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Based on a multi-dimensional model of wellbeing in school that includes psychological, cognitive and social components, the aim of this investigation was to (a) analyse differences based on gender and school level (primary or middle school) in children’s subjective reports of their school wellbeing, (b) analyse correlates of subjective school wellbeing considering learning skills, grades and behavioural problems, and (c) investigate parents’ and teachers’ personal experiences and observations related to children with a low level of subjective school wellbeing. The sample comprised 1038 third- to eighth-grade students who completed the Questionnaire on School Wellbeing (QBS; Tobia and Marzocchi in QBS 8-13. Questionari per la valutazione del benessere scolastico e identificazione dei fattori di rischio [QBS 8-13. Questionnaires for the evaluation of school wellbeing and the identification of risk factors], Erickson, Trento, 2015a), which investigates the gratification obtained by results in school, relationships with teachers and classmates, emotional attitude towards school, and self-efficacy. The results showed significant gender differences (e.g., a better relationship with teachers but a poorer emotional attitude towards school for girls) and lower scores on school wellbeing in middle school students compared to primary school students. Among primary school students, wellbeing tended to be positively influenced by learning skills, whereas it was positively influenced by grades and negatively influenced by behavioural problems among middle school students. Finally, both parents and teachers of children with low levels of school wellbeing described greater feelings of worry, guilt, and tension in relation to the children’s difficulties. Parents reported more learning and emotional difficulties in these children, whereas teachers reported lower self-awareness. These results may offer insights to inform school policies and interventions aimed at improving children’s wellbeing.

Background It is important to examine factors associated with patient adherence to hypertension control strategies. Purpose A meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients. Methods Journal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review. Results Findings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses. Conclusions Functional social support, but not structural social support, was associated with adherence in hypertensive patients.

PURPOSE:To evaluate the visual outcomes and possible complications of a new foldable sutureless scleral fixation intraocular lens (SSF-IOL), the Carlevale IOL (Soleko). METHODS:The SSF-IOL, which has two T-shaped self-blocking plugs on each haptic, was inserted into the posterior chamber. Both haptics was grabbed through two sclerotomies and the two short arms were blocked under the scleral flap, without any suture. A complete clinical evaluation was done preoperatively and at 3, 6, and 12 months postoperatively. RESULTS:A total of 54 eyes of 50 consecutive patients were retrospectively analyzed. The mean corrected distance visual acuity was 0.93 ± 0.61 logMAR preoperatively and improved to 0.42 ± 0.34 logMAR at 3 months, 0.42 ± 0.37 logMAR at 6 months, and 0.38 ± 0.38 logMAR at 12 months postoperatively (all P < .0001). The mean corneal endothelial cell density decreased from 1,725.37 ± 528.06 to 1,612.81 ± 522.91 cells/mm2 at 12 months postoperatively (P < .0001). The mean IOL tilt value was 3.1 ± 1.1° at 12 months postoperatively. The authors observed 6 cases (11.1%) of intraoperative rupture of the IOL haptics, 4 cases (7.4%) of early hyphema, 4 cases (7.4%) of macular cystoid edema, 2 cases (3.7%) of haptic exposure under the conjunctiva, and 1 (1.8%) late retinal detachment. CONCLUSIONS:This newly introduced surgical technique provided promising results regarding efficacy and safety. Complications occurred in a few cases and were successfully managed. The Carlevale IOL seems to be a surgical solution combining the advantages of an easy and minimally invasive implantation with a good functional recovery with minimal complications.[J Refract Surg. 2021;37(2):126–132.]

•Managed Entry Agreements can be classified into 2 main categories: financial-based agreements (FBAs) and outcome-based agreements (OBAs).•FBA offers short-term relief but may disincentivize investment in Advanced Therapy Medicinal Products (ATMPs).•For ATMPs targeting rare conditions, limited biological knowledge complicates endpoint selection, prolonging uncertainties in spread payments and outcome-linked payments. Such selection becomes even more challenging when survival is not a driver.•The fragmentation in the US health care system hinders OBAs, but a new Cell and Gene Therapy Access model enables direct negotiations with the Centers for Medicare & Medicaid Services, streamlining implementation.•Although no specific challenges or opportunities related to particular types of ATMPs (gene therapy, cell therapy, or tissue-engineered-specific) were identified, some were exacerbated by the intrinsic nature of ATMPs. Managed Entry Agreements (MEAs) are agreements between firms and competent authorities for pricing and reimbursement, designed to enable coverage of new medicines while managing uncertainties around their financial impact or performance. Although these agreements can facilitate patient access, their complexity and costs seem to dampen enthusiasm for implementation. Nevertheless, MEAs remain a potential route, particularly for high-cost drugs with uncertain value claims. Given their pivotal role in bridging Advanced Therapy Medicinal Products (ATMPs) to patients, their foreseeable future implementation calls for a specific investigation of their associated challenges and opportunities. Therefore, this work aims to identify challenges and opportunities in implementing MEAs specifically for ATMPs. A systematic literature review was conducted on PubMed, MEDLINE, Scopus, and Google Scholar, based on the updated Preferred Reporting Items for Systematic Review and Meta-Analysis. This has been supplemented by a snowball search. Through the thematic content analysis, opportunities and challenges were identified and grouped into themes and subthemes. Afterward, the subgroup analysis was performed to investigate challenges and opportunities with outcome-based agreements (OBAs) versus financial-based agreements (FBAs), jurisdiction, and ATMP type. Of the 787 peer-reviewed articles, 42 met the inclusion criteria. Challenges and opportunities were clustered into the mentioned themes: evidence generation and data management, financial and reimbursement, administration and resources, negotiation, and governance, law, and regulations. Of note, no specific challenges or opportunities were found to be cell- or gene-therapy-specific, but certain challenges seem amplified for ATMPs. Several differences emerged per MEA type and jurisdiction. OBAs are described to reward innovative and effective treatments and boost research and development (R&D) returns. FBAs improve cost-effectiveness ratios but can negatively affect curative ATMP's revenues. Still, their versatility facilitates payer engagement in MEA combinations (eg, OBA with spread payments). The US decentralized health care system reported additional implementation challenges to OBAs. Each payer internally decides on reimbursement, and coordination among private payers is hindered by antitrust law. Yet, a new Cell and Gene Therapy Access model has been proposed. This would allow manufacturers to negotiate OBAs directly with the Centers for Medicare & Medicaid Services avoiding individual negotiation with each state. In Europe, there is an evident interest in implementing spread payments, yet accounting rules currently hamper their implementation. This work offers insights into challenges and opportunities in MEAs implementation for ATMPs by investigating differences in MEA types and jurisdictions. Our findings provide significant insights that may help move successful MEA implementation forward, improving patient access to ATMPs.

International literature in the field of rehabilitation and psychological support is increasingly characterized by the inclusion and use of video games and virtual media, even if the results are controversial. The theoretical basis on which the study presented is based is Video Game Therapy®. This approach uses commercial video games, which are generally free or available at a relatively low cost. These games possess many essential functions that make them practical as preventive tools or support for integration into traditional therapies. Video Game Therapy® allows the patient to reflect on emotional containment and cognitive self-regulation to establish a state of mental balance and well-being. It encourages insight and leads the player to reflect on some salient aspects of their character and lifestyle and their emotions and thoughts linked to specific life episodes relived in the game setting. Starting from these premises, the study shows promising results, presenting a single case of a boy with social isolation problems and relational difficulties, in which significant changes were highlighted in the perception, expression, and management of emotions, as well as in metacognition and self-efficacy.

This study proposes a psychometric validation of the Italian version of the Mentalized Affectivity Scale (MAS) developed by Greenberg and colleagues in 2017. The mentalized affectivity construct integrates mentalization ability in the process of emotional regulation. An adult sample (N = 506) completed the 60-items MAS online version. In contrast to the three-factor structure of the original version, the Italian context confirmatory and exploratory factor analyses with splitted sample (CFA = 258; EFA = 248) revealed a five-factor structure. The hierarchically structured MAS factors are: Emotional Processing (being able to process emotion in situations); Expressing Emotions (talking and knowing emotions); Identifying Emotions (awareness of emotions); Control Processing (to control emotional reactions and expression), and Autobiographical Memory (related to childhood experiences). We also verified the convergent validity and reliability of the Italian version of the MAS by correlating the above five factors with measures of emotion regulation and reflective functioning. Moreover, we analyzed the relationships among the factors of the MAS, personality measures and well-being indexes, such as life satisfaction and self-efficacy: The new 35-item MAS scale showed robust correlations with all the tested constructs. Our results confirm that the MAS is a useful measure to assess mentalized affectivity, with the Italian version showing a more complex structure than the original English one, thus enriching the literature about mentalization.

In the forensic medicine field, molecular autopsy is the post-mortem genetic analysis performed to attempt to unravel the cause of decease in cases remaining unexplained after a comprehensive forensic autopsy. This negative autopsy, classified as negative or non-conclusive, usually occurs in young population. In these cases, in which the cause of death is unascertained after a thorough autopsy, an underlying inherited arrhythmogenic syndrome is the main suspected cause of death. Next-generation sequencing allows a rapid and cost-effectives genetic analysis, identifying a rare variant classified as potentially pathogenic in up to 25% of sudden death cases in young population. The first symptom of an inherited arrhythmogenic disease may be a malignant arrhythmia, and even sudden death. Early identification of a pathogenic genetic alteration associated with an inherited arrhythmogenic syndrome may help to adopt preventive personalized measures to reduce risk of malignant arrhythmias and sudden death in the victim’s relatives, at risk despite being asymptomatic. The current main challenge is a proper genetic interpretation of variants identified and useful clinical translation. The implications of this personalized translational medicine are multifaceted, requiring the dedication of a specialized team, including forensic scientists, pathologists, cardiologists, pediatric cardiologists, and geneticists.

[This corrects the article DOI: 10.1371/journal.pone.0249272.].[This corrects the article DOI: 10.1371/journal.pone.0249272.].

Background The COVID-19 pandemic has had clear and dramatic repercussions on health, the economy, and psychosocial well-being. Behavioral measures, such as wearing facemasks and maintaining distance from others, have proven crucial in fighting the contagion’s spread. This study aimed to investigate Type A personality traits and sociodemographic predictors of adherence to governmental measures in a sample of frail individuals. Methods A sample of 105 Italians over age 60 (Mean age = 70 years; 60.6% male) affected by hypertension who participated in a previous longitudinal study were assessed through a telephone structured interview. Sociodemographic information and Type A personality traits were retrieved from the original longitudinal study. Adherence behaviors were investigated through several questions regarding the compliance with home confinement, the use of facemasks and the observance of social distancing. Repeated measures Analyses of Variance (RMANOVA), Reliable Change Index, and binomial logistic regression analysis were performed. Results Only 33.3% of the participants reported adherence to all the governmental COVID-19 measures. Being a woman (OR = 4.84; 95% CI = 1.58, 14.90; p  < 0.01), being retired (OR = 4.89; 95% CI = 1.09, 21.86; p  < 0.05), and suffering from hypertension for a relatively short time (OR = 4.20; 95% CI = 1.22, 14.44; p  < 0.05) positively predicted adherence to the governmental measures. Impulsivity resulted in a stable personality characteristic over the last ten years ( p  = 0.30). Having high levels of impulsivity (OR = 2.28; 95% CI = 1.13, 4.59; p  < 0.05) negatively predicted adherence. Conclusions Our results demonstrate that impulsivity is a stable personality facet that can have a robust negative impact on adherence behaviors to health claims. Overall, results show the importance to tailor communication strategies that consider the role of sociodemographic indicators and impulsivity to achieve a high level of adherence.

COVID-19 has brought considerable changes and caused critical psychological responses, especially among frail populations. So far, researchers have explored the predictive effect of diverse factors on pandemic-related psychological distress, but none have focused on the impact of prior depression and anxiety symptomatology adopting an extended (10-year) longitudinal design. 105 patients aged over 60, affected by hypertension who participated in a previous longitudinal study were assessed through a follow-up telephone structured interview. The Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) were used for assessing depression and anxiety symptoms and the psychological impact of COVID-19, respectively. Multiple linear regression analyses were conducted. At the assessment, participants did not report clinically relevant depression, anxiety, and psychological pandemic-related distress symptoms. However, significant mean differences between baseline and current follow-up evaluations for both depression and anxiety were found, reflecting a decrease in symptomatology over time ( p  < .001). Baseline depression symptoms ( β  = 1.483, p  = .005) significantly predicted the psychological impact of COVID-19 after 10 years. Conversely, their decrease ( β  = −1.640, p  < .001) and living with others ( β  = −7.274, p  = .041) significantly contributed to lower psychological distress scores. Our findings provide insight into the predisposing influence of depressive symptoms on pandemic-related psychological distress ten years later. Preventive interventions and strategies considering these factors are needed to better pre-empt the severe mental consequences of the pandemic.