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Its architecture draws on the cultural traditions of Apulia and contains the stone, the stone walls , the red geraniums, the pinnacles of trulli, the natural flavors. Staying here means finding a dimension of relax and authentic pleasure.


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Among the Valle d'Itria olive trees, close to the Adriatic Sea, in every corner of the estate you can listen to a story of gestures, smells and voices of an authentic land. Many different souls coexist in here. Comparison of means and standard deviations of six CD-Chart dimensions between children 8—11 and adolescents 12—18 with CD. Further comparison was calculated for each of the two factors and the additional component and significant differences are presented in Table 5. Examination of each dimension within this factor indicated that the children with CD liked participation in these activities significantly more than the adolescents with CD.

However, the adolescents were significantly more involved in the preparation process and showed significantly higher self-determination than the children Table 5. As indicated in Table 5 , while children with CD participated significantly less often in the activities than adolescents, the adolescents with CD were significantly more involved in the preparation and showed significantly higher self-determination Table 5 in comparison to the children.

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The children participated in significantly fewer activities and less frequently than the adolescents see Table 5. The adolescents had significantly lower preference for these activities than the children yet were significantly more involved in the preparation process. The CD-Chart was developed in response to a recognized need to provide a valid and reliable tool for the evaluation of unique participation characteristics among children and adolescents with celiac disease who are required to adhere to a life-long GFD [ 19 ].

The two factors found for participation preference in the current study were the social environment and the close family environment. These factors correspond with the meaning of participation as a direct result of the interaction between personal and environmental factors [ 32 , 41 ]. More specifically, previous literature has emphasized the important role of specific environments such as at home, out of the home, school, and with friends and diverse experiences in different environments among children and adolescents with CD has been described [ 8 , 13 , 42 , 43 , 44 , 45 ].

However, the CD-Chart can differentiate not only between activities in relation to environments, but the activities were more accurately characterized by the relationship with the people involved in the participation. Indeed, according to the ICF-CY, interpersonal interactions and relationships with people appear as one of the components that needs to be taken into account with reference to activities and participation.

Among the many ICF-CY sub-classifications that are included in the interpersonal interactions and relationships chapter are relationships with children, with parents, and with siblings.

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These kinds of relationships are in line with the close family environment factor found in this study. Whereas other ICF-CY sub-classifications, for instance the extended family, friends and formal relationships are pursuant to the CD-Chart social environment factor [ 15 ]. Thus, these factors accentuate the significant roles of different relationships according to the ICF-CY activities and participation, when examining characteristics of developing children and the influence of the environment [ 15 , 17 ].

It was interesting to find similar frequencies of participation alongside different preference ratings. Recognition of these subtle differences that are unique to the children and adolescents with CD was accomplished by incorporation of the ICF-CY concepts that can capture the unique nuances of functioning. Such subtle differences in participation are reflected by the lower scores that were evident only in the social environment factor and the trip environment component, yet not in the close family environment.


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  6. The age range in this study encompassed the developmental stage of childhood years approaching adolescence, during which the value of peers becomes increasingly important and the desire to belong increases [ 46 ]. As adolescence progresses, they strive to fit in and their peer relationships offer them social integration, a sense of belonging and acceptance [ 47 ].

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    Thus, the similar CD-Chart scores in frequency of participation alongside the activity scores, may possibly reflect the limitations that the group with CD experience and therefore their choice to avoid participation in some food-related activities. Additionally, the lower preference scores, albeit similar participation frequency characteristics, may possibly reflect the many burdens experienced by that those diagnosed with CD, when eating out, travelling, socializing with friends, and at school [ 48 ]. These described interactions that are revealed by the CD-Chart that reflect specific food-related activities, may be conveyed in the required self-management characteristics and thus impact participation in daily activities [ 23 ].

    As children grow from childhood into early adolescence, their participation in daily life activities takes place in wider, more diverse, circles and away from home [ 49 ]. The sensitivity of the CD-Chart to developmental factors was highlighted in the varied features that were found in the differences between the younger and older groups with CD. Generally, young children require more mediation and supervision while participating in basic daily activities. However, as they develop, they need sophistication and refinement of daily activities, such as managing and preserving a healthy lifestyle [ 32 , 50 ].

    During the critical transition to adolescence, several main developmental experiences occur such as: striving for independence, gaining of control, development of identity, acquisition of skills needed to carry out adult relationships and roles, and the capacity for abstract reasoning [ 51 , 52 ].

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    The distinction in preference of participation that was recognized in the CD-Chart as the children grow into adolescence might reflect the complexity of this transitional stage. Furthermore, this difference may be due to their increased responsibility and commitment to sticking to a GFD during this developmental stage, alongside the shared responsibility with the parents [ 53 ].

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