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This paper grants some considerations on a critical phenomenon for child health: child neglect. It is an omission-type form of childhood maltreatment, which is widespread but very hard to intercept. For the assessment of child neglect, the Italian Society of Pediatric Psychology (S.I.P.Ped.) has developed and validated a specific assessment technique (the C.N.A. technique). It is supposed to be for parents of children between 3 and 9 years old. It is based on a paradigm that identifies the dysregulation of parental competence as the cause of neglect. It can occur in hypo- or hyperactivation of three fundamental factors (recognition, stimulation, and care). The child neglect assessment technique (C.N.A.) differs from the retrospective tools available in the literature since it allows for interception of the “signs” of possible child neglect when negligence occurs.

Mutations of TSC1 and TSC2 genes cause classical Tuberous Sclerosis Complex (TSC), a neurocutaneous disorder characterized by a tendency to develop hamartias, hamartomas, and other tumors. We herein report on a girl, now aged 5 years, who presented a previously unreported, distinct clinical phenotype consisting of primary microcephaly (head circumference = 40 cm, −5.6 standard deviations), brain anomalies including hypoplasia of the corpus callosum (with a residual draft of the genu), simplified parieto-temporal gyral pattern, colpocephaly with ectasia of the temporal ventricular horns, intellectual disability, and a general pattern of reduced growth (with weight and height A). We hypothesize that her clinical phenotype could be related to a “gain-of-function” of the TSC1 protein product hamartin, causing an increase in the effects of the protein on inhibition of its intracellular targets (i.e., mTORC or RAC1 pathways), resulting in a distinct “inverse TSC1-hamartin” phenotype characterized by reduced growth of cells instead of the more classical predisposition to increased cell growth.

This study addresses the complexity of caregiver-infant/child interactions from the theoretical frame of Gestalt psychotherapy and the field of application of Pediatric Psychology. Based on a previous empirical study on the process of reciprocity in caregiver-infant/child interactions (Spagnuolo Lobb, 2016), the authors have worked on the construction of an observational tool to look at the co-creation of meaningful experiences, switching the focus from the child to the “dance” of reciprocity between caregiver and infant/child. Considering the contextualization in the field of Pediatric Psychology, this pilot study aimed to test the tool’s application with caregiver-preterm infant dyads, but exclusively referring to moderately preterm birth condition and with lack of disability or in any case serious evolutionary compromises. The study measured: 1. the content/construct validity of the tool, 2. its internal reliability, 3. its “sensitivity” to grasp the changing of the relational “dance” in the transition from one developmental step of the infant to another, regarding the times considered (between 6-9-12 months of corrected age), 4. co-occurrences between the behavioral flows of the infant-caregiver dyad in the three developmental stages considered. 32 expert psychotherapists were involved in measuring the instrument’s validity, and 13 caregiver-infant dyads were observed in their interactions at 6-9-12 months of corrected age of the infant. This pilot study promises to define – both for preventative and psychotherapeutic interventions – specific parental competencies for the infant’s neurodevelopment in the first year of life. This paper is part of the “Pediatric Psychology and Related Issues” Section (Sezione “Psicologia Pediatrica e Dintorni”) by S.I.P.Ped. (Italian Society of Pediatric Psychology, Società Italiana di Psicologia Pediatrica).

Klippel–Trenaunay syndrome is an uncommon, infrequent, congenital disorder characterized by a triad of capillary malformation, varicosities, and tissue and bone hypertrophy. The presence of two of these three signs is enough to obtain the diagnosis. Capillary malformations are usually present at birth, whereas venous varicosities and limb hypertrophy become more evident later. The syndrome has usually a benign course, but serious complications involving various organs, such as gastrointestinal and genitourinary organs, as well as the central nervous system, may be observed. Recently, Klippel–Trenaunay syndrome has been included in the group of PIK3CA-related overgrowth spectrum (PROS) disorders. In terms of this disorder, new results in etiopathogenesis and in modalities of treatment have been advanced. We report here a review of the recent genetic findings, the main clinical characteristics and related severe complications, differential diagnoses with a similar disorder, and the management of patients with this complex and uncommon syndrome.

This study provides a descriptive analysis of the Lègami/Legàmi service, a free psychological support service in maternal and childcare, offered through the internet and by telephone that was initiated by the Italian Society of Pediatric Psychology (S.I.P.Ped.) during the COVID-19 medical emergency as an act of solidarity, first independently, and then in collaboration with the Italian Ministry of Health. This paper presents findings related to the “universe” of people who called the toll-free service, from the sociocultural characteristics of the users to the information collected by the professionals during the psychological pathways until human satisfaction was achieved. We provide a retrospective description of an experience that took place between April and June 2020, and which involved users of the maternal-infant area calling from the whole Italy. (1) Methods: The aims of this study were to investigate the configuration of the indicators identified and to detect the possible correlations between them in the sample. There were 193 users who took advantage of the Service, 160 of whom continued beyond the reception service; it is this group that we report the findings from here. The tool used was a form reporting access to care and interventions, and the resulting data underwent a content analysis and the indicators were subject to non-parametric statistical analysis to analyze differences and relationships. (2) Results: There were many correlations among the indicators that revealed a high prevalence of calls due to personal motivations and requests for support, which later allowed users to gain a greater understanding of the underlying problems they were facing. The professionals running the service noticed a prevalence of weaknesses attributable to the negative emotions of its users, alongside a presence of cognitive and relational resources. The professionals’ interventions, which can be characterized by a prevalence of social support, psychological rehabilitation, and psychoeducation, achieved outcomes of redefining users’ relationships with themselves and others. All of the service’s users have expressed a high level of satisfaction with it. (3) Discussion: Our results revealed the protective and transformative effects of the service for its users and the underlying importance of having an easily accessible psychological support system in place during emergencies, like the recent pandemic. In conditions like these, the great value of a remote support service should be noted, and despite its limitations, assures its own efficacy when a medical emergency precludes closer in-person forms of psychological assistance.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: “what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures” and “the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars”? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Abstract Background For a number of persons with rare diseases (RDs) a definite diagnosis remains undiscovered with relevant physical, psychological and social consequences. Undiagnosed RDs (URDs) require other than specialised clinical centres, outstanding molecular investigations, common protocols and dedicated actions at national and international levels; thus, many “Undiagnosed RDs programs” have been gradually developed on the grounds of a well-structured multidisciplinary approach. Methods The Italian Undiagnosed Rare Diseases Network (IURDN) was established in 2016 to improve the level of diagnosis of persons with URD living in Italy. Six Italian Centres of Expertise represented the network. The National Centre for Rare Diseases at the Istituto Superiore di Sanità coordinates the whole project. The software PhenoTips was used to collect the information of the clinical cases. Results One hundred and ten cases were analysed between March 2016 and June 2019. The age of onset of the diseases ranged from prenatal age to 51 years. Conditions were predominantly sporadic; almost all patients had multiple organs involvements. A total of 13/71 family cases were characterized by WES; in some families more than one individual was affected, so leading to 20/71 individuals investigated. Disease causing variants were identified in two cases and were associated to previously undescribed phenotypes. In 5 cases, new candidate genes were identified, although confirmatory tests are pending. In three families, investigations were not completed due to the scarce compliance of members and molecular investigations were temporary suspended. Finally, three cases (one familial) remain still unsolved. Twelve undiagnosed clinical cases were then selected to be shared at International level through PhenomeCentral in accordance to the UDNI statement. Conclusions Our results showed a molecular diagnostic yield of 53,8%; this value is comparable to the diagnostic rates reported in other international studies. Cases collected were also pooled with those collected by UDNI International Network. This represents a unique example of global initiative aimed at sharing and validating knowledge and experience in this field. IURDN is a multidisciplinary and useful initiative linking National and International efforts aimed at making timely and appropriate diagnoses in RD patients who still do not have a confirmed diagnosis even after a long time.

IntroductionThe emergence of gaming technologies, such as videogames and virtual reality, provides a wide variety of possibilities in intensively and enjoyably performing rehabilitation for children with neurological disorders. Solid evidence-based results are however required to promote the use of different gaming technologies in pediatric neurorehabilitation, while simultaneously exploring new related directions concerning neuro-monitoring and rehabilitation in familiar settings.Aim of the Study and MethodsIn order to analyze the state of the art regarding the available gaming technologies for pediatric neurorehabilitation, Scopus and Pubmed Databases have been searched by following: PRISMA statements, PICOs classification, and PEDro scoring.Results43 studies have been collected and classified as follows: 11 feasibility studies; six studies proposing home-system solutions; nine studies presenting gamified robotic devices; nine longitudinal intervention trials; and eight reviews. Most of them rely on feasibility or pilot trials characterized by small sample sizes and short durations; different methodologies, outcome assessments and terminologies are involved; the explored spectrum of neurological conditions turns out to be scanty, mainly including the most common and wider debilitating groups of conditions in pediatric neurology: cerebral palsy, brain injuries and autism.ConclusionEven though it highlights reduced possibilities of drawing evidence-based conclusions due to the above outlined biases, this systematic review raises awareness among pediatricians and other health professionals about gaming technologies. Such a review also points out a definite need of rigorous studies that clearly refer to the underlying neuroscientific principles.

Background: An inconclusive diagnosis of cystic fibrosis (CF) after positive newborn screening (NBS) may cause parental distress. We compared the psychological impact of CF transmembrane conductance regulator-related metabolic syndrome (CRMS)/CF screen-positive, inconclusive diagnosis (CFSPID), and clear CF diagnosis, on parents. Methods: The participants were administered the Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, and the Italian version of the Impact of Event Scale-Revised as quantitative tools and semi-structured interviews as qualitative tools. Parental experience, child representation, relationships, future information, and perception of health status were investigated. Interviews were recorded and transcribed verbatim maintaining anonymity. Results: Thirty-two families were enrolled: sixteen with CF and CRMS/CFSPID, respectively. Anxiety and depression values were high in both groups, as were the measurement of traumatic impact subscales: avoidance, intrusiveness, and hyperarousal. The children’s health was evaluated by respective parents as being nearly healthy. Conclusions: Our results highlight negative psychological impacts, including emotional and affective representations, on parents of children with inconclusive CF diagnosis compared with those with clear diagnosis.

Background: Gestational SARS-CoV-2 infection can impact maternal and neonatal health. The virus has also been reported to cause newborn sensorineural hearing loss, but its consequences for the auditory system are not fully understood. Objective: The aim of this study was to evaluate the impact of maternal SARS-CoV-2 infection during pregnancy on newborn’ hearing function during the first year of life. Methods: An observational study was conducted from 1 November 2020 to 30 November 2021 at University Modena Hospital. All newborns whose mother had been infected by SARS-CoV-2 during pregnancy were enrolled and underwent audiological evaluation at birth and at 1 year of age. Results: A total of 119 neonates were born from mothers infected by SARS-CoV-2 during pregnancy. At birth, five newborns (4.2%) presented an increased threshold of ABR (Auditory Brainstem Evoked Response), but the results were confirmed only in 1.6% of cases, when repeated 1 month later, while the ABR thresholds in all other children returned to normal limits. At the 1-year follow-up, no cases of moderate or severe hearing loss were observed, while concomitant disorders of the middle ear were frequently observed. Conclusions: Maternal SARS-CoV-2 infection, regardless of the trimester in which it was contracted, appears not to induce moderate or severe hearing loss in infants. It is important to clarify the possible effect of the virus on late-onset hearing loss and future research is needed.

The aim of the study was to systematically review and compare the accuracy of smartphone scanners versus stereophotogrammetry technology for facial digitization in children. A systematic literature search strategy of articles published from 1 January 2010 to 30 August 2022 was adopted through a combination of Mesh terms and free text words pooled through boolean operators on the following databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and OpenGrey. Twenty-three articles met the inclusion criteria. Stationary stereophotogrammetry devices showed a mean accuracy that ranged from 0.087 to 0.860 mm, portable stereophotogrammetry scanners from 0.150 to 0.849 mm, and smartphones from 0.460 to 1.400 mm. Regarding the risk of bias assessment, fourteen papers showed an overall low risk, three articles had unclear risk and four articles had high risk. Although smartphones showed less performance on deep and irregular surfaces, all the analyzed devices were sufficiently accurate for clinical application. Internal depth-sensing cameras or external infrared structured-light depth-sensing cameras plugged into smartphones/tablets increased the accuracy. These devices are portable and inexpensive but require greater operator experience and patient compliance for the incremented time of acquisition. Stationary stereophotogrammetry is the gold standard for greater accuracy and shorter acquisition time, avoiding motion artifacts.

The present study focuses on the relation between coping strategies of children with leukemia during treatment and locus of control of their mothers. In particular, the study aims to determine whether maternal locus of control can influence sick children’s coping styles, and if this relation can be used to predict maladjustments. The study analyzed a cohort of 60 pediatric leukemia patients undergoing treatment and a group formed by their mothers. The participants were recruited from two Pediatric Onco- Hematology Units in Italy. The Child Behavioral Style Scale (CBSS) was used to assess children’s coping strategies, whereas the Parental Health Locus of Control Scale (PHLCS) was employed to analyze maternal locus of control. A linear regression model was applied to verify a possible interdependent relationship between children’s coping styles and maternal locus of control. The differences in mean CBSS scores were analyzed by K-S test. Multivariate analysis of variance was performed to assess any potential effect of child’s gender, hospital context and maternal socio-cultural status on children’s coping strategies. Our results show a significant relationship between children’s coping strategies and maternal locus of control. In particular, the scales mass media, fate and healthcare professionals display a predictive effect on children’s monitoring coping style, given the positive correlation observed (F=3.28, P=0.008). In contrast, the same scales negatively correlate with blunting coping style (F=3.5, P=0.005). Our results reveal several interesting resources having a profound impact on the psychological functioning of children with leukemia undergoing treatment as well as their mothers. Furthermore, with regard to the central hypothesis of the study, our findings show both positive and negative correlations between specific scales of maternal locus of control and children’s coping style, which could be used to predict children at risk of emotional maladjustment.

Abstract Background Minor Recurrent Aphthous Stomatitis (RAS) represents a disease which is very difficult to prevent. This case-control study focused on possible associations between minor Recurrent Aphthous Stomatitis in children, their oral health, and underlying behavioral indexes of children’s attitudes and habits pertaining to (home) oral hygiene, with the further goal of enabling the dentist to prevent these specific kind of lesions, both from a clinical and a broader psychosocial perspective. Methods Four hundred one school-children (5–10 years old) in Milan (Italy) were submitted to an intra-oral examination, and interviewed with the aid of a brief psychosocial questionnaire. Results At the clinical level, statistically significant associations were observed between the presence of decayed teeth and minor Recurrent Aphthous Stomatitis (Odds Ratio: 3.15; 95% CI: lower limit 1.06; upper limit: 9.36; Z-test: 2.07, p = 0.039; Chi-square = 4.71, p = 0.030), and between the Decayed Missing or Filled Teeth (DMFT) index and minor aphthous stomatitis (Odds Ratio: 3.30; 95% CI: lower limit 1.13; upper limit: 9.67; Z-test = 2.18, p = 0.029; Chi-square = 5.27; p = 0.022), both results pointing to a significant increase—by circa 3 times—in the risk of developing minor Recurrent Aphthous Stomatitis in children exposed to the two above-identified factors (i.e., the presence of decayed teeth and a clearly compromised oral condition, as signaled by the DMFT index), if compared with the risk run by their non-exposed counterparts. At the psychosocial level of analysis, statistically significant associations were observed (1) between children’s practice of spontaneously brushing teeth when not at home and a comparatively lower (i.e. better) Decayed Missing or Filled Teeth index (Chi-square: 8.95; p = 0.011), and (2) between receiving parental aid (e.g., proper brushing instructions) while practicing home oral hygiene and a significantly reduced presence of decayed teeth (Chi-square = 5.40; p = .067; Spearman’s Rho, p = .038). Further, significant associations were also observed between children’s reported severity of dental pain and both (a) the presence of decayed teeth (Chi-square = 10.80; p = 0.011), and (b) children’s (poor) oral health condition as expressed by the Decayed Missing or Filled Teeth index (Chi-square = 6.29; p = 0.043). Interestingly, specific lifestyles and social status, showed no systematic association to other clinical or psychological/psychosocial indices. Conclusions These systematic relations suggest that, in the presence of Recurrent Aphthous Stomatitis in pediatric patients, the dentist should carefully monitor children for potential carious lesions, implement protocols of prevention to control Recurrent Aphthous Stomatitis disease in children affected by caries, and also be particularly aware of the right or wrong habits children may acquire in the course of continued social exchange with their caregivers and peers.

Abstract Background Woolly Hair is an uncommon congenital anomaly of the scalp hair presenting with strongly coiled hair involving a localized area of the scalp or covering the entire side and occurring in non-black people. Isolated or localized wooly hair is usually benign and is not related to other disorders and/or complications. On the contrary, the generalized type may be related to disorders and syndromes affecting heart, cutis, liver and gastrointestinal organs. Among the syndromes presenting with wooly hair, the most known are the Naxos syndrome, the Carvajal-Huerta syndrome, the wooly hair/hypotrichosis, the ectodermal dysplasia-skin fragility, the tricho-hepato-enteric syndrome. Case presentation To our knowledge, no cases of wooly hair syndromes has been associated to neurologic involvement. Among the clinical notes of patients admitted in the Pediatric Units of the Catania University, we have selected four individuals presenting wooly hair, who showed different clinical features and course: case 1 presenting with a localized wooly hair type; case 2, member of a family affected by WH with autosomal dominant inheritance, not associated to complications; case 3, a wooly hair patient who displayed a progressive, severe form of Rasmussen’s encephalitis with fatal evolution, and case 4, wooly hair associated to brain malformation and drug-resistant epilepsy. Conclusions With this report, we aim to underline the wide spectrum of clinical presentation of individuals with WH and in particular we wish to give an annotation on a possible association of WH with severe neurologic disorders.

Purpose: To investigate the possible effects of the fetal echocardiography experience on the prenatal attachment process. The predictive effect of specific women’s psychological variables will be explored as well. Design and methods: This between groups study involved 85 women with pregnancy at risk who underwent the fetal echocardiography, and 83 women who were about to undergo the morphological scan. The tools employed were: the Prenatal Attachment Inventory (P.A.I.) to explore the maternal-fetal attachment; the Maternity Social Support Scale to investigate the woman perception of being socially supported during pregnancy; both the Big Five Questionnaire and the FACES III to explore the personality traits of pregnant women and their perception of their couple relationship functioning. Findings: The outcomes of ANOVA do not show statistically significant differences between the two groups of the mothers-to-be with regard to the scores of the P.A.I. (F = .017; p = .897; η2 = .000), while the regression analysis of the possible effect of the maternal psychological variables on the mother-fetus relationship shows a statistically significant result only with regard to the “social support” variable (r2 = .061; df = 80; p = .025). Conclusions: It would seem that the process of the prenatal attachment develops independently whether the woman has to undergo a first level screening or a second level examination such as the fetal echocardiography.

This study has explored the valence of sibship that may empower the self-esteem of children with asthma at the interpersonal, environmental control competence, emotionality management, and body-image levels. It has been assumed that the relationship between siblings may have a moderating effect on the negative impact that asthma has on child’s development. Seventy children suffering from chronic asthma have been involved: 40 children with siblings (experimental group) and 30 sibling-free children (control group). The children with asthma have exhibited higher levels of self-esteem in comparison with the sibling-free children. The results of the study, at the clinical significance level, highlight how meaningful could be the involvement of healthy siblings to support the development, and to ease the compliance of children suffering from asthma. The outcomes have confirmed the supportive valence of sibship for the self-esteem of the children with asthma.

This article is concerned with the description of rehabilitative training aimed at severely and moderately preterm children at preschool age who display impairments of processes of selective attention, self-control and problem solving and who are at risk of Attention Deficit Hyperactivity Disorders. In line with a perspective of field study suggested by pediatric psychology, the treatment calls for the involvement of parents, teachers, neonatologists and children’s reference pediatricians. To be more precise, it is a study aimed at investigating the sustainability of the training path in terms of impact and transformative valence of the focalised processes. Involved in the study was a group of 55 healthy preterm children (35 moderately preterm children and 20 severely preterm children) at mean age of 5.2 years attending the third year of infancy school; a group of 55 mothers; a group of 15 pediatricians; a group of 5 neonatologists and one of 10 teachers. Specific questionnaires (the IPDAG and IPDDAI) were administered to parents and teachers before and after the training sessions to detect the transformation of the focalised processes. According to a modality of continuous observation during the activities, the trainer used techniques of narrative (the critical incident technique) and descriptive (encoding scheme) observation. A checklist to detect the participation of adults was used. It was structured as follows: presence, production and aftermath of the effects of the personal intervention with child. A telephone follow-up was performed three months after the end of training to detect the involved adults’ considerations about the stability of promoted changes. Data show good levels of sustainability of the proposed training.

Acute lymphoblastic leukemia (ALL) is a very distressing experience for children and requires a special effort of adjustment. Therefore, it seems to be crucial to explore coping resources for the experienced risk condition. In this sense, the study focuses on coping strategies and locus of control in children with ALL during the treatment phase, and on their possible relation. The correlation between children and maternal coping strategies is also investigated. The participants involved were an experimental group of 40 children with ALL and their mothers, and 30 healthy children as the control group. The tools used were: the Child Behavioral Style Scale and the Monitor-Blunter Style Scale to assess the coping strategies of children and mothers; the locus of Control Scale for Children to analyze the children’s perception of controlling the events. Both children with ALL and their mothers resorted to monitoring coping strategies with a statistically significant rate of occurrence (children: M=17.8, SD=3.8; mothers: M=10.48, SD=3.4). The data concerning the locus of control show this tendency towards internal causes (M=53.1, SD=4.7). There were statistically significant correlations between monitoring coping strategies and external locus of control (r=0.400, P

