Daily music listening to reduce work-related stress: a randomized controlled pilot trial.

BACKGROUND: Literature shows that music can reduce stress conditions. This pilot study investigated the effects of music listening on work-related stress and well-being in healthcare professionals. METHOD: A total of 45 subjects were randomly assigned to three treatment groups: No Music, Individualized Music and Melomics-Health Listening. Music groups experienced a daily 30-min-playlist listening for 3 weeks at home. The Maugeri Stress Index-Revised (MASI-R) and the Psychological General Well-Being Index (PGWBI) were administered at baseline, after 3 weeks and after 7 weeks (follow-up). Longitudinal data were analyzed by means of a nested ANOVA model, testing the main effects of time and treatment and the interaction between them. RESULTS: MASI-R scores showed a positive trend in music groups and a worsening in the control group. Only the interaction time/treatment emerged as supporting a trend toward statistical significance (P = 0.07). PGWBI showed a stability in music groups and a clear decline in controls, without significant effects. CONCLUSIONS: Results from the study support the need for a larger clinical trial: it is suggested that daily music listening could be implemented to reduce work-related stress and that the effects may be related, not only to individual musical preferences and familiarity, but also to specific music structures and parameters.

Prevalence of Polysubstance Abuse and Dual Diagnosis in Patients Admitted to Alcohol Rehabilitation Units for Alcohol-Related Problems in Italy: Changes in 15 Years.

AIMS: Alcohol abuse has long been known as a disease with social and economic burden to society. Given the complex nature of alcohol treatment, it is worthwhile to examine the change over time of patients admitted to residential alcohol abuse rehabilitation units. METHODS: The data were collected from two Italian projects on alcoholics performed in the mid-1990s (ASSALT) and in 2009 (CORRAL), respectively. Categorical variables were considered in terms of absolute and relative frequencies. Comparisons of relative frequencies between groups were assessed by means of Fisher's exact test. Mixed logistic regression models were fitted to CORRAL data to identify the predictors of the probability of being a polysubstance abuser or having a dual diagnosis. The association estimates were reported as adjusted odds ratios and relative 95% confidence intervals. RESULTS: Compared to the mid-1990s, in 2009 patients were older (P= 0.0003), with a higher level of education (P= 0.0204), with fewer comorbidities (liver disease except cirrhosis, P < 0.0001; polyneuropathy, P= 0.0001), more frequently polysubstance abusers (P < 0.0001), affected by dual diagnosis (P < 0.0001). In 2009, the probability of being a polysubstance abuser was higher in younger and in patients with dual psychiatric diagnosis. Female gender and polysubstance abuse were positively associated to the probability of being affected by dual psychiatric diagnosis. CONCLUSIONS: The increment of patients admitted to residential programs for alcohol dependence with polysubstance abuse and/or dual psychiatric diagnoses suggests the need to pay more attention to both psychological/psychiatric interventions and internal medicine/physical rehabilitation. SHORT SUMMARY: The results of this study suggest that further research is needed to identify the best treatment strategy that is safe and effective for the new population of alcoholics.

Could different TMJ disc positions observed in MRI cause different sounds? Analysis on a group of subjects with ADD with reduction: a pilot study.

AIMS: Magnetic resonance imaging (MRI) is the method of choice for examining soft-tissue pathology of the temporomandibular joint (TMJ). MRI shows a high spatial resolution with accuracy for the identification of internal derangement. Tasaki developed a classification system for disc displacement in the TMJ, identifying eight different types of disc displacements in addition to the superior disc position. This study aims to test the ability of electrosonography (ESG) in discriminating different kinds of disc displacement according to the disc position criteria proposed, comparing the ESG results with those obtained by MRI. METHODOLOGY: Twenty-seven patients were selected from an initial group of 50 patients with articular disc displacement, selected by means of clinical examinations, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and who had both MRI and ESG studies performed. For each patient and for each peak in ESG, both in the opening and closing movements, three different parts of the sound were analyzed. The frequency (Hz) and the mean amplitude (µV) of the sounds were calculated in the three analyzed windows. Afterwards, gathering the data for the Tasaki's classes and dividing opening and closing sounds, the number of peaks was calculated, as well as average and standard deviations for both the Hz and µV. RESULTS: The peak frequency shows significant differences between different disc positions during the first and second third of the opening phase and during the first third of the closing phase. The peak amplitude shows significant differences between different disc positions during all of the opening and closing phases. CONCLUSIONS: Although limited by sample size, the present study shows the presence of different sounds with different Hzs and µVs associated with different disc positions that were recorded with ESG.

