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Purpose: A number of studies have explored patients' subjective experience of waiting for spinal surgery, however, they did so through an investigation conducted post-operatively. Thus, the aim of this study was to explore the experience of patients while still on the waitlist for lumbar spinal arthrodesis., Methods: This qualitative study of semi-structured interviews was conducted at an orthopedic research institute in Italy. The interview track was developed by a team of professionals (physiotherapists, orthopedic surgeon, psychologist) and consisted of 40 questions. Fifteen patients, 10 females and 5 males aged between 23 and 80 years, waiting for spinal arthrodesis were interviewed. The interviews were performed, transcribed and analyzed by the multiprofessional team through thematic analysis using a reflexive approach., Results: Five main themes were generated: (1) Impact of persistent pain on patients' physical and psychological functioning; (2) Fear of the unknown and uncertainties; (3) Hope and regaining normality; (4) The impact of the unpredictability of the waiting time; (5) Need for better communication and information on the care pathway. Two minor themes were also produced., Conclusions: These findings highlighted that patients on the waiting list for spinal arthrodesis need more certainty about waiting times, better communication with hospital staff, more thorough information about their care pathway. This could help patients feel more confident and may lead to more adequate expectations before surgery., Trial Registration: The study protocol was registered on ClinicalTrials.gov database on 14/03/2022 with ID number NCT06323694., Competing Interests: Declarations. Competing interests: The authors confirm that there are no relevant financial or non-financial competing interests to disclose regarding this article. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Istituto Ortopedico Rizzoli on 24/03/2022, Prot. n. 0005021. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: The authors affirm that human research participants provided informed consent for publication of the interview transcripts., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The study explores whether racial identity and appearance-based trustworthiness judgments can affect recognition of pain in medical students differing in levels of resting heart rate variability (HRV), a measure of parasympathetic control of the heart. After undergoing HRV assessment, 68 medical students (37 females) participated in a dynamic pain recognition task, viewing video clips of White and Black faces, which differed in perceived trustworthiness based on facial appearance, transitioning from neutral to intense pain expressions. Response time, pain intensity attribution and treatment recommendations were analyzed. Pain was recognized slower and estimated as less intense in Black compared to White faces, leading to a lower likelihood of recommending therapy. Pain recognition was faster for untrustworthy-looking White faces compared to trustworthy ones, while perceived trustworthiness had a minimal impact on the speed of pain recognition in Black faces. However, untrustworthy-looking faces were estimated to express more pain, particularly for Black faces. Notably, these biases were more pronounced in individuals with low, rather than high, resting HRV. Considering that therapeutic decisions mirrored pain intensity attribution, it would be important to increase awareness of these biases during medical training in order to promote equity in future pain assessment and treatment., (© 2024. The Author(s).)

Previous research suggests that emotion recognition is influenced by social categories derived by invariant facial features such as gender and inferences of trustworthiness from facial appearance. The current study sought to replicate and extend these findings by examining the intersection of these social categories on recognition of emotional facial expressions. We used a dynamic emotion recognition task to assess accuracy and response times in the happiness and anger categorization displayed by female and male faces that differed in the degree of facial trustworthiness (i.e., trustworthy- vs. untrustworthy-looking faces). We found that facial trustworthiness was able to modulate the own-gender bias on emotion recognition, as responses to untrustworthy-looking faces revealed a bias towards ingroup members. Conversely, when faces look trustworthy, no differences on emotion recognition between female and male faces were found. In addition, positive inferences of trustworthiness lead to faster recognition of happiness in females and anger in males, showing that facial appearance was able to influence also the intersection between social categories and specific emotional expressions. Together, these results suggest that facial appearance, probably due to the activation of approach or avoidance motivational systems, is able to modulate the own-gender bias on emotion recognition., (© 2023. The Author(s).)

Social context has been shown to influence pain perception. This study aimed to broaden this literature by investigating whether relevant social stimuli, such as faces with different levels of intrinsic (based on physical resemblance to known individuals) and episodic (acquired through a previous experience) familiarity, may lead to hypoalgesia. We hypothesized that familiarity, whether intrinsic or acquired through experience, would increase pain threshold and decrease pain intensity. Sixty-seven participants underwent pain induction (the cold pressor test) viewing previously seen faces (Episodic Group) or new faces (Non-episodic Group) that differed in the level of intrinsic familiarity (high vs low). Pain threshold was measured in seconds, while pain intensity was measured on a rating scale of 0 to 10. The results did not show an effect of episodic familiarity. However, compared to low, high intrinsic familiar faces had an attenuating effect on pain intensity, even after controlling for pain expectation. These results suggest that physical features conveying a higher feeling of familiarity induce a top-down hypoalgesic modulation, in line with the idea that familiarity may signal safety and that the presence of familiar others reduce perceived threat-related distress. This study provides further evidence on the social modulation of pain and contributes to the literature on first impressions' influence on social behavior. PERSPECTIVE: Consistent with the idea that familiar others signal safety and reduce the sense of threat, facial features conveying familiarity induce a top-down hypoalgesic modulation. This knowledge may contribute to understanding differences in pain perception in experimental and clinical contexts., (Copyright © 2023 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

This study highlights the role of psychological influences in triggering and amplifying the adverse effects of the COVID-19 vaccine (i.e., nocebo effects). Fear, beliefs, and expectations about the COVID-19 vaccine, trust in health and scientific institutions, and stable personality traits were measured in 315 adult Italian citizens (145 men) during the 15-min waiting time after vaccination. The occurrence and severity of 10 potential adverse effects were assessed 24 hr later. Nonpharmacological variables predicted nearly 30% of the severity of the vaccine's adverse effects. Expectations are important determinants of adverse effects from vaccines, and the results of the path analyses show that these expectations stem primarily from people's vaccine beliefs and attitudes, which can be changed. Implications for increasing vaccine acceptability and limiting the nocebo effect are discussed.

Non-alcoholic fatty liver disease (NAFLD) is a potentially progressive condition characterized by the presence of fat in more than 5% of hepatocytes, representing the hepatic expression of metabolic syndrome (MetS). A reduction of at least 5-7% in initial body weight improves the metabolic profile underlying NAFLD. The aim of our study was to evaluate the effects of the COVID-19 lockdown on a cohort of non-advanced NAFLD Italian outpatients. We identified 43 patients with 3 available time point visits in our center: first visit (T0) when behavioral indications aimed at controlling MetS were provided, a pre-COVID visit (T1) and a post-COVID visit (T2). During the lockdown, an online compilation of validated psychological tests (SRQ-20, EQ5D, SF-12 and STAI) and a specifically formulated questionnaire for NAFLD was presented to our cohort and completed by 14 consenting patients. Patients who had lost more than 5% of the initial weight at T1 (9 subjects, 21%) maintained the results even at T2, with an overall reduction in BMI and liver stiffness; patients who had not lost the desired weight at T1 (34 subjects, 79%) displayed a further increase in BMI and visceral adiposity at T2. Of interest is that patients in the latter group reported signs of psychological suffering. Our data demonstrated that the setting of good counseling was effective in controlling the metabolic disorder underlying NAFLD in our cohort of outpatients. Given the need for patients to play an active role in the behavioral therapy for NAFLD, we advocate that a multidisciplinary approach be adopted, including a psychological support to obtain the best results over time.

The aim of the study was to test an information booklet containing suggestions to parents on how to prepare their child for the first dental visit. Forty-five children and one parent per included child took part in the trial. Children were randomized in two groups; the information booklet was e-mailed to the parents of the study group. At the end of the visit, the dentist and the parent evaluated the child's behavior through the Frankl Behavior Rating Scale (FBRS) and the utility of the booklet through a Likert scale. The children evaluated the pleasantness of the visit and the perceived pain through the Wong-Baker FACES ® Pain Rating Scale (WBFPRS). Parents evaluated the information booklet as highly understandable and useful. According to the dentist, informed children were more cooperative (FBRS median score: 4; IQR: 3.5-4) than the control group (median score 3; IQR: 2-4) ( p = 0.013; Mann-Whitney U test). Children prepared with the booklet reported less pain (WBFPRS: 0.40 ± 0.82 vs. 1.42 ± 1.99; p = 0.034; t -test;) and tended to evaluate the visit as more enjoyable (WBFPRS: 1.1 ± 2.14 vs. 2.75 ± 3.43; p = 0.064; t -test) than unprepared children. The information booklet increases the child's ability to cooperate during the visit and could represent a useful instrument for the clinical practice.

To protect themselves from COVID-19, people follow the recommendations of the authorities, but they also resort to placebos. To stop the virus, it is important to understand the factors underlying both types of preventive behaviour. This study examined whether our model (developed based on the Health Belief Model and the Transactional Model of Stress) can explain participation in WHO-recommended and placebo actions during the pandemic. Model was tested on a sample of 3346 participants from Italy, Japan, Poland, Korea, Sweden, and the US. It was broadly supported: objective risk and cues to action showed both direct and indirect (through perceived threat) associations with preventive behaviours. Moreover, locus of control, decision balance, health anxiety and preventive coping moderated these relationships. Numerous differences were also found between countries. We conclude that beliefs about control over health and perceived benefits of actions are critical to the development of interventions to improve adherence to recommendations., (© 2022. The Author(s).)

Trait inferences based solely on facial appearance affect many social decisions. Here we tested whether the effects of such inferences extend to the perception of physical sensations. In an actual clinical setting, we show that healthcare providers' facial appearance is a strong predictor of pain experienced by patients during a medical procedure. The effect was specific to familiarity: facial features of healthcare providers that convey feelings of familiarity were associated with a decrease in patients' perception of pain. In addition, caring appearance of the healthcare providers was significantly related to patients' satisfaction with the care they received. Besides indicating that rapid, unreflective trait inferences from facial appearance may affect important healthcare outcomes, these findings contribute to the understanding of the mechanisms underlying social modulation of pain perception.

The healthcare provider profession strongly relies on the ability to care for others' emotional experiences. To what extent burnout may relate to an actual alteration of this key professional ability has been little investigated. In an experimentally controlled setting, we investigated whether subjective experiences of global burnout or burnout depersonalization (the interpersonal component of burnout) relate to objectively measured alterations in emotion recognition and to what extent such alterations are emotion specific. Healthcare workers ( n = 90) completed the Maslach Burnout Inventory and a dynamic emotion recognition task in which faces with neutral emotional expressions gradually changed to display a specific basic emotion (happiness, anger, fear, or sadness). Participants were asked to identify and then classify each displayed emotion. Before the task, a subsample of 46 participants underwent two salivary cortisol assessments. Individuals with global burnout were less accurate at recognizing others' emotional expressions of anger and fear, tending to misclassify these as happiness, compared to individuals without global burnout. Individuals with high burnout depersonalization were more accurate in recognizing happiness and less accurate in recognizing all negative emotions, with a tendency to misclassify the latter as positive ones, compared to healthcare workers with moderate/low depersonalization. Moreover, individuals with high depersonalization-but not participants with global burnout-were characterized by higher cortisol levels. These results suggest that the subjective burnout experience relates to an actual, but selective, reduction in the recognition of facial emotional expressions, characterized by a tendency to misclassify negative emotional expressions as positive ones, perhaps due to an enhanced seeking of positive social cues. This study adds to the understanding of emotional processing in burnout and paves the way for more nuanced studies on the role of altered processing of threat signals in the development and/or persistence of burnout., Competing Interests: The authors declare that they have no competing interests., (© 2021 Colonnello et al.)

Medical students' motivations for choosing a medical career are likely based on and remain tethered to the affectively-laden caring component of doctor-patient interactions. However, this component is rarely presented in educational surgical videos. It is unknown whether affectively engaging students by including patient-related emotionally salient information potentiates or draws focus away from learning a surgical procedure and whether such information affects motivation and attitudes toward the video. Therefore, we investigate whether presenting a patient's emotional state before video surgery enhances or weakens the educational value of that video. In a within-subjects crossover design, second-year medical students (n = 130) viewed video clips of surgeries. These videos, from online medical education platforms, were preceded by the patient's information from the original video or by information about the patient's preoperative emotional preparation. After each video, participants completed a multiple-choice test about the video's content to measure learning, answered a question about their motivation to re-watch the video, and completed an attitude scale regarding the video. Incorporating patient's information into surgical videos significantly enhanced students' acquisition of the technical aspects of surgery procedures (p < 0.0001), motivation to re-watch the video (p < 0.001), and favorable attitudes toward the video (p = 0.02). These findings show that incorporating information about patients' emotional states may enhance students' positive attitudes and motivations toward educational videos and may improve their learning of surgical techniques. They also suggest that the role of this factor should be considered when developing guidelines for medical educational video release.

Rationale: Extensive research has shown that implicit trait inferences from facial appearance can bias everyday life in a pervasive way, influencing our decisions in different social contexts such as mate choice, political vote and criminal sentence. In situations characterized by time pressure and scant information, decisions based on inferences from facial appearance may have particularly critical and serious consequences, such as in emergency healthcare. No studies today have investigated this aspect in an actual emergency., Objective: The aim of the present study was to go beyond this gap and to determine whether implicit inferences from patients' facial appearance could be predictive of disparities in clinical evaluations and priority of treatment., Methods: In total, 183 cases of patients were evaluated by independent judges at zero acquaintance on the basis of different implicit facial appearance-based inferences, including trustworthiness and distress. Color-based priority code (White, Green, or Yellow) attributed by the triage nurse at the end of the registration process were recorded., Results: Our results showed that more trustworthy- and distressed- looking patients' faces have been associated with a higher priority code., Conclusions: The present study shows that specific facial appearance-based inferences influence the attribution of priority code in healthcare that require quick decisions based on scarce clinical information such as in emergency. These results suggest the importance to bring to the attention of the healthcare professionals' the possibility of being victims of implicit inferences, and prompt to design educational interventions capable to increase their awareness of this bias in clinical evaluation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

We tested whether episodic information about people facilitates memory for their faces (Experiment 1) and whether this effect is specific for face identity (Experiment 2). Participants were presented with faces paired with behavioral descriptions (positive, neutral, or negative) and faces displayed alone. In both experiments, participants were more likely to recognize faces paired with behavioral descriptions, and after 1-week delay, their memory was better for faces paired with descriptions of salient behavior (i.e., with positive and negative valence) than faces paired with neutral behaviors or faces presented without information. To examine whether these effects are about memory for face identity rather than face image memory, in Experiment 2, we presented different facial images (varying in facial angle) of the same people at the encoding and at the recognition test. Although this manipulation decreased the overall recognition, the findings of Experiment 1 were fully replicated. The findings suggest that minimal affective information is sufficient to facilitate memory for face identity.

Purpose: Managing radiotherapy (RT)-induced pain is essential for reducing the likelihood of treatment interruption and improving the chance of tumor control. The current study aimed to examine the role of radiation therapist (RTTs) interaction and effective information communication in modulating patients' experiences of pain and discomfort during RT., Methods: Participants were 91 cancer patients undergoing RT for the first time referred to the Radiotherapy Unit of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Patient-reported outcome measures included patient satisfaction with the quality of the relationship and the information received by the RTTs, assessed by the Communication with RTTs - Shortened, scale, and pain and discomfort experienced during RT, assessed through two VAS scales. Attitudes toward RT were also assessed. All measures were collected as patients were approximately halfway through the overall RT duration (on average at the end of the 12th session)., Results: Patient satisfaction with RTT relationships and treatment-information communication was significantly related to RT-induced pain intensity and patient attitudes toward RT. The more satisfied patients were with RTT interactions and communication, the more positive their attitudes were toward RT and the lower the pain intensity experienced during treatment., Conclusion: Clinical implications can be drawn in terms of highlighting the need for RTTs to be mindful of their technical and supportive role in delivery of patient care and in structuring treatment information content in a way that contrasts potential nocebo effects related to patients' negative expectations about RT. The findings support the idea that RTTs may benefit from training interventions and structured education sessions with a focus on interpersonal skills and patient-centered communication., Competing Interests: Professor Alessio Morganti reports financial support from Elekta and Beyer outside the submitted work. The other authors report no conflicts of interest in this work., (© 2019 Mattarozzi et al.)

Several studies have highlighted the role of heart rate variability (HRV) in social engagement and social cognition. However, whether HRV is involved in the ability to remember faces associated with affectively salient behavioural information remains unexplored. The present study aims to close this gap by investigating long-term face-memory accuracy in individuals differing in resting vagally-mediated HRV. Individuals with high or low resting HRV viewed faces associated with episodic information differing in affective valence (positive, neutral, negative) or without any behavioural description. After one week, a face recognition test was administered. High HRV individuals were better at recognizing faces paired with positive and negative behavioural descriptions compared to neutral faces or faces without descriptions. Conversely, low HRV participants did not show any face memory advantage from personal information. The present results suggest that HRV may provide a novel biological marker of long-term face recognition., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Surgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); (2) the Zung Self-Rating Depression Scale; (3) the Psychosomatic Problems Scale. One-hundred and ninety residents completed the survey. Overall, the prevalence of burnout was 73% in the SS group and 56.3% in the NSS group (P = 0.026). More specifically, SS reported higher levels of EE and DP compared to NSS. No significant differences between SS and NSS emerged for PA, depression, or somatic problems. The present findings indicate that burnout is more prevalent in surgical residents than in residents attending non-surgical specialties. ClinicalTrials.gov identifier: NCT03668080.

Recognition of others' emotions is a key life ability that guides one's own choices and behavior, and it hinges on the recognition of others' facial cues. Independent studies indicate that facial appearance-based evaluations affect social behavior, but little is known about how facial appearance-based trustworthiness evaluations influence the recognition of specific emotions. We tested the hypothesis that first impressions based on facial appearance affect the recognition of basic emotions. A total of 150 participants completed a dynamic emotion recognition task. In a within-subjects design, the participants viewed videos of individuals with trustworthy-looking, neutral, or untrustworthy-looking faces gradually and continuously displaying basic emotions (happiness, anger, fear, and sadness). The participants' accuracy and speed in recognizing the emotions were measured. Untrustworthy-looking faces decreased participants' emotion recognition accuracy and speed, across emotion types. In addition, faces that elicited a positive inference of trustworthiness enhanced emotion recognition speed of fear and sadness, emotional expressions that signal another's distress and modulate prosocial behavior. These findings suggest that facial appearance-based inferences may interfere with the ability to accurately and rapidly recognize others' basic emotions.

Context: Identifying the factors that may interfere with or sharpen the ability to recognise emotions when observing patients is a critical goal in medical education. This study addressed these issues by investigating the effects of facial appearance bias on medical students' emotion recognition (Experiment 1) and whether such bias is modulated by the activation of relational caregiving schema (Experiment 2)., Methods: In Experiment 1, medical students were asked to recognise the emotions expressed by individuals differing in facial appearance (trustworthy, neutral and untrustworthy). In Experiment 2, they completed the same type of emotion recognition task after activating and anchoring themselves to the representation of the relational/human competences typical of a competent professional caregiver or after a control non-representation condition., Results: In both experiments, emotion recognition was affected by facial appearance bias: medical students were less accurate and slower in their recognition of emotions displayed by untrustworthy-looking individuals than in their recognition of emotions exhibited by individuals evoking more positive inferences. In Experiment 2, the activation of care schema enhanced medical students' emotion recognition ability regardless of facial appearance-based inferences., Conclusions: Medical students' emotion recognition is affected by appearance-based bias, but such bias may be weakened by techniques that harness medical students' personal affective/relational and representational resources. Thus, the results provide a basis for designing curricula aimed at challenging implicit negative bias and promoting medical students' emotion recognition ability starting in the early stages of their education., (© 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background and Objectives: A few studies have found that low scores on self-rated health and quality of life measures are associated with following worsening disability in multiple sclerosis (MS). We wanted to estimate the association between self-rated quality of life scores among patients with clinically isolated syndrome (CIS) and the risk of subsequent conversion to definite MS., Methods: One hundred sixty-two patients from the GERONIMUS cohort with a symptom or sign suggestive of MS and without a definite diagnosis of MS at the time of inclusion were asked to evaluate their health-related quality of life according to MSQoL-54 scale. They were clinically assessed and mood and depression scales were applied. The association between the scores of these scales and the risk of converting to definite MS during a 5-year follow-up was estimated using the Cox- proportional hazard regression model., Results: Quality of life at examination was significantly lower compared to those of an age- and sex-adjusted general Italian population. During the follow-up, 116 patients (72%) converted to definite MS. No significant predictive effects were found for the summary scales of MSQol-54 or other scales. The estimates did not change after adjusting for age, sex, BMI, education, MRI findings, Expanded Disability Status Scale (EDSS) score, and treatment at time of examination., Conclusion: Persons with CIS in this cohort reported reduced self-rated quality of life compared to the general population, but variation in these scores was not associated with subsequent conversion from CIS to clinical definite MS.

Purpose: Prior research has demonstrated that healthcare providers' implicit biases may contribute to healthcare disparities. Independent research in social psychology indicates that facial appearance-based evaluations affect social behavior in a variety of domains, influencing political, legal, and economic decisions. Whether and to what extent these evaluations influence approach behavior in healthcare contexts warrants research attention. Here we investigate the impact of facial appearance-based evaluations of trustworthiness on healthcare providers' caring inclination, and the moderating role of experience and information about the social identity of the faces., Method: Novice and expert nurses rated their inclination to provide care when viewing photos of trustworthy-, neutral-, and untrustworthy-looking faces. To explore whether information about the target of care influences caring inclination, some participants were told that they would view patients' faces while others received no information about the faces., Results: Both novice and expert nurses had higher caring inclination scores for trustworthy-than for untrustworthy-looking faces; however, experts had higher scores than novices for untrustworthy-looking faces. Regardless of a face's trustworthiness level, experts had higher caring inclination scores for patients than for unidentified individuals, while novices showed no differences., Conclusions: Facial appearance-based inferences can bias caring inclination in healthcare contexts. However, expert healthcare providers are less biased by these inferences and more sensitive to information about the target of care. These findings highlight the importance of promoting novice healthcare professionals' awareness of first impression biases., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Purpose: Receiving clear, complete and up-to-date information and having a satisfying relationship with the health professional (HP) are of primary importance for MS patients. Healthcare organization plays a key role in promoting an effective relationship and communication between patients and HPs. The present study aims to explore which care organization and service characteristics provided by Italian MS centres best predict patients' satisfaction with healthcare., Methods: Eighty-one centres and 707 patients (502 women, mean age 40.5 years, SD 10.2; mean education 12.2 years, SD 3.6; time since diagnosis 5.9 years, SD 1.5) were included in the analysis. The care organization and service provided by each centre were evaluated in comparison with the National Institute for Health and Care Excellence (NICE) guidelines on management of MS. Patients' satisfaction with care was measured using the patient self-assessed questionnaire 'Comunicazione medico-paziente nella Sclerosi Multipla, revised' section 2 (COSM-R section 2)., Results: The clinical characteristics of patients significantly affected their satisfaction. A multivariate regression model showed that higher patients' satisfaction (COSM-R score) was inversely associated with hospital size (number of patients under care) (β = -0.21, 95% confidence interval -0.35; -0.07) and directly associated with psychological interventions (β = 2.44, 95% confidence interval 0.29; 4.59)., Conclusions: Multiple sclerosis patients from larger hospitals are less satisfied with the information received and the relationship with HPs. Building an individualized relationship between patients and HPs and tailoring the communication of information improve patients' satisfaction. Such a goal is probably less likely to be accomplished in larger centres with many incoming patients. Moreover, when the centres also provide structured psychological interventions, the patients are more satisfied., (© 2017 EAN.)

Objective: In order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise., Design and Setting: One thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patient's family member or a legal representative) to a northern-Italian hospital were analysed., Main Outcome Measures: We adopted Reader and colleagues' (2014) patients' complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects., Results: The most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues., Conclusions: This study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients' satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients., (© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Objectives: Dental anxiety could impede dental treatment in children. Evidence shows that parents' fear of dentists contributes to children's anxiety towards dentists. The aim of the present study was to determine whether and to what extent: a) parents' anxiety and depression personality traits, b) parent's dental fear, and c) child personality traits can predict children's dental anxiety in an Italian population., Methods: One hundred and four children (5-14 years old) and one of their parents participated in the study. Well-known and validated questionnaires were administered to children (MCDASf, CFSS-DS, TAD) and parents (FDPQ, STAI Y1, Y2, and BDI-II)., Result: Dental anxiety is significantly associated with the anxiety personality trait and depression of the child and with parental fear of dental pain. A hierarchical regression analysis showed that, regardless of age and gender, the best predictor of child dental anxiety is parent's fear of dental pain, rather than relatively stable temperaments of the child., Conclusions: In line with the literature concerning adults, these findings highlight the children dental anxiety as a complex phenomena consisting of different components, including the child's personality traits (anxiety trait and depression) and parents' dental fear. Clinical implications of this evidence are discussed., (© 2015 American Association of Public Health Dentistry.)

Background and Objective: An investigation of the domains Italian patients with multiple sclerosis (MS) named as constituting their quality of life over time., Design: We assessed, in 68 patients, QoL domains using the Schedule for the Evaluation of Individual QoL: (a) before MS diagnosis disclosure, (b) thirty days after disclosure, and (c) after one and (d) four years' follow-up., Results: The life domains most frequently named by patients were as follows: Family, Work and Finance, Hobbies, Health, Relationship with Friends and Job Effectiveness. Only Health and Job Effectiveness domains varied with time. The Health domain became a critical dimension when MS diagnosis was revealed. In addition, patients tended to be more satisfied with their health after disclosure compared to pre-diagnosis. Job Effectiveness seemed to be an important aspect until 1 year after diagnosis disclosure, but it tended to become less crucial over time. Family seems to be the most important domain over time, and psychological adaptation to MS seems to be characterized by a reconceptualization of aspects that revolve around oneself, such as professional success, rather than relational or affective factors., Conclusions: Evaluating the most relevant life domains for patients and their alteration over time may provide practitioners with an important tool in making health-related decisions, thus improving health outcomes and QoL., (© 2015 John Wiley & Sons Ltd.)

The present study explores whether and to what extent individual differences (i.e., gender and personality traits of perceiver) predict inferences of trustworthiness from emotionally neutral unfamiliar faces and the related confidence in judgment. Four hundred and ten undergraduate students participated in the study. Personality was assessed using the Big Five model (i.e., Extraversion, Neuroticism, Conscientiousness, Agreeableness and Openness to experience) and measures of trait anxiety and aggression. The results suggest that trustworthiness judgments are affected by the gender of the perceiver, although this effect depends on the valence of the face. Women tend to judge trustworthy-looking faces as significantly more trustworthy than men do, and this is particularly pronounced for judgments of female faces. There were no gender differences for judgments of untrustworthy-looking or neutral faces. Gender also seems to affect the confidence in judgment. Specifically, women were generally less confident than men in judging trustworthiness of unfamiliar faces. Personality also affected judgment. Both low agreeable individuals and high trait aggressive individuals tend to perceive unfamiliar faces as less trustworthy. The present findings suggest that both gender and personality traits are relevant for understanding how people evaluate the trustworthiness of others. Whom we decide to trust is a function not only of their facial features but also of gender and individual differences in personality traits.

We investigated the effects of appearance of emotionally neutral faces and the context in which the faces are encountered on incidental face memory. To approximate real-life situations as closely as possible, faces were embedded in a newspaper article, with a headline that specified an action performed by the person pictured. We found that facial appearance affected memory so that faces perceived as trustworthy or untrustworthy were remembered better than neutral ones. Furthermore, the memory of untrustworthy faces was slightly better than that of trustworthy faces. The emotional context of encoding affected the details of face memory. Faces encountered in a neutral context were more likely to be recognized as only familiar. In contrast, emotionally relevant contexts of encoding, whether pleasant or unpleasant, increased the likelihood of remembering semantic and even episodic details associated with faces. These findings suggest that facial appearance (i.e., perceived trustworthiness) affects face memory. Moreover, the findings support prior evidence that the engagement of emotion processing during memory encoding increases the likelihood that events are not only recognized but also remembered.

Background: The Comunicazione medico-paziente nella Sclerosi Multipla - Revised (COSM-R) is a patient self-assessed questionnaire probing the moment of multiple sclerosis (MS) diagnosis disclosure (section 1, five items) and following period (section 2, 15 items)., Objectives: This study examined COSM-R dimensionality and measurement properties through Rasch analysis (partial-credit model) and proposed a revised questionnaire., Methods: Cross-sectional COSM-R data were obtained from 1068 people with MS (PwMS, 1065 questionnaires) participating in four studies (102 centres). Mean age was 40 years (range 17-73); 70% were women; 53% were from Northern, 25% from Central, and 21% from Southern Italy., Results: Unidimensionality was not confirmed for COSM-R section 1, but was for section 2 after removal of three items. The revised instrument (COSM-S, Shortened) consisted of the original five-item checklist (section 1), modified by removing the table grouping of three items, and 12 of the original 15 section 2 items, which could now be summed and transformed into an interval scale. Scores were higher for items assessing emotional satisfaction than for those assessing informational satisfaction., Conclusions: The proposed COSM-S is a composite measure of satisfaction with MS diagnosis communication with improved metric properties over the original COSM-R, and whose section 2 satisfies Rasch model expectations., (© The Author(s) 2014.)

Background and Objectives: This study investigated whether the altered organization of post-training sleep in patients with narcolepsy-cataplexy (NC) is associated with a lower off-line improvement in the consolidation of motor skills compared with normal subjects., Study Design: Fourteen drug-naive NC patients, fulfilling the international clinical and polysomnographic diagnostic criteria, and 14 individually-matched controls underwent training at a sequential finger tapping task (FTT) and were re-tested on the next morning (after a night with polysomnographic recording) and after another six nights (spent at home)., Setting: Training and retrieval sessions were performed in a controlled laboratory setting., Results: FTT performance was worse in NC patients than controls at training and at both retrieval sessions and showed a fairly different time course (slower than in controls) of consolidation. Several sleep indices (lower values of stage-2 NREM sleep and SWS) were compatible with a lower effectiveness of sleep for consolidation of motor skills in NC patients, although no statistically significant relationship was found between such indices and improvement rate., Conclusion: The consolidation process of motor skills results less effective in NC patients since training and slower than in normal subjects over the week following training. The wider variations in performance scores and sleep parameters of post.-training night in NC patients relative to controls suggest that a) the lower initial consolidation may be due to a less effective encoding consequent to altered prior sleep, and b) the consolidation process over the 24 h following training is negatively influenced not only by the altered characteristics of post-training sleep, but also by the daytime sleepiness following training.

Background: In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients' anxiety, mood and quality of life (QoL)., Methods: Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS-QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years' follow-up., Results: Two hundred and twenty-nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p(s) < 0.03), and this improvement remained stable over the two annual follow-ups. However, as suggested by a significant 'Time' × 'Diagnosis' interaction with regard to both QoL and Anxiety and Depression (p(s) < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health-related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p(s) < 0.01). Differently, on SEIQoL, which is a non health-related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p(s) < 0.03)., Conclusions: This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient's QoL and psychological well-being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects., (© 2012 Blackwell Publishing Ltd.)

Background: The long-term effect of liver transplantation (LT) on cognitive functions and the complete reversibility of minimal hepatic encephalopathy are poorly documented. Much evidence indicates that spatial attention improves starting from the immediate period after LT. However, at least in the first 2 years, some cognitive defects seem to persist to some degree, especially for supramodal nonverbal cognitive functions. The aim of this study is to investigate (i) whether the improvements observed in the perioperative period fluctuate or remain stable 10 years after LT and (ii) whether the functions that have been found defective also improve., Methods: We called patients previously included in a prospective study (Mattarozzi et al., Arch Neurol 2004; 61: 242) for a further neuropsychological evaluation. We compared the cognitive evaluation after 7 to 10 years with previous data gathered 6 and 18 months after LT., Results: The improvements obtained in the first 2 years after transplantation remain stable during the 7 to 10 years thereafter, especially for visuospatial attention, F(12,96) 1.70; P=0.04 and selective attention, F(6,66) 3.51; P=0.005. Furthermore, these findings also seem to suggest an improvement in supramodal cognitive functions, such as spatial planning intelligence, measured by the Elithorn Maze Test, F(3,33) 7.42; P=0.002. Verbal short-term memory, F(3,33) 3.69; P=0.038, and visuospatial short-term memory, F(6,64) 2.97; P=0.013, show a more fluctuating trend over time., Conclusions: Despite the risk of surgery, the neurotoxicity of immunosuppression therapy, and the effects of aging and related comorbidities, our data indicate that LT is able to significantly improve patients' cognitive functions in the long term.

Objective: The study aimed to examine the temporal distribution of episodes of REM sleep behaviour disorder (RBD) over the night and their motor and polysomnographic (PSG) characteristics in patients with narcolepsy-cataplexy (NC)., Methods: Full-night video-PSG recordings of a continuous series of 37 drug-naïve NC patients with clinically-documented RBD were examined to detect the occurrences of RBD episodes (disclosed in 27 patients) and to classify their related PSG and motor behaviour features., Results: RBD episodes occurred with comparable frequency in REM sleep periods of the first and second halves of the night, regardless of the length of REM periods, patients' age or disease duration. Vocalisations and pantomimes occurred in comparable proportions of RBD episodes in the two halves of the night, while aggressive-violent movements were significantly more frequent in RBD episodes of the second half of the night. No sleep parameter significantly differed in patients with RBD occurring in the first/second/neither half of the night., Conclusions: RBD episodes (a) are not an every night phenomenon in NC patients with clinically documented RBD, regardless of their age or disease duration; (b) can occur in any period of REM sleep, regardless of length; and (c) display less violent-aggressive motor features when they occur in the first half of the night. Multi-night studies with dream-report collection may disclose whether this overnight variation in the violent-aggressive features in RBD episodes of NC patients is associated with a time-of-night-related variation in dream content., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: We describe the development and clinical validation of a patient self-administered tool assessing the quality of multiple sclerosis diagnosis disclosure., Method: A multiple sclerosis expert panel generated questionnaire items from the Doctor's Interpersonal Skills Questionnaire, literature review, and interviews with neurology inpatients. The resulting 19-item Comunicazione medico-paziente nella Sclerosi Multipla (COSM) was pilot tested/debriefed on seven patients with multiple sclerosis and administered to 80 patients newly diagnosed with multiple sclerosis. The resulting revised 20-item version (COSM-R) was debriefed on five patients with multiple sclerosis, field tested/debriefed on multiple sclerosis patients, and field tested on 105 patients newly diagnosed with multiple sclerosis participating in a clinical trial on an information aid. The hypothesized monofactorial structure of COSM-R section 2 was tested on the latter two groups., Results: The questionnaire was well accepted. Scaling assumptions were satisfactory in terms of score distributions, item-total correlations and internal consistency. Factor analysis confirmed section 2's monofactorial structure, which was also test-retest reliable (intraclass correlation coefficient [ICC] 0.73; 95% CI 0.54-0.85). Section 1 had only fair test-retest reliability (ICC 0.45; 95% CI 0.12-0.69), and three items had 8-21% missed responses., Conclusions: COSM-R is a brief, easy-to-interpret MS-specific questionnaire for use as a health care indicator.

Objective: To describe the unique case of a middle-aged woman with severe insomnia recurring with a regular infradian period without any other significant clinical condition. To infer the existence of a circadian dysfunction modeled according to the physical phenomenon of the "beats.", Patient/methods: A two-year prospective observation by means of a sleep log was performed during the patient's normal life. She underwent one month of motor activity recording and also polysomnography, circadian rhythm of body core temperature and psychiatric evaluation during periods with and without insomnia., Results: Visual inspection of the 293-day plot of the sleep log disclosed a regular 42-day rhythm of insomnia recurrence confirmed by a Discrete Fourier Transform. During the periods of insomnia, lasting 5-7days, only moderate mood symptoms (depressive overlapping hypomaniac symptoms) were present. Treatment with sodium valproate was effective in curtailing insomnia., Conclusion: The wax and wane infradian modulation of the sleep length suggested the presence of a basic mechanism similar to the physical phenomenon of the "beats," i.e., a long period modulation of the amplitude of an oscillating system due to the interference of two uncoupled oscillators with a slightly different oscillation frequency. Hypothesizing a dysfunction of the circadian component of sleep, namely two uncoupled circadian cycles, a simple mathematical model estimated the difference of their periods of oscillation |34+/-2min| and reproduced the sleep-log data of the drug-free period of observation., (Copyright 2010 Elsevier B.V. All rights reserved.)

An abundant recall of dreams has been observed in clinical studies on patients with narcolepsy-cataplexy (NC), a neurological disorder characterized by an altered sleep architecture. Laboratory studies have shown that dream experiences developed during 1st-rapid eye movement (REM) sleep by NC patients are longer and more complex than those of healthy subjects. To establish whether these features indicate an earlier optimal functioning of the cognitive processes involved in dream generation rather than a more accurate dream recall, we compared the indicators of length and structural organization in reports of REM-dreams collected from 14 NC patients and their matched controls. During an experimental night two awakenings were provoked after 8 min in 1st- and 3rd-REM sleep; participants were asked to report their dream experience (spontaneous report) and then, if possible, further remembered parts of this experience (prompted report). All reports were analyzed using story-grammar rules, which allow us to identify units larger than single contents and describe their story-like organization. While dream recall (about 90%) was comparable in NC patients and controls, 1st-REM spontaneous reports were longer and more complex in NC patients, half of whom also provided prompted reports. After 3rd-REM awakening more than one third of NC patients and controls gave prompted reports, which were fairly comparable in length and complexity with the spontaneous reports. These findings confirm that the cognitive processes underlying dream generation reach their optimal functioning earlier in the night in NC patients than in normal subjects, and raises the question of whether the dream-stories described in spontaneous and prompted reports are part of the same or distinct REM-dreams.

The level of procedural skills improves in normal individuals when the acquisition is followed by a period of sleep rather than wake. If sleep plays an important role in the consolidation process the advantage it provides should be reduced or delayed when its organization is altered, as in patients with chronic sleep disorders. To test this prediction in patients with narcolepsy-cataplexy (NC), who usually have a more fragmented organization of sleep than normals, we compared the initial, intermediate and delayed level of consolidation of visual skills. Twenty-two drug-naive NC patients and 22 individually-matched controls underwent training at a texture discrimination task (TDT) and were re-tested on the next morning (after a night spent in laboratory with polysomnography) and after another six nights (spent at home). TDT performance was worse in patients than controls at training and at both retrieval sessions and the time course of consolidation was different in NC patients (who improved mainly from next-day to 7th-day retrieval session) compared with controls. Moreover, the less-improving patients at next-day retrieval had a wider disorganization of sleep, probably because of an episode of rapid eye movement (REM) sleep at sleep onset REM, on post-training night more frequently than more-improving patients. These findings suggest that the time course of the consolidation process of procedural skills may be widely influenced by the characteristics of sleep organization (varying night-by-night much more in NC patients than controls) during post-training night.

Background: Patient involvement in decisions regarding their care has been advocated, but preferences have not been adequately canvassed, particularly in people with multiple sclerosis (MS)., Objectives: To cross-culturally adapt and validate the Italian version of the Control Preference Scale (CPS) subsequently used to assess preferences of people with MS., Methods: Translation-adaptation into Italian of CPS from the original Canadian English followed by administration in 140 people with MS from five Italian centers (with re-administration in 35) and semi-structured interview., Results: Cross-cultural adaptation of CPS was successful. The 140 people with MS, who varied in clinical and general characteristics, considered the CPS clear and acceptable. Test-retest reliability was moderate (weighted Kappa 0.65; p<0.001). A collaborative role was preferred (61%), followed by passive (33%) and active (6%) roles. Education (odds ratio [OR] 2.43, 95% confidence limits [CI] 1.05-5.66) and length of follow-up at referral center (OR 0.36, 95% CI 0.14-0.92) were associated with choice of an active/collaborative role in the logistic model., Conclusions: The Italian CPS was well accepted by our MS population. Our data indicate that a high proportion of Italians with MS prefer a more passive role and this should be considered during the clinical encounter.

Narcolepsy with cataplexy (NC) is a neurological disorder characterized by excessive daytime sleepiness and an altered architecture of sleep. Previous laboratory studies have shown that frightening, bizarre and visually vivid contents are more frequent in dream experiences developed during the first period of REM sleep by NC patients than healthy subjects. As the structural organization of dream experiences of NC patients has not been yet examined, we compared its indicators in dream reports collected from a sample of NC patients and their matched controls. During an experimental night two awakenings were provoked after 8min of REM sleep in the first and third sleep cycle. Dream reports were analyzed using the rules of story grammars, capable of identifying units larger than single contents and describing their story-like organization. While dream recall (about 85%) was comparable in NC patients and controls, 1st-REM dream reports were longer in NC patients. Statistical analyses on the 12 NC patients and their matched controls who reported dreams after both REM periods showed that dream experiences occurring in 1st-REM reports of NC patients were longer and had a more complex organization than those of controls. These findings suggest that the cognitive processes underlying dream generation reach their optimal functioning earlier in the night in NC patients than in normal subjects.

CNS involvement is frequent in patients with chronic liver disease, resulting in overt or subclinical ("minimal") encephalopathy. Occasionally, patients liver cirrhosis may develop a progressive encephalopathy known as chronic acquired hepatocerebral degeneration (CAHD), presenting with neuropsychiatric changes and movement disorders. In patients affected by CAHD cognitive dysfunction is the rule, but to date this aspect has not been systematically studied. Our aim was to characterize the neuropsychological profile of cognitive impairment associated with CAHD. Eight patients with CAHD received extensive neuropsychological assessment, far from episodes of acute liver decompensation. Their cognitive performances were compared with those of 8 patients with cirrhosis free from CAHD or overt hepatic encephalopathy (HE) and with those of 8 healthy controls matched for age, sex and educational level. Patients with CAHD revealed a significant impairment of visuo-spatial attention compared to healthy controls, and a lower performance on a single task of visual search and sequencing when compared to cirrhotics without CAHD. Our findings support the hypothesis of a linear decline in attentional performances of patients with chronic liver disease, starting from cognitively intact patients, moving toward patients with minimal HE, and finally progressing to those with overt HE and CAHD.

Background: Cataplexy is the main motor symptom of narcolepsy/cataplexy and is considered a form of rapid eye movement (REM) sleep motor dyscontrol appearing during wakefulness and elicited by emotions. This study examined the relationship between the frequency of cataplectic attacks in patients with narcolepsy/cataplexy and (a) the clinical and behavioural characteristics of cataplectic attacks, including the emotional tone of trigger events, and (b) the polysomnographic characteristics of daytime sleepiness, nocturnal sleep structure and indices of motor disorders during sleep., Methods: A consecutive series of 44 first-diagnosed drug-naive patients with narcolepsy/cataplexy, fulfilling the International Classification of Sleep Disorders, 2nd edition (ICSD-2) clinical and polysomnographic diagnostic criteria, were interviewed to estimate the frequency and clinical characteristics of cataplectic attacks and the occurrence of REM sleep behaviour disorder (RBD). All patients also underwent a video-polysomnographic recording to assess their sleep parameters and indices of altered motor control during sleep., Results: Patients were divided into two groups on the basis of the frequency of cataplectic attacks, namely high-frequency (n=30) or low-frequency (n=14) depending on whether they estimated they had more or less than one attack per month. High-frequency patients (with a larger proportion of men) reported attacks more often affecting mainly the head, jaw and shoulder muscles and experienced more events among those listed as possible triggers of attacks. Sixty-one percent of patients reported RBD and 43% had an RBD episode at video-polysomnography regardless of the frequency of cataplectic attacks or gender. Lastly, the frequency of periodic leg movements (PLM) per hour was higher in men than women and increased with age., Conclusions: Patients with more than one cataplectic attack per month had more frequent involvement of head, jaw and shoulder muscles and were mainly men. The proportions of patients with clinically assessed RBD and an RBD episode documented by video-polysomnography, as well as conspicuous values of PLM per hour, are fairly consistent with those reported in recent small-group studies. Therefore, it seems legitimate to argue that RBD and PLM are nocturnal manifestations intrinsic to narcolepsy/cataplexy and that the gender-related differences in the frequency of attacks and the value of PLM per hour may be indicative of a larger difference in the clinical and polysomnographic characteristics of narcolepsy/cataplexy than hitherto suspected.

Patients with narcolepsy-cataplexy (NC) present excessive daytime sleepiness (EDS), cataplexy and an altered architecture of nocturnal sleep, with frequent episodes of REM-sleep at sleep onset (SOREM-sleep). This altered organization of nocturnal sleep may be accompanied by some differences in the functioning of the cognitive processes involved in the access, organization and consolidation of information during sleep. This study attempts to ascertain whether the activation of semantic memory during REM-sleep, as measured using a technique of semantic priming (namely, the facilitation of the activation of strongly-related rather than weakly-related and, overall, unrelated pairs of prime-target words) is different in NC patients compared to normal subjects. A lexical decision task (LDT) was carried out twice in wakefulness (at 10a.m. and after a 24h interval) and twice in the period of sleep inertia following awakening from SOREM and 4th-cycle REM-sleep on 12 NC patients and from 1st- and 4th-cycle REM-sleep on 12 matched controls. Reaction time (RT) to target words, taken as a measure of the semantic priming effect, proved to be longer (a) in NC patients than in control subjects; (b) in the period of REM-sleep inertia than in wakefulness; (c) in the first rather than the second session; and (d) for unrelated compared to weakly-related and, overall, strongly-related prime-target pairs. RT in post-REM-sleep sessions was less impaired, compared to waking sessions, and less dependent on the associative strength of prime-target pairs in NC patients than in normal subjects. Finally, RT of NC patients, although longer than that of normal subjects in waking sessions, significantly improved in the second session, as a consequence of either the amount of exercise or the consolidation advantage provided by REM-sleep for the procedural components of the task. The whole picture suggests a greater effectiveness of the activation of semantic memory during (SO)REM-sleep in NC patients rather than in normal subjects, and overall for the organization of new and unexpected relationships (such as those between unrelated pairs) between items of information.

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of "functional" memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.

It is well-known that liver cirrhosis is frequently accompanied by a wide range of neuropsychiatric abnormalities, including general and specific cognitive impairment. The aim of this study was to investigate which cognitive functions are selectively compromised in Hepatic Encephalopathy (HE) and to clarify the relationship between clinically overt or nonovert HE and the different forms and degrees of decay in cognitive deficits. Twenty-two patients without overt HE and 12 patients who showed overt HE at the first level of severity, along with matched control subjects, were compared in several cognitive domains. The results showed significant differences in some measures of attention between patients with minimal HE (mHE) and patients with overt HE. There were also notable differences in verbal short-term memory between patients with mHE and healthy subjects. Thus, we can hypothesize that there is a linear diminution in short-term memory and attentional performance starting from healthy patients, moving toward patients with mHE, and finally progressing toward patients with the first grade of overt HE. There are two types of diminution that we noted: between patients with mHE and the overt form, the decline in the attentional domain was more evident, while between healthy subjects and mHE patients, short-term memory showed a more evident decline.

Background: The long-term effects of liver transplantation (LT) on minimal hepatic encephalopathy are poorly documented., Objective: To assess the cognitive performance of patients with cirrhosis and without overt encephalopathy, before and after LT., Design: Longitudinal study comparing cognitive performance of patients with cirrhosis before LT and 6 to 18 months after LT, with matched control patients., Setting: University medical center., Results: Six months after LT, patients had improved their performance in visuospatial and selective attention, visuospatial short-term and long-term memory, and language tasks. After 18 months, a further improvement was found for selective attention and verbal short-term memory, while no other cognitive functions varied over time., Conclusions: The present findings confirm preliminary studies showing that LT improves cognitive functions in patients with cirrhosis. The cognitive improvement is not generalized, but appears prominent in attention and memory and, once achieved, remains stable. Rates of recovery differ, being early for some functions and later for others.

The positive influence of sleep on memory may partly depend on the processing which transforms items of declarative knowledge into contents of mental sleep experience (MSE). This view implies that the consolidation level should be more enhanced for those items which have been repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs in the same night. We examined here the occurrence of interrelated contents in the MSEs reported after an awakening provoked in stage 2 at sleep onset and the spontaneous awakening in the morning. Interrelated contents resulted much more frequently than the chance occurrence of contents with the same semantic features, regardless of the sleep stage in which morning awakening occurred. The accessibility of given items for transformation into MSE contents over the night makes it plausible that they are reprocessed, and thus further consolidated, during various stages and cycles of sleep.

Twelve consecutive patients having previously experienced one or more episodes of isolated transient topographical amnesia (TTA) underwent neuropsychological examination 6-12 months after the last episode to detect signs of global cognitive decline and to assess, in particular, cognitive functions deemed critical for topographical orientation. The test scores were compared with those of 12 normal subjects matched for age, sex, educational level and place of residence. Both patients and controls showed normal performances in all tasks. The comparison between the two groups revealed a significantly lower performance of the patient group in a task of geographical orientation, namely 'Map of Italy'. We conclude that isolated episodes of TTA in the elderly per se do not represent a sign of mental deterioration, but can be associated with frailty on survey components of spatial orientation. It remains to be explained whether this feature is a pre-existing condition favouring the occurrence of the episodes of topographical amnesia or represents a sequela.