The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990-2019: Results From the Global Burden of Disease Study 2019.

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10-24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for prevalence, incidence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results: In 2019, prevalence and disability estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM showed a greater increase in prevalence and disability than T1DM in the 30 years observation period in all WE countries. Prevalence increased with age, while only minor differences were observed between sexes. Conclusion: Our findings highlight the substantial burden posed by DM in WE among adolescents. Health system responses are needed for transition services, data collection systems, education, and obesity prevention.

Experimental study protocol of the project "MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)".

Musculoskeletal injuries, a public health priority also in the military context, are ascribed to several risk factors, including: increased reaction forces; low/reduced muscle strength, endurance, body mass, Vitamin D level, and bone density; inadequate lifestyles and environment. The MOVIDA Project-funded by the Italian Ministry of Defence-aims at developing a transportable toolkit (assessment instrumentation, assessment protocols and reference/risk thresholds) which integrates motor function assessment with biological, environmental and behavioural factors to help characterizing the risk of stress fracture, stress injury or muscle fatigue due to mechanical overload. The MOVIDA study has been designed following the STROBE guidelines for observational cross-sectional studies addressing healthy adults, both militaries and civilians, with varying levels of physical fitness (sedentary people, recreational athletes, and competitive athletes). The protocol of the study has been designed and validated and is hereby reported. It allows to collect and analyse anamnestic, diagnostic and lifestyle-related data, environmental parameters, and functional parameters measured through portable and wearable instrumentation during adapted 6 minutes walking test. The t-test, one and two-way ANOVA with post-hoc corrections, and ANCOVA tests will be used to investigate relevant differences among the groups with respect to biomechanical parameters; non-parametric statistics will be rather used for non-normal continuous variables and for quantitative discrete variables. Generalized linear models will be used to account for risk and confounding factors.

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques.

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

Health software: a new CEI Guide for software management in medical environment.

INTRODUCTION: The increasing spread of software components in the healthcare context renders explanatory guides relevant and mandatory to interpret laws and standards, and to support safe management of software products in healthcare. METHODOLOGY: In 2012 a working group has been settled for the above purposes at Italian Electrotechnical Committee (CEI), made of experts from Italian National Institute of Health (ISS), representatives of industry, and representatives of the healthcare organizations. RESULTS: As a first outcome of the group activity, Guide CEI 62-237 was published in February 2015. The Guide incorporates an innovative approach based on the proper contextualization of software products, either medical devices or not, to the specific healthcare scenario, and addresses the risk management of IT systems. CONCLUSIONS: The Guide provides operators and manufacturers with an interpretative support with many detailed examples to facilitate the proper contextualization and management of health software, in compliance with related European and international regulations and standards.

A quality assessment of systematic reviews on telerehabilitation: what does the evidence tell us?

AIMS: To evaluate the quality of systematic reviews on telerehabilitation. METHODS: The AMSTAR--Assessment of Multiple Systematic Reviews--checklist was used to appraise the evidence related to the systematic reviews. RESULTS: Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their characteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the high-scored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. CONCLUSIONS: In the authors' knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies.

Correlates between kinematics and baropodometric measurements for an integrated in-vivo assessment of the segmental foot function in gait.

Baropodometry and multi-segmental foot kinematics are frequently employed to obtain insight into the mechanics of the foot-ground interaction in both basic research and clinical settings. However, nothing hitherto has been reported on the full integration of kinematics with baropodometric parameters, and only a few studies have addressed the association between intersegmental kinematics and plantar loading within specific foot regions. The aim of this study was to understanding the relationships between foot joint mobility and plantar loading by focusing on the correlation between these two measures. An integrated pressure-force-kinematics system was used to measure plantar pressure and rotations between foot segments during the stance phase of walking in 10 healthy subjects. An anatomically-based mask was applied to each footprint to obtain six regions according to the position of the markers; hence each kinematic segment was paired with a corresponding area of the plantar surface. Relationships between segmental motion and relevant baropodometric data were explored by means of correlation analysis. Negative, weak-to-moderate correlations (R(2)<0.5) were found between pressure (mean and peak) and inter-segmental range of motion across all foot joints except the Calcaneus-Midfoot. Temporal profiles of sagittal-plane kinematics and baropodometric parameters were well correlated, particularly at the ankle joint. Larger motion in the foot joints during walking was associated with lower plantar pressure in almost all regions. The study helps improve our understanding of the relationship between joint mobility and plantar loading in the healthy foot and represents a critical preliminary analysis before addressing possible clinical applications.

Hardware performance assessment recommendations and tools for baropodometric sensor systems.

Accurate plantar pressure measurements are mandatory in both clinical and research contexts. Differences in accuracy, precision, reliability of pressure measurement devices (PMDs) prevented so far the onset of standardization processes and of reliable reference datasets. The Italian National Institute of Health (ISS) approved and conducted a scientific project aimed to design, validate and implement dedicated testing methods for both in-factory and on-the-field PMD assessment. A general-purpose experimental set-up was built, complete and suitable for the assessment of PMDs based on different sensor technology, electronic conditioning and mechanical solutions. Preliminary assessments have been conducted on 5 commercial PMDs. The study lead to the definition of: i) an appropriate set of instruments and procedures for PMD technical assessment; ii) a minimum set of significant parameters for the technical characterization of the PMD performance; iii) some recommendations to both manufacturers and end users for an appropriate use in clinics and in research context.

Appropriateness of plantar pressure measurement devices: a comparative technical assessment.

Accurate plantar pressure measurements are mandatory in both clinical and research contexts. Differences in accuracy, precision and reliability of the available devices have prevented so far the onset of standardization processes or the definition of reliable reference datasets. In order to comparatively assess the appropriateness of the most used pressure measurement devices (PMD) on-the-market, in 2006 the Institute the author is working for approved a two-year scientific project aimed to design, validate and implement dedicated testing methods for both in-factory and on-the field assessment. A first testing phase was also performed which finished in December 2008. Five commercial PMDs using different technologies-resistive, elastomer-based capacitive, air-based capacitive-were assessed and compared with respect to absolute pressure measurements, hysteresis, creep and COP estimation. The static and dynamic pressure tests showed very high accuracy of capacitive, elastomer-based technology (RMSE<0.5%), and quite a good performance of capacitive, air-based technology (RMSE<5%). High accuracy was also found for the resistive technology by TEKSCAN (RMSE<2.5%), even though a complex ad hoc calibration was necessary.

Tele-rehabilitation: present and future.

SUMMARY: During the last decade we assisted to relevant progress in rehabilitation studies and in technological development. From the combination of these issues rises the tele-rehabilitation--a subfield of telemedicine consisting of a system to control rehabilitation "at distance"--as an actual possibility of application and a promising development in the future. The present paper offers a short review of the state of the art in the field of tele-rehabilitation, with a special focus on upper limb tele-rehabilitation. The experience is also briefly reported of the preliminary application of the H-CAD (home care activity desk) system and the HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) tele-rehabilitation service, conducted by the authors within two European projects in the period 2003-2005 and 2005-2007 respectively.

Technical assessment of the HELLODOC service.

SUMMARY: A technical assessment activity has been conducted by Istituto Superiore di Sanità (ISS) in the European project HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) for evaluating the tele-rehabilitation service. The activity was mainly focussed on architectural aspects and a step by step monitoring of the service. It was mainly related to the following aspects: service implementation, service performances, service integration and fault management. The technical assessment analysis demonstrated that the service worked in a quite satisfactory way, also considering the pioneering aspect of the project; the set of malfunctioning occurred, which had a low impact on the service continuity, are typical of a post-debug phase.

Clinical assessment of the HELLODOC tele-rehabilitation service.

SUMMARY: Within the EU project HELLODOC, the clinical effectiveness was investigated of the home care activity desk (H-CAD). Eighty-one patients with chronic stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) were recruited; 50 out of 81 received 1 month of H-CAD intervention, with one training session a day lasting 30 minutes for 5 days a week. The overall satisfaction of both patients and therapists was high. The Action Research Arm (ARA) and the Nine Hole Peg Test (NHPT) were used as main outcome measures. They proved the H-CAD system to be at least as effective as usual care. Maybe due to limited length and intensity of treatment, during the training month subjects improved on the individual H-CAD exercises but, as in the usual care group, the arm/hand function remained at the same level.

Gait analysis with an integrated system for functional assessment of talocalcaneal coalition.

There is little knowledge of the functional performance of patients with talocalcaneal coalition because of the marginal quantitative information accessible using current motion-analysis and plantar pressure-measurement techniques. A novel system was developed for comprehensively measuring foot-floor interaction during the stance phase of gait that integrates instrumentation for simultaneously measuring bony segment position, ground reaction force, and plantar pressure with synchronization of spatial and temporal variables. An advanced anatomically based analysis of foot joint rotations was also applied. Tracking of numerous anatomical landmarks allowed accurate selection of three footprint subareas and reliable estimation of relevant local forces and moments. Eight patients (11 feet) with talocalcaneal coalition were analyzed. Major impairment of the rearfoot was found in nonsurgical patients, with an everted attitude, limited plantarflexion, and overloading in all three components of ground reaction force. Surgical patients showed more normal loading patterns in each footprint subarea. This measuring system allowed for accurate inspection of the effects of surgical treatment in the entire foot and at several footprint subareas. Surgical treatment of talocalcaneal coalition seems to be effective in restoring more physiologic subtalar and forefoot motion and loading patterns.