Adults with Down syndrome: a comprehensive approach to manage complexity

BackgroundDown syndrome (DS) is characterised by premature ageing that affects selected organ systems, and persons with this condition can present patterns of co‐morbidities and deficits often observed in the older population without DS. However, information on the characteristics of adult persons with DS is limited.The objective of the study is to describe characteristics of adults with DS collected with a standardised, comprehensive assessment instrument.MethodsCross‐sectional study.Four hundred thirty adults with DS (age range 18/75 years) from three countries (Italy, n = 95; USA, n = 175; and Canada, n = 160).A standardised assessment instrument (interRAI intellectual disability) was used to assess sample characteristics.ResultsMean age ranged from 35.2 (standard deviation 12.0) years in the US sample to 48.8 (standard deviation 9.0) years in the Canadian sample. Most participants in the Italian and US sample were living in private homes, while more than half of those in the Canadian sample were institutionalised. Prevalences of geriatric conditions, including cognitive deficits, disability in the common activities of daily living, symptoms of withdrawal or anhedonia, aggressive behaviour, communication problems, falls and hearing problems were high in the study sample. Gastrointestinal symptoms, skin and dental problems and obesity were also frequently observed.ConclusionsAdults with DS present with a high level of complexity, which may suggest the need for an approach based on a comprehensive assessment and management that can provide adequate care. Further research is needed to understand better the effectiveness of such an approach in the DS population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149322/1/jir12588.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149322/2/jir12588_am.pd

Where are You Watching? Patterns of Visual Exploration in the Ultimatum Game

The study aimed to advance the traditional issue of identifying decision strategy by analyzing the information processing in terms of visual exploration patterns. Twenty-seven participants played as responders in a computerized version of Ultimatum Game with an anonymous virtual partner. Responders tended to reject unfair offers, probably due to their taste for fairness and to the unidentifiability of the other player that reduced the willingness to cooperate. Furthermore, according to the evolutionary approach, participants focused their attention more at themselves than at the partner. Among the three type of offers \u2013 hyperfair, fair and unfair \u2013 mid-value offers, such as fair ones, required more number of fixations and fixations duration, related to the more complex cognitive and reasoning processes involved. Implications of this study could be applied in decisional settings with anonymous partners, such as those online, with future studies confirming the results found and integrating them through other process tracing methodologies

Inverse correlates of COVID-19 mortality across European countries during the first versus subsequent waves

The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the correlation between SMRs and selected indicators in the first versus the subsequent waves until 23 June 2021. We used indirect standardisation (using Italy as the reference) to compute SMRs and considered 16 indicators of health and social well-being, health system capacity and COVID-19 response. The highest SMRs were in Belgium, the UK and Spain in the first wave (1.20-1.84) and in Hungary, Czechia and Slovakia in the subsequent waves (2.50-2.69). Human Development Index (HDI), life expectancy, urbanisation and healthcare expenditure had positive correlations with SMR in the first wave (rho=0.30-0.46), but negative correlations (rho=-0.67 to -0.47) in the subsequent waves. Retail/recreation mobility and transit mobility were negatively correlated with SMR in the first wave, while transit mobility was inversely correlated with SMR in the subsequent waves. The first wave hit most hard countries with high HDI, high life expectancy, high urbanisation, high health expenditures and high tourism. This pattern may reflect higher early community seeding and circulation of the virus. Conversely, in the subsequent waves, this pattern was completely inversed: countries with more resources and better health status did better than eastern European countries. While major SMR differences existed across countries in the first wave, these differences largely dissipated by 23 June 2021, with few exceptions

Child maltreatment and management of pediatric patients during COVID-19 pandemic: Knowledge, awareness, and attitudes among students of medicine and surgery. A survey-based analysis

Purpose of the studyTo assess perception, awareness, and attitudes regarding the medico-legal relevance of child maltreatment and management of pediatric patients during the COVID-19 pandemic in a cohort of medicine and surgery students, with a particular focus on child safety and maltreatment. MethodsA cross-sectional, web-based survey was conducted through an anonymous questionnaire on the personal websites of Universita Cattolica del Sacro Cuore medical students. ResultsThe study included 1,166 participants, the majority of whom were experienced with child maltreatment and defensive medicine; only a small percentage was aware of the government's efforts to prevent child maltreatment and safeguard vaccination physicians. Moreover, there was no agreement on the use of telemedicine for non-serious pediatric patients or on the consequences it might have on their health. Finally, the detrimental impacts of lockdown on children's mental health are a major worry. ConclusionsKnowledge of these themes is mainly implemented by deepening these concepts during the undergraduate studies since a high level of knowledge on child maltreatment and on the management of COVID-19 pandemic was significantly associated with clinical years of course. Specific seminars analyzing telemedicine and legislative protections concerning minors and those concerning vaccination doctors should be included in the study plan to raise awareness these concepts

Impact of COVID-19-Related Lockdown on Psychosocial, Cognitive, and Functional Well-Being in Adults With Down Syndrome

People with Down Syndrome (DS) have a high prevalence of physical and psychiatric comorbidities and experience early-onset dementia. With the outbreak of CoVID-19 pandemic, strict social isolation measures have been necessary to prevent the spreading of the disease. Effects of this lockdown period on behavior, mood and cognition in people with DS have not been assessed so far. In the present clinical study, we investigated the impact of CoVID-19-related lockdown on psychosocial, cognitive and functional well-being in a sample population of 46 adults with DS. The interRAI Intellectual Disability standardized assessment instrument, which includes measures of social withdrawal, functional impairment, aggressive behavior and depressive symptoms, was used to perform a three time-point evaluation (two pre-lockdown and one post-lockdown) in 37 subjects of the study sample, and a two time point evaluation (one pre- and one post-lockdown) in 9 subjects. Two mixed linear regression models - one before and one after the lockdown - have been fitted for each scale in order to investigate the change in the time-dependent variation of the scores. In the pre-lockdown period, significant worsening over time (i.e., per year) was found for the Depression Rating Scale score (beta = 0.55; 95% CI 0.34; 0.76). In the post-lockdown period, a significant worsening in social withdrawal (beta = 3.05, 95% CI 0.39; 5.70), instrumental activities of daily living (beta = 1.13, 95% CI 0.08; 2.18) and depression rating (beta = 1.65, 95% CI 0.33; 2.97) scales scores was observed, as was a significant improvement in aggressive behavior (beta = -1.40, 95% CI -2.69; -0.10). Despite the undoubtful importance of the lockdown in order to reduce the spreading of the CoVID-19 pandemic, the related social isolation measures suggest an exacerbation of depressive symptoms and a worsening in functional status in a sample of adults with DS. At the opposite, aggressive behavior was reduced after the lockdown period. This finding could be related to the increase of negative and depressive symptoms in the study population. Studies with longer follow-up period are needed to assess persistence of these effects

Influenza and pneumococcal vaccinations are not associated to COVID-19 outcomes among patients admitted to a university hospital

In order to reduce the burden on healthcare systems and to support differential diagnosis with COVID-19, influenza and pneumococcal vaccinations were strongly recommended during the COVID-19 pandemic, especially in vulnerable groups. However, no univocal and conclusive evidence on the relationship between influenza and pneumococcal vaccinations and COVID‐19 outcomes exists. We evaluated the association between such vaccinations, COVID-19 hospitalization, intensive care unit admissions and deaths in a cohort (N = 741) of COVID-19 patients who had access to the emergency room of a large Italian University hospital between March 1, 2020 and June 1, 2020. Results show that influenza and pneumococcal vaccinations did not affect hospitalization, intensive care unit admission and deaths in COVID-19 patients in the overall sample and in those ≥65 years. The same pattern of results was confirmed considering timing of influenza vaccine administration, vaccination type, and number of uptakes in the last five vaccination campaigns. In conclusion, our study does not support an impact of influenza and pneumococcal vaccinations on COVID-19 outcomes

Debate on globalization. A comment

Globalization means the affirmation of a single market at the global level. More generally, the word globalization is usually used to indicate a unified world that tends to homogenize products and consumption patterns. In addition to the undoubtedly positive effects that the processes of globalization have on the overall well-being and the possibilities of consumption in all countries, a lively debate has developed among economists, but also among philosophers, sociologists and other scholars about the negative effects of globalization, particularly in terms of poverty and inequality. This paper mainly aims to analyze, consider and comment on the proposals contained in the book edited by Giancarlo Mazzocchi and Andrea Villani entitled Debate on globalization (2002).Globalizzazione; Integrazione Economica; Finanza Internazionale, Stato Sociale; Povertà; Diversità Culturale

