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Abstract Background Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. Case presentation We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. Discussion and conclusion To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.

Due to the growing environmental impact of the fashion industry, the demand for sustainable consumption is currently an urgent issue. The exponential increase of textile waste and the progressive reduction of product lifespan call for a shift to circular models, and in this context, consumer awareness has also become crucial. The retail environment, driven by an increasing shift towards a servitisation of the consumer experience, with its associated Product-Service Systems (PSSs), can provide a compelling opportunity to nurture consumer awareness, thus acting as a proactive mechanism to induce more responsible and sustainable behaviour. Within this framework, retail design is emerging as a key driver for sustainable behavioural changes in fashion consumption. This article, therefore, reflects on how fashion brands are actively orchestrating strategies within retail, defining dedicated PPSs to promote responsible consumption practices involving informative content, empowerment tools and co-creation initiatives that, going beyond awareness, can evolve into advocacy.

IntroductionThe red nucleus is part of the motor system controlling limb movements. While this seems to be a function common in many vertebrates, its organization and circuitry have undergone massive changes during evolution. In primates, it is sub-divided into the magnocellular and parvocellular parts that give rise to rubrospinal and rubro-olivary connection, respectively. These two subdivisions are subject to striking variation within the primates and the size of the magnocellular part is markedly reduced in bipedal primates including humans. The parvocellular part is part of the olivo-cerebellar circuitry that is prominent in humans. Despite the well-described differences between species in the literature, systematic comparative studies of the red nucleus remain rare.MethodsWe therefore mapped the red nucleus in cytoarchitectonic sections of 20 primate species belonging to 5 primate groups including prosimians, new world monkeys, old world monkeys, non-human apes and humans. We used Ornstein-Uhlenbeck modelling, ancestral state estimation and phylogenetic analysis of covariance to scrutinize the phylogenetic relations of the red nucleus volume.ResultsWe created openly available high-resolution cytoarchitectonic delineations of the human red nucleus in the microscopic BigBrain model and human probabilistic maps that capture inter-subject variations in quantitative terms. Further, we compared the volume of the nucleus across primates and showed that the parvocellular subdivision scaled proportionally to the brain volume across the groups while the magnocellular part deviated significantly from the scaling in humans and non-human apes. These two groups showed the lowest size of the magnocellular red nucleus relative to the whole brain volume and the largest relative difference between the parvocellular and magnocellular subdivision.DiscussionThat is, the red nucleus has transformed from a magnocellular-dominated to a parvocellular-dominated station. It is reasonable to assume that these changes are intertwined with evolutionary developments in other brain regions, in particular the motor system. We speculate that the interspecies variations might partly reflect the differences in hand dexterity but also the tentative involvement of the red nucleus in sensory and cognitive functions.

AbstractPlastic pollution in the environment has become a much-discussed issue worldwide. In recent decades, the contamination of all environments has become increasingly evident, in particular, that of water is highly concerning. Ingestion by different animal species under natural conditions has also been demonstrated. Among these is the Talitrid Amphipod Cryptorchestia garbinii, which lives on the banks of the internal waterways and lakes’ shorelines. As detritivores species, it is very exposed to microplastics that can be ingested, probably mistaking them for food. Aiming to highlight the microplastic ingestion and the role of this species as an entry point for the food web, we analyzed 80 specimens from 4 sites along the shores of Garda Lake, one of the first lakes in Italy to be studied for this type of contamination. The microplastics ingested were observed and quantified through the Nile Red staining method. We were able to verify the presence of ingested microplastics in all the samples analyzed and, therefore, in the food web. This species could serve as valuable natural models of plastic exposure. Microplastic sentinel species can be used as a proxy for environmental exposure and ecosystem monitoring tools to quantify and assess the impacts of microplastic contamination.

The predicted increase in demand for minor metals for modern technologies raises major concerns regarding potential environmental concentration increases. Among the minor metals, lithium (Li) is particularly noteworthy due to growing demand for battery production. Concerns have been raised about the impact on biota of increasing Li concentrations in the environment. To expand the knowledge of the effects of Li on plants, garden cress (Lepidium sativum L.), a model plant for ecotoxicity assay, was tested in a 72 h test in Petri plates. The results showed a stimulation effect of Li at the lowest concentration (Li chloride 10 mg L−1) on seed germination and primary root elongation. Conversely, higher Li concentrations (50 and 150 mg L−1) caused a progressive impairment in both parameters. A genotoxic effect of Li on root cells, evaluated through the alkaline comet assay, was observed at each concentration tested, particularly at 150 mg L−1 Li chloride. Elemental analysis showed that Li accumulated in the seedlings in a dose–concentration relationship, confirming its ability to be readily absorbed and accumulated in plants. Given the likely increase in Li levels in the environment, further research is required to clarify the toxicity mechanisms induced by Li on growth and nucleic acids.

The Arctic Ocean is undergoing several transformations because of global climate change. Small microplastics (SMPs) or nanoplastics (NPs) carried by marine aerosols may settle in the land ice and be released to the waters, produced following its melting. As sea ice extent reduces and shipping and fishing activities increase, microplastics (MPs) may enter the region following ocean and maritime transports, with implications on Arctic biota, human health, and socioeconomic issues related to the exploitation of marine resources. First analyses on amphipods collected in Ny-Ålesund confirmed the presence of SMPs. Nevertheless, the threat posed by SMPs/NPs to polar biota and regional human health is not fully understood. This article addresses this issue and the need for organisms as potential bioindicators of plastic pollution, which is currently being carried out in the Svalbard region under the framework of the MICROTRACER project funded by the Italian Arctic Research Program (PRA, Call 2021). The outputs of this research are expected to contribute to deepening the current knowledge of SMPs in Svalbard, providing new insights on their occurrence, distribution, and transfer through the marine trophic web, to realize effective control and regulatory framework measures to implement an integrated multidisciplinary approach for monitoring and to reduce MPs pollution in this fragile polar environment.

The fashion industry is recognized among the most impactful industries in relation to environmental and social damage due to unsustainable models. While countless research studies focus on the supply chain and product innovation, the presented inquiry studies the fashion retail sector with the goal of systematizing existing sustainable practices based on service offerings. We present the results of an extensive case-study analysis conducted on 370 initiatives of different natures gathered among international companies and local actors in the European context that offer services oriented toward sustainability. As a result, we propose an ontology that encompasses three areas (services for environmental sustainability, culture of sustainability, and implementation of social sustainability) and comprehensively describes existing sustainability strategies for helping retailers preserve the environment, while promoting socially inclusive practices and disseminating the culture of sustainability. The innovation of retailing from a similar perspective aims at rendering businesses more resilient to survive market and social transformations, especially in consideration of the boost to sustainable and circular transformation advocated by recent European legislation. [ABSTRACT FROM AUTHOR]

This paper focuses on the notion of experience, whose conceptual analysis seems to be often neglected or at least not sufficiently made explicit in the current discourse on Everyday Aesthetics. In our investigation this notion will be tackled, in particular, through the lens of such concepts as Erlebnis, Erfahrung, and Lebenswelt, which are drawn from the continental philosophical tradition. Purpose of the paper is to present a provisional framework aimed at clarifying that a more accurate conceptualization of experience allows for a better contemporary reflection on the aesthetics of everyday life.

Severe acquired brain injuries (sABI) represent one of the main causes of disability and limitation in social life participation that need an intensive rehabilitation approach. The purpose of this study was to identify a possible correlation between different supposed conditioning factors and the efficiency of rehabilitation interventions. In this retrospective study, data were processed regarding 44 patients admitted to a neurorehabilitation department after sABI. A significant correlation with the efficiency of the rehabilitation intervention (expressed as the variation of the Barthel score between discharge and admittance in relation to the duration of the rehabilitative hospitalization) was found for both the etiology of the brain injury (p = 0.023), the precocity of the rehabilitation treatment (p = 0.0475), the presence of a tracheal cannula (p = 0.0084) and forms of nutrition other than oral (p < 0.0001). The results of this study suggest that improving the management of the respiratory system, swallowing and nutritional aspects, and favoring an early and personalized rehabilitation treatment, can help to optimize the overall care of patients suffering from sABI, thus allowing a reduction in complications, improvement in functional recovery and ensuring a better management of economic, social and health resources.

Microplastic (MP) contamination is a globally recognised issue in aquatic environments, and recently, there has been an increase in investigations focusing on lake contamination, revealing significant amounts of dispersed MPs. However, our understanding of the ingestion and effects of MPs on organisms living in lake ecosystems remains limited. This study aims to develop an effective protocol for assessing the ingestion of MPs by the talitrid amphipod Cryptorchestia garbinii, with the goal of verifying and evaluating the biological effects following ingestion. Individuals sampled from the shores of Lake Albano were exposed to four different polymers, namely low-density polyethylene (PE), polyethylene terephthalate (PET), polyester (PES), and polypropylene (PP), under laboratory conditions. To deliver MPs through the diet, we decided to employ DECOTABs (DEcomposition and COnsumption TABlets) which have been successfully used as a food source in aquatic toxicity tests. At the end of the experiments, we employed the solvatochromic and fluorescent dye Nile red to detect and quantify the MPs present in the digestive tube contents of the animals. The results clearly demonstrate the ingestion of the supplied polymers through the tabs, validating this method of exposure as effective. Furthermore, the measurement of glucose, glycogen, and lipid levels reveals that within 24 h of ingestion, MPs had an impact on the macromolecules involved in the energy metabolism of C. garbinii. This research underscores the suitability of this species as a model organism for studying MP uptake and its effects.

The digital and technological transformation, whose effects have profoundly influenced the last two decades, and which has recently undergone a sudden acceleration, changed how fashion brands produce, sells and communicate and also how individuals come into contact with fashion, experience, share, and “consume” it. Within this framework, fashion has progressively embraced and incorporated technologies in the retail system opening up to new opportunities in terms of communication and distribution strategies, pushing towards an increased integration between physical and digital systems. In the light of current consumer dynamics, the omnichannel approach is evolving into a phygital one, with the progressive merging of the material and digital dimensions. Retail spaces are undergoing a process of proliferation and integration of channels, multiplication of messages and narratives, increase of services resulting in a new "augmented" scenario. Assuming a design perspective, the paper aims to investigate the nature and the impact of digital transformation in fashion retailing, with a focus on in-store technologies and their relationship with spaces and the customer journey, identifying, starting from the most recent fashion retail concepts, some possible scenarios and innovation trajectories.

Aim/HypothesisTo compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019.MethodsForty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019.ResultsOverall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p

(1) Background: This multi-center study aimed to identify a risk profile for disordered eating behaviors (DEBs) in youth with type 1 diabetes (T1D) based on their dietary intake, lipid profile, body mass index (BMI-SDS), and glycometabolic control. (2) Methods: Adolescents aged 11 to 18 years from five centers across Italy were recruited. Lipid profile, HbA1c, BMI-SDS, and dietary intake data were collected. The risk for developing DEBs was assessed via the Diabetes Eating Problems Survey-R (DEPS-R) questionnaire. A latent class analysis (LCA) was performed using a person-centered approach. (3) Results: Overall, 148 participants aged 11–18 (12.1, ±3.34), 52% males with a mean diabetes duration of 7.2 (±3.4), were enrolled. Based on the results of the DEBS-R score, LCA allowed us to highlight two different classes of patients which were defined as “at-risk” and “not at-risk” for DEB. The risk profile for developing DEBs is characterized by higher BMI—SDS (23.9 vs. 18.6), higher HbA1c (7.9 vs. 7.1%), higher LDL cholesterol (99.9 vs. 88.8 mg/dL), lower HDL cholesterol (57.9 vs. 61.3 mg/dL), higher proteins (18.2 vs. 16.1%), and lower carbohydrates (43.9 vs. 45.3%). Adolescents included in the “at-risk” class were significantly older (p = 0.000), and their parents’ SES was significantly lower (p = 0.041). (4) Conclusions: This study allowed us to characterize a risk profile for DEBs based on dietary behavior and clinical parameters. Early identification of the risk for DEBs allows timely intervention and prevention of behavior disorders.

Among plastic additives, bisphenol A (BPA), used mainly in manufacturing objects of everyday use, has received considerable attention for acting as a xenoestrogen and causing endocrine disruption. We now observe its rapid replacement with analogue compounds with similar structures (BPs) whose safety is not fully demonstrated. The present paper investigates the possible adverse effects of BPA, BPF, and BPS on DNA integrity of two gammarid species, Echinogammarus veneris and Gammarus aequicauda, to assess the environmental risk posed by these compounds in the aquatic ecosystem. Moreover, we analysed the cell-specific sensitivity to BPs using somatic (hemocytes) and germ (spermatozoa) cells that could have wide-ranging implications for their reproductive biology and long-term adverse effects at the population level. Results demonstrate that BPA and its analogues caused a genotoxic impact and highlighted lower genotoxic damage induced in sperm cells in both species tested. The implications of the findings of this study on the aquatic ecosystem are discussed, taking into account the critical role of amphipods within the freshwater trophic chain.

The widespread occurrence of microplastics (MPs) has resulted in their interaction with biological processes. Thus, there is a great concern about the potential toxicity of MPs on animal and plant cells and on the possibility that MPs reach humans through the food web. In order to shed light on both issues, laboratory assays were performed for evaluating the effects of polyethylene (PE) microparticles on the aquatic plant Spirodela polyrhiza (L.) Schleid. and the gammarid Echinogammarus veneris (Heller, 1865). Moreover, a stock of MP-treated Spirodela plants was used to feed gammarid individuals, and the presence of MP particles in their digestive tracts was analyzed. Results evidenced the lack of toxic effects of MPs on plants, evaluated at growth and physiological level by biometric parameters, pigment content, and photosynthetic performance estimated by chlorophyll fluorescence imaging through the ETPT (EcoTox Photosystem Tool). Only a slight reduction in pigment-related indices in MP-treated plants was observed. A remarkable genotoxic effect was instead highlighted by Comet assay in the hemocytes of gammarid individuals exposed to MPs, with three times more DNA damage (expressed as Tail Moment) in MP-treated individuals compared to control ones. Finally, the gut content of the gammarids fed with MP-treated plants revealed the presence of 7.6 MP particles/individual, highlighting the occurrence of trophic transfer of MPs among freshwater ecosystem organisms. Novel indications about the potential impact of the PE microparticles in the aquatic compartment are provided. Notably, the transfer of MP particles between primary producer and primary consumer organisms of the freshwater trophic chain and the genotoxic effects associated with the ingestion of such particles by gammarids are issues of concern for the aquatic ecosystem and the food web leading to the human diet.

Fashion is increasingly manifested as a phenomenon, both local and global, capable of reflecting not only different styles but also different identities and cultures. This phenomenon has redesigned contemporary geography composed of a proliferation of cultural, productive and education-related epicentres. Geographical areas in which fashion is created, produced, communicated, sold and, above all, valued as a cultural asset: we assist, thanks also to the rise of the digital world, to the globalisation of local realities that define new trajectories between multiple fashion capitals. New paths are also determined by the consolidated companies in the sector, which become nomadic, creating itinerant fashion weeks: presentations of collections that not only search for unusual and spectacular places but that recover and enhance workmanship, materials and places of different cultures and traditions. The text, starting from a geographical history (or historical geography) of fashion, intends to investigate the dialogue between local and global, from the places where it was born and developed, to the excellences that have developed within a specific geographical, historical, social, productive and cultural context.

The predicted increase in demand for minor metals for modern technologies raises major concerns regarding potential environmental concentration increases. Among the minor metals, lithium (Li) is particularly noteworthy due to growing demand for battery production. Concerns have been raised about the impact on biota of increasing Li concentrations in the environment. To expand the knowledge of the effects of Li on plants, garden cress (Lepidium sativum L.), a model plant for ecotoxicity assay, was tested in a 72 h test in Petri plates. The results showed a stimulation effect of Li at the lowest concentration (Li chloride 10 mg L−1) on seed germination and primary root elongation. Conversely, higher Li concentrations (50 and 150 mg L−1) caused a progressive impairment in both parameters. A genotoxic effect of Li on root cells, evaluated through the alkaline comet assay, was observed at each concentration tested, particularly at 150 mg L−1 Li chloride. Elemental analysis showed that Li accumulated in the seedlings in a dose–concentration relationship, confirming its ability to be readily absorbed and accumulated in plants. Given the likely increase in Li levels in the environment, further research is required to clarify the toxicity mechanisms induced by Li on growth and nucleic acids. [ABSTRACT FROM AUTHOR]

Background: Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. Case presentation: We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. Discussion and conclusion: To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management. [ABSTRACT FROM AUTHOR]

This study is the first to investigate the ingestion of microplastics (MPs), plasticizers, additives, and particles of micro-litter < 100 μm by larvae of Simuliidae (Diptera) in rivers. Blackflies belong to a small cosmopolitan insect family whose larvae are present alongside river courses, often with a torrential regime, up to their mouths. Specimens of two species of blackfly larvae, Simulium equinum and Simulium ornatum, were collected in two rivers in Central Italy, the Mignone and the Treja. Small microplastics (SMPs, 90%. Differences in the abundances of the SMPs and APFs ingested by the two species under exam were statistically significant. Additives and plasticizers can be specific to a particular polymer; thus, these compounds can be proxies for the presence of plastic polymers in the environment.

