Emotions, Stress and Coping among Healthcare Workers in a Reproductive Medicine Unit during the First and Second COVID-19 Lockdowns

The impact of the COVID-19 pandemic on global healthcare workers’ (HCWs) mental health has been well documented in the last two years; however, little is known regarding HCWs working in specific healthcare fields. During two subsequent periods of national lockdown in Italy (June–July 2020, T1, and November–December 2020, T2), a total sample of 47 HCWs working in a reproductive medicine hospital unit completed an ad hoc questionnaire for assessing emotional reactions to the pandemic, stress symptoms, and ways of coping. Moderate–high levels of anger and sadness were experienced by 65.9% and 68.1% of the HCWs, respectively, while moderate–high levels of anxiety and fear were experienced by 51.1% and 56.8%, respectively. Higher stress symptoms experienced by HCWs were hypervigilance, avoidance of thoughts and memories, and tiredness/low energy. At T2, levels of hypervigilance, irritability, intrusive thoughts, and detachment were higher than at T1, while avoidance of external triggers decreased. Moderate–high levels of anxiety resulted significantly associated with several symptoms of stress: irritability/fearfulness, depression/hopelessness, tiredness/low energy, problems with concentration, and intrusive thoughts. Regarding coping strategies, HCWs tended to adopt more problem-focused coping (e.g., contributing to improving a situation) and this tendency was higher at T2. Overall findings suggest a risk for the persistence of stress symptoms and, therefore, a risk for a chronic course, which might interfere with the global quality of mental health at work and the care provided to patients. Clinical implications highlight the relevance of implementing support programs for this category of HCWs focused on the elaboration of negative emotions and on fostering adaptive coping strategies.

Maternal and Paternal Representations in Assisted Reproductive Technology and Spontaneous Conceiving Parents: A Longitudinal Study

Aim of this study was to investigate whether parental mental representations during pregnancy and after delivery differed between parents who conceived after Assisted Reproductive Treatments (ART) and spontaneous conceiving (SC) parents. Effects of specific ART variables (previous ART attempts, treatment type and cause of infertility) were also taken into account. Seventeen ART couples and 25 SC couples were recruited at Santa Maria Nuova Hospital (Reggio Emilia, Italy). At both 32 weeks of gestation (T1) and 3 months postpartum (T2) participants completed the Semantic Differential of the IRMAG, a self-report tool which measures specific domains of mental representations pertaining either individual (Child, Self-as-woman/man, and Partner) or parental (Self-as-parent, Own parent) characteristics. Results showed that ART parents had significantly more positive representations of the child compared to SC parents, while the scores at Partner dimension improved from T1 to T2 for SC parents only. With regards to ART history, scores at the Self-as-woman/man dimension were significantly less positive for ICSI than IVF parents and improved substantially from T1 to T2 only in case of mothers with previous ART attempts and of fathers at the first ART cycle. The representation of own parents increased from T1 to T2 in case of infertility diagnosis due to male factors, while a decrease emerged when infertility was due to female factors. Findings suggest the need to investigate parental mental representations after ART, in order to improve the understanding on the transition to parenthood of infertile couples and to target more specific intervention for parenting support.

Characteristics of Early Mother-Infant and Father-Infant Interactions: A Comparison between Assisted Reproductive Technology and Spontaneous Conceiving Parents

This study aims to describe parents’ and infant’s interactive styles after assisted reproduction treatments (ART), to compare them with parent–infant interactions after spontaneous conception (SC), and to assess the effect of specific ART variables (cause of infertility, treatment type, and previous ART attempts) on interaction quality. The sample included 25 ART conceiving couples and 31 SC couples with their 3-months-old babies. Free parent–infant interactions (3–5 min) were coded using the CARE-Index, a video-based assessment scale that gives both dimensional (e.g., sensitivity, control, passivity) and categorical scores (sensitive, inept, at-risk) for parents and infants. Results showed a global similarity between groups in CARE-Index dimensions. Nevertheless, differences emerged in categorical scores, as the interactive patterns of ART parents were more frequently classified as “inept” and “at-risk” compared to SC parents. With regards to ART dyads only, infants conceived through intracytoplasmic sperm injection scored significantly lower to the dimension compulsivity and higher to passivity, compared to infants conceived through in vitro fertilization. Yet, infants conceived at the first ART cycle had significantly lower levels of difficulty than infants conceived after one ART attempt. These results speak about the existence of important parent–infant interactive differences related to conception modality and ART technique and suggest the need to implement support programs to promote more sensitive parenting styles.

Effect of the previous reproductive outcomes in subfertile women after in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatments on perinatal anxious and depressive symptomatology

INTRODUCTION

The present study aims to investigate the effects of previous reproductive outcomes on the levels of depression, anxiety and perceived social support in subfertile women who conceived after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.

METHODS

A prospective cohort study was developed. Data were collected on subfertile patients who conceived after IVF/ICSI treatment. All demographic and clinical data were recorded. The Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory-Y and the Multidimensional Scale of Perceived Social Support at 22 and 32 weeks of gestation and 15 days after delivery were completed. Data were analyzed comparing patients who conceived at their first IVF/ICSI cycle, after one unsuccessful ARTs cycle, and after multiple unsuccessful IVF/ICSI cycles.

RESULTS

A significant increase in state anxiety and depression scores from 22 gestational weeks of gestation to 15 days after delivery was observed in patients who received multiple unsuccessful IVF/ICSI cycles compared with other groups. No significant difference in perceived social support was detected among groups. The differences in depression and anxiety scores remained consistent after controlling for perceived social support.

DISCUSSION

A history of unsuccessful IVF/ICSI treatments seems to leave women more vulnerable in facing the duties of the new parental role. Such possibility underlies the importance of the availability of a psychological support for these women, even after a successful medical treatment for infertility.

The attachment of prematurely born children at school age: A pilot study

This prospective longitudinal study compared the psychological development and patterns of attachment of 20 prematurely born children and 20 full-term children at 7 years of age. The School-age Assessment of Attachment (SAA) was used, and hypotheses and interpretation of the findings were drawn from the Dynamic-Maturational Model of Attachment and Adaptation (DMM). Significant differences between prematurely born and full-term children were found: 10% versus 0% at "high" risk, 55% versus 25% at "moderate" risk, and 35% versus 75% at "low" risk. There were no differences in the percentage of psychological trauma between samples, but there was a difference in the types of experiences leading to trauma. For prematurely born children, it was most often illness, whereas for full-term children, it was family problems. We discuss the implications for clinicians.

Effects of assisted reproductive technology and of women's quality of life on depressive symptoms in the early postpartum period: a prospective case-control study

This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.

Surgical treatment of anterior iliac spines fractures: our experience

INTRODUCTION

Iliac spines fractures represent 4% of all pelvic ring fractures and affect more frequently young people with open growth physis. These lesions are usually the consequence of an indirect avulsion trauma due to a sudden and forceful contraction of the muscles that take their origin on these structures. The treatment can be conservative or surgical according to the size and the amount of the dislocation of the fragment. The aim of this study is to evaluate the outcomes of surgical approach of these fractures.

MATERIALS AND METHODS

Between 2002 and 2010, 9 patients with fractures of anterior iliac spines were surgically treated. All patients, after an average follow up of 48 months, were evaluated clinically with the Non-arthritic Hip Score (NAHS) and radiographically in order to detect their consolidation. Complications related to the fracture and its treatment were analyzed. Time between trauma and return to sport performance (RSP) was recorded.

RESULTS

Mean NAHS was 98 points and RSP averaged 82 days. In 2 cases a transient meralgia paresthetica was observed. In 2 other cases follow-up radiographs showed asymptomatic hyperostosis around the iliac spines.

CONCLUSION

The treatment of iliac spines fractures is mainly conservative. When fragment size is bigger than 2 cm and is dislocated of more than 2 cm surgical treatment is indicated. We recommend a fixation with metallic screws in order to obtain a more stable fixation and an earlier recovery especially in high demanding patients.

Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation

Acromioclavicular (AC) joint dislocations are common in young, active patients. In case of surgical indications, Rockwood type IV, type V and selected type III dislocation, we use modified Phemister procedure. At mid-term follow-up, by an average of 35.1 months, we reassessed the records of 14 patients surgically treated for acute AC dislocation from February 2007 to November 2010. In patients with a diagnosis of grade III lesion, indication for surgery was given on the basis of the patient's functional demand. Full recovery was obtained on average 3 months after surgery. Constant Score accounted for 92.7 points, mean Disabilities of the Arm, Shoulder and Hand Score for 3.2 points, and mean Simple Shoulder Test Score for 11.4 points. X-ray findings were partial loss of reduction (9 cases), subclinic re-dislocation (2 cases), calcification (5 cases) and post-traumatic arthritis (2 cases). Modified Phemister is a reliable technique, technically easy, a low learning curve procedure and cheap with low hardware's costs.

Psychosocial support for infertile couples during assisted reproductive technology treatment

OBJECTIVE

To evaluate the psychosocial support perceived by couples during assisted reproductive technology (ART) treatments.

DESIGN

Prospective follow-up of patients undergoing ART.

SETTING

Department of Obstetrics and Gynecology, S. Maria Nuova Hospital, Reggio Emilia, Italy.

PATIENT(S)

Eighty-three women and 83 men admitted for ART.

INTERVENTION(S)

Patients completed a sociodemographic questionnaire and the Multidimensional Scale of Perceived Social Support at the beginning of ovarian stimulation, upon oocyte pick-up, and 1 month after ET.

MAIN OUTCOME MEASURE(S)

Perception of psychosocial support.

RESULT(S)

Men, compared with women, consistently reported poorer perception of psychosocial support, especially from friends and significant others; family support showed no difference. Women showed a decrease in perceived support, especially from friends, in cases of failure. Both reported less support from significant others if they had previously already undergone ART treatments.

CONCLUSION(S)

Men might feel excluded from the treatment because of the greater attention to women, leading to feelings of isolation from friends and partners. Women suffer particularly in cases of failure that reconfirms the trauma of infertility. These psychological risk factors underline the usefulness of psychological support for these couples, especially in cases of prolonged infertility.

Anxiety symptoms during late pregnancy and early parenthood following assisted reproductive technology

OBJECTIVE

To evaluate the relationship between assisted reproduction technology (ART) and anxiety symptoms during late pregnancy and early parenthood.

METHOD

Women with ART pregnancies were prospectively compared to their partners and to women with spontaneous pregnancies. The sample of 87 subjects, 48 ART (25 mothers and 23 fathers) and 39 non-ART mothers were given the ASQ-IPAT Anxiety Scale at 30-32 weeks of gestation, and at one week and three months after delivery.

RESULTS

The main socio-demographic and obstetrical characteristics were similar between groups. ART women showed higher scores for latent anxiety than non-ART women at three months after birth and showed no difference from ART men in all assessments. Manifest anxiety scores in ART women were higher, compared to non-ART women during the third trimester of pregnancy and one week after birth and were higher in all assessments when compared to ART men. Overall level of anxiety was higher in ART women in all assessments when compared to non-ART women and higher than in ART men during the two postnatal assessments.

CONCLUSION

We confirm the higher level of anxiety that characterizes the pregnancy-birth process in ART pregnancies. In addition, the higher manifest anxiety present before delivery and one week post-partum can be explained by the special nature of these pregnancies. Psychological support should be offered to ART patients because anxiety is an important risk factor for maternal post-partum depression and can lead to negative effects on the neonate and on child emotional and behavioral development.

Transrectal contrast-enhanced (Levovist) ultrasonography in evaluation of urinary leakage after radical prostatectomy: A preliminary report

Quick postoperative catheter removal remains one of the main goals of radical prostatectomy, but it leads to a greater risk of urinary leakage. Transrectal ultrasonography with enhancing contrast medium (Levovist) is a simple, effective, and minimally invasive examination to evaluate vesicourethral integrity.

Cerebellar granule cell Cre recombinase expression

The cerebellum maintains balance and orientation, refines motor action, stores motor memories, and contributes to the timing aspects of cognition. We generated two mouse lines for making Cre recombinase-mediated gene disruptions largely confined to adult cerebellar granule cells. For this purpose we chose the GABA(A) receptor alpha6 subunit gene, whose expression marks this cell type. Here we describe mouse lines expressing Cre recombinase generated by 1) Cre knocked into the native alpha6 subunit gene by homologous recombination in embryonic stem cells; and 2) Cre recombined into an alpha6 subunit gene carried on a bacterial artificial chromosome (BAC) genomic clone. The fidelity of Cre expression was tested by crossing the mouse lines with the ROSA26 reporter mice. The particular alpha6BAC clone we identified will be valuable for delivering other gene products to cerebellar granule cells.

Alternative splicing of mGlu6 gene generates a truncated glutamate receptor in rat retina

A novel splice variant of metabotropic glutamate receptor type 6 (mGlu6 receptor) was identified by reverse transcription-polymerase chain reaction amplification and sequence analysis of rat retina cDNA. The new rat receptor isoform (mGlu6b receptor) is characterized by an additional exon of 88 nucleotides containing an inframe stop codon, thus predicting the expression of a truncated protein of 508 amino acids. In situ hybridization reveals mGlu6b receptor mRNA to be predominantly expressed in the outer part of the inner nuclear layer of rat retina, containing ON-bipolar cells. The mGlu6b protein would comprise the extracellular domain of the receptor containing the ligand-binding site, but would lack the transmembrane and intracellular portions, thus possibly acting as a retinal soluble receptor for glutamate.

A technique of transrectal ultrasound guided transperineal percutaneous drainage of pelvic abscess after radical cystectomy

PURPOSE

Pelvic abscess after pelvic surgery may be a serious complication. We describe a technique of accurate transrectal ultrasound guided transperineal percutaneous drainage.

MATERIAL AND METHODS

Drainage of a pelvic abscess was required in a patient 30 days after radical cystectomy and ileal neobladder construction were performed for bladder cancer. Drainage was performed via perineal access under transrectal ultrasound guidance.

RESULTS

The procedure was painless and easily performed. About 100 ml. of pus were removed. The next day the patient was afebrile and 5 days later he was discharged from the hospital.

CONCLUSIONS

Pelvic abscess after pelvic surgery is a serious complication. Percutaneous perineal ultrasound guided drainage is a safe and effective therapeutic option.

Identification of novel alternatively-spliced mRNA isoforms of metabotropic glutamate receptor 6 gene in rat and human retina

Novel splice variants of metabotropic glutamate receptor type 6 (mGlu6 receptor) were identified by reverse transcription-polymerase chain reaction (RT-PCR) amplification and sequence analysis of rat and human retina cDNAs. The new rat mGlu6 receptor mRNA isoform is characterized by an additional exon of 88 nucleotides containing an in frame stop codon, thus predicting the expression of a truncated protein of 508 amino acids. The human retina was found to express two different mGlu6 receptor mRNA variants: one lacking 97 nucleotides from exon 6, the other including five nucleotides of intron 5. These mRNAs would encode truncated receptors of 425 and 405 amino acids, respectively. Both in rats and in humans, the truncated mGlu6 receptor proteins would comprise the extracellular domain but lack the transmembrane and intracellular portion of the receptor, thus possibly acting as retinal soluble receptors for glutamate. Though generated by different patterns of alternative splicing, the inter-species conservation of truncated mGlu receptor molecules strongly suggest their relevance in the regulatory network of glutamatergic neurotransmission.

Expression of the neuronal calcium sensor protein family in the rat brain

The neuronal calcium sensor proteins are members of the calcium-binding protein superfamily. They control localized calcium signalling on membranes and may make G-protein cascades sensitive to cytosolic calcium. The family members are recoverin (visinin, S-modulin), neuronal calcium sensor-1 (frequenin), hippocalcin, neuronal visinin-like protein-1 (visinin-like protein, neurocalcin-alpha), neuronal visinin-like protein-2 and neuronal visinin-like protein-3. Recoverin is expressed only in the retina and pineal gland. Using in situ hybridization, we mapped the expression of the other neuronal calcium sensor protein genes in the adult rat brain. Neuronal visinin-like protein-1 messenger RNA has a widespread distribution and is abundant in all brain areas except the caudate-putamen. Neuronal calcium sensor-1 gene expression is pan-neuronal. Neuronal calcium sensor-1 messenger RNA is present in the dendrites of hippocampal pyramidal and granule cells, suggesting a specific role in dendritic function. Hippocalcin and neuronal visinin-like protein-2 are mainly expressed in the forebrain and have similar expression patterns (neocortex, hippocampus and caudate-putamen). Neuronal visinin-like protein-3 has the most restricted expression; its highest expression level is in the cerebellum (Purkinje and granule cells). However, the neuronal visinin-like protein-3 gene is also expressed in many ventral nuclei throughout the fore- and midbrain, in the medial habenulae, and in the superior and inferior colliculi. The neuronal calcium sensor proteins are a relatively unexplored family of Ca(2+)-binding proteins. They are likely to be involved in many diverse areas of neuronal signalling. In this paper, we describe their expression in the rat brain as determined by in situ hybridization. As all five neuronal calcium sensor protein genes have distinctive expression patterns, they probably perform specific functions.

Opposing regulation of tau protein levels by ionotropic and metabotropic glutamate receptors in human NT2 neurons

Human NT2-N neurons derived from retinoic acid treatment of the NTera 2 cell line were used to determine the consequences of ionotropic glutamate receptor (iGluR) hyperstimulation and possible modulatory role(s) exerted by metabotropic glutamate receptor (mGluR) activation. We found that NT2-N neurons express the NR1 subunit of N-methyl-D-aspartate (NMDA) iGluRs and mRNA encoding the 1a isoform of mGluRs. A 15 min pulse with 100 microM NMDA induced an increase in the levels of tau proteins in NT2-N cells. This effect was prevented by incubating NT2-N neurons in the presence of the mGluR agonist (1 S,3R)-1-aminocyclopentane-1,3-dicarboxylic acid (1S,3R-ACPD). This phenomenon was related, in terms of doses and time, with the observed 1S,3R-ACPD-mediated protection against NMDA-induced NT2-N cell death. Our findings suggest that iGluRs and mGluRs might participate in the control of human neuron viability by differentially affecting the expression of tau proteins.

Echo-guided SWL of vesical stones with Dornier MPL 9000 lithotripter in obstructed and unobstructed patients

Sixty-one patients with vesical stones (38 with underlying obstructive conditions and 23 unobstructed) underwent SWL using ultrasound targeting under no regional or general anesthesia. A foley catheter was not routinely employed, and the bladder was filled in a physiologic way. Complete resolution was obtained in 47 patients (78%); in particular, 66% of the obstructed patients and 96% of the unobstructed patients became stone free in one to four SWL sessions. The average number of sessions for all patients was 1.28+/-0.63. Fragments were completely evacuated also in some patients with severe obstruction and in all three patients with neurogenic bladder dysfunction. The size and number of stones did not seem to play a limiting role in SWL effectiveness: the principal limiting factor was the hardness of the stone. No severe complications occurred. However, in six patients (10%), some fragments stopped in the urethra, causing acute urine retention, and endoscopic extraction was necessary. Echo-guided SWL of bladder stones is safe and highly effective in nonobstructed patients and can be considered the elective monotherapy method. In obstructed patients, SWL efficacy is lower, but the method may be suggested for patients who refuse or delay other, more invasive techniques.

Metabotropic glutamate receptor mRNA expression in rat spinal cord

It has recently become clear that, analogous to the situation observed in the brain, glutamatergic neurotransmission in the spinal cord relies upon the activation of ionotropic and metabotropic glutamate receptors (mGluRs). Although electrophysiological studies have emphasized the relevance of mGluR activation in the modulation of spinal neuron responses to glutamate, a detailed study of the molecular forms of receptors belonging to the mGluR family in the spinal cord is still lacking. Using a reverse transcriptase-polymerase chain reaction technique with primers specifically recognizing each cloned mGluR subtype, we found that rat adult spinal cord specifically expresses high levels of mRNA encoding mGluR1a but not mGluR1b. The expression of mRNAs for mGluRs 5a and 5b was also found at levels roughly comparable to that observed in mGluR5-positive brain areas. mGluR2, mGluR3, mGluR4 and mGluR7 mRNAs appeared to be expressed at lower levels, while mGluR6 and mGluR8 mRNAs were not detectable.

mGluR5 metabotropic glutamate receptor distribution in rat and human spinal cord: a developmental study

By combining biochemical, molecular and immunohistochemical approaches, we have investigated the presence of metabotropic glutamate receptors (mGluRs) belonging to the subtype 5 in rat and human spinal cords and the developmental changes in their expression. A polyclonal antibody raised against the carboxy-terminal portion of mGluR5 was used to study the distribution of the receptor in rat foetal (Et15), neonatal (P8) and adult spinal cords and dorsal root ganglia (DRG). mGluR5 appeared to be predominantly expressed in regions containing the primary sensory afferents. Immunoblotting with anti-mGluR5 antibody revealed lower receptor protein levels in rat adult spinal cord when compared with P8 rat spinal cord. Reverse transcriptase-polymerase chain reaction showed both mGluR5a and mGluR5b mRNAs expression in rat spinal cord. The mGluR5a variant was found more abundant in young animals than in adults. The pattern of mGluR5 immunostaining was also studied in foetal (6-8, 10, 12 and 22 weeks of gestation) and adult human spinal cord. At all stages of human development, a strong mGluR5 immunoreactivity was observed in the dorsal roots and in the dorsal and dorsolateral funiculi with maximum levels of staining at week 12 of gestation. Foetal DRG neurons were heterogeneously labeled. mGluR5 was also diffusely detectable in the mantle layer. In adult human spinal cords, immunoreactivity was confined to laminae I and II of the dorsal horns. These results demonstrate for the first time the presence of mGluR5 in human spinal cord. The distribution of this receptor suggests a role in the development of somatosensory pathways and in the control of nociceptive neurotransmission.

Opposing regulation of amyloid precursor protein by ionotropic and metabotropic glutamate receptors

The effects of the ionotropic glutamate receptor (iGluR) selective agonist N-methyl-D-aspartate (NMDA) on amyloid precursor protein (APP) levels were investigated in primary cultures of rat cerebellar granule cells. Both immunocytochemistry and immunoblotting techniques showed increased APP levels 4 h after a 15 min pulse with NMDA. This effect was completely prevented by incubating the neurones in the presence of the selective metabotropic GluR (mGluR) agonist 1S,3R-ACPD. This phenomenon was related, in terms of doses and time, with the observed 1S,3R-ACPD-mediated protection on NMDA-induced granule cell death. Our findings indicate that APP metabolism is differentially regulated by the stimulation of various GluR subtypes. The GluR-mediated changes in APP content might participate in the control of neuronal viability.