Narrazioni affettive nella gestione del diabete di tipo 1. Studio pilota di una triade familiare

Il diabete mellito tipo 1 è una malattia cronica dovuta ad un disordine metabolico ad eziologia multipla. Definita da Bury (2005) come una “discordanza biografica”, il suo trattamento si basa sul coinvolgimento attivo delle famiglie e rende necessario una riorganizzare della vita quotidiana del paziente e della famiglia. Lo studio ha lo scopo di analizzare le interazioni di una triade familiare in termini di modalità enabling (facilitante) e constraining (ostacolante) e l’influenza sulla salute del ragazzo di queste modalità comunicative. Gli strumenti self report, come la Scala degli ambiti di discussione familiari (Gambini, 2008) per il tema scelto e il Sample Diabetes Questionnaire (SDQ) dello Stanford Patient Education Research Center (2007), per la salute del paziente, hanno affiancato lo strumento Constraining and Enabling Coding System (CECS; Hauser, et al.1991 adattato da Chiarolanza, et al. 2016) per le analisi dell’interazione videoregistrata di una triade familiare. Dall’analisi delle interazioni emerge che le forme comunicative nella triade si orientano verso modalità comunicative della dimensione cognitiva vincolante. Questo sembra interferire sul monitoraggio della glicemia e sul rapporto del figlio col medico. La modalità con cui i membri di una triade riescono a coordinarsi o non, dunque, durante un’interazione sembra avere effetti sulla salute dell’adolescente sia declinata come qualità delle relazioni familiari che di benessereThe type 1 diabetes mellitus is a chronic disease caused by a metabolic disorder with multiple etiologies. Defined by Bury (2005) as a "biographical disagreement ", its treatment is based on the active involvement of families and makes it necessary to reorganize both patient daily life and his/her family one. This paper aims to analyze the interactions of a family triad in terms of enabling and constraining style and how this type of communication has an impact on the child health. We utilized for this study self-report questionnaires and Constraining and Enabling Coding System (CECS; Hauser, et al.,1991 adapted by Chiarolanza, et al., 2016) for analysis of a family triad interaction. Results showed that interactive communication in the triad are oriented towards constraining cognitive dimension. This could interfere with blood glucose monitoring and the patient relationship with integrated team care. Members of a triad can coordinate or not during a family interaction and this could have effects on adolescent health in terms of quality of family relationships and well bein

Corrigendum: The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the covid-19 pandemic in 2020(Front. Endocrinol., (2022), 13, (878634), 10.3389/fendo.2022.878634)

[This corrects the article .]

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0-18 years

After a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013-2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign

Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study

Idiopathic REM sleep behaviour disorder (iRBD) is a powerful early sign of Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. This provides an unprecedented opportunity to directly observe prodromal neurodegenerative states, and potentially intervene with neuroprotective therapy. For future neuroprotective trials, it is essential to accurately estimate phenoconversion rate and identify potential predictors of phenoconversion. This study assessed the neurodegenerative disease risk and predictors of neurodegeneration in a large multicentre cohort of iRBD. We combined prospective follow-up data from 24 centres of the International RBD Study Group. At baseline, patients with polysomnographically-confirmed iRBD without parkinsonism or dementia underwent sleep, motor, cognitive, autonomic and special sensory testing. Patients were then prospectively followed, during which risk of dementia and parkinsonsim were assessed. The risk of dementia and parkinsonism was estimated with Kaplan-Meier analysis. Predictors of phenoconversion were assessed with Cox proportional hazards analysis, adjusting for age, sex, and centre. Sample size estimates for disease-modifying trials were calculated using a time-to-event analysis. Overall, 1280 patients were recruited. The average age was 66.3 \ub1 8.4 and 82.5% were male. Average follow-up was 4.6 years (range = 1-19 years). The overall conversion rate from iRBD to an overt neurodegenerative syndrome was 6.3% per year, with 73.5% converting after 12-year follow-up. The rate of phenoconversion was significantly increased with abnormal quantitative motor testing [hazard ratio (HR) = 3.16], objective motor examination (HR = 3.03), olfactory deficit (HR = 2.62), mild cognitive impairment (HR = 1.91-2.37), erectile dysfunction (HR = 2.13), motor symptoms (HR = 2.11), an abnormal DAT scan (HR = 1.98), colour vision abnormalities (HR = 1.69), constipation (HR = 1.67), REM atonia loss (HR = 1.54), and age (HR = 1.54). There was no significant predictive value of sex, daytime somnolence, insomnia, restless legs syndrome, sleep apnoea, urinary dysfunction, orthostatic symptoms, depression, anxiety, or hyperechogenicity on substantia nigra ultrasound. Among predictive markers, only cognitive variables were different at baseline between those converting to primary dementia versus parkinsonism. Sample size estimates for definitive neuroprotective trials ranged from 142 to 366 patients per arm. This large multicentre study documents the high phenoconversion rate from iRBD to an overt neurodegenerative syndrome. Our findings provide estimates of the relative predictive value of prodromal markers, which can be used to stratify patients for neuroprotective trials