Stefania Maggi

The role of impulsivity in self-mutilators, suicide ideators and suicide attempters — A study of 1265 male incarcerated individuals

OBJECTIVEnWe explored differences between high and low-impulsive incarcerated individuals in the context of lifetime self-mutilation, suicide ideation and suicide attempt.nnnMETHODSnA total of 1265 males detained in Italian penitentiary institutions were studied between January 2006 and December 2008. The study raters were specifically trained to discriminate between suicide attempters, ideators and self-mutilators. Participants completed the Barratt Impulsivity Scale, Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), Connor-Davidson Resilience Scale (CD-RISC), Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and Buss and Durkee Hostility Inventory (BDHI). Based on BIS 7 total score distribution, two extreme quarters - high-impulsive group (n=306) and low-impulsive group (n=285) - were compared.nnnRESULTSnOver 42% of participants had lifetime suicide ideation, 13% attempted suicide and 17% were self-mutilators. High-impulsive subjects were younger, more often single and with more prominent psychoticism, extraversion, aggression, hostility and resilience capacity. They were more frequently diagnosed with substance use disorders and engaged in self-mutilating behaviour. There was no difference in the rate of suicide attempts between the two groups.nnnCONCLUSIONnAlthough high-impulsive subjects were more prone to suicidal behaviour, it was not predicted by higher impulsivity when other psychological variables were accounted for.

Insomnia and suicidal behaviour in prisoners

Insomnia has been associated with suicidality. Prisoners have an increased risk of both insomnia and suicidal behaviour. Therefore, it was decided to examine for a relationship between insomnia and suicidal behaviour in a large group of 1420 prisoners. Prisoners had a semi-structured psychiatric interview, which included the Hamilton Depression Rating Scale (HDRS), and completed the Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Spielberg Anger Expression Inventory and Connor-Davidson Resilience Scale. It was found that 568 (61.2%) of the prisoners scored in the insomnia cluster of the HDRS and that 183 (12.8%) had attempted suicide. Regression analyses showed that insomnia was significantly and independently associated with a lifetime history of attempting suicide. Insomnia was also significantly related to actual suicidality. After controlling for confounders, axis 1 psychiatric disorder, childhood trauma, neuroticism, low resilience, and anger were significantly associated with insomnia in male prisoners. These data suggest the possibility of a relationship between insomnia and suicidality in prisoners. Assessing insomnia may be helpful when evaluating the risk of suicidality in prisoners.

Vitamin D deficiency, serum leptin and osteoprotegerin levels in older diabetic patients: an input to new research avenues

The aim of this study was to assess the effects of single oral bolus of 300,000xa0IU Vitamin D3 on serum levels and on bone and metabolic parameters in diabetic patients. This study is a Phase IV, randomized, double-blind, placebo-controlled, monocenter clinical trial. Thirty patients, 60xa0years or older, with type 2 diabetes mellitus, and diabetic foot complications, were enrolled and monitored for 24xa0weeks: 14 were treated with Vitamin D3 and 16 with placebo. Parameters including glucose, adiponectin, leptin, osteoprotegerin (OPG), 25-hydroxyvitamin D [25(OH)D], beta-CrossLaps, osteocalcin, bone-specific isoenzyme of alkaline phosphatase, tumor necrosis factor-α and parathyroid hormone were measured at screening and baseline and 12 and 24xa0weeks after treatment. Analysis of covariance was used to compare treatment groups. Analysis of the data detected a significant increase in 25(OH)D serum levels both at 12 and 24xa0weeks with respect to baseline values only in the treated patients. Significant variations with respect to baseline values were noted in OPG (Pxa0=xa00.0085) and in leptin (Pxa0=xa00.0442) levels: these were lower in the placebo group at week 24 but higher in the treated group. Vitamin D3 supplementation significantly increased serum leptin and OPG levels. Further, large-scale clinical trials are warranted to confirm these results.

Cognitive functioning among patients with diabetic foot.

AIMSnUsing diabetic foot (DF) as an indicator of severe diabetes, we aimed to investigate the cognitive profile of DF patients and the relations between cognitive functioning and both diabetes complications and comorbidities.nnnMETHODSnDementia-free patients with DF aged 30-90 (n=153) were assessed through medical records and a cognitive battery. Information on diabetes complications and comorbidities was collected via interview; glycated hemoglobin (HbA1c) was tested. Data were analyzed using robust logistic or quantile regression adjusted for potential confounders.nnnRESULTSnThe mean Mini-Mental Examination (MMSE) score of patients was 24.6 (SD=3.6), and 40% had global cognitive dysfunction (MMSE ≤24). Among elderly patients (aged ≥65), MMSE impairment was related to amputation (OR 3.59, 95% CI 1.07-12.11). Episodic memory impairment was associated with foot amputation (OR 4.13, 95% CI 1.11-15.28) and microvascular complications (OR 9.68, 95% CI 1.67-56.06). Further, elderly patients with HbA1c <7% had increased odds of psychomotor slowness (OR 7.75, 95% CI 1.55-38.73) and abstract reasoning impairment (OR 4.49, 95% CI: 1.15-17.46). However, such significant associations were not shown in adult patients aged <65.nnnCONCLUSIONnAmputation, microvascular diseases and glycemic control were associated with impaired global cognitive function and its domains among patients aged ≥65.

Functional limitations of upper limbs in older diabetic individuals. The Italian Longitudinal Study on Aging

Background and aims: This study aimed at assessing the prevalence rate of symptoms of shoulder osteoarthritis in diabetic subjects and their possible associations, as part of the prospective study called ILSA (Italian Longitudinal Study on Aging). Methods: The study examined 5632 individuals aged 65–84 years, living either independently or in institutions. Of the above number, 2109 subjects were examined in the 1996 follow-up, with evaluation of the diabetic status and osteoarthritis symptoms (at least one of the following sites: hand, knee, shoulder, hip). Associations between diabetes and osteoarthritis symptoms were examined by means of the χ2 test or the non-parametric Wilcoxon rank-sum test. Relationships of diagnoses of osteoarthritis and possible risk factors were analysed by multinomial logistic regression, adjusting for significant interactions. Results: Only for shoulders did osteoarthritis symptoms reveal a significant association with diabetes (p=0.0107). Significant risk factors for shoulder osteoarthritis were gender, age, completed years of schooling, BMI and diabetes. A woman of ≤76 years was 3.3 times more likely to have definite osteoarthritis and almost 2 times more likely to have possible osteoarthritis than a man of similar age. A man of over 76 years was estimated to be 3.5 times as likely to have definite osteoarthritis and almost 1.6 times more likely to have possible osteoarthritis than a younger man. Conclusions: It was concluded that the high prevalence rates of osteoarthritis symptoms in diabetic patients should be a major concern when planning treatment, because they might lead to a reduction in physical exercise, due to joint pain. Common pathophysiological pathways should be identified, such as RANKL/OPG and inflammation markers, to explain the independent association of these disabling conditions.

Obesity: Definition and Epidemiology

Obesity is the most prevalent form of malnutrition in the industrialized countries, and it is rapidly becoming highly prevalent also in the developing world. In 2008, 35 % of adults aged 20+ were overweight and 11 % were obese (meaning that in the world 205 million men and 300 million women were obese). Obesity is considered a multifactorial condition, caused by a complex interaction between the environment, genetic predisposition, and human behavior. The relevance of obesity as a risk factor for medical conditions is very well known; it is now considered as a major contributor to the global burden of disease and disability, because it is linked to various disabling conditions, such as heart disease, diabetes, hypertension, stroke, certain cancers, osteoarthritis, etc. Moreover, it has been reported that obesity is associated with an increased risk of death, although the relation of BMI categories with mortality has been the subject of much controversy, because epidemiologic studies have found linear, U-shaped, or J-shaped relationship between BMI and total mortality. The problem of overweight and obesity is considered one of the most pressing global issues that we will continue to face during the next several decades and demands attention from the healthcare community, researchers, and policy makers.