[Alcohol-addiction inpatient: characteristics of patients and rehabilitation program]. / La residenzialità alcologica ospedaliera: caratteristiche dei pazienti e dei percorsi terapeutici/riabilitativi.

AIM: The treatment of alcohol addiction in Italy has had a progressive evolution of therapeutic structures for in-and outpatients. During the last 20 years there had been a crescent presence of short residential treatment facilities (1-6 months) characterized by a high level of medical and psychotherapeutic intervention. About two years ago 12 of them jointed together in an association called CORRAL (COordinamento of Residenzialità Riabilitive Alcologiche). The aim of this study was to describe the socio-demographic medical and other characteristics of the patients coming for this type of treatment and to describe the characteristics of the residential treatment itself including referring and aftercare. METHODS: Two thousand sixty-one hospitalized patients of the 12 rehabilitative alcohol units were examined by using a questionnaire and collecting various sociodemographic variables and clinical diagnosis of the patients. Even it was asked who had referred the patients, the characteristics of the residential treatment and of the planned aftercare. RESULTS: The present residential facilities are mainly distributed in the North of Italy. The typical patient is male, with a high school instruction and with a comorbidity regarding psychiatric and liver disorders. The majority of the patients were referred by the public ambulatory services for addictions (SerT/SerD). The characteristics of the residential treatment were medical, pharmacological and psychotherapeutic interventions with a high intensity and the presence of a general-purpose staff. CONCLUSIONS: This study outlined a model of residential rehabilitation of alcohol disorders characterized by short duration and a complex, intense therapeutic intervention mainly addressed to patients with a severe clinical condition and a low level of social problems. Further research should be useful to understand better which sort of patient characteristics obtain a better clinical result and for that even economically a major effectiveness from this type of residential treatment.

Diagnostic concordance between MRI and electrovibratography of the temporomandibular joint of subjects with disc displacement disorders.

OBJECTIVES: The aim of this study is to evaluate the diagnostic concordance of MRI and electrovibratography (EVG) of the temporomandibular joint (TMJ) in the diagnosis of articular disc displacement with reduction (ADDwR) and articular disc displacement without reduction (ADDw/oR). METHODS: 50 patients (12 males, 38 females; mean age 37.46 ± 15.64 years) with a hypothesis of disc displacement were selected. For each patient an MRI of the TMJ was performed. MRIs were evaluated sorting the 100 TMJs by kind of pathology (no pathology, ADDwR, ADDw/oR, and joint hypermobility). Afterwards, the patients had an EVG exam. The EVG exams were performed with vibration transducers over each TMJ, enabling simultaneous, bilateral recording of vibrations emanating from joint sounds during the opening and closing movements. The presence of a sound peak was compared with the MRI diagnosis of ADDwR, while a multipeak aspect was compared with ADDw/oR diagnosis using Cohen's kappa test. RESULTS: The presence of a peak-shaped track has high specificity for ADDwR (90.27%). The Cohen's kappa calculated for the ADDwR was 0.5615 (good-moderate). The presence of a multipeak-shaped track has low specificity (65.22%) and sensitivity (70.42%). The Cohen's kappa calculated for the ADDw/oR was 0.2992 (poor). CONCLUSIONS: The present study recommends the use of EVG to support the clinical diagnosis of a disc displacement with reduction when MRI is not available or when subjects cannot be investigated by MRI.

8-azapurine nucleus: a versatile scaffold for different targets.

-Azapurine nucleus is a bioisoster of the purine nucleus. Variously substituted 8-azapurines have been synthesised and studied for their interactions with many enzymes and receptors and for their antitumor and antiviral activity. In this paper the main results of the studies made in these last years on this topic are reported.

[E-learning and occupational medicine: results of one experience in Italy]. / E-learning e Medicina del Lavoro: risultati di una sperimentazione in Italia.

In Italy, there is at present a certain drive in order to make e-learning for Continuous Medical Education (CME) to take off, even though a normative framework for distance CME has not been completely defined yet. This paper describes the phases of course supply and usage of an e-learning system in the occupational medicine area in Italy. The system provides 10 courses for occupational physicians and one course for nurses, physiotherapists and occupational physiotherapists. During the span of time of 11 months, 2034 users have registered to the website and 1804 of them enrolled themselves into at least one course, for a total number of 5183 course enrolments, with a mean number of course enrolments per person of about 3, and 3710 courses were successfully concluded. This study points out on one hand a wide request for this kind of educational sessions, and on the other hand good results in terms of knowledge acquisition. Since the present experimental project was aimed at contributing to the definition of the normative framework for distance education for CME, it can be expected that e-learning for CME in Italy will get off the ground in the near future.

[Evaluation of usability of an e-learning software in healthcare]. / Valutazione dell'usabilità di un sistema per l'e-learning in ambito sanitario.

The usability study of a software system aims at improving learning times and task execution, as well as decreasing the number of errors and increasing the user satisfaction. Goal of the present study is to assess the usability of a healthcare e-learning software in relationship with professional and personal variables. To eighty healthcare operators have been administered: a) a questionnaire for the assessment of their skills in using PCs and their opinions on e-learning; b) SUS and SUMI questionnaires for the evaluation of system usability; c) the LOC-L questionnaire, to assess the type of individual locus-of-control, either internal or external. The data analysis resulted in positive usability assessment for the system here considered. No relationship could be found between SUS scores and the number hours per week spent in using the PC, the experience and opinions of users on e-learning systems. Data from the LOC-L questionnaire show how usability scores are not influenced by the type of individual locus-of-control. The results here obtained show how SUS and SUMI questionnaires can be effectively employed to assess usability of an e-learning software system.

Communicating medical information: a little lesson from Italian patients.

OBJECTIVE: To construct and validate a questionnaire that could be used to investigate the clarity of the medical information received by patients and their satisfaction with it, as well as their knowledge and opinions concerning advance directives and their associated variables. METHODS: We administered a 30-item questionnaire to 157 adult patients affected by progressive neurological, oncological and nephrological diseases. RESULTS: The results indicate the good reliability and structure of the questionnaire, which identifies three factors: "information and knowledge" (alpha .91), "need for physical and mental support" (alpha .89), and "determination and decision-making capacity" (alpha .75). The amount of time dedicated to medical communication proved to be one of the variables determining the patients' knowledge of their disease and their capacity to express their needs, neither of which changed over time. The oldest patient, a man in the most advanced phase of disease, was the most fragile in expressing his needs and making decisions. Advance directives, living wills, active/passive euthanasia and therapeutic obstinacy' at most only marginally reach the cognitive and emotional sphere of the patients. CONCLUSION: Patients' needs unequivocally lead us back to the primary matrices of medical act: paying attention to patients, offering adequate time, listening to him/her concerns and asking when no question emerges. This so obvious evidence does not match with the increasingly techno-oriented attitude of health professional, who also have to guarantee more productivity in less time. The quality of medical information received by patients impacts their decision making process, particularly in the oldest people. In Italy, as well as in other countries, it is necessary to pay more attention to this issue, keeping in mind that nobody can really choose without knowing exactly what it is going to happen.

[Characteristics of personality in subjects who complain vexing on [corrected] workplace]. / Caratteristiche di personalità in un campione di soggetti che lamentano vessazioni sul posto di lavoro.

A few authors maintain the characteristics of personality might play an important role in the developing of mobbing, others did not find out any differences personality profiles in subject exposed to harassment compared to non-exposed ones. This study assesses, the psychological features of the sample of 276 subjects (114 males, 162females) admitted to a unit of Occupational Medicine, using Minnesota Multiphasic Personality Inventory MMPI-2. Increase in score over 65 cut off compared to clinical scales was found out: Hypochondria, Depression, Hysteria, Paranoia and compared to content scale: Anxiety and Health concerns. No significant different resulted between males and females as regards clinical scales. To conclude our date confirm the hypothesis of a remarkable psychic discomfort in subjects complaining about harassment work. This discomfort, in compliance with the date of literature seem to be characterized by depression, anxiety and somatizations. However show a tendency to focus on working problems and a disposition to persecutories tendencies. All the above said characteristics might be due to negative working conditions or they reflect a psychological frailty which made the subjects more vulnerable to working stress.

