The Psychosocial Cardiological Schedule (PCS) was developed as a screening tool for patients undergoing cardiac rehabilitation (CR) to detect clinically relevant psychosocial/cognitive problems requiring psychological assessment/intervention. Filled out by a trained nurse, it classifies patients according to their need or not for a psychological interview and intervention provided by the psychologist (PCS-Yes vs. PCS-No).The main aim was to compare PCS data collected, respectively, in 2010 and 2017, regarding patients' socio-demographic characteristics, clinical variables, and the inclusion criteria for psychological counseling. Subsequently, the original Italian PCS was revised and an English version of the schedule was provided [PCS-Revised (PCS-R)].28 patients (aged 53.5 + 12.6 years, M = 20) of the 87 recruited in 2010 vs. 35 (aged 64.9 + 12.7 years, M = 28) of the 83 recruited in 2017 met the criteria for PCS-Yes: age < 55 years, social problems (living alone, no social support), manifest psychological/behavioral problems, suspected neuropsychological disorders, low prescription adherence, inadequate disease awareness. Comparing the two samples (2010 vs. 2017), clinical variables were similar, and the need for a psychological interview did not differ substantially (32.2 vs. 42.2%), but age increased significantly (PCS-Yes: 53.5 ± 12.6 vs. 64.9 ± 12.7 years, p = 0.001; PCS-No: 68.3 ± 8.0 vs. 75.0 ± 7.7 years, p = 0.0001). A significant increase was observed in the recommendation for neuropsychological assessment (3.6 vs. 25.7%, p = 0.02) to confirm eventual cognitive deficits. These results, the clinical experience, and the recent evidences from literature led to the PCS-R, incorporating a psychosocial screening, a psychological/neuropsychological deeper assessment, and a recommendation for a specific intervention to be carried out either during rehabilitation or in outpatient services.The data comparison highlight changes in the cardiac population, which is aging and more frequently requires neuropsychological assessment. The PCS-R could be considered in clinical practice as a useful screening tool to implement a timely coordinated interdisciplinary intervention, comprehensive of specific and tailored psychotherapeutic techniques.
Chronic heart failure has emerged as an important public health problem. The consequent increase in the sanitary services has induced an increased consumption of financial resources and conditioned the need to investigate new sanitary models that guarantee, by integrating the inpatient and outpatient health care delivery, the continuity of health assistance. Cardiac rehabilitation in the context of a day-hospital Heart Failure Unit allows for the organization of a rehabilitation program including various health approaches aimed at guaranteeing a multidisciplinary program and the relief continuity. This article describes the experience developed in the Heart Failure Unit of Montescano.
Presentation of the Psycho-Cardiological Schedule and convergence levels analyses among the psycho- cardiological screening and the psychological assessment. A. Pierobon, S. Callegari, A. Giardini, M. Ferrari, F. Olmetti, D. Corbellini, O. Febo, G. Majani. In Cardiovascular Rehabilitation the increasing inpa- tients complexity suggests the necessity to develop screening methods which allow to identify those patients that require a psychological intervention. Material and methods: A Psycho-Cardiological Sched- ule (PCS) was developed with the aim of detecting the crit- ical situation indicators or the presence of psychological, social and cognitive problems. The PCS, compiled by a nurse or cardiologist in collaboration with a psychologist, allows to assess the need for a deeper psychological exami- nation, clinical and/or with tests. Aim of the present study is to identify the convergence levels among the observa- tional and anamnestic data of the PCS collected by a nurse and the clinical and/or test data of the psychological deeper assessment. Results: Among the 87 patients recruited in January- February 2010, 28 (aged 53.5±12.6, M=20, F=8) fulfilled the criteria for a deeper psychological examination: age <50, manifestation of psychological/behavioural problems, neu- ropsychological disorders, low adherence to prescriptions, inadequate disease knowledge/representation. From data comparisons emerged convergence levels with 100% con- cordance as to smoke habits and problems in social-family support. High convergence levels also resulted as to emo- tional and/or behavioural problems (92.8%) and inadequate adherence to prescriptions (89.3%). Lower levels of concor- dance (82.1%) emerged when considering disease knowl- edge/representation, issues specifically linked to cognition and subjective illness experience, not directly detectable from behaviour. Conclusions: our data confirm the synergic efficacy of the two evaluations: the Psycho-Cardiological Schedule reli- ably identifies the problematic macro-categories, mainly if they are characterized by behavioural indicators, which fa- cilitate the detection. The psychological approach appears more suitable for better specifing macro-categories charac- teristics and for detecting critical aspects not overt but not less important, providing therefore advice for a therapeutic psychological management.
Background The independent prognostic impact of diabetes mellitus ( DM ) and prediabetes mellitus (pre‐ DM ) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐ DM on survival outcomes in the GISSI ‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial. Methods and Results We assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI ‐ HF trial, who were stratified by presence of DM (n=2852), pre‐ DM (n=2013), and non‐ DM (n=2070) at baseline. Compared with non‐ DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐ DM patients and those with pre‐ DM . Cox regression analysis showed that DM , but not pre‐ DM , was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI , 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI , 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI , 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI , 1.01–1.29, respectively). Conclusions Presence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00336336.
Visceral larva migrans (VLM) is caused by Toxocara canis larvae infection, which is a small intestine parasite found mainly in dogs, infecting humans occasionally, causing inflammation and damage to several organs with clinical signs ranging from asymptomatic to nonspecific symptoms. The goal of this study was to investigate the occurrence of anti- T. canis IgG in children attended at Basic Health Care Units in the city of Lages, Santa Catarina Brazil. Children's blood samples were collected by digital puncture, stored in filter papers and later analyzed by the Enzyme-linked Immunosorbent Assay (ELISA) to detect IgG antibodies against T. canis . Laboratory tests were conducted at the Zoology and Parasitology Laboratory of the Planalto Catarinense University (UNIPLAC). The research was conducted from July 2014 to May 2015, in children of both genders aged two to six years old, residing in the peripheral area of the city. Of the 82 children sampled, 43 were boys and 39 girls where 23.17% (19/82) aged five years old. Positivity for anti- T. canis IgG was 15.85% (13/82), i.e., 20.33% of all boys and 10.26% of the girls. Although the seroepidemiological anti- T. canis data in children at the national level present many variations, it is of paramount importance to know the parasitosis data atdifferent regions of Brazil, since the cities harbor an elevated number of urban dogs transiting in parks and schools.
Osteopathic manipulative treatment (OMT) has been reported to reduce significantly low back pain (Licciardone et al. 2005). However, the mechanics by which osteopathic treatment may produce an incr...
Visceral larva migrans (VLM) is caused by Toxocara canis larvae infection, which is a small intestine parasite found mainly in dogs, infecting humans occasionally, causing inflammation and damage to several organs with clinical signs ranging from asymptomatic to nonspecific symptoms. The goal of this study was to investigate the occurrence of anti- T. canis IgG in children attended at Basic Health Care Units in the city of Lages, Santa Catarina Brazil. Children’s blood samples were collected by digital puncture, stored in filter papers and later analyzed by the Enzyme-linked Immunosorbent Assay (ELISA) to detect IgG antibodies against T. canis . Laboratory tests were conducted at the Zoology and Parasitology Laboratory of the Planalto Catarinense University (UNIPLAC). The research was conducted from July 2014 to May 2015, in children of both genders aged two to six years old, residing in the peripheral area of the city. Of the 82 children sampled, 43 were boys and 39 girls where 23.17% (19/82) aged five years old. Positivity for anti- T. canis IgG was 15.85% (13/82), i.e., 20.33% of all boys and 10.26% of the girls. Although the seroepidemiological anti- T. canis data in children at the national level present many variations, it is of paramount importance to know the parasitosis data atdifferent regions of Brazil, since the cities harbor an elevated number of urban dogs transiting in parks and schools.
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with functional worsening, cognitive dysfunctions, treatment non-adherence, psychological distress and poor quality of life (QoL). In addition, since patients suffering from these conditions are often older adults, the presence of frailty syndrome could worsen the clinical situation.
Physical training has proven to be a valid and effective therapeutic tool capable of counteracting muscle changes that occur in chronic heart failure (CHF) patients. Nevertheless, few studies have analyzed the frequency of use of this therapy and the reasons for any reduced compliance and adherence to the prescription. The aim of this study was to quantify the frequency of the participation of CHF patients in a program of domiciliary physical training and to analyze the factors that can influence adherence to the program.Three hundred and twenty-two consecutive CHF patients (ejection fraction 28 +/- 7%) in a stable condition with optimized medical therapy performed a cardiopulmonary test, including determination of peak oxygen consumption, at baseline and after 9 +/- 3 months. All the patients had participated in sessions of health education on the relationship between illness/physical activity. The prescription of physiotherapy was decided by the physician on the basis of each patient's clinical need assessed in the diagnostic-therapeutic management. The patient referred for physiotherapy entered a therapeutic strategy that included sessions of training on anaerobic threshold, self-management of the session, and formulation of a domiciliary physical training program. During the follow-up evaluation the patients were asked to complete a questionnaire, which investigated the relationship between several factors and the patient's adherence to the physical training program, which was objectively evaluated by the change in peak oxygen consumption recorded at the end of the training, taking into account the spontaneous variations found in the control group.Two hundred and eighty-two of the patients (88%) satisfied the criteria for inclusion in the study. Only 61 (22%) of them were judged to have adhered to the recommended physical training. Type of employment (chi 2 = 7.08, p < 0.02), the state of retirement (chi 2 = 8.9, p < 0.01), ischemic etiology (chi 2 = 5.91, p < 0.01), compatibility with employment (chi 2 = 15.8, p < 0.0004), availability of suitable domestic conditions (chi 2 = 14.5, p < 0.0008), the structure of the training program (chi 2 = 22.33, p < 0.0001) and a learning phase in a gym (chi 2 = 71.33, p < 0.0001) were significantly correlated at univariate analysis with the performance of the physical training. Multivariate analysis identified the structure of the training program (odds ratio 9.6, 95% confidence interval 2.8-33) and a learning phase in a gym (odds ratio 49.6, 95% confidence interval 11-210.8) as independent factors (r2 = 0.48) determining adherence to the physical training program.Adherence to unmonitored, recommended domiciliary physical training appears to be modest even in patients who have been in-patients in a cardiac rehabilitation center. Various factors seem to influence the adherence of the patient to this therapy, but structural factors, such as the organization and learning of the program, more strongly influenced the patient's subsequent compliance.
