Sleep and psychological characteristics in habitual self-awakeners and forced awakeners.

Previous studies described the modifications of physiological and behavioural variables associated with self-awakening, while only few studies assessed subjective sleep quality and psychological characteristics in habitual self-awakeners. Here we investigated self-reported sleep habits and features, as well as psychological variables of habitual self-awakeners and forced-awakeners, with special regard to subjective sleep quality, personality characteristics, anxiety and depression symptoms. In our sample, the prevalence of habitual self-awakeners was 15.1%. Compared to forced-awakeners, habitual self-awakeners showed more regular sleep/wake schedules and were more frequently morning types. Moreover, habitual self-awakeners referred to be more satisfied about their sleep, to wake up more easily in the morning, to need less time to get out of bed and to feel more refreshed upon awakening than forced-awakeners. We also observed an association between the habit of self-awakening and the "ability" to set the awakening to an unusual time. Concerning psychological features, habitual self-awakeners showed higher scores in Conscientiousness and Openness and lower scores in Extraversion compared to forced-awakeners, whereas no differences between groups emerged for anxiety and depression levels. In conclusion, our findings point to an association between the habit of self-awakening and good subjective sleep quality. In this perspective, future research should objectively test in detail the effects of the self-awakening habit on sleep structure and organization, taking into account also microstructural sleep features

The effects of the COVID19-related lockdown are modulated by age: an Italian study in toddlers and pre-schoolers

Although the issue has been repeatedly explored, data on the impact of the COVID-19 pan- demic on children’s sleep quality are inconsistent. To clarify these discrepancies, here we investigate possible age-related differences. During the lockdown, 112 parents of toddlers (0–3 years, N = 61) and pre-schoolers (4–5 years, n = 51) completed an online survey including the Children’s Sleep Habits Questionnaire (CSHQ). Sleep-related items required an additional retrospective judgment, referring to the pre-pandemic period. During the lockdown, sleep schedules were delayed in both age groups whereas sleep quality (CSHQ total scores) improved in pre-schoolers but not in toddlers. Between-groups comparisons revealed that, prior to the lockdown, pre-schoolers showed worse sleep quality than toddlers, whereas this difference disappeared during home confinement. Also, pre-schoolers’ sleep timing was advanced before the lockdown and delayed during the lockdown relative to toddlers’. Our data highlight a significant modulation of age on the impact of the pandemic crisis on sleep, with pre-schoolers experiencing greater effects than toddlers. This profile suggests that factors affecting sleep features have different weights at different ages: sleep patterns would be mainly determined by developmental factors (i.e., biological drive) in younger children, whereas environmental factors (e.g., major lifestyle changes) would have a stronger effect on older ones

Evaluation of bone mineral density and bone turnover in children on anticoagulation

BackgroundChildhood and adolescence are critical periods of bone mineral acquisition. Children on anticoagulation (AC) might have an increased risk for reduced bone mineral density (BMD). Risk factors for impaired bone accumulation include chronic diseases, immobility, and medication. Vitamin K (VK) deficiency reflected by undercarboxylated osteocalcin levels (ucOC) has been identified as a predictor of osteoporosis and fractures. Data on bone health in children under AC are sparse.AimsTo evaluate BMD in children on AC and characterize the risk factors of low BMD, including VK and Vitamin D (VD) status.MethodsSingle-center cross-sectional study of clinical, biochemical, and densitometric parameters. Assessment of VK surrogate parameters included ucOC and matrix gla protein (MGP).ResultsA total of 39 children (4–18 years; 12 females) receiving AC were included, 31 (79%) on VK antagonists and 8 (21%) on direct oral anticoagulants. Overall, BMD was decreased for both the lumbar spine (LS; −0.7SDS) and total body less head (TBLH; −1.32SDS) compared with pediatric reference data. Significant associations were found between early pubertal development and TBLH-BMD, and between BMI and LS-BMD. VK surrogate parameters were highly related to patients’ age and pubertal development. Neither serum parameters nor AC-related factors predicted BMD. VD was detected in 10/39 patients with lower values during puberty.ConclusionOur data indicate BMD reduction in pediatric patients on AC. Although AC-related factors did not predict reduced BMD, low BMI and pubertal stages represented important risk factors. Awareness of risk factors for low BMD and high prevalence of VD deficiency during puberty could contribute to the improvement of bone health in this vulnerable patient group

Inspiration for the Future: The Role of Inspiratory Muscle Training in Cystic Fibrosis

Cystic fibrosis (CF) is an inherited, multi-system, life-limiting disease characterized by a progressive decline in lung function, which accounts for the majority of CF-related morbidity and mortality. Inspiratory muscle training (IMT) has been proposed as a rehabilitative strategy to treat respiratory impairments associated with CF. However, despite evidence of therapeutic benefits in healthy and other clinical populations, the routine application of IMT in CF can neither be supported nor refuted due to the paucity of methodologically rigorous research. Specifically, the interpretation of available studies regarding the efficacy of IMT in CF is hampered by methodological threats to internal and external validity. As such, it is important to highlight the inherent risk of bias that differences in patient characteristics, IMT protocols, and outcome measurements present when synthesizing this literature prior to making final clinical judgments. Future studies are required to identify the characteristics of individuals who may respond to IMT and determine whether the controlled application of IMT can elicit meaningful improvements in physiological and patient-centered clinical outcomes. Given the equivocal evidence regarding its efficacy, IMT should be utilized on a case-by-case basis with sound clinical reasoning, rather than simply dismissed, until a rigorous evidence-based consensus has been reached

