Il Diploma Supplement: core e certificazione delle conoscenze e delle competenze. L’esperienza del CdLM in Scienze delle Professioni Sanitarie della Riabilitazione Università degli Studi di Milano

*The following article was published in the paper version of our journal Vol. XII , Num. 3, dec., 2012. Nevertheless, due to its substantial interest we decided to reproduce it in our digital and open access edition.Background: Diploma Supplement (DS) is a document intended as a supplement to the Diploma awarded by the institution which has scheduled a training process and that characterizes in detail the core competencies and core curriculum derived achieved by the learner. Also called Syllabus, is a description of the study plan. Aim: The purpose of our work is to write up the Diploma Supplement of Master’s Degree course in Healthcare Professions for Rehabilitation in the Faculty of Medicine, University of study of Milan. Methods: According to Italian legislation, the DS can be written in Italian and other European language and is composed of different sections with personal study plan and teaching date. Additional informations can also be conteined. Discussion: The DS has been a preliminary laborious work of collection, sorting and organization of general and specific learning objectives and teaching content of the course curriculum to complement the objectives of the course study of job opportunities and the characteristics of the studies with the aim of enhancing the acquired curriculum and encourage the academic recognition in other countries. We have possible future purposes to improve and implement the document. Conclusion: In conclusion it seems to say that as a course of study and attention placed on the student with the Diploma Supplement are in line with national and European policies

Promoting well-being in old age : the psychological benefits of two training programs of adapted physical activity

In the last few decades, the relationship between physical conditions and mental health has increasingly attracted the interest of researchers and professionals across disciplines. This relationship is especially relevant in old age, as the challenges posed by aging at various levels represent crucial concerns for policy makers. Due to the remarkable increase in life expectancy across countries, sustainable prevention strategies are needed to help individuals preserve psychophysical well-being in old age. In particular, the regular practice of a moderately intense physical activity is recommended by the World Health Organization to enhance balance, prevent falls, strengthen muscles, and promote psychophysical well-being. Daily physical exercise represents a beneficial and low-cost strategy, easily accessible to the general population and potentially customizable to specific needs through brief training programs. Based on these premises, the present research aimed at longitudinally evaluating mental well-being among 58 Italian people aged 67-85, who were involved in two Adapted Physical Activity (APA) training programs. Inclusion criteria for participation comprised high autonomy levels in daily activities, no cognitive impairment, sedentary habits or only occasional performance of moderate physical activity. Based on physical and functional assessment, 39 participants joined a program of adapted motor activity (PoliFit; Study 1), while 19 participants attended a variant program specifically designed for people with osteoporosis (OsteoFit; Study 2). Well-being dimensions were assessed through the Mental Health Continuum-Short Form, the Emotion Regulation Questionnaire and the Satisfaction with Life Scale. Physical functioning were evaluated before and after the programs through the Short Physical Performance Battery and the Handgrip Dynamometer Jamar Test. Findings highlighted that, besides physical benefits, participants reported significantly more adaptive emotion regulation strategies after both training programs; in addition, participants attending OsteoFit reported significantly higher levels of emotional well-being. Results suggest the potential of moderate physical activity in promoting mental health, emphasizing the additional role of training programs as cost-effective opportunities for elderly people to socialize and improve emotional functioning. Overall, the findings support the view of old age as a stage of competence development and adaptive adjustment, rather than a phase of mere psychophysical decline

Analysis of Early Events during the First Year of Tyrosine Kinase Inhibitor Therapy in Patients with Chronic Phase - Chronic Myeloid Leukemia: A "Campus CML" Study

Tyrosine kinase inhibitors (TKIs) revolutionized treatment of chronic myeloid leukemia (CML). However, the rst months of therapy are crucial, as optimal response is dened as the achievement of molecular milestones at 3, 6 and 12 months (mo.) and as many toxicities, also causing a TKI switch, are more frequent in the 1st yea

An immersive virtual reality-based application for treating ADHD: A remote evaluation of acceptance and usability

Introduction Virtual reality (VR) is a digital technology currently considered to implement rehabilitation programs for children with ADHD, a disorder characterised by inattention, overactivity and impulsiveness. This study presents the results of the acceptance and usability of a VR application developed for children with ADHD aiming to provide an environment capable of supporting the development of the different attentional components. Due to COVID-19 restrictions, this study had the secondary aim of assessing whether a remote evaluation was feasible and meaningful. Methods A sample of 20 clinical experts (neuro and psychomotor therapists of the developmental age) was involved in assessing the proposed environment. Two different tools have been applied: the Technology Acceptance Model (TAM-3) questionnaire and a semi-structured interview were self-administered. Six sessions were planned in total, and each one lasted 30 min. Results With respect to the acceptance of the system, the mean of the answers given is for most of the constructs greater than 4, showing agreement among experts. Cronbach alpha and correlations of subscales seem to confirm the reliability of measures. According to results from the interviews, the developed application has shown versatility in being able to be applied to the heterogeneity of the disorder and it was also possible to obtain valuable insights on possible additional features and functionalities. Regarding the secondary aim, the collected outcomes were positive: all the participants were satisfied with what they could perceive about the application. Conclusions The results of this work pave the way for a future validation study with children due to the active participation of clinicians and their unanimous positive judgement confirming that the application was considered user-friendly and well accepted

Evidence of Better Autonomic, Metabolic and Psychological Profile in Breast Cancer Survivors Meeting Current Physical Activity Recommendations: An Observational Study

The increased cardiometabolic risk observed in breast cancer survivors (BCS) is due to multiple mechanisms: Hormonal and immunological dysfunction are well-identified ones, while cardiac autonomic regulation (CAR) is less recognized but may play a new complementary role particularly relevant when considering conditions and behaviors associated with a better prognosis in BCS, such as physical training. This observational study investigated a group of consecutive (172) BCS subdivided in two groups: those who reached the physical activity goals above 600 (MET·min/week) and those who did not. We assessed CAR by autoregressive spectral analysis of cardiovascular variabilities (considering in particular the unitary autonomic nervous system index—ANSI), body mass composition, stress perception and lifestyle in order to verify possible differences due to execution of physical activity. Subjects who spontaneously met physical activity recommendations presented a better autonomic, metabolic and psychological profile compared to those who did not. Lower physical activity volume, poor metabolic parameters, increased stress and fatigue perception may cluster together, leading to worsened CAR. This control mechanism may play a complementary role in determining the increased cardiometabolic risk observed in BCS. Furthermore, it may also explain, albeit in part, the better prognosis observed in patients following interventions aiming to improve the sympathetic–parasympathetic balance, such as physical training, using a personalized medicine approach

A longitudinal ICF-CY-based evaluation of functioning and disability of children born with very low birth weight

This paper aims to describe the longitudinal changes in disability, defined by the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) biopsychosocial model, and developmental outcomes in a cohort of 56 very low birth weight children over 14-20 months. We used a neurofunctional assessment, the Griffiths Mental Development Scales-Revised: 2-8 years (Griffiths 2-8) to evaluate psychomotor development and the ICF-CY questionnaire for ages 0-3 and 3-6 to address children's disability. Extension indexes on the basis of ICF-CY categories were computed, and longitudinal change was tested. Complete follow-up was available for 55 children (mean age 36.7 months, SD 6.7). Considering the sample as a whole, neurofunctional assessment, Griffiths score and disability were basically stable. When the subsample of children with the higher baseline functioning was taken into account, some degree of worsening, in terms of an increase in the number of impairments and limitations, was found. Our results show that disability profiles, neurofunctional assessment and global development were basically stable, except for the subgroup of children who were in the intermediate/high-functioning cluster at baseline. The increased disability among these children might be because of the possibility to observe a wider set of age-specific problems, such as emotional, regulation and social abilities that are not detectable at an early stage of development and that might lead to reduced participation in social activities. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

Psychological Intervention Based on Mental Relaxation to Manage Stress in Female Junior Elite Soccer Team: Improvement in Cardiac Autonomic Control, Perception of Stress and Overall Health

Chronic stress may represent one of the most important factors that negatively affects the health and performance of athletes. Finding a way to introduce psychological strategies to manage stress in everyday training routines is challenging, particularly in junior teams. We also must consider that a stress management intervention should be regarded as “efficacious” only if its application results in improvement of the complex underlying pathogenetic substratum, which considers mechanistically interrelated factors, such as immunological, endocrine and autonomic controls further to psychological functioning and behavior. In this study, we investigated the feasibility of implementing, in a standard training routine of the junior team of the Italian major soccer league, a stress management program based on mental relaxation training (MRT). We evaluated its effects on stress perception and cardiac autonomic regulation as assessed by means of ANSI, a single composite percentile-ranked proxy of autonomic balance, which is free of gender and age bias, economical, and simple to apply in a clinical setting. We observed that the simple employed MRT intervention was feasible in a female junior soccer team and was associated with a reduced perception of stress, an improved perception of overall health, and a betterment of cardiac autonomic control. This data may corroborate the scientific literature that indicates psychological intervention based on MRT as an efficacious strategy to improve performance, managing negative stress effects on cardiac autonomic control

Age-Associated Changes on Gait Smoothness in the Third and the Fourth Age

Although gait disorders represent a highly prevalent condition in older adults, the alterations associated with physiologic aging are often not easily differentiable from those originated by concurrent neurologic or orthopedic conditions. Thus, the detailed quantitative assessment of gait patterns represents a crucial issue. In this context, the study of trunk accelerations may represent an effective proxy of locomotion skills in terms of symmetry. This can be carried out by calculating the Harmonic Ratio (HR), a parameter obtained through the processing of trunk accelerations in the frequency domain. In this study, trunk accelerations during level walking of 449 healthy older adults (of age > 65) who were stratified into three groups (Group 1: 65–74 years, n = 175; Group 2: 75–85 years, n = 227; Group 3: >85 years, n = 47) were acquired by means of a iniaturized Inertial Measurement Unit located in the low back and processed to obtain spatio-temporal parameters of gait and HR, in antero-posterior (AP), medio-lateral (ML) and vertical (V) directions. The results show that Group 3 exhibited a 16% reduction in gait speed and a 10% reduction in stride length when compared with Group 1 (p < 0.001 in both cases). Regarding the cadence, Group 3 was characterized by a 5% reduction with respect to Groups 1 and 2 (p < 0.001 in both cases). The analysis of HR revealed a general trend of linear decrease with age in the three groups. In particular, Group 3 was characterized by HR values significantly lower (−17%) than those of Group 1 in all three directions and significantly lower than Group 2 in ML and V directions (−10%). Taken together, such results suggest that HR may represent a valid measure to quantitatively characterize the progressive deterioration of locomotor abilities associated with aging, which seems to occur until the late stages of life

Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre–post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro–Wilks test). Pre–post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity