Primary Health Care Physicians Research Articles

The world noncommunicable disease federation’s international certification course of primary health-care physician in noncommunicable diseases: Key to strengthen primary health-care interventions in noncommunicable diseases

The world noncommunicable disease federation’s international certification course of primary health-care physician in noncommunicable diseases: Key to strengthen primary health-care interventions in noncommunicable diseases

Rosacea Meibomian Gland Dysfunction Posterior Blepharitis May Be a Marker for Earlier Associated Dyslipidaemia and Inflammation Detection and Treatment with Statins.

Posterior blepharitis and dry eye are common disorders with meibomian gland dysfunction (MGD), a principal driver of their pathophysiology. Meibomian gland dysfunction is increasingly prevalent in older populations with contributory hormonal imbalances. The abnormal meibum in MGD has been documented to have an excess of cholesterol with a resultant disruption of the lipid layer of the tear film. This leads to tear film instability due to the inadequate trapping of the aqueous portion of the tear film with resultant evaporative dry eye. Significant morbidity may follow MGD with ocular surface inflammation disrupting both social and work function. Rosacea is a common chronic inflammatory condition of the central face but can have ocular and systemic inflammatory associations. It is especially prevalent in North European populations and can have onset at any age, but commonly presents between thirty and fifty years of age. In ocular rosacea, MGD is a recognised manifestation as is dyslipidaemia. Ocular rosacea can predate cutaneous disease. As yet, there is no directly reported evidence of the efficacy of the early identification and treatment of ocular rosacea with associated dyslipidaemia and systemic inflammation. We posit that MGD in ocular rosacea sufferers may be a marker for dysregulated cholesterol synthesis and inflammation, and that statins maybe a potential therapy. This article introduces potential strategies to utilise ocular rosacea MGD as a possible marker for ophthalmologists, cardiologists, and primary healthcare physicians to treat rosacea-associated dyslipidaemia and systemic inflammation. This could aid in overall cardiovascular morbidity and mortality control for rosacea sufferers, potentially at an earlier age, while also addressing their tear film de-stabilisation through cholesterol lowering and inflammation reduction.

First-time traumatic anterior shoulder dislocation: Approach for the primary health care physician.

Traumatic anterior shoulder dislocation is a very common injury encountered in emergency rooms as well as in the primary health care physician's office. This injury occurs either in the setting of competitive or recreational sports injuries or as a high-energy injury during a fall or a road traffic accident. Common complications such as a recurrent dislocation can be predicted, monitored and prevented. Early appropriate treatment of associated cuff tears or fractures is associated with improved outcomes. There is a plethora of literature on the assessment and management of the primary anterior shoulder dislocation in specialised fields such as sports medicine, orthopaedic surgery and shoulder surgery. These studies are often highly technical, addressed to a particular subset of readers and often deal with one aspect of the management of the injury. This narrative aims to provide the reader with a simplified, evidence-based assessment and management approach for the first-time acute anterior shoulder dislocation. Emphasis is on closed reduction techniques, position and duration of immobilisation, and return to activities of life or sports. Risk factors for recurrence and other indications for primary referral to the orthopaedic surgeon are discussed. Other forms of shoulder instability such as posterior shoulder dislocation, inferior dislocation and multidirectional instability will not be the focus of this narrative.

FAMILY PHYSICIANS’ MOTIVATION PROCESS TOWARD THE DIAGNOSIS AND MANAGEMENT OF DEPRESSION

Depression is a widespread disease and remarks a difficult clinical challenge for primary health care providers or physicians. Primary health care providers, namely Family Physicians (FPs), are crucial in recognizing and managing depression process. The study employed a cross-sectional survey of FPs’ attitudes toward diagnosis and management, asking about their perceptions of their patient depression process. Data for the study was gathered from the FPs who were Facebook group members. 229 out of 550 FPs answered the survey questions. Statistical analysis was conducted using SPSS 24th edition. The study examined whether FPs made a significant difference between gender and years of experience in the profession. A questionnaire comprising items on a 9-point Likert scale was used to capture the perceptions and the data was analyzed using descriptive statistics and t-tests. Analysis of variance (ANOVA) was further employed to examine if the critical factors were perceived differently by FPs’ experience years. The study findings presented that gender did not make a statistically significant difference. There was a significant difference between the 6-10 years of experience group of FPs, the 16-20 years of experience group, and the 21+ years group. The study showed that FPs were undecided in diagnosing and treating depressed patients. The study displayed that FPs' getting to know their patients better facilitates the diagnosis and treatment of depression. However, the study indicated that family physicians were indecisive in the depressed patients' diagnosis and treatment. It can be concluded that the success of depression processes requires the cooperation of FPs and psychiatrists. These findings suggest that healthcare policymakers should consider FPs' strategies for managing depression in the improvement of mental health services.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0015/a.php" alt="Hit counter" /></p>

Central venous pressure line insertion for the primary health care physician

Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.

Allergic rhinitis guidelines knowledge, attitudes, and practices among primary health care physicians: A national multicentre cross-sectional study.

Allergic rhinitis (AR) is considered one of the most common reasons for patients visiting primary health care clinics. Physicians' adherence to management guidelines for AR results in better patient outcomes. Therefore, the present study aimed to assess the knowledge, attitudes, and practices of primary health care practitioners (PHCPs) towards allergic rhinitis guidelines in Saudi Arabia. This observational cross-sectional study conducted from August 2021 to November 2021 included 282 primary care physicians across all regions of Saudi Arabia. We used a two-part, validated, self-administered Perception Attitude and Practice of Primary Care Practitioners questionnaire. The first part was demographics, and the second part comprised three domains (perception, attitude, and practice) including 48 items. Statistical Package for the Social Sciences (SPSS), version 21 was used to analyze the data. Most of the 282 physicians were Saudis (79%). Allergic rhinitis and its impact on asthma (ARIA) guidelines were recognized by 71% of the physicians. Second-generation oral antihistamines were considered the safest drug by the majority (82%), followed by intranasal corticosteroids (75.2%). Most physicians diagnosed AR based on clinical history (95%), while (43%) utilized allergy testing. Intranasal corticosteroids were the most preferred treatment option (70%) followed by second-generation and first-generation oral antihistamines (66% and 55%, respectively). Our study demonstrates the importance of education and awareness for PHCPs managing AR. ARIA guidelines should be implemented as a standard of care for AR, as PHCPs are the first ones to encounter patients with AR, to improve outcomes and avoid undertreatment and complications.

Accuracy of Dengue, Chikungunya, and Zika diagnoses by primary healthcare physicians in Tegucigalpa, Honduras

BackgroundDengue, Chikungunya, and Zika are co-endemic in Honduras and are often misdiagnosed due to similar clinical and epidemiological behavior. Most arboviral infections reported in primary care are based on clinical diagnoses without laboratory confirmation. Therefore, the accuracy of physicians’ diagnoses and the factors that affect them needs to be evaluated.MethodsA cross-sectional study with convenience sampling at primary healthcare centers was conducted from June to September 2016 and 2017. Clinical data and dried blood spots on Whatman 903 filter paper from 415 arboviral cases and 248 non-arboviral febrile cases were collected. Viral RNA was extracted from a 6-mm DBS paper disc and confirmed by RT-qPCR and sequencing.ResultsOnly 30.84% of diagnostic accuracy was observed in physicians in primary care when comparing arboviral clinical diagnosis with RT-qPCR detection. Moreover, in Dengue and Zika clinical cases, only 8.23% and 27.08% were RT-qPCR confirmed, respectively. No Chikungunya cases were confirmed. In 2017, 20.96% of febrile cases were RT-qPCR confirmed arboviral infections. The symptoms of 45.5% of arboviral cases can fit more than one case definition for arboviruses. The “symptom compliance” and “patient with suspected close contact” were the criteria most utilized by physicians for arboviral diagnosis. The pattern of the epidemiological curves of the arboviral clinical cases didn’t match the one of the RT-qPCR confirmed cases.ConclusionsLow diagnostic accuracy for overall and individual arboviral infections was observed in physicians. Unspecific symptomatology, overlapping case definitions, and reported close contact to an arboviral patient might contribute to misdiagnosis. Without laboratory confirmation, surveillance data may not reflect the real behavior of these diseases and could impact health interventions.

Physical Activity among Primary Health Care Physicians and Its Impact on Counseling Practices

Introduction: Physical inactivity has been linked to various noncommunicable diseases and their related health problems. As primary health care physicians (PHCPs) play a crucial role in promoting health and preventing disease, this study aims to determine the extent of physical inactivity among PHCPs and its impact on their counseling practices. Methods: A cross-sectional study was conducted across all primary health care centers in Qatar, targeting 511 physicians. A modified self-administered WHO stepwise tool was used to measure physical activity (PA) with another questionnaire to assess the counseling practices among PHCPs. Results: Out of 511 physicians, 306 (59.9%) responded to the survey. The majority of the participants were male (58.1%) with an average age of 45.8 ± 7.9 years. The majority of PHCPs were from the UK (44.3%), while only 4.1% were Qatari. Family physician consultants made up 51% of the respondents, while 30.2% were general practitioners, and the average years of experience were 14 ± 8.3 years. Only 39.5% of the respondents met the WHO PA recommendations. 50.5% of the physicians were overweight, and 23.1% were obese. The median percentage of patients counseled about PA was only 60 [IQR: 40–80]%, and there was no link found between a physician’s PA level and the percentage of patients they counseled on the subject. Conclusion: Physicians reported a high prevalence of physical inactivity. Furthermore, the practice of counseling the public on PA was low. Interventions are needed inside and outside the workplace to improve the PA among PHCPs and their counseling practices.

Various Factors in Pediatric to Severe Dengue Infection-A Retrospective Study

Introduction: Dengue epidemics are known to have occurred over the last three centuries in tropical, subtropical and temperate areas of the world. The World Health Organization (WHO) estimated that approximately 2.5 billion people living in dengue-endemic countries. Objective: To assess the various factors in pediatric to severe dengue infection-A Retrospective study. Methods: A hospital-based Retrospective study was conducted at Emergency, Observation and Referral Unit, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh from January to June 2021. Number of patients included in the study was 52. In children with high degree clinical suspicion of Dengue infection NS 1 antigen (who came within first 48 hours of fever) and/or Dengue Antibody IgM, IgG (who came after five days of fever) were performed. Results: The study was enrolled 102 patients of suspected dengue fever of whom 52 (50.98%) were serologically confirmed to have dengue infection. 29 (55.8%) patients were males and 23 (44.2%) were females. 38 (37.25%) patients had classic dengue fever while 12 (11.76%) fulfilled the criteria of dengue hemorrhagic fever. Of those patients with dengue hemorrhagic fever, 6 patients had developed dengue shock syndrome. Most of dengue cases occurred during the month of June to September depicts the role of rainy season on clustering of cases. Maximum number of cases 52 cases (68.49%) was in the children age groups. All cases and is the most common symptom followed by headache, myalgia, vomiting etc. Hemorrhagic manifestations were seen that included petechiae, ecchymosis, gum bleeding, hematuria, malena, hematemesis and epistaxis. Most common complications were hepatic dysfunction, renal failure, multi organ failure, encephalopathy and ARDS. Conclusion: Dengue is one amongst the key causes of dedifferentiated fever. It presents as an extremely broad wellness and is hardly recognized as a clinical entity by primary health care physicians. This study support additional studies on applying intervention measures to boost the diagnostic accuracy and exactness at the first tending level in dandy fever endemic regions.

Study of the problems of ageism and assessment of attitudes towards age in the medical environment

BACKGROUND: Ageism pervades all areas of life, including the areas of medical and social care. Gerontological ageism has a significant negative impact on indicators of physical, mental health, functional status and well-being of older people. In the conditions of an aging society, the study of the scale and characteristics of this problem in various spheres of life is very relevant.
 AIM: To assess the prevalence of stereotypes of attitudes towards older age among primary health care physicians, senior students of a medical university and directly elderly people.
 MATERIALS AND METHODS: In the period from 2018 to 2022, 538 people aged 20 to 75 were interviewed in 3 subgroups: 1) senior students of a medical university of medical specialties, 2) young and middle-aged primary health care doctors, 3) elderly people.
 RESULTS: It was revealed that the opinions about the problems in this age period in the elderly and the beliefs of doctors and medical students often do not coincide.
 CONCLUSIONS: When training medical personnel, it is necessary to form the correct attitude to age and skills of communicative competence with different age groups of patients.

Lifestyle Assessment of Primary Healthcare Physicians in Taif, Saudi Arabia in the Year 2022.

Objective This study aims to evaluate primary healthcare physicians' lifestyles to promote their well-being and improve care quality for the general population. Methods This cross-sectional quantitative study was conducted on primary healthcare physicians in Taif, Kingdom of Saudi Arabia (KSA), using self-administered questionnaires. Results We included 206 participants aged 26-66. Most participants were 35 years old or younger (67%), male (62.1%), and residents (52.4%). Of all participants, 49.5% held a Bachelor's degree, 40.8% had completed their board certificate or Ph.D., and 69.9% had at least 10 years of experience. Of all participants, 16.5% and less than 9% reported having hypercholesterolemia and other comorbidities, respectively. More than 50% were physically inactive, 26.2% were moderately inactive, and 17.4% were moderately active or active individuals. Physical activity was significantly associated with job titles (p < 0.018). The qualification was associated with dietary score (p = 0.034), and 42.7% of participants were in need of diet change. About a quarter (25.2%) were smokers, and 92.3% of them smoked daily. Male participants were associated with a greater likelihood of smoking (p < 0.001). Overall, 41.7% were overweight, and 25.7% were obese. Increased BMI was associated with older age and male gender (p < 0.001 and p < 0.002, respectively), as well as the title of the physician and years of experience (p < 0.001 and p < 0.002, respectively). Conclusion Participants' unhealthy lifestyles indicate the need to establish measures to promote healthy lifestyles among physicians.

Intimate Partner Violence; Are Saudi Physicians in Primary Health Care Setting Ready to Identify, Screening, and Respond?

Intimate partner violence (IPV) is a growing hot topic in Saudi Arabia and primary health care (PHC) physicians play a significant role in preventing it. Our objective was to assess the PHC Physicians' readiness and barriers to identify, screen, and respond to IPV in Saudi Arabia. A cross-sectional study recruited physicians working in PHC centers in Saudi Arabia. Data was collected using a modified online self-administered questionnaire based on the PREMIS "The Physician Readiness to Identify and Manage IPV." The questionnaire consisted of respondent profile, perceived preparedness and knowledge, actual knowledge, practice issues, and opinion regarding barriers. Among 169 PHC physicians, 60.9% had never experienced any formal IPV training. Around one-fifth of participants have a good perceived and actual knowledge, whereas one-third have a good perceived preparedness. Nearly half of the participants (46.7%) do not screen for IPV and two-thirds of them (66.3%) have never identified an IPV case during the previous 6 months. The logistic regression model showed that family physicians were 2.27 times more likely to have a good knowledge than a general practitioner, and participants with IPV training were more likely to have a good level of perceived preparedness, perceived knowledge, and more likely to perform screening of IPV. The low level of PHC physicians' readiness to identify and respond to IPV is worrisome. Findings emphasize the urgent need for an IPV training program, a supportive work environment, and a clear referral system in order to help the practitioner to provide comprehensive services and ensure safety plans for abused women.

119 Usability and acceptability of an assistive technology WebAPP for the management of older adults’ functional disabilities in activities of daily living: Primary care physicians’ perspective

OBJECTIVES/GOALS: Assistive technology (AT) can improve older adults’ function in daily activities. However, Latinos are among the least likely to use AT. Given that primary health care physicians (PCPs) have low awareness about AT, this study aims to evaluate the usability and acceptability of an AT WebAPP among PCPs to increase older Latinos’ access to AT. METHODS/STUDY POPULATION: A team of an established researcher, a sub-graduate faculty and student, and a graduate student will recruit ten PCPs in Puerto Rico and will interview them to explore their current practice in addressing the functional needs of older Spanish-speaking Latinos. The researchers will then train PCPs in the use of a Spanish evidence-based AT WebAPP developed in one of our earlier studies. PCP participants will use the APP with their older patients for 30 days. At the end of the usage period, the analysis will include a mixed method design, consisting of the simultaneous collection of quantitative data using a validated scale followed by qualitative data through individual interviews. Quantitative data will be analyzed with descriptive statistics and qualitative data with thematic content analysis. RESULTS/ANTICIPATED RESULTS: We expect that the AT WebAPP will be rated as particularly useful and acceptable by the PCPs to increase older Latinos’ access to information about AT that could compensate for their physical function disabilities. We also expect that PCPs will offer recommendations for enhancing the design and usability of the AT WebAPP. DISCUSSION/SIGNIFICANCE: Studying the usability and acceptability of this AT WebAPP among PCPs will advance our understanding of its feasibility in enhancing PCPs AT knowledge and recommendations of AT devices for older adults with disabilities in Puerto Rico and in Latino communities in the continental United States.

Evaluation of a modernized supported housing intervention for individuals who experience severe and persistent mental illness in Ontario, Canada.

Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services. This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. INTRODUCTION: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Using health care administrative databases, a pre-post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. The results suggest that a supported housing model may be associated with increased usage of outpatient person-centred health services in people experiencing SPMI. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals.

Intraosseous line insertion for the primary health care physician

Early rapid access to the vascular system is essential in emergencies and is lifesaving. In this article, we will provide information on the common sites used, the equipment that is required, the indications and contraindications for intraosseous line insertion, how to correctly and safely do the procedure, medication that can be administered, post insertion line management and possible complications. This is a lifesaving procedure and primary healthcare physicians should acquire this skill.

Primary Care Physician's Perception and Satisfaction With Telehealth in the National Guard Primary Healthcare Centers in Jeddah, Saudi Arabia in 2022.

Background Telehealth is a tool to facilitate the connection between patients and their healthcare providers. With the recent emergence of telehealth, implementation of this service in primary healthcare centers (PHCs) has been accompanied by specific challenges despite the high levels of satisfaction reported. This study aimed to assess the factors that affect clinicians' perceptions and satisfaction with telehealth in National Guard PHCs to help explore and overcome any barriers and challenges. Methods A cross-sectional survey was distributed among primary healthcare physicians using virtual clinics in the National Guard PHCs in Jeddah, Saudi Arabia, in 2022. A validated questionnaire from previous literature was used to evaluate clinicians' perceptions and satisfaction with telehealth. Results The study included 53 primary healthcare physicians, with an overall response rate of 90%. Most physicians (77%) were satisfied with their overall experience with offering virtual visits. Nevertheless, 72% of physicians perceived patients' limited technical knowledge, and 70% considered limited access to technology a significant barrier against virtual visits. Higher satisfaction levels were significantly associated with those who did not consider the lack of integration of virtual visits with current workflow or electronic medical records (EMRs) a significant barrier to conducting virtual visits (p-value =0.005). Conclusion Despite the undeniable advantages of telehealth, barriers, and challenges remain extant and can influence clinicians' satisfaction. Continuous monitoring for improvements is needed to enhance the telehealth experience.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study.

Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion. A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL. Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = -0.027, 95% CI = -0.079 to -0.003) and frequency of eating breakfast (β = -0.041, 95%CI = -0.079 to -0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL. These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Eliciting primary healthcare physicians’ preferences for job characteristics in rural China: a discrete choice experiment

IntroductionThe outflow and scarcity of physicians in rural areas can adversely affect universal health coverage and population health outcomes, which are critical concerns in China. This study explored primary healthcare...

Knowledge, Attitude, and Practice Regarding Fibromyalgia Among Primary Care Physicians in Tabuk, Saudi Arabia.

Adequately informed family physicians have the greatest potential to correctly identify the diagnosis of fibromyalgia (FM) and develop an initial treatment plan. Therefore, it is substantial to determine the levels of weakness and inaccuracy among primary care physicians regarding FM diagnostic criteria and management strategies. This study aimed to assess the knowledge, attitude, and practices regarding FM among primary care physicians in Tabuk, Saudi Arabia. This cross-sectional study included family physicians who were board-certified or registered in the family medicine training program and working at the government family healthcare centers in Tabuk. A pre-designed, structured questionnaire was distributed either in written form or as an online survey. This study included 52 primary healthcare physicians. Twenty-two (42.3%) participants incorrectly recorded localized pain as a diagnostic symptom, and 45 (86.5%) incorrectly recorded nonsteroidal anti-inflammatory drugs (NSAIDs), prednisolone, and/or opioids as drugs that are used for treating FM. Only 59.6% were confident in recognizing the symptoms of FM, and 55.8% were confident in differentiating FM from other similar diseases. The primary healthcare physicians working in the government's primary healthcare centers in Tabuk City, Saudi Arabia, have low levels of knowledge about diagnostic criteria and treatment strategies for FM. These findings highlight the need for continuous professional development involving family physicians in the primary healthcare setting with suitable continuous medical education (CME) programs concerning FM.

Guidelines on atopic dermatitis for Mexico (GUIDAMEX): using the ADAPTE methodology

With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.