Search

PurposeConsistent with current literature, which highlights the role of narration as a key tool for exploring the processes by which people construct the meaning of their critical experiences the authors propose a theoretical and methodological model to analyse the narratives of illness and identify any innovative aspects. The generative model of mind presented refers to a semiotic, narrative and socio-constructivist perspective according to which narration constitutes one of the possible processes by which the affective and pre-verbal sense of experience is transformed into a meaning that can be symbolized and shared.Design/methodology/approachThe onset of an illness represents a critical event which interrupts a person's life narrative, shattering his/her biographical continuity and undermining any assumptions of him/herself and the world. In particular, the model proposes a method of analysis, currently absent in literature, of the narrative interview Narrative Function Coding System (NFC) in order to grasp the ways by which four main narrative functions, namely psychic functions, are classified: the search for meaning, the expression of emotions, the temporal organization and the orientation to action.FindingsNFC appears to be able to capture the complexity of the narrative process of construction of illness' sense-meaning making process, identifying both representative modalities of good functioning, which express a gradual process of connection with the variability of the experience, and modalities that express moments of disorganization and rigidity, which can persist throughout the time of treatment. The NFC represents not only a method for analysing illness narratives but also a method for tracking and monitoring the process of clinical intervention and change.Originality/valueThe sense-meaning making process perspective within the narrative socio-constructivist and semiotic framework of analysis proposed by NFC is currently absent in the literature. NFC can be a device for analysing the narrative process of sense-meaning making both for its use for clinical and preventive purposes. In addition we believe that this method, which focuses on the “form” and “way” of narratively constructing the subjective experience, rather than on the specific thematic content, can be used with all types of illness narratives, in particular the longitudinal one to explore the changes in sense-meaning making process.

Cancer narration is an elective tool to construct sensemaking processes aimed at supporting adaptation to the experience. The literature lacks a longitudinal narrative sensemaking exploration of breast cancer experience (BC) at an age below 50 years old. We administered an ad hoc narrative interview during pre-hospitalization-T1/postoperative counseling-T2/adjuvant therapy-T3/follow-up-T4. This study is a qualitative analysis of how narrative functions, as semiotic connection processes at the base of adaptation to the experience, are articulated during the four phases. Results highlight that the function of the organization of temporality changes from a relieved mode-T1 to reconstructive/chronological/blocked-T4; the search for meaning changes from an internalized mode-T1 to an internalized/externalized/generalized/nonsense-T4; emotional regulation changes from pervasive mode-T1 to connected/pervasive/disconnected -T4; and orientation to action changes from uncertain mode-T1 to combative-T2-T3-T4. From a clinical health psychology perspective, the different natural sensemaking trajectories emerged suggest constructing a personalized narrative intervention to follow the natural path of adaptation during BC experience, not only at the end, to accompany phases of integration and fluidity and to support phases of psychic stiffening and disconnection.

Breast cancer (BC) in younger age is a critical and potentially traumatic experience that can interrupt the continuity of self-narrative during a crucial phase. In the Narrative Identity framework the translation of memories into autobiographical narratives is an internal and external process that plays a key role in meaning-making, social relationships and self-coherence. The aim of this study is to examine the role and function that autobiographical memory narratives (AMN) play in the process of adaptation to BC medical treatment. Seventeen BC women below 50 years received prompts to provide autobiographical memory narratives at four phases during their treatment (pre-hospitalization-T1-post-surgery-T2-chemo-radio therapy-T3-follow-up-T4). The Emotional Processing Scale (EPS) was also administered. In all, 68 AMN were collected. A three step procedure of data analysis was conducted. The first one, an empirically-derived memory coding manual to analyze key dimensions of AMN was developed: Agency; Emotional Regulation and Interpersonal Relations. Findings show a particular vulnerability in narrative identity faced by BC women during the shift from T1-T3. In the second one, an emotional coping profile for each woman focusing on the shift from T1-T3 was created. For the third step, these profiles were compared with the EPS scores. The final results suggest the capacity of the AMNs to differentiate the women’s emotional adaptation over the course of the BC treatment. Despite the study’s limitations, it supports the use of AMN as clinical device to construct a deeper knowledge and profiling trajectory of how women have internalized and elaborated past encounters with illness and help providers, as well as their prior experience of bodily/psychological health and integrity. This information adds to an understanding of their current efforts at recovery and adaptation. In this way we believe that the recollection of narrative memories, not only at the end of the cancer treatment but also during its process, could help the women to mend the broken continuity of their narrative self, as they seek to maintain a healthy balance of internal resources across their past, present, and projected future.

Despite the proven effectiveness of cancer prevention, the literature highlights numerous obstacles to the adoption of screening, even at a young age. In cancer discourse, the metaphor of war is omnipresent and reflects an imperative demand to win the war against disease. From the psychodynamic perspective, the risk of cancer forecasts an emotionally critical experience for which it is important to study mental representations concerning illness and health care. Through the creation of an invented story that offers a framework for imagination, our aim is to understand what the relationship with preventive practices in oncology means for young women and how this relationship is revealed by their metaphors. A total of 58 young women voluntarily participated in the present research, answering a narrative prompt. The stories written by the participants were analyzed using qualitative methodology to identify construct, themes and metaphors. Our findings identify four constructs: the construction of a defense: youth as protection; the attribution of blame about cancer risk; learning from experience as a prevention activator; and from inaccessibility to access to preventive practices: the creation of engagement. The construction of an invented story allows us to promote a process of prefiguration on the bodily, affective and thought planes invested in preventive practice and brings out the use of metaphors to represent cancer risk and self-care. The results allow us to think about the construction of interventions to promote engagement processes in prevention from an early age.

Cancer screening programs are public health interventions beneficial to early diagnoses and timely treatments. Despite the investment of health policies in this area, many people in the recommended age groups do not participate. While the literature is mainly focused on obstacles and factors enabling access to health services, a gap from the point of view of the target population concerns healthcare providers. Within the “Miriade” research–action project, this study aims to explore the dimensions that mediate the relationship between healthcare providers and preventive practices through the narrations of 52 referents and healthcare providers involved in breast, cervical and colorectal cancer screening. We conducted ad hoc narrative interviews and used theory-driven analysis based on Penchansky and Thomas’ conceptualization and Saurman’s integration of six dimensions of healthcare access: affordability, availability, accessibility, accommodation, acceptability and awareness. The results show that 21 thematic categories were representative of the access dimensions, and 5 thematic categories were not; thus, we have classified the latter as the dimension of affection. The results suggest trajectories through which psychological clinical intervention might be constructed concerning health, shared health decisions and access to cancer screening.

Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.

The recent medical progress ensures high rates of long-term survival even in the face of illness previously with an unfortunate outcome: this is the case of breast cancer, which, to date, ensures more than 80% of long-term survival rates, and that for this reason can be interpreted as a chronic illness. In particular, the onset of breast cancer in under-50 women represents a potentially traumatic event that storms in the life of a young woman breaking the narrative sense of continuity, sameness, and integrity. This chapter discusses the role of narrative psychological devices for the understanding and the promotion of sense-making process and psychological adjustment to illness. Within a psychological risk preventive framework, the authors show findings from a longitudinal narrative research on the sense-making processes with breast cancer younger women highlighting narrative indexes of risks and resources during the first year of treatment. Implications for longitudinal support will be discussed.

Taking into account the current transformation of the healthcare systems in the Western societies, the authors argue that several challenges can be addressed only starting from a relational perspective. In the field of the health practices, psychological vision has been addressed for a long time on single individuals (generally the patients) in order to offer sustain and help to treat their suffering during a disease. In the authors' perspective, being a patient means to take up a positioning within a cultural-normative frame. In this sense, the psychological intervention requires to be directed toward the relational field. The proposal is aimed to present the constitutive elements and tenets of a clinical psychological model of intervention aimed to develop the healthcare relation: the scaffolding for the healthcare relationship. It is based on a clinical, semiotic, and dynamic perspectives of health psychology. By its implementation, the aims of ownership, cum-sensum, sharing decision making, and emotional elaboration are pursued.

Objective: The present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation. Methods: A literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted. Results: Multiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination. Conclusions: Overall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence-based interventions and health-promotion campaigns worldwide. Research and practical implications are highlighted and discussed.

IntroductionThe onset of breast cancer is considered a potential traumatic event associated with physical and psychological effects, in particular when it occurs at the age below 50. The literature lacks a longitudinal narrative exploration of breast cancer experience of young women.Participants and procedureUsing the narrative device as a diachronic tool aimed at promoting semiotic connection processes during the different phases of the therapeutic path, the authors constructed an ad hoc narrative interview to explore the meaning-making processes of 10 breast cancer patients below 50 years old during three turning-point phases: pre-hospitalization (T1); postoperative counseling (T2); and adjuvant therapy (T3). The research took place at National Cancer Institute Pascale of Naples. Through an ad hoc qualitative methodology, this study identifies the prevailing modes with which the five narrative meaning-making functions are articulated in the repeated narrative during the three phases.ResultsThe findings capture the patterns of change of narrative meaning-making markers during the illness experience, highlighting both integrated modes of connections between aspects of experience over time and moments of block in specific critical phases for women under 50.ConclusionsFrom a clinical health psychology point of view the results suggest the promotion of integration between the synchrony of the medical path and the diachrony of the subjective experience of women to support resources for adapting to experience.

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for discussion and this could also depend upon the severity of lung damage and the staging of the infection. Methods: We performed a real-life study of patients hospitalized forCOVID-19 and receiving non-invasive ventilation (NIV). In this single-center study, a 5 day course of Remdesivir was administered as compassionate use. Further therapeutic supports included antibiotics, low molecular weight heparin and steroids. Data collection included clinical signs and symptoms, gas exchange, laboratory markers of inflammation, and radiological findings. Major outcomes were de-escalation of oxygen-support requirements, clinical improvement defined by weaning from ventilation to oxygen therapy or discharge, and mortality. Adverse drug reactions were also recorded. All data were collected during hospitalization and during a 20-day follow up after treatment. Results: 51 patients were enrolled. A global clinical improvement was recorded in 22 patients (43%) at 12 days, and 36 (71%) at 20 days, in particular, at 12 days, 27 patients (53%) also had a de-escalation of oxygen-support class from a therapeutic point of view. Remdesivir use was associated with a lower hazard ratio for clinical improvement in the elderly (older than 70 years) and in subjects with more extensive lung involvement (total severity score at HRCT of more than 14). The 20-day mortality was 13%. Conclusions: Results demonstrated that Remdesivir is associated with an improvement in clinical, laboratory and radiological parameters in patients with severe COVID-19 and showed an overall mortality of 13%. We conclude that, in this cohort, Remdesivir was a beneficial add-on therapy for severe COVID-19, especially in adults with moderate lung involvement at HRCT.

Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for investigating hilar and mediastinal lymphadenopathy. This study reports eleven cases in which EBUS-TBNA was used to assess mediastinal and hilar lymph nodes for the presence of metastatic melanoma. Material and method A retrospective study was performed of all patients who had a history of melanoma and underwent EBUS-TBNA to assess hilar or mediastinal lymphadenopathy for the presence of metastatic melanoma. In seven cases, molecular analysis to detect mutations in the BRAF gene was also used. Results Eight patients had been diagnosed with malignant melanoma in the past (mean 54.4 months, range 18 to 115 months) while in the other three this tumor was primarily diagnosed in the staging phase. The male-female ratio was 6:5, and the mean age was 60.3 years (range 42 to 88 years). The mean hilar or mediastinal lymph node size detected with computed tomography was 3.0 cm (range 1.1 to 8.1 cm). Eight (72.7%) cases had metastases to the lung associated with metastases in the mediastinal lymph nodes. In four (50%) of these cases, the lung metastasis was solitary. Three (27.3%) cases had metastases in the mediastinal lymph nodes in absence of lung metastases. Metastatic melanoma was diagnosed by cytology and confirmed by cell block study with immunohistochemistry in all cases. BRAF mutations were detected in two (28.6%) of seven cases studied. Conclusion Cytology and tissue samples obtained from EBUS-TBNA are adequate to detect metastatic melanoma and permit in some cases the determination of biomarkers and identify the presence or absence of mutations in the BRAF gene. The procedure is safe, fast, and precise for the staging of melanoma.

OBJECTIVE: Prone positioning (PP) has demonstrated to be a safe adjunctive therapy for severe acute respiratory distress syndrome (ARDS). There is limited evidence of PP effects on awake patients. This study aimed to investigate the effects and feasibility of PP on coronavirus disease 2019 (COVID-19)-associated awake patients with ARDS in a subintensive setting of care. MATERIAL AND METHODS: This is a single-center case-control study involving patients with severe COVID-19 infection. A total of 29 patients underwent noninvasive ventilation, and PP was initiated 12 h from admission; 18 patients tolerated prone and side positioning for at least 10 h/d and cycled their position every 2 h, and 11 patients had no complaints with PP. RESULTS: A total of 29 patients (25 men and 4 women) with a median age of 64 years showed the average baseline white blood cell count of 8.45×10(9) cells/L, C-reactive protein of 10.1 mg/L, lactate dehydrogenase of 366 mU/mL, and interleukin-6 of 172 pg/mL. Basal pO(2)/FiO(2) ratio (P/F) was 95 (±56.5) and showed no linear correlation with any of the inflammatory markers tested. Computed tomography findings included ground-glass opacities in 100% (29/29) of patients. Consolidation/atelectasis was found in 58% (17/29) of patients. P/F was homogeneously distributed at baseline in patients with PP (96.5) and without PP (95). P/F during PP increased significantly compared with noncompliant controls (288 vs. 202; p=0.0002). Total duration of respiratory failure was significantly shorter in patients with PP (14 vs. 21 days; p=0.002). The number of days to recover from respiratory failure inversely correlated with PP P/F independently from baseline P/F. CONCLUSION: COVID-19 can lead to a severe impairment of gas exchange regardless of inflammatory status. Therefore, respiratory support may play a major role in COVID-19 treatment. We documented substantial efficacy of PP when started early and for at least 10 h/d. On awake patients, PP feasibility strictly depends on patient’s compliance. The interface should be carefully chosen to best fit every patient.

Introduction A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients. Material and methods Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2. Results Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days. Conclusions HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions.

BACKGROUND: High flow nasal cannula (HFNC) showed better oxygenation than standard oxygen therapy delivered through a face mask in acute respiratory failure for all causes HFNC may offer an alternative in patients with acute hypoxemia and potentially reduce mortality It was widely applied in China during the COVID-19 emergency However, no data have been published about settings and protocols The purpose of this paper was to report a single center experience on effectiveness and safety of HFNC in weaning of COVID-19 associated respiratory failure METHODS: We retrospectively analyzed patient records from Sub-intensive Care Unit (Cotugno Hospital, Naples, Italy) Four patients (3F;age: 60±9 23 years;BMI: 27 5±5 2) were de-escalated from ventilation (3 Helmet CPAP, 1 invasive mechanical ventilation) to HFNC oxygen therapy All patients were admitted for severe acute respiratory failure and pneumonia due to SARS-COV-2 (PaO2/Fio2 at baseline: 104±42 3 mmHg) and showed a typical progressive stage at chest imaging Weaning was initiated following a stable period of ventilation (PaO2/Fio2 in last days of first respiratory support: 377±60 2 mmHg) HFNC was set on 34 °C, with flow ranging from 50 to 60 L/min and FiO2 from 40 to 60% RESULTS: Right after initiation of HFNC (day 1), the mean PaO2/Fio2 was 238 mmHg (±65), without clinical signs of respiratory distress No difference was observed on lactate After 3 days of therapy mean PaO2/Fio2 increased to 377 mmHg (±106 3) All patients recovered from respiratory failure (PaO2>60 mmHg in room air) after 7 days (±3 2) CONCLUSIONS: HFNC might be helpful in weaning severe respiratory distress Clinical effectiveness and comfort should be assessed within 3 days The correct timing should be ruled by PaO2/Fio2 during ventilation and clinical signs of distress Further evidence is required for firm conclusions

Clear cells in thyroid neoplasms can take two main forms: balloon-shaped and signet-ring cells. Balloon-shaped cell change in follicular adenoma is rare. A review of the literature has revealed only 20 previously published cases. We report herein a new case in the right thyroid lobe of a 45-year-old man. The clinicopathological data of the 21 cases including our paper have revealed that the ages of the patients ranged from 22-70 years, with a mean of 41.6 years. There was a clear predominance in women (M:F, 1:6). The most frequent location was in either of both lobes (81.8%), rarely affecting the isthmus. One case was observed in an ectopic thyroid in the submandibular region. The size ranged from 0.7-5.5 cm (mean 2.9 cm). The type of surgical intervention where this data was reported it was lobectomy for 10 (55.5%) cases, thyroidectomy for six (33.3%) cases, and simple excision for two (11.1%) cases. In one patient, the lobectomy was accompanied by cervical lymph node dissection. No cases recurred or extended outside the thyroid. The main differential diagnoses include intrathyroidal clear cell tumor of parathyroid origin, clear cell carcinoma of follicular, oncocytic, papillary, medullary or undifferentiated (anaplastic) origin, paraganglioma, metastatic clear cell carcinoma, especially of renal origin, metastatic balloon cell melanoma, and clear large-cell lymphoma. A thyroid lesion showing clear cell change constitutes a diagnostic challenge in cytological and biopsy diagnosis. Careful observation of the routine techniques along with the aid of an adequate immunohistochemical panel is essential to reach a correct biopsy diagnosis.

Within a semiotic and psychodynamic frame, we present and discuss the psychological construct of modal articulation. By modality, we mean the way a subject organizes the meaning of his/her own experience according to categories of necessity, possibility, opportunity, will, knowledge, permission, and duty. Modality is a relevant topic in some branches of philosophy, logics, linguistics, and semiotics, but there is no systematic discourse about it in psychology. The proposal of this work is to deal with some interesting and promising features of modal categories in the sensemaking process of subjective experience. Modalization is presented as a relevant semiotic organization in each contextual and dynamic sensemaking process in order to perform three functions: (a) connection between affective matrix and subjective experience, (b) mediation between subjective positioning in intersubjective context, and (c) vectorialization of action, namely orienting subjective agency in becoming temporal. Theoretical, methodological, and clinical implications are discussed.

Background Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5–20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life. Methods Forty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B). The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X). Results There was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation. Conclusions The “new” bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.

Patients with severe uncontrolled asthma despite best inhalation therapy can receive biologics. In addition to anti-IgE therapy that has improved outcomes in allergic asthma, anti- IL-5 biologic have recently emerged as promising treatments for T2 asthma. Is there any baseline feature that can predict efficacy of therapy? We retrospectively analyzed 20 asmathic patients with good response to Omalizumab (group O) compared to 20 similar patients with unsatisfatory response to omalizumab after 1 yr that were witched to Mepolizumab (group M). All patients were adult, atopic with severe asthma. All patients had positive results for perennial inhalant allergen sensitivity, IgE≥30 KU/L and eosinophil levels ≥ 300/mcL. Regardless of baseline levels of IgE, eosinophil count and baseline exacerbations rate (ER: 5.3±1.75 group O and 5.3±1.53 in group M), some patients had a good response to Omalizumab in the first yr (group O ER 1.3±0.8 p Age may be a predictor of efficacy of monoclonal antibodies in adult allergic asthma. it could help clinicians in the therapeutic decision.

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (

A diagnosis of breast cancer is considered a potential traumatic event associated with physical and psychological effects. In literature, an exploration of breast cancer experience in young women is lacking, able to shed light on the narrative processes of meaning-making of the experience in specific phases of treatment, as may be the initial impact with the onset of the cancer. Meaning-making processes are determinant aspects when dealing with traumatic events. The research took place at National Cancer Institute Pascale of Naples. We collected 50 ad hoc narrative interviews to explore the different domains of the experience with under-fifty women at the first phase of the hospitalization. The Narrative Interviews were analyzed through a qualitative methodology constructed ad hoc. Starting from the functions of meaning-making that the narrative mediate we have highlight the different modes to articulate the narrative functions: The Organization of Temporality: chronicled (38%), actualized (26%), suspended (18%), interrupted (16%), and confused (2%). The Search for Meaning: internalized (42%); generalized (24%); externalized (18%); suspended (16%). The Emotional Regulation: disconnected (44%), splitted (28%), pervasive (26%), and connected (2%). The Organization of self-other Relationship: supportive (46%), avoidant (22%), overturned (16%), and sacrificial (16%). The Finding Benefit: revaluating (38%), flattened (34%), and postponed (28%). The Orientation to Action: combative (38%), blocked (36%), and suspended (26%). Findings capture the impact with the onset of the cancer, identifying both risk and resource aspects. The study allows to identify a specific use of narrative device by under-fifty women who impacted with the experience of breast cancer. The ways in which meaning-making functions are articulated highlight the specificity of the first phase of the treatment of the cancer. From a clinical psychology point of view, our findings can be used as clinical narrative markers to grasp, in a diachronic way, the process of meaning-making, integration, and coping during the first phase of breast cancer experience in young women. We consider it valuable to increase longitudinal studies with young women to highlight trajectories of meaning-making during the different phases of the treatment to think about personalized intervention practices diachronically to the experience.

The recent literature shows an increase of breast cancer in women under 50, however still few are the studies which analyse the impact of the disease in this specific target age. This study aims at exploring the most prevalent topics in Italian cancer blogs of women who have received a breast cancer diagnosis before the age of 50, in order to understand their experience of illness and the characteristics of women’s narrations at different times after diagnosis (1 year, 2 years, 3 years). We collected the textual corpus of 4 Italian breast cancer blogs and performed a thematic analysis. Five themes resulted, which, after interpretation using factorial mapping, fall into 3 sense vectors: toward the thought of the experience; from the external to the internal world; breast cancer: from rigidity to mobility. The blog analysis allows to build a first step of the scientific knowledge about the traumatic specificity of this experience, showing a need for processing the emotions. This allows to think about clinical support practices tailored to this group, in order to develop a diachronic processing of the experience and the construction of a new continuity of life.

A significant proportion of HIV-infected patients experiencing a late diagnosis highlights the need to define immunological protocols able to help the clinicians in identifying patients at higher risk for immunological failure. The aim of the study was to evaluate the feasibility of easy cytometric tests in defining the effect of antiretroviral treatment (cART) on immunological homeostasis and in identifying predictive markers of early immune recovery. Chronic HIV infected patients (n = 202) were enrolled in a prospective multicentric study, and their immunological profile was studied before (w0) and after 24 weeks (w24) of antiretroviral treatment (cART) using a standardized flow cytometric panel. Based on CD4 T cell count before treatment, patients were divided in late (LP: CD4 500/mmc) presenters. In all groups, cART introduction increased CD4 and CD4/CD8 T cell ratio, naïve T cell (CD4 and CD8) and CD127-expressing CD4 T cells. In parallel, cART significantly reduced effector memory T cells (CD4 and CD8) and T cell activation (CD38+CD8 and CD95+CD4 T cells). Moreover, the frequency of Naïve and Effector CD4 T cells before treatment correlated with several immune parameters key associated with the pathogenesis of HIV, thus mirroring the health of immune system. Interestingly, we identified the Naïve/Effector CD4 T cell ratio (N/EM) at w0 as a marker able to predict early immune recovery. Specifically, in LP, N/EM ratio was significantly higher in immunological responder patients (CD4>500/mmc at w24) when compared to immunological non responder (CD4 T cells

Background COVID-19 is a potentially critical infectious disease. Inflammatory response and disease severity may vary according to immune system status. The aim of this case series is to investigate different presentation of COVID-19 in immunocompromised patients. Methods this is a single centre case series about 17 immunocompromised patients admitted to our respiratory department during the recent COVID-19 pandemic. White blood cell count, C reactive protein, interleukin 6, lymphocytic subpopulation count (CD4+, CD8+, CD20+) and immunoglobulin count (IgG, IgM, IgA) were measured at hospitalization. Results the most common causes of immunosuppression observed in our severe COVID-19 population are hematological malignancies, immunosuppressant drugs for transplant, primary immunodeficiency and inflammatory bowel disease. Onset symptoms were fever (88%), cough (53%), dyspnoea (24%), asthenia (35%), anosmia and/or ageusia (17%), expectoration (12%). Compared to benign conditions, patients with malignancies show a lower lymphocytic count (490 vs 1100 cells/uL) and higher interleukin 6 (33 vs 13 pg/mL). Conclusions immunocompromised patients are at risk of adverse outcome from COVID-19. Hematological malignancies and anti-CD20 therapies induce a high risk. Primary immunodeficiency and classical immunosuppressant such as calcineurin inhibitors and antimetabolites share an intermediate risk.

Temporality is a fundamental dimension of each narrative process of meaning making. In fact, the narration constructs and organizes temporal frames that connect one’s own experiences. From this point of view, oncological illness is experienced as a traumatic experience that interrupts the sense of continuity of one’s own life, resulting in the configuration of different temporal frames, which are not always able to support the processes of elaboration of this experience. The aim of this article is to ex- plore the way the modal verbal predicates (must, can, will, know) are organized and work in relation to the representation of time in narrations of cancer patients. The modal verbal predicates—introducing the meanings of possibility, knowledge, will, desire, duty, need, or ability—allow us to organize the relationship between the subject, action, and context. Six narrations of cancer experience were analyzed—one for each time frame (linear, circular, fragmentary, static, cyclic, and spiral) proposed by Brockmeier (2000)—by means of quali-quantitative analysis of the use of modal verbs. Narrations show specific modal positioning: dispersion, plasticity, focusing, rigidity, and poverty. It is possible organize them along a continuum from plasticity to rigidity. The modal plasticity is the capacity to reconfigure a new temporal relation between subject and context, whereas modal rigidity shows a repetition of a specific and same modality in connecting subject and context. This preliminary research allows us to reflect about some possible clinical implications to support and foster processes of meaning making of cancer conditions.

Asthma is an heterogeneous disease, with many patients experiencing severe disease despite use of recommended therapy. Severe exacerbations may lead to emergency department (ED) visits. Are ED patients always severe asthmatic ones? This is the first European study on characteristics of ED asthmatic patients. It is crucial to correctly phenotype patients to prevent and treat them. We followed up in a pneumology setting, patients discharged from ED the same day or the day after the discharge. 130 patients (F 89) were evaluated as reported in Tab1. All patients had history of frequent severe exacerbations in the last 12 months. We identified 2 different populations come to ED for asthma: a young adult population 40 years, with a late onset asthma (38,4 y), mostly females (F 68/M 28), smokers (63,5%) with comorbidities (GERD and obesity 66,7%), higher eosinophils (313/µl±195). They present an impaired quality of life. Severe Asthma Exacerbations recorded in over40 were compared to under40 (4.1 vs 2.5 p=.0001). SAE were also evaluated according to eosinophils ≥400/µl (4.7 vs 3.3 p=.001). This study suggests that physiopathology and susceptibility to exacerbations vary with age and with eosinophils count. More complete and multicentric studies are needed to phenotype asthmatic patients at risk.

Diagnosis and management of non CF bronchiectasis has been largely empirical and therapies other than antibiotics are subject of relatively few controlled clinical trials.

There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents’ psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.

Background The impact of an onco-haematological illness for children is a traumatic event that opens to pain, hospitalizations and interrupts the continuity of daily life. It is difficult for the child to make meaning, to share the pain or ask a question related to the illness because, often, the parents or doctors cannot find a way to communicate in a suitable way for the child who remains in a situation of ‘unspoken’, where, fear, anxiety and pain cannot find a space to express. Methods The present research-intervention uses the methodology of invented fairy tales in groups with onco-haematological children, in the hospital, in order to explore the organization of the meanings at the base of the tales co-constructed by the participants underlying weaknesses and strengths of the invented fairy tales in groups intervention. The invented fairy tales in groups is used as a tool, such as a play, to express, share and support the experience of the illness of children. Forty-nine children participated to the invented fairy tales in groups in an onco-haematological hospital. Within a quali-quantitative framework we performed a thematic analysis of elementary context, cluster analysis, on the fairy tales considered as a unique narrative corpus of the thought of the group. Results The analysis shows four thematic clusters: fantasy as search for a meaning, 29.71%, the group as a space for illusions, 27.90%, the illness as a family problem, 25.72%, anchoring reality, 16.67%. The results highlighted three main carriers of sense: the representation of illness/the relational world/the representation of the institution. Conclusions The use of invented-fairy-tales groups allowed the onco-haematological children to tell and share the experience of illness through a different way, which let them express symbolically their pain. The invented fairy tale in groups becomes a mediator of psychic processes which offer new solutions while improving interpersonal relationships/communication between the participants in group.

Background: Small airways are considered the major site of airflow limitation in COPD patients. The forced oscillation technique has been successfully used as a measure of the airway resistance heterogeneity and gas trapping. Methods: 40 patients with moderate-to-severe COPD were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 to receive fixed dose once daily Indacaterol/Glycopyrronium (GroupA) and 20 received single Glycopyrronium (Group B). Lung function was measured at baseline and after 6 months. The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20), and lung reactance (X). Results: After the bronchodilator therapy, FEV1 and Inspiratory Capacity increased in both groups (Group A ΔFEV1 = 7,67%; Group B ΔFEV1 = 5,7%; Group A ΔIC = 15,72%; Group B ΔIC = 4,88%). Furthermore, impulse oscillometry detected an improvement in lung function. In Group A, all impulse oscillometry parameters significantly improved at follow-up, with a decrease of 47,8% (p=0,017) in R5, and in R20 =23,7% (p=0,024), in X = 295,23% (p=0,05). In Group B, impulse oscillometry showed a milder decrease in R5 (6,55%), in R20 (13,3%) and in X (267,77%). Conclusions: The new bronchodilators significantly reduce bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long term therapy. This technique should facilitate the early optimization of therapy and a more personalized medicine for COPD patients.

The process of meaning-making of personal experience is realized through the development of borders. They represent dynamic semiotic devices that allow us simultaneous processes of distinction and connection, separation and integration, individuation and belonging. In a semiotic and psychodynamic perspective, the skin is the first and fundamental boundary process that makes possible the development of identity, the intersubjective dimension and sharing within life contexts. The illness appears as a life discontinuity constituting a laceration of personal somatic, psychic, social borders. From this wound, the victim of an illness may find his/herself in a state of liminality. This concept, originally anthropological, is of current interest in the psychological context as the main feature is the feeling of disorientation, isolation, fragmentation, exclusion from the world of others. In clinical terms, the elaboration of the liminal experience can occur through the construction of new border systems that can construct new meaning to the many aspects of life.

Nowadays it is a general opinion that oncological illness leads to a traumatic experience (Burke & Sabiston, 2012; Cordova et al., 2007; Sumalla, Ochoa, & Blanco, 2009; Freda & Martino, 2015). The onset of an oncological illness forces the patient to face a strenuous therapeutic process, which according to the cancer staging and location may require local surgery (operation and radiotherapy) or systemic treatment (chemo and hormone therapy). Cancer is a traumatic experience of specific and peculiar nature, owing to the difficulty of recognizing: a unique stressful event, the internal triggering process, its temporal continuity (hereditary or possible relapse) (Mehnert & Koch, 2007). The psychological trauma, which may occur as a result of such a severely distressing event, in this case the communication of diagnosis (De Luca Picione, Dice, & Freda, 2015), within a socio-constructivist and semiotic perspective (Salvatore & Freda, 2011), is due to: the sudden and unexpected alteration of the basic elements governing the relation between the patient and the external world (Freda, De Luca Picione, & Martino, 2015; Janoff-Bulman, 2004; Joseph & Linley, 2005) and the interruption of the temporal continuity resulting in a crisis of meaning processes that support the personal self-narrative of life (Bonomi, 2003; Brockmeier, 2000; Frank, 1998; Martino, Onorato, & Freda, 2015; Margherita, Troisi, & Nunziante Cesaro, 2014; Neimeyer, 2004, 2006). During the last fifty years, the research activity has had its focus on the pathological outcomes which this traumatic event generates (Joseph & Linley, 2005; Lindstrom & Triplet, 2010; Norris & Sloane, 2007). Only recently, the research moved away from analysing the negative changes placing emphasis on the need of a better understanding of the positive ones. It was realized that such a traumatic experience could also deliver the possibility of improving life, relationships, health and well-being. The possibility that traumatic events may lead to a positive change/transformation has been named "post traumatic growth" (PTG; Calhoun & Tedeschi, 2004, 2006). This construct offers a better comprehension of the consequences of a severely traumatic event, pointing out the positive possible changes, although it is well known that the negative changes must be also taken into account (Hussain & Bhushan, 2013; Janoff-Bulman & Yopyk, 2004; Lindstrom & Triplet, 2010).The positive changes, to which this construct refers, are meant to deal with the three main domains of life: improvements in self, improvements in interpersonal relationships, and enhanced spiritual or religious experiences (Tedeschi & Calhoun, 2004). Until recently, much research has been undertaken by using quantitative methods (Barakat, Alderfer, & Kazak, 2006). A comparison between cancer survivors with a selected sample of healthy people highlights that the former show a general growth against the latter in many aspects (Tomich, Helgeson, & Nowak Vache, 2005). The PTG-process cannot be seen as a natural psychological development. That can only happen in the aftermath of a traumatic event, although it could still fail in case that this traumatic event would not be felt as a traumatic experience (Margherita & Troisi, 2013; Martins da Silva, Moreira, & Canavarro, 2011). The positive changes experienced by the cancer survivors are mainly due to more specific goals in appreciation of life and its priorities, the revaluation of oneself, a new awareness and relationship with the body, and a new spirituality. These changes are: a greater sense of self-efficacy and mastery in difficult situations, a greater appreciation of interpersonal relationships, a new sense of altruism and empathy with people in difficulty, and a reorganization of the time line (Barakat, Alderfer, & Kazak, 2006; Hefferson, Grealy, & Mutrie, 2009; Lindstrom & Triplett, 2010). …

Book of abstracts - XXXVII Congresso Nazionale AIEOP, Bari, 20-22 maggio 2012

Background: Allergen-specific immunotherapy is an effective treatment and improves clinical symptoms of allergic asthma and rhinitis. Aim: To evaluate the response of basophilic activation in patients receiving subcoutaneous(SCIT) and sublingual(SLIT) immunotherapy. Methods: 28 patients (18M/10F; mean age 33.5; range 17- 46 years) with asthma and allergic rhinitis from polysensitisation to perennial allegens(Parietaria, grass pollen, Dermatophagoides) started treatment with allergen-specific immunotherapy(ITS). 23 patient received subcoutaneus therapy with modified allergens (allergoids)(19 for Parietaria, 4 for grass pollen)and 5 patients received SLIT.The SCIT was used before the pollination season.The BAT was performed at start-time, after 1 month, 6 months (during the pollen season) and after 12 months. Results: At T0, the mean levels of basophils activation (CD63+)were elevated(84% ± 10.2 in 19 allergic patients to Parietaria pollens, 64% ± 14.4 in 4 allergic pts to grass pollen, 5 pts 72 % ± 8.9 for DP/DF). At T1, the mean percentage of basophilic degranulation decreased (32% ± 8.2 for Parietaria, p

During pregnancy and the transition toward motherhood, a special time for the restructuring of the female identity and representational world, dreaming may play an important function in the psychic life. If we accept that psychological and psychosocial risk factors influence representation during pregnancy, this article explores, from a psychodynamic perspective, how the presence/absence of biological risk is represented into women’s dream narration. Forty dreams of pregnant women (20 healthy pregnancies/20 at risk) were audio-recorded and transcribed verbatim. We performed a thematic analysis of multiple correspondences to see whether the dreams recounted by the women in the 2 different categories had any specific characteristics. Four thematic clusters resulted, which, after interpretation using factorial mapping, fall into 3 sense vectors: from the unrepresentable to the representable; from dependency to reciprocal relationships; from undifferentiated to different. The work we did enabled us to observe that in healthy pregnancies dreams have a mainly elaborative function, whereas when there are risk factors, it seems to be difficult to construct a psychic representational space.