The low attention and hyperactivity are major morbidities associated with very and moderately preterm birth. The study has been aimed at investigating the likely occurrence of early precursors of Attention Deficit and Hyperactivity Disorder (ADHD) in very and moderately preterm children at preschool age. The involved children were: 25 very preterm children (M=29.4 weeks of gestational age, SD=2), with low birth weight (M=1200 g, SD=250 g); 35 moderately preterm children (M=34.6 weeks of gestational age, SD=1) with low birth weight (M=2100 g, SD=250 g); 60 healthy full-term children as the control group. Parents of children have been administered specific questionnaires to detect low attention and hyperactivity of their children at home. The data have shown the risk of precursors of ADHD, highlighting statistically significant birth-related differences in both hyperactivity/impulsivity [F(2,119)=3.5, P=0.03, η2=0.06] and inattention [F(2,119)=2.4, P=0.04, η2=0.04], where very preterm children have got higher scores in these two dimensions compared with full-term and moderately preterm children. The very preterm children have got higher scores of impulsivity and inattention than the full-term children (Tukey’HSD − Honestly Significant Difference; P

The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia) called the A group, and the control group (women who refused it) called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y) scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment) scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

A child’s oncological or chronic disease is a stressful situation for parents. This stress may make it difficult for appropriate management strategies aimed at promoting the child’s well-being and helping him or her cope with a disease to be adopted. In particular, this study focuses on the possible connections between the variable national cultural influences and the parental strategies used to cope with a child’s severe disease by comparing the experiences of Italian and Portuguese mothers. The study investigates differences and cross-cultural elements among the coping strategies used by Italian and Portuguese mothers of children with oncological or chronic disease. Two groups of mothers took part: 59 Italian mothers (average age 37.7 years; SD=4.5) and 36 Portuguese mothers (average age 39.3 years; SD=4.6). The tool used was the Italian and the Portuguese versions of the COPE inventory that measures five coping strategies: Social Support, Avoidance Coping, Positive Aptitude, Religious Faith and Humor, Active Coping. There were statistically significant differences between Portuguese and Italian mothers regarding Social Support (F(3, 94)=6.32, P=0.014, η2=0.065), Religious Faith and Humor (F(3, 94)=20.06, P=0.001, η2=0.18, higher values for Portuguese mothers) and Avoidance Coping (F(3, 94)=3.30, P=0.06, η2=0.035, higher values for Italian mothers). Regarding child’s disease, the only statistically significant difference was in Religious Faith and Humor (F(3, 94)=7.49, P=0.007, η2=0.076, higher values for mothers of children with chronic disease). The findings of specific cultural transversalities provide the basis for reflection on important factors emerging on the relationship between physicians and parents. In fact, mothers’ coping abilities may allow health workers involved in a child’s care not only to understand how parents face a distressful event, but also to provide them with professional support.

Child development may be subject to forms of motor, physical, cognitive and self-representation impairments when complex congenital heart disease (CHD) occurs. In some cases, inadequacy of both self-representation as well as the family system are displayed. It seems to be important to search the likely internal and external resources of the CHD child, and the possible connections among such resources, which may help him/her to manage his/her own risk condition. The research project inquires the possible resources related to the self-representation and self-esteem levels of the CHD child, and those related to maternal self-perception as competent mothers. A group of 25 children (mean age = 10.2; SD=1.8) suffering from specific forms of CHD, and a group made up of their relative mothers (mean age = 38.2; SD=5) were studied. The tools used were the Human Figure Drawing, to investigate child body-related self-representation; the TMA scale (Self-esteem Multidimensional Test), to investigate the child’s self-esteem; and the Q-sort questionnaire, to assess how mothers perceived their maternal competence. Data concerning the likely correlations between the child’s self-representation and the maternal role competence show [that] positive correlations between some indicators of maternal competence, specific aspects of CHD children’s self-representation (mothers’ emotional coping and children’s self-image adequacy) and self-esteem (mothers’ emotional scaffolding and children’s self-esteem at an emotional level). By detecting the occurrence of specific correlations among resources of both child and mother, the study provides cardiologists with information that is useful for building a relationship with the families concerned, which would seem to enhance the quality of the process of the cure itself.