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Background Although children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements. Methods Ad hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals. Results Seventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs. Conclusions Access of CSHCN to an ED is not infrequent. For this reason, it is fundamental for pediatricians working in any kind of ED to increase their general knowledge about CHSCN and to gain expertise in the management of such patients and their related medical complexity.

Objective: The management of prediabetes and hyperglycemia is an increasingly important aspect of care in patients with thalassemia. In light of the limited evidence about the management of GD (glucose dysregulation) with glucose-lowering agents (GLAs), we have conducted a retrospective survey in TDT and NTDT patients with diabetes mellitus to collect more detailed information on GLA use in order to make preliminary recommendations. Study design and method: A questionnaire was prepared and distributed to the tertiary thalassemia care Centers of ICET-A Network. Results: Eight thalassemia care Centers [Bulgaria, Greece, Iran, Italy (4 Centers) and Qatar], following 1.554 with transfusion-dependent thalassemia (TDT), 132 (8.4%) with diabetes and 687 with non-transfusion-dependent thalassemia (NTDT), 27 (3.9%) with diabetes, participated in the retrospective survey. The records of 117 TDT patients and 9 NTDT patients with diabetes treated with GLAs were analyzed. Metformin, a biguanide, was the most frequently used drug (47.6 %), followed by alpha-glucosidase inhibitors (5.5 %), incretins (4.7%) and insulin secretagogues (3.1%). In 68 (61.2) patients GLAs was prescribed as monotherapy, while the remaining 49 (38.8%), who had inadequate glucose control with metformin, were treated with combination treatment. Fifty-one patients of 126 (40.4%) initially treated with oral GLA, for a mean duration of 61.0 ± 35.6 months (range: 12-120 months), required insulin therapy for better metabolic control. Conclusion: This retrospective study covers an unexplored area of research in patients with thalassemia and GD. Oral GLAs appear to be safe and effective for the treatment of diabetes mellitus in patients with thalassemia, and can achieve adequate glycemic control for a substantial period of time. (www.actabiomedica.it). © 2022, Mattioli 1885. All rights reserved.

Background: In physical activity, testing procedures generally require maximal efforts. They are not always administrable or appropriate (e.g., with beginners, elderly, or in school), therefore, alternative submaximal procedures might be more fitting. This study aimed to assess the criterion validity and reliability of submaximal tests based on perceptual variables to be used instead of the corresponding maximal procedures to evaluate muscular endurance, flexibility, and cardiorespiratory fitness. The sustainability of this &ldquo, educational&rdquo, rationale to achieve the individual self-government and self-determination of testing and exercising has been further discussed. Methods: A total of 16 female gym practitioners (age 23 &plusmn, 3 years) performed five submaximal tests (push-up, S-PU, crunch, S-CR, wall-sit, S-WS, bending forward, S-BF, Step test, S-ST), whose results were compared to those from the corresponding maximal tests (push-up, PU, crunch, CR, wall-sit, WS, sit-and-reach, S&amp, R, Yo-yo, YY). Results: The Interclass Correlation Coefficient (ICC) was higher than 0.8 in all of the submaximal tests. High correlations were found between all submaximal and maximal tests except between YY and S-ST, though their mean heart rates were correlated. Conclusions: Submaximal tests based on an internal load at about 50% of the maximal perceived exertion are equally valid and reliable to the corresponding gold-standard maximal tests, except for the cardiorespiratory evaluation. The educational rationale of this study supports self-acting as a calibration mechanism of physical activity, promoting a proper use of the body but not its overuse.

The aim of this study was to compare the external load associated with different small-sided game formats played using external wildcard players. Twenty-two professional soccer players (24.7±3.9 years; 78.4±4.2 kg; 182.9±4.5 cm) performed the three formats (5vs5,6vs6 and 7vs7) on a 60 x 35 m pitch and were monitored usingGPS.Two-way ANOVA for repeated measures was performed to calculate the level of significance between the various parameters analyzed. From the results it emerged that the greatest distance covered at high intensity was in the 5vs5 format (p20W/kg; p

The aim of the paper is to demonstrate the effectiveness of the sports industry not only in the classic perspective of improving the state of physical well-being or of celebration of the athlete's performance, but rather in a multidimensional perspective. In this regard, it was shown how through an evolutionary process over time, sport has come to considerably and positively affect other contexts, including certainly education and school, tourism industry and that concerning socio-economic issues. The essay has helped to highlight that sport, intended in its broadest sense, is a valuable resource that can foster a global and sustainable development in the long run.

Background: More than five decades ago, thalassemia major (TDT) was fatal in the first decade of life. Survival and quality of life have improved progressively thanks to the implementation of a significant advance in diagnostic and therapeutic methods, consisting mainly of a frequent transfusion program combined with intensive chelation therapy. Improvement also includes imaging methods used to measure liver and cardiac iron overload. Improved survival has led to a growing number of adults requiring specialised care and counselling for specific life events, such as sexual maturity and acquisition of a family. Aims of the study: The main aim is to present the results of a survey on the marital and paternity status in a large population of adult males with TDT and NTDT living in countries with a high prevalence of thalassemia and a review of current literature using a systematic search for published studies. Results: Ten out of 16 Thalassemia Centres (62.5%) of the ICET-A Network, treating a total of 966 male patients, aged above 18 years with β- thalassemias (738 TDT and 228 NTDT), participated in the study. Of the 966 patients, 240 (24.8%) were married or lived with partners, and 726 (75.2%) unmarried. The mean age at marriage was 29.7 ± 0.3 years. Of 240 patients, 184 (76.6%) had children within the first two years of marriage (2.1 ± 0.1 years, median 2 years, range 1.8 - 2.3 years). The average number of children was 1.32 ± 0.06 (1.27 ± 0.07 in TDT patients and 1.47 ± 0.15 in NTDT patients; p: >0.05). Whatever the modality of conception, 184 patients (76.6%) had one or two children and 1 NTDT patient had 6 children. Nine (4.8%) births were twins. Of 184 patients, 150 (81.5%) had natural conception, 23 (12.5%) required induction of spermatogenesis with gonadotropins (hCG and hMG), 8 (4.3%) needed intracytoplasmic sperm injection (ICSI) and 3 adopted a child. 39 patients with TDT and NTDT asked for medical help as they were unable to father naturally: 7 TDT patients (17.9%) were azoospermic, 17 (37.7%) [13 with TDT and 4 with NTDT] had dysspermia and 15 (33.3%) [13 with TDT and 2 with NTDT] had other “general medical and non-medical conditions”. Conclusions: Our study provides detailed information in a novel area where there are few contemporary data. Understanding the aspects of male reproductive health is important for physicians involved in the care of men with thalassemias to convey the message that prospects for fatherhood are potentially good due to progressive improvements in treatment regimens and supportive care. © 2019, Mattioli 1885. All rights reserved.

Changes in thyroid function and thyroid function tests occur in patients with β-thalassemia major (TM). The frequency of hypothyroidism in TM patients ranges from 4% to 29 % in different reports. The wide variation has been attributed to several factors such as patients' genotype, age, ethnic heterogeneity, treatment protocols of transfusions and chelation, and varying compliance to treatment. Hypothyroidism is the result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. The main laboratory parameters of thyroid function are the assessments of serum thyroid-stimulating hormone (TSH) and serum free thyroxine (FT4). It is of primary importance to interpret these measurements within the context of the laboratory-specific normative range for each test. An elevated serum TSH level with a standard range of serum FT4 level is consistent with subclinical hypothyroidism. A low serum FT4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism. Doctors caring for TM patients most commonly encounter subjects with subclinical primary hypothyroidism in the second decade of life. Several aspects remain to be elucidated as the frequency of thyroid cancer and the possible existence of a relationship between thyroid dysfunction, on one hand, cardiovascular diseases, components of metabolic syndrome (insulin resistance) and hypercoagulable state, on the other hand. Further studies are needed to explain these emerging issues. Following a brief description of thyroid hormone regulation, production and actions, this article is conceptually divided into two parts; the first reports the spectrum of thyroid disease occurring in patients with TM, and the second part focuses on the emerging issues and the open problems in TM patients with thyroid disorders. © 2019 Universita Cattolica del Sacro Cuore. All rights reserved.

The present research examined the effect of physical fitness on self-esteem of pre-adolescent children. Students performed the MOTORFIT tests and filled IPAQ-C and Self-Esteem questionnaires. According to the level of the physical fitness we evaluated the self-esteem. Results showed no gender differences, while differences for the level of physical fitness was found. In particular, participants who performed better the MOTORFIT test reported a higher self-esteem compared to less physical fit participants. However, a discrepancy emerged when the self-esteem was analysed as a function of the physical activity reported where no differences emerged between the groups. In conclusion, our results provided an effect of physical activity on self-esteem through objective measures. Key words: physical activity, pre-adolescent, psychosocial characteristics.

The purpose of this study is to examine the physical effort required at professional football players (Italian Championship) in relation to the examination of a series of friendly matches at different times of the year, compared to their role, using the technology of GPS, for finalizing the training to improve the sport performance. The activities of players were monitored using GPS technology with a sampling rate of 10 Hz. The total distance covered, distances with different speed and accelerations were analyzed in relation to five different roles: (CD) central defenders, (FB) full-backs, (M) midfielders, (AM) advanced midfielders and (A) attackers. Players activities were monitored using GPS technology with a sampling rate of 10 Hz. Total distance covered, distance at different speeds and accelerations were analyzed in relation in five different roles: (CD) central defenders, (FB) full-backs, (M) midfielders, (AM) advanced midfielders and (A) attackers. The maximum covered distance (over 10 km) during a friendly match was reached by the third (FB), midfielders (M) and advanced midfielders (AM); The same ones have covered, too, the greatest distances in high-intensity running (> 16 km/h); instead, the attackers and central defenders covered the distance in high power. The full-backs (FB) and Advanced Midfielders (AM) have producted high acceleration and deceleration compared to other roles, while midfielders (M) have developed greater metabolic power. Finally, the end-of-season results were compared with the data gained at the beginning of the year and important differences between the various roles were noted.

The aim of the paper is to show that sport activity, bolstered by the social, educational and cultural principles that govern it, can contribute in a positive and concrete way to the management of diversities. The current socio-economic context is characterized by the phenomenon of globalization, which requires a plurality of different relationships between individuals that are different from each other for different reasons, which can vary from the race to the cultural and economic status, up to the physical or mental conditions. So managing optimally the concept of diversity becomes a primary objective to guarantee the sustainable social and economic development in time. In this connection, sport is identified as one of the few sectors able to manage diversity through an effective and efficient strategic approach that produces educational, cultural, social and economic benefits for the community.

The aim of this paper is to prove that, through diversity management in sport by a professional who has the requirements and skills that characterize the role of the Diversity Manager, there can be both social and economic benefits in this field. If managed inefficiently and ineffectively, diversity represents a barrier to the sustainable development in any context, especially in sport, which is full of sporting, social and economic relationships between subjects considered different from each other. In this regard, also in sports, it is assumed that diversity management should be entrusted to a Diversity Manager able to value it as a valuable resource to achieve a socio-economic benefit.

In adult thalassemia major (TM) patients, a number of occult and emerging endocrine complications, such as: central hypothyroidism (CH), thyroid cancer, latent hypocortisolism, and growth hormone deficiency (GHD) have emerged and been reported. As the early detection of these complications is essential for appropriate treatment and follow-up, the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A) promoted a survey on these complications in adult TM patients, among physicians (pediatricians, hematologists and endocrinologists) caring for TM patients in different countries. The data reported by 15 countries are presented.The commonest endocrine complications registered in 3.114 TM adults are CH and GHD (4.6 % and 3.0 %, respectively), followed by latent hypocortisolism (1.2%). In 13 patients (0.41%) a cytological papillary or follicular thyroid carcinoma was diagnosed in 11 and 2 patients, respectively, and a lobectomy or thyroidectomy was carried out. Of 202 TM patients below the age of 18 years, the reported endocrine complications were: GHD in 4.5%, latent hypocortisolism in 4.4% and central hypothyrodisim in 0.5%. Transition phase was an area of interest for many clinicians, especially as patients with complex chronic health conditions are responding to new treatments extending their lifespan beyond imagination.. In conclusion, our survey provides a better understanding of physicians’ current clinical practices and beliefs in the detection, prevention and treatment of some endocrine complications prevailing in adult TM patients. Regular surveillance, early diagnosis, treatment and follow-up in a multi-disciplinary specialized setting are recommended. (www.actabiomedica.it). © Mattioli 1885.

In water polo lacks a codified methodology for tactics training, which is thus only left to coach’s discretion.Nine women water polo matches, during season 2011/2012 (Italian female Serie A1), have been analyzed by a water polo coach, helped by a statistician and a performance analyst. Purpose of the analysis process was to identify single events during the matches, to examine the tactical pattern implemented in this events, to obtain by the coach an evaluation on tactical pattern compliance and then to put this compliance in relation to event’s outcome. Aim of the work is to verify the efficacy of different attack patterns, when they were well-performed, in order to create a codified methodology for teaching water polo through tactics.The research approach is integrated and consists of 3 distinct methods: case study (9 matches of the Italian Serie A1 Women's Championship, season 2011/2012, played by the Volturno sc) for the analysis of matches, action research method for coach contribution, and theoretical-argumentative method to deduce a theoretical framework in which define the data processing.The research team examined matches with Dartfish TeamPro, isolating single keyframes relative to attack events, identifying the implemented attack pattern, then the coach expressed an evaluation on attack pattern compliance.The results showed a general efficacy of tactical patterns (when they are well performed), but showed significant differences within correlation coefficients of single patterns, confirming the need for developing a common methodology for teaching waterpolo through tactics.