Adherence to Mediterranean diet in liver transplant recipients: a cross-sectional multicenter study

BACKGROUND

Seeing the importance of healthy diet after liver transplant (LT), our study aimed to evaluate the adherence to Mediterranean diet (MD) in a large population of LT recipients.

METHODS

The present multicenter study was developed in clinically stable, liver transplanted patients, from June to September 2021. Patients completed a survey about adherence to MD, Quality of Life (QoL), sport, and employment. To analyze the correlations, we computed Pearson's coefficients; while to compare subgroups, independent samples t-tests and ANOVAs. We used a multivariable logistic regression analysis to find the predictors of impaired adherence to MD.

RESULTS

The questionnaire was administered to 511 patients. They were males in 71% of cases with a mean age of 63.1 years (SD±10.8). LT recipients coming from central Italy displayed higher adherence to the MD (M=11.10±1.91) than patients from northern (M=9.94±2.28, P<0.001) or southern Italy (M=10.04±2.16, P<0.001). Patients from central Italy showed a significantly higher consumption of fruit, vegetables, legumes, cereals, olive oil, fish and a significantly lower intake of dairy products than patients resident in the other Italian areas. At multivariate analysis, recipients from central Italy were 3.8 times more likely to report adherence to the MD. Patients with a high physical health score were more adherent to MD, as well as patients transplanted at an earlier time.

CONCLUSIONS

We demonstrated that place of stay, time from transplant and physical dimension of QoL significantly influences the adherence to MD. Continuous information campaigns about a correct diet and lifestyle would be necessary.

Physical activity in liver transplant recipients: a large multicenter study

AIM

Healthy lifestyle and appropriate diet are of critical importance after liver transplant (LT). We provided an analysis of the main patterns of physical activity and found factors associated with physical activity itself.

METHODS

Clinically stable LT recipients were enrolled between June and September 2021. Patients completed a composite questionnaire about physical activity, adherence to Mediterranean Diet (MD), quality of life (QoL), and employment. Correlations were analysed using the Pearson coefficients while different subgroups were compared by t-test for independent samples or ANOVAs. Multivariable logistic regression analysis was conducted to find predictors of inactivity.

RESULTS

We enrolled 511 subjects (71% males, mean age 63 ± 10.8 years). One hundred and ninety-three patients reported high level of physical activity, 197 a minimal activity and 121 declared insufficient activity. Among these latter, 29 subjects were totally inactive. Considering the 482 LT recipients performing some kind of physical activity, almost all reported a low-quality, non-structured activity. At multivariate analysis, time from LT (odds ratio 0.94, 95% CI 0.89-0.99, p = 0.017), sedentary lifestyle (odds ratio 0.99, 95% CI 0.19-0.81, p = 0.012), low adherence to MD (odds ratio 1.22, 95% CI 1.01-1.48, p = 0.049), and low level of QoL (physical dimension) (odds ratio 1.13, 95% CI 1.08-1.17, p < 0.001), were independently associated with total inactivity.

CONCLUSION

A large portion of LT recipients report an insufficient level of physical activity or are wholly inactive. Inactivity increases with time from LT and was strongly associated with suboptimal diet and low QoL.

Effects of cancer severity on the relationship between emotional intelligence, perceived social support, and psychological distress in Italian women

PURPOSE

This study aims to understand the association between emotional intelligence, perceived social support, and psychological distress (i.e., anxiety, depression, stress) in women with cancer at different stages. Specifically, the aims of this study were to investigate: i) the links between emotional intelligence and psychological distress (i.e., symptoms of anxiety, stress and depression); ii) the mediating role of perceived social support provided by family members, friends, and significant others in the relationship between emotional intelligence and psychological distress; iii) the impact of cancer type and cancer stage (I-II vs III-IV) in moderating these relationships, among Italian women.

METHODS

The research sample consisted of 206 Italian women (mean age = 49.30 ± 10.98 years; 55% breast cancer patients) who were administered a questionnaire to assess emotional intelligence, perceived social support, and psychological distress. Structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model.

RESULTS

Emotional intelligence had a positive association with perceived social support, which in turn prevented psychological distress only in women with early-stages cancers. The type of cancer has no effect on these relationships.

CONCLUSIONS

The findings of this study indicate a pressing need to screen and recognize women with lower emotional intelligence and perceived social support, as they may be more prone to experiencing psychological distress. For such individuals, our results recommend the implementation of psychological interventions aimed at enhancing emotional intelligence and fortifying their social support networks, with consideration for the stage of cancer they are facing.

Measuring Spiritual Well-being using a numerical rating scale: Additional evidence of the validity of the Well-being Numerical Rating Scales (WB-NRSs)

The Well-being Numerical Rating Scales (WB-NRSs) can be used to assess rapidly and accurately different types of well-being. However, the spiritual well-being scale showed slightly weaker psychometric properties. This study aimed to further investigate its suitability in measuring spiritual well-being. Participants (N = 270, age: M = 32.98; SD = 15.64; 67% females) were administered a questionnaire including spiritual well-being, gratitude, compassionate love, and personality traits measures. A network analysis (based on correlations) was used to display graphically the pattern of relationships among the measured constructs (i.e. the nomological net). Results provided evidence that the scale measures spiritual well-being as defined in the literature, that is, a component distinct from faith and compassionate love, but connected to meaning in life, quality of relationships, personality traits, and gratitude. These findings confirm the WB-NRSs is a psychometrically sound and easy-to-use tool with clear benefits for both research and clinical assessment.

Attitudes and perceptions of Italian Students in Healthcare Settings on COVID-19 vaccines and vaccinations strategies, one year after the immunization campaign

Background

The topic of vaccine confidence is increasingly relevant, particularly due to the COVID-19 pandemic and the global distribution of COVID-19 vaccines. This issue is even more critical for students in healthcare settings, given their future role not only as vaccine recipients but also as advocates for vaccination. In light of this, achieving a good level of vaccine acceptance is crucial. Hence, the aim of our study was to evaluate the attitudes and perceptions of healthcare students regarding vaccines and COVID- 19 vaccination.

Methods

Medical and pharmaceutical area students attended an Elective Teaching Activity on COVID-19 vaccines and vaccination campaign, organized at the University of Florence (Italy) and participated in filling two anonymous questionnaires. The first questionnaire was submitted before the Elective Teaching Activity was focused on students' attitudes and perceptions toward vaccines. The second questionnaire was designed to evaluate the students' satisfaction with the course topics. Both descriptive and inferential analyses were performed on the results. In addition, the Vaccine Confidence Index was calculated to evaluate the propensity of students toward vaccinations.

Results

A total of 423 students attended the Elective Teaching Activity in the early beginnings of 2022. Overall, students have shown greater confidence in vaccines, compared to COVID-19 vaccines, especially as regards the safety profile. Students' Vaccine Confidence Index was very close to 0.25 value, which indicates being in favor of vaccinations. Nevertheless, in the satisfaction questionnaire filled in at the end of the course, the percentage of students in favor of COVID-19 vaccination increased for both medical (from 94% to 99%) and pharmaceutical area students (from 81% to 97%).

Conclusions

Our study suggests that educational activities such as this Elective Teaching Activity, could be considered an effective teaching strategy to improve vaccine acceptance rates among students in healthcare settings.

Chinese cross-cultural adaptation and validation of the Well-being Numerical Rating Scales

Introduction

Well-being is a multi-domain concept that involves measuring physical, psychological, social, and spiritual domains. However, there are currently few multi-domain and comprehensive well-being instruments available. In addition, measures that do exist customarily contain a vast number of items that may lead to boredom or fatigue in participants. The Well-being Numerical Rating Scales (WB-NRSs) offer a concise, multi-domain well-being scale. This study aimed to perform the translation, adaptation, and validation of the Chinese version of WB-NRSs (WBNRSs-CV).

Methods

A total of 639 clinical participants and 542 community participants completed the WB-NRSs-CV, the Single-item Self-report Subjective Well-being Scale (SISRSWBS), the World Health Organization Five-item Well-Being Index (WHO-5), the 10-item Perceived Stress Scale (PSS-10), and the Kessler Psychological Distress Scale (K10).

Results

High internal consistency and test-retest reliability were obtained for both samples. Additionally, WB-NRSs-CV was positively associated with SISRSWBS and WHO-5 and negatively associated with PSS-10 and K10. In the item response theory analysis, the model fit was adequate with the discrimination parameters ranging from 2.73 to 3.56. The diffculty parameters ranged from -3.40 to 1.71 and were evenly spaced along the trait, attesting to the appropriateness of the response categories. The invariance tests demonstrated that there was no difference in WB-NRSs-CV across groups by gender or age.

Discussion

The WB-NRSs-CV was translated appropriately and cross-culturally adapted in China. It can be used as a rapid and relevant instrument to assess well-being in both clinical and non-clinical settings, with its utility for well-being measurement and management among the Chinese people.

Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS-Total Care (TC)

AIM

The aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System-Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation.

METHODS

A sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too.

RESULTS

The questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90-100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10-50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients.

CONCLUSIONS

Only through an adequate routine assessment with validated tools is it possible to detect total suffering, the "Total pain" of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.

Touch Avoidance with Close People and Strangers: Effects of Gender, Sexual Orientation, and Relationship Status

Human contact through physical touch is a core element in social bonding, which facilitates psychosocial well-being. Touch avoidance is an individual disposition that may prevent individuals from engaging in or benefiting from physical touch. The present study recruited 450 Italian participants (51.1% female) with a mean age of 32.2 ± 13.5 to complete a battery of demographic questionnaires and the Touch Avoidance Questionnaire (TAQ). Individuals who were single and reporting same-sex attraction avoided touch with family more often than their coupled counterparts or those reporting opposite-sex attraction. Moreover, males reporting same-sex attraction avoided touch with a potential partner more frequently. When comparing sex differences, women reported greater touch avoidance with opposite-sex friends more frequently, while males avoided touch with same-sex friends more frequently. Individuals reporting opposite-sex attraction reported greater touch amongst same-sex friends. Single males avoided touch with same-sex friends more frequently than those in a relationship. Overall, this contribution reflects the individual differences related to social touch avoidance with respect to sex, relationship status, and sexual orientation in an Italian sample.

Positive Touch Deprivation during the COVID-19 Pandemic: Effects on Anxiety, Stress, and Depression among Italian General Population

Physical distancing due to the COVID-19 Pandemic has limited the opportunities for family members, friends, and significant others to show physical affection (i.e., hugs, kisses, caresses, holding hands) during social interactions. The present study investigated the effects of positive touch and psychological distress in 991 Italian participants (Mage = 34.43, SD = 14.27). Results showed the frequency of hugs with the cohabiting partner significantly decreased the symptoms of depression (β = −1.187, p = 0.018, eβ = 0.30, 95% CI = 0.11–0.82), whereas the frequency of caresses with cohabiting relatives predicted the symptoms of anxiety (β = 0.575, p = 0.034, eβ = 1.78, 95% CI = 1.04–3.03). The frequency of hugs (β = −0.609, p = 0.049, eβ = 0.54, 95% CI = 0.30–1.00), and kisses (β = 0.663, p = 0.045, eβ = 1.94, 95% CI = 1.01–3.71) with non-cohabiting relatives predicted the symptoms of anxiety (χ2 = 1.35, df = 5, p = 0.93). These results suggest the importance of positive touch on psychological well-being in the social context.

Needs evaluation questionnaire for liver disease: a novel assessment of unmet needs in patients with chronic liver disease

Patients with chronic liver disease face debilitating complications in their daily living and constantly report several types of unmet needs, but there is a paucity of validated questionnaires to assess these needs. In this study, we present the development of the Needs Evaluation Questionnaire for Liver Diseases (NEQ-LD) for the assessment of unmet needs in patients with chronic liver disease. Two hundred eighty-six outpatients with chronic liver diseases from a single tertiary referral center completed the NEQ-LD and related validity measures. Item response theory analyses were performed and demonstrated the strong psychometric properties of the questionnaire. Differential item functioning analyses showed that the scale functions equally across groups differing for age, sex, and presence of cirrhosis, suggesting the large applicability of the NEQ-LD for the assessment of unmet needs and between-group comparisons. Criterion validity measures provided evidence that unmet needs were positively associated with measures of depression and anxiety and negatively associated with measures of subjective well-being and physical and mental health. Unmet needs were expressed by a high percentage of patients, especially in the areas of information and dialogue with clinicians. One third of the sample reported material needs. Most of the items describing unmet needs were reported more frequently by patients with cirrhosis. Conclusion: We developed a reliable, valid, and largely employable instrument that can promote patient-centered care and facilitate support services in Hepatology.

Cultural Differences in How People Deal with Ridicule and Laughter: Differential Item Functioning between the Taiwanese Chinese and Canadian English Versions of the PhoPhiKat-45

The PhoPhiKat-45 measures three dispositions toward ridicule and laughter, including gelotophobia (i.e., the fear of being laughed at), gelotophilia (i.e., the joy of being laughed at), and katagelasticism (i.e., the joy of laughing at others). Despite numerous cultural adaptations, there is a paucity of cross-cultural studies investigating measurement invariance of this measure. Undergraduate students from a Canadian university (N = 1467; 71.4% females) and 14 universities in Taiwan (N = 1274; 64.6% females) completed the English and Chinese PhoPhiKat-45 measures, respectively. Item response theory and differential item functioning analyses demonstrated that most items were well-distributed across the latent continuum. Five of 45 items were flagged for DIF, but all values had negligible effect sizes (McFadden's pseudo R² < 0.13). The Canadian sample was further subdivided into subsamples who identified as European White born in Canada (n = 567) and Chinese born in China, Hong Kong, or Taiwan (n = 180). In the subgroup analyses, no evidence of DIF was found. Findings support the utility of this measure across these languages and samples.

The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic

BACKGROUND

The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic.

METHODS

A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ.

RESULTS

Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI.

CONCLUSIONS

Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.

The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility

The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043-0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001-0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.

COVID-19 vaccine uptake among family caregivers of people with dementia: The role of attitudes toward vaccination, perceived social support and personality traits

People with dementia have an increased risk of contracting severe forms of COVID-19. Although in worldwide vaccination programs priority has been given to older people, having taken the vaccine does not totally eliminate the risk of contracting COVID-19 when one is in close contact with unvaccinated people. Thus, family caregivers’ choices to remain unvaccinated against COVID-19 could have potentially lethal consequences for their relatives. To our knowledge, this study represents the first attempt within the international literature to analyze COVID-19 vaccine uptake among family caregivers of people with dementia and to identify some of the psychological factors, related to COVID-19 and vaccination behavior, that could facilitate or hinder vaccine uptake. Contact information for family caregivers was obtained from five different centers and associations throughout the Italian territory. Data were collected from 179 respondents during July-September 2021 using a cross-sectional web-based survey design. More than 75% of the respondents indicated that had been vaccinated against COVID-19 and reported receiving vaccine information mainly from print or electronic newspapers (86%), followed by TV (81%) and families (64.2%). In multivariable logistic regression analyses, worries about unforeseen future effects was significantly related to COVID-19 vaccine uptake, indicating that family caregivers concerned about potential side effects of vaccines were less likely to have been vaccinated against COVID-19 (OR = 0.60, CI = 0.40-0.89). Openness to experience was also related to COVID-19 vaccine uptake, with family caregivers higher on this trait being less likely to have been vaccinated against COVID-19 (OR = 0.83, CI = 0.71-0.98). Implications for targeting of vaccine-related messages are discussed.

Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study

BACKGROUND

Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic.

METHODS

This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis.

RESULTS

We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors.

CONCLUSIONS

Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.

The state-trait model of cheerfulness: Tests of measurement invariance and latent mean differences in European and Chinese Canadian students

The State-Trait Cheerfulness Inventory (STCI) assesses latent traits and states of cheerfulness, seriousness, and bad mood to represent the temperamental basis of humor. The present study (1) tested the generalizability of the three-factor model in both state and trait versions of the STCI across European Canadian (N = 489) and first generation Chinese Canadian (N = 147) participants completing the English version of the STCI and (2) compared latent mean differences. Results indicated the confirmatory factor analyses of the three-factor model for European White participants born in Canada and Chinese participants born in China showed adequate fit for both trait and state measures. Furthermore, substantial equivalence of factor model parameters and partial scalar invariance were found for both the state and trait STCI measures. In examining latent mean differences, European White Canadian participants reported significantly higher trait cheerfulness, z = 3.30, p < .001, d = 0.84, and lower trait bad mood z = 3.25, p < .01, d = 0.80 compared to the Chinese Canadian groups. European White Canadian participants reported significantly lower state bad mood, z = 3.59, p < .001, d = 1.15, compared to the Chinese Canadian groups. Limitations and future directions based on study findings are discussed.

Measuring Italian Resilience

Abstract. The Essential Resilience Scale (ERS) measures global trait resilience and three factors of physical, emotional, and social resilience. This study developed an Italian adaptation of the ERS and recruited participants from Italy ( N = 500) to complete the measure along with criterion validity measures of broad personality traits and related psychological concepts. Confirmatory factor analysis (CFA) demonstrated robust evidence for a well-fitting three-factor model of the ERS, with items strongly loading onto their respective latent factors. Utilizing Samejima’s graded response model, most item discrimination values were moderate-to-high, and category threshold parameters were well-distributed throughout the latent continuum. The ERS showed correlations in the expected directions with extraversion, emotionality, optimism, mastery, resilience, behavioral activation, behavioral inhibition, stress, and well-being. Cultural invariance was supported (at the scale- and item-level) with multigroup CFA and differential item functioning (DIF) with a sample of Canadian English speakers ( N = 874). Findings evinced the internal consistency (i.e., total MacDonald’s ω), factorial validity (i.e., three-factor CFA), criterion validity (i.e., personality, temperament), and convergent validity (i.e., trait resilience and well-being) of the Italian ERS. Results suggest the Italian ERS can be applied for measuring resilience for future research studies in Italian-speaking populations.

Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)

 

In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Key messages

Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up

INTRODUCTION

The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival.

AIM

The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation.

METHODS

A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field).

RESULTS

The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status.

CONCLUSIONS

The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.

The State-Trait Cheerfulness Inventory State Version-Short Form (STCI-S18): An Examination of Language Use and Psychometric Properties

The State-Trait Cheerfulness Inventory-State Version (STCI-S) measures three states of cheerfulness, seriousness, and bad mood as the temperamental basis of humor. The present study investigates (1) the development and psychometric validation of a newly developed short version and (2) test-criterion validity with state measures and language use. Study 1 (N = 933) confirmed the three-dimensional structure, and both the short and standard versions demonstrated strong psychometric properties. Study 2 (N = 617) replicated these findings in a separate sample. Study 3 (N = 750) demonstrated expected intercorrelations with self-report state measures (i.e., inspiration, self-esteem, depression, anxiety). Participants were randomized to expressive writing conditions (i.e., writing about a retrospective cheerful, serious, or bad mood scenario). Unacquainted judges' and participants' ratings of three states in their respective scenarios converged (.44 < r < .62). Retrospective states cheerfulness, seriousness, and bad mood were associated with linguistic categories (e.g., emotional tone, clout, achievement, insight) identified in the Linguistic Inquiry and Word Count (LIWC) software. The impact of personality states on word usage may only be evident in specific contexts and situations. Presence of distinctive language use in these writing samples further demonstrated test-criterion validity and practicality of the STCI-S18.

Mean differences and individual changes in nursing students' attitudes toward statistics: The role of math background and personality traits

Nursing students have compulsory statistics courses in their degree program, but they usually have negative attitudes toward statistics that may hinder their learning. The present study aims: (i) to investigate nurse students' attitudes toward statistics and the relationships with mathematical background and personality traits; (ii) to stress individual changes in attitude that occur during the course; and (iii) to explore if mathematical background and personality traits influence these changes. We adopted a one-group pre-post survey study. Fifty nursing students were enrolled in an introductory statistics course at the Sapienza University of Rome in Italy during the 2018-2019 academic year. Participants were surveyed at the beginning and end of the course administering a multidimensional measure of attitude toward statistics. Multiple regression analyses were run to establish the relative impact of mathematical background and Big Five personality factors on attitude components, as well as the changes in these attitude components. Results confirmed the predictive role of mathematic competence on some attitude dimensions and showed that also personality traits influenced attitudes toward statistics. However, the observed changes in attitudes during the course were minimally influenced by these factors. Findings suggest that course pedagogy can enhance students' attitudes regardless their mathematical background and personality.

Playing With Networks

Abstract. Video gaming behavior may offer information about the players and the widespread diffusion of this form of entertainment produces a staggering amount of data about gaming behaviors. The aim of the current study was to investigate the possibility to use the information about the way the player acts and reacts in a competitive video game to assess personality traits inside the HEXACO space. Deep learning was used to train deep neural networks that classified a sample of players ( N = 41) with different personality traits by how they play in a Massive Online Battle Arena (MOBA) video game. Results suggested that the likelihood of correctly identifying the player’s trait level was above chance for five out of the six personality dimensions, but there is a medium to high margin of error in the classification. These findings provide interesting suggestions to set the premises for future studies to test the feasibility of this alternative assessment tool.

Measuring self-control across gender, age, language, and clinical status: A validation study of the Italian version of the Brief Self- Control Scale (BSCS)

The present study aims to develop and validate an Italian version of the Brief Self-Control Scale (BSCS). A large sample of Italian-speaking participants (N = 1139) completed the BSCS and measures of personality and individual dispositions. A clinical sample (N = 217) was administered the Italian version and an English-speaking sample (N = 274) completed the original version to test measurement invariance. Using confirmatory factor analysis, the best fit was observed for a shortened two-factor model (i.e., impulse control and self-discipline). Metric invariance across languages and partial strong invariance across genders, ages, and clinical status were demonstrated. Internal consistency and test-retest reliability for the total scale were adequate, and validity was established based on its correlations with related constructs and confirming that males and young individuals are more likely to have lower self-control. Results support the use of the shortened BSCS version to assess self-control in Italian-speaking individuals.

Development and Linguistic Cue Analysis of the State-Trait Cheerfulness Inventory-Short Form

The present study derived a short form of the State-Trait Cheerfulness Inventory-Trait Version (STCI-T30) using an item response theory framework. Latent trait test-retest correlations and reliability across the latent continuum in the STCI-T30 remained high. Moreover, the STCI-T30 showed external validity with criterion variables (e.g., playfulness) and a short writing task completed by these participants was rated by unacquainted judges to infer the author's cheerfulness, seriousness, and bad-mood. Results suggested significant self-other and inter-judge agreement of cheerfulness, seriousness, and bad-mood and linguistic cues analysis suggested cheerfulness and bad-mood manifested through writing in tone, social processes, and affect.

A revised short version of the compassionate love scale for humanity (CLS-H-SF): evidence from item response theory analyses and validity testing

Background

Compassionate love is defined as awareness and understanding of one’s suffering, connecting with the distress, and being emotionally and cognitively moved to alleviate suffering. The Compassionate Love Scale for Humanity (CLS-H) was developed to measure compassion towards strangers who need help and/or are vulnerable. The present study aimed to develop an abbreviated version of the CLS-H using item response theory to provide a precise and non-redundant compassion measure for use in research and practice.

Methods

Undergraduate students (N = 790; 65.8% females) completed the CLS-H and other measures intended to establish external validity. Items for the short version were selected based on high amounts of information and taking into account the content coverage of the construct.

Results

The shortened scale consisted of 9 items and performed well in measuring a large spectrum of the underlying construct with acceptable reliability. In terms of validity, the previously observed pattern of correlations was confirmed demonstrating positive associations between compassionate love and measures of self-esteem, positive affect, and life satisfaction, as well as negative associations with negative affect and anxiety.

Conclusions

Using IRT, we obtained a brief, precise, and valid tool for assessing compassionate love.

The Italian Version of the State-Trait Cheerfulness Inventory Trait Form: Psychometric Validation and Evaluation of Measurement Invariance

The State-Trait Cheerfulness Inventory–Trait Version (STCI-T60) measures the temperamental basis of sense of humor involving theoretically derived personality dispositions of cheerfulness, seriousness, and bad mood. The reliability and validity of the newly developed STCI-T60 Italian version were assessed in a sample of Italian speakers ( N = 683). Proper fit for a three-dimensional factor structure observed in previous studies was replicated and each factor demonstrated acceptable internal consistency and test–retest reliability. The associations between the STCI subscales and major personality dimensions, optimism, resilience, stress, and general well-being were further examined and results were in the expected directions (e.g., cheerfulness and bad mood being positively and negatively associated with well-being variables, respectively). Cross-cultural invariance examination was conducted to provide more validity data for the Italian STCI. Metric invariance was found between Italian and Canadian English speakers ( N = 632), but scalar invariance was not shown.

Validation study of the Italian version of Communication Activities of the Daily Living (CADL 2) as an ecologic cognitive assessment measure in older subjects

INTRODUCTION

Communication can be affected by age related cognitive decline and mental deterioration. The second edition of the Communication Activities of the Daily Living (CADL 2) appears as an interesting ecological assessment tool of cognitive functions in old age.

OBJECTIVE

The aim of this work is to (1) develop an Italian version of CADL 2, (2) to test its psychometric properties in terms of reliability and validity, and (3) to measure CADL 2 discriminative capacity between cognitively healthy and cognitively impaired older subjects.

METHOD

One hundred and eleven subjects were enrolled (36 M; 75 F, age 80, 80.85 ± 7 years, education 9.3 ± 4.7 years). The CADL 2 was administered together with a standard neuropsychological battery.

RESULTS

The CADL 2 showed good reliability and correlates with all the cognitive evaluation tests. The CADL 2's area under the curve was equal to 0.80, index of good diagnostic accuracy.

CONCLUSIONS

The CADL 2 is an appropriate assessment tool for communication skills in aging.

What is the temperamental basis of humour like in China? A cross-national examination and validation of the standard version of the state-trait cheerfulness inventory

The State-Trait Cheerfulness Inventory-trait version (STCI-T60) consists of three dimensions of cheerfulness, seriousness, and bad mood integrated to measure the temperamental basis of the sense of humour. The present study replicated the three-dimensional factor structure of the STCI in China using 60 items consistent with other standard trait versions (e.g., English, Chilean-Spanish). Closer examination of associations between traits suggested bad mood showed curvilinear associations with both cheerfulness and seriousness, such that cheerfulness and bad mood were negatively associated for those low and average in trait bad mood but not for those with high trait bad mood. Seriousness was positively associated with bad mood at high levels of trait bad mood, but not at average or low levels of bad mood. Associations between the STCI traits and major personality dimensions, humour styles, and well-being were further examined. Cheerfulness and seriousness showed positive associations with satisfaction with life and emotional well-being (EWB) while bad mood showed a curvilinear association with EWB. Using multi-group confirmatory factor analyses, partial metric invariance was found between English and Chinese versions of the STCI-T60, but structural invariance was not observed. Implications based on the empirical literature in dialecticism and cross-cultural assessment were thoroughly discussed.

Applying Item Response Theory to Develop a Shortened Version of the Need for Cognition Scale

The 18-item Need for Cognition Scale (NFC-18) is the most commonly used tool to measure the need for cognition. The aim of this study was to explore the possibility of developing an abbreviated version of the scale, applying the item response theory (IRTirt). Item response theory analyses suggested the exclusion of eight items that did not perform well in measuring the latent trait. The resulting 10-item scale (NFC-10), which included highly discriminative items, covered the same range of the measured trait as the original scale and showed high measurement precision along various levels of the trait. Additionally, since IRT analyses can only confirm the accuracy of the short scale in measuring the underlying construct, we sought to replicate the nomological net of the NFC-18 using the shortened version of the scale. The results showed that the NFC-10 reflects an adequate operationalization of the construct, in line with the longer version. In particular, as expected, the NFC-10 showed moderate relations with various measures of cognitive skills and self-report measures of cognitive styles, confidence, and anxiety. These findings confirm that we have obtained a much shorter version of the NFC that maintains excellent reliability and validity

Are Three Items Sufficient to Measure Sense of Coherence?

Abstract. The present study aimed at evaluating if the three-item sense of coherence (SOC) scale developed by Lundberg and Nystrom Peck (1995) can be effectively used for research purpose in both nonclinical and clinical samples. To provide evidence that it represents adequately the measured construct we tested its validity in a nonclinical (N = 658) and clinical sample (N = 764 patients with cancer). Results obtained in the nonclinical sample attested a positive relation of SOC – as measured by the three-item SOC scale – with Antonovsky’s 13-item and 29-item SOC scales (convergent validity), and with dispositional optimism, sense of mastery, anxiety, and depression symptoms (concurrent validity). Results obtained in the clinical sample confirmed the criterion validity of the scale attesting the positive role of SOC – as measured by the three-item SOC scale – on the person’s capacity to respond to illness and treatment. The current study provides evidence that the three-item SOC scale is a valid, low-loading, and time-saving instrument for research purposes on large sample.

Hope Herth Index (HHI): A Validation Study in Italian Patients with Solid and Hematological Malignancies on Active Cancer Treatment

Aims and background

Although hope is a widely used term, the experience of hope in patients with chronic or even life-threatening diseases is often disregarded due to the scarcity of carefully designed and validated assessment tools. The aim of this study was to validate the Hope Herth Index (HHI) questionnaire in the Italian population of patients with solid or hematological malignancies during active cancer treatment.

Methods

After the translation procedures, the psychometric properties of the Italian version of HHI were evaluated in 266 patients with non-advanced cancer cared for in four different settings. Summative scores ranged from 12–48, with a higher score denoting greater hope. Confirmative factorial analysis was performed to assess dimensionality. The test-retest reliability was assessed by means of the Lin concordance coefficient (two weeks' interval, 80 patients). Concurrent validity was assessed through the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), Edmonton Symptom Assessment Scale (ESAS), and System Belief Inventory (SBI-15R).

Results

A total of 266 patients were enrolled. Confirmative factor analysis did not confirm the original three-factor solution, whereas a one-factor solution did perform well. Cronbach's alpha was 0.84 and the test-retest reliability was 0.64 (95% CI 0.51; 0.76). Large convergence was found with spiritual well-being as measured by the FACIT-Sp (0.69) and with anxiety-depression as measured by the HADS (inverse correlation: –0.51). Physical symptoms and religiousness were only slightly correlated, as expected.

Conclusions

The Italian version of HHI is a valid and reliable assessment tool – useful to initiate conversation with someone who is troubled but finds it difficult to talk – in patients with either solid or hematological malignancies on active cancer treatment during the non-advanced stages of the disease.

Gambling-Related Distortions and Problem Gambling in Adolescents: A Model to Explain Mechanisms and Develop Interventions

Although a number of gambling preventive initiatives have been realized with adolescents, many of them have been developed in absence of a clear and explicitly described theoretical model. The present work was aimed to analyze the adequacy of a model to explain gambling behavior referring to gambling-related cognitive distortions (Study 1), and to verify the effectiveness of a preventive intervention developed on the basis of this model (Study 2). Following dual-process theories on cognitive functioning, in Study 1 we tested a model in which mindware gap, i.e., susceptibility to the gambler's fallacy, and contaminated mindware, i.e., superstitious thinking, were the antecedents of gambling-related cognitive distortions that, in turn, affect gambling frequency and problem gambling. Participants were 306 male adolescents (Mage = 17.2 years). A path analysis indicated that cognitive distortions have a mediating role in the relationship that links probabilistic reasoning fallacy and superstitious thinking with problem gambling. Following these findings, in Study 2 we developed a school-based intervention aimed to reduce gambling-related cognitive distortions acting on the above cited mindware problems. A pre- and post-test design - with a 6 months follow-up - was performed with 34 male adolescents (Mage = 16.8), randomly assigned to two groups (Training and No Training), and their baseline equivalence was verified. A Mixed 2 × 2 ANOVA attested a significant Time X Group interaction, indicating a significant reduction of the cognitive distortions from pre-test to post-test only in the Training group. The follow-up attested to the stability of the training effects and the reduction of gambling frequency over time. These findings suggest that prevention strategies should address mindware problems, which can be considered as predictors of gambling-related cognitive distortions.

Is the 15-item Geriatric Depression Scale a Fair Screening Tool? A Differential Item Functioning Analysis Across Gender and Age

The 15-item version of the Geriatric Depression Scale (GDS-15) is widely employed to assess depression in old people, but it is unclear if there are biases in the total score depending on respondents' gender and age. In the current study, we investigated the measurement equivalence of the GDS-15 to provide evidence that the test is a fair screening tool when administered to young-old, old-old, and oldest-old men and women. Item Response Theory-based Differential Item Functioning analyses were applied on a large sample of Italian old people. One item exhibited Differential Item Functioning when comparing men and women, and one item showed Differential Item Functioning across different age-groups. Nonetheless, the magnitude of Differential Item Functioning was small and did not produce any differential test functioning. The gender and age measurement equivalence of the GDS-15 confirms that the test can be used for clinical and research screening purposes.

Assessing unmet needs in patients with cancer: An investigation of differential item functioning of the Needs Evaluation Questionnaire across gender, age and phase of the disease

The Needs Evaluation Questionnaire (NEQ) is a self-administered instrument used in oncology clinical practice and research.

Gender Invariance of the Gambling Behavior Scale for Adolescents (GBS-A): An Analysis of Differential Item Functioning Using Item Response Theory

As there is a lack of evidence attesting the equivalent item functioning across genders for the most employed instruments used to measure pathological gambling in adolescence, the present study was aimed to test the gender invariance of the Gambling Behavior Scale for Adolescents (GBS-A), a new measurement tool to assess the severity of Gambling Disorder (GD) in adolescents. The equivalence of the items across genders was assessed by analyzing Differential Item Functioning within an Item Response Theory framework. The GBS-A was administered to 1,723 adolescents, and the graded response model was employed. The results attested the measurement equivalence of the GBS-A when administered to male and female adolescent gamblers. Overall, findings provided evidence that the GBS-A is an effective measurement tool of the severity of GD in male and female adolescents and that the scale was unbiased and able to relieve truly gender differences. As such, the GBS-A can be profitably used in educational interventions and clinical treatments with young people.

What About the Different Shortened Versions of the Mindful Attention Awareness Scale?

Given the mixed conclusions on the psychometric properties of the Mindful Attention Awareness Scale (MAAS) and the variety of subsets of items identified as abbreviated forms, the current study aimed to (a) further investigate the performance of single items and different combinations of items of the MAAS from within an Item Response Theory framework, (b) to expand upon existing knowledge about the coverage of the construct of the scale and its shortened versions. A sample of 914 participants (67.6% women; mean age 23.28, SD = 4.77) completed the MAAS. To fulfill the second aim of the study, of the total sample, two subsamples (N = 156 and N = 158, respectively) were administered a battery of self-report questionnaires. Analyses attested that four items of the MAAS have weak psychometric properties and that the reliability of the scale remains unchanged when these items are excluded. The relationships with several constructs (consciousness, present-time attitude, emotional intelligence, alexithymia, emotion regulation strategies, behavioral inhibition and activation, affect, anxiety, and depression) provided evidence that the scale adequately reflects the operationalization of the construct, although some facets of the construct are only partially covered. The current findings confirm that the MAAS might be slightly shortened without reducing its reliability and validity, but drastically abbreviated forms, such as the proposed five-item version, fail to maintain adequate psychometric properties.

The local reliability of the 15-item version of the Geriatric Depression Scale: An item response theory (IRT) study

The 15-item version of the Geriatric Depression Scale (GDS-15) is a self-report screening instrument widely used. The current study aimed at providing evidence of the measurement precision of the GDS-15 applying Item Response Theory (IRT). The relative contribution of each item and the reliability of the whole scale in measuring the trait level around the cutoffs were investigated employing data collected from a sample consisting of 1344 old people (M=76.44years, SD=5.13; 58.7% women) involved in a large gerontological research project. The unidimensional two-parameter (2PL) logistic model was employed to item estimate location and slope parameters as well as the Test Information Function (TIF). Nine out of fifteen items were located around the cutoffs and the slopes showed that the majority of the items had substantial discrimination ability. The TIF peaked in correspondence of the cutoffs attesting the good local reliability of the scale. These findings support to the utility of the GDS-15 in detecting depression among older people.

Use of the Needs Evaluation Questionnaire with cancer outpatients

PURPOSE

The Needs Evaluation Questionnaire (NEQ) is a self-administered instrument with 23 dichotomous items that is used both in oncology clinical practice and in research. It was originally developed for use in setting of hospitalization. The aim of the present study was to assess the factor structure of the NEQ in an outpatient oncology sample and to compare the unmet needs of inpatients and outpatients in the Italian context.

METHODS

In 6 Italian oncology departments, 783 patients completed the NEQ. Patients included in the study had different primary tumor sites and were in different phases of the disease and care process. There were 195 inpatients and 588 outpatients total.

RESULTS

Confirmatory factor analysis (CFA) showed that, with outpatients, the NEQ retained the distribution of the items in five main areas previously described with inpatients. Cancer outpatients expressed high percentages of unmet needs primarily concerning "material needs" and "needs for psycho-emotional support." Our survey also suggested that, in addition to the 23 original items, four new items could be tested for specific use with outpatients.

CONCLUSIONS

Our findings highlight the importance of establishing routine assessment of unmet needs also in clinical oncology settings different from wards-such as day hospitals, ambulatory rehabilitation, or follow-up ambulatory care-where, at least in the Italian context, the rate of unmet needs is currently considerably high. The NEQ could be an effective tool for this assessment.

Trait Emotional Intelligence is Related to Risk-Taking Through Negative Mood and Anticipated Fear

Abstract. Existing research showed that negative mood and the anticipated fear of bad outcomes lead people to prefer risk-averse tendencies, and these effects have often been implicitly considered as a universal phenomenon. Nevertheless, interactionist accounts emphasized the importance of both person and situation in predicting outcomes. We aimed to prove whether trait Emotional Intelligence (EI; a person’s characteristic) was related to risk-taking through factors naturally occurring in decision-making processes (i.e., negative mood and anticipated fear). One hundred fifty-eight participants completed the Positive and Negative Affect Schedule (PANAS), the anticipated fear rating and the hot-Columbia Card Task (CCT; a risk-taking measure), 1 month following assessment of trait EI. Results showed that negative mood and anticipated fear were two simultaneous mediators of the relationship between trait EI and risk-taking.