Francesco Tramonti

Quality of life of patients with amyotrophic lateral sclerosis

The aim of this study is to evaluate the correlation between different measures of quality of life (QoL), functional status and mood status in patients with amyotrophic lateral sclerosis (ALS). A sample of 40 patients with ALS was recruited and scales for the evaluation of health-related QoL (SF36), patient-centered QoL (SEIQoL), functional status (ALSFRS) and depression (ZDS) have been administered to them. All the correlations (Pearsons r) between the scores have been considered and the t-test was performed in order to compare male with female patients. No correlation emerged between the different measures of QoL and functional status, apart from the scores of the Physical Functioning subscale of the SF36 which resulted positively correlated (p < 0.01) with those of the ALSFRS. Mood status resulted negatively correlated with many aspects of health-related QoL but not with patient-centred QoL. Data suggest that the relationship between functional status and different domains of QoL in this population of patients with a severely compromising disease is not linear and that the satisfaction with life of the patients themselves is not strongly related to the level of physical impairment.

Age, gender, kinship and caregiver burden in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a neurodegenerative disease that affects the motor neurons and causes progressive physical impairment. Also, other functions, such as breathing, swallowing and speech are compromised, and the loss of independence makes caregiver burden extremely high. The present study aimed at evaluating the differences in the caregiver burden due to age, gender and kinship. Women reported a higher physical and social burden than men, and partners scored higher in several dimensions of the caregiver burden when compared to sons and daughters. With respect to adult child caregivers, daughters reported higher levels of developmental burden than sons. Age has a significant impact on the caregiver burden, especially for the time dedicated to assistance and physical burden; disease severity is significantly related to the physical burden as well, and also with the developmental burden.

Family functioning in severe brain injuries: correlations with caregivers’ burden, perceived social support and quality of life

Severe brain injuries have long-term consequences on functional status and psychosocial functioning. Family life can be greatly influenced as well, and features of high caregiver burden can emerge. Although the data on caregivers’ distress are constantly increasing, less information is available about the role of family functioning. Thirty caregivers of hospitalised patients with severe brain injuries received questionnaires for the evaluation of caregiver burden, family functioning and perceived social support. A semi-structured interview was performed for the evaluation of quality of life. Family cohesion and adaptability positively correlated with caregivers’ quality of life and perceived social support. Partner caregivers’ scores were significantly higher on the time-dependent burden than those of sons and daughters, whereas the latter scored higher on the emotional burden.

Psychological well-being of patients with insomnia and its relationship with anxiety and depression

The aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons. Significant differences between patients and controls were detected for anxiety and depression, as well as for psychological well-being. Even if subclinical on average, anxiety and depression symptoms were significantly related to poor psychological well-being, whereas insomnia per se was not. These findings suggest that patients with insomnia report a relevant impact on their psychological well-being, and that such an impact seems to be strongly associated with concomitant subthreshold symptoms of anxiety and depression. The implications for diagnosis and treatment are discussed.

Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting.

BACKGROUND While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life. OBJECTIVE The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support. METHODS Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them. RESULTS While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes. CONCLUSIONS The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures.

Caregiver burden and family functioning in different neurological diseases

ABSTRACT Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.

Stili di funzionamento familiare e carico assistenziale in un campione di famiglie di persone con handicap

Le ricerche su handicap e relazioni familiari mostrano dati contrastanti. Obiettivo di questo studio e l’analisi delle associazioni tra funzionamento familiare e carico assistenziale dei caregiver di persone con handicap. Sono stati intervistati 37 soggetti cui sono stati somministrati il Caregiver Burden Inventory e il Family Adaptability and Cohesion Evaluation Scale IV. I punteggi medi del carico assistenziale non evidenziano frequenti condizioni di burn-out ed il funzionamento familiare e descritto come generalmente bilanciato. Le madri lamentano un carico fisico e sociale maggiore dei padri. La coesione bilanciata, la soddisfazione familiare e la comunicazione correlano negativamente con il carico emotivo e sociale. La flessibilita bilanciata correla negativamente con il carico sociale, che correla invece positivamente con il disimpegno. Non emergono segni di elevato distress nei caregiver o diffuse percezioni di relazioni familiari disfunzionali, ma si evidenziano associazioni significative tra carico assistenziale e funzionamento familiare. Aspetti positivi del funzionamento familiare si associano infatti ad una percezione di ridotto carico assistenziale, mentre aspetti negativi ad una percezione di maggiore carico.

La sclerosi laterale amiotrofica nel contesto della famiglia: una ricerca sui parametri di coesione e adattabilità nella percezione di pazienti e caregiver

La sclerosi laterale amiotrofica (SLA) e la piu grave delle malattie del motoneurone e causa limitazioni motorie ingravescenti, nonche problemi nelle funzioni della respirazione, della deglutizione e della parola. Per le caratteristiche del decorso e della sintomatologia, la malattia minaccia continuamente l’autonomia delle persone affette e impone un carico assistenziale enorme ai caregiver e alle famiglie. Un’ampia letteratura descrive l’impatto della SLA sulla qualita di vita dei pazienti e dei loro caregiver, mentre poco studiato e il rapporto tra queste variabili e il funzionamento della famiglia nel suo insieme. Scopo del presente lavoro e proprio quello di valutare determinati indici di organizzazione familiare, nello specifico coesione ed adattabilita, in rapporto a variabili quali il carico assistenziale dei caregiver e la qualita di vita dei pazienti. I dati evidenziano un’elevata incidenza di famiglie che tendono verso punteggi estremi rispetto a tali indici, punteggi che tuttavia non si associano ad esiti negativi sul piano dell’adattamento psicologico ma, al contrario, mostrano correlazioni positive con le variabili che indicano processi funzionali di adattamento. Gli autori avanzano ipotesi sull’interpretazione di questi dati alla luce delle caratteristiche della malattia in esame, nonche su aspetti metodologici relativi all’utilizzo del questionario FACES III.

Severe brain injury and caregiver burden within the context of the family

Background: Theorised pathways in an ‘extended’ common-sense model of illness representations (CSM) in those affected by Irritable Bowel Syndrome (IBS) were examined. Analysis contrasted between those using complementary medicines (CAM-users) and those not using CAM (non-users). Methods: A web-based cross-sectional survey. Participants (n=653) were recruited from an IBS self-help network and other online illness discussion forums and assessed on the IPQ-R, the BMQ-General, the Brief-COPE and IBS-QOL. Findings: CAM-users reported poorer quality of life compared to non-users. Stronger perceptions of illness consequences and emotional representations were strongly correlated with reduced quality of life and poorer emotional outcomes in both groups. Self-blame and behavioural disengagement partially mediated the pathway from perception to outcome. Discussion: Findings suggest consistency with CSM theory. The detected influence of representations on quality of life (via coping strategies) suggests health psychologists could address components of illness perceptions to improve quality of life in those affected by IBS.Background: Psychological preparation has been demonstrated to improve post-operative outcomes including pain and health care resource use. This systematic review (registered with the Cochrane Anaesthesia Review Group) will investigate which methods of preparation are effective and for which outcomes. Economic data will be reviewed where available. Methods: Randomised controlled trials (RCTs) of adults undergoing elective surgery under general anaesthesia are included. Papers are identified using electronic searches, reference lists and contact with authors of studies to identify unpublished research. Expected results: In a meta-analysis including 38 RCTs, Johnston and Vogele (1993) found psychological preparation to be effective in improving various postoperative outcomes. It is expected that this up-dated review will provide further evidence about which techniques are effective because more studies are now available. Current stage of work: Papers are being screened for inclusion. Discussion: Identifying effective pre-surgical interventions may result in improved patient outcomes and healthcare resource use.[Extract] Background: Qualities of resilience have been strongly identified within farming populations. This resilience is being challenged, with high suicide rates raising concerns about the mental health of the farming population. This research explored those factors which impacted the resilience of farming families of Australia. Methods: Interviews were conducted (N=53 participants) and analysed using Grounded Theory and Content Analysis. Based on qualitative findings, a subsequent sample (N=278) of farming families from across Australia completed the survey. Measures of stressors, work-life balance, coping, buffering characteristics and well-being were distributed. Findings: Outcomes suggested themes of commitment and identification with farming helped build resilience. Path analysis indicated that buffering characteristics mediated and moderated the impact of stressors and role interference on indicators of well-being, χ² (18)=23.98, p=0.156. Discussion: Recommendations were made for raising awareness to the farming community of the risk factors for poor health and suggestions for increasing the resilience of groups at-risk of poor well-being.Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012Using two behavioral risk tasks (Balloon Analogue Risk Task BART; Lejuez et al. 2002 and Columbia Card Task, CCT; Figner et al. 2009) that mimic important features of real-world risk taking behaviors, we investigated the effects of different types of negative affect on risk taking. Methods: Participants (N¼50) were first administered the Hospital Anxiety and Depression Scale (HADS; Zigmond et al. 1983). One month later, they completed the BART and the cold CCT, in counterbalanced order. State mood was assessed before participants played the CCT and BART. Findings: Higher levels of anxiety were associated with less risk taking in both tasks; depression was unrelated to risk taking. Hierarchical regression analysis showed that these findings were robust to mood effects. Discussion: Findings from the current study indicated that healthy subjects’ risk taking tendencies vary between anxiety and depression. Implications for prevention of health risks are discussed. 194 EHPS 2012 abstracts Downloaded byBackground: Physical exercise contributes to healthy ageing, and strength training has beenshown to improve independence in older people.Method: Six hundred older people wererandomly selected from ...Background: Conceptual clarification of salutogenesis (Antonovsky 1987) and resilience – what is common and different? Methods: A systematic research synthesis 1992–2010 based on about 1300 papers ...Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012This conference abstract looks provides an analysis of the behaviour change techniques used in Scottish Government supported behaviour change interventionsBackground: The aim of this research was to examine variables that influence attention to health information in order to develop a predictive model. Methods: Community participants(N=330) were randomly assigned to one of two conditions presenting information about coronary heart disease (CHD) or road accidents. Information was either risk or neutral in valency. Attention to information was measured using a surprise recall task. Other variables measured included perceived risk, optimism, control and coping strategies. Findings: Overall, participants in the CHD condition remembered significantly more risk information than participants in the road condition. Participants in the road condition endorsed significantly lower beliefs in personal control perceptions while also endorsing greater beliefs in other’s control over their own road outcomes. Discussion: While perceived control is usually emphasised as integral in adopting protective behaviours these findings suggest that they are also central in communicating health information.