This study aims to compare the frequency of Diabetic Ketoacidosis (DKA) at diagnosis in 2014–2016 with the one previously reported in 2004–2013; and to assess the association between family socioeconomic status and DKA at type 1 diabetes (T1D) diagnosis in children

The aim of this study was to evaluate the association between macronutrient intake and time in range (TIR) of 70–180 mg/dL in children and adolescents with type 1 diabetes (T1D). A multi-center study recruited patients with T1D using continuous glucose monitoring (CGM) between January 2019 and January 2020 from centers across Italy. Diet intake was recorded using three-day weighed food diaries. Nutrients were evaluated as percentages of total intake. TIR was considered at target if the percentage of readings was higher than 70%. Clinical and nutritional factors associated with TIR at target were analyzed using multiple correspondence analysis and multiple logistic regression. Data from 197 participants (53% male, median age 11.6 years, median HbA1c 55.2 mmol/mol, median TIR 60%) were analyzed. Macronutrient intake was 45.9% carbohydrates, 16.9% protein, 37.3% fat, and 13.1 g/day fiber (median values). TIR > 70% was observed in 28% of participants; their diet contained more protein (17.6%, p = 0.015) and fiber (14.4 g/day, p = 0.031) than those not at target. The probability of having a TIR > 70% was significantly higher with 40–44% consumption of carbohydrates compared with 45–50% consumption of carbohydrates and with the use of a carbohydrate counting system. Based on these results, a five percent reduction in the percentage of carbohydrate intake can help children and adolescents with T1D achieve the goal of a TIR > 70%. Both a lower and higher percentage of carbohydrate intake appears to reduce the probability of reaching the target TIR > 70%. These results require validation in other populations before being used in clinical practice.

Maturational processes in the developing brain are disrupted by exposure to environmental toxicants, setting the stage for deviant developmental trajectories. Manganese (Mn) is an essential nutrient that is neurotoxic at high levels of exposure, particularly affecting the basal ganglia and prefrontal cortex. Both the intensity and timing of exposure matter; deciduous teeth can be used to retrospectively and objectively determine early-life windows of vulnerability. The aim of this pilot study was to examine associations between prenatal, early postnatal and childhood dentine Mn concentrations and intrinsic functional connectivity (iFC) of adolescents' brains. 14 adolescents (12-18 years; 6 girls) from northern Italian regions with either current, historic or no Mn contamination, completed a 10-minute resting state functional Magnetic Resonance Imaging (MRI) scan in an 1.5T MRI scanner. We estimated prenatal, early postnatal and childhood Mn concentrations in deciduous teeth using laser ablation-inductively coupled plasma-mass spectrometry. We performed seed-based correlation analyses, focusing on six subcortical seeds (left and right caudate, putamen, pallidum) and one cortical seed (bilateral middle frontal gyrus) from Harvard-Oxford atlases. We examined linear and quadratic correlations between log-transformed Mn concentrations and seed-based iFC (Bonferroni-corrected p

Diagnosis of type 1 diabetes (T1D) in a child is often associated with anger, denial, fear, and depression from the parents. The aim of the study was to improve parents’ adaptation to the diagnosis of diabetes of their child. Sixty-two parents (29 mothers, 33 fathers) of 36 children with type 1 diabetes (mean age=11.3‐3.3 years; diabetes duration>1 year; HbA1c=57±11 mmol/mol) participated in a three-day educational working group pilot intervention study. Intervention was based on the reexamination of the traumatic event of diagnosis of T1D through spatial and time-line anchorage, retracing of the future, emotional awareness, and interactive discussion. Relaxing technique, diaphragmatic breathing, and guided visualization were used by 2 psychologists and 1 pediatric endocrinologist. The study was approved by EC and participants filled a consent form. At baseline and after intervention, parents filled in a questionnaire including Diabetes-Related Distress (DRD), Parent Health Locus of Control Scale (PHLOC), Parent Stress Index Short Form (PSI-SF), Hypoglycemia Fear Survey-Parents (HFS-P) and Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC), and Health Survey Short Form-36 (SF-36). Three months after the intervention, both parents reported a reduction in the “difficult child” subscale of the PSI-SF (p