Papers by Claudia Ravaldi
Minerva ginecologica, Jan 26, 2018
The most recent WHO recommendations "Intrapartum care for a positive childbirth experience&q... more The most recent WHO recommendations "Intrapartum care for a positive childbirth experience" highlight the need to identify women-centred interventions and outcomes for intrapartum care, and to include service users' experiences and qualitative research into the assessment of maternity care. Babies Born Better (B3) is a trans-European survey designed to capture service user views and experiences of maternity care provision. Italian service users contributed to the survey. The B3 survey is an anonymous, mixed-method online survey, translated into 22 languages. We separated out the Italian responses and analysed them using computer-assisted qualitative software (MAXQDA) and SPSS and STATA for quantitative data analysis. Simple descriptives were used for the numeric data, and content analysis for the qualitative responses. Geomapping was based on the coded qualitative data and postcodes (using Tableau Public). There were 1000 respondents from every region of Italy, using a...
Minerva Ginecologica, 2018
BACKGROUND: The most recent WHO recommendations “Intrapartum care for a positive childbirth exper... more BACKGROUND: The most recent WHO recommendations “Intrapartum care for a positive childbirth experience” highlight the need to identify women-centered interventions and outcomes for intrapartum care, and to include service users’ experiences and qualitative research into the assessment of maternity care. Babies Born Better (B3) is a trans-European survey designed to capture service user views and experiences of maternity care provision. Italian service users contributed to the survey.
METHODS: The B3 Survey is an anonymous, mixed-method online survey, translated into 22 languages. We separated out the Italian responses and analyzed them using computer-assisted qualitative software (MAXQDA) and SPSS and STATA for quantitative data analysis. Simple descriptives were used for the numeric data, and content analysis for the qualitative responses. Geomapping was based on the coded qualitative data and postcodes (using Tableau Public).
RESULTS: There were 1000 respondents from every region of Italy, using a range of places of birth (hospital, birth center, home) and experiencing care with both midwives and obstetricians. Most identified positive experiences of care, as well as some practices they would like to change. Both positive and critical comments included provision of care based on the type of providers, clinical procedures, the birth environment, and breastfeeding support. There were clear differences in the geomapped data across Italian regions.
CONCLUSIONS: Mothers highly value respectful, skilled and loving care that gives them a strong sense of personal achievement and confidence, and birth environments that support this. There was distinct variation in the percentage of positive comments made across Italian regions. Cit: Skoko E, Ravaldi C, Vannacci A, Nespoli A,Akooji N,Balaam MC, Battisti A,Cericco M,Iannuzzi L, Morano S, Downe S, "Findings from the Italian Babies Born Better Survey", Minerva Ginecologica, 2018, Vol. 70, doi: 23736/S0026-4784.18.04296-X.
Background and aims: The degree of motivation before starting the treatment represents a pre-trea... more Background and aims: The degree of motivation before starting the treatment represents a pre-treatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment MOtivation and REadiness test) (TRE-MORE) for overweight patients. Methods and results: TRE-MORE was evaluated in a consecutive series of 129 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through test-retest reliability, internal consistency, psycho-pathological correlates, and concurrent validity. Subjects have been evaluated by means of a clinical interview, and different self-reported questionnaires, assessing the eating specific and general psychopathology, and quality of life. TRE-MORE total and subscales scores showed good test-retest reliability and internal consistency. We identified 10 items grouped in 3 areas (obstacles and desire to overcome, taking care of themselves, and sharing the problems, current lifestyle). TRE-MORE scores were significantly correlated with eating specific psychopathology and quality of life measures. Univariate and Receiver Operating Characteristic curve analysis showed that TRE-MORE total and subscales scores represent a good model for predicting a weight loss >5% of the initial weight after 6 months of treatment. Conclusion: TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime the treatment motivation and readiness with good predictive capacity for weight loss. (J. Endocrinol. Invest. 34: e70-e77, 2011)
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Apr 11, 2017
Rivista Di Psichiatria, Jul 1, 2006
Recenti progressi in medicina
ABSTRACT
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2007
This study is aimed at the comparison between an individual and a group cognitive-behavioral prog... more This study is aimed at the comparison between an individual and a group cognitive-behavioral program for the treatment of obesity. Parallel series, prospective, 3-year study. A group program of 10 weekly sessions focused on lifestyle modification was compared with a similar, individual 10-session program. Fifty-seven patients were assigned to individual treatment, and 84 patients to the group program. One hundred- forty-one obese female outpatients without binge eating disorder, aged 42.0+/-11.6 years (m+/-SD), with Body Mass Index (BMI) 37.3+/-5.2 kg/m(2). BMI and waist circumference were measured at 0, 6, 12 and 36 months. Analysis was performed on an intention-to-treat basis. Mean weight loss was superior with the group program at 6 months (2.0+/-3.9 vs 0.8+/-2.5 kg/m(2); p<0.05), while no difference between the two treatments was observed at 12 and 36 months. Mean waist circumference was significantly different at 6 months (group 97.4+/-2.5 vs individual 102.9+/-2.4, p<0.05), still remaining superior in the patients following individual treatment (100.2+/-5.0 vs 103.7+/-5.9) at 12 months, while no difference between the two treatments was observed at 36 months. The proportion of patients losing more than 5% of initial body weight with the group program (16.6, 15.5, and 38.1% at 6, 12, and 36 months, respectively) was not significantly different from that observed with individual treatment (5.3, 14.0, and 35.0%, respectively). A group cognitive-behavioral program for the treatment of obesity is not inferior to a similar program applied in individual setting, and it may enhance weight loss (especially fat mass, according to the waist measurement) in the short term.
Preventive Medicine, 2010
Psychotherapy and Psychosomatics, 2012
Different studies considered the mechanisms involved in the maintenance of binge eating in bulimi... more Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes. 85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2). At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients. Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.
Psychotherapy and Psychosomatics, 2004
It has been argued that lay interviewers&... more It has been argued that lay interviewers' use of fully-structured interviews could lead to a diagnostic pattern different to that by treating physicians. Clinical interviewers in community samples should probably identify cases that are closer to those seen in clinical settings. The greatest advantage of using clinical interviewers consists of the immediate assessment of a possible psychopathology, i.e. the evaluation of current disorders. Two thousand three hundred and sixty-three citizens from the community of Sesto Fiorentino, Italy, were interviewed by their own general practitioners using the Mini International Neuropsychiatric Interview (MINI). Positive cases for any lifetime psychiatric disorder as well as a random sample of the negative cases were re-interviewed by psychiatrists or trained residents in psychiatry using the Florence Psychiatric Interview (FPI). The point prevalence for any current disorder was 8.7%; the two disorders with the highest prevalence were generalised anxiety disorder (2.9%) and major depressive episode (2.7%). The figures increase about 50% when the sub-threshold sequelae of previous disorders are considered. Current comorbidity was generally high. The one-year prevalence of any disorder was 10.6%. Ninety-two percent of the cases sought help, 82% were being treated at the moment of interview. Social impairment was considerable. The period prevalence rates for most of the disorders considered were generally comparable with the range defined by previous studies conducted in other Western countries, despite using different methodologies. Conversely, the use of health facilities, the treatment received and the social impairment were much higher than those reported by the other studies, suggesting a greater similarity with the clinical samples.
Psychotherapy and Psychosomatics, 2004
This paper presents lifetime prevalences and estimated risks of DSM-IV psychiatric disorders from... more This paper presents lifetime prevalences and estimated risks of DSM-IV psychiatric disorders from a community survey conducted in Sesto Fiorentino, Italy, using psychiatric interviewers with clinical experience and clinical instruments. Two thousand five hundred subjects aged 14 or more were randomly selected from the lists of 15 general practitioners (GPs) regardless of whether or not they had consulted the GP. A three-phase design was adopted, with the GPs using the Mini International Neuropsychiatric Interview (MINI) for the first stage. All positive cases at the MINI and a probability sample of 123 negative cases were re-interviewed by psychiatrists or trained residents in psychiatry using the Florence Psychiatric Interview (FPI) at the second stage. During phase III, the subjects were administered the rating scales specific to the pathology detected by the FPI. Two thousand three hundred and sixty-three subjects were interviewed (response rate 94.5%) by their own GP; 623 were found positive for any psychiatric disorder. The psychiatrists could re-interview 605 of these, along with a random sample of 123 negatives. Almost twenty-five percent (24.4%; 15.7% males, 31.7% females) of the population was found positive for any DSM-IV disorder during their lives. The most common diagnosis was major depressive episode, followed by anxiety not otherwise specified. Women had higher rates for most disorders. The prevalence rates for most of the disorders considered are generally comparable with the range identified by previous studies conducted in other Western countries, even though they were using different methodologies. Exceptions are represented by the high prevalence of residual categories and the lower prevalence of phobias.
Psychotherapy and Psychosomatics, 2010
Few long-term follow-up studies have evaluated the response to psychotherapeutical interventions ... more Few long-term follow-up studies have evaluated the response to psychotherapeutical interventions in anorexia nervosa (AN). The effectiveness of individual cognitive-behavioral therapy (CBT) and the possible predictors of outcome in outpatients suffering from threshold and subthreshold AN (s-AN) were evaluated. At the beginning (T0) and at the end of treatment (T1), and 3 years after the end of treatment (T2), 53 subjects with AN and 50 with s-AN (all DSM-IV criteria except amenorrhea or underweight) were assessed by a face-to-face clinical interview and by self-reported questionnaires for eating attitudes and behavior (Eating Disorder Examination Questionnaire), body uneasiness (Body Uneasiness Test) and general psychopathology (Symptom Checklist, Beck Depression Inventory, State-Trait Anxiety Inventory). No deaths occurred during the treatment and the follow-up period. At the end of the follow-up 34 subjects (33%) initially enrolled in the study obtained a full recovery. AN and s-AN patients did not show significant differences on most of the clinical measures at baseline and in terms of treatment response (T1, T2). The reduction in weight and shape concerns was associated with weight gain at T1 and T2, and the shape concern level at baseline represented the main risk factor for recovery and treatment resistance. According to survival analysis, patients with high shape concern had a lower probability of remission across time. The distinction between threshold and subthreshold AN does not seem to be of clinical relevance in terms of response to CBT. Shape concern rather than demographic or general psychopathological features represents the best predictor of outcome for CBT.
Psychotherapy and Psychosomatics, 2006
another DSM-IV axis I psychiatric disorder. At the moment of the interview, conducted a few years... more another DSM-IV axis I psychiatric disorder. At the moment of the interview, conducted a few years (average 7 years) after the onset of the disorder, 50% had fully recovered from EDs, 26.9% were currently affected by an ED, 23.1% showed a persistent body image disturbance and/or the presence of compensatory behaviours. Conclusions: Community surveys conducted by clinicians may provide useful additional information on the psychopathological features, natural course and outcome of these disorders on naturalistic grounds.
Psychosomatic Medicine, 2011
To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with ea... more To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the DSM-V proposed criteria. Patients with EDs move in and out of illness states over time, display frequent relapses, show a relevant lifetime psychiatric comorbidity, and migrate between different diagnoses. A total of 793 patients (including anorexia nervosa, bulimia nervosa, binge eating disorder, and EDs not otherwise specified) were evaluated on the first day of admission, at the end of treatment, 3 years after the end of treatment, and 3 years after the first follow-up. Clinical data were collected through a face-to-face interview; diagnosis was performed by means of the Structured Clinical Interview for DSM-IV and the Eating Disorder Examination Questionnaire was applied. A consistent rate of relapse and crossover between the different diagnoses over time was observed. Mood disorders comorbidity has been found to be an important determinant of diagnostic instability, whereas the severity of shape concern represented a relevant outcome modifier. Using the DSM-V proposed criteria, most patients of EDs not otherwise specified were reclassified, so that the large majority of ED patients seeking treatment would be included in full-blown diagnoses. Among EDs, there are different subgroups of patients displaying various courses and outcomes. The diagnostic instability involves the large majority of patients. An integration of categorical and dimensional approaches could improve the psychopathological investigation and the treatment choices.
Psychopathology, 2003
Eating disorders are frequent among elite performers of certain sports or physical activities; ho... more Eating disorders are frequent among elite performers of certain sports or physical activities; however, little is known about non-professional performers. 113 female non-elite ballet dancers, 54 female gymnasium users, 44 male non-competitive body builders, 105 female controls and 30 male controls were evaluated using the Body Uneasiness Test, the State-Trait Anxiety Inventory, the Beck Depression Inventory, and the Eating Disorder Examination 12th edition (EDE-12). Non-elite ballet dancers reported the highest prevalence of eating disorders (anorexia nervosa 1.8%; bulimia nervosa 2.7%; eating disorders not otherwise specified 22.1%), followed by gymnasium users (anorexia nervosa 2.6%; eating disorders not otherwise specified 18%). Significant differences (p < 0.01) between athletes and their controls were found in the following parameters (median values): Beck Depression Inventory (female dancers 5.7, gymnasium users 6.1, female controls 2.8, body builders 1.6, and male controls 1.3), Body Uneasiness Test (female dancers 1.08, gymnasium users 0.62, female controls 0.54, body builders 0.35, and male controls 0.27), EDE total scores (female dancers 1.6, gymnasium users 1.7, female controls 1.0, body builders 1.0, and male controls 0.4), EDE - restraint subscale scores (female dancers 0.8, gymnasium users 1.6, female controls 0.0, body builders 0.8, and male controls 0.0), EDE--eating concern subscale scores (female dancers 0.4, gymnasium users 0.2, female controls 0.0, body builders 0.0, and male controls 0.0), EDE--weight concern subscale scores (female dancers 2.1, gymnasium users 2.1, female controls 1.6, body builders 1.4, and male controls 0.5), and EDE--shape concern subscale scores (female dancers 2.7, gymnasium users 2.8, female controls 2.0, body builders 2.1, and male controls 0.9). EDE scores were highly related to Body Uneasiness Test scores, especially in non-elite ballet dancers and in non-competitive body builders (p < 0.01). Non-professional performers of sports emphasising thinness or muscularity, such as ballet and body-building, show a high degree of body uneasiness and inappropriate eating attitudes and behaviours.
Neuroscience Letters, 2006
Animal studies showed that nitric oxide (NO)/cyclic-GMP (cGMP) pathway is involved in the modulat... more Animal studies showed that nitric oxide (NO)/cyclic-GMP (cGMP) pathway is involved in the modulation of eating behavior. To address its role in eating disorders (ED), plasma nitrite and cGMP levels were studied in 50 ED patients (25 with Anorexia Nervosa, AN; 25 with Bulimia Nervosa, BN) and 20 sex-and age-matched controls (C). Nitrites (nmol/mg protein, mean ± S.E.M.: any ED 1.01 ± 0.29; AN 1.15 ± 0.47; BN 0.88 ± 0.36; C 0.25 ± 0.07; p < 0.01) and cGMP (nmol/ml plasma, mean ± S.E.M.: any ED 2.58 ± 0.60; AN 2.81 ± 1.10; BN 2.41 ± 0.70; C 0.11 ± 0.05; p < 0.01) were significantly higher in ED patients than in C. Nitrite and cGMP levels inversely correlated with BMI in AN patients (nitrites: r = −0.62 p < 0.01; cGMP r = −0.45 p < 0.05) but not in BN patients (nitrites: r = −0.15 p = 0.49; cGMP: r = −0.05 p = 0.13) or in control subjects (nitrites: r = 0.11 p = 0.98; cGMP r = 0.37 p = 0.32). Significant correlations were also present in bulimic patients between nitrite levels, frequency of binges and several psychopathological dimensions, as assessed through the EDE. This is the first evidence of an alteration of the NO pathway in ED patients. Further studies are needed to ascertain whether an increase in NO levels plays a possible role in the pathogenesis of ED.
Neuroscience Letters, 2004
Various studies have evaluated the possible role of the −1438 G/A polymorphism within the 5-HT 2A... more Various studies have evaluated the possible role of the −1438 G/A polymorphism within the 5-HT 2A receptor gene in the susceptibility to Eating Disorders (EDs). One hundred and forty-eight ED patients (EDp) and 89 control subjects were interviewed by means of the Eating Disorder Examination (EDE) and analyzed for distribution of the −1438 G/A polymorphism. Patients with the AA genotype suffering from Anorexia Nervosa and Bulimia Nervosa showed higher Weight and Shape Concern (P = 0.003 and P = 0.010, respectively) scores and greater overall severity of the ED psychopathology (EDE total score) (P = 0.012). The obtained preliminary data suggest the use of dimensional psychopathological measures in ED genetic studies.
Neuropsychobiology, 2008
The etiopathogenesis of eating disorders (ED) is complex and poorly understood. Biological, psych... more The etiopathogenesis of eating disorders (ED) is complex and poorly understood. Biological, psychological and environmental factors have all been considered to be involved in the onset and the persistence of these syndromes, often with conflicting results. The recent literature focused on the possible role of hormonal pathways, in particular the hypothalamic-pituitary-adrenal (HPA) axis, as a relevant factor capable of influencing the onset and the course of ED. Other studies have suggested that the onset of ED is often preceded by severe life events, and that chronic stress is associated with the persistence of these disorders. As the biological response to stress is the activation of the HPA axis, the available literature considering the relationships between stress, HPA axis functioning and anorexia nervosa, bulimia nervosa and binge eating disorder is reviewed by the present article.
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Papers by Claudia Ravaldi
METHODS: The B3 Survey is an anonymous, mixed-method online survey, translated into 22 languages. We separated out the Italian responses and analyzed them using computer-assisted qualitative software (MAXQDA) and SPSS and STATA for quantitative data analysis. Simple descriptives were used for the numeric data, and content analysis for the qualitative responses. Geomapping was based on the coded qualitative data and postcodes (using Tableau Public).
RESULTS: There were 1000 respondents from every region of Italy, using a range of places of birth (hospital, birth center, home) and experiencing care with both midwives and obstetricians. Most identified positive experiences of care, as well as some practices they would like to change. Both positive and critical comments included provision of care based on the type of providers, clinical procedures, the birth environment, and breastfeeding support. There were clear differences in the geomapped data across Italian regions.
CONCLUSIONS: Mothers highly value respectful, skilled and loving care that gives them a strong sense of personal achievement and confidence, and birth environments that support this. There was distinct variation in the percentage of positive comments made across Italian regions. Cit: Skoko E, Ravaldi C, Vannacci A, Nespoli A,Akooji N,Balaam MC, Battisti A,Cericco M,Iannuzzi L, Morano S, Downe S, "Findings from the Italian Babies Born Better Survey", Minerva Ginecologica, 2018, Vol. 70, doi: 23736/S0026-4784.18.04296-X.
METHODS: The B3 Survey is an anonymous, mixed-method online survey, translated into 22 languages. We separated out the Italian responses and analyzed them using computer-assisted qualitative software (MAXQDA) and SPSS and STATA for quantitative data analysis. Simple descriptives were used for the numeric data, and content analysis for the qualitative responses. Geomapping was based on the coded qualitative data and postcodes (using Tableau Public).
RESULTS: There were 1000 respondents from every region of Italy, using a range of places of birth (hospital, birth center, home) and experiencing care with both midwives and obstetricians. Most identified positive experiences of care, as well as some practices they would like to change. Both positive and critical comments included provision of care based on the type of providers, clinical procedures, the birth environment, and breastfeeding support. There were clear differences in the geomapped data across Italian regions.
CONCLUSIONS: Mothers highly value respectful, skilled and loving care that gives them a strong sense of personal achievement and confidence, and birth environments that support this. There was distinct variation in the percentage of positive comments made across Italian regions. Cit: Skoko E, Ravaldi C, Vannacci A, Nespoli A,Akooji N,Balaam MC, Battisti A,Cericco M,Iannuzzi L, Morano S, Downe S, "Findings from the Italian Babies Born Better Survey", Minerva Ginecologica, 2018, Vol. 70, doi: 23736/S0026-4784.18.04296-X.