Architettura, tecnologie digitali e building automation - Progetto di un padiglione tematico per l'EXPO di Osaka 2025 con applicazione di un sistema di building automation per la gestione degli impianti e dei dispositivi digitali dell'edificio

Il progredire e il diffondersi delle tecnologie digitali sembrano destinati ad assumere un valore sempre più consistente, nei sistemi sociali come nella vita individuale. In questo lavoro di tesi viene tracciato il percorso sulle mutazioni che ha subito il linguaggio architettonico in relazione alle nuove possibilità tecniche e tecnologiche, dalla rivoluzione industriale fino all’avvento della building automation e del digitale in architettura, e di come questo processo sia legato in maniera inscindibile ai cambiamenti delle nostre abitudini. Si cerca così di definire lo stato di fatto delle tecnologie disponibili, della loro diffusione e accessibilità, e quale impatto hanno e potranno avere sulle tipologie e gli elementi architettonici tradizionali, facendo anche riferimento alla strada tracciata dal settore tecnologico stesso con l’esperienza dell’Internet of Things. Sulla base di queste considerazioni si affronta il tema relativo al ruolo del progettista in questo scenario di cambiamento, con riferimento particolare a quei fenomeni costruttivi, come il Design for Disassembly, che presentano maggiori punti di contatto con alcune caratteristiche fondamentali delle tecnologie digitali, quali la modularità e la configurabilità. In seguito viene sinteticamente fatto il quadro del più ampio dibattito artistico e culturale (in cui si inserisce quello architettonico) sui cambiamenti innescati dal progresso tecnologico, focalizzandosi sulla figura e il lavoro di Yoichi Ochiai (media artist e ricercatore) e sull’Expo di Osaka 2025, intitolata proprio Designing Future Society for Our Lives. Ad Osaka, Ochiai è direttore artistico di uno degli otto padiglioni tematici previsti nel masterplan, pubblicato dal Japan Association for the 2025 World Exposition nel Dicembre 2020. Nella seconda parte della tesi si affronta dunque l’elaborazione di un progetto per il Padiglione a tema Forging lives (“Creare paesaggi sinestetici […] che sono resi coordinativi attraverso infrastrutture tecnologiche. Il progetto darà un’immagine di una nuova forma della natura combinata con la tecnologia digitale”, come si legge nel documento del masterplan). Dopo aver fatto un quadro delle aree tematiche e degli obiettivi di EXPO Osaka 2025, e dello spazio destinato all’architettura all’interno di essa, vengono definiti i temi principali di progetto, come sintesi degli indirizzi e delle finalità di EXPO e delle riflessioni affrontate nella prima parte di questa tesi. L’ultima parte è dedicata alla descrizione del progetto nel suo insieme (inserimento nel contesto, analisi tipologica, dimensionale, funzionale, ecc.) per poi concludere con una relazione sulla componente di gestione dei sistemi impiantistici e digitali utilizzata

Focused Update on Pulmonary Hypertension in Children—Selected Topics of Interest for the Adult Cardiologist

Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults

Monatsschrift Kinderheilkunde / Pathophysiologie der Synkope : Weg zu Diagnose und Management

Synkopen bei Kindern und Jugendlichen sind häufig, können aber auch schon im Säuglingsalter auftreten. Da es sich um ein „Symptom“ handelt, bedarf jedes Ereignis einer Diagnose als Erklärung. Eine Synkope ist eine plötzlich auftretende Episode kurz andauernder Bewusstlosigkeit, gefolgt von rascher und vollständiger Erholung, die durch eine globale zerebrale Hypoperfusion verursacht wird. Die vasovagalen Synkopen (VVS) oder Reflexsynkopen (RS) stehen im Vordergrund. Neue Erklärungsmodelle wie der „Selbstschutzmechanismus des Gehirns“ oder das „neuroviszerale Integrationsmodell“ verändern das Verständnis der komplexen pathophysiologischen Abläufe. Sorgfältige Anamnese und Statuserhebung sowie ein 12-Ableitungs-EKG lassen die meisten Pathomechanismen erkennen und helfen, potenziell lebensbedrohliche Erkrankungen auszuschließen.Syncope is a frequent condition in children and adolescents but can also occur in infancy. As syncope itself only represents a “symptom”, every event requires an adequate explanation of the underlying clinical mechanism. Syncope is caused by global cerebral hypoperfusion, leading to a short loss of consciousness with sudden onset and normally rapid and complete recovery. Vasovagal syncope (VVS) or reflex syncope (RS) is predominant in every age group and the course is most often benign. The concept of a brain self-protection mechanism and the model of neurovisceral integration have changed the perspectives in the interpretation of the underlying complex pathomechanisms. Meticulous patient history taking, a thorough physical examination and a 12-lead electrocardiogram (ECG) most often provide the key to the diagnosis helping to understand both the pathomechanisms and to rule out potentially life-threatening diseases.(VLID)505441