High risk of macrosomia in newborns of immigrant mothers

Background In Italy live about 8.7% immigrants, which contribute to more than 15% of all deliveries taking place in Italy. We aimed to investigate whether newborns from high migratory pressure countries (HMPC) mothers have a different macrosomia and post-term pregnancy incidence compared to Italian newborns. Methods In this retrospective observational study, we analyzed data on 404.863 babies born between 2010 and 2017. Italian mothers delivered 309.658 (76.5%), HMPC mothers 88.179 (21.8%) and developed country (DC) mothers 7.026 (1.7%) babies. We analyzed the incidence of macrosomia and post term pregnancy. We estimated incidence rate (IR), unadjusted incidence rate ratio (IRR) and 95% confidence intervals (CIs) to evaluate the association between these perinatal parameters and the mother's region of birth. Results HMPC compared to Italian newborns showed a significantly higher incidence of birthweight > 4000 g (53.3 parts per thousand vs 39.1 parts per thousand, p-value < 0.001; IRR 1.4, 95%CI = 1.36-1.45), birthweight >= 4500 g. (7.0 parts per thousand vs 3.8 parts per thousand, p-value < 0.001; IRR 1.8, 95%CI = 1.67-2.0) and gestational age at birth > 41 weeks (19.9 parts per thousand vs 12.8 parts per thousand, p-value < 0.001; IRR 1.55, 95%CI = 1.47-1.64). The macrosomia incidence between HPMC and Italian newborns was significantly increased at all gestational ages (Fig. 1), especially for mothers coming from Central Eastern Europe (121.79 parts per thousand vs 91.1 parts per thousand, p-value< 0.001; IRR 1.34, 95%CI = 1.11-1.62). Conclusion In Italy immigrant status represents a risk factor for macrosomia and post-term birth, which could be related to socio-economic status and unfavorable life conditions of immigrant mothers during pregnancy

Editorial: Positive Technology: Designing E-experiences for Positive Change

While there is little doubt that our lives are becoming increasingly digital, whether this change is for the better or for the worse is far from being settled. Rather, over the past years concerns about the personal and social impacts of technologies have been growing, fueled by dystopian Orwellian scenarios that almost on daily basis are generously dispensed by major Western media outlets. According to a recent poll involving some 1,150 experts, 47% of respondents predict that individuals’ well-being will bemore helped than harmed by digital life in the next decade, while 32% say people’s well-being will bemore harmed than helped. Only 21% of those surveyed indicated that the impact of technologies on people well-being will be negligible compared to now (Pew Research Center, 2018)

Le accademie lincee tra Chiesa, fascismo e Stato: una guida alle fonti (1847-1946)

La guida qui proposta ha come oggetto gli intrecci scientifici, culturali, politici e storici che interessarono, a partire dalla metà dell’Ottocento, la Pontificia Accademia dei Nuovi Lincei e le istituzioni accademiche che ne derivarono: la Reale Accademia dei Lincei (ente predecessore dell’attuale Accademia Nazionale dei Lincei) e la Pontificia Accademia delle Scienze. Attraverso l’individuazione e l’analisi comparata delle fonti archivistiche e bibliografiche si è affrontato un percorso storico non sempre lineare, in cui le vicende della Pontificia Accademia dei Nuovi Lincei (depauperata dalla scissione degli anni immediatamente successivi alla breccia di Porta Pia) si intrecciarono con quella della Reale Accademia dei Lincei e della Reale Accademia d’Italia (il sodalizio accademico sorto per volere del regime fascista per dare una rappresentanza unitaria al mondo scientifico italiano). Attraverso l’analisi comparata delle diverse fonti, la guida affronta l’evoluzione delle accademie lincee, dalla ricostituzione nel 1847 della Pontificia Accademia dei Nuovi Lincei su impulso di papa Pio IX (ultimo atto di una vicenda iniziata con la fine del sodalizio lincei fondato da Federico Cesi), fino agli accadimenti del ventennio fascista, col tentativo di unificare sotto un’unica ragione sociale (l’Accademia d’Italia) le istituzioni nazionali che organizzavano allora le diverse anime dell’alta cultura italiana. La politica accademica del regime segnò una temporanea interruzione della vita dell’Accademia dei Lincei, che confluì nella Reale Accademia d’Italia, mentre in Vaticano si arrivò alla soppressione definitiva della Pontificia Accademia dei Nuovi Lincei, sostituita dalla Pontificia Accademia delle Scienze. Si è indagato soprattutto sulla ricerca di fonti relative al passaggio storico-politico che portò all’abolizione simultanea delle due accademie lincee, e all’abbandono da parte di entrambe del nome di ascendenza galileiana, per capirne i meccanismi e apprezzarne le influenze sulla politica accademica del dopoguerra, sulle due sponde del Tevere. Il percorso archivistico e storico prende le mosse da un’indagine di più ampio respiro, scelta determinata dalla necessità di comprendere al meglio i legami tra le accademie lincee, soprattutto per quanto concerne l’apporto della Chiesa alla storia dei differenti sodalizi, ma è stato importante anche per analizzare correttamente le motivazioni sottostanti la volontà del regime di “conquistare” l’eredità lincea e rivolgerla a proprio favore, in un’ottica propagandistica e accentratrice che ha caratterizzato il fascismo fin dalle sue origini. La guida presenta una nota storica che racchiude il contesto all’interno del quale hanno operato le accademie lincee, dalla prima istituzione seicentesca alla Reale Accademia dei Lincei, fino alla restaurazione del sodalizio nel dopoguerra. La strutturazione in capitoli, paragrafi e sottoparagrafi segue una logica aggregativa per istituti. In questo modo, non solo la distinzione degli eventi, cronologicamente definiti, ma anche la divisione delle differenti fasi di vita del sodalizio appaiono immediatamente visibili in un’ottica che tiene conto delle differenti riprese dell’eredità lincea nel corso dei secoli. Per quanto concerne l’ordine individuato per la strutturazione della guida, questo non segue l’elemento di rilevanza istituzionale del singolo istituto conservatore, quanto piuttosto il valore della documentazione conservata nel concorrere alla ricostruzione della storia dell’Accademia dei Lincei e dei rapporti tra Chiesa, fascismo e Stato. La scelta è motivata dalla necessità di rendere immediatamente evidente la sequenzialità degli istituti di conservazione utili per una disamina esaustiva dell’oggetto della ricerca. Per questo motivo la guida si struttura partendo dai principali fondi afferenti all’Accademia Nazionale dei Lincei e sfrutta l’indicazione cronologica relativa ad ogni declinazione del sodalizio, inserendo anche gli archivi utili per la ricerca che si trovano nel medesimo istituto di conservazione. Poi, si è proceduto con l’inserimento dell’Archivio Centrale dello Stato, che per sua natura conserva la documentazione relativa agli organi centrali dello Stato e quindi raccoglie le carte che in second’ordine sono da considerarsi di fondamentale rilevanza per ricostruire, dal punto di vista del regime e dello Stato, le intricate vicende dell’Accademia dei Lincei e dell’Accademia d’Italia. Poi, si è inserito l’Archivio dell’Università Cattolica del Sacro Cuore di Milano. Il suo inserimento ai livelli più alti della guida è determinato dalla presenza delle carte relative alla gestione da parte di Agostino Gemelli, della Pontificia Accademia dei Nuovi Lincei, costituendo l’archivio cardine per gli studi sul sodalizio, essendo stato impossibile accedere alla documentazione conservata in Vaticano. A seguire, sono stati inseriti gli archivi conservati presso l’Accademia delle Scienze, detta dei XL. L’archivio istituzionale è seguito da quelli personali di Millosevich e di Marconi. Poi, è stata inserita l’Accademia delle Scienze dell’Istituto di Bologna, con l’indicazione relativa all’archivio istituzionale. A seguire, la scelta del percorso della guida si sposta procedendo attraverso gli archivi delle personalità più rilevanti per la ricerca. In prima battuta si riscontra la Società Geografica Italiana, all’interno della quale è conservato l’archivio di Giotto Dainelli. A seguire la Fondazione Giovanni Gentile, la Fondazione Benedetto Croce e la Fondazione Arnoldo e Alberto Mondadori, al cui interno è conservato l’archivio di Giuseppe Bottai. Infine, la guida si chiude con la Provincia dell’Ordine dei Frati Minori di Lombardia, all’interno del quale sono conservate le carte relative al percorso religioso di Gemelli