Flow experience fosters university students' well-being through psychological resilience: A longitudinal design with cross-lagged analysis

BACKGROUND

Existing research has linked individuals' flow experience - a positive affective and cognitive state of deep immersion and engagement in daily activities - and their well-being, particularly among university students. A growing number of longitudinal studies have further contributed to this understanding. However, limited attention has been given to exploring the dynamic interplay between these two variables and their underlying mechanisms (i.e., the mediator) of psychological resilience, specifically among university students in the context of the COVID-19 pandemic.

AIMS

To address this research gap, the present study draws on self-determination, flow and broaden-and-build theories. It examines the temporal dynamics and relationships between flow experience and well-being, and the mediating role of psychological resilience among Chinese university students.

SAMPLE

The study adopts a three-wave longitudinal design with a sample of 474 university students in Southwest China.

METHODS

Participants' flow experience, well-being and psychological resilience were measured across three time waves.

RESULTS

The findings of this study reveal that flow experience predicts well-being across the three waves and that psychological resilience mediates this prediction. This empirical evidence emphasizes the significance of both flow experience and psychological resilience in contributing to the well-being of university students over time amid COVID-19.

CONCLUSIONS

These findings enrich our understanding of the factors contributing to well-being in educational settings and provide highly relevant and timely insights for developing strategies to foster well-being among university students, especially in the transition into the post-pandemic era; findings also offer valuable insights not only for researchers but also for educators and policymakers.

Authentic Leadership and Employee Resilience: A Moderated Mediation Analysis

Authentic leadership is essential for predicting employee resilience. However, despite fruitful findings, more adapted models of authentic leadership - employee resilience based on empirical findings can serve as a guide to understand the complex mediators and moderators in different industries such as in construction engineering project organizations during the turbulent pandemic. This study, therefore, based on the organizational identification theory and flow theory through the lens of positive organizational psychology, aims to disentangle the authentic leadership-employee resilience association by investigating their underlying mechanism and their boundary condition. To test our hypothetical model, we applied a cross-sectional design with data collected from a large sample of 884 employees from a big enterprise in China. Findings from confirmatory factor analysis, structural equation modeling analysis, and Hayes's conditional process model indicated that: authentic leadership positively predicted employee resilience through the partial mediation effect of organizational identification, and such a mediation model was moderated by the experience of flow. In other words, flow moderated the relationships between authentic leadership, organizational identification, and employee resilience. Findings provide evidence for cultivating leaders' authenticity in promoting their subordinates' resilience; findings also highlight the significance of organizational identification in bridging authentic leadership and employee resilience and the essential role of flow experience in supporting the relationships mentioned above.

Societal extinction of species

The ongoing global biodiversity crisis not only involves biological extinctions, but also the loss of experience and the gradual fading of cultural knowledge and collective memory of species. We refer to this phenomenon as 'societal extinction of species' and apply it to both extinct and extant taxa. We describe the underlying concepts as well as the mechanisms and factors that affect this process, discuss its main implications, and identify mitigation measures. Societal extinction is cognitively intractable, but it is tied to biological extinction and thus has important consequences for conservation policy and management. It affects societal perceptions of the severity of anthropogenic impacts and of true extinction rates, erodes societal support for conservation efforts, and causes the loss of cultural heritage.

The Relationship Between Perceived Residential Environment Quality (PREQ) and Community Identity: Flow and Social Capital as Mediators

The wide-spread novel coronavirus disease (Covid-19) has posed severe challenges to people's life especially their life style. Due to the residential confinement contingency, people were restricted in their study, work and leisure within constrained residential community. The physical environment of residential community therefore became the main activity place and it thus played a significant role for facilitating inhabitants' daily activities and influencing community identity. Based on the eudaimonic identity theory, this study explored how the spatial dimensions of perceived residential environment quality (PREQ), activity experience (i.e., flow) and social capital, would impact on urbanities' residential community identity during Covid-19. Results from 508 Chinese residential inhabitants analyzed via structural equation modeling suggested that: a better degree in the spatial dimensions of PREQ would predict a stronger community identity; flow and social capital mediated the relationship between the spatial dimensions of PREQ and the inhabitants' community identity. The implications of such accounts for our understanding of community identity are then discussed, considering the important meaning of the relationships between people and the perceived physical properties of their residential place.

The Role of Place Attachment in Promoting Refugees' Well-Being and Resettlement: A Literature Review

Refugees are at great risk of developing mental health problems. Yet, little is known about how to optimally help this vulnerable group as there is a lack of evaluated refugee mental health interventions. The current article presents the results of a literature review which investigates the importance of place attachment for the promotion of refugees’ well-being in the resettlement process. This review concentrated on the most recent and current literature regarding the potential role, importance, and relevance of people–place bonds in the dynamic process of refugee resettlement. It examines literature from the field of positive and environmental psychology, highlighting key theoretical concepts and research findings as well as gaps in research. The review revealed that little is known about the dynamics of place bonding, while the debate rages on about the geometry of the psychological constructs of person–place relationships. Yet, knowing more about which needs should be satisfied for easing place bonding could be of crucial importance for facilitating refugee well-being. Ultimately, improving the knowledge and understanding of the phases of this dynamic process could be useful for a more successful implementation of refugee resettlement practices and activities.

A Research Agenda to Better Understand the Human Dimensions of Energy Transitions

The Social Sciences and Humanities (SSH) have a key role to play in understanding which factors and policies would motivate, encourage and enable different actors to adopt a wide range of sustainable energy behaviours and support the required system changes and policies. The SSH can provide critical insights into how consumers could be empowered to consistently engage in sustainable energy behaviour, support and adopt new technologies, and support policies and changes in energy systems. Furthermore, they can increase our understanding of how organisations such as private and public institutions, and groups and associations of people can play a key role in the sustainable energy transition. We identify key questions to be addressed that have been identified by the Platform for Energy Research in the Socio-economic Nexus (PERSON, see person.eu), including SSH scholars who have been studying energy issues for many years. We identify three main research themes. The first research theme involves understanding which factors encourage different actors to engage in sustainable energy behaviour. The second research theme focuses on understanding which interventions can be effective in encouraging sustainable energy behaviour of different actors, and which factors enhance their effects. The third research theme concerns understanding which factors affect public and policy support for energy policy and changes in energy systems, and how important public concerns can best be addressed as to reduce or prevent resistance.

Italian Food? Sounds Good! Made in Italy and Italian Sounding Effects on Food Products' Assessment by Consumers

Italian Sounding—i. e., the Italian appearance of a product or service brand irrespective of its country of origin—represents a global market phenomenon affecting a wide range of economic sectors, particularly the agro-food sector. Although its economic impact has been repeatedly stressed from different points of view (policy, economy, culture, etc.), systematic scientific knowledge regarding its social–psychological bases is lacking. Three studies carried out in three different countries (Italy, China, and USA) address this literature gap. Different consumer groups (both native and/or non-native) are targeted regarding major product categories pre-selected categories, which are the major Italian food goods within the specific country according to piloting (oil and/or pasta). In each study, the main independent variable (product version) has been manipulated by presenting real product images (previously pre-selected within the tested food category in each country market), whose “Italianness” degree is effectively manipulated by the main study variable (product version) across three or four levels (Protected Designation of Origin Made in Italy, Made in Italy, Italian Sounding, and Generic Foreign). Main hypotheses are tested via a survey with the specific product images administered to samples in Italy (N = 204, 148 Italians and 56 non-Italians), China (N = 191, 100 Chinese and 91 non-Italian expatriates in China), and the USA (N = 237 US citizens). Across the three studies, results show that Made in Italy products, compared to the other ones, are advantaged in terms of the main dependent variables: reputation profile, general reputation, attitude, and willingness to pay (WTP). Moreover, Italian Sounding products are endowed with corresponding significant advantages when compared to the Generic Foreign by non-Italian samples (although to a different degree according to the different sub-samples). Results reveal the specific social–psychological profile of Italian Sounding products in terms of either weaknesses or strengths when compared to both Made in Italy products and Generic Foreign ones, differently in the eyes of Italian and non-Italian consumers across different countries. Finally, consistently across the three studies, the extent to which a food product is perceived to be Italian increases consumers' WTP for that product, and this effect is consistently mediated by the product's reputation.

Exercise and Physical Activity eHealth in COVID-19 Pandemic: A Cross-Sectional Study of Effects on Motivations, Behavior Change Mechanisms, and Behavior

OBJECTIVES

The aims of this research were (1) to compare the levels of physical activity of eHealth users and non-users, (2) to determine the effects of these technologies on motivations, and (3) to establish the relationship that could exist between psychological constructs and physical activity behaviors.

METHODS

This cross-sectional study involved 569 adults who responded to an online questionnaire during confinement in France. The questions assessed demographics, usage of eHealth for exercise and physical activity, and behavioral levels. The questionnaire also measured the constructs of Social Cognitive Theory, the Theory of Planned Behavior, and automaticity facets toward eHealth for exercise and physical activity.

RESULTS

Participants who were users of eHealth for exercise and physical activity presented significantly higher levels of vigorous physical activity and total physical activity per week than non-users (p < 0.001). The chi-square test showed significant interactions between psychological constructs toward eHealth (i.e., self-efficacy, behavioral attitudes, intentions, and automaticity) and physical activity levels (all interactions were p < 0.05). Self-efficacy was significantly and negatively correlated with walking time per week. Concerning the automaticity facets, efficiency was positive and significantly correlated with vigorous physical activity levels per week (p < 0.05). Then, regressions analyses showed that self-efficacy and automaticity efficiency explained 5% of the variance of walking minutes per week (ß = -0.27, p < 0.01) and vigorous physical activity per week (ß = 0.20, p < 0.05), respectively.

CONCLUSION

This study has shown that people during confinement looked for ways to stay active through eHealth. However, we must put any technological solution into perspective. The eHealth offers possibilities to stay active, however its benefits and the psychological mechanisms affected by it remains to be demonstrated: eHealth could be adapted to each person and context.

Expanding Social, Psychological, and Physical Indicators of Urbanites' Life Satisfaction toward Residential Community: A Structural Equation Modeling Analysis

Attention on, and interest in, life satisfaction has increased worldwide. However, research on life satisfaction focused toward the urban dwellers' residential community is mainly from western countries, and the limited research from China is solely focused on the geriatric population via a narrowly constrained research perspective. This study, therefore, aimed to investigate urbanites' life satisfaction toward their community, combining the psychological (behavioral community engagement, mental state of flow, and cognitive community identity), physical (PREQIs-perceived residential environment quality indicators: e.g., green area), and social perspectives (social capital). The proposed conceptual model was tested on a regionally representative sample of 508 urban community residents in the city of Chengdu, Sichuan province, China. Data were analyzed via a structure equation modelling approach in AMOS software. Findings suggested that all of the psychological, physical and social factors contributed to a prediction of life satisfaction. Specifically, social capital mediated the path from community engagement and flow to life satisfaction, and community identity mediated the path from flow experience and green area to life satisfaction. Additionally, social capital contributed to predict life satisfaction through its influence on community identity. Findings provide suggestions for urban designers and policymakers to focus on creating an urban community equipped with green area, which helps to promote physical activities that are flow-productive, to enhance residents' identification to their residential community and, therefore, increase life satisfaction.

Food Reputation and Food Preferences: Application of the Food Reputation Map (FRM) in Italy, USA, and China

Given the food challenges that society is facing, we draw upon recent developments in the study of how food reputation affects food preferences and food choices, providing here a starting standard point for measuring every aspect of food reputation in different cultural contexts across the world. Specifically, while previous attempts focused either on specific aspects of food or on measures of food features validated in one language only, the present research validates the Food Reputation Map (FRM) in Italian, English and Chinese over 2,250 participants worldwide. Here we successfully measure food reputation across 23 specific indicators, further grouped into six synthetic indicators of food reputation. Critically, results show that: (a) the specific measurement tool of food reputation can vary across cultural contexts, and that (b) people's reputation of food products or categories changes significantly across different cultural contexts. Therefore, in order to understand people's food preferences and consumption, it is important to take into account the repertoire of cultural differences that underlies the contexts of analysis: the three context-specific versions of the FRM presented here effectively deal with this issue and provide reliable context-specific insights on stakeholders' interests, perspectives, attitudes and behaviors related to food perceptions, assessment, and consumption, which can be effectively leveraged to foster food sustainability.

Social support in the company canteen: A restorative resource buffering the relationship between job demands and fatigue

BACKGROUND

The quality of the places where workers take their breaks may affect the completeness of recovery in the time available. Little is known about how characteristics of a company canteen buffer the relationship between job demands and fatigue.

OBJECTIVE

We addressed the possibility that the company canteen buffers the relationship between job demands and fatigue to the extent that workers perceive it to hold restorative quality. Further, we considered how the restorative quality of the canteen signals the provision of organizational support, another job resource thought to buffer the demands-fatigue relationship.

ETHODS

A questionnaire was completed by 141 male blue collars workers during their lunch break in the factory canteen of an Italian industrial organization.

RESULTS

Canteen restorative quality correlated positively with organizational support. In multivariate regression analyses, the demands-fatigue association was weaker among workers who saw greater restorative quality in the canteen. This buffering effect was accounted for by a buffering effect of organizational support.

CONCLUSIONS

When settings for rest in the workplace have higher restorative quality, they may better function as job resources in two respects: serving the immediate needs of workers for recovery from job demands, and signaling the interest of the organization in their well-being.

Residential Place Attachment as an Adaptive Strategy for Coping With the Reduction of Spatial Abilities in Old Age

This study intended to test whether attachment to one's own residential place at neighborhood level could represent a coping response for the elderly (consistently with the "docility hypothesis;" Lawton, 1982), when dealing with the demands of unfamiliar environments, in order to balance their reduction of spatial abilities. Specifically, a sequential path was tested, in which neighborhood attachment was expected to play a buffer role between lowered spatial competence and neighborhood satisfaction. The participants (N = 264), senior citizens (over 65-year-old), responded to a questionnaire including the measures of spatial self-efficacy, spatial anxiety, attitude toward wayfinding, residential attachment and residential satisfaction. Results from the mediation analysis showed that a lower perceived spatial self-efficacy is associated to a higher spatial anxiety, and both promote a more negative attitude toward wayfinding tasks in non-familiar places. This leads to a higher attachment to one's own neighborhood, which in turn predicts a higher residential satisfaction. Thus, the "closure" response of becoming more attached to their residential place may be an adaptive strategy of the elderly for compensating the Person-Environment (P-E) mis-fit (Lawton and Nahemow, 1973) when they feel unable (or less able) to cope with the demands of unfamiliar environments.

Is it Really Nature That Restores People? A Comparison With Historical Sites With High Restorative Potential

Research on restorative environments has showed the healthy outcomes of nature experience, though often by comparing attractive natural to unattractive built environments. Some studies indeed showed the restorative value of artistic/historical settings. In a quasi-experimental study involving 125 participants in Rome, Italy, a natural and a built/historical environment, both scoring high in restorative properties, were evaluated in a natural, built/historical, or neutral setting. In accordance with the Biophilia hypothesis and the Attention Restoration Theory (ART), we hypothesized: a higher restorative potential of nature also when compared to built/historical environments; a moderation effect of on-site experience on perceived restorative potential (PRP) of both environmental typologies; higher levels of restorative properties of the environment for on-site vs. not on-site respondents; and a mediation effect of the restorative properties of the environment in the relationship between time spent on-site and PRP. Results supported the hypotheses. In addition, different psychological processes leading to restoration emerged for the natural and the built/historical environment. Theoretical implications for ART and practical applications for an integrative urban design with natural and historical elements are discussed.

Green Breaks: The Restorative Effect of the School Environment's Green Areas on Children's Cognitive Performance

Restoration involves individuals’ physical, psychological, and social resources, which have diminished over the years in the process of meeting the demands of everyday life. Psychological restoration can be provided by specific environments, in particular by natural environments. Studies report a restorative effect of nature on human beings, specifically in terms of the psychological recovery from attention fatigue and restored mental resources that were previously spent in activities that require attention. Two field studies in two Italian primary schools tested the hypothesized positive effect of recess time spent in a natural (vs. built) environment on pupils’ cognitive performance and their perceived restorativeness, using standardized tests. In Study 1, children’s psychological restoration was assessed by measuring sustained and selective attention, working memory, and impulse control, before and after the morning recess time. Team standardized playtime was conducted in a natural (vs. built) environment, and the perceived restorativeness was measured after each recess time. Results showed a greater increase in sustained and selective attention, concentration, and perceived restorativeness from pretest to posttest after the natural environment condition. In Study 2, the positive effect of free play recess time in a natural (vs. built) environment was assessed during the afternoon school time on sustained and selective attention and perceived restorativeness. Results showed an increase in sustained and selective attention after the natural environment condition (vs. built) and a decrease after the built environment break. Higher scores in perceived restorativeness were registered after the natural (vs. built) environment condition. Team standardized playtime and individual free play recess in a natural environment (vs. built) support pupils’ attention restoration during both morning and afternoon school times, as well as their perceived restorativeness of the recess environment. Theoretical and practical implications are discussed in terms of nature’s role both for the school ground design or redesign and for the organization of the school’s activities.

Good News or Bad News, Which Do You Want First? The Importance of the Sequence and Organization of Information for Financial Decision-Making: A Neuro-Electrical Imaging Study

Investment decisions are largely based on the information investors received from the target firm. Thaler introduced the hedonic editing framework, in which suggests that integration/segregation of information influence individual's perceived value. Meanwhile, when evaluating the evidence and information in a sequence, order effect and biases have been found to have an impact in various areas. In this research, the influence of the Organization of Information (Integration vs. Segregation) and the Sequence of Information (Negative-Positive order vs. Positive-Negative order) on individual's investment decision-making both at the behavioral level (decision) and neurometrix level (measured by an individual's emotion and Approach Withdraw tendency) was assessed for the three groups of information: a piece of Big Positive Information and a piece of Small Negative Information, a piece of Big Negative Information and a piece of Small Positive Information, and a piece of Small Negative information. The behavioral results, which are an individual's final investment decision, were consistent for all three scenarios. In general, individuals will invest more/retire less when receiving two pieces of information in a Negative-Positive order. However, the neurometric results (Emotional Index, Approach Withdraw Index and results from LORETA) show differences among information groups. An effect of the Sequence of Information and the Organization of Information was found for the different scenarios. The results suggest that in the scenarios that involve large-scale information, the organization of information (Integration vs. Segregation) influences the emotion and Approach Withdraw tendency. The results of this investigation should provide insight for effective communication of information, especially when large-scale information is involved.

Hedonic editing and order effect in decision-making with neurometric evaluation

Investment decisions are based largely on the information that investors are received from the target firm. In this research, we consider both the variable of Organization of Information, either segregate or integrate, and the Order of the information, either in the order of Negative-Positive or in the order of Positive-Negative. Three groups of information are tested in the experiment: a piece of Big Positive information and a piece of Small Negative information (BP/SN); a piece of Big Negative information and a piece of Small Positive (BN/SP); and a piece of Small Positive information and a piece of Small Negative information (SP/SN). The study applied the gathering of the electroencephalographic rhythms variations, as well as the heart rate and galvanic skin response. The neurometric indicators here employed were the Approach-Withdrawal (AW) and the Emotional (EI) indexes. In SP/SN group, the recency effect is found in AWI. However, when receiving information in large scale, either big positive or big negative, emotion plays a role during decision-making. In both case of BP/SN and BN/SP, emotion is effected by organization of information. In the condition of BP/SN, neurometrics AWI result suggests more approach potentials when two pieces of information presented integrated. While in the case of BN/SP, we observe the influence of both order and organization. Individual favours separation of information with the order of Negative-Positive, the recency effect.

Protecting the Environment for Self-interested Reasons: Altruism Is Not the Only Pathway to Sustainability

Concerns for environmental issues are important drivers of sustainable and pro-environmental behaviors, and can be differentiated between those with a self-enhancing (egoistic) vs. self-transcendent (biospheric) psychological foundation. Yet to date, the dominant approach for promoting pro-environmental behavior has focused on highlighting the benefits to others or nature, rather than appealing to self-interest. Building on the Inclusion Model for Environmental Concern, we argue that egoistic and biospheric environmental concerns, respectively, conceptualized as self-interest and altruism, are hierarchically structured, such that altruism is inclusive of self-interest. Three studies show that self-interested individuals will behave more pro-environmentally when the behavior results in a personal benefit (but not when there is exclusively an environmental benefit), while altruistic individuals will engage in pro-environmental behaviors when there are environmental benefits, and critically, also when there are personal benefits. The reported findings have implications for programs and policies designed to promote pro-environmental behavior, and for social science research aimed at understanding human responses to a changing environment.

Optimal Experience and Personal Growth: Flow and the Consolidation of Place Identity

This study examined the relationship between flow experience and place identity, based on eudaimonistic identity theory (EIT) which prioritizes self-defining activities as important for an individual’s identification of his/her goals, values, beliefs, and interests corresponding to one’s own identity development or enhancement. This study focuses on place identity, the identity’s features relating to a person’s relation with her/his place. The study is also based on flow theory, according to which some salient features of an activity experience are important for happiness and well-being. Questionnaire surveys on Italian and Greek residents focused on their perceived flow and place identity in relation to their own specific local place experiences. The overall findings revealed that flow experience occurring in one’s own preferred place is widely reported as resulting from a range of self-defining activities, irrespective of gender or age, and it is positively and significantly associated with one’s own place identity. Such findings provide the first quantitative evidence about the link between flow experienced during meaningfully located self-defining activities and identity experienced at the place level, similarly to the corresponding personal and social levels that had been previously already empirically tested. Results are also discussed in terms of their implications for EIT’s understanding and enrichment, especially by its generalization from the traditional, personal identity level up to that of place identity. More generally, this study has implications for maintaining or enhancing one’s own place identity, and therefore people–place relations, by means of facilitating a person’s flow experience within psychologically meaningful places.

Optimal Experience and Optimal Identity: A Multinational Study of the Associations Between Flow and Social Identity

Eudaimonistic identity theory posits a link between activity and identity, where a self-defining activity promotes the strength of a person’s identity. An activity engaged in with high enjoyment, full involvement, and high concentration can facilitate the subjective experience of flow. In the present paper, we hypothesized in accordance with the theory of psychological selection that beyond the promotion of individual development and complexity at the personal level, the relationship between flow and identity at the social level is also positive through participation in self-defining activities. Three different samples (i.e., American, Chinese, and Spanish) filled in measures for flow and social identity, with reference to four previously self-reported activities, characterized by four different combinations of skills (low vs. high) and challenges (low vs. high). Findings indicated that flow was positively associated with social identity across each of the above samples, regardless of participants’ gender and age. The results have implications for increasing social identity via participation in self-defining group activities that could facilitate flow.

Hand Gestures and Perceived Influence in Small Group Interaction

A laboratory study was carried out to establish the relative importance of verbal and gestural behavior, as well as their interaction, for perceived social influence in more or less competitive small groups. Forty women (psychology students) participated in leaderless small group discussions of different sizes (fourmember and eight-member): at the end, each member rated the perceived influence in decision-making of every other member. Verbal dominance coding is based on traditional quantitative conversational dominance (number of talk turns). Gestural coding (conversational, ideational, object-adaptor, self-adaptor gestures) is based on classical gesture classifications. Beside a substantial effect of verbal dominance, the main result is that frequency of object-adaptors and conversational (only in large groups) and ideational (in both small and large groups) gestures increases perceived influence scores particularly when the verbal dominance of the speaker is low.

Integrated Healthscape Strategies: An Ecological Approach to Evidence-Based Design

Aim:

This paper explores some of the premises of evidence-based design (EBD) and suggests that greater attention to and differentiation of the various purposes of research are needed, along with the development of an ecological theory that reflects the complexity of the health systems studied and more varied ways to communicate with and engage practitioners.

Background:

Problems with the American healthcare system are well known. For the past 20 years, an intervention that has gained increasing attention has been the physical design of healthcare facilities—hospitals in particular. EBD has been advocated as one means of using research to examine the relationship between design and healthcare to improve patient safety and the quality of care.

Conclusions:

The concept of integrated healthscape strategies is proposed to focus not only on research “evidence” and the methods used to collect and analyze it, but also on the different purposes research serves, the role of theory, and the use of EBD research in practice.

Aerobic exercise and non-alcoholic fatty liver disease: a case report

Non-alcoholic steatosis (non-alcoholic fatty liver disease [NAFLD]), now considered a metabolic pathway to advanced liver disease, cirrhosis and hepatocellular carcinoma, can also be explained by physical inactivity and increased dietary fat intake. No established treatment exists for this potentially serious disorder. The authors present the case of a 29-year-old man with NALFD who followed a restricted diet and practiced aerobic exercise for 16 weeks. Outcome after a combination therapy of aerobic exercise and diet was good, suggesting that treatment with a restricted diet and physical exercise can improve blood biochemical values in patients with NAFLD. Moderate-intensity aerobic exercise may help to normalize liver enzyme values and the quality of life of patients with fatty liver diseases.

Inhabitants' Environmental Perceptions in the City of Rome within the Framework for Urban Biosphere Reserves of the UNESCO Programme on Man and Biosphere

The article presents the main tenets of the UNESCO Programme on Man and Biosphere (MAB), launched by the United Nations at the beginning of the 1970s. The program aimed at supporting applied research and scientific knowledge for managing natural resources in a rational and sustainable way. The implication of the full ecological perspective, typical of the MAB, for promoting multidisciplinary and integrated approaches in the study of environmental issues is briefly outlined. In particular, we point out the role of the MAB, through the biosphere reserve concept, in supporting the collaboration between natural-biological and social-behavioral sciences when dealing with biodiversity conservation problems and with urban ecosystems. Then, the specific UNESCO-MAB Project on the city of Rome, launched at the end of the 1980s, is briefly presented, together with the recent project of the Department of the Environment of the Rome Municipality to propose Rome's urban and periurban green areas as a new UNESCO-MAB Biosphere Reserve. The results of the main research activities conducted therein are summarized. In particular, the specific research lines of the environmental psychology research group, involved in the MAB-Rome Project for approximately two decades, are presented. These research lines dealt with various aspects of residents' environmental perceptions and behaviors in the city of Rome. The practical implications of these results are also briefly discussed.

Effects of simvastatin treatment on sICAM-1 and sE-selectin levels in hypercholesterolemic subjects

This study was performed to determine whether the levels of soluble intercellular adhesion molecule-1 (sICAM-l) and soluble endothelial molecule-1 (sE-selectin) were elevated in subjects with hypercholesterolemia who presented with no other risk factors or evidence of atherosclerosis. The effects of administration of an HMG-CoA reductase inhibitor on the serum levels of these molecules were also examined. Forty hypercholesterolemic subjects (HCh) (19 males and 21 females), without hypertension or cardiovascular disease, received placebo for 4 weeks. The patients were then randomized in two groups; 20 of them (simvastatin group) were treated with simvastatin (20 mg/day) and the other 20 (placebo group) continued placebo administration. After 12 and 24 weeks of either simvastatin or placebo treatment, sICAM-1 and sE-selectin levels were measured. The same parameters were measured in 20 control subjects (C) with normal cholesterol levels, matched for sex and age. HCh had sICAM-1 basal values higher than C (352.4+/-57.9 ng/ml versus 114.9+/-89.6 ng/ml; P<0.001); however, sE-selectin basal values were not different in the two groups. No correlation was observed between HCh sICAM-1 levels and cholesterol levels (total and low-density lipoprotein). Furthermore, cholesterol-lowering treatment with simvastatin did not significantly diminish sICAM-1 levels. Our findings would support the hypothesis that patients with isolated hypercholesterolemia and without clinical atherosclerosis may be silent carriers of arterial subendothelial inflammation, expressed as an increase of sICAM-1.

Effects of fluvastatin treatment on red blood cell Na+ transport systems in hypercholesterolemic subjects

This study was performed to ascertain the effects of short-term cholesterol-lowering therapy with fluvastatin on red blood cells Na+ transport systems. Forty familial hypercholesterolemic subjects (FH; 19 men and 21 women) without hypertension or cardiovascular disease were given a placebo for 4 weeks, and then randomized in two groups. Twenty (fluvastatin group) were given fluvastatin (40 mg/day), and the other 20 (placebo group) continued placebo administration. After the placebo period and after 4 and 12 weeks of placebo or fluvastatin treatment, we measured Na+/K+ pump activity, Na+/K+ cotransport (Na+/K+ Ct), Na+/Li+ countertransport (Na+/Li+ Cnt), passive Na+ permeability (Na+PP), and internal Na+ content (Na+i). The same parameters were measured in 23 control subjects (C) with normal cholesterolemic values, who were matched for sex and age. FH had higher Na+/Li+ Cnt values than C (193.2 +/- 59.4 vs. 139.8 +/- 48.7 microM cells/h; p < 0.01), an increase in Na(+)PP (0.034 +/- 0.012/h vs. 0.018 +/- 0.004/h; p < 0.001), and higher Na(+)i (7.5 +/- 1.5 vs. 6.2 +/- 0.9 mM cells; p < 0.001). In hypercholesterolemic subjects, Na(+)i values were correlated with cholesterol (total and LDL) and apo B levels, whereas an inverse correlation was found for HDL-c and apo AI levels. Reduced total and LDL cholesterol and apo B levels after fluvastatin treatment caused a decrease in both Na(+)/Li(+) Cnt (from 186.1 +/- 60.5 to 125.1 +/- 34.0 microM cells/h; p < 0.001) and Na(+) PP (from 0.035 +/- 0.013/h to 0.02 +/- 0.016/h; p < 0.01), and an increase in Na+/K+ pump activity (from 1,549.0 +/- 507.7 to 1,894.2 +/- 536.2 microM cells/h; p < 0.04), with a significant reduction in the internal Na+ content (from 7.5 +/- 1.6 to 5.8 +/- 2.4 mM cells; p < 0.001). Our findings show that hypercholesterolemia affects red blood cell Na+ transport systems, with an increase in Na+/Li+Cnt, Na+PP, and the internal Na+ content. Cholesterol-lowering treatment with fluvastatin influences Na+ transport systems and reduces the internal Na+ content. This might also be responsible for the greater vascular reactivity observed in hypercholesterolemic patients, and its amelioration after a reduction in cholesterol levels.

[Elevated levels of lipoprotein(a) are present in subjects with early ischemic cardiopathy and with a familial history of ischemic cardiopathy]

BACKGROUND

Elevated levels of lipoprotein(a) are associated with a greater risk of atherothrombotic cardiovascular diseases. Since the Lp(a) levels are genetically determined and fairly stable in the course of life and a family history appears to be an independent risk factor of cardiovascular diseases, we evaluated the behavior of Lp(a) levels in patients with early events of coronary heart disease (CHD) and also in subjects with positive family history of ischemic heart diseases.

METHODS

The levels of lipoprotein (a) [Lp(a)] were measured in 254 subjects, 138 males and 116 females with an average age of 48.6 +/- 13.8 years (range 20-76 years). Diabetic subjects, females submitted to oestrogen treatment and those already in treatment with hypolipidaemic drugs were excluded from the study. Forty of the 254 patients (15.7%), 27 males and 13 females, had CHD (29 a previous myocardial infarction and 11 a stable angina). A positive family history for CHD was considered present (102 of the 254 patients) if one or more first degree relatives had angina or myocardial infarction before the age of 60 years in men and 65 in women.

RESULTS

The levels of Lp(a) were higher (p < 0.01) in women (25.1 +/- 28.3 mg/dl) compared to men (17.6 +/- 18.4 mg/dl), without differences in relation to age. The Lp(a) plasmatic levels were not correlated with age, body mass index, total cholesterol, LDL and HDL, triglycerides, apo B, apo AI, fibrinogen and there were no differences in Lp(a) levels in presence or absence of other known cardiovascular risk factors such as hypertension and smoking. The Lp(a) levels were not different between subjects with CHD (28.15 +/- 31.7 mg/dl) and controls (20.3 +/- 22.8 mg/dl). The subjects with CHD were older and had higher levels of fibrinogen and a significantly greater prevalence of hypertension and family history of CHD. Fifteen of the 40 subjects with CHD had an early onset of CHD (before 50 years of age) and only in such patients the Lp(a) levels were significantly greater compared to controls (35.8 +/- 33.2 mg/dl vs 20.3 +/- 22.8 of the controls, p < 0.01), independently of other variables (age, BMI, smoking, hypertension, cholesterol, triglycerides, HDL-c, LDL-c, fibrinogen). Furthermore the Lp(a) plasmatic levels were higher in subjects with a family history of CHD (28.3 +/- 27.6 mg/dl vs 16.3 +/- 18.6 mg/dl of the subjects without a family history of CHD, p < 0.01) even if they had or not had a previous coronary ischemic event.

CONCLUSIONS

Such data confirm the importance of high levels of Lp(a) above all for the early events of CHD and for the subjects with a family history of CHD, which could be expression of a greater predisposition for cardiovascular events.

Effects of picotamide on release of endothelin-1, thromboxane and prostacycline after treadmill stress in patients with peripheral artery disease

To assess the effects of picotamide, an antithromboxane receptor and antithromboxane synthase drug, on vascular function and endothelin-1 release, 20 patients with peripheral arterial disease, without hypertension or diabetes mellitus, receiving placebo and picotamide (900 mg/day) were studied. The modifications of vascular parameters were evaluated by arterial distensibility index and postischemic hyperemia test (postischemic perfusion index and recovery time). Endothelin-1, prostacycline, and thromboxane B2 were determined under resting conditions and after treadmill test. Picotamide treatment caused a decrease of resting thromboxane B2 and endothelin-1 concentrations, produced an improvement of the vascular function as seen by the increase of vascular parameters reported, and attenuated the ischemic treadmill-induced increase of thromboxane B2, but not of endothelin-1. These data confirm that the picotamide improved vascular flow by the reduction of thromboxane-mediated effects, reduced resting endothelin-1 levels, but did not attenuate endothelin-1 concentrations induced by the treadmill stress.

Erythrocyte passive potassium flux is increased in patients with ischemic coronary disease (ICD) and in subjects with family history of ICD

BACKGROUND

It has been proposed that ischemic coronary disease (ICD) associated potassium loss could be due to modifications of potassium permeability. We investigated whether a positive family history of ICD can influence this parameter. We have compared potassium permeability in erythrocytes from ICD patients and from positive family history subjects (FICD) with control subjects.

METHODS

All patients and subjects were carefully selected for the absence of hypertension and dysmetabolic pathologies. ICD group: 24 patients (19 males, 5 females; ages 43 to 69) all affected by ischemic coronary disease, under no drug treatment; FICD group: 18 subjects (all males, ages 27 to 42) with a verified positive ICD family history, without hypertensive family history and cardiovascular pathology; control group: 16 subjects (11 males, 5 females; ages 28 to 48) without positive family history of ICD. Passive potassium efflux (PPE) was spectrophotometrically measured in K-free medium containing ouabain and bumetanide. The kinetic constant was calculated by dividing PPE by the erythrocyte potassium concentration.

RESULTS

No statistically significant differences were noted between the intracellular potassium content of the three groups. However, (1) the passive potassium permeability of the ICD group was significantly higher (kK=0.055 +/- 0.021 h(-1), n=24) than that of the control group (kK=0.023 +/- 0.008 h(-1), n= 16; p<0.00001), (2) the FICD group was higher (kK=0.036 +/- 0.012 h(-1), n=18) than the control group (p<0.001), and (3) the ICD group was higher than the FICD group (p<0.001).

CONCLUSIONS

Our results suggest an inheritability of ICD, paralleling the familial aggregation of the pathology. Erythrocyte potassium permeability could represent an early marker of ischemic coronary disease and be used as a prophylactic tool.

Rhetorical intentionality attribution: its ontogenesis in ordinary conversation

This paper addresses the assumption that the epistemological dichotomy between reality and its construction is an everyday rhetorical tool children and adults use in their explanations and arguments. Within a discursive psychology perspective, the phenomenon of attribution of rhetorical intentionality (AIR) is theoretically defined developing the notion of prepackaged interest attribution technique (Edwards & Potter, 1992). AIR consists in an explanation of others' discursive moves in terms of a rhetorical-argumentative activity; that is, in terms of a deliberate attempt aimed at construing and presenting reality as a function of the speaker's point of view, perspective and interests, in order to affect the listeners mental state (belief, knowledge, intention) or action. Theoretical links are made to the theory of mind paradigm in the study of intentionality attribution, particularly to the form of life approach which defines intentionality attribution in terms of language games. On this basis, the present study examines the structures and functions of AIR used by children and their parents in everyday conversation. Qualitative discourse analysis of transcripts of 22 dinner conversations from eight Italian families shows explicit and implicit AIR in children from three and a half to seven years of age. Moreover, parents attribute rhetorical intentionality to their children, contributing to their social construction as rhetorical speakers. AIR is used as a rhetorical strategy within disputes and argumentative contexts, often achieving topic closure. Results are discussed with reference to the ontological status of intentionalist talk.

[Effects of adrenergic stimulation on transmembrane transport of Na+ in patients with essential hypertension]

BACKGROUND

It has been studied whether an adrenergic stimulation induced by the cold pressor test (CPT) could influence the behaviour of the transmembrane transport systems of sodium in hypertensive subjects compared to a normotensive control population.

MATERIALS AND METHODS

Twenty-two hypertensive subjects (average age 43.2 +/- 5.7 years), with normal weight, without signs of cardiovascular and metabolic diseases, underwent the cold pressor test. The dynamic behaviour of sodium erythrocytic transport systems and plasmatic norepinephrine was evaluated basally, at the third minute during the cold pressor test and 20 minutes after the end of the test. The same test was carried out in a control population made up of 20 normotensive subjects (average age 41.9 +/- 4.8 years), selected on the basis of the absence of any cardiovascular or metabolic pathology and without family history of arterial hypertension.

RESULTS

The cold pressor test did not cause significant changes in the sodium transmembrane transport systems in normotensive subjects, while in the hypertensive subjects a significant reduction was observed, during the test, in the total efflux of sodium and in the sodium/potassium pump, respectively from 2636 +/- 296 mumol/l/red blood cells/hr to 2032 +/- 178 mumol/l/red blood cells/hr (p < 0.0001) and from 2156 +/- 149 mumol/l/red blood cells/hr to 1610 +/- 101 mumol/l/red blood cells/hr (p < 0.0001); the intraerythrocytic sodium increased from 6.5 +/- 1.0 mmol/l/cells to 7.2 +/- 1.1 mmol/l/cells (p < 0.04) and the passive permeability decreased from 0.039 +/- 0.004 hr-1 to 0.018 +/- 0.006 hr-1 (p < 0.0001). During cold pressor test the increase in the plasma norepinephrine levels was correlated to the reduction in the total efflux of sodium (r = -0.60; p < 0.003) and in the sodium/potassium pump (r = -0.59; p < 0.003) only in hypertensive subjects.

CONCLUSIONS

Our data show that an adrenergic stimulation, induced by the cold pressor test, is able to significantly influence the behaviour of transmembrane fluxes of sodium in hypertensive subjects, and it causes an inhibitory effect on the sodium/potassium pump and an increase in the intraerythrocytic sodium. Such data show the existence in hypertensive subjects of an interrelationship between adrenergic activity and sodium transport systems that could cooperate in causing and/or in maintaining the hypertensive syndrome.

[Effect of beta blockade on the erythrocyte transport of Na+: evaluation during stimulation by cold pressure test in patients with essential hypertension]

Several studies have shown in essential hypertension alterations of the transmembrane red blood cells sodium fluxes, as an involvement, especially in the early phases, also of the adrenergic system. In this study we evaluated the behaviour of red blood cells fluxes of sodium before, during and after the cold pressor test, a method used also to evoke an adrenergic stimulation, in twenty hypertensive subjects, 14 males and 6 females, with an average age of 43.2 +/- 5.7 years, with normal weight and without cardiovascular complications and metabolic diseases. The behaviour of the Na+ total efflux (Na+ TE), of the Na+/K+ pump, of the Na+K+ cotransport (Na+/K+ CT), of the Na+/Li+ counter transport (Na+/Li+ Cnt), of the Na+ passive permeability (Na+ PP), of the intracellular Na+ (I Na+) and of the plasmatic noradrenaline (NE) was evaluated basally, at the third minute during cold pressor test (CPT) and 20 minutes after the end of the test. The test, which the same method, was repeated after a 30 day treatment with propranolol at the dose of 240 mg/day in three daily administrations. The beta-blockade caused, besides the reduction of both the systolic and diastolic pressure values, a significant increase in the Na+/K+ CT (from 248 +/- 41 to 314 +/- 71 mmol/l/cells/h, p < 0.001) and a decrease in the Na+ PP (from 0.039 +/- 0.004 to 0.023 +/- 0.007 hr-1, p < 0.00001), probably directed towards the reduction of the accumulation of intracellular Na+, that could compete, among the other mechanisms, with the anti-hypertensive action of the beta-blockers. The CPT caused, before the beta-blockade, a significant depression of the Na+/K+ pump (from 2057 +/- 149 to 1610 +/- 101 mmol/l/cells/h, p < 0.00001) and of the Na+ TE (from 2640 +/- 397 to 2032 +/- 179 mmol/l/cells/h, p < 0.00001) inversely correlated to the levels of NE (r = -0.60, p < 0.003), with a consequent increase in I Na+ (from 6.2 +/- 0.6 to 7.5 +/- 1.5 mmol/l/cells, p < 0.001), showing how the adrenergic activation in hypertensive subjects is able to interfere with the systems of transmembrane transport with an inhibitory attitude, that is expressed by an increase in the levels of I Na+. The beta-blockade was able to outweigh the depression of the Na+/K+ pump (from 1843 +/- 584 to 1728 +/- 640 mmol/l/cells/h, p: ns) and the reduction of the Na+ TE, preventing the accumulation of I Na+ (from 6.3 +/- 1.6 to 6.6 +/- 1.3 mmol/l/cells, p: ns). Such data show an increased susceptibility of the Na+ transport systems to the adrenergic stimuli in hypertensive subjects with a tendency to favor the accumulation of I Na+ and that the beta-blockade is able to antagonize the effects, with a maintenance of the intracellular levels of Na+.

[Transmembrane sodium transport systems in various forms of hyperlipoproteinemia]

The possible interrelationships between the erythrocytic transport systems of Na+ (Na+/K+ pump, Na+/K+ cotransport, Na+/Li+ countertransport, Na+ passive permeability) and the plasmatic lipids (cholesterol, triglycerides, HDL, LDL, apoprotein A1, apoprotein B) were studied in 42 normotensive subjects with different forms of hyperlipoproteinaemia and with a negative familiarity for arterial hypertension. In subjects with hypercholesterolaemia (hyperlipoproteinaemia II A and II B) an elevated activity of the Na+/K+ pump was noticed, while in subjects with hypertriglyceridaemia (type IV) an increase in Na+ passive permeability and Na+/Li+ countertransport with a lower level of intraerythrocytic Na+ was shown. A negative correlation was observed between the total efflux of Na+ and Na+/K+ pump and the levels of cholesterol (r = -0.43, p < 0.04 and r = -0.41, p < 0.05) and the apoprotein B/A ratio (r = 0.42, p < 0.05 and r = -0.50, p < 0.01). A negative correlation was also noticed between the Na+/K+ pump and the levels of apoprotein B (r = -0.41, p < 0.05). The Na+/K+ cotransport appeared inversely correlated with the levels of HDL cholesterol (r = -0.42, p < 0.05), while the Na+ passive permeability was negatively correlated with the levels of LDL (r = -0.43, p < 0.04) and positively correlated with the plasmatic triglycerides (r = +0.54, p < 0.01). Such data show that the plasmatic lipids can influence the systems of transmembrane ionic transport of Na+ and play an important role also this way, in cardiovascular pathology.

Acute cardiovascular effects of salmeterol in subjects with stable bronchial asthma

The airway response and cardiovascular effects of salmeterol (SM) and salbutamol (SB) given as a single dose from metered-dose inhalers were studied in 10 patients with mild asthma. In a double-blind, randomized, cross-over, placebo-controlled study, the subjects received SM 100 micrograms (four puffs, 25 micrograms per actuation), SB 200 micrograms (four puffs, 50 micrograms per actuation) or placebo (P) (four puffs). SM caused a greater and longer lasting increase of peak expiratory flow rate (PEFR) value than SB and P. There was no significant difference either with P or the study drugs in heart rate, PR interval, QT interval corrected for heart rate (QTc), incidence of ventricular and supraventricular ectopics, and in echocardiogram evaluation. These findings show that at dosages based on those used in clinical practice salmeterol causes cardiovascular effects comparable to those induced by salbutamol and confirm the favourable cardiac safety profile of this drug.

Effects of cloricromene on the levels of endothelin and on the microcirculatory function in peripheral atherosclerotic arteriopathies

The effects of cloricromene on plasma endothelin-1 (ET-1) levels and on microcirculatory function in 9 patients with peripheral atherosclerotic arteriopathy (PAA) and in healthy control subjects were studied. ET-1 levels and microcirculatory function were evaluated both under basal conditions and 30, 60, and 90 min after acute administration of cloricromene (30 mg i.v.). PAA patients had significantly increased levels of ET-1 and impaired vascular parameters (studied by means of Winsor's Index, Gosling's Index, postischemic perfusion index and recovery time) when compared to control subjects. The acute administration of cloricromene (30 mg i.v.) did not change plasma ET-1 both in control subjects and in patients with PAA. In contrast, cloricromene produced a significant improvement in the postischemic perfusion index and in recovery time in arteriopathic patients. Control subjects and patients with PAA also underwent a cold pressor test (CPT) under basal conditions and (72 h later) 30 min after an acute intravenous administration of cloricromene (30 mg i.v.). CPT caused a higher increase in ET-1 in the patients with PAA compared to the control group, and a reduction in the vascular flow at the femoral level, while the pretreatment with cloricromene prevented both the increase in the levels of ET-1 and the reduction of the femoral vascular flow observed after the cold stimulus in patients with PAA. Our data show that cloricromene, besides ameliorating the microcirculatory function, is able to interfere with dynamic mechanisms, such as those induced by the CPT, capable of stimulating the release of ET-1 at the vascular level.

Effects of gallopamil on epinephrine and norepinephrine plasmatic levels and on TxB2 and beta-tg release in patients with coronary artery disease during adrenergic stimulus with cold pressor test

We investigated the effect of gallopamil administration during a cold pressor test (CPT) in 18 patients suffering from chronic angina (CA) and in 21 healthy subjects. CA patients showed increased basal levels of beta-thromboglobulin and thromboxane B2 compared to control patients and normal plasma levels of catecholamines. CPT caused plasma catecholamines, beta-thromboglobulin and TxB2 levels to rise. This rise was greater in CA patients than in control patients. Administration of gallopamil (50 mg kg-1 three times a day for 30 days) reduced plasma levels of catecholamines, beta-thromboglobulin and TxB2 blood concentrations either under basal conditions or after CPT. Our data suggest that gallopamil is able to modulate the response induced by adrenergic stress.

[Evaluation of the anti-arrhythmic action of propafenone treatment and its influence on left ventricular function]

Twelve patients (9 males, 3 females, mean age 59.2 +/- 7.0 years) with hyperkinetic ventricular arrhythmias were treated for 30 days with 150 mg propafenone three times daily; the daily dosage was raised to 900 mg in non responders (< 85% reduction of ectopic ventricular beats/h). A 24-hour ECGD and mono- and bidimensional echocardiography were carried out at baseline, after 30 days on 450 mg, 30 days on 900 mg propafenone, and one week after drug withdrawal. Propafenone treatment was found to reduce significantly ectopic ventricular beats, especially with the higher dosage (44.9% reduction under 450 mg; 88.8% reduction under 900 mg). At the lower dosage, 25% of patients responded, under the higher dosage 88.9%; the latter dosage also induced a significant reduction of Lown class. Propafenone treatment was also accompanied by a reduction of maximum and mean heart rate, and by a lengthened PR interval which was almost always within the normal range, without changes of QTc. The two months of propafenone treatment did not induce significant changes of cardiac volume or left ventricular function; on the contrary, at the end of the treatment period an increase, albeit not a significant one, of the ejection fraction and a shortening of the circumference inversely proportional to the reduction in ectopic ventricular beats could be noted. In conclusion, propafenone was found to have a valid antiarrhythmic effect, especially at the 900 mg/day dosage without interfering with left ventricular function which was even found to improve under chronic treatment, probably as a result of improved compliance thanks to the reduction of ventricular ectopic beats.

[Evaluation of arteriolar reactivity and blood coagulation parameters during picotamide treatment]

Thirty-two patients, nineteen males and thirteen females, mean age 59.4 +/- 11.9 years, 18 with peripheral arteriopathy Fontaine stage II and 14 with cerebral vasculopathy were submitted to treatment with picotamide, 900 mg/die. In basal conditions and after 30 and 60 days of treatment, we evaluated some blood clotting parameters concerning both platelets (circulating platelet aggregates, beta-thromboglobulin, TxB2, 6-keto-pgF1 alpha) and plasma (fibrinogen, plasminogen, ATIII, Factor VIII-C and VIII Ag, prothrombin time, activated thromboplastin time) and some instrumental parameters such as walking distance and Doppler with a post-ischaemic hyperaemia test in patients with peripheral arteriopathy and Doppler of epiaortic vessels with resistance and pressure-perfusion index evaluation in patients with cerebral vasculopathy. Treatment with picotamide significantly reduced circulating platelet aggregates, beta-TG and TxB2 levels, without change of 6-keto-PGF-alpha values, with reduction of F VIII-C and slight increase of plasminogen and ATIII levels. In patients with peripheral arteriopathy after two months, a significant increase in distance and an improvement of arteriolar reactivity were observed, as shown by increase of the perfusion-index and by reduction of the post-ischaemic recovery time. These observations, together with the good tolerance of the drug, justify the use of picotamide in the treatment of patients with atherosclerotic vasculopathy at different localizations.

[Changes in the QT interval caused by autonomic cardiovascular involvement in diabetes mellitus]

The aim of the study was to assess the role of altered autonomic regulation on changes in the QT interval. Fifty-three diabetic patients, comprising 32 men and 21 women with a mean age of 49.4 +/- 15.9 years (range 13-73 years), underwent sympathetic and parasympathetic stimulatory tests (changes in heart rate between clino- and orthostatism, lying to standing, while deep breathing, Valsalva's manoeuvre, changes of arterial pressure related to posture) to study cardiovascular reflexes. Patients who were positive for at least two of the tests were considered to be affected by autonomic neuropathy. Ten non-diabetic age-matched subjects (44.8 +/- 14.8 years) with no cardiovascular diseases were included in the study as a control group. The QTc interval was measured in basal conditions and during sympathetic and parasympathetic stimulatory tests, in clino- and orthostatism, during deep breathing and Valsalva's manoeuvre. A significantly greater QTc interval (p less than 0.05) was found in neuropathic patients compared to controls and non-neuropathic patients both in basal conditions and following stimulatory tests at the lowest heart rate (phase IV of Valsalva's manoeuvre and slow exhalation during deep breathing), while at a higher heart rate (orthostatism, L-S, deep inhalation during deep breathing, phase II of Valsalva's manoeuvre) there was no difference in QTc between controls, and neuropathic and non-neuropathic patients due to a lesser extension of the QTc in neuropathic patients. This difference appears to be the expression of autonomic dysregulation in neuropathic patients, given the lack of correlation with diabetes or duration of disease, and is only conditioned by the presence or absence of autonomopathic damage. Among other causes, the observed extension of the QT interval might therefore justify the increased frequency of sudden death in diabetic patients with cardiovascular autonomic neuropathy.