the predominant limitations are in emotional behaviour and sleep and rest in the psychosocial dimension. The SIP score matched for depth and extent of burns show that females were in poorer health than males. At the first administration, gender-related differences were particularly marked in Ambulation (p = .005), Body Care and Movement (p = .004), Home Management (p = .013), Mobility (p = .011), Physical Dimension (p = .004) and the QoL general score (p = .031). Although all of these areas had improved by the time of the retest, the gender-related differences remained. The categories assessed with the Psychosocial Dimension of SIP did not correlate with the clinical parameters of the burn, whereas those pertaining to the Physical Dimension did. CONCLUSION: Multidisciplinary support for burn patients appears to be necessary even many months after hospital discharge.

[New questionnaire to evaluate psychological treatment effects]. / Proposta di un nuovo strumento per la verifica dell'efficacia nella pratica dei trattomenti psicologici e psicoteropeutici.

A new questionnaire named CBA-VE (Cognitive Behavioral Assessment for outcome evaluation) was developed to evaluate psychological treatment intervention--especially for counseling and psychotherapy. The questionnaire has 80 items and a 5 point Likert-like scale ranging from 1 = nothing to 5 = a lot. The aim of this study was to evaluate the validity and the reliability of the five constructs of the questionnaire both in normal and clinical subjects. Participants. Two samples were analyzed: a "Normal" group composed of 250 normal adults plus 51 university students; and a "Clinical" group including 261 adults undergoing psychotherapy and psychological counseling provided by the public health service. The questionnaire includes five scales: three of them are related to important psychological aspects (anxiety, depression, and psychological distress); the remaining two are measurements of psychological wellbeing and self-perception of a positive change. The questionnaire has excellent psychometric characteristics, both for normal and clinical subjects. We observed a good reliability, good internal consistency, and an excellent structural validity for the five interrelated dimensions. The normalized factorial loadings are consistent, significant (from around 0.6 up), and similar in both the groups. The so-called Clinical group showed higher scores in anxiety, depression, and psychological distress and smaller scores in wellbeing and change perception. This is coherent with what the authors assumed a priori.

[Organizational climate, trust and burnout in a rehabilitation center]. / Clima organizzativo, fiducia e burnout in un centro di riabilitazione.

Today human resources are considered of fundamental importance and necessity for the success of the organizations that provide health services. The aims of the present study were: 1) to investigate the perception that rehabilitation medical staff employees have of their hospital organization, 2) to quantify their evaluation concerning organizational trust, 3) to identify eventual burnout symptoms and their relationship with perceived organizational climate and trust. The sample consisted of 131 employees, subdivided into 6 professional categories. Three questionnaires were administered to the employees. The results evidenced significant differences between the various professional groups regarding the climate perceived and trust in the organization. Administrative personnel, nurses and medical graduates revealed a greater satisfaction, responsibility and work integration than the other employee groups (p = 0.023). All the scales which measured organizational climate correlated (inversely) with those measuring burnout (p" 0.05), indicating the existence of a close relationship between a work climate perceived as collaborative (r = -0.33) and characterized by a continuous exchange of information about the hospital organization (r = -0.50), and the psychological well-being experienced by the employees. This study confirms the importance of promoting organizational strategies aimed at mutual reinforcement and support characterized by regular and constructive feedback, wherein there is a reciprocal recognition of each employee's role through a clear, open communication.

[Formal representation of the cognitive-behavioral assessment in obsessive-compulsive disorder]. / Rappresentazione formale dell'assessment cognitivo-comportamentale per il disturbo ossessivo-compulsivo.

Psychological assessment is a crucial and important part of psychologist's work. Despite this, tools utilized by clinicians are often inadequate and methods used to investigate and make decisions on the basis of collected data are even logically incorrect. In this paper two mathematical psychology theories (Knowledge Space Theory and Formal Concept Analysis) are employed to propose a method for collecting diagnostic information. The conjoint application of these two theories allows to build a hierarchical structure composed by diagnostic elements. This structure is very similar to the one determined by the clinical diagnostic process. Correct logical inferences on the patient's situation, and an exact depiction of those diagnostic elements presented or not by the patient, represent the potential advantages of such a methodology. An applicative example on Obsessive-Compulsive Disorder (using the background determined by two shared diagnostic tools i.e. DSM IV-TR and CBA 2.0) is presented. Finally, the opportunity to build an adaptive assessment procedure from the derived structure is investigated.

Maugeri Respiratory Failure questionnaire reduced form: a method for improving the questionnaire using the Rasch model.

PURPOSE: The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically developed for use with chronic respiratory failure (CRF) patients. The 28 items were selected using classical test theory. The purpose of the current analysis was to further refine the questionnaire using item response theory, specifically, the Rasch model analysis. METHODS: Three hundred and seventeen CRF patients (mean aged 66.7 yrs; Male 219, Female 98) completed the MRF-28 health status measure. Data were collected through the self-report questionnaire and analyzed using 1-parameter logistic models by means of RUMM software. RESULTS: The 28-item questionnaire has good psychometric properties in terms of discriminant power because the Person Separation Index is 0.896. However, the item-trait interaction was not good as shown by the total-item Chi-square (chi(2)(112), p<0.001). Removing two items that did not fit the Rasch model well, produced a minor improvement in Person Separation Index to 0.899 and the item-trait interaction improved (chi(2)(104), p = NS). In the preliminary analysis we identified 21 patients who were outliers; when they were excluded the distribution of the residuals, according to the Kolmogorov-Smirnov statistics, was normal and factor analysis of the item residuals showed that the components had similar eigenvalues and no strong correlation with items. These results suggest that the MRF-26 is a unidimensional measure of health-related quality of life impairment for chronic respiratory failure patients. CONCLUSIONS: A combination of classical psychometric tests and Rasch analysis produced an instrument of moderate size that covers a wide range of effects of CRF and has interval scaling properties.

[Structural equation model in the study of risk factors in the maintenance of binge eating]. / Un modello di equazioni strutturali per Lo studio dei fattori di rischio nel mantenimento del disturbo da alimentazione incontrollata.

This study investigated, in a sample of 483 adolescent girls, a number of risk factors associated with Binge Eating (BE) disorder, i.e. negative feelings, dieting behaviour, social influence and body dissatisfaction. Participants completed the following questionnaires: Bulimia Test, Depression Questionnaire, Dieting Self-Efficacy Measure, Dieting Success, Dieting Status Measure, Dutch Eating Behavior Questionnaire, Eating Disorder Inventory, Positive and Negative Affect Scale Revised, Rosenberg Self-Esteem Scale and Socio-cultural Attitudes Towards Appearance Questionnaire. Structural equation modeling was used in the data analysis to verify the hypothesized relations among the variables, with the aim of identifying the main predictors of BE. This methodology explains the correlation between the considered variables, and determines, using quantitative good fit indexes, both the strength of the correlations and the plausibility of the causal links between the hypothesized factors. Our findings confirm that negative feelings (Negative Affect) are the primary predictor for the maintenance of BE and highlight the significant role played by Social Influence. While Dieting Behaviour is not a primary predictor for the maintenance of BE it appears to influence it through its link with Negative Affect.

A new questionnaire specifically designed for patients affected by chronic obstructive pulmonary disease; The Italian Health Status Questionnaire.

The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy-which are two culturally distinct areas. The project consisted in three steps: (1) initial item set generation to identify items relevant to both genders, all ages and both regions; (2) item reduction including tests of regional specificity; (3) tests of internal validity using item-response theory using Rasch one-parameter modelling. Ninty-six COPD patients (mean aged 69 yr; 78 Male) completed the original set of 124 items of the Italian Health Status Questionnaire (IHSQ). Item reduction was carried out using an established standardised approach employing classical psychometric test theory. The internal construct validity of the 47 items that survived this process were tested to determine whether they constituted a unidimensional construct "impaired health due to COPD" using Rasch analysis. This showed that the questionnaire had very good psychometric properties, with an excellent Person Separation Index of 0.95 and no evidence of bias due to item-trait interaction (chi104(2)=127.1, P=n.s.). The combination of classical test theory and modern item-response methodology has produced a questionnaire with excellent measurement properties suitable for COPD patients whether from the north or south of Italy.

The psychometric and psychosocial dimension of Albanian immigration: data from a preliminary study.

The present study is part of a wider ministerial project aimed at analysing--both the healthcare and psychological aspects--the phenomenon of illegal immigration, in particular Albanian immigration in Apulia. The CBA 2.0 Primary Scale was duly translated, in accordance with the guidelines set out in literature, to allow for identification and future use of psychological tools in Albanian and therefore assess the psychological dimension of a sample group of adult Albanians. Moreover, the eventual presence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in subjects who arrived in Italy after a traumatic journey was studied. 82 Albanians were chosen (47 male and 35 female) having lived in Italy for over a year. All subjects were given the Albanian version of CBA 2.0 Primary Scale; subjects who had entered Italy illegally were asked to answer the DSM-IV questionnaire to assess PTSD and MDD and a semi-structured questionnaire made up to evaluate their experiences, before, during and after the trauma of their journey. CBA 2.0 translated into Albanian does not reveal psychological disturbances of clinical significance but did reveal values of hardship significantly lower than the normal Italian standards. Only 3 cases of PTSD and 6 of MDD arose from the questionnaire regarding the assessment of PTSD and MMD.

[Akrasia in ancient and modern thought--towards a cognitive model of akrasia]. / L'akrasia tra riflessioni antiche e moderne--verse un modello cognitive dell'akrasia.

Akrasia is a philosophical concept that denotes the tendency to act in contradiction with one's best judgement. This study aimed to clarify the phenomenon in psychological terms through a working construct drawn from the available philosophical and sociological literature. After redefining akrasia in terms more appropriate to cognitive science, the authors designed a self-description test suitable for measuring the latent dimensions hypothetically related to the akratic process. The questionnaire was administered to a group of 197 subjects aged between 18 and 60 years and the collected data underwent a confirmatory factorial analysis involving Structural Equations Models. The successive verification of the instrument's reliability and coherence showed the questionnaire to be a good indicator of the construct examined and confirmed that akratic behaviour--as the authors have defined it--is in fact explained by the factors which emerged.

[Anxiety and Depression Short Scale: norms for its use in rehabilitation]. / Scheda ansia e depressione forma ridotta: norme per l'utilizzo in ambito riabilitativo.

In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisciplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individual's problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index.

[Questionnaire of perceived quality (QQP): a study on the differences of gender]. / Questionario di qualità percepita (QQP): uno studio sulle differenze di genere.

In the present paper we analyze the psychometric properties of an Italian questionnaire measuring the perceived quality of health services (Questionnaire of Perceived Quality; Coluccia, Ferretti, Lorini, Calamai, 2002). Subjects answered 14 questions subdivided into four factors (i.e. Satisfaction regarding Medical Doctors, Nurses, Auxiliary Staff, and Hospital Structure). We administered the questionnaire to 1,600 patients in the "Le Scotte" Hospital of Siena. According to structural equation modeling, we studied the dimensionality of the questionnaire using confirmatory factor analysis and, successively, we studied differences in gender using Multi-sample analysis. Results show significant gender differences for two dimensions (i.e. Satisfaction regarding Nurses and Satisfaction regarding Hospital Structures). Females, compared to males, express more negative evaluations in these two factors.

Psychological and emotional aspects and pain.

A patient's psychological condition can be influenced by symptoms and, at the same time, it can influence the perception of symptoms. In psychological assessment, pain can modify the results of a questionnaire, so a patient's state at the moment of the evaluation should be taken into account. Questionnaires used in assessment do not always provide clear-cut answers concerning the individual psychological component. Moreover, difficulties in classifying headache patients does not permit correct comparisons between population samples whenever patients are not classified into well defined homogeneous groups. Overall, in the three groups examined - migraine, tension-type headache and cluster headache - it can be affirmed that with self-report assessment based on questionnaires, the tension-type headache subjects present a more interesting psychological profile for its clinical implications.

[Anxiety and acceptance of gynecological laparoscopic operations]. / Ansia e gradimento degli interventi eseguiti in laparoscopia ginecologica.

BACKGROUND: To evaluate the acceptance of gynecological laparoscopic operations. METHODS: A comparative analysis has been performed in a group of 32 women by analyzing a) the cognitive component, by means of 2 questionnaires administered before and after the operation and b) the emotional component, by evaluating the pre- and post-operative anxiety levels (State anxiety) and the constitutional ones (Trait anxiety) using the STAI Y test. The anxiety level of our group has been compared with that attributed to the general population by means of the Z test. Moreover, significant correlations have been searched between: 1) pre- and postoperative Trait and State anxiety, through the Pearson's correlation test; 2) the variables investigated by the two informational questionnaires and the anxiety measures, through the Student t test; 3) the informative variables themselves through the c2 test. RESULTS: Postoperative State anxiety is lower than that of the general population (p<0.05); a significant correlation exists between post- operative State and Trait anxiety (p<0.05); Trait anxiety is higher when fantasies linked to the operation are characterized by fear (p<0.05), and attribution of the decision to operate to the doctor (p<0.05); post-operative State anxiety is higher when the level of education is low (p<0.05) and the attribution of the decision to operate is to the doctor (p<0.05); a significant correlation exists between fantasies characterized by fear and the experience of postoperative pains, between postoperative pains and attribution of the decision to operate to the doctor (p<0.05) and between fantasies characterized by fear and attribution of the decision to operate to the doctor (p<0.05). CONCLUSIONS: Higher anxiety levels have been detected in the pre-operative phase, in less educated patients and when the decision to operate has been attributed to the doctor. A not wholly convinced personal attitude has been accompanied by preoperative fantasies characterized by fear and has resulted in subjectively more painful postoperative course.

[Sickness Impact Profile: the Italian version]. / Il Sickness Impact Profile: versione Italiana.

The Sickness Impact Profile (SIP) is one of the questionnaires most widely used for the generic evaluation of functional health status. Besides measuring functional status or quality of life, it is also a precious font of information for the psychologist in the inpatient-rehabilitative context when planning an intervention focused on the most dysfunctional areas indicated by the subject. In producing the Italian version of the SIP, attention was duly paid in the translation to maintain equivalence in terms of idioms, grammar and syntax, so as to render it free of erroneous translations or possible. misunderstandings. Since the SIP employs "weighted" items, in order to obtain the weights corresponding to each individual statement a 3-phase procedure was followed: A) each subject "judge" was asked to express on a scale his/her own dysfunctionality judgement for each item; B) statements with the highest and lowest mean weight for each category were identified; C) the same "judges" were then asked to reclassify the statements which had obtained the highest and lowest weights, respectively, on a scale of 15 equidistant intervals; subsequently the same subjects completed the SIP a second time (retest). Results show that the judges were coherent in their estimation of the specific weights for each item. In the judges' second completion of the SIP it was found that the majority of the test-retest correlations fell almost always within the r = 0.70-0.90 range. Moreover, given the marginal difference between Italian and United States weights, both methods may be used for the calculation of the scores. One thus concludes that the SIP questionnaire can be applied in the Italian context.

The EORTC quality of life questionnaire-head and neck 35 in Italian laryngectomized patients. European organization for research and treatment of cancer.

The aim of this study was to test the validity and reliability of the European organization for research and treatment of cancer (EORTC) quality of life questionnaire (QLQ)-head and neck (H&N) 35 in Italian laryngeal cancer patients. The original questionnaire was developed by the EORTC quality of life (QoL) study group and tested in H&N cancer patients from Norway, Sweden, and the Netherlands. The Italian translation of the questionnaire used in this study was made by a team of the CRO, National Cancer Institute, using a double-back translation method between independent translators. The translated EORTC QLQ-H&N35 was given to 99 patients with H&N cancer who had undergone total laryngectomy 1-26 years before and had been then treated with radiotherapy and, in some cases, chemotherapy. The questionnaire was re-administrated to 33 patients after 1 month to test its stability over time. It was structurally made up of seven scales (pain, swallowing, sense, speech, social eating, social contact, and sexuality) and 11 single items that considered the most important clinical aspects characterizing the QoL in H&N cancer patients. The statistical analysis of the indexes of validity and reliability confirmed the results obtained with other linguistic versions of the questionnaire. Our Italian version of the EORTC QLQ-H&N35 proved to be a statistically valid instrument to assess QoL in laryngectomized patients.