[Usability study of an e-learning system for CME in occupational medicine: preparatory analysis and remedial actions]. / Studio di usabilità di un sistema di e-learning per l'educazione continua in Medicina del Lavoro: analisi preliminare e azioni correttive.

This paper describes the activities carried out in order to make an e-learning system for CME be a good tool in terms of usability. The following steps are described:--the needs analysis of the potential users;--the prototype of the e-learning system that has been set up;--the usability evaluation of the prototype by a sample often users before and after the implementation of the identified remedial actions. The obtained results support the hypothesis of an effective usage of the system in the near future. The follow-up of real users' usage, through the tracing facilities of the e-learning platform, will confirm or reject our hypothesis.

[Caregiver Need Assessment: a questionnaire for caregiver demand]. / Caregiver Need Assessment: uno strumento di analisi dei bisogni del caregiver.

UNLABELLED: Many studies have focused on the importance of the informal care provided by caregivers and on its impact in terms of worsening quality of life and increased burden. The aim of the present study is to analyze the psychometric validity and reliability of the Caregiver Needs Assessment (CNA) questionnaire, which has been built to investigate the needs (related to assistance) perceived by caregivers of severely impaired patients, particularly in the first stages of their illness. METHODS: The CNA was administered to 226 family caregivers (24.3% males) of 197 patients (50.8% males) hospitalized for neuromotor rehabilitation after a stroke, head injury, Lateral Amyotrophic Sclerosis, Parkinson or other severely impairing diseases. RESULTS: The instrument was tested on a large sample (KMO = 0.83) of heterogeneous caregivers. Explorative and confirmatory factor analysis, performed on a two subgroup random subdivision of the sample, showed the presence of two factors with good internal consistency: the factor "needs of emotional and social support" (alpha = 0.765) and the factor "needs of information and communication" (alpha = 0.742). The structural equation modeling confirms the goodness of fit of the 2-factor structure (RMSEA = 0.073; SRMR = 0.1; CFI = 0.96). We observed a positive correlation (p < 0.01) between the factor "needs of emotional and social support" of the CNA and other questionnaires aimed at assessing psychological wellbeing, and between the factor "needs of information and communication" and the factor "needs for knowledge about the disease" of the Family Strain Questionnaire, showing good convergent validity. We also observed high Pearson correlation coefficients (0.942 and 0.965) between test-retest measurements of both factors in the CNA. CONCLUSION: The statistical analysis confirms the good psychometric properties of the CNA questionnaire. For its brevity and ease in compilation the CNA is promising practical tool aimed at assessing caregivers' needs in order to personalize a programme of psychological support, to measure it's outcome and to provide comparison of the different needs in different diseases.

Italian validation of the "Constructed Meaning Scale": preliminary results.

The sense or meaning (constructed meaning) that a person attributes to their own illness is one of the factors involved in the process of adaptation. The Constructed Meaning Scale (CMS), originally developed in the United States by Fife in 1995, is a brief 8-item survey investigating the subjective meaning that patients associate with their disease. The purpose of this study was to validate an Italian version of the CMS in a sample of patients with chronic disabling disease. The validation process consisted of 4 steps: (1) creation of an Italian version (translation and back translation); (2) administration of the translated version to a small sample of patients affected by different types of disease to verify its comprehensibility; (3) administration of the final version to a sample of 122 patients affected by chronic disabling conditions; (4) statistical analysis. The Italian version of the CMS was found to have the following psychometric properties: range of total-item correlation = .30 to .64; Cronbach's Alpha = .79; correlation with CBA 2.0 Depression Scale = -.44. We isolated two factors through VARIMAX factor analysis, which we defined as "disease as permanent damage" and "process of adaptation". The Italian version of the CMS is easy to understand and minimizes possible cultural biases. The psychometric properties of the scale are satisfactory.

[Personality characteristics, defence mechanisms and binge eating in obese patients]. / Caratteristiche di personalità, meccanismi di difesa e binge in un gruppo di pazienti obesi.

AIMS: This study aimed to investigate defence mechanisms and personality characteristics in obese subjects. In particular, we compared the use of defence mechanisms in two groups: obese persons vs. normal weight subjects. We also compared the defence mechanisms and personality characteristics of two groups of obese subjects: those with Binge Eating Disorder vs. those without this disorder. Finally, we investigated the presence of possible differences linked to gender or to age of onset of obesity. METHODS: 93 obese subjects and 68 normal weight subjects were administered a test battery composed of the following self-complete questionnaires (in the Italian version): Binge Eating Scale, Response Evaluation Measure-71, Eating Disorder Inventory-2 and Minnesota Multiphasic Personality Inventory). RESULTS: Obese subjects appear to use specific defence mechanisms. A gender effect was found on the use of defence mechanisms, on the psychological characteristics associated to an Eating Disorder and on personality features. Obese subjects with Binge Eating Disorder showed a marked tendency to manifest anxiety and bulimic behaviour. Obesity with onset in adolescence was associated with the possibility of developing drug dependence. CONCLUSION: Specific defence characteristics and personality features in obese subjects should be taken into account in designing a slimming program.

[Analysis of a case series of workers with mobbing syndrome]. / Analisi di una casistica di lavoratori con patologia da mobbing.

Mobbing represents nowadays a major challenge for Occupational Medicine. We examined, during the last seven years, 253 patients who asked medical assistance for psychopathological problems by them ascribed to mobbing in the working environment. All patients underwent occupational health visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A clinical picture probably due to mobbing was diagnosed in 37 workers: 2 cases of Post-Traumatic Stress Disorder (PTSD), 33 of Adjustment Disorder (AD), and 2 of anxiety disorder. Regarding mobbing typology, we found 19 cases of vertical mobbing (by an employer/manager to employees), 14 cases of strategic mobbing, 3 cases of horizontal mobbing (among colleagues), and one non intentional mobbing. In conclusion, a pure mobbing syndrome was diagnosed in a lower proportion than that reported by other investigators. The described interdisciplinary approach appears useful for the diagnostic assessment of suspect mobbing cases, that in turn is crucial for prognosis and treatment, as well as in relation to medico-legal issues and work-related compensation claims.

[Assessment of occupational stress among workers in rehabilitation medicine]. / Indagine sullo stress occupazionale di operatori della medicina riabilitativa.

Emerging evidence confirms the risk of distress in staff involved in the Helping Professions resulting in the possibility of reduced efficacy and efficiency of the structure which offers health services. The aim of the present study was to reveal the presence of burnout and its relationships with environmental and organizational factors of health care professionals enrolled in medical rehabilitation. 88 health care professionals underwent a psychometric assessment by filling the Organizational Checkup System Questionnaire (OCS) for measuring burnout and associated organizational factors. Data analysis demonstrated the presence of major emotional distress (p = 0.05) in the group who had an executive role (social-assistants and assistant nurses), especially regarding organization factors linked with: Overwork (p = 0.009), lack of Leadership (p = 0.01), lack of Comprehension of modifications offered by the structure (p = 0.0001) and Professional Development (p = 0.016). OCS revealed to be a sensitive psychometric instrument, especially for the identification of organizational weaknesses, which can stimulate the application of strategies to prevent the burnout syndrome and to improve coping skills.

[Management of occupational stress among patients with cardiac diseases]. / Gestione dello stress occupazionale in pazienti cardiopatici.

The object of our study was the evaluation of psycophysic condition, stress perception and coping in a sample of subject in cardiac rehabilitation. Our study recruited 48 worker patients (44 male, M = 50.5 +/- 8.8; 4 female, M = 50.8 +/- 8.7). They were submitted to: 1) cardiac evaluation and rehabilitation in DH regimen; 2) psychological assessment; 3) work's characteristic evaluation. The evaluation were made at the moment of recruitment and six month later 42 subjects went back to work after 81.8 +/- 49 days; 2 subjects had a worsening of their clinic conditions not consistent with an occupational resumption; 4 subjects didn't go back to work. In the 42 worker subjects we have find a significant decrease of anxiety (p < 0.019) and depression levels (p < 0.004); a significant improvement of Quality of Life perception in its physical (p < 0.000) and psychic aspects (p < 0.021) and an improvement about the ability to reorganize the work to better ménage stress (p < 0.012).