The use of online pornography among minors: epidemiological analysis of the phenomenon.

INTRODUCTION: In recent years, the quick spread of Internet has brought many children and teenagers to be increasingly connected online without adult control. The use of Internet offers many opportunities, but at the same time it exposes young users to multiple risks. Among these, the consumption of sexually explicit internet material (SEIM) is one of the most relevant. The aim of the present study is to describe the epidemiology of this phenomenon regarding its prevalence and distribution among sexes and different age groups. EVIDENCE ACQUISITION: A literature search was performed on PubMed and ScienceDirect using the query "(pornography OR sexually explicit internet material) AND (adolescent OR child OR young)." Only papers published between 2013 and 2018 were included in the analysis. EVIDENCE SYNTHESIS: According to selected studies (N.=21), the prevalence of boys approaching SEIM ranges from 56% to 100%, whereas the percentage widely varies between 7.6% and 82% for girls. The first exposure to SEIM happens in a purely accidental way in over half of cases and at a mean age of 12 years for males and 14.5 years for females. The risk of exposure is doubled for smartphone and tablet owners. CONCLUSIONS: The spread of pornography and SEIM among minors seems to be epidemic and even pandemic. We need to consider its possible effects on the psychophysical welfare of the very young, influencing their growth and development. Therefore, the impact that pornography may have on the physical, psychological, and sexual health of younger people warrants further investigation.

Consumption of sexually explicit internet material and its effects on minors' health: latest evidence from the literature.

INTRODUCTION: Nowadays adolescents and children are more and more exposed to sexually explicit internet material (SEIM), but most parents and healthcare professionals neglect this issue. The aim of the present study was to evaluate the impact of online pornography on minors' health with a specific focus on the effects produced on their behavioural, psychophysical and social development. EVIDENCE ACQUISITION: A literature search was performed on PubMed and ScienceDirect in March 2018 with the query "(pornography OR sexually explicit internet material) AND (adolescent OR child OR young) AND (impact OR behaviour OR health)." Results published between 2013 and 2018 were analysed and compared with previous evidence. EVIDENCE SYNTHESIS: According to selected studies (N.=19), an association between consumption of online pornography and several behavioral, psychophysical and social outcomes - earlier sexual debut, engaging with multiple and/or occasional partners, emulating risky sexual behaviors, assimilating distorted gender roles, dysfunctional body perception, aggressiveness, anxious or depressive symptoms, compulsive pornography use - is confirmed. CONCLUSIONS: The impact of online pornography on minors' health appears to be relevant. The issue can no longer be neglected and must be targeted by global and multidisciplinary interventions. Empowering parents, teachers and healthcare professionals by means of educational programs targeting this issue will allow them to assist minors in developing critical thinking skills about pornography, decreasing its use and obtaining an affective and sex education that is more suitable for their developmental needs.

Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method.

BACKGROUND: Controlling inappropriateness of care is an essential issue, especially in rehabilitation medicine. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. AIM: The aim was to define clinical admission criteria and rules in rehabilitation medicine. DESIGN: Survey based on the application of the Delphi method on a sample of rehabilitation medicine experts. SETTING: Administration of electronic online questionnaires concerning appropriateness of admission to intensive rehabilitation. POPULATION: Volunteer sample of 53 experts with the following inclusion criteria: being members of the Italian Society of Physical and Rehabilitation Medicine, having practical experience in the research field, agreeing to the confidentiality of the information and being skilled in both rehabilitation and healthcare organization. METHODS: A three-round Delphi survey was conducted according to international guidelines. The two initial rounds consisted of an electronic online questionnaire while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed. RESULTS: A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions. The second round was designed according to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, seven criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated. CONCLUSIONS: This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules. CLINICAL REHABILITATION IMPACT: To increase appropriateness of admission to rehabilitation. Improving appropriateness in healthcare delivery must be a primary goal in order to improve healthcare quality, save money and ensure system sustainability.

Bilateral transfer phenomenon: A functional magnetic resonance imaging pilot study of healthy subjects.

BACKGROUND: The bilateral transfer of a motor skill is a physiological phenomenon: the development of a motor skill with one hand can trigger the development of the same ability of the other hand. OBJECTIVE: The purpose of this study was to verify whether bilateral transfer is associated with a specific brain activation pattern using functional magnetic resonance imaging (fMRI). METHODS: The motor task was implemented as the execution of the Nine Hole Peg Test. Fifteen healthy subjects (10 right-handers and five left-handers) underwent two identical fMRI runs performing the motor task with the non-dominant hand. Between the first and the second run, each subject was intensively trained for five minutes to perform the same motor task with the dominant hand. RESULTS: Comparing the two functional scans across the pool of subjects, a change of the motor activation pattern was observed. In particular, we observed, in the second run, a change in the activation pattern both in the cerebellum and in the cerebral cortex. We found activations in cortical areas involved in somatosensory integration, areas involved in procedural memory. CONCLUSIONS: Our study shows, in a small group of healthy subjects, the modification of the fMRI activation pathway of a motor task performed by the non-dominant hand after intensive exercise performing the same task with the dominant hand.