Risultati per: L’educazione alimentare nel setting della medicina generale: niente è più come prima

Sip, ‘è indispensabile per contrastare l’ondata di malattie croniche’

Circulation, Ahead of Print. BACKGROUND:Plasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) is commonly used to diagnose heart failure with preserved ejection fraction (HFpEF), but its diagnostic performance in the ambulatory/outpatient setting is unknown because previous studies lacked objective reference standards.METHODS:Among patients with chronic dyspnea, diagnosis of HFpEF or noncardiac dyspnea was determined conclusively by exercise catheterization in a derivation cohort (n=414), multicenter validation cohort 1 (n=560), validation cohort 2 (n=207), and a nonobese Japanese validation cohort 3 (n=77). Optimal NT-proBNP cut points for HFpEF rule out (optimizing sensitivity) and rule in (optimizing specificity) were derived and tested, stratified by obesity and atrial fibrillation. Derived cut points were tested in 3 additional validation cohorts (cohorts 4–6) in whom HFpEF was diagnosed by resting catheterization only (n=260), previous hospitalization for heart failure (n=447), or exercise echocardiography (n=517), respectively.RESULTS:Current recommended rule-out NT-proBNP threshold

Bartoletti,attenzione a sottobosco professionisti ‘improvvisati’

Società Italiana Nutrizione Umana, obiettivi più sani per 60%

Introduction
Dementia is one of the most relevant widespread diseases, with a prevalence of currently 55 million people with dementia worldwide. However, about 60–75% of people with dementia have not yet received a formal diagnosis. Asymptomatic screening of cognitive impairments using neuropsychiatric tests has been proven to efficiently enhance diagnosis rates. Digital screening tools, in particular, provide the advantage of being accessible without spatial or time restrictions. The study aims to validate a digital cognitive screening test (digiDEM-SCREEN) as an app in the German language.

Methods and analysis
This is a multicentre study in Bavaria. Participants are people with mild cognitive impairment, people with dementia in an early stage and cognitively healthy people. Recruitment will take place in specialised diagnostic facilities (memory outpatient clinics). 135 participants are aimed based on a power analysis. Sociodemographic data, diagnosis and results of neuropsychiatric tests (Consortium to Establish a Registry for Alzheimer’s Disease, Montreal Cognitive Assessment, digiDEM-SCREEN) will be collected at one point per person via electronic data capturing. The sensitivity, specificity and corresponding cut-off values will be determined based on receiver-operating-characteristic curves. The correlation of the digiDEM-SCREEN test with existing cognitive screening/testing procedures will be analysed.

Ethics and dissemination
The study obtained ethical approval from the Ethics Committee of the Julius-Maximