Well-being, distress and health status in a population of adolescent students

The present work explores the psychosocial issues emerging from a large cross-sectional study aimed to assess the prevalence, clinical manifestations, and psychosocial correlates of hyperandrogenism in a population of Italian high school students. Participants were 1804 adolescents, aged between 15 and 19 years, who volunteered to fill in a package of self-report questionnaires (including the Psychosocial Index, the Symptom Questionnaire and Ryff’s Psychological Well-Being scales for the assessment of psychological aspects) and undergo a comprehensive physical examination. Significant gender differences were found with regard to psychological distress, with females reporting higher scores compared with males, but not on well-being dimensions. The relationships of well-being to distress were found to be complex. Although inversely associated, well-being and ill-being appeared to be distinct domains of mental functioning. The evaluation of the moderating effects of well-being in the association between stress and psychological distress indicated that well-being may act as a protective factor, contributing to less pronounced psychological distress as stress levels increased. Higher rates of somatic complaints were found among current smokers. However, substance use (i.e., smoking and drug use) was also found to be positively associated with some well-being dimensions. A considerable number of participants were found to present with disordered eating symptoms, particularly females, and associated higher stress levels and lower quality of life. Sport activities were found to favourably affect psychological health. As to clinical signs of hyperandrogenism, a significant impairment in psychosocial functioning was found among females, whereas no effects on psychological measures could be detected among males. Subgroups of adolescents with distinct clinical and psychological characteristics could be identified by means of cluster analysis. The present study provides new insights into better understanding of the complex relationships between well-being, distress and health status in the adolescent population, with important clinical implications.

The application of a new psychotherapeutic strategy for enhancing eudaimonic well-being in children with mood and anxiety disorders

The aim of the dissertation was to test the feasibility of a new psychotherapeutic protocol for treating children and adolescents with mood and anxiety disorders: Child-Well-Being Therapy (CWBT). It originates from adult Well-Being Therapy protocol (WBT) and represents a conceptual innovation for treating affective disorders. WBT is based on the multidimensional model of well-being postulated by Ryff (eudaimonic perspective), in sequential combination with cognitive-behavioral therapy (CBT). Results showed that eudaimonic well-being was impaired in children with affective disorders in comparison with matched healthy students. A first open investigation aimed at exploring the feasibility of a 8-session CWBT protocol in a group of children with emotional and behavioural disorders has been implemented. Data showed how CWBT resulted associated to symptoms reduction, together with the decrease of externalizing problems, maintained at 1-year follow-up. CWBT triggered also an improvement in psychological well-being as well as an increasing flourishing trajectory over time. Subsequently, a modified and extended version of CWBT (12-sessions) has been developed and then tested in a controlled study with 34 patients (8 to 16 years) affected by mood and anxiety disorders. They were consecutively randomized into 3 different groups: CWBT, CBT, 6-month waiting list (WL). Both treatments resulted effective in decreasing distress and in improving well-being. Moreover, CWBT was associated with higher improvement in anxiety and showed a greater recovery rate (83%) than CBT (54%). Both groups maintained beneficial effects and CWBT group displayed a lower level of distress as well as a higher positive trend in well-being scores over time. Findings need to be interpret with caution, because of study limitations, however important clinical implications emerged. Further investigations should determine whether the sequential integration of well-being and symptom-oriented strategies could play an important role in children and adolescents’ psychotherapeutic options, fostering a successful adaptation to adversities during the growth process.

The role of proactive coping strategies and perceived health status for Social well-being and life-project in old age.

The latter part of the 20th century was a period characterized by a fundamental demographic transition of western society. This substantial and structural demographic change proposes several challenges to contemporary society and fosters the emergence of new issues and challenges. Among these, none is more crucial than the comprehension of the mechanisms and the processes that lead people to positive aging. Rowe and Kahn’s model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Other systemic models of successful aging (Kahana et al., 1996; 2003; Stevernik et al., 2006) emphasize the role of internal and external resources for attaining positive aging. Among these, the proactive coping strategies are indicated as important active strategies for avoiding the depletion of resources, counterbalancing the declines and maintaining social and civic involvement. The study has analyzed the role of proactive coping strategies for two facets of positive aging, the experience of a high social well-being and the presence of personal projects in fundamental life domains. As expected, the proactive coping strategies, referred to as the active management of the environment, the accumulation of resources and the actualization of human potentials are confirmed as positive predictors of high level of social well-being and of many personal projects focused on family, culture, leisure time, civic and social participation. Perceived health status give a significant contribution only to the possession of many personal projects. Gender and level of school education give also a significant contribution to these two dimensions of positive aging, highlighting how positive aging is rooted not only in the possession of personal resources, but also in historical models of education and in positive longitudinal chains related to early development.

Enhancing Workers’ Well-Being. Scientific and social relevance of managing stress in the workplace

Purpose. Despite work-related stress is one of the most studied topic in organizational psychology, many aspects as for example the use of different measures (e.g. subjective and objective, qualitative and quantitative) are still under debate. According to this, in order to enhance knowledge concerning which factors and processes contribute to create healthy workplaces, this thesis is composed by four different studies aiming to understand: a) the role of relevant antecedents (e.g. leadership, job demands, work-family conflict, social support etc.) and outcomes (e.g. workplace phobia, absenteeism etc.) of work-related stress; and b) how to manage psychosocial risk factors in the workplace. The studies. The first study focused on how disagreement between supervisors and their employees on leadership style (transformational and transactional) could affect workers well-being and work team variables. The second and third study used both subjective and objective data in order to increase the quality of the reliability of the results gained. Particularly, the second study focused on job demand and its relationship with objective sickness leave. Findings showed that despite there is no direct relationship between these two variables, job demand affects work-family conflict, which in turn affect exhaustion, which leads to absenteeism. The third study analysed the role of a new concept never studied before in organizational settings (workplace phobia), as a health outcome in the JD-R model, demonstrating also its relationship with absenteeism. The last study highlighted the added value of using the mixed methods research approach in order to detect and analyse context-specific job demands which could affects workers’ health. Conclusion. The findings of this thesis answered both to open questions in the scientific literature and to the social request of managing psychosocial risk factors in the workplace in order to enhance workers well-being.

Pet food: quality and quality improvement

Today’s pet food industry is growing rapidly, with pet owners demanding high-quality diets for their pets. The primary role of diet is to provide enough nutrients to meet metabolic requirements, while giving the consumer a feeling of well-being. Diet nutrient composition and digestibility are of crucial importance for health and well being of animals. A recent strategy to improve the quality of food is the use of “nutraceuticals” or “Functional foods”. At the moment, probiotics and prebiotics are among the most studied and frequently used functional food compounds in pet foods. The present thesis reported results from three different studies. The first study aimed to develop a simple laboratory method to predict pet foods digestibility. The developed method was based on the two-step multi-enzymatic incubation assay described by Vervaeke et al. (1989), with some modification in order to better represent the digestive physiology of dogs. A trial was then conducted to compare in vivo digestibility of pet-foods and in vitro digestibility using the newly developed method. Correlation coefficients showed a close correlation between digestibility data of total dry matter and crude protein obtained with in vivo and in vitro methods (0.9976 and 0.9957, respectively). Ether extract presented a lower correlation coefficient, although close to 1 (0.9098). Based on the present results, the new method could be considered as an alternative system of evaluation of dog foods digestibility, reducing the need for using experimental animals in digestibility trials. The second parte of the study aimed to isolate from dog faeces a Lactobacillus strain capable of exert a probiotic effect on dog intestinal microflora. A L. animalis strain was isolated from the faeces of 17 adult healthy dogs..The isolated strain was first studied in vitro when it was added to a canine faecal inoculum (at a final concentration of 6 Log CFU/mL) that was incubated in anaerobic serum bottles and syringes which simulated the large intestine of dogs. Samples of fermentation fluid were collected at 0, 4, 8, and 24 hours for analysis (ammonia, SCFA, pH, lactobacilli, enterococci, coliforms, clostridia). Consequently, the L. animalis strain was fed to nine dogs having lactobacilli counts lower than 4.5 Log CFU per g of faeces. The study indicated that the L animalis strain was able to survive gastrointestinal passage and transitorily colonize the dog intestine. Both in vitro and in vivo results showed that the L. animalis strain positively influenced composition and metabolism of the intestinal microflora of dogs. The third trail investigated in vitro the effects of several non-digestible oligosaccharides (NDO) on dog intestinal microflora composition and metabolism. Substrates were fermented using a canine faecal inoculum that was incubated in anaerobic serum bottles and syringes. Substrates were added at the final concentration of 1g/L (inulin, FOS, pectin, lactitol, gluconic acid) or 4g/L (chicory). Samples of fermentation fluid were collected at 0, 6, and 24 hours for analysis (ammonia, SCFA, pH, lactobacilli, enterococci, coliforms). Gas production was measured throughout the 24 h of the study. Among the tested NDO lactitol showed the best prebiotic properties. In fact, it reduced coliforms and increased lactobacilli counts, enhanced microbial fermentation and promoted the production of SCFA while decreasing BCFA. All the substrates that were investigated showed one or more positive effects on dog faecal microflora metabolism or composition. Further studies (in particular in vivo studies with dogs) will be needed to confirm the prebiotic properties of lactitol and evaluate its optimal level of inclusion in the diet.

The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Psychobiological correlates of allostatic load

Introduction: The term Clinimetric was introduced by Feinstein in 1982, who first noticed that despite all the improvements in the assessment methods, a number of clinical phenomena were still unconsidered during the evaluation process. Yet today clinical phenomena, such as stress, relevant in diseases progression and course, are not completely evaluated. Only recently, according to the clinimetric approach, Fava and colleagues have introduced specific criteria for evaluating the allostatic overload in clinical setting. Methods: Participants were 240 blood donors recruited from May 2007 to December 2009 in 4 different blood Centers (AVIS) in Italy. Blood samples from each participant were collected for laboratory test the same day the self-rating instruments were administered (Psychosocial Index, Symptom Questionnaire, Psychological well-being scales, Temperament and Character inventory, Self-Report Altruism scale). The study explore different aspects describing sample characteristics and correlates of stress in the total sample (part I), new selection criteria applied to existing instruments to identify individuals reporting allostatic load (part II), and differences on biological correlates between subjects with vs without AL. Results: Significant differences according to gender and past illnesses have been found in different dimensions of well-being and distress. Further, distress was explained for more than 60% by 4 main factors such as anxiety, somatic symptoms, environmental mastery and persistence. According to the new criteria, 98 donors reported AL. Allostatic load individuals reported to engage in less altruistic behaviours. Also they differ in personality traits and characters from controls. In the last part, results showed significant differences among donors according to allostatic load on diverse biological parameters (RBC, MCV, immune essay). Conclusion: This study presents obvious limitations due to its preliminary nature. Further research are need to confirm that these new criteria may lead to identify high risk individuals reporting not only stressful situations but also vulnerabilities.

Poverty and Mental Health. Tangible and Intangible Aspects of Microcredit

Microcredit, a small lending system, invests on an individual's creativity by stimulating the development of their own potential. This process leads to the attainment of various objectives which in turn allow individuals to develop their skill awareness. Consequently, this process also increases an individual’s self-esteem and self-confidence. These factors play an important role in the aetiology of a number of mental disorders. Namely, those characterized by a series of psychological conditions which impede the full development of a person’s personal, relational and social sphere. Furthermore, since Microcredit is thought to produce tangible goods, such as income, and intangible goods, such as self-esteem and mutual trust, it could also represent an innovative socio-economic tool. We therefore also hypothesize that, Microcredit would be valuable in maximizing abilities/skills in those subjects who are financially excluded and rarely perceived as a ‘resource’ for the Community The longitudinal study set the impact of the Grameen Bank microcredit program on new borrowers women from Noakhali District at the south Bangladesh. The impact evaluation assessment has been structured to detect individual, family and social changes. Manova Analysis allowed distinguishing from women with positive or negative outcomes related to the loan performance. Data revealed consistent differences in terms of economical outcomes and psychological well being amongst the groups of subject analyzed. The data gathered in relation to the changes arisen in the individuals should be looked into through future, continuous and systematic, monitoring.

The impact of cardiac rehabilitation on lifestyles, psychological correlates and the clinical course of cardiac disease

Objectives: The aim of this research was to evaluate the impact of Cardiac Rehabilitation (CR) on risky lifestyles, quality of life, psychopathology, psychological distress and well-being, considering the potential moderating role of depression, anxiety and psychosomatic syndromes on lifestyles modification. The influence of CR on cardiac morbidity and mortality was also evaluated. Methods: The experimental group (N=108), undergoing CR, was compared to a control group (N=85) of patients affected by cardiovascular diseases, not undergoing CR, at baseline and at 1-month, 6- and 12-months follow-ups. The assessment included: the Structured Clinical Interview for DSM-IV, the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), GOSPEL questionnaire on lifestyles, Pittsburgh Sleep Quality Index, Morisky Medication Adherence Scale, MOS 36-Item Short Form Health Survey, Symptom Questionnaire, Psychological Well-Being Scale and 14-items Type D Scale. Results: Compared to the control group, CR was associated to: maintenance of the level of physical activity, improvement of correct dietary behaviors and stress management, enhancement of quality of life and sleep; reduction of the most frequently observed psychiatric diagnoses and psychosomatic syndromes at baseline. On the contrary, CR was not found to be associated with: healthy dietary habits, weight loss and improvement on medications adherence. In addition, there were no relevant effects on sub-clinical psychological distress and well-being, except for personal growth and purpose in life (PWB). Also, CR did not seem to play a protective role against cardiac recurrences. The presence of psychosomatic syndromes and depressive disorders was a mediating factor on the modification of specific lifestyles. Conclusions: The findings highlight the need of a psychosomatic assessment and an evaluation of psychological sub-clinical symptomatology in cardiac rehabilitation, in order to identify and address specific factors potentially associated with the clinical course of the heart disease.

Inserimento eterofamigliare supportato di adulti sofferenti di disturbi psichici: Valutazione degli esiti

L’Inserimento Eterofamigliare Supportato di Adulti (IESA) sofferenti di disturbi psichici consiste nell’accogliere persone in cura presso i servizi psichiatrici territoriali, nel proprio domicilio, integrandole nelle proprie relazioni famigliari. Obiettivo è migliorare la qualità di vita dell’utente e favorirne l’integrazione nella comunità. Obiettivo. Valutare gli esiti dello IESA, con un disegno di ricerca longitudinale, considerando: psicopatologia, benessere psicologico, funzionamento sociale e familiare. Metodologia. 40 soggetti: 20 pazienti e 20 ospitanti. La valutazione clinica è stata effettuata all’inizio della convivenza e al follow-up di 1, 3, 6 e 12 mesi. Strumenti utilizzati: BPRS, VGF, PWB, SQ, FAD. Analisi statistica: Modello Lineare Generale (GLM) con l’Analisi della Varianza per prove ripetute e calcolo dell’effect-size. Risultati. 15 pazienti maschi e 5 femmine, 17 italiani. 11 soddisfano i criteri diagnostici (DSM-IV-TR) per schizofrenia e disturbi psicotici, 5 per i disturbi dell’umore e 4 per i disturbi di personalità. Dopo l’inserimento 3 sono stati i ricoveri e 4 le visite psichiatriche urgenti. 8 pazienti modificano/diminuiscono la terapia e 3 la sospendono. Aumenta il benessere psicologico (PWB); diminuiscono i sintomi psicopatologici (BPRS ed SQ) e migliora il funzionamento globale (VFG). Il gruppo dei famigliari composto da 11 uomini e 9 donne, 19 di nazionalità italiana; con età media di 55 anni. 8 sono coniugati, 6 celibi/nubili, 4 divorziati e 2 vedovi. 9 hanno figli, 11 lavorano e 8 sono pensionati. Nei famigliari aumenta il benessere psicologico (PWB), migliora il funzionamento famigliare (FAD) e la valutazione del funzionamento globale (VGF) rimane costante nel tempo. Discussioni e conclusioni. Il progetto IESA sembra migliorare la psicopatologia, con una diminuzione dei comportamenti maladattativi e un aumento delle capacità relazionali dell’ospite favorendone l’integrazione. Inoltre, lo IESA sembra diminuire i costi della cronicità psichiatrica: diminuzione degli accessi al Pronto Soccorso, delle visite psichiatriche urgenti e delle giornate di ricovero.

Dal Bes ad Urbes: I piani di performance e di trasparenza nelle citta'

Obiettivo del lavoro è quello di legare tra di loro due aspetti che storicamente sono sempre stati scollegati. Il primo è il lungo dibattito sul tema “oltre il PIL”, che prosegue ininterrottamente da circa mezzo secolo. Il secondo riguarda l’utilizzo dei sistemi di misurazione e valutazione della performance nel settore pubblico italiano. Si illustra l’evoluzione del dibattito sul PIL facendo un excursus storico del pensiero critico che si è sviluppato nel corso di circa cinquanta anni analizzando le ragioni assunte dagli studiosi per confutare l’utilizzo del PIL quale misura universale del benessere. Cogliendo questa suggestione l’Istat, in collaborazione con il CNEL, ha avviato un progetto per individuare nuovi indicatori da affiancare al PIL, in grado di misurare il livello non solo della crescita economica, ma anche del benessere sociale e sostenibile, con l’analisi degli indicatori riferiti a 12 domini di benessere individuati. Al progetto Istat-CNEL si è affiancato il progetto UrBES, promosso dall’Istat e dal Coordinamento dei sindaci metropolitani dell’ANCI, che hanno costituito una rete di città metropolitane per sperimentare la misurazione e il confronto sulla base di indicatori di benessere urbano equo e sostenibile, facendo proprio un progetto del Comune di Bologna e di Laboratorio Urbano (Centro di documentazione, ricerca e proposta sulle città), che ha sottoposto a differenti target un questionario on line, i cui risultati, con riferimento alle risposte fornite alle domande aperte, sono stati elaborati attraverso l’utilizzo di Taltac, un software per l’analisi dei testi, al fine di individuare i “profili” dei rispondenti, associando i risultati dell’elaborazione alle variabili strutturali del questionario. Nell’ultima parte i servizi e progetti erogati dal comune di Bologna sono stati associati alle dimensioni UrBES, per valutare l’impatto delle politiche pubbliche sulla qualità della vita e sul benessere dei cittadini, indicando le criticità legate alla mancanza di dati adeguati.