Preliminary Validation of the CI-FRA Checklist: A Simple Screening Tool for Measuring the Early Signs of Reading and Spelling Disorders in Italian Primary Students

Although several screening tests for recognizing early signs of reading and spelling difficulties have been developed, brief and methodologically grounded tools for teachers are very limited. The present study aimed to lay the foundation for a new screening tool for teachers: the Checklist for early Indicators of risk Factors in Reading Ability (CI-FRA). The proposed checklist consists of 20 items, based on a 7-point Likert scale, and it investigates five domains: reading, writing, attention, and motor skills. Six hundred sixtyseven children were evaluated by 40 teachers during the first year of primary school and, longitudinally, in the second year. Exploratory factor analysis and confirmatory factor analysis (CFA) were applied to verify structural validity. Concurrent validity was assessed by Spearman correlation to analyze the link between CI-FRA and reading and spelling standardized tests and cognitive tests. Reliability was assessed by Cronbach a and interclass correlation coefficient. The CFA reported a three-factor structure as the optimal solution, including language (reading and writing), visuospatial attention, and fine motor skills subscales. Good reliability, good internal consistency, and acceptable test\u2013 retest indices were found. Concurrent validity was confirmed by significant correlations between CI-FRA total score and standardized reading and spelling test, as well as by correlations between CI-FRA subscales and neuropsychological standardized test scores. Preliminary evaluation of sensitivity by receiver operating characteristic curves showed that the CI-FRA score has particularly high sensitivity and specificity for word reading speed deficit. In conclusion, the results confirm that CI-FRA is a theoretically grounded and statistically valid tool that could help the teachers to screen for early signs of reading and spelling difficulties

Analisi dell\u2019efficacia di un intervento volto alla promozione dei prerequisiti delle abilit\ue0 di lettura. Uno studio preliminare su classi prime della scuola primaria

Scopo del presente studio \ue8 la valutazione dell\u2019efficacia di un programma di intervento di potenziamento delle competenze fonologiche e metafonologiche, in quanto abilit\ue0 precursori a fondamento dell\u2019apprendimento della lettoscrittura. Lo studio ha coinvolto 99 bambini (f = 55; m= 44) frequentanti cinque classi prime della scuola primaria. Il campione \ue8 stato diviso in: gruppo di potenziamento composto da 3 classi e gruppo di controllo composto da 2 classi. Inoltre i bambini sono stati classificati in \uaba rischio DSA\ubb e \uabnon a rischio\ubb in base alle valutazioni sulle capacit\ue0 fonologiche e metafonologiche, percettive e visuo-motorie effettuate prima del trattamento. L\u2019intervento \ue8 strutturato in fasi ed \ue8 standard per tutte le classi. Prevede 3 incontri settimanali di 30 minuti ciascuno, per una durata complessiva di 15 settimane. I risultati mostrano che i soggetti sottoposti a potenziamento ottengono un miglioramento maggiore rispetto al gruppo di controllo nelle abilit\ue0 potenziate. Le competenze nelle quali \ue8 stato riscontrato un miglioramento significativo sono quelle di fluenza verbale e di sintesi fonemica. Inoltre \ue8 emerso che, nel gruppo di potenziamento, sia i bambini a rischio DSA che quelli non a rischio ottengono un vantaggio dall'intervento. I risultati del presente studio confermano l\u2019efficacia del programma di intervento effettuato all'interno del contesto classe e basato sul potenziamento delle abilit\ue0 prerequisito per l\u2019apprendimento delle abilit\ue0 di lettoscrittura

Esperienze di valutazione e interventi di potenziamento in classe

Negli ultimi decenni l\u2019attenzione rivolta ai Disturbi Specifici dell\u2019Apprendimento (DSA) nel nostro paese \ue8 cresciuta in modo esponenziale. La centralit\ue0 di tale tematica in ambiente educativo e scolastico, cos\uec come la sua rilevanza sul piano sociale, ha spinto numerosi studiosi e professionisti del settore ad occuparsi del disturbo, ricercandone le cause e proponendo strumenti e strategie per il supporto ed il potenziamento delle abilit\ue0-apprendimento. Il crescente numero di diagnosi che si \ue8 riscontrato negli ultimi anni in Italia, ha portato alla luce una problematica rilevante e sentita, relativa alla necessit\ue0 di adeguare e ripensare la didattica tradizionale al fine di promuovere la creazione e l\u2019utilizzo di strategie compensative favorenti l\u2019apprendimento del bambino con DSA, la sua integrazione nel contesto classe ed evitare che dinamiche disfunzionali possano minare la serenit\ue0 e la crescita del bambino. Numerosi sono stati i passi avanti percorsi, negli ultimi anni, in ambiente clinico-sanitario cos\uec come in quello scolastico-educativo, anche grazie all\u2019inquadramento legislativo del disturbo ed alle successive linee guida del MIUR. Tale processo appare, tuttavia, ancora lungo e non privo di ostacoli e resistenze. A parere di chi scrive, la fatica caratterizzante questo percorso di cambiamento rispecchia le difficolt\ue0 riscontrate negli anni dagli studiosi che hanno tentato di inquadrare in modo univoco e deterministico il disturbo dell\u2019apprendimento scolastico, partendo dagli studi eziologici. Ad oggi, la comunit\ue0 scientifica del settore non ha ancora sviluppato un modello eziologico condiviso per i diversi DSA. Uno dei modelli pi\uf9 recenti ipotizza che le cause dei DSA sarebbero da ricercare in un complesso quadro di alterazioni neurobiologiche interagenti fra loro che si legano alla grande eterogeneit\ue0 delle manifestazioni fenotipiche del disturbo. L\u2019interazione fra fattori neurobiologici, ambientali ed emozionali concorre alla determinazione di profili funzionali anche molto differenti, nei quali le difficolt\ue0 relative alle abilit\ue0-specifiche (lettura, scrittura e calcolo) possono associarsi a difficolt\ue0 legate a domini cognitivi generali e trasversali (memoria, attenzione, percezione visiva). E\u2019 ormai riconosciuto che mentre le abilit\ue0 specifiche di lettura e scrittura giungono a maturazione solo al termine del secondo anno della scuola primaria (motivo per il quale \ue8 possibile fare diagnosi solo in tale periodo), la presenza di deficit relativi alle abilit\ue0 che si pensa siano associate al disturbo sono valutabili anche in un\u2019epoca precedente. Pertanto, negli ultimi decenni, stanno crescendo le ricerche che si occupano di studiare i fattori predittivi, ovvero quelle abilit\ue0 cognitive che, se deficitarie, non rappresentano di per s\ue9 la presenza di un disturbo specifico, ma aumentano significativamente la probabilit\ue0 di una manifestazione futura dello stesso. In tal senso, la Scuola ricoprirebbe un ruolo fondamentale non solo in termini di compensazione (adeguamento della didattica a fronte della diagnosi) ma anche in quelli di identificazione e di potenziamento precoce, seguendo un\u2019ottica di prevenzione primaria. Un attento e costante monitoraggio dello sviluppo delle abilit\ue0 predittive permetterebbe da un lato l\u2019identificazione di aree di fragilit\ue0, dall\u2019altro la strutturazione di azioni mirate al potenziamento ed al rinforzo di tali aree. Interventi di questo tipo consentirebbero di prevenire, o di ridurre, l\u2019impatto che tali deficienze possono avere sullo sviluppo delle competenze-apprendimento future, riducendo la severit\ue0 della manifestazione del disturbo. La centralit\ue0 del ruolo degli insegnanti viene inoltre ribadita dalla normativa in materia di DSA, alla quale sono seguiti diversi Decreti Interministeriali (Legge 170/2010 "Nuove norme in materia di disturbi specifici di apprendimento in ambito scolastico; Decreto Interministeriale MIUR-MS "Linee guida per la predisposizione dei protocolli regionali per le attivit\ue0 di individuazione precoce dei casi sospetti di DSA). Date queste considerazioni, si \ue8 ritenuto di raccogliere in questo nucleo monografico le esperienze e le riflessioni di ricercatori e professionisti che da anni si occupano di DSA, con lo scopo di offrire spunti di riflessione e nuove idee sui protocolli di identificazione precoce e sui programmi di prevenzione primaria che si possono effettuare nel contesto della classe

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors

Drug prescription and delirium in older inpatients: Results from the nationwide multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship