(8) ROCCO GOES TO ITALY, MOMMYS HELPER
He is dedicated with heart and soul, so much so that he helps to mend the relationship between the man and his daughter, a relationship that deteriorated over the years due to lies and misunderstandings. Raccontami il tuo personaggio. How did the locals around Potenza take to the shooting? Come sono stati i locali nel ricevere la troupe cinematografica? Since you are from Potenza, do you feel a special pride for this role? I absolutely felt an immense joy when I learned that I got the role.
I am lucano proud of it. I am thrilled for the opportunity to contribute to the promotion of my land. This has been an emotional experience that I will remember for as long as I live. Why do I care? Shouldn't I, like most consumers of American pop culture, revel in seeing a once-dignified person debased on television? Because the fact is, Union Pacific was one of the first truly nonpareil meals I'd ever eaten. Rocco's food helped make me interested in food. And as a lover of said food, I struggle -- truly struggle -- with trying to understand Rocco's refusal to cook. It upsets me, still.
Confuses me. Is it an act of defiance, or one of survival? A temporary respite that just got too comfortable, or a well-planned second act? When we look at Rocco, are we looking at an American success story, or a tragic narrative of talent wasted? Or Salinger started doing Harlequin romance novels? What happens when someone believed to have a transcending talent simply stops doing the thing they've been blessed with?
Is he cheating himself? Is he cheating us? What recourse, or right, do we have to tell them they're making a mistake? Because the fact is, one of America's great culinary talents refuses to cook. And I need to know why. At the CIA he flourished, rising to the top of his class. In , he enrolled at Boston University's school of hospitality, and paid his way working as a chef de partie at the now closed Aujourd'hui in the Four Seasons, and a personal chef to legendary legal journalist Anthony Lewis and his wife Margaret Marshall , former Chief Justice of the Massachusetts Supreme Court.
After graduation, Rocco moved back to New York and got a gig at one of the biggest restaurants of the '90s, Lespinasse , under famous Swiss chef Gray Kunz, who called him "concentrated, focused, and quiet," but impressive enough to be offered two executive chef jobs, one at Dava, and one at Annabelle. Both restaurants failed under his stewardship, but on September 30, , in a brief Diner's Journal review , New York Times food critic Ruth Reichl gushed about a calamari salad at Annabelle, mentioning in the last sentence of her second paragraph that "the restaurant's chef, Rocco DiSpirito, is someone to watch.
A year later, restaurateurs Steven Scher and Jeff Kadish realized that it was the '90s and that they had to buy rollerblades and open an Asian-fusion place. Rocco cooked for them and they offered him the job the next day, and, in , Union Pacific opened its doors -- though the food wasn't Asian fusion as much as it was unadulterated Rocco creativity. But a year later, in August , Reichl revisited the young chef she'd been watching. Talking to her today, she still remembers her meal. As a critic, you're dying to find chefs like him. DiSpirito's menu that is not wonderful.
With that illustrious Reichl co-sign, the media floodgates opened. Gourmet magazine, which Reichl took over after leaving the Times , put him on the cover holding a fish and named him the Most Exciting Young Chef in America. People magazine called him the Sexiest Chef Alive. Zagat labeled him a "rock star. Chef Ari Weiswasser , who was working in some of NYC's fanciest kitchens at the time, says that famously judgmental superstar British chef Paul Liebrandt routinely sang his praises. Rocco's cookbook, Flavor , won a James Beard award, became a New York Times bestseller, and included a recipe for cinnamon glazed duck.
His boyish looks coupled with his prodigious talent and "aw, shucks" persona created an unstoppable, unquenchable monster of publicity. By , the world had become Rocco DiSpirito's giant, locally harvested oyster, with a house-made mignonette made up of equal parts fame and riches.
He could do anything he wanted. So Rocco made a decision. He decided to open another restaurant. And this time he was going to do it on network television. This was the landscape onto which Rocco's show, The Restaurant , was foisted. The Restaurant followed the trials and tribulations of opening Rocco's, a casual red-sauce Italian joint Rocco DiSpirito wanted to create in tribute to his heritage.
The main characters were Rocco, Rocco's adorable Italian mom -- who actually worked in the kitchen making her famous meatballs -- and the financier of the entire enterprise, restaurateur Jeffrey Chodorow. Debuting in the summer of on NBC, the show is still captivating. Yes, the camera work is terrible, and the product placement is hilariously blatant at one point during a discussion with his managers, Rocco calmly suggests they should apply for an American Express Small Business Loan , but it also offers an entirely raw look at how and why Rocco's career in the kitchen ended.
Dressed in all black, riding around NYC in a limo, Chodorow who didn't respond to requests for comment on this story is a natural money-man villain, and that's well before you discover he owns a purple pool table. You can tell he and Rocco will have tension 10 minutes into the pilot, when he shoots down Rocco's suggestion that they look at a more intimate Downtown space in favor of a clusterfuck at 22nd and Broadway that was, as the Times' William Grimes puts it to me, an "absolute restaurant graveyard.
The first season consisted of basic narratives: Will the restaurant open on time? Will the staff get their shit together? Will the veteran pretty blonde bartender Heather stop being mean to the new pretty blonde server Lauren? Early aught celebrity cameos were common. Fran Drescher showed up. Anthony Bourdain and Eric Ripert came to dinner, Bourdain wearing a thumb ring and going on a diatribe about the food not being enough, that a chef's second job was "to be a motherfucking hustler.
Conflict-wise, it was a producer's dream. And naturally, when pitted against Chodorow, I wanted to cheer for Rocco. He seemed like a good guy, even when wearing an orange graffiti letter trucker hat that said "Rocco.
(8) Rocco Goes to Italy, Mommy's Helper
But here's the thing: A lot of the points Chodorow and his corporate lackeys made in meetings with Rocco weren't wrong. They complained he was never in the kitchen, then there would be a quick cut to Rocco at a book signing in Connecticut, playfully asking for middle-aged women's phone numbers. And here I am, desperately trying to have Rocco's back when he claims Chodorow hasn't shown him financial information in six months, and yet there's his unflappable French GM, Laurent, openly admitting he'd gotten those docs, which means Rocco's got them too.
When Chodorow and Rocco argued, Chodorow argued about financial peculiarities and Rocco not responding to phone calls and emails, and Rocco complained about being disrespected, about decisions being made without his approval. They were speaking two different tongues. It is associated with conditions that interfere with normal binocular vision, such as strabismus ocular misalignment , anisometropia a difference in refractive power between the two eyes , bilateral refractive error, and media opacity such as cataracts or other blockage of the visual pathway such as ptosis or eyelid drooping.
We present main pre-scholar screening tests and the more frequent emergency diseases that pediatrics could have to face up in their practice. Red reflex is a test that can detect potentially life-threatening ocular abnormalities and, despite the high number of false positives, the red reflex test has proven to be a useful, easy to perform and low cost test for the early detection of congenital low vision diseases. The base of the red reflex test is that if the ophthalmoscope light directly placed on the optic axis of the dilated pupil, the pupil area would seem in a uniform light orange close to red color.
Any resentment placed within this path in the eye, partially or completely prevents the reflection, and would appear as a black mark or a shadow. More frequent pediatric ophthalmological emergency conditions and their appropriate management are presented. Direct evidence on effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Early intervention is critical to prevent treatable causes of vision loss in children, then screening for impaired visual acuity in primary care settings could identify children with vision problems at a critical period of visual development and lead to interventions to improve vision, function, and quality of life.
Limited are the evidences in relation to the effectiveness of visual screening tests in pediatric patients. The editorial process is a complex work that needs content knowledge, continuous updating, time, organization. Authors should have followed formatting requirements, manuscript structure, literature citation style and original articles should have obtained approval of Ethical Committee when appropriate. Then, the editorial office must check if the Authors have effectively followed the instructions for Authors of the journal and, when it is necessary, have received the permission to publish material, already appeared in other articles from the Publisher.
Editor is a pivot figure in the publication and verifies the content and the process of the script itself. If all conditions of writing are satisfied the Editor receives the manuscript. He sends the paper to reviewers, usually two, to check its quality; otherwise he can take the decision of rejecting the article before reviewing when it is out of scope or not scientifically sound. Technical reviewers to realize statistical or bioinformatics analysis, are sometimes required too. After revision the paper may return to the Authors to make corrections, be rejected or be accepted for publication.
The final decision is taken by the Editor. Reviewers are only advisors. When the article has been accepted for the publication, the Technical Staff checks vocabulary and graphic design. So, to warrant a correct and comprehensive publication, a close cooperation among Authors, Editor and Reviewers is needed . Recenti Prog Med. International Committee of Medical Journal Editors Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical Journals.
Last access on 2 August Invasive infectious diseases represent threatening conditions in pediatric age: prescription of the most targeted therapy is essential for a good prognosis. Revision of the available diagnostic methods described in English Literature for pathogen identification. Polymerase chain reaction methods can identify pathogens in approximately 6 hours directly from biological fluids, some kits disclosing the presence of genes related to antibiotic resistance.
Identification is not influenced by the antinfective therapies prescribed, however it is limited to the kit pathogen panel and both false positive e. Mass spectrometry is performed on positive cultures: pathogen identification may be accelerated of about 48 hours compared to traditional methods. Methods to identify resistance profiles through mass spectrometry are in progress .
Traditional methods as standard identification from cultures and antibiotic susceptibility testing are based on EUCAST guidelines . Pathogen isolation and susceptibility testing on positive cultures remain the gold standard for microbiological diagnosis in infectious diseases. However, mass spectrometry and polymerase chain reaction methods could be adjunctive diagnostic tools for an early diagnosis.
(8) Rocco Goes to Italy, Mommy's Helper by Rina 'Fuda' Loccisano | Waterstones
A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples. Med Microbiol Immunol. Multiplex PCR allows rapid and accurate diagnosis of bloodstream infections in newborns and children with suspected sepsis. J Clin Microbiol. Diagn Microbiol Infect Dis. Ongoing revolution in bacteriology: routine identification of bacteria by matrixassisted laser desorption ionization time-of-flight mass spectrometry.
Clin Infect Dis. Accessed on 12 July Creation and Evolution theories share two major features: uniqueness and variability of human kind. This approach is new in that bypasses the age-old problem about their conflicting relationship. Evolution theories are based upon the results of paleontologic, anthropologic, ethnic, linguistic and genetic studies.
Skin color is one of the most conspicuous ways in which humans vary and has been widely used to define human races. Recent studies have definitely proven that the variations in skin color are adaptive and related to the regulation of ultraviolet UV radiation penetration in the integument and its direct and indirect effect on good health .
The earliest members of the mankind lineage probably had a mostly unpigmented or lightly pigmented integument covered by dark black hairs, similar to that of the modern chimpanzee . The evolution of a naked, darkly pigmented skin occurred early in the evolution of the genus Homo. A dark epidermis protected sweat glands from UV-induced injury, thus insuring the integrity of thermoregulation. Of greater significance in individual reproductive success was that highly melanized skin protected against UV-induced proteolysis of folate, a metabolite that is essential for normal development of the embryonic neural tube and spermatogenesis.
As hominides migrated out of Africa, varying degrees of depigmentation evolved in order to permit UV-induced synthesis of previtamin D3. Generally speaking the impact of UV-eradiation on skin increases by latitude and decreases by altitude. Recent observations explain the apparent exceptions to the general rule, like the Ituin group in Eskimo population.
In general, females require a lighter color of the skin to synthesize more amounts of Vitamin 3, necessary during pregnancy and location . Thus skin coloration in humans is adaptive and labile. Skin pigmentation levels have changed more than once in human evolution similar to the alternation of glaciation and desertification.
Because of that, the skin coloration should not be considered of value in determining phylogenetic relationship among modern human groups. The project sounds as Alphaantitrypsin would return back home. Cann GR et al. Genealogical tree of human population, Nature In Cavalli Sforza LL et al. Homo Sapiens. The story of Human Diversitry. Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol. Mineralization of alphaantitrypsin inclusion bodies in Mmalton alphaantitrypsin deficiency.
Orphanet J Rare Dis, ; Antitrypsin phenotypes in St. The purpose of a nutritional assessment in pediatrics is to document a normal growth and to identify children who need further clinical investigations, since a difficult growth can be the first sign of many diseases. Moreover, a poor nutritional status can modify the therapeutic choices, such as the timing of a surgical operation.
Clinical evaluation of the nutritional status is an essential part of the pediatric visit, in both inpatients and outpatients. It does not require particular instruments, but only of a regular systematic approach which is the essential prerequisite for a longitudinal analysis. Background : Functional urinary incontinence UI and enuresis EN are the commonest lower urinary tract symptoms LUTS in children and can lead to major distress for the affected children and their parents. Organic UI due to anatomic malformation or neurologic disease is continuous; functional UI due to disorders of bladder-sphincter function is intermittent.
When functional UI occurs during nighttime is named enuresis. Necessary information can be acquired using non-invasive procedures: detailed medical history, bladder and bowel diary, physical examination and urinalysis. Sonography is used to investigate renal abnormalities, bladder, and rectum. Pathological amounts of postvoiding residual urine PVR and relevant thickening of the bladder wall are indications of a bladder voiding disorder.
A retrovesically extended rectum indicates constipation. In the other cases, the mainstay of the non specialistic management is urotherapy educational and rehabilitative procedures ; however, some patients will need supportive medication in addition. Conclusions : Urinary incontinence in children is a heterogeneous phenomenon.
Functional forms are much more common than organic ones. Diagnosis and therapy of functional UI are based on non-invasive diagnostic evaluation. Urotherapy is the most important therapeutic cornerstone. Neuro Urol Urodyn. Nieman R. Diagnosis and Management of urinary incontinence in childhood. International Continence Society; Phytotherapy has ancient origins but despite this, even today, its use for health purposes is widespread in both adults and children.
Many food supplements on the market, contain, among their components, plant extracts. This aspect is particulary relevant in Italy, where the use of food supplements containing plant extracts botanicals prevails compared to herbal medicines, unlike what happens in other European Countries. However, there is a marked difference, both from a regulatory point of view and sales to the public, between botanicals and herbal drugs. The main differences, however, concern their clinical use: food supplements can in fact maintain, optimize or support a function, but cannot boast a therapeutic action, that is the sole competence of drugs .
In the pediatric environment, there are plants or their extracts, which cannot be used or have age limits, others that require a dose reduction or caution. The purpose of this report is to provide pediatricians with the skills to be able to advise, according to criteria of safety and effectiveness, the use of plant extracts in child care. Bilia AR. Herbal medicinal products versus botanical-food supplementes in the European market: state of art and perspectives.
Nat Prod Commun. Section 4. Fundamentals of pharmacognosy and phytotherapy. Second Edition. London: Churchill Livingstone; Le Basi Scientifiche dei Prodotti Fitoterapici. Last access on 1 August Infantile hemangiomas IHs are the most common tumors of infancy with a prevalence of 2. IHs are benign vascular tumors. They are characterized by a typical clinical history: they manifest within the first weeks of life, followed by a rapid proliferative phase during the first month, a stabilization phase at approximately months of age and a successive spontaneous involution over the next years.
Oral treatment is indicated for ulcerated IHs, IHs at risk for life, those with potential functional or relevant aesthetic sequela . During the last 10 years, treatment of IHs significantly changed after the accidental discovery of efficacy of oral propranolol, a beta-blocking drug, already used in cardiology . The European Consensus of defines propranolol as the first line therapy for IHs, especially during proliferative phase of IHs, between the second and the fifth month of life.
Patients may be treated earlier, in case of obstruction or functional damage, or later in case of delayed referral of the patient . The drug showed optimal results in terms of efficacy, safety and tolerability, reserving a secondary or obsolete role to steroids, interferon, vincristine and surgery. Children affected by IHs usually need treatment until 12 months of life, but, in case of deep, segmental or laryngeal IHs, may be prolonged until months.
Clinical studies, scientific literature and clinical experience of the least 10 years demonstrate that oral propranolol is successfully used in the treatment of IHs. Infantile haemangioma. Propranolol for severe hemangiomas of infancy. N Engl J Med. Treatment of infantile haemangiomas: recommendations of a European expert group. Eur J Pediatr. El Hachem M, F.
Gesualdo, A. Diociaiuti, I. Berti, N. Vercellino, V. Boccaletti, I. Neri, G. Porcedda, A. Greco, C. Carnevale, T. Oranges, M. Cutrone, P. Safety and effectiveness of oral propranolol for infantile hemangiomas started before 5 weeks and after 5 months of age: an Italian multicenter experience. Propranolol treatment for infantile hemangioma IH is not associated with the developmental risk or growth impairment at age 4 years.
J Am Acad Dermatol. Study of cognitive function in children treated with propranolol for infantile hemangioma. Pediatr Dermatol. Clinic case of a 13 year-old adolescent who was inside depression criteria Table 1 Table 2 of DSM5 . What paediatricians should do: catching early signals to identify difficulties of the adolescents; during health state evaluation at a year-old, making simple questions to eventually identify inconveniences, e. Tell me something about what you do every day? Have you got friends? Carefully observe behaviours, just as a listener, avoiding expressing judgements, following the pace of the patient without imposing pressure and finally avoiding devalueing or trivialising the distress, understanding whether there are specific synptoms depressed mood, melancholy, weeping, irascibility, loosing of interests or anger crisis ; looking for alterations in sleepiness hypersomnia, insomnia , nutrition lack of appetite or bulimia nervosa , level of energy fatigue or will to undertake new activities; noticing whether melancholy is replaced by rage, as often happens, being the only way adolescents can express their distress.
Latest guidelines published by Pediatrics in [7,8] recommend training of physicians to identifying depressed adolescents, also using screening tests every year starting from National trends in the prevalence and treatment of depression in adolescents and young adults. The impact of the social determinants on life styles in the province of Trento, Managing and preventing depression in adolescents. BMJ ; c American Psychiatric Association. Pedditzi ML, Lucarelli L. Bullismo e rischio depressivo: una indagine esplorativa in un campione di studenti nella prima adolescenza.
Medico e Bambino pagine elettroniche ; Soldateschi M, Masi G. Salute mentale. Practice preparation, identification, assessment, and initial management.
Treatment and ongoing management. Advancements in medical treatment and technology have increased the life expectancy of children with special health care needs. The shift from infancy to adulthood represents a delicate moment for the child who is growing up, and for his family.
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The management of the chronically ill child previously handled by the pediatrician, all-round spokesman of the clinical and organizational problems of the child and his family, is passed on to a greater number of specialists who manage the single health-related issues.
This frequently translates in the loss of a holistic approach and with the family being left behind in a new and more fragmented system. Therefore, there is a need to identify collaborative process, tools and resources for all stakeholders involved in the transition process. The principal problematics to take in consideration while transitioning are: the acquisition of self-consciousness regarding their condition, the capacity to manage their chronic condition easily accessing the assistance services needed and the adequate integration to their social context.
