An explanatory case report about critical differences of ‘inability to work’ in Italian welfare and social security systems
Michele Sammicheli, Marcella Scaglione
Published Online: January 8, 2019
In Italy, there is a different status of ‘inability to work’ in civil invalidity and INPS social security insurance systems. These differences and overlaps cause some concerns. We show a case report of a 55-year-old woman with a recent left radical mastectomy and ipsilateral lymphadenectomy, for infiltrating ductal and lobular carcinoma. The woman, showing no radiological evidence of metastases, was undergoing chemotherapy with taxanes and cisplatin. The patient reported no significant osteo-articular functional limitations, with the exception of a reduction in left shoulder movements at extreme degrees in a right-handed person, due to the recent mastectomy and complained nausea and vomiting due to chemotherapy. The civil invalidity committee assessed her as being disabled, with a total and permanent incapacity for work as 100%, whereas the INPS Medical Legal Department (C.M.L.) recognised her as disabled in employments suitable for her capabilities (article 1 of Law no 222/1984), but not incapable of carrying out any works (article 2 of Law no 222/1984). Progress in medicine and workplace adjustments may enable employees with disabilities to come back work. Therefore, knowledge of these differences and overlaps and the role of legal practitioners and policymakers could be decisive resulting in a source of savings for the Italian welfare system.
Tarred with the same brush: An initial Inquiry into Courtesy Stigma and Problem Gambling
Matthew D. Sanscartier, Jason D. Edgerton, Derek Chadee, Lance W. Roberts
Published Online: January 8, 2019
Introduction: This study explores the relative intensity of courtesy stigma around problem gambling to other stigmatized conditions, and the ways in which courtesy stigma (or fear thereof) impacts problem gambling.
Method: We draw on data from a government-commissioned national survey in a southern Caribbean country (n = 1,008). Comparative t-tests and multiple regression (ordinary least squares) were used to identify relative intensity and what impacts courtesy stigma of problem gambling, respectively. Statistical significance was set up at P < 0.05.
Results: Problem gambling by a family member elicits more shame/embarrassment (M = 1.75) than using a wheelchair (M = 1.15) and having a mental illness (M = 1.22), but less shame than having a drug problem (M = 2.12) and on par with having an alcohol problem (M = 1.79, ns). With respect to courtesy stigma around problem gambling, the extents to which one considers various activities ‘gambling’ (b = -0.031, B = -0.068), one gambles him or herself (b = -0.015, B = -0.127), and the quality of experience with gambling (i.e. positive/negative; b = -0.038 B = -0.095) impacts potential embarrassment of a family member with a gambling problem. Catholics (b = 0.357, B = 0.355) and Hindus (b = 0.378, B = 0.376) were more likely to be embarrassed or ashamed than Anglicans, Muslims, Protestants, and other religions. Additionally, the unemployed (b = 0.282, B = 0.150) and the self-employed (b = 0.292, B = 0.290) were more likely to be embarrassed of a family member with a gambling problem.
Discussion and conclusions: Normalization of gambling in the family impacts how much shame or embarrassment one feels about their problem-gambling family member. Moreover, some religions (Catholic and Hindu) and economic positioning (unemployed and self-employed) may affect embarrassment or shame of problem gambling family members.
A systematic review of Randomized Controlled Trials about some non-pharmacological interventions for treatment of hypertension: Physical exercise, sodium restriction, weight and alcohol use reduction
Amobi Akonobi, Jawad Khan
Published Online: January 10, 2019
Introduction: Aim of this study was to systematically review available evidence to analyse how effective are some non-pharmacological interventions such as physical exercise, sodium restriction, weight reduction and alcohol reduction in the management of hypertension and to study which of them produce the greatest reduction in blood pressure.
Method: A systematic literature search was carried out on Pubmed, Medline, EBSCO and EMBASE, by using several key terms and following the PRISMA statement. Original papers and randomized clinical trials, published in English between 1988 and 2010 and regarding hypertensive individuals as participants were included. The narrative synthesis system of analysis was used and the Revman 5.0 software was used to carry out heterogeneity analysis.
Results: A total of 51 RCT on salt restriction (n = 11, 22%), weight loss (n = 6, 12%), alcohol reduction (n = 7, 14%), physical exercise (n = 15, 29%), or a combination of these intervention modalities (n = 12, 23%) were included in our review. 94% of them reported a significant improvement on blood pressure following these interventions, whereas 6% of them reported a statistically non-significant improvement. None of the papers reported a post-intervention deterioration. Salt restriction was found to give the greatest reduction in blood pressure. However, significant heterogeneity exists among the results of the papers reviewed in our study.
Discussion and Conclusions: Our findings confirm that physical exercise, sodium restriction, weight and alcohol use reduction are four non-pharmacological interventions effective in the control of hypertension. As they involve lifestyle modification, policy interventions for primary prevention are recommended in this area.
Emotion dysregulation and loneliness as predictors of food addiction
Eirini Tatsi, Atiya Kamal, Alistar Turvill, Regina Holler
Published Online: January 10, 2019
Introduction: This study aimed to investigate whether multiple aspects of emotion dysregulation contribute to the etiology of Food Addiction (FA); as well as to provide further evidence and clarity regarding the role of loneliness on the development of addictive behaviour towards food.
Methods: A correlational study was employed to assess associations within 162 participants which were recruited via online forums on FA and student population. The Yale Food Addiction Scale (YFAS), Difficulties in Emotion Regulation Scale (DERS), and UCLA Loneliness Scale, and a demographic and personal information questionnaire were all completed online. A Poisson regression analysis was carried out and statistical significance was set at P <0.05.
Results: 79% of the sample endorsed a persistent desire or repeated, unsuccessful attempts to cut down or control their use of highly processed foods, while 21% met diagnostic criteria for food addiction. Poisson regression analysis demonstrated that the model predicts food addiction (P <0.001). Specifically, food addiction symptom count was positively predicted by difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness and limited access to emotion regulation strategies (P <0.05); DERS total, nonacceptance of emotional responses and lack of emotional clarity were not significant predictors. Loneliness positively predicted food addiction (P =0.002).
Discussion and Conclusions: The findings of this research provide further evidence on the etiology of food addiction, as multiple aspects of emotion dysregulation, including difficulty in engaging in goal-directed behaviour, impulsiveness, emotional awareness and limited access to emotion regulation strategies, and loneliness were found to influence the development of an addictive behaviour towards certain types of food. Future research will need to understand possible causality between these factors and insights into the potential role addictive behaviour of food has in overeating phenomena, such as binge-eating.
A case of silent myocardial ischemia associated with severe and prolonged hypoglycemia
Antonio Villa, Donata Saltafossi, Annalisa Re, Silvia Garavaglia
Published Online: January 10, 2019
The scientific literature on treatment options and complications following large insulin overdoses is limited to case reports and few retrospective, epidemiological reports providing limited clinical insights. The effect of hypoglycemia on the heart is uncertain. There are two main factors that are commonly associated with electrocardiographic changes during hypoglycemia, of which the first is linked to the rapid decrease in blood glucose levels, and the other to the decrease in potassium serum levels.
We report a case of severe and prolonged hypoglycemia due to deliberate misuse of long-acting insulin associated with transient electrocardiographic ischemic changes without symptoms of myocardial ischemia. We diagnosed and treated this patient as a case of silent cardiac ischemia.
Hypoglycemia is a common event in patients affected by insulin dependent diabetes mellitus. The emergency physicians should be aware of aspecific or ischemic ECG alterations associated with severe hypoglycemia. As shown in this case report, ECG monitoring is crucial for early detection of ischemic electrocardiographic changes suggestive of myocardial ischemia in diabetic patients.
Relationship between social media use and disordered eating behavior among female university students in Qatar
Yara Qutteina, Catherine Nasrallah, Linda Kimmel, Salma M. Khaled
Published Online: January 18, 2019
Introduction: Abundant literature has established the negative impact of traditional media on body image and disordered eating behaviors among young women. In the past few years, social media use has soared especially among youth, yet the influence of social media in relation to disordered eating has not been fully explored. The aim of this study was to assess the relationship between social media use and disordered eating outcomes among young Arab women.
Methods: A cross-sectional study was carried out using a probability sample of 1,418 undergraduate female students living in Qatar, a rapidly developing nation in the Middle East. Popular social media platforms were assessed including Instagram, Snapchat, Facebook, and Twitter. Other covariates assessed included body image, body mass index, and socioeconomic status. To assess the multivariate association between social media (main predictor or exposure variable), and disordered eating as measured by three levels of the 26-item Eating Attitudes Test (EAT-26) (dependent variable), stepwise backward ordinal regression models were fit to the data. Data analysis was performed using Stata 14 software.
Results: Findings confirmed that intensive use of social media, particularly Instagram, was positively associated with increased disordered eating behaviors among young women. Social media use intensity showed a significant association with increased disordered eating [(OR 1.207, SE (0.075), P < 0.01, 95% Confidential Interval [CI] 1.068 to 1.363)]. Among the four social media platforms measured, Instagram use had a significant association with disordered eating [OR 1.387, SE (0.186), P < 0.05, 95% CI 1.107 to 1.804)].
Discussion and Conclusions: This study highlights the significant role of social media on the behavior of young women, and supports the sociocultural theory linking media to disordered eating. Such an understanding of social media’s role is instrumental for the promotion and prevention of disordered eating among young women.
Understanding emotional issues of clients approaching to nutrition counseling: A qualitative, exploratory study in Italy
Angelo R Pennella, Cristina Rubano
Published Online: January 18, 2019
Introduction: This study aimed to explore how stressful file events and clients’ emotional feelings may affect their approach towards diet intervention, the client-nutritionist relationship, and dietary outcomes.
Methods: Semi-structured interviews were administered to a purposive sample of clients (n = 15; F = 15) and nutritionist/dietitians (n = 14; M = 2, F = 12). All interviews were conducted using an ad hoc track, and the analysis of transcripts was referenced to the Grounded Theory (GT) and to its qualitative analysis methodology.
Results: Our findings showed all clients experienced stressful life events and used food as emotional crutch, albeit with three levels of emotional self-awareness: 1) Clients with poor level of emotional self-awareness, emotionally vulnerable, who were diagnosed as ‘emotional eaters’. In this case, the paternalist model in the therapeutic interpersonal relationship between client and nutritionists was prevalent; 2) ‘emotional eaters’ who were partially aware of their disorder and sough emotional support from nutritionist. In this case, the client-nutritionist relationship was more balanced; 3) no ‘emotional eaters’ clients, who well-recognized the risk of ‘emotional eating’ as a maladaptive strategy used to cope with emotionally negative life events and in turn were able to use adaptive coping strategies. In this case, the patient-centred approach in the client-nutritionist relationship was dominant. Conversely, nutritionists all understood that emotional feelings of their clients may impact on the effectiveness of diet and client-nutritionist relationship. Despite this, they all followed the biomedical approach to some degree, yet emphasizing the need to acquire new and more relevant competences in this area, as well as the importance of cooperation between nutritionists and psychologists.
Discussion and Conclusions: Having an holistic approach in order to meet the emotional needs of clients may enable nutritionists and dietitians to improve dietary outcomes through a more active, autonomous and patient-centred role for the client. Therefore, nutritionists and dietitians should acquire specific psychological skills and work together with psychologists for an integrative and interdisciplinary approach in the nutrition counselling.
Initiation and sustenance of small portion size consumption behavior in rural Appalachia, USA: Application of multi-theory model (MTM)
Ram Lakhan, Sierra Turner, Sangayal Dorjee, Manoj Sharma
Published Online: January 28, 2019
Introduction: About 81% counties of the central Appalachia in USA are experiencing the nation’s highest obesity rates. It is generally accepted that the consumption of large food portion sizes is associated with obesity which in turn is related to the etiopathogenesis of several chronic diseases. Developing consumption of small portion size behavior can address obesity and related consequences. This study aimed to assess the likelihood of initiation and sustenance of small portion size consumption behavior based on application of multi-theory model (MTM) among residents from rural Appalachia.
Methods: The study utilized a cross-sectional research design (n = 156). A previously validated Multi-theory Model for Small Portion Size (MTM-SPS) questionnaire with acceptable reliability and validity for food portion size consumption behavior was adapted and used for data collection. Six counties of the rural Appalachian region of Kentucky defined as distressed, at risk, and transitional on socio-economic indicators by the Appalachians Research Commission (ARC) were selected for data collection. Stepwise multiple regression modeling was applied to predict the likelihood of initiation and sustenance of small portion size consumption behavior.
Results: Stepwise multiple regression demonstrated that initiation of small portion size consumption was explained by participatory dialogue (advantages outweighing disadvantages), behavioral confidence, and changes in physical environment (R2 = 47.9%, P < 0.001) and continuation of behavior by emotional transformation and practices for change (R2 = 40.2%, P < 0.001). Sociodemographic factors including age, gender, education, and ethnicity did not significantly contribute towards initiation and sustenance of small portion size consumption behavior in rural Appalachia (P > 0.05).
Conclusion: The MTM was found to be a useful theoretical framework that has the ability to predict initiation and sustenance of small portion size consumption. Findings of this study can be considered for designing an appropriate intervention in rural Appalachia.
Health effects of the National Health Insurance Scheme (NHIS): A study among federal civil servants in Bayelsa State, Nigeria
Endurance Uzobo, Aboluwaji D Ayinmoro
Published Online: January 29, 2019
Introduction: This study aimed to analyze the level of satisfaction and health effects of the National Health Insurance Scheme (NHIS) among federal civil servants employed in Bayelsa State, Southern Nigeria.
Methods: A cross-sectional survey was adopted using simple random sampling to recruit 337 federal employees living in the state. A structured questionnaire was used as data collection instrument to elicit socio-demographic information and types of services enjoyed under the scheme by the participants. Satisfaction levels and self-rated health were measured as continuous variables. Data was analysed using analysis of variance (ANOVA), multiple linear regression, and χ2 statistics. The level of statistical significance was set up at P < 0.05.
Results: Satisfaction levels and self-rated health differed significantly by demographic variables and types of services enjoyed by the participants (P < 0.05). Our findings showed that malaria treatment (β = 0.737, P < 0.05), prescriptions of drugs (β = 0.187, P < 0.05) and vaccinations (β = 0.422, P < 0.05) were good predictors of satisfaction levels and self-rated health status. Malaria treatment had the highest satisfaction level (β = 0.737, P < 0.05) compared to other services enjoyed under the scheme.
Discussion and Conclusion: In spite of the fact that most of the services under the scheme were associated with good self-reported health status and high satisfaction level by the participants, there are still some issues concerning supply of drugs and health facilities for federal employees living in Bayelsa State. The government and key stakeholders should ensure that NHIS provide adequate provisions of drugs, skilled health professionals and equipped healthcare facilities, as proper referral systems could mitigate the effects of health conditions affecting federal civil servants and promote the quality of health-care system.
Key health impacts and support systems for informal carers in the UK: A thematic review
Susanna Abraham Cottagiri, Peter Sykes
Published Online: January 29, 2019
Introduction: The economic contributions made by informal carers in the UK per year mount up to £132 billion. This is equivalent to the total amount of the health care costs, yet the health and wellbeing of carers are often not prioritised. This review paper aims to determine the key health impacts of informal caregiving and evaluate support/control methods in the UK.
Methods: This thematic review was conducted in accordance with an adapted version of the PRISMA guidelines for systematic reviews. Of the 6,482 articles identified through Pubmed/Medline, CINAHL, SpringerLink, Summon, and grey literature, 38 studies were included in the review.
Results: The key health impacts of being an informal carer were identified as musculoskeletal disorders and psychological issues (such as depression, stress and anxiety), which were categorized as ‘high-risk impact’ areas. The review further identified cardiovascular disease and early mortality as ‘low to moderate risk impact’ areas and a thematic area that revolves around positive impacts on health of informal carers. Financial help, proper respite care, availability and accessibility of information and advice, provision of equipment in a timely manner and adequate support networks were found to be key factors useful in minimising musculoskeletal and psychological disorders.
Discussion and Conclusions: There is a need for policy makers and program implementers to recognize and accommodate the ever-changing role of carers on different stages of caring. There is also a need to review key health policy documents to include informal carers’ needs and improve support systems available. The lack of evidence-based research on the psycho-physical impacts of caring and the lack of evaluation of services that impact the health of carers also needs to be addressed with priority.
Role of epigenetics in aetiology and therapies for Type 1 Diabetes Mellitus: A narrative review
Yahaya O. Tajudeen, Ufuoma B. Shemishere
Published Online: January 29, 2019
Introduction: Some studies have demonstrated the possibility of using epigenetic modifications to manage or treat some cases of Type 1 diabetes mellitus (T1DM) in the near future. However, there are diverse opinions on the strategies suggested, necessitating this study to review epigenetic mechanisms and their possible therapeutic applications for T1DM.
Results and Discussion: Through enzyme-mediated DNA methylation, histone post-transcriptional modifications and microRNAs (miRNAs) gene expression, environmental factors may program the epigenomes of several cells during intrauterine life. In the β-cells, these biological processes may lead to altered expressions of certain insulin genes along with their promoter regions, resulting in dysfunctional insulin biosynthesis, hyperglycemia and T1DM. By inhibiting the enzymes modulating these pathways, epigenetic changes can be reversed and normal functions of the affected genes restored, culminating in improved insulin production.
Conclusions: Epigenetic programming during intrauterine life may be responsible for the pathogenesis of some cases of T1DM. Fortunately, epigenetic mechanisms are reversible, so when detected early, could be used to prevent some cases of T1DM. It can also be used to formulate treatment procedures for T1DM.