Italian General Practitioners Research Articles

Knowledge, attitudes and practices of Italian general practitioners on food supplements

Abstract Background Food supplements are widely used, but they can be dangerous if used inappropriately, as they often interaction with patients’ treatment. Their misuse has public health and patient out-of-pocket expenditure implications; general practitioners (GPs) play a central role in managing patient safety. This study aims to investigate the knowledge, attitudes and practices (KAP) of Italian GPs’ toward the use of food supplements. Methods From March to April 2024, an online survey was conducted via the EU-Survey platform among Italian GPs invited through their professional organization. The 62-question survey, adapted from a tool used among pharmacists, comprises two sections: A) KAP questions (28 true/false, 34 on a 5-point Likert scale) and B) socio-demographic questions (i.e. age, sex, years of experience, urban/extra-urban environment). Survey reliability was evaluated using Cronbach alfa and responses were analysed to look for differences between sub groups using Kruskal Wallis Test. Results 202 GPs participated in the survey, 46.0% were male, 53.5% female and 0.5% non-binary, with a mean age of 47±2 years. The majority (70.3%) came from an urban environment and 54.9% worked in group medicine. Only 53.5% of GPs showed an adequate knowledge of the topic (more than 60% of correct answers), with a mean of 18 correct answers. The overall reliability of the test was evaluated as acceptable (alfa>0.7). The 99.5% of GPs interview agreed (score 4 or more on the Likert scale) that they have an important role in food supplements prescription and 98% are involved in life styles counselling activities, but only 66.3% felt they have adequate formation on the topic. No statistically significant differences between population groups were found (p < 0.05). Conclusions Although GPs have recognized their key role in prescribing food supplements, there seem to be a general lack of knowledge on the subject that requires targeted educational interventions to ensure patient safety. Key messages • Food supplements are often taken by patients because they are under the impression that these products are always and completely safe. • Clinical recommendations for the use of food supplements are much more limited than their actual use.

Examining the training needs and perspectives of Italian general practitioners on transgender and gender diverse healthcare: Insights from a national survey

Introduction General practitioners (GPs) play a crucial role in supporting transgender and gender diverse (TGD) individuals by providing healthcare, information, and referrals. However, a major challenge arises from the insufficient training of healthcare professionals in TGD healthcare. The lack of research on the training needs of GPs in this area further exacerbates the issue. To address this gap, we conducted a national survey aimed at Italian GPs to assess their knowledge and attitudes toward the health of TGD individuals. Methods A total of 631 GPs participated in an anonymous cross-sectional survey conducted in Italy from January 2021 to June 2022. Results In accordance with the questions about gender identity and gender affirming pathway, between 23.9% and 79.1% of GPs responded correctly. Less than half of them provided correct responses about the need for cancer prevention. Overall, the younger the age, the more likely it was to answer TGD health questions exactly. Most GPs (90.7%) believed that TGD people experience differences in healthcare access compared to the cisgender population and 37.4% agreed that TGD people experience transphobia in a healthcare context. The implementation of specific training programs and the development of evidence-based guidelines were identified by almost half of respondents as the most urgent measures to enhance TGD healthcare. Only 5.9% of GPs attended training courses on TGD healthcare, yet 97% acknowledged the utility of education in this field. Conclusions The outcomes of our study pave the way for developing strategies to improve GPs’ training in TGD health, ensuring that TGD people receive competent and sensitive healthcare.

Rifaximin in diverticulosis and diverticular disease: a national survey among Italian gastroenterologists and general practitioners.

The management of patients with diverticular disease remains challenging. The aim of this national survey was to assess how gastroenterologists and general practitioners use rifaximin to manage diverticulosis and diverticular disease.Members of theItalian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Federation of General Practitioners (FIMMG)were invited to complete a 39-item online survey concerning the use of rifaximin in five clinical settings: (1) diverticulosis; (2) reducing symptoms in symptomatic uncomplicated diverticular disease;(3) reducing the occurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease (primary prevention);(4) reducing the recurrence of diverticulitis in patients with previous attacks of diverticulitis (secondary prevention);(5) treatment of uncomplicated acute diverticulitis.A total of 1094 physicians completed the survey. Overall, 25.1%, 83.5%, 68%, 74.2%, and 63% of physicians prescribed rifaximin for the clinical settings 1, 2, 3, 4, and 5, respectively. In each clinical setting, the dosage of rifaximin most frequently used was 800mg/day, the most common duration of therapy was 7days, and the cyclic administration of treatment (expressed in months) most frequently used was > 24months. These results highlight that a reappraisal of the use of rifaximin in patients with diverticulosis and diverticular disease is required to reduce the gap between the evidence available and the daily clinical practice, optimizing also the use of healthcare resources.

Survey on the Knowledge and the Management of Helicobacter pylori Infection by Italian General Practitioners and Doctors in General Practice Training

The management of gastric Helicobacter pylori (H. pylori) infection represents a significant concern in primary healthcare. This survey evaluates the approaches, attitudes, and knowledge regarding gastric H. pylori infection among Italian general practitioners (GPs) and young doctors undergoing general practice training (ITGPs). The survey enrolled 466 GPs and 70 ITGPs. Among GPs, specialist recommendations and the Maastricht–Florence guidelines were frequently referenced sources, while ITGPs relied more on the Maastricht–Florence guidelines and internet resources. ITGPs demonstrated more proactive approaches than GPs in investigating and treating conditions such as gastric ulcers, atrophic gastritis, and iron-deficiency anemia. However, there was limited attention given to the role of H. pylori treatment in first-degree relatives of gastric cancer patients. The most used diagnostic methods were the urea breath test and fecal test. Triple therapy was the most frequently chosen initial treatment regimen, with quadruple bismuth therapy becoming the primary option after initial treatment failure, followed by quinolone therapy and concomitant therapy. This survey underscores a disparity between real-world practices and the recommendations outlined in current guidelines, indicating a need for improved understanding of H. pylori guidelines among both GPs and ITGPs.

Health and economic impact of dapagliflozin for type 2 diabetes patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian general practitioners setting: a budget impact analysis

AimIn 2022, in Italy, general practitioners (GPs) have been allowed to prescribe SGLT2i in Type 2 Diabetes (T2D) under National Health Service (NHS) reimbursement. In the pivotal clinical trial named DECLARE-TIMI 58, dapagliflozin reduced the risk of hospitalization for heart failure, CV death and kidney disease progression compared to placebo in a population of T2D patients. This study evaluated the health and economic impact of dapagliflozin for T2D patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian GPs setting.MethodsA budget impact model was developed to assess the health and economic impact of introducing dapagliflozin in GPs setting. The analysis was conducted by adopting the Italian NHS perspective and a 3-year time horizon. The model estimated and compared the health outcomes and direct medical costs associated with a scenario with dapagliflozin and other antidiabetic therapies available for GPs prescription (scenario B) and a scenario where only other antidiabetic therapies are available (scenario A). Rates of occurrence of cardiovascular and renal complications as well as adverse events were captured from DECLARE-TIMI 58 trial and the literature, while cost data were retrieved from the Italian tariff and the literature. One-way sensitivity analyses were conducted to test the impact of model parameters on the budget impact.ResultsThe model estimated around 442.000 patients eligible for the treatment with dapagliflozin in the GPs setting for each simulated year. The scenario B compared to scenario A was associated with a reduction in the occurrence of cardiovascular and renal complication (−1.83%) over the 3 years simulated. Furthermore, the scenario A allowed for an overall cost saving of 102,692,305€: 14,521,464€ in the first year, 33,007,064€ in the second and 55,163,777€ in the third. The cost of cost of drug acquisition, the probability of cardiovascular events and the percentage of patients potentially eligible to the treatment were the factor with largest impact on the results.ConclusionsThe use of dapagliflozin in GPs setting reduce the number of CVD events, kidney disease progression and healthcare costs in Italy. These data should be considered to optimize the value produced for the T2D patients who had or were at risk for atherosclerotic cardiovascular disease.

Primary care doctors retirements in the context of an ageing population in Italy.

Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years. Ecological study. We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs. On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having >15% more patients aged over 65 years compared to the expected number. over 65 years compared to the expected number. Conclusions. The study highlighted that some regions do not currently have the required primary care workforce, and the expec-ted retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country.

Outpatient healthcare costs associated with overweight and obesity in Italy

BackgroundTo evaluate outpatient healthcare expenditure associated with different levels of BMI and glucose metabolism alterations.MethodsThe study is based on a representative national sample of adults, with data obtained from electronic clinical records of 900 Italian general practitioners. Data relative to the year 2018 were analyzed. The study population was classified according to BMI (normal weight, overweight, and obesity classes 1, 2, and 3) and glucose metabolism status (normoglycemia – NGT; impaired fasting glucose – IFG; diabetes mellitus – DM). Outpatient health expenditures include diagnostic tests, specialist visits, and drugs.ResultsData relative to 991,917 adults were analyzed. Annual per capita expenditure rose from 252.2 Euro among individuals with normal weight to 752.9 Euro among those with class 3 obesity. The presence of obesity determined an excess cost, particularly among younger individuals. Within each BMI class, the presence of IFG or DM2 identified subgroups of individuals with substantially higher healthcare expenditures.ConclusionsOutpatient healthcare costs markedly increased with increasing BMI in all age categories, particularly among individuals below 65. Addressing the double burden of excess weight and hyperglycemia represents a significant challenge and a healthcare priority.

P359 A POSSIBLE ROLE OF A NOVEL NUTRACEUTICAL COMPOUND FOR IBS IN TRIGLYCERIDES–LOWERING EFFECT

Abstract In the last few years, growing evidence indicate that gut miocrobiome is linked to irritable bowel syndrome (IBS) and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have been also recorded. Triobiotix is a nutraceutical consisting of: maltodextrin; mineralized extract of Lithothamnion; Bioecolians® gluco–oligosaccharides; ferment mix; short–chain fructo–oligosaccharides powder. We analyzed the database of 40 Italian General Practitioners (GPs). A total of 587 patients with IBS and on Triobiotix were identified. Of these, in only 535 patients, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia. Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the TO evaluation. Triglycerides levels were also significantly decreased (186.37+66.4 vs. 176.13+67.9; p < 0.05). Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL–C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low–moderate dyslipidaemia.

The Management And Evaluation of the Diagnostic-Therapeutic Pathway of Patients with Chronic Obstructive Diseases: A Retrospective Survey of the Italian Population

The study is an independent retrospective cohort study, the data used were collected after obtaining informed consent from patients and were conducted anonymously online. The study was conducted on a heterogeneous population of patients with chronic obstructive respiratory disease (200 survey responses) who were attending the outpatient pneumology clinic "La Madonnina" based in Reggio Calabria, Italy from May 2021 until May 2022. The survey included ten multiple-choice questions with a single answer allowed and in some questions also the possibility of writing comments, carried out through the Survey Monkey digital platform. The objectives of the study are: 1. To identify the prevalence of symptoms perceived by patients with chronic obstructive pulmonary disease (COPD and asthma), 2. The role of the Respiratory Medicine Specialist and General Practitioner in the management of these diseases. 3. The emerging figure of self-management of these diseases is indirectly indicative of a high degree of depression in the population with these diseases, which is still poorly known and addressed by Italian general practitioners. The extrapolated data from the online survey, indicate that there is to date a prevalence of Asthma versus COPD, confirming that the prevalent common symptom is dyspnea, also clarifies that the management of the diagnostic and therapeutic pathway of chronic respiratory diseases is of specialist relevance; the prescribed therapies act mainly on the symptom dyspnea (25.36%).

Role of a novel nutraceutical composition for irritable bowel syndrome management: symptoms relief and unexpected triglycerides-lowering effect

Background: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and an irregular bowel habit. The prevalence is up to 20% in Western adults, which makes IBS the most common diagnosis in gastroenterology. Despite extensive interest and investigation, IBS's precise aetiology and pathophysiology are poorly understood. Current knowledge suggests that an altered gut microbiota, altered motility, visceral hyperalgesia, and dysregulation of the brain-gut axis are central to IBS. This is also significantly related to a higher prevalence of metabolic syndrome and elevated triglycerides among the adult population. This retrospective study examines the effect of a novel nutraceutical compound, Triobiotix, on gastrointestinal symptoms in IBS patients. Effects on lipid profiles have also been recorded. Objectives: The focus of this study is to evaluate the effectiveness of Triobiotix, a nutraceutical compound composed of prebiotics and probiotics. Methods:Triobiotix is a nutraceutical consisting of Maltodextrin; mineralized extract of Lithothamnion (Lithothamnion calcareum (Pallas) Areschoug, thallus dry extract); Bioecolians® gluco-oligosaccharides; Ferment mix (corn starch, Bifidobacterium animalis ssp. Lactis BLC1 (DSM 17741), Lactobacillus acidophilus LA3 (DSM 17742), Lactobacillus rhamnosus IMC 501 (DSM 16104), Lactobacillus paracasei Streptococcus 501 IMC102 SP4 (DSM 19385); short-chain fructo-oligosaccharides powder. The database of 40 Italian General Practitioners (GPs) was analyzed. A total of 587 patients with IBS treated with Triobiotix were identified. Among them, 535/587 (91.1%) completed the first (T0) and second (T1) visits and their data were available. The primary endpoint of this analysis was to assess if Triobiotix, at a dosage of 1 sachet per day for 30 days, could reduce abdominal pain and bloating, thus resulting in a lower intensity of the main gastrointestinal symptoms. Secondary endpoints were to evaluate presence of any significant changes in triglycerides blood levels and glycaemia.Results: Treatment with this nutraceutical for one month resulted in a reduction in the frequency and intensity of bloating, abdominal pain, flatulence, and tenesmus. In the 85 patients who reported evacuative urgency, the frequency of the episodes didn’t significantly change while their intensity was statistically reduced. Unexpectedly, triglyceride levels also significantly decreased.Conclusions:Our analysis demonstrates this formulation is effective in the relief of the main symptoms associated with IBS. Moreover, an unexpected effect of this combination of micronutrients on tryglicerides, beyond IBS symptoms, was also found. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect.Keywords: Irritable bowel disease; Triglyceridemia; Nutraceuticals

682 UNEXPECTED TRIGLYCERIDES-LOWERING EFFECT OF A NOVEL NUTRACEUTICAL COMPOUND FOR IBS

Abstract Background In the last few years the role of gut microbiome in human health has been reported. Growing evidence indicate that it is linked to intestinatal diseases, such as the irritable bowel syndrome (IBS), and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. The severity of psychological and gastrointestinal symptoms in IBS has been linked with a distinct intestinal microbiota signature. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have bee also recorded. Methods Triobiotix is a nutraceutical consisting of: Maltodextrin; mineralized extract of Lithothamnion (Lithothamnion calcareum (Pallas) Areschoug, thallus dry extract); Bioecolians® gluco-oligosaccharides; Ferment mix (corn starch, Bifidobacterium animalis ssp. Lactis BLC1 (DSM 17741), Lactobacillus acidophilus LA3 (DSM 17742), Lactobacillus rhamnosus IMC 501 (DSM 16104), Lactobacillus paracasei Streptococc5 501 IMC102 SP4 (DSM 19385); short-chain fructo-oligosaccharides powder. The database of 40 Italian General Practitioners (GPs) were analyzed. At total of 587 patients with IBS and on Triobiotix were identified. Of these in only 535, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia. Results Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the T0 evaluation. Triglycerides levels were also significantly decreased (186.37±66.4 vs. 176.13±67.9; p < 0.05). Conclusions Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL-C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low-moderate dyslipidaemia.

Primary care management strategies and COVID-19 related hospitalization: a population-based study

Abstract Background Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care. In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce. This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management. Methods This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote monitoring), patients’ socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression. Results 46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home. Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80 and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of determinants showed that GPs’ patient load, setting, age, and sex were significantly associated with management strategies. Conclusions Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed. Key messages • Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19. • Primary and hospital care integration can be effective for COVID-19 management.

Translational Gap between Guidelines and Clinical Medicine: The Viewpoint of Italian General Practitioners in the Management of IBS.

Irritable bowel syndrome (IBS) guidelines are generally developed by experts, with the possibility of a translational gap in clinical medicine. The aim of our study was to assess an Italian group of general practitioners (GPs) for their awareness and use of criteria for the diagnosis and management of IBS. For this purpose, a survey was carried out involving 235 GPs, divided into two groups according to their years of activity: 65 “junior general practitioners” (JGPs) (≤10 years) and 170 “senior general practitioners” (SGPs) (>10 years). JGPs were more familiar with the Rome IV Criteria and Bristol Scale than SGPs. Abdominal pain, bowel movement frequency and bloating were the symptoms most frequently used to make a diagnosis. The most probable causes of IBS were reported to be abnormal gastrointestinal motility and psychological triggers. SGPs reported more frequently than JGPs that challenging management and patient’s request were motivations for a gastroenterological consultation. The practice of clinical medicine is still far from the guidelines provided by the specialists. Abdominal pain related to defecation and changes in bowel frequency are considered to be the more important symptoms for IBS diagnosis, but most GPs, both JGPs and SGPs, like to consider abdominal bloating as another useful symptom. Involving both gastroenterologists and GPs in developing shared guidelines would be highly desirable in order to improve IBS management strategies in everyday clinical practice.

Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study.

A major problem of the primary healthcare system is the deficiency in performance quality. From the second half of the 20th century, many countries introduced pay for performance reimbursement schemes to encourage practitioner behaviour to align with specific objectives of decision-makers and to incentivise the provision of targeted services. The study of Krauth etal. (2016) provides key evidence from a European country, determining whether German general practitioners would participate in a pay for performance programme and under what conditions. Our research replicates this survey, adjusting it to the Italian context. We assessed the attitudes of Italian general practitioners towards the current remuneration scheme and analysed how such views varied among respondents. Results showed that the current remuneration scheme for Italian general practitioners does not seem to be proportional to the efforts given for the provision of care and does not provide appropriate incentives to supply high-quality healthcare. Most of respondents supported the introduction of a pay for performance remuneration system, although perceived potential obstacles. We conclude that for a successful implementation of a quality-based compensation scheme, GPs should be involved. Such participation would help better identify perceived obstacles and overcome them.

Appreciation by migrants of the health care assistance provided by apulian family doctors

Introduction: Health promotion is the highest level of human sensitivity directed to break down differences and produce equal opportunities for unselected people to enjoy the best health care potential. This study aimed to evaluate the quality of the assistance provided to immigrants by Italian general practitioners (GPs), the level of satisfaction declared by migrants, and the perception of GPs about the needs of migrants. Methods: A survey was conducted. Both immigrant patients (regular and illegal) and some Italian GPs filled a questionnaire. Ten GPs were selected among those available to perform the study by a convenience sampling method; the immigrants were consecutively included among those attending the medical offices. Results: Over 90% (n = 66) of immigrants declared to be fully satisfied with the overall assistance provided with easy access to care. GPs declared no problems in assisting even illegal immigrants and suggested the accurate evaluation of patients’ needs to provide successful care. Conclusions: These findings indicate the importance of promoting health and education as provided by Italian GPs. The satisfaction declared by the interviewed immigrants is mainly attributable to the model of assistance provided in Apulia, which includes interventions for any health problem.

The Management of Irritable Bowel Syndrome: The Viewpoint of Italian General Practitioners in Activity and in Training

Background: Guidelines on Irritable Bowel Syndrome (IBS) are usually developed by specialists, with a possible translational gap in primary care. Aims: To evaluate the knowledge of IBS of Italian General Practitioners (GPs) and the difference compared to doctors in Training for General Practice (ITGPs). Methods: A questionnaire was completed by 170 GPs and 64 ITGPs. Results: The Rome Criteria and Bristol Scale are more familiar to ITGPs than GPs. The most frequently used diagnostic symptoms are abdominal pain, bowel movement frequency and bloating. GPs and ITGPs think that bloating and abdominal discomfort should be introduced into the definition of IBS. Intestinal motility disorders and psychological factors are considered to be the most probable cause of IBS. GPs report more frequently than ITGPs that the patient's request and difficulties in managing the disorder are reasons for a gastroenterological referral. Conclusions: There is still a gap between the indications provided by the experts and clinical practice, and this seems greater on the part of GPs than ITGPs. Abdominal pain and bowel frequency changes are considered the main symptoms for diagnosing IBS, but most GPs and ITGPs would like to include bloating among the diagnostic criteria. It would be highly desirable to develop commonly shared guidelines between gastroenterologists and GPs.

Household disinfectant exposure during the COVID-19 pandemic: a retrospective study of the data from an Italian poison control center.

Since the beginning of the COVID-19 pandemic it has been recommended that chemical disinfectants are used to protect surfaces. This study aimed to determine whether the number of exposure calls related to household disinfectants (HD) received between January 30, 2020 to May 18, 2020 varied from the same time period in the previous year. A retrospective review of the poison control center database from the Fondazione Universitario Policlinico Agostino Gemelli IRCCS, Rome, Italy, was conducted. Calls from Italian citizens, hospitals, and general practitioners received during the same time period in 2019 and 2020 were compared. The center received 1972 exposure calls during the study period. A 5% increase in calls regarding exposure to HDs was noted from 2019 to 2020 (9.8% to 15.2%, p<0.001). The majority of enquiries regarded bleach-containing products, hand sanitizers, ethanol, and hydrogen peroxide. Most calls were received from patients in their homes (n, 259; prevalence, 86%; increase, 107%) and concerned accidental exposure (n, 280; prevalence, 93%; increase, 76%), while cases of intentional exposure decreased (n, 14; prevalence, 5%; decrease, 33%). The main route of exposure was ingestion (n, 170; prevalence, 57%; increase, 45%), but the highest increase was observed in inhalation cases (n, 82; prevalence, 27%; increase, 122%). As the incidence of enquiries regarding products that can represent an important health hazard, when improperly used, increased in 2020 suggests that the COVID-19 public health messaging on the proper use of HDs should be improved.

Construction of a Frailty Indicator with Partially Ordered Sets: A Multiple-Outcome Proposal Based on Administrative Healthcare Data

Given the progressive aging of Italian and European populations, the number of cases with chronic diseases is steeply increasing. This calls for new strategies for health resource management and the implementation of prevention policies. Among chronic patients, frail subjects have special and wider care requirements, along with an increased risk of adverse health outcomes. Thus, their identification is an important step for the Italian National Program for Chronic Diseases. This study aims at constructing an indicator that measures the frailty level of individuals in the population aged over 65 y using administrative healthcare data-flows of the Piedmont region. Following the multidimensional nature of frailty, we adopted a multiple-outcome approach in our proposal. This was done by considering the capacity to predict six unfavorable outcomes: death, urgent unplanned hospitalization, access to the emergency room with red code, avoidable hospitalization, hip fracture, and disability. We identified a parsimonious set of seven explanatory variables that can simultaneously predict the six outcomes we considered. We then assembled them into a unique frailty indicator through the use of a partially ordered set (poset) theory. Our indicator performed well with respect to all the outcomes and was able to describe several individual characteristics that are not directly considered in the computation of the indicator. Thanks to its parsimony and to the use of administrative healthcare data, our indicator allows all the stakeholders involved in the healthcare process, such as Italian Local Health Units, general practitioners, and regional managers, to use it to target frail individuals with better comprehensive healthcare actions.

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency.

During the COronaVIrus Disease 2019 (COVID-19) pandemic in Italy, general practitioners (GPs) are ensuring continued access to primary care for citizens while also absorbing more of the impact of the crisis than most professional groups. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian GPs during the COVID-19 emergency. A group of 102 GPs completed self-administered questionnaires available online through Google Forms, including Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and Coping Inventory for Stressful Situations (CISS). Cluster analysis highlighted four distinct burnout risk profiles: Low Burnout, Medium Risk, High Risk, and High Burnout. The High Burnout group showed both lower Resilience and lower CISS Task-oriented coping strategy than the Medium Risk group and higher IU Prospective than the Low Burnout group. Results of a linear regression analysis confirmed that CISS Emotion-oriented style positively predicted MBI Emotional Exhaustion, CISS Task-oriented and Emotion-oriented emerged as significant predictors (negatively and positively, respectively) of MBI Depersonalization, and Resilience positively predicted MBI Personal Accomplishment. In conclusion, the results showed that the COVID-19 emergency had a significant impact on GPs’ work management. Implementing task-oriented problem management, rather than emotional strategies, appears to protect against burnout in these circumstances. It is possible that the emotions related to the pandemic are too intense to be regulated and used productively to manage the professional issues that the COVID-19 pandemic presents.

Inside the doctor's office. Talking about intersex with Italian health professionals

This article explores how health professionals in Italy understand variations of sex characteristics (VSC), also referred to as intersex and/or disorders of sex development (DSD). With estimates of VSC frequency ranging from 0.018% to 1.7%, only a handful of highly specialised medical doctors are considered DSD experts. When addressing the daily health management of children and families who do not live near specialist DSD centres, these experts may refer individuals to the nearest health professional that Italian health services provides, opening up questions regarding how these professionals might act and react when faced with VSC. In this analysis of interview data from 65 Italian general practitioners, paediatricians and psychologists, we address two themes. The first theme discusses participants’ previous experiences and case management, with a focus on social, medical and gender biases. The second theme examines health professionals’ opinions and perspectives on ongoing conflicts concerning current best care practices. Our results highlight health professionals’ cultural and gendered biases, confirming the need to develop specific professional training, guidelines and policies to improve the healthcare of people with VSC.