Frailty in Caregivers and Its Relationship with Psychological Stress and Resilience: A Cross-SectionalStudy Based on the Deficit Accumulation Model.

BACKGROUND: Studies increasingly suggest that chronic exposure to psychological stress can lead to health deterioration and accelerated ageing, thus possibly contributing to the development of frailty. Recent approaches based on the deficit accumulation model measure frailty on a continuous grading through the "Frailty Index" (FI), i.e. a macroscopic indicator of biological senescence and functional status. OBJECTIVES: The study aimed at testing the relationship of FI with caregiving, psychological stress, and psychological resilience. DESIGN: Cross-sectional study, with case-control and correlational analyses. PARTICIPANTS: Caregivers of patients with dementia (n=64), i.e. individuals a priori considered to be exposed to prolonged psychosocial stressors, and matched controls (n=64) were enrolled. MEASUREMENTS: The two groups were compared using a 38-item FI condensing biological, clinical, and functional assessments. Within caregivers, the association of FI with Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS) was tested. RESULTS: Caregivers had higher FI than controls (F=8.308, p=0.005). FI was associated directly with PSS (r=0.660, p<0.001) and inversely with BRS (r=-0.637, p<0.001). Findings remained significant after adjusting for certain confounding variables, after excluding from the FI the conditions directly related to psychological stress, and when the analyses were performed separately among participants older and younger than 65 years. CONCLUSIONS: The results provide insight on the relationship of frailty with caregiving, psychological stress, and resilience, with potential implications for the clinical management of individuals exposed to chronic emotional strain.

Ovarian fibrosarcoma: case report and latest trends in diagnostic and therapeutic management.

The authors describe a rare case of primary ovarian fibrosarcoma and the latest trends in diagnosis and therapy. The rarity of this dis-ease and the scarce number of reported cases pose serious problems in differentiating it from other fibrous forms. A 58-year-old woman presented intermittent pelvic pain and a demarcated, mobile, and solid lump in the right adnexa. Diagnostic imaging revealed a solid- cystic inhomogeneous mass occupying the right adnexa and the CA125 level was elevated. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Histological findings with immunomarkers led to the final diagnosis of low-grade malignant mesenchymal neoplasm derived from the ovarian stroma compatible with fibrosarcoma. Twenty-four months follow-up showed no recurrence of disease. Ovarian fibrosarcoma is very uncommon neoplasm with a poor prognosis. Despite the efforts of several authors in reporting morphological, histological, and immunohistochemical features of this neoplasm, nowadays, the diagnosis, treatment, and prognosis are unresolved issues. The present case highlights the important role of immunohistochemistry to define histological type and differential diagnosis. As demonstrated by the authors' experience, they believe that surgery is curative in the early stages with low immunohistochemical positivity for ki67 and that chemotherapy should be reserved in advanced stages with regimens in use for the treatment of sarcomas.

[Sonographic aspects in the study of endometrial receptivity in women undergoing in vitro fertilization]. / Aspetti ecografici nello studio della recettività endometriale in donne sottoposte a programmi di fertilizzazione in vitro.

AIM: The embryo implant is the limiting step of the reproductive process about the phenomena involved in the determinism of endometrial receptivity. Some aspects of ultrasound could help us in this regard. The aim of this study was to test the relationship between three ultrasound parameters such as endometrial pattern, subendometrial vascularization, and uterine artery pulsatility index with success rates of in-vitro fertilization (IVF) and with pregnancy rates. METHODS: Twenty-four women candidates for IVF in 2009 were enrolled. A transvaginal ultrasound was performed two-four hours before the embryo transfer to assess differences in the endometrial pattern, subendometrial vascularization, and uterine artery pulsatility index with reference to the group of pregnant and non-pregnant women. RESULTS: Pregnant women most often reveal a trilaminar pattern, a subendometrial vascularization with vessels that penetrate the outer hyperechoic edge of endometrium, and a low-medium uterine artery pulsatility index compared to the group of non-pregnant patients. CONCLUSION: All three studied parameters seem to correlate in the determinism of endometrial receptivity. This leads us to conclude that a trilaminar pattern supported by a correct vascularization and by uterine artery pulsatility index of less than three are good predictors of implant. Their evaluation before subjecting the patient to the embryo transfer may help to increase the pregnancy rate.

[A fetal soft marker in obstetric ultrasonography: single umbilical artery]. / Un fetal soft marker nell' ultrasonografia ostetrica: l'arteria ombelicale unica.

The recent advancement in the field of ultrasonography allows for the prenatal precocious diagnosis of an ever increasing number of congenital defects found in various areas of the foetal body. These phenotype variants (markers) and/or morphological anomalies reveal in the majority of cases of a foetus with chromosome defects. They represent ''alarm bells'' that intrigue us to uncover any average case with more tests. It is for this that many more efforts are made to identify echographical markers which allow us to select among the pregnant women those that are not at risk and to advise those that may be of the existence of a specific cytogenetic test. One of these markers is actually represented by the single umbilical artery. This anomaly is made up of the presence of only two vessels (an artery and a vein) at the level of the umbilical cord, and its lack of an artery. The clinical meaning of this pathology is not yet completely known today. Often, in fact, when isolated, it is not associated with a chromosome defect and to other foetal pathologies. When, however, it is presented as associated to other soft markers or other structural anomalies, the risk of a chromosome defect is notably higher.

Home-based Health Risk Appraisal and screening program.

In an effort to improve Health Risk Appraisals and to induce individuals to change their lifestyles, comprehensive evaluations and counseling sessions were carried out for 476 participants of an experimental preventive care program (1984). Nurse practitioners interviewed participants in their homes and collected information about their lifestyle, medical history, and family history. In addition, physical examinations were performed and blood samples were obtained for laboratory analysis. This information was used to formulate health risk profiles for all participants who were then counseled on how to decrease identified health risks. Interventions included education about health risks and specific programs which were administered to help modify high-risk behaviors. At one year follow-up, significant risk reductions were reported in many areas of increased risk.