Participation of nurses and allied health professionals in research activities: a survey in an academic tertiary pediatric hospital.

BACKGROUND: Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. METHODS: A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. RESULTS: Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% (n = 196) reported participating in a research project, while 33% (n = 297) had attended a scientific conference as a speaker, and 11% (n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. CONCLUSIONS: Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice.

Evolving Concepts of the SCORE System: Subtracting Cholesterol from Risk Estimation: A Way for a Healthy Longevity?

The role of cholesterol, mainly low-density lipoproteins (LDL-C), as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) is now established and accepted by the international scientific community. Based on this evidence, the European and American guidelines recommend early risk stratification and "rapid" achievement of the suggested target according to the risk estimation to reduce the number of major cardiovascular events. Prolonged exposure over the years to high levels of LDL-C is one of the determining factors in the development and progression of atherosclerotic plaque, on which the action of conventional risk factors (cigarette smoking, excess weight, sedentary lifestyle, arterial hypertension, diabetes mellitus) as well as non-conventional risk factors (gut microbiota, hyperuricemia, inflammation), alone or in combination, favors the destabilization of the atherosclerotic lesion with rupture/fissuration/ulceration and consequent formation of intravascular thrombosis, which leads to the acute clinical manifestations of acute coronary syndromes. In the current clinical practice, there is a growing number of cases that, although extremely common, are emblematic of the concept of long-term exposure to the risk factor (LDL hypercholesterolemia), which, not adequately controlled and in combination with other risk factors, has favored the onset of major cardiovascular events. The triple concept of "go lower, start earlier and keep longer!" should be applied in current clinical practice at any level of prevention. In the present manuscript, we will review the current evidence and documents supporting the causal role of LDL-C in determining ASCVD and whether it is time to remove it from any score.

Beyond Medical Therapy-An Update on Heart Failure Devices.

Heart failure (HF) is a complex and progressive disease marked by substantial morbidity and mortality rates, frequent episodes of decompensation, and a reduced quality of life (QoL), with severe financial burden on healthcare systems. In recent years, several large-scale randomized clinical trials (RCTs) have widely expanded the therapeutic armamentarium, underlining additional benefits and the feasibility of rapid titration regimens. This notwithstanding, mortality is not declining, and hospitalizations are constantly increasing. It is widely acknowledged that even with guideline-directed medical therapy (GDMT) on board, HF patients have a prohibitive residual risk, which highlights the need for innovative treatment options. In this scenario, groundbreaking devices targeting valvular, structural, and autonomic abnormalities have become crucial tools in HF management. This has led to a full-fledged translational boost with several novel devices in development. Thus, the aim of this review is to provide an update on both approved and investigated devices.

Non-Conventional Risk Factors: "Fact" or "Fake" in Cardiovascular Disease Prevention?

Cardiovascular diseases (CVDs), such as arterial hypertension, myocardial infarction, stroke, heart failure, atrial fibrillation, etc., still represent the main cause of morbidity and mortality worldwide. They significantly modify the patients' quality of life with a tremendous economic impact. It is well established that cardiovascular risk factors increase the probability of fatal and non-fatal cardiac events. These risk factors are classified into modifiable (smoking, arterial hypertension, hypercholesterolemia, low HDL cholesterol, diabetes, excessive alcohol consumption, high-fat and high-calorie diet, reduced physical activity) and non-modifiable (sex, age, family history, of previous cardiovascular disease). Hence, CVD prevention is based on early identification and management of modifiable risk factors whose impact on the CV outcome is now performed by the use of CV risk assessment models, such as the Framingham Risk Score, Pooled Cohort Equations, or the SCORE2. However, in recent years, emerging, non-traditional factors (metabolic and non-metabolic) seem to significantly affect this assessment. In this article, we aim at defining these emerging factors and describe the potential mechanisms by which they might contribute to the development of CVD.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review.

BACKGROUND: Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. METHODS: We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. RESULTS: Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. CONCLUSIONS: Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

Developmental dyslexia and explicit long-term memory.

The reduced verbal long-term memory capacities often reported in dyslexics are generally interpreted as a consequence of their deficit in phonological coding.The present study was aimed at evaluating whether the learning deficit exhibited by dyslexics was restricted only to the verbal component of the long-term memory abilities or also involved visual-object and visual-spatial domain. A further goal of the present study was to investigate the predictive value of non-verbal long-term memory abilities with respect to word and non-word reading in dyslexic children.In accordance with these aims, performances of 60 dyslexic children were compared with that of 65 age-matched normal readers on verbal, visual-spatial and visual-object task.Results documented a generalized impairment of episodic long-term memory capacities in dyslexic children and the results did not vary as a function of children's age.Furthermore, in addition to verbal measures, also individual differences in non-verbal long-term memory tasks turn out to be good predictors of reading difficulties in dyslexics.Our findings indicate that the long-term memory deficit in dyslexia is not limited to the dysfunction of phonological components but also involves visual-object and visual-spatial aspect, thus suggesting that dyslexia is associated to multiple cognitive deficits.

Preliminary Validation of the CI-FRA Checklist: A Simple Screening Tool for Measuring the Early Signs of Reading and Spelling Disorders in Italian Primary Students.

Although several screening tests for recognizing early signs of reading and spelling difficulties have been developed, brief and methodologically grounded tools for teachers are very limited. The present study aimed to lay the foundation for a new screening tool for teachers: the Checklist for early Indicators of risk Factors in Reading Ability (CI-FRA). The proposed checklist consists of 20 items, based on a 7-point Likert scale, and it investigates five domains: reading, writing, attention, and motor skills. Six hundred sixty-seven children were evaluated by 40 teachers during the first year of primary school and, longitudinally, in the second year. Exploratory factor analysis and confirmatory factor analysis (CFA) were applied to verify structural validity. Concurrent validity was assessed by Spearman correlation to analyze the link between CI-FRA and reading and spelling standardized tests and cognitive tests. Reliability was assessed by Cronbach α and interclass correlation coefficient. The CFA reported a three-factor structure as the optimal solution, including language (reading and writing), visuospatial attention, and fine motor skills subscales. Good reliability, good internal consistency, and acceptable test-retest indices were found. Concurrent validity was confirmed by significant correlations between CI-FRA total score and standardized reading and spelling test, as well as by correlations between CI-FRA subscales and neuropsychological standardized test scores. Preliminary evaluation of sensitivity by receiver operating characteristic curves showed that the CI-FRA score has particularly high sensitivity and specificity for word reading speed deficit. In conclusion, the results confirm that CI-FRA is a theoretically grounded and statistically valid tool that could help the teachers to screen for early signs of reading and spelling difficulties.

Implicit learning deficit in children with developmental dyslexia.

Several neuropsychological deficits have been reported as characteristic of the cognitive profile of dyslexic children. Phonological and visual processing are often impaired as well as auditory processing, attention and information processing speed. We investigated whether implicit learning, is impaired in dyslexic children and adolescents. Tests of implicit and declarative learning were administered to 18 clinically defined dyslexics and 18 similar age controls. Dyslexics showed a reduced learning rate in the implicit but not in the declarative task, suggesting a specific deficit of implicit learning. Although alternative hypothesis cannot be ruled out, considering that implicit learning is a cognitive function primarily processed by the cerebellum and that recent neurological and physiological data suggest a cerebellar dysfunction in dyslexia, the present results suggest an impairment of cerebellar system in reading disabilities.

Understanding motor acts and motor intentions in Williams syndrome.

Williams syndrome (WS) is a rare genetic disorder associated with unusually hyper-social demeanor and ease with strangers. These personality traits are accompanied by difficulties in social interactions, possibly related, at least in part, to a difficulty in understanding others' mental states. Studies on mentalizing capacities in individuals with WS have often led to contrasting results, some studies revealing specific impairments, others highlighting spared mentalizing capacities. So far, however, no study investigated the performance of individuals with WS in non-inferential understanding of others' motor intentions. In the present study we investigated this capacity by using a computer-based behavioral task using pictures of hand-object interactions. We asked individuals with WS first to describe what the other was doing (i.e. a task implying no kind of intention reading), and secondly, if successful in answering the first question, to describe the motor intention underlying the observed motor acts (i.e. why an act was being done, a task requiring non-inferential motor intention understanding). Results showed that individuals with WS made more errors in understanding what the other was doing (i.e. understanding a motor act) compared to both mental-age matched controls and chronological-age matched peers with typical development, while showing mental-age appropriate performance in understanding why an individual was acting (i.e. understanding a motor intention). These findings suggest novel perspectives for understanding impairments in social behavior in WS.