Evaluation of bio-psycho-social frailty in older persons on the territory: the method and the experience of the "Medesano Health House".

BACKGROUND AND AIM OF THE WORK: Frailty in older people is a situation of risk of dependency caused by many factors. On this consideration, the Medesano  city started a survey on the condition of fragility of people >75 aimed at building a monitoring system for timely interventions on the factors of risk and implementation of measures for preventing dependency. METHODS: The survey was conducted jointly by the family doctor and the social worker in the City. The multidimensional assessment considered logistic and housing conditions, disease, medications, basic and instumental acitvities of daily living, neurological and psycological conditions. RESULTS: The survey included 761 older people, with a following definition of condition and levels of frailty both at social (loneliness, lack of supporting network, etc..) and health level (complexity of the regimen, high and / or severe comorbidity) was planned from the beginning as the basis on which developing a continuous in time monitoring program for assessing the frailty, for a early taking in charge by Health and Welfare services, boosting integrated health and welfare interventions and promoting networks of solidarity and sociality. CONCLUSION: The data seem to confirm that the methodology used is sufficiently adequate to intercept frailty in > 75 years unknown to social services indicating that the monitoring on the functionality of the subjects obtained from the surveys by the General Practitioners could be deemed as a privileged way for a survey on large populations. After the survey was activated continuous monitoring of patients with social and clinical frailty.

Gesture and Symbolic Representation in Italian and English-Speaking Canadian 2-Year-Olds.

Analyses of elicited pantomime, primarily of English-speaking children, show that preschool-aged children are more likely to symbolically represent an object with gestures depicting an object's form rather than its function. In contrast, anecdotal reports of spontaneous gesture production in younger children suggest that children use multiple representational techniques. This study examined the spontaneous gestures of sixty-four 2-year-old Italian children and English-speaking Canadian children, primarily from middle-class Caucasian families. The Italian children produced twice as many gestures as Canadian children in a picture-naming task but produced a similar range of representational techniques. Two-year-olds were equally likely to produce gestures depicting function as form. These data suggest young children's communicative skills are supported by a symbolic capacity that reflects contextual communicative demands.

Motoric characteristics of representational gestures produced by young children in a naming task.

This study explores the form of representational gestures produced by forty-five hearing children (age range 2 ; 0-3 ; 1) asked to label pictures in words. Five pictures depicting objects and five pictures depicting actions which elicited more representational gestures were chosen for more detailed analysis. The range of gestures produced for each item varied from 3 to 27 for a total of 128 gestures. Gestures have been analyzed with the same parameters used to describe signs produced by deaf children: handshape, location and movement. Results show that gestures for a given picture exhibit similarities in many of the parameters across children. Some motor characteristics found in the production of hearing toddlers' gestures are similar to those described for early signs. Implications of this similarity between gestural and signed linguistic representations in young children are discussed.

Manual actions affect vocalizations of infants.

Upper limb gestures, as well as transitive actions (i.e. acted upon an object) when either executed or observed affect speech. Broca's area seems to be involved in integration between the two motor representations of arm and mouth (Bernardis and Gentilucci, Neuropsychologia, 44:178-190, 2006, Gentilucci et al., Eur J Neurosci, 19:190-202, 2004a, Neuropsychologia, 42:1554-1567, 2004b, J Cogn Neurosci, 18:1059-1074, 2006). The relevance of these data is in relation with the hypothesis that language evolved from manual gestures, and was gradually transformed in speech by means of a system of dual motor commands to hand and mouth (Gentilucci and Corballis, Neurosci Biobehav, Rev 30:949-960, 2006). The present study aimed to verify whether this system of integration between gestures (and transitive actions) and speech is involved also in the language development of infants. Vocalizations of infants aged between 11 and 13 months were recorded during both manipulation of objects of different size and request arm gestures towards the same objects presented by the experimenter. Frequency in voice spectra increased when the infants manipulated or gestured to large objects in comparison with the same activities directed to small objects. These data suggest that intrinsic properties of an object evoking commands of manual interaction are used to identify that object, and to communicate.