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.

Skeletal variability of the fibular ends and evolutionary implications

This thesis investigates the morphological variations of fibular extremities in humans and non-human hominids using a 3D Geometric Morphometric approach. The study has three objectives: (1) to assess the shape, form, and size variations of fibular epiphyses within the human species, highlighting sexually dimorphic features; (2) to explore interpopulation variability of fibular extremities from the Upper Paleolithic to the 20th century, comparing subsistence, mobility, and lifestyles; and (3) to examine interspecific variations in fibular ends, testing potential associations with locomotor and positional behavior among extant hominid taxa. In terms of intraspecific variations, sex-related differences in fibular form and size were observed, suggesting distinct functional requirements for the lower limb between sexes. Interpopulation variations revealed a decline in activity level over time, influenced by terrain and footwear use. Hunter-gatherer groups exhibited greater joint mobility, loading, and range of motion compared to sedentary pre- and post-industrial populations. Interspecific variations demonstrated significant morphological differences among hominid taxa, indicating functional implications related to both phylogeny and specific loading patterns on the lower limb. The study identified features indicative of bipedalism in humans, as well as shared characteristics among non-human great apes. Furthermore, distinguishing features were found between Asian and African apes, along with unique morphological signals associated with distinct positional behavior in each hominid taxa. By comprehensively analyzing fibular morphology, this research sheds light on the importance of this bone in knee support, ankle stabilization, and overall locomotor function. The findings contribute to our understanding of the evolutionary and functional aspects of the fibula across human populations and non-human hominids throughout history.