At the same time, it is necessary to identify adult specialists adequately trained to care for patients with childhood onset conditions. Seemingly important is for the pediatrician who is in charge of the child with chronic disease to have an identifiable representative in the multidisciplinary team of the referral center for the specific pathology, for an adequate handing over of the patient.
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Such take on of responsibility of the patient with identification of his issues, his needs and planning of future follow-up should be discussed by the referral team with a coordinated transfer of care and secure attachment to adult service. Multiple studies have demonstrated that an unsuccessful transition of care translates in higher rates of scarce compliance to therapy and frequent withdrawal from follow-up, increased hospitalizations for acute complications and inadequate prevention, frequent anxiety and stress disorder related to the loss of a contact person and the fear of a possible relapse or worsening of symptoms.
All these problematics have negative consequences for quality of life of the patient and its family. Therefore, there is an increased need for planned programs for transition of youth with special health care needs from the pediatric system to adult health services. Short stature is one of the most common reasons for consultation for paediatricians and paediatric endocrinologists.
The definition of short stature may vary, but it is commonly defined as a height is 2 standard deviations SD or more below the mean for children of that sex and chronologic age and ideally of the same racial-ethnic group. The first thing first that a paediatrician must rule out is whether the short stature is a variant of normal growth or caused by a disease.
When diseases like inflammatory bowel diseases, coeliac disease, cystic fibrosis, thyroid or adrenal diseases are excluded, then the most frequent causes of short stature are familial short stature FSS , idiopathic short stature ISS and constitutional delay of growth and puberty CDGP. The diagnosis of the causes underlying short stature sometimes is not easy and availability of growth velocity and growth trajectory is very important for a proper evaluation of a child with short stature.
Assessing the severity of the short stature is also important to facilitate decisions about intervention, when appropriate.
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In recent years research has given a major contribution to facilitate the deciphering of short stature, with particular reference to discovering of new genes regulating the secretion of GH, IGF-1, ALS, etc. When a diagnosis is made, then the decision to treat or not to treat with GH must be taken; children with GH deficiency, Turner syndrome, SGA, may respond very well to treatment and increase their final height significantly.
In other children the outcomes are less advantageous. Therefore, further research is needed to increase our knowledge in this field and, more importantly, to improve the long term prognosis and final height of short children. Nevertheless, several studies, carried out to evaluate response to vaccination, suggested that they showed a satisfactory response to immunization and developed protective serum antibody levels, including the PCV-7, PCV, and PCV pneumococcal vaccine, although slightly reduced as compared to term infants .
The same may apply to combined vaccines, as the hexavalent that should be administered in accordance to the summary of product characteristics . As for rotavirus vaccination in hospitalized infants, some recommendations suggest to wait until discharge , while others consider safe its use in the NICU, with appropriate infection control precautions .
The occurrence of vaccine-attributable adverse events such as fever, local inflammatory reaction, prolonged crying, and irritability are not increased in preterm vaccine recipients. However, extremely low birth weight infants, particularly if immunized before hospital discharge, may show episodes of apnea, bradycardia and desaturation, partly associated to an inflammatory response, that resolve spontaneously in most cases.
It is therefore prudent to ensure a 48 hours period of observation and monitoring after administration in these infants [11,12]. In conclusion, according to guidelines issued several years ago and recently reaffirmed, preterm infants should be immunized following chronological age, or when stability has been reached, and should receive full vaccine doses . The measles-mumps-rubella vaccination, to be administered usually after 12 months of age, is also highly recommended ; the vaccine could be anticipated in the preterm, in relation to the lower risk of interference by maternal antibodies, which are no longer measurable after six months of age .
Although there are no particular contraindications to vaccination in preterm infants, other than those considered for term newborns, it is common to observe a delay of the beginning of vaccinations, as confirmed by both Italian [15, 16]and foreign studies. It is therefore highly needed a public information campaign, to disseminate the word on the incomparable resource available with vaccinations, and to underline the particular usefulness in some categories of high-risk patients, such as those born preterm.
Vaccines and preterm neonates: why, when, and with what. Immunization of preterm infants. Hum Vaccin Immunother. General Best Practice Guidelines for Immunization. Safety and immunogenicity of pneumococcal conjugate vaccine in preterm infants: a meta-analysis. Indian J Pediatr. Schedules for pneumococcal vaccination of preterm infants: An RCT.
Immunization of preterm infants with valent pneumococcal conjugate vaccine. Immunization of preterm infants with GSK's hexavalent combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine: A review of safety and immunogenicity. Risk of rotavirus nosocomial spread after inpatient pentavalent rotavirus vaccination. Respiratory decompensation and immunization of preterm infants.
Pediatr Infect Dis J. Humoral immune response to measles and varicella vaccination in former very low birth weight preterm infants. Braz J Infect Dis. Effect of early measles vaccination AIK-C strain for preterm infants. Pediatr Int. Timeliness of routine immunization in a population-based Italian cohort of very preterm infants: results of the ACTION follow-up project. Are pre-terms born timely and right immunized? Results of an Italian cohort study. The effect of media pressure has determined, in recent years, a lower interest of the population to immunization programmes, increasing the risk of serious consequences for health.
The current National Vaccination Prevention Plan develops in continuity to the previous one, sharing the general objective of harmonizing the prevention strategies actually carried out in Italy, in order to guarantee the full benefits of vaccination to the whole population. A series of strategies can be carried out in order to create organizational models that aim to increase vaccination coverage. Among these, especially with regards to the developmental age and adolescence, there are health education interventions and the administration of vaccinations in alternative settings.
The School, for example, represents the ideal setting for the development of such actions . In addition, internal communication among the various figures involved in the vaccination world Pediatricians and Immunization Services Operators is the basis of an effective system of cooperation that would lead to an improvement in coverage. In the Health Local Unit ASL of Taranto, the integration of health promotion and vaccination programmes seems to be a sustainable solution: the comparative assessment of anti-HPV coverage strategies, suggests that school vaccination has resulted in significantly better outcomes than outpatient clinic one, for all the groups considered overall Building a cooperation system is necessary in order to achieve ambitious goals.
The institutional reinforcement between public health and the education system, as well as a multidisciplinary collaboration approach in the vaccination field, are two excellent examples of how these strategies are crucial for achieving ideal coverage . Vandelaer J, Olaniran M. Using a school-based approach to deliver immunization — A global update. Universal proposal strategies of anti-HPV vaccination for adolescents: comparative analysis between school-based and clinic immunization programs.
J Prev Med Hyg. Paul P, Fabio A. Literature review of HPV vaccine delivery strategies: considerations for school- and non-school based immunization program. The physical abuse is defined as the intentional use of physical force against a child that results in—or has a high likelihood of resulting in—harm for the child's health, survival, development, or dignity. Much physical violence against children in the home is inflicted with the object of punishing .
Depending on the type of force involved, specific injury patterns are produced on the body of the child, the morphology and localization of which are forensically relevant . Among the diverse lesions that it can be found in maltreated children, same are peculiar and may help to differentiate these forms from accidental injuries:.
The severity of the resulting thermal lesion is the product of temperature and exposure time . It is difficult to estimate its incidence because not all the abused children reach the medical system . For these reasons, long since the scientific community is working hard to identify certain data in order to reach accurate diagnosis of AHT. Several studies have demonstrated programs are effective in reducing the incidence of the syndrome. Starting from a national network of centres of excellence equipped with a protection team at five main teaching third —level hospitals, coordinated by the no profit organization Terre des Hommes , the prevention strategy, the target population and the main message were defined, according to the evidence derived from the international literature review combined with the expert in-the-field experiences.
A prevention TV video spot and few synthetic parents-friendly information was provided in the first Italian dedicated web-site [ www. World report on violence and health. Geneva: World Health Organization; Michael Tsokos Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation Forensic Sci Med Pathol. Cutaneous signs of child abuse.
Vale GL. Dentistry, bite marks and the investigation of crime. J Calif Dent Assoc. Nuzzolese E, Di Vella G. The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma. J Forensic Odontostomatol. Ellis P. Cutaneous findings in children. Forensic pathology of infancy and childhood. NewYork: Springer; Cigarette burns in forensic medicine. Forensic Sci Int. Christian CW, Block R.
Abusive head trauma in infants and children, Pediatrics Educational paper: abusive head trauma part I.
Clinical aspects. EurJ Pediatr. In were published the first recommendations for the use and interpretation of h ambulatory blood pressure monitoring ABPM in children . In the American guideline for screening and Management of high blood pressure, published in , the rule and importance of ABPM in children was emphasized . ABPM values correlates with left ventricular hypertrophy and carotid intima media thickness, known cardiovascular risk factor.
Data provided by ABPM consist of the mean of systolic and diastolic blood pressure values recorded during 24 h and, separately, during daytime and nighttime. The suggested frequency of the measurements is 3—4 per hour during daytime and 2—3 per hour during the night. At least 1 or 2 valid readings should be obtained per hour to consider an ABPM interpretable. ABPM make it possible to verify the efficacy of therapy, especially when clinic or home BP measurements indicate insufficient BP response.
The American Guidelines recommend routine use of ABPM in children with high-risk conditions: secondary HYT, chronic kidney disease CKD , diabetes, solid-organ transplant, obesity, obstructive sleep apnea syndrome and in some genetic syndrome neurofibromatosis, Williams. As we reported in a recent publication  however, some critical points concerning its use. In particular, the lack of solid reference values for normal subjects within an age range of 5—16 years and the use of appropriate cuff size and validated monitors. In conclusion in the last years the use of ABPM is increasing.
Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association.. Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors. All isolated strategies result less or at all efficacious . The child interacts with the environment. Besides family, other microsystems play a role in his development: school, work, church, recreation and sports .
Family is the main actor of changes, at least until age years, but it is not enough to work only with it during the adolescence. The adolescent should be sustained in his maturation and need of autonomy, ensuring support for motivation, self-esteem and self-efficacy . School peers, teachers and the entire system is decisive for relationships, and, therefore, it is a privileged place for implementation of prevention and treatment.
In healthcare a network of services is necessary.
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Different professionals should be involved with shared training and a life-course approach. Professionals should be trained to work on different levels with a shared method and to cooperate in teams. Food and sport lifestyles should be approached with therapeutic education and motivational interviews [2,5]. Besides prevention and identification of children who should undergone treatment, his task is to motivate the family towards treatment and support them in time, act as a mediator, participate in decisions when a superior level intervention is required .
The second level should receive secondary, severe, already complicated or unresponsive patients . It should be organized by health districts and requires a multidisciplinary team, which includes a pediatrician, a dietitian and a psychologist with documented experience. If severe comorbidities persist, patient should be sent to third level care in specialized centers for the evaluation and treatment of comorbidities on a multidisciplinary basis, including a possible surgical approach . The main obstacles to success of this model, that currently needs to be created or completed in most Italian regions, are the persistence of prejudice on obesity as an exclusive personal responsibility, the failure to recognize obesity as a chronic disease and the lack of coordination among healthcare levels, especially between primary care and multidisciplinary teams.
Area Pediatrica ; Management of obesity: improvement of health-care training and systems for prevention and care. Bronfenbrenner, U. The ecology of human developmental processes. In: Damon, W. Eisenberg, N. The handbook of child psychology. Effect of attendance of the child on body weight, energy intake, and physical activity in childhood obesity treatment: a randomized clinical trial.
JAMA Pediatr. The role of the pediatrician in primary prevention of obesity. How good are BMI charts for monitoring children's attempts at obesity reduction? Arch Dis Child.