Acute Heart Failure: Diagnostic-Therapeutic Pathways and Preventive Strategies-A Real-World Clinician's Guide.

Acute heart failure (AHF) is the most frequent cause of unplanned hospital admission in patients of >65 years of age and it is associated with significantly increased morbidity, mortality, and healthcare costs. Different AHF classification criteria have been proposed, mainly reflecting the clinical heterogeneity of the syndrome. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of cases. Furthermore, a marked reduction in cardiac output with peripheral hypoperfusion may occur in most severe cases. Diagnosis is made on the basis of signs and symptoms, laboratory, and non-invasive tests. After exclusion of reversible causes, AHF therapeutic interventions mainly consist of intravenous (IV) diuretics and/or vasodilators, tailored according to the initial hemodynamic status with the addition of inotropes/vasopressors and mechanical circulatory support if needed. The aim of this review is to discuss current concepts on the diagnosis and management of AHF in order to guide daily clinical practice and to underline the unmet needs. Preventive strategies are also discussed.

Distance Learning Effects Among Italian Children and Parents During COVID-19 Related School Lockdown

Background: During the COVID-19 pandemic, both children and their parents experienced consequences related to distance learning (DL). However, positive and negative effects have varied greatly among families, and the specific factors explaining these differences in experiences are still underexplored. In this study, we examined children's executive functions (EF) and parents' psychological well-being in relation to negative and positive effects of DL on both children and their parents. Method: Participants were 637 Italian parents (92% mothers) with a child (48% male) aged between 6 and 19 years involved in DL due to school closures during the first wave of the COVID-19 pandemic. Data were collected using an online survey. We performed three fixed-order hierarchical multiple regression analyses with child age and sex, children's EF deficits, and parents' psychological well-being as independent variables, and DL-related negative effects (on the child and on the parent) and DL-related positive effects as dependent variables. Results: The results of the regression analyses showed that for negative effects of DL, younger age and greater EF deficits explained most part of the variance. Specifically, regarding negative effects on children, the most important factor was EF deficits, whereas regarding negative effects on parents, child age was the most important factor. For positive effects of DL, all variables explained only a small part of the variance. Child age was the most important factor, but EF deficits and parents' psychological well-being also had a significant impact. Conclusions: The effects of DL during school closures vary widely across families. Our findings indicate that intervention efforts need to consider background variables, child factors, as well as parent factors when supporting families with homeschooling in times of pandemic.

Parental experiences of homeschooling during the COVID-19 pandemic: differences between seven European countries and between children with and without mental health conditions.

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508), the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics.