Un “selfie” in dialisi: valutazione delle abitudini personali degli infermieri di un centro dialisi

Introduction: Healthcare workers represent a population that is well analysed by health studies: since 1976, the Nurses’ Health Study has been examining American nurses for health-related risks and is currently recruiting its third cohort. The survey models used are predominantly biomedical, i.e. based on the disease-healing scheme which focuses on purely biological factors with little or no assessment of psychological, behavioural and environmental aspects. The biopsychosocial assessment model, in its multifaceted nature, is probably more suitable for assessing occupational distress as a progressive cause of health worker burnout. It attributes the outcome of illness, as well as that of health, to the numerous, complex interactions of biological, psychological and social factors. In this work, we decided to evaluate the lifestyle and habits of a homogeneous population of nurses, all belonging to an Operative Unit of Nephrology (Pistoia). Methods: We decided to use unconventional instruments: a “selfie” questionnaire on habits, constructed with scientifically validated items, aimed at the self-assessment of habits, scientifically recognised as determinants of health (nutritional, behavioural, relational, physiological...), correlating it with the analysis of the receipts of the weekly shopping of the family unit of the nurse in the study, according to the principle that “we eat what we buy”. Results and conclusion: Nurses evaluated in the study showed a frequent unhealthy lifestyle which can have negative effects on their health, on their family and, consequently, on their work environment. Questionnaire and focus group discussions were appreciated and potentially useful and effective in changing bad habits.

Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More?

Background Firearm injuries are the second leading cause of death among youth in the United States. Nonfatal firearm injuries far outnumber fatalities, yet data detailing the recovery and post-injury needs of pediatric patients after hospital discharge are limited. This study evaluated health system support of pediatric patients after firearm injury, from acute hospitalization to outpatient follow-up. Methods We conducted a retrospective chart review of patients <18 years who presented to an urban level 1 trauma center between 2014 and 2019. Cases were categorized as accidental or intentional (stratified as assault-related or “crossfire” injuries). Outcomes included biopsychosocial assessment (BA) utilization, trauma psychology service consultation, and linkage to outpatient services. Results Among 115 patients, 94% were victims of community violence. Black (50%) and Latinx (44%) patients were disproportionately affected, as were males aged 15-16 years (71%). Overall mortality was 8%. Biopsychosocial assessment and trauma psychology consultations occurred in 43% and 20% of cases, respectively. Of eligible patients, 71% received referral to post-hospitalization support services. The most commonly identified needs were counseling, gang intervention, and help with the carceral system. Conclusion Health systems should support long-term recovery of pediatric patients after firearm injury, particularly addressing social and structural determinants of health. Inpatient-to-outpatient linkages should be strengthened, and prospective follow-up is needed.

Somatosensory Testing in Pediatric Patients with Chronic Pain: An Exploration of Clinical Utility

We aimed to evaluate the utility of clinical somatosensory testing (SST), an office adaptation of laboratory quantitative sensory testing, in a biopsychosocial assessment of a pediatric chronic somatic pain sample (N = 98, 65 females, 7–18 years). Stimulus–response tests were applied at pain regions and intra-subject control sites to cutaneous stimuli (simple and dynamic touch, punctate pressure and cool) and deep pressure stimuli (using a handheld pressure algometer, and, in a subset, manually inflated cuff). Validated psychological, pain-related and functional measures were administered. Cutaneous allodynia, usually regional, was elicited by at least one stimulus in 81% of cases, most frequently by punctate pressure. Central sensitization, using a composite measure of deep pressure pain threshold and temporal summation of pain, was implied in the majority (59.2%) and associated with worse sleep impairment and psychological functioning. In regression analyses, depressive symptoms were the only significant predictor of pain intensity. Functional interference was statistically predicted by deep pressure pain threshold and depressive symptoms. Manually inflated cuff algometry had comparable sensitivity to handheld pressure algometry for deep pressure pain threshold but not temporal summation of pain. SST complemented standard biopsychosocial assessment of pediatric chronic pain; use of SST may facilitate the understanding of disordered neurobiology.

Psychological Treatment of Individual Sexual Dysfunction

Cancer patients struggle with sexual problems after cancer treatment. They often discover the sexual side effects after treatment and must learn how to manage their bodies, which now function differently, and work to continue to be sexually active with their partners. Recovering confidence in their ability to function in their sexual relationships means that they must grieve for their sexual losses, understand their new sensitivities, manage altered body capacities, and develop an expanded sexual repertoire. In their relationships, they must learn to communicate about their needs. If they are single, anxiety about starting a new relationship must be managed through the development of confidence that they can still be good lovers despite their altered sexual function. A thorough biopsychosocial assessment helps identify physical changes, psychological vulnerabilities, and relationship areas that will have to be addressed to maintain sexual viability and satisfaction. Psychosocial as well as biomedical interventions are needed in guiding patients toward recovering an ability to function well sexually. Reliance on multiple relevant disciplines and addressing couple issues can lead to patients’ renewed confidence and satisfactory functioning in their intimate relationships after cancer treatment.