Attachment styles as predictors of self-reported empathy in medical students during pre-clinical years

OBJECTIVE

To assess medical students' attachment profile and to explore its relationship with empathy dimensions.

METHODS

Three cohorts of medical students were consecutively enrolled in the study at the beginning of their second year, before their clinical internship experience, and assessed using the Attachment Style Questionnaire (a self-report measure of attachment styles) and the Interpersonal Reactivity Index (a self-report measure of empathy). t-test, partial correlations, and multiple linear regression models were used to analyze relationships between attachment styles and gender, age, and empathy dimensions.

RESULTS

A total of 361 out of 450 (80.2%) Italian second-year medical students participated in the study. Female students considered interpersonal relationships more important and showed a higher need for approval than did their male counterparts. Among the attachment styles, considering relationships as secondary to achievement was the most important significant predictor of both emotional and cognitive empathy variables.

CONCLUSIONS

This study shows that the attachment styles of medical students are related to self-evaluated empathy, over and above the effects of gender and age differences.

PRACTICE IMPLICATIONS

The Attachment Style Questionnaire may be a useful tool for medical educators to identify medical students with low empathy scores during their pre-clinical years of study.

Evaluation of the impact of early childhood caries, traumatic dental injury, and malocclusion on oral health-Related quality of life for Turkish preschool children and families

Aim

The aim of this study was to assess the impact of the presence of early childhood caries (ECC), traumatic dental injury (TDI), and malocclusion, as well as severe conditions, on the oral health-related quality of life (OHRQoL) of preschool children and families.

Materials and Methods

A cross-sectional survey was conducted in children aged 1 to 6 years old, who attended to the Department of Paediatric Dentistry, Gazi University. The questionnaires were adapted to Turkish, and OHRQoL was measured using the Turkish version of Early Childhood Oral Health Impact Scale (T-ECOHIS). Children were classified into four main groups, two subgroups in each group based on their severity conditions-Group 1: ECC group; Group 2: TDI group; Group 3: Malocclusion group; Group 4: Control group. Parents answered the questions about sociodemographic conditions and T-ECOHIS. The Kolmogorov-Smirnov test was used for non-normal distribution and Kruskal-Wallis and Mann-Whitney tests were used to compare T-ECOHIS score regarding ECC, TDI, and malocclusion.

Results

Both simple and severe conditions of TDI showed a negative impact on the family and child based on T-ECOHIS scores (P < 0.05). The severe condition of ECC and malocclusion showed significantly negative impact on family (P > 0.05) but not on child (P > 0.0.5).

Conclusion

The presence of ECC, TDI, and malocclusion has a negative effect on OHRQoL of Turkish preschool children and specially their families. So, public health programs should be carried out about oral health for raising parents' and children's awareness and increasing OHRQoL.

The impact of multi-organ procurement surgery in the nursing team: An Italian qualitative study

The removal of organs and tissues is characterized by a high level of stress and can be very traumatic for the nursing team. This study was informed by a grounded theory approach and was based on data drawn from two focus groups with 15 nurses. Main themes centered on factors that modulate the level of stress (first experiences, children donors, doubts about death, organizational factors), and coping strategies (including nurses' attitudes toward organ donation and training needs). There is a need to implement training for the stress management of the operating nurses and to provide supportive interventions.

Pattern of self-injurious behavior and suicide attempts in Italian custodial inmates: A cluster analysis approach

Self-injurious behaviors and suicide attempts are more frequent in prison settings than in the general population and represent a crucial problem. The aims of this work are to assess the prevalence of self-injurious behaviors and suicide attempts in an Italian prison setting, to determine whether inmates could be differentiated based on profiles of psychological distress and impulsiveness, and to assess the predictive power of the proposed profiles. A sample of 1422 male inmates of a north Italian penitentiary was assessed upon admission with a clinical interview and completed a set of self-report questionnaires to assess psychological distress and impulsiveness; the number of self-injurious behaviors and suicide attempts occurring in the first year of detention was recorded. A cluster analysis approach was used. Prevalence of self-Injurious behaviors and suicide attempts is similar to what has been observed in previous work. Cluster analysis revealed four clusters: dysregulated (high impulsivity and distress), impulsive (high impulsivity and mean distress), mildly distressed (mean impulsivity and moderate distress) and well-balanced (low impulsivity and distress). The four clusters help to discriminate subjects more at risk of self-injurious behaviors and suicide attempts and are confirmed by the inclusion of risk factors such as marital status and relatives'/social support. Clinical implications are discussed.

Protecting emergency room nurses from burnout: The role of dispositional mindfulness, emotion regulation and empathy

AIM

To verify the role of dispositional mindfulness, difficulties in emotion regulation and empathy in explaining burnout levels of emergency room (ER) nurses.

BACKGROUND

Many studies have examined the variables that can affect burnout amongst ER nurses, but little is known about factors that can protect ER nurses against work-related stress.

METHOD

A multi-centre cross-sectional design was used. Burnout level intensity, dispositional mindfulness facets, difficulties in emotion regulation and empathy dimensions were assessed using valid and reliable self-report questionnaires in a sample of ER nurses (N = 97) from three different hospitals.

RESULTS

Higher dispositional mindfulness and cognitive empathy levels and lower difficulties in emotion regulation, were negatively associated with emotional exhaustion levels.

CONCLUSION

ER nurses with more mindful, emotion regulation and empathy skills are more able to manage work-related distress.

IMPLICATIONS FOR NURSING MANAGEMENT

Experiential interventions to promote mindfulness skills, emotion regulation variability and flexibility in a clinical context and the cognitive side of empathy are recommended for ER nurses to reduce professional distress, and to enhance personal and work satisfaction. Future research should assess the effectiveness of new multi-factorial interventions which combine the development of mindfulness, emotion regulation and empathy skills in ER nurses.

Comparison of three different ketofol proportions in children undergoing dental treatment

Aim and Background

Sedation is gaining popularity among dental procedures in children. Ketamine and propofol mixture, known as ketofol, is one of the promising choices in sedation protocols; however, there is no consensus on the exact ratio of ketamine plus propofol especially in dental practice. The aim of present study was to compare perioperative side effect profiles, recovery profiles, and satisfaction rates of both parents' and dentists' following three different ratio of ketofol mixtures in children undergoing dental treatment. Materials and.

Methods

Three study groups each containing 30 children scheduled for dental treatment were created. Following anesthesia induction with 5% sevoflurane, 50% nitrous oxide mixture in 50% oxygen, 1 mg/kg bolus ketofol dose was administered. Patients in Group 1 received ketofol as a 1:1 mixture, patients in Group 2 received 1:2 ketofol while in Group 3; 1:4 ketofol was administered at a constant dose of 100 μg/kg/min. Additional doses of the ketofol solution at the same concentration with infused solutions in groups (0.5 mg/kg from either 1:1, 1:2, or 1:4 proportions) were administered if required. Perioperative vital signs, side effects, postoperative side effects, recovery durations, parents' and dentists' satisfaction levels were compared between groups.

Results

There were no significant differences between groups in terms of perioperative vital signs and side effects. Depth of sedation, dentists' satisfaction levels and postoperative side effects -myoclonus, hypersalivation and tachycardia were significantly higher in Group 1. Parents' satisfaction was highest in Group 3, however, necessity of additional doses and dissatisfaction of dentists' were found highest in this group. Mean duration of recovery recorded in Group 3 was shortest compared with other groups.

Conclusion

Decreased ketamine doses in ketofol mixture was related with decreased side effect profile, high parents' satisfaction with fast recovery, however, dentists' satisfaction was lower. In this context, results of present study indicated that ketofol mixture of 1:2 ratio was more reliable choice than others when all investigated parameters evaluated simultaneously.

Does the severity of psychopathology of Italian students receiving counselling services increase over time? A 5-year analysis and a comparison with a clinical and non-clinical sample

Psychological problems-from the most minor such as exams anxiety to the more severe such as personality disorders-are not rare in young adults. University Counselling Services often present the only opportunity for undergraduates to meet health professionals and to be confronted with their difficulties in a non-clinical setting or-in cases of more severe psychopathology-to be referred to mental health services. Recent research attests to the increasing severity of psychological problems among undergraduate and graduate university students. The question necessarily arises as to whether this trend is replicated in the general population being referred to mental health services and, if such is the case, whether there are differences between the two populations. This paper analyses the change in the severity of self-reported symptoms in a sample of 194 students attending a University Counselling Service over a course of 5 years (2010-2014). Clinical severity was assessed in both groups by Symptoms Check List 90-Revised, Clinical Outcome in Routine Evaluation-Outcome Measure, and Emotion Regulation Questionnaire scores. Results show a substantial stability in severity level across time, and a comparison with an age-matched sample of patients referred to a public hospital clinical psychology service shows overlapping data with respect to disease severity level. As the mental health of university students is an important public health issue, the implications for the organization and structure of university counselling services and the connection with public mental health hospital centres are discussed.

Age of onset of bipolar disorders: A systematic review and meta-analysis

Introduction

Although the onset of bipolar disorder (BD) is usually estimated in early adulthood (Burke et al., 1990; Kessler et al., 1997), it is still not clear which age-specific triggering factors may contribute to the underlying vulnerability.

Objectives/aims

The present meta-analysis attempts to clarify the number of untreated years of BD, from first symptoms appearance, to first actions carried out by health services (first diagnosis, treatment and hospitalization).

Methods

A literature search of three databases PubMed, Web of Science and Psychology and Behavioral Sciences Collection was performed, looking for peer-reviewed publications in English, French, German and Italian language that reported the AOO of BD; the search string adopted was “bipolar and onset”. Standardized mean differences were calculated between (i) mean AOO, operationally defined as onset of first symptoms/episodes, and (ii) mean AOO, operationally defined according to four criteria: first contact with services, date of the diagnosis, first pharmacological treatment, or first hospitalization.

Results

The searches yielded 8710 articles; 2424 of these articles met the inclusion criteria. A final set of 19 studies presenting multiple definitions of AOO has been analyzed, revealing an overall effect size of 6.96 of untreated years (Cohen's d = 0.65)

Conclusion

To our knowledge, this is the first meta-analysis that addresses the definition and the modulation of the AOO in bipolar disorder. Identifying the time-frame of untreated illness is very important for the best planning of timely interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The reasons for extractions of primary teeth in Turkish children

AIM

The aim of this study was to determine the current reasons for primary teeth extractions in Turkish children and their relative importance.

STUDY DESIGN

retrospective evaluation of patients by analysing dental records of children aged 2-13 years, receiving treatment in different regions in Turkey over a period of five years (2007-2012). Patient's age, gender, any significant medical finding, type of tooth extracted and the reason for the extraction were the parameters evaluated.

RESULTS

It resulted that 2,508 primary teeth belonging to 1,755 children aged of 2-13 years were extracted. Extraction due to caries (57,4%) was found to be the most common reason.

STATISTICS

Chi-square tests were performed for statistical analysis. Although no differences in the types of teeth extracted were observed between genders, striking differences were noted in the different age groups.

CONCLUSION

From this study it can be concluded that caries and subsequent pulpal pathology are the most common reasons for extraction of primary teeth in Turkey. Primary molars were the most common tooth type extracted. Preventive programmes for preschool children should be given importance.

Are behaviour risk factors for traumatic dental injuries in childhood different between males and females?

AIM

Examination of the risk factors for childhood traumatic dental injuries for male and female patients have been elusive. The present study aimed to examine whether males and females are differentially vulnerable to Traumatic Dental Injuries in relation to emotion regulation, attention deficiency hyperactive disorder symptomatology and behaviour problems.

MATERIALS AND METHODS

An institutional ethical review board approved the case-control study carried out at the Gazi University, Faculty of Dentistry, Turkey. A total of 80 patients with traumatic dental injuries and 80 patients with other dental problems participated in the study. Patients' parents filled in two scales: Conners' Rating Scales-Revised Attention Deficiency Hyperactive Disorder-Index, Oppositional Behavior, Hyperactivity, Anxious-Shy, Social Problems, Inattentive and Hyperactive-Impulsive subscales; and Emotion Regulation Checklist, with two subscales of Emotional Lability and Emotion Regulation. Multiple logistic regression analyses were performed separately for male and female patients.

RESULTS

Oppositional behaviour, hyperactivity and social problems were found to be risk factors for male patients. Being anxious/shy was the protective factor for both males and females. Classification accuracy for males and females were calculated to be 79.2% and 85.2% respectively.

CONCLUSION

Several risk factors for childhood traumatic dental injuries were found to differ for male and female patients.

Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.

Can Doll therapy preserve or promote attachment in people with cognitive, behavioral, and emotional problems? A pilot study in institutionalized patients with dementia

Doll therapy is a non-pharmacological intervention aimed at reducing behavioral and psychological disorders in institutionalized patients with dementia. This therapy as a care tool has been integrated into the context of long-term care institutions, in which the need to find solutions to cognitive, behavioral and emotional problems showed by people with dementia meets the primary objective of developing good care practices focusing on patients and their needs. In the present work we adopt the Bowlby's theory of attachment to investigate the effectiveness of Doll therapy. The hypothesis that we here propose is that the emotional experience of the person with dementia during Doll therapy activates caregiving and exploration systems together with the attachment one. To test this hypothesis we compared institutionalized patients with dementia undergoing Doll therapy with a control group and assessed measures of the relational dimension with the environment, such as gaze direction, behaviors of exploration, and behaviors of caregiving. We used an experimental protocol consisting of 10 non-consecutive sessions structured with the goal of recreating a situation of (1) separation from a known figure and (2) interaction with the environment in order to partially recreate the prototypical phases of the "Strange situation." All sessions were videotaped and analyzed through an observational grid. Results support the effectiveness of Doll therapy in promoting and maintaining the affective-relational dimension of attachment-caregiving and the attentive dimension of exploration in patients with advanced stage of dementia. Thus, our results suggest that the use of Doll therapy promotes clinically significant improvements in the ability to relate with the surrounding world. This may be important for managing and caring for patients with dementia in institutionalized context.

Gender differences and frequency of whole blood donation in Italian donors: even though I want to, I cannot?

Women are under-represented among blood donors and this difference is particularly strong in Italy. This study explore the reasons for the gender gap using a sample of donors who had stopped donating at least two years previously and analyzing the role of frequency of donation. No significant gender differences emerged between the reasons provided by subjects but Italy was the country with the longest prescribed interval between whole blood donations for women. The gender gap is related to the lengthy interval between successive donations of whole blood and reducing this interval could help increase the proportion of women donors.

Evaluation of Newly Adapted Clip Marker System in Ultrasound-Guided Core Needle Biopsy for Suspicion of Breast Cancer

Introduction: A newly adapted clip system for intramammary marking during ultrasound-guided core needle biopsy for suspicion of breast cancer is described and evaluated here. Material and Method: Fifty patients with suspicion of breast cancer (cT2) had ultrasound-guided core needle biopsy using a newly adapted clip marker system (HistoCore™ and O-Twist Marker™). Subsequently, ultrasound follow-up and tomosynthesis scans were done to determine the location of the marker clips. Results: No dislocation of the marker clip was detected on ultrasound in 45 of 50 patients (90 %), and 5 patients (10 %) had a maximum dislocation of 5 mm along the x-, y- or z-axis. Tomosynthesis scans demonstrated precise placement without dislocation of the clip markers in 48 patients (96 %); 2 patients (4 %) had a maximum dislocation of 3 mm along the x-, y- or z-axis. Conclusion: The newly developed clip marker system, a combination of a single-use breast biopsy needle and a precise, length-adapted intramammary marker clip, represents a further improvement in oncological therapy. This is of particular importance for patients requiring subsequent neoadjuvant chemotherapy, as in cases with complete tumour remission, there is no target point for preoperative, ultrasound-guided wire marking.

Full Field Digital Mammography (FFDM) versus CMOS Technology, Specimen Radiography System (SRS) and Tomosynthesis (DBT) - Which System Can Optimise Surgical Therapy?

Aim: This prospective clinical study aimed to evaluate whether it would be possible to reduce the rate of re-excisions using CMOS technology, a specimen radiography system (SRS) or digital breast tomosynthesis (DBT) compared to a conventional full field digital mammography (FFDM) system. Material and Method: Between 12/2012 and 2/2013 50 patients were diagnosed with invasive breast cancer (BI-RADS™ 5). After histological verification, all patients underwent breast-conserving therapy with intraoperative imaging using 4 different systems and differing magnifications: 1. Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm; 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS technology, photodiode array, flat panel, tungsten source, focus 0.05, resolution 50 µm pixel pitch, 12 lp/mm; 3. the Trident™ specimen radiography system (SRS) (Hologic, Bedford, MA, USA), amorphous selenium, tungsten source, focus 0.05, resolution 70 µm pixel pitch, 7.1 lp/mm; 4. tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm, angular range 50 degrees, 25 projections, scan time > 20 s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiographs were prospectively shown to 3 radiologists. Results: Of the 50 patients with histologically proven breast cancer (BI-RADS™ 6), 39 patients required no further surgical therapy (re-excision) after breast-conserving surgery. A retrospective analysis (n = 11) showed a significant (p < 0.05) increase of sensitivity with the BioVision™, the Trident™ and tomosynthesis compared to the Inspiration™ at a magnification of 1.0 : 2.0 or 1.0 : 1.0 (tomosynthesis) (2.6, 3.3 or 3.6 %), i.e. re-excision would not have been necessary in 2, 3 or 4 patients, respectively, compared to findings obtained with a standard magnification of 1.0 : 1.0. Conclusion: The sensitivity of the BioVision™, the Trident™ and tomosynthesis was significantly (p < 0.05) higher and the rate of re-excisions was reduced compared to FFDM using a conventional detector at a magnification of 2.0 but without zooming.