Antonella Varetto

Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients

Abstract Objectives: To assess the level of pain intensity at which patients feel the impetus to ask for a breakthrough cancer pain (BTcP) medication, and level of pain intensity at which patients consider they have achieved acceptable pain control after receiving a BTcP medication. Methods: A consecutive sample of patients who were receiving oral morphine equivalents equal to or more than 60 mg daily, and were prescribed rapid onset opioids for the management of episodes of BTcP, were included in the study. Focused educational activities regarding BTcP and numerical scales were established during hospital admission. At discharge patients were interviewed to find out what was the pain intensity level which gave the impetus to take the BTcP medication, what was the pain intensity for acceptable pain control after a BTcP medication had been given, and which factors prevented the patient calling for BTcP medication. A brief COPE (coping orientation to problems experienced) questionnaire was also administered. Results: Fifty-two patients were recruited for this study. The meaningful pain intensity for asking for a BTcP medication was 7.1; 77% of patients had a pain intensity of 7–8 on a numerical scale of 0–10. The meaningful pain intensity for adequate analgesia after a BTcP medication was 3.5. Similarly, 77% of patients had a pain intensity of 3–4. There was no relationship with the variables examined. Concerns by patients about the use of BTcP medications were minimal. Conclusion: The meaningful BTcP intensity and pain intensity expected after BTcP medication can be useful in selecting patients in studies of BTcP. The principal limitation of this study was the specific setting of an acute unit with specific features and the relatively low number of patients. This observation should be followed up by further surveys with a larger number of patients and different settings.

Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer.

Head and neck tumors and their treatments negatively affect speech, swallowing, body image, and quality of life (QOL). The purpose of this study was to allow us to evaluate the impact of flap reconstructive surgery with adjuvant radiotherapy (RT) on QOL and psychological functioning.

Occupational stress, anxiety and coping strategies in police officers.

BACKGROUND Studies on occupational stress have shown that police officers are exposed to stressful events more often than other workers and this can result in impaired psychosocial well-being and physical health. AIMS To measure the level of stress experienced, the consequences in terms of anxiety and the coping strategies adopted in a sample of police officers working in a large city in northern Italy. METHODS We used the Police Stress Questionnaire and the Distress Thermometer to measure occupational stress, the State-Trait Anxiety Inventory to measure anxiety and the Brief COPE questionnaire to measure coping strategies. RESULTS Six hundred seventeen police officers completed the questionnaire, a response rate of 34%. Differences between genders, sectors and roles emerged, but overall the study population generally demonstrated good use of positive coping strategies. Women in all operational service roles were more vulnerable to both organizational and operational stressors than men (P < 0.001), while in the interior department, men were more vulnerable to organizational stressors (P < 0.05). CONCLUSIONS Our results suggest that for Italian police officers, training courses and support in dealing with occupational stress should take into account gender, role and type of work. Tailored training courses and support programmes could be useful and effective tools for preventing stress before it becomes chronic.

Stress among Italian male and female patrol police officers: a quali-quantitative survey

Purpose – The purpose of this paper is to carry out a quali-quantitative study to analyze unease and perceived stress in a population of 485 male and female police officers in a large city in northern Italy, and investigate the consequences of these and the coping strategies adopted. The working context the paper chose to investigate was the Municipal Police, which is characterized by strong links with the local community. As suggested in the literature, the paper focalized the attention both on organizational and operational stressors. Design/methodology/approach – Quali-quantitative study: a self-administered questionnaire. Findings – Results show that both men and women are self-critical and their evaluation of the professional and contextual circumstances in which they operate is filtered by pessimism and self-blame, with higher levels of somatization in women: female patrol police officers are at the highest risk of psychological distress. Originality/value – This is, to the best of the knowledge, th...

Italian nurses' experience of stalking: a questionnaire survey.

A literature analysis shows that nurses are at greater risk of being stalked both by ex-partners and acquaintances (such as colleagues and patients) and by unknown stalkers. The aim of this study was to explore Italian nurses’ experience of stalking. A copy of the Italian modified version of the Networking for Surviving Stalking (NSS) Questionnaire on Stalking, Beck Depression Inventory (BDI), and State Trait Inventory (STAI) Y1-Y2 scales were distributed to 2,000 nurses working in 4 Italian state hospitals. There were 765 nurses who returned the questionnaire (38.4%), 107 of whom had been victims (14.0%). On average, victims had been stalked for more than 12 months by an acquaintance (41.1%), whose behavior included unwanted communications, following, control, and threatening behavior. The coping strategies used most involved offensive and interactional tactics. Stalking has both emotional and physical consequences for victims, although depression levels were not as high as we expected (BDI M = 11.05, SD = 8.84; STAI Y1 M = 42.11, SD = 11.75; STAI Y2 M = 44.04, SD = 12.90). The need to adopt legal, organizational, and individual strategies is also discussed.

Health Care Professionals as Victims of Stalking Characteristics of the Stalking Campaign, Consequences, and Motivation in Italy

Stalking is a phenomenon characterized by a set of repetitive behaviors, intrusive surveillance, control, communication, and search of contact with a victim who is afraid and/or worried and/or annoyed by such unwanted attention. Literature analysis shows that Health Care Professionals (HCPs) are at greater risk of being stalked than the general population. As described by Mullen, Pathé, Purcell, and Stuart, stalkers may have different motives: relational rejection, an infatuation, an inability to express their own emotions and recognize those of others, or a desire for revenge. The aim of this study was to explore stalkers’ motivation as perceived by their victims, characteristics of stalking campaigns, and consequences. A copy of the Italian modified version of The Network for Surviving Stalking (NSS) Questionnaire on Stalking, the Beck Depression Inventory (BDI) and the State Trait Inventory (STAI) Y1-Y2 scales were distributed in six Italian state hospitals. Participants included 1,842 HCPs, 256 (13.9%) of which had been victims. The majority of victims reported that stalkers were Rejected (96, 37.5%), Intimacy seekers (41, 16%), Incompetent suitors (60, 23.4%), and/or Resentful (43, 16.8%; χ2 = 163.3, p = .001). Stalking campaigns were characterized by several behaviors, principally contact (by telephone calls, text message) and following. The stalking campaign caused in victims both physical and emotional consequences, the most frequent being weight changes, sleep disorders, weakness, apprehension, anger, and fear. The most used coping strategies were moving away and moving toward, the less used was moving inward. Intervention programs and preventive measures (both individual and organizational) for HCP victims and those who could be considered at risk are also discussed.

Workplace Violence Toward Hospital Staff and Volunteers: A Survey of an Italian Sample

ABSTRACT Interest in the phenomenon of workplace violence has increased in recent years because such violence is evident in the healthcare sector. The prevalence and consequences of victimization among healthcare professionals have been well-investigated but not in volunteers who have direct and prolonged contact with patients and visitors. The aim of this study was to investigate the prevalence of physical and psychological workplace violence, the psychological and emotional consequences for hospital staff and volunteers, and the coping strategies that they adopted. In the current study, both of these groups worked with patients suffering from chronic diseases in a hospital in northern Italy. The participants included 108 hospital staff and 96 volunteers in cardiology and oncology units. The results revealed that for the staff victims of physical or psychological violence, the increase in depressive and anxiety symptoms (both state and trait) corresponded to a greater use of coping strategies to avoid facing the event. For the volunteer victims of physical violence, an increase in state anxiety was associated with an attempt to cope with the discharge of emotion, whereas trait anxiety was associated with a coping strategy that represents a positive interpretation of life events. A worrisome finding was the number of staff and volunteer victims of physical and psychological violence who did not report these occurrences: only one third of staff and volunteers reported these events to management or to the police.

Organizational and Occupational Stressors, Their Consequences and Coping Strategies: A Questionnaire Survey among Italian Patrol Police Officers

Background: Traditionally, workers employed in police forces have been found to be exposed to a high risk of distress. Several studies reported that the main stressors were associated more with organizational aspects, whilst other researchers underlined that the main stressor were associated more with operational issues. The aim of this research was to investigate operational and organizational stressors, their consequences also in terms of anxiety and the coping strategies adopted. Methods: We compared Patrol Police Officers working in the Operational Service (Outdoor Patrol Officers) and those in the Interior Department (Indoor Patrol Officers) in the same Municipal Police force. Results: The results revealed that both Outdoor Patrol Officers and Interior Patrol Officers suffered from organizational and occupational stressor. Outdoor Patrol Officers appeared more willing to use different coping strategies, whereas Indoor Patrol Officers used avoidance strategies. This allows Outdoor Patrol Officers to explore new responses and approaches to deal with situations which—owing to the type of work—it is impossible to change. Outdoor Patrol Officers appeared better equipped to change their attitude to work than Indoor Patrol Officers. Conclusion: Interventions on both organizational and operational stressors would improve the quality of Patrol Police Officers’ working life and have positive repercussions on the service offered to the general public.

Physical Practice and Wellness Courses Reduce Distress and Improve Wellbeing in Police Officers

Background: The aim of this work was to evaluate a course to reduce distress in an Italian police force. Based on the findings from the first investigations on this population, courses to improve the ability to manage distress were tailored by management. Several free courses were proposed, including physical efficiency (e.g., total body conditioning) and wellness (e.g., autogenic training) classes. The goal of this research was to evaluate the courses and their impact on the perceived distress and general health of the participants, as well as the effectiveness in increasing the use of adaptive coping strategies. Methods: A descriptive investigation was conducted involving a sample of 105 police officers before (time 1) and after (time 2) they had participated in the courses. Results: Findings confirmed both physical and wellness courses affected, in participants, the perceived distress, thereby increasing the perception of wellbeing. The participants expressed having mental health benefits, the use of adaptive coping strategies increased, while the maladaptive coping strategies decreased. Conclusion: This study confirms that these courses could effectively reduce the risk of chronic disease, a consequence of persistent exposure to distress.

Psychological Impact of Stalking on Male and Female Health Care Professional Victims of Stalking and Domestic Violence

The aim of this work was to investigate stalking experiences in a sample of Health Care Professionals, or HCPs, who experienced domestic violence in their previous relationships with an intimate romantic or non-romantic who had become their stalkers. A comparison between males and females was made to highlight the differences among the genders. The findings showed that, for the most part, the victims experienced stalking by a stalker that was not of the same gender. Moreover, the nature of the relationship was romantic, for the most part, for both female and male subjects, suggesting that the principal motivation of stalking is the disruption of an intimate relationship. Regarding domestic violence, females described the phenomenon from a different perspective, indicating verbal, physical, and sexual abuse, while males indicated only verbal abuse. Females tended to amplify, more than the males, depression, and state and trait anxiety. Even if all symptoms were expressed in both females and males, the males exhibited a lack of confidence in their bodies, and the emotional literacy made the expression of distress more difficult. At the same time, the expression of anxiety presented in the women permitted them to become progressively less victimized over time; depression and anxiety allow the recognition of these symptoms as signs of distress and to intervene to reduce them.