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Vittorio Lenzo,1 Alberto Sardella,2 Alessandro Musetti,3 Maria Francesca Freda,4 Daniela Lemmo,4 Elena Vegni,5 Lidia Borghi,5 Giuseppe Plazzi,6,7 Laura Palagini,8,9 Gianluca Castelnuovo,10,11 Roberto Cattivelli,12 Rachele Mariani,13 Giovanni Michelini,14 Tommaso Manari,3 Emanuela Saita,10 Maria C Quattropani,15 Christian Franceschini16 1Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio, Calabria, Italy; 2Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 3Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy; 4Department of Humanistic Studies, University of Naples Federico II, Naples, Italy; 5Department of Health Sciences, University of Milan, Milan, Italy; 6Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 7IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; 8Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy; 9Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; 10Department of Psychology, Catholic University of Milan, Milan, Italy; 11Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy; 12Department of Psychology, University of Bologna, Bologna, Italy; 13Department of Dynamic and Clinical Psychology, University of Rome “La Sapienza”, Roma, Italy; 14Sigmund Freud University, Milano, Italy; 15Department of Educational Sciences, University of Catania, Catania, Italy; 16Department of Medicine and Surgery, University of Parma, Parma, ItalyCorrespondence: Vittorio LenzoDepartment of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Via del Torrione 95, Reggio Calabria, 89125, ItalyEmail v.lenzo@unidarc.itPurpose: Previous studies showed poor sleep quality during the first Italian lockdown consequent to the quick spread of the virus. Poor sleep quality remained stable during the so-called “second wave”, which started in Autumn 2020. This study aimed to compare sleep quality between the two waves of contagions and to examine the effect of resilience, together with sociodemographic and COVID-related variables, on sleep quality during the second wave.Patients and Methods: A total of 648 participated in this longitudinal study through an online survey during the first lockdown consequent to the COVID-19 and during the second wave. The Medical Outcomes Study—Sleep Scale (MOS-SS) and the Resilience Scale (RS) were administered. Sociodemographic and COVID-related information were also collected.Results: The results showed sleep quality slightly increased in the second wave, even though with a small effect size. Correlational analysis showed that resilience is inversely correlated with sleep quality measured in the two waves. Sleep quality during the second wave was positively correlated with sleep quality in the first lockdown. Likewise, the results of multiple regression revealed that the sleep quality in the first lockdown and resilience were significant predictors of sleep quality during the second wave.Conclusion: These findings highlighted that the prevalence of poor sleepers remained high during the second wave. Together with the sleep quality in the first lockdown, resilience represents an important factor related to sleep quality during the second wave. Interventions to improve sleep quality among the general population should take into account these findings.Keywords: clinical psychology, health, sleep quality, resilience, longitudinal

O presente estudo analisou a sub-bacia do Rio Km 119 no município de Campo Mourão, Estado do Paraná – PR. Foi levantado problemas existentes na área de estudo e fez-se os cálculos das características físicas (morfometria). Analisou-se as proporções do uso do solo e conflitos na sub-bacia que devem ser recuperados levando em conta a legislação ambiental. Aplicou-se o EUPS com auxílio das técnicas de geoprocessamento e por fim realizou-se prognóstico dos problemas e foi proposto soluções. Na literatura foi discutido vários problemas como o aumento da população urbana que acarretou em poluição antrópica e a consequente contaminação na sub-bacia do Rio Km 119 bem como a erosão do solo, a degradação da vegetação ciliar e a ocupação de Área de Preservação Permanente (APP), causando impactos ambientais no local de estudo. Os resultados encontrados permitiram observar os conflitos de uso do solo e a falta de planejamento urbano é um dos problemas que agravam a degradação dos recursos naturais em todo percurso da área de estudo. A agricultura e urbanização vem se expandindo em direção ao rio, diminuindo assim a área de vegetação presente no entorno do corpo hídrico. Uma das alternativas para gerenciar esse conflito é a criação de Unidades de Conservação para promover a fiscalização e monitoramento de forma a buscar o equilíbrio do ecossistema com sustentabilidade.

Starting from the idea that dreaming could be considered an index of the psychological health of individuals regarding the COVID-19 outbreak, a major risk of psychological maladjustment has been registered for maladaptive daydreamers (MDers; i.e., people with a compulsive fantasy activity associated with distress and psychological impairment). Nevertheless, there is a gap in literature about dreaming in MDers in general and particularly during the COVID-19 pandemic. The aim of this study was to investigate differences in dreaming and dream content between probable MDers and non-MDers during the COVID19 lockdown in Italy. A total of 3,857 Italian adults (664 probable MDers), completed the Maladaptive Daydreaming Scale (MDS-16) and the Mannheim Dream Questionnaire (MADRE). Among them, 1,095 participants (222 probable MDers) decided to recount their dreams, subsequently analysed through a cluster analysis performed by T-LAB software. Significantly higher levels of dream recall, emotional intensity of dreams, nightmare frequency, nightmare distress, recurring nightmares about daytime, lucid dreams, interest toward dreams, problem solving and creative dreams, and dreams affecting daytime mood emerged in probable MDers compared to non-MDers. No differences were observed in the emotional tone of dreams. From the quali–quantitative analysis of dream narratives, similar themes emerged in probable MDers and non-MDers, except for a cluster named Dreaming the loss of others, where the non-MDers variable is highly represented. Our results highlight some significant differences between probable MDers and non-MDers with respect to dreaming activity. The massive use of dream activity as an affective regulator emerges for both probable MDers and non-MDers during lockdown.

Introdução: O estágio vem se mostrando cada vez mais importante para a formação do acadêmico de medicina e a consolidação do seu conhecimento, bem como oportunidade de experiências valiosas para o aprendizado prático. Assim, vivências proporcionadas por estágios voluntários contribuem para a formação de habilidades necessárias de um médico generalista, com capacidade de resolutividade, reflexão e integração do conhecimento. Objetivo: Relatar a experiência de um estágio voluntário em otorrinolaringologia e a sua importância para a formação do estudante de medicina como generalista. Relato de experiência: O relato conta com experiências vividas por um discente no estágio obrigatório e optativo durante o período de 18 de fevereiro de 2019 a 08 de abril de 2019, com carga horaria de 40 horas semanais, pelo Instituto de Otorrino Dr. Aureo C. Cangussu, na cidade de Imperatriz-MA. O estágio optativo é um elo entre o mercado de trabalho e a rotina estudantil, como uma forma de apresentação do estudante a sua rotina profissional. Assim, é permitido desfrutar de diversas áreas de aprendizagem, bem como acompanhar a rotina ambulatorial e ainda do centro cirúrgico, aumentando assim a possibilidade de novas experiências. Conclusão: Nesse sentido, conclui-se que o estágio traz ao acadêmico de medicina grandes possibilidades referentes a aplicabilidade do conteúdo teórico aprendido durante a sua formação nas atividades que são propostas durante esse período, além de permitir uma formação generalista com maior qualidade devido as experiências que são desenvolvidas no estágio.

Background: Long-term sequelae, called Long-COVID (LC), may occur after SARS-CoV-2 infection, with unexplained dyspnoea as the most common symptom. The breathing pattern (BP) analysis, by means of the ratio of the inspiratory time (TI) during the tidal volume (VT) to the total breath duration (TI/TTOT) and by the VT/TI ratio, could further elucidate the underlying mechanisms of the unexplained dyspnoea in LC patients. Therefore, we analysed TI/TTOT and VT/TI at rest and during maximal exercise in LC patients with unexplained dyspnoea, compared to a control group. Methods: In this cross-sectional study, we enrolled LC patients with normal spirometry, who were required to perform a cardio-pulmonary exercise test (CPET) for unexplained dyspnoea, lasting at least 3 months after SARS-CoV-2 infection. As a control group, we recruited healthy age and sex-matched subjects (HS). All subjects performed spirometry and CPET, according to standardized procedures. Results: We found that 42 LC patients (23 females) had lower maximal exercise capacity, both in terms of maximal O2 uptake (VO2peak) and workload, compared to 40 HS (22 females) (p < 0.05). LC patients also showed significantly higher values of TI/TTOT at rest and at peak, and lower values in VT/TI at peak (p < 0.05). In LC patients, values of TI/TTOT at peak were significantly related to ∆PETCO2, i.e., the end-tidal pressure of CO2 at peak minus the one at rest (p < 0.05). When LC patients were categorized by the TI/TTOT 0.38 cut-off value, patients with TI/TTOT > 0.38 showed lower values in VO2peak and maximal workload, and greater values in the ventilation/CO2 linear relationship slope than patients with TI/TTOT ≤ 0.38 (p < 0.05). Conclusions: Our findings show that LC patients with unexplained dyspnoea have resting and exertional BP more prone to diaphragmatic fatigue, and less effective than controls. Pulmonary rehabilitation might be useful to revert this unpleasant condition.

The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8–10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (β = 0.203; p

Currently available gestational age scoring systems are complex and inaccurate for wider use in low- and middle-income countries (LMIC), particularly in infants with neonatal encephalopathy. Here, we aimed to develop a scoring system based on physical characteristics for identifying late preterm infants from term infants. This was a prospective observational study conducted in 2 phases- the discovery phase and validation phase. In the first phase, we examined the accuracy of 10 objective physical characteristics in a prospective cohort of 1,006 infants recruited from three hospitals in South India. A weighted scoring system and a photo card were then developed based on the six best performing characteristics which were validated in another prospective cohort of 1,004 infants. The final score had a sensitivity of 66.0% (95% confidence intervals [CIs], 58.4-73.8%), specificity of 80.0% (95% CI, 77.2-82.7%), and a negative predictive value of 93.0% (95% CI, 90.5-94.5%). This scoring system may have wider applications in LMIC, particularly in community settings and in infants with neonatal encephalopathy.· This is an easily administered scoring system using physical characters to identify late preterm infants.. · The scoring is not affected by neurological injury and can be used in encephalopathic infants.. · Overall accuracy is better than previous scores encompassing the physical criteria alone..

Introdução: O estágio vem se mostrando cada vez mais importante para a formação do acadêmico de medicina e a consolidação do seu conhecimento, bem como oportunidade de experiências valiosas para o aprendizado prático. Assim, vivências proporcionadas por estágios voluntários contribuem para a formação de habilidades necessárias de um médico generalista, com capacidade de resolutividade, reflexão e integração do conhecimento. Objetivo: Relatar a experiência de um estágio voluntário em otorrinolaringologia e a sua importância para a formação do estudante de medicina como generalista. Relato de experiência: O relato conta com experiências vividas por um discente no estágio obrigatório e optativo durante o período de 18 de fevereiro de 2019 a 08 de abril de 2019, com carga horaria de 40 horas semanais, pelo Instituto de Otorrino Dr. Aureo C. Cangussu, na cidade de Imperatriz-MA. O estágio optativo é um elo entre o mercado de trabalho e a rotina estudantil, como uma forma de apresentação do estudante a sua rotina profissional. Assim, é permitido desfrutar de diversas áreas de aprendizagem, bem como acompanhar a rotina ambulatorial e ainda do centro cirúrgico, aumentando assim a possibilidade de novas experiências. Conclusão: Nesse sentido, conclui-se que o estágio traz ao acadêmico de medicina grandes possibilidades referentes a aplicabilidade do conteúdo teórico aprendido durante a sua formação nas atividades que são propostas durante esse período, além de permitir uma formação generalista com maior qualidade devido as experiências que são desenvolvidas no estágio.

Objetivo: O objetivo desse relato é descrever um caso raro de sinusite fúngica invasiva crônica que evoluiu com meningite causando síndrome de hipertensão craniana e tetraplegia, demonstrando por meio deste, a importância da realização de uma investigação diagnóstica mais aprofundada mesmo em uma doença considerada de diagnóstico clinico. Assim, evitar o retardo da terapia adequada.

The present study investigated the patterns of mutual associations between maladaptive daydreaming-related variables (MD, i.e., interference with life and somatosensory retreat), psychopathological symptoms (i.e., depression, anxiety, somatization, obsessive–compulsive, interpersonal sensitivity, psychoticism), emotion regulation strategies (i.e., cognitive reappraisal and expressive suppression), and problematic social networking sites use (PSNSU). A total of 531 young adults completed self-report measures through an online survey shared on social network groups. Two network models were performed on 297 young adults with probable MD (MDers) (Mage = 23.2, SD = 2.7) vs. 234 non-MDers (Mage = 23.4, SD = 2.6). Results showed that, compared to non-MDers, MDers showed significantly higher scores in all the study variables, except for cognitive reappraisal. Moreover, in the MDers network, the following patterns were identified: (i) no connections between the cluster of psychopathological symptoms, and neither cognitive reappraisal nor expressive suppression; (ii) a connection, through obsessive–compulsive (OC) symptoms, between the cluster of psychopathological symptoms and MD-interference with life; and (iii) a connection between PSNSU and MD-interference with life. Accordingly, the Network Comparison Test evidenced that the network structures of MDers vs. non-MDers were significantly different (M = .24; p = .01). Overall, higher scores on psychopathological symptoms in MDers provide support to the assumption that MD is a clinical condition, in which OC symptoms may play a critical role. Additionally, the association of PSNSU and MD-interference with life suggests that MDers might rely on PSNSU as a maladaptive emotion regulation strategy. Under this scenario, MD may be regarded as a potential vulnerability factor for PSNSU.

The COVID-19 pandemic and the restrictive measures taken against the spread of the contagion can be considered as traumatic events having a major impact on mental health. Dreams after undergoing traumatic experiences could “replay” traumatic scenes or have a para-therapeutic role that facilitates connections between a traumatic event and associated emotions. However, the studies carried out thus far in the field of sleep and dreams during the COVID-19 pandemic have mostly focused on sleep disorders, emotional tones, and contents of dreams. The aim of the present study was to explore, from a qualitative–quantitative perspective, the contents of dreams and the functions of dreaming during the COVID-19 pandemic. A sample of 1,095 subjects who decide to recount their dreams, during the early phase of the COVID-19 outbreak, was involved. A part of the Mannheim Dream questionnaire was also examined, considering both dream recall and the attitudes toward the dreams—both meaningful and transformative—as indicators of the dreaming process. A cluster analysis was performed on dream narratives through the T-Lab software. In all, 4 thematic clusters emerged: Escape From the Threat; The Work of Mourning, Unrecalled Dreams; COVID-19: As Manifest Content. The factorial mapping organized 3 vectors of meaning, representative of the function of dreaming: Remembering, Repeating, and Working Through; From Traumatic Content to Problem-Solving Strategy; From the Safe-Guardian of Sleep to the Safe-Guardian of Dream Waking continuity. The dreaming process shows functions of integration and processing of memories but also that a decrease in dream recall can act as a defense and have a crucial role in mental life. Clinical implications are discussed.

Introdução: O OSCE (Exame Clínico Objetivo Estruturado) é o método avaliativo que tem como foco o aprendizado e o desenvolvimento de habilidade e comportamento. Desde situações clínicas mais comuns até as mais complexas são exigidas no OSCE, todas baseadas na disciplina estudada durante o semestre. Dessa forma, erros se tornam comuns, comprometendo seu desempenho. Método: Estudo transversal com dados resultantes de uma única coleta em junho/2019 e elaboração do “Guia para o OSCE: Aprendendo com os erros”, com realização do seu cadastro na Câmara Brasileira do Livro obtendo o Número Padrão Internacional de Livros (ISBN) e sua distribuição do guia em formato digital para os alunos participantes do estudo, assim como para os demais acadêmicos do curso de medicina. Resultados: Foram avaliados trinta discentes de Medicina na prova prática OSCE. Os alunos foram avaliados por questionário, composto de 12 itens, aplicado por um avaliador. Foi atribuído um valor “acertou” se ele realizou todas as atividades de determinada questão, “errou” se não realizou nenhuma atividade da questão, ou “parcial” se ele completou parcialmente as atividades. Foram avaliados trinta discentes de Medicina na prova prática OSCE. Os alunos foram avaliados por questionário, composto de 12 itens, aplicado por um avaliador. Foi atribuído um valor “acertou” se ele realizou todas as atividades de determinada questão, “errou” se não realizou nenhuma atividade da questão, ou “parcial” se ele completou parcialmente as atividades. Conclusão: Neste estudo transversal realizado com estudantes do segundo semestre da graduação de medicina conclui-se que, ao realizar prova prática abordando temáticas contempladas ao longo do período, as questões que abordavam parâmetros básicos do eletrocardiograma, assim como a interpretação de achados patológicos, tiveram performance ruim. Além do nervosismo já associado a um pior desempenho em avaliações práticas, o estudo do ECG é considerado um desafio, aulas teóricas são insuficientes e não influenciam no melhor desempenho. A melhoria das habilidades tem relação com autodatismo, estudo individual com uso de metodologias relevantes.

Previous research has examined several parental, child-related, and contextual factors associated with parental quality of life (QoL) among parents with a child or an adolescent with autism spectrum disorders (ASD); however, no systematic review has examined the relationship between parental QoL and parental involvement in intervention. To fill this gap, a systematic review was conducted using four electronic databases and checked reference lists of retrieved studies. Records were included in the systematic review if they presented original data, assessed parental QoL, and involvement in intervention for children or adolescents with ASD, were published in peer-reviewed journals between 2000 and 2020, and were written in English. Among the 96 screened full-texts, 17 articles met the eligibility criteria. The selected studies included over 2000 parents of children or adolescents with ASD. Three categories of parental involvement (i.e., none, indirect, direct) were identified, which varied across studies, although most had direct parental involvement. The results from this review show that increased parental involvement in the intervention for children or adolescents with ASD may be one way to promote their QoL. However, further research specifically focused on parental involvement during the intervention for children and adolescents with ASD is warranted.

This cross-sectional study aims to investigate the impact of psychological distress experienced during the second wave of the COVID-19 pandemic on emotional eating and to assess the mediating role of emotional dysregulation in a sample of Italian young adults (20–35). A total of 437 participants provided demographical data and were assessed using the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire. Correlational analyses were performed to assess the relationship between continuous variables, while ANOVA was conducted to detect differences between males and females for emotional eating. To assess whether demographic and clinical data predicted emotional eating, hierarchical linear regression was performed. Then, a mediation analysis was conducted to assess whether emotional dysregulation was a mediator between psychological distress and emotional eating. Emotional eating was associated with psychological distress and emotional dysregulation. Moreover, higher levels of emotional eating were found in females than in males. Predictors of emotional eating were sex, psychological distress, and emotional dysregulation. Mediation analyses showed that the indirect effect of psychological distress on emotional eating through emotional dysregulation was significant (b = 0.0069, SE = 0.0024, CI = 0.0024–0.0118), confirming that the relationship between psychological distress and emotional eating was mediated by emotional dysregulation, controlling for sex. The model explained 26.8% (R2 = 0.2680) of the variance. These findings may help to plan and develop psychological interventions aimed at addressing emotional eating in young adults by targeting emotional dysregulation.

The primary aim is to describe the changes in the knowledge of mental health conditions, the attitudes toward the mentally ill, and the intended behaviour towards people with mental illness among the entire student population of the third year of a degree course in Psychology. A total of 570 students attended a seminar on stigma towards mental illness and were invited to complete an online survey which collected data on sociodemographic characteristics and three validated questionnaires evaluating different aspects of stigma at three different time points (pre-intervention, post-intervention, and at one year follow up). A total of 253 students (44.39%) completed the questionnaires at t0, t1, and t2. The mean age of the sample was 23.7 (SD = ±5.89), and 86.96% (n = 220) were females. Between t0 and t1, a statistically significant improvement was observed for all three outcomes, while the intended behaviour outcome was no longer significant between t1 and t2 (Z = −0.70, p = 0.48). Females and who participated live at the seminar maintained a significant knowledge of mental illness and a better attitude toward community mental health care. The effects of the seminar focused on reducing stigma tended to diminish over time at one year follow-up, particular in relation to intended behaviour.