Pediatric palliative care

The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices) and two based at home (the so-called home-based hospitalization and integrated home-based care programs). Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected

Reattivit\ue0\ua0 psicofisiologica ad uno stimolo doloroso preavvertito in pazienti con dolore cronico

Lo studio descrive gli effetti dell'anticipazione di uno stimololo doloroso sulla reattivit\ue0 psicofisiologic

Biofeedback and progressive muscle relaxation in the treatment of headache in childhood, and the long term regular monitoring of their effect

Primary headache is common in childhood. The painful symptoms interfere with the children\u2019s and adolescents\u2019 performance at school, in games and in their family lives. After an initial diagnosis, taking not only the physical, but also the affective, behavioral and situational factors into account, it is consequently essential to provide treatment as promptly as possible to avoid the condition becoming chronic. In recent years, the literature has increasingly supported the application of non-pharmacological treatments to headache in childhood, but few studies have routinely monitored the clinical and physiological modifications induced by such treatments in the course of a short- and long-term follow-up. The aim of the present study was to analyze the effectiveness of two different non-pharmacological treatments, electromyographic biofeedback (BFB) and progressive muscle relaxation (PMR), by means of a systematic assessment of the clinical and physiological changes observed after the treatment and at various follow-up points for up to 1 year. Twenty children took part in the study, 10 treated with BFB and 10 with PMR. All the children had suffered from recurrent headache for at least 6 months. They were given a headache diary to complete before the treatment, at the end of the treatment and then at 1, 3, 6 and 12 months of follow-up. The variables analyzed were: headache frequency, duration and intensity, headache index, muscle tension (EMG), intake of medication, percentage of improvement. The results showed that both treatments led to a significant improvement in the frequency of the painful attacks and in the headache index. PMR also induced a reduction in the duration of the headache episodes. After treatment, there was a marked reduction in the use of medication and the mean percentage of improvement tended to increase with time, remaining consistently higher than 50% at all the time points considered. On the whole, the improvements tended progressively to be consolidated and even increase, especially from the third month of follow-up onwards. Our findings confirm the effectiveness of non-pharmacological therapies in the treatment of childhood headache and support the likelihood of stable and generalized short- and long-term therapeutic effects

Il Biofeedback nelle cefalee pediatriche: monitoraggio degli effetti terapeutici

Il Biofeedback, tecnica ampiamente utilizzata nelle cefalee primarie pediatriche, produce miglioramenti clinici significativi, simili \u2013 se non superiori \u2013 al trattamento farmacologico. Sebbene in letteratura siano stati eseguiti follow-up a distanza, le segnalazioni su una modalit\ue0 di monitoraggio costante in ambito pediatrico sono invece del tutto assenti. Scopo del presente studio \ue8 stato quello di valutare l\u2019efficacia del Biofeedback elettromiografico (EMG-BFB), effettuando un monitoraggio cadenzato degli effetti terapeutici nelle fasi di post-trattamento e follow-up a 1, 3 e 6 mesi. Hanno preso parte allo studio 10 pazienti pediatrici affetti da cefalea primaria ricorrente. I dati ottenuti dimostrano un miglioramento significativo dei parametri clinici (frequenza e indice della cefalea) e fisiologici (EMG) non solo nell\u2019immediata fase di post-trattamento ma anche nel corso dei successivi follow-up, senza sostanziali modificazioni tra le diverse fasi. Tale monitoraggio assicura una verifica della stabilizzazione degli effetti terapeutici anche nelle fasi successive al trattamento

Il biofeedback: un'alternativa terapeutica per la cura della cefalea in et\ue0 evolutiva

Lo studio descrive l'applicazione del biofeedback elettromiografico nella cefalea in et\ue0 evolutiva, indicando le potenzialit\ue0 applicative di tale procedura ad integrazione o in alternativa alla terapia farmacologic