Psycho-social impact of social distancing and isolation due to the COVID-19 containment measures on patients with physical disabilities.

BACKGROUND: While the COVID-19 pandemic was spreading worldwide, the Italian government stated lockdown, with a drastic reorganization of healthcare systems. The psychological and social effects of the pandemic and the restrictions of freedom could have had a detrimental impact on people with physical disabilities, for whom well-being depends strongly on their social environment. AIM: Our main aim was to describe the overall impact of the pandemic on mental health, social condition and illness perception among patients with disabilities, to provide early interventions for this particularly vulnerable population. For this purpose, we performed a specific screening protocol to detect the prevalence of any psychological distress. DESIGN: Cross-sectional observational study. SETTING: Telephonic interview administered to patients and their caregivers attending the Unit of Neurorehabilitation at the University Hospital of Pisa. POPULATION: 134 patients with physical disability related to neurological disorders, who had their outpatient appointment cancelled, because of the government dispositions, were enrolled. METHODS: A specific questionnaire (COVID19-q) was designed to test patients' psycho-social state, including a section addressed to the caregiver. Moreover, a standardized psychological evaluation, using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), was also performed. RESULTS: Results show a different impact in our study population compared to the general population on psychological aspect. Patients did not manifest any clinically relevant distress, as assessed with CORE-OM. However, patients with higher disability degree reported a statistically lower outcome in the social function, in the well-being domains and an increase in risk behavior. Results from COVID19-q show that most of our patients reported none or mild change in their psycho-social habits and perception of illness during lockdown. However, reduction of family cohesion and lack of healthcare support are two important aspects that people with disability had to face with during the pandemic emergency. CONCLUSIONS: People with physical disabilities surprisingly shown milder effects of the pandemic on their psychological state and good coping skills in facing social isolation, manifesting resilience resources. However, the is a need to give concrete support to healthcare and social care, especially in the management of severe disability. CLINICAL REHABILITATION IMPACT: This unexpected and reassuring result may reveal a worrying scenario regarding-the social participation and quality of life of people with disabilities: were they already in lockdown?

Multiple sclerosis in the Republic of San Marino, Italian peninsula: an incidence and prevalence study from a high-risk area.

Epidemiological studies on multiple sclerosis (MS) carried out in Southern Europe in the last years have shown a significant increase in the disease frequency. Previous surveys conducted in the Republic of San Marino, Northern Italian peninsula, identified that the population is at high risk for MS, with a prevalence of 51.6 per 100,000 population in 1982 and of 166.7 in 2005 and with a mean annual incidence of 7.9 per 100,000 for the period 1990-2005. The present work is a community-based intensive prevalence and incidence survey, by a complete enumeration approach, to update the prevalence and incidence of MS in the Republic of San Marino. The mean annual incidence for the period 2005-14 was 7.7 (95% CI 4.9-11.4) per 100,000, 3.3 (95% CI 1.1-7.6) for men and 11.9 (95% CI 7.2-18.6) for women. On 31 December 2014, 67 patients (19 men and 48 women), suffering from definite or probable MS and living in the Republic of San Marino, yielded a crude prevalence of 204.3 (95% CI 158.4-259.5) per 100,000, 117.8 (95% CI 70.9-183.7) for men and 288.2 (95% CI 212.4-383.3) for women. Our study has confirmed San Marino is an area at high risk for MS, in line with epidemiological data from continental Italy. The marked increase in MS prevalence over time in this population can be ascribable to increased survival and improved ascertainment, in the presence of a substantially stable, yet high, incidence rate.