Fostering quality of life in young adults living with multiple sclerosis: a pilot study of a co-created integrated intervention.

Introduction: Multiple sclerosis (MS) is generally diagnosed at an early age, making the acceptance of this chronic disease challenging. Research dedicated to young adults with MS (YawMS) is still limited. A biopsychosocial co-created intervention for YawMS integrating social, physical and psychological activities was developed (ESPRIMO intervention) in order to improve the quality of life (QoL) and well-being. This pre-post intervention assessment study examines the feasibility of the ESPRIMO intervention and its signal of efficacy. Methods: Inclusion criteria were: age 18-45 years, MS diagnosis, Expanded Disability Status Scale score < 3.5. After giving informed consent, YawMS completed a battery of questionnaires, which was repeated after the intervention. The battery included a bespoke feasibility scale, the COOP/WONCA charts, and the Short Form-12 Health Survey (SF-12). Results: Fifty-three YAwMS were enrolled and 43 (81.1%) completed the intervention. The majority of the sample positively rated the pleasantness, usefulness and feasibility of the intervention. A significant change in the COOP/WONCA "general QoL" chart (t = 3.65; p < 0.01) and SF-12 mental wellbeing component (t = -3.17; p < 0.01) was found. Discussion: ESPRIMO is an innovative intervention that is feasible; preliminary results show an improvement in QoL and mental wellbeing. Further studies are needed to test its efficacy and evaluate future implementation in health services.Clinical trial registration: ClinicalTrials.gov, NCT04431323.

Promoting participatory research in chronicity: The ESPRIMO biopsychosocial intervention for young adults with multiple sclerosis.

Background: Co-creation allows to develop tailored interventions in chronicity and to increase patients' engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial. Aims: This paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18-45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation. Methods: A participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS (n = 121) and HCPs (n = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey's results. Results: An integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation. Conclusion: The co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability.

The role of short-time work and discretionary policy measures in mitigating the effects of the COVID-19 crisis in Germany.

In this paper, we investigate the impact of the COVID-19 pandemic on German household income in 2020 using a micro-level approach. We combine a microsimulation model with novel labour market transition techniques to simulate the COVID-19 shock on the German labour market. We find the consequences of the labour market shock to be highly regressive with a strong impact on the poorest households. However, this effect is nearly entirely offset by automatic stabilisers and discretionary policy measures. We explore the cushioning effect of these policies in detail, showing that short-time working schemes and especially the one-off payments for children are effective in cushioning the income loss of the poor.

COVID-19 and (gender) inequality in income: the impact of discretionary policy measures in Austria.

This paper analyzes the impact of the COVID-19 crisis on household income in Austria, using detailed administrative labor market data, in combination with micro-simulation techniques that enable specific labor market transitions to be modeled. We find that discretionary fiscal policy measures in Austria are key to counteracting the inequality- and poverty-enhancing effect of COVID-19. Additionally, we find that females tend to experience a greater loss in terms of market income. The Austrian tax-benefit system, however, reduces this gender differences. Disposable income has dropped by around 1% for both males and females. By comparison, males profit mainly from short-time work scheme, while females profit especially from other discretionary policy measures, such as the one-off payment for children.

The impact of COVID-19 on households´ income in the EU.

This analysis makes use of economic forecasts for 2020 issued by the European Commission in Autumn 2019 and Spring 2020, and of a counterfactual under a no-policy change assumption, to analyse the impact of the COVID-19 crisis on EU households´ income. Additionally, our analysis assesses the cushioning effect of discretionary fiscal policy measures taken by the EU Member States. We find that the COVID-19 pandemic is likely to affect significantly households' disposable income in the EU, with lower income households being more severely hit. However, our results show that due to policy intervention, the impact of the crisis is expected to be similar to the one experienced during the 2008-2009 financial crisis. In detail, our results indicate that discretionary fiscal policy measures will play a significant cushioning role, reducing the size of the income loss (from -9.3% to -4.3% for the average equivalised disposable income), its regressivity and mitigating the poverty impact of the pandemic. We conclude that policy interventions are therefore instrumental in cushioning against the impact of the crisis on inequality and poverty. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10888-021-09485-8.

Hospital Employees' Well-Being Six Months after the COVID-19 Outbreak: Results from a Psychological Screening Program in Italy.

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers. This study aims to describe a psychological screening program developed at a large University Hospital in Milan, Italy, and assess the psychological outcomes of employees and associated factors. A survey was electronically conducted among hospital employees between July and October 2020. Sociodemographic data, information about COVID-19 experience and three scales assessing anxiety (STAI-Y1), depression (HAM-D) and post-traumatic stress disorder (PCL-5) were collected. A total of 308 employees (80% women; mean age 45.1 years) responded: 16% physicians, 68% other healthcare professionals, and 16% administrative staff. Employees reported moderate/severe symptoms of anxiety (23%), depression (53%), and post-traumatic stress disorder (40%). At multivariate logistic regression analysis, having suffered a loss for COVID-19 in the personal context was independently associated with higher risk of moderate/severe anxiety (OR = 2.40; 95% CI 1.16-4.98), being female was associated with higher risk of moderate/severe depression (OR = 2.82; 95% CI 1.43-5.59), and having had a family member affected by COVID-19 was associated with higher risk of moderate/severe post-traumatic stress disorder (OR = 2.75; 95% CI 1.01-7.48). COVID-19 personal experience may have a profound impact on hospital workers' mental health and should be considered in supportive interventions.

Laughs and Jokes in Assisted Reproductive Technologies: Quantitative and Qualitative Analysis of Video-Recorded Doctor-Couple Visits.

Purpose: To explore the characteristics of the use of laughs and jokes during doctor-couple assisted reproductive technology (ART) visits. Methods: 75 videotaped doctor-couple ART visits were analyzed and transcribed in order to: (1) quantify laugh and jokes, describing the contribution of doctors and couples and identifying the timing of appearance; (2) explore the topic of laughs and jokes with qualitative thematic analysis. Results: On average, each visit contained 17.1 utterances of laughs and jokes. Patients contributed for 64.7% of utterances recorded. Doctor (40.6%) and women (40%) introduced the majority of laughs and jokes. Visits with female physicians had significantly more laughs and jokes than visits with male doctors; no differences were found considering physicians' age and years of experience, cause of infertility, and prognosis. Laughs and jokes were mainly recorded during history taking and information giving. Four core themes were identified, regarding the topic of laughs and jokes: health status, infertility treatment, organizational aspects, and doctor-patient interaction. Conclusion: Laughs and jokes are common in doctor-couple ART visits and are frequently used during the dialogue, covering a wide range of topics. Results seem to show that laughs and jokes are related to doctor's personal characteristics (like gender), while are not associated with infertility aspects. Given the complexity of this communicative category, further studies are needed to explore the functions and the effects of laugh and jokes.

"If You Can't Control the Wind, Adjust Your Sail": Tips for Post-Pandemic Benefit Finding from Young Adults Living with Multiple Sclerosis. A Qualitative Study.

The COVID-19 outbreak has impacted the wellbeing of people worldwide, potentially increasing maladaptive psychological responses of vulnerable populations. Although young adults with multiple sclerosis (yawMS) might be at greater risk of developing psychological distress linked to the pandemic, they might also be able to adapt to stress and find meaning in adverse life events. The aim of the present study was to explore benefit finding in response to the pandemic in a sample of yawMS. As part of a larger project, data were collected using a cross-sectional, web-based survey. Benefit finding was analysed using a qualitative thematic approach; descriptive and inferential statistics were performed to describe the sample and compare sub-groups. Out of 247 respondents with mostly relapsing-remitting MS, 199 (31.9 ± 6.97 years) reported at least one benefit. Qualitative analysis showed that during the pandemic yawMS found benefits related to three themes: personal growth, relational growth, and existential growth. No differences in benefit finding were found between age sub-groups (18-30 vs. 31-45). Participants reported a wide range of benefits, some of which seem to be specific to MS or the pandemic. Results have been transformed into tips to be introduced in clinical practice to promote resilience in yawMS through meaning making.

Surveillance for early stages of colon cancer: potentials for optimizing follow-up protocols.

BACKGROUND: Although several meta-analyses showed the positive effects of follow-up on the prognosis of colon cancer (CC), international guidelines are not in accordance on appropriate tests and their time frequency to optimize surveillance. Furthermore, stratified strategies based upon risk grading have not been implemented. This approach may be useful to rationalize resources. METHODS: From 2006, all patients operated for an early stage CC (I, IIA, IIB) according to the 7th edition of the AJCC-2010 classification entered in a prospective surveillance program in accordance to our local guidelines. Patients who underwent surgical resection after 2009 have been excluded to guarantee at least a 5-year follow-up. Classic histopathologic prognostic factors such as grade, T and N status, lymphatic and vascular invasion were assessed. Moreover, tumor budding and tumor-to-stroma proportion were evaluated. RESULTS: We had complete records of 196 patients. Distribution was as follows: 65 (33.2%) in stage I, 122 (62.2%) in stage IIA, and 9 (4.6%) in stage IIB. Eleven patients (5.6%) had a disease recurrence (local or distant). The median recurrence time was 20 months (range 6-48). Nine patients (82%) had recurrence with 24 months, and 91% were asymptomatic and detected by ultrasound or CT scan. According to the log-rank test, the risk factors with significant effect on the disease-free survival (DFS) were the number of lymph nodes <12 (p = 0.027) and the vascular invasion (p = 0.021), while for the overall (OS), only the vascular invasion was significant (p = 0.043). By the univariate and multivariate analyses, DSF was significantly lower in patients with less than 12 nodes removed, with vascular invasion, and with left of double cancer. OS was negatively affected only by vascular invasion despite the hazard ratios were similar to DSF. Stage IIB was associated with a threefold-increased risk of reduced OS and DSF. CONCLUSIONS: Stages I and IIA appear to behave similarly and should be considered as true early stages. The detection of fibrosis and budding do not seem to add valuable information for prognosis. In early CC stages, the surveillance program should be maximized within the first two years.

Emotional anticipation rather than processing is altered in patients with vasovagal syncope.

OBJECTIVE: To investigate whether the electrocortical activity underlying the anticipation and processing of emotional stimuli is enhanced in individuals with recurrent episodes of vasovagal syncope (VVS). METHODS: Fifteen fainters and 15 age-matched healthy controls were presented a S1-S2 task, where the content of high-arousal pleasant and unpleasant, and neutral pictures (S2) was forecasted by word cues (S1). Stimulus Preceding Negativity (SPN) amplitude during the S1-S2 interval was computed as a measure of affective anticipation. The event-related potentials (ERPs) to S1 and S2 were measured to assess the processing of emotional warning stimuli and pictures. RESULTS: Relative to controls, fainters showed smaller P300 to warning cues anticipating emotional (and, particularly, unpleasant) pictures, and smaller SPN during anticipation of unpleasant pictures. No differences between groups were found with regard to ERP amplitudes during picture processing. CONCLUSIONS: These results suggest that the anticipation, rather than the processing, of aversive stimuli is altered in syncopal patients. SIGNIFICANCE: The reduced cortical anticipation in fainters might reflect the use of non-adaptive emotion regulation strategies for reducing the impact of upcoming highly arousing (and, particularly, of unpleasant) events.

Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections.

PURPOSE: Surgical site infections (SSIs) are the most common infections in colorectal surgery. Although some studies suggest that rectal surgery differs from colon surgery for SSI incidence and risk factors, the National Nosocomial Infection Surveillance system categorizes all colorectal surgeries into only one group. The aim of this study was to determine incidence, characteristics, and risk factors of SSIs according to the subclassification of colorectal surgery into right colon surgery (RCS), left colon surgery (LCS), and rectum surgery (RS). METHODS: From November 2005 to July 2009, all patients requiring colorectal resectioning were enrolled into our program. The outcome of interest was an SSI diagnosis. Univariate and multivariate analyses were performed to determine SSI predictors in each group. RESULTS: Two hundred seventy-seven consecutive colorectal resections were analyzed. SSI rates were 8% in RCS, 18.4% in LCS, and 17.6% in RS. LCS and RS showed significantly higher SSI incidences (p = 0.022) and greater rates of organ/space infections compared to RCS (p = 0.029). Predictors of SSI were steroid use among RCS, age greater than 70 years, multiple comorbidities, steroid use, non-neoplastic colonic disease, urgent operation, ostomy creation, postoperative intensive care among LCS, preoperative chemoradiation, heart disease, and prolonged operation among RS patients. On multivariate analysis, the coupled LCS and RS groups showed an increased risk for SSI compared to RCS (OR, 2.57). CONCLUSIONS: SSI incidences, characteristics, and risk factors seem to be different among RCS, LCS, and RS. A tailored SSI surveillance program should be applied for each of the three groups, leading to a more competent SSI recognition and reduction of SSI incidence and related costs.

A função sinestésica da música no jingle político / The synaesthetic function of music on jingle policy

Sendo uma ferramenta de importante utilização, o jingle político esteve presente nas principais campanhas na história política brasileira. Sua melodia embalou manifestações de apoio a candidatos que se apresentavam como a escolha ideal para a resolução dos problemas do cidadão. Melodias construídas com precisão agem de forma sinestésica no ouvinte resultando em uma resposta emocional à música apresentada. Essa resposta emocional se transforma em ato racional levando o eleitor à ação, ao voto, contrapondo a idéia de emoção como resposta irracional. Através da teoria dos afetos é possível visualizar quais ‘sentimentos’ são transmitidos para o público que responde à música com exaltação emocional e fidelidade. Busca-se neste trabalho apresentar de que forma o jingle político atua de forma sinestésica no eleitor ao transmitir, através da melodia, os ‘sentimentos’ que correspondiam às necessidades do candidato e do contexto social do período histórico em questão.

Stimulus-Preceding Negativity and heart rate changes in anticipation of affective pictures.

The aim of the present study was to investigate the affective modulation of the Stimulus-Preceding Negativity (SPN) and heart rate changes in anticipation of visual stimuli differing in emotional content. A S1-S2 task was employed with a word (S1) indicating the content of a subsequent emotional picture (S2). Both valence and arousal dimensions were manipulated by presenting positive and negative pictures, high and low in arousal. Irrespective of valence, the amplitude of the SPN resulted to be significantly larger preceding high rather than low arousal pictures, indicating that the SPN does reflect the intensity of the motivational engagement ascribed to affective stimuli. Heart rate responses showed a deceleration preceding S2, which was larger preceding high arousal stimuli in comparison with neutral stimuli. Results suggest a coherent response pattern in both cortical and peripheral measures during affective anticipation.

Pre-motion positivity during self-paced movements of finger and mouth.

The present study investigated the role of pre-motion positivity in movement initiation and the reason why it is not reliably detectable in every study participant. Nineteen right-handed participants performed self-initiated simple movements of the right index finger and mouth while electroencephalography activity was recorded. Most of the participants showed a clear-cut pre-motion positivity with its characteristics varying as a function of the effector involved in the movement. The pre-motion positivity distribution was ipsilateral for finger movements and symmetrical for mouth movements. The results suggest that pre-motion positivity might represent a go-signal to initiate the movement and its occurrence might depend on movement initiation strategies.

Changes in EEG alpha power to different disgust elicitors: the specificity of mutilations.

It is unclear in the literature whether the various disgust elicitors are differentially processed by the brain and/or able to elicit distinct psychophysiological response patterns. On the other hand, disgusting stimuli depicting mutilations have been proved to elicit a distinct autonomic response pattern and to demand greater attentional resources, as compared with other unpleasant visual stimuli. In this EEG study, 34 participants viewed 4 film-clips depicting surgery, cockroach invasion, human attack and neutral landscape during EEG recording, and then rated the clips for valence, arousal and the basic emotions. Independent of location, the highest cortical activation was found during the viewing of the surgery scene. Moreover, the above activation was prominent over the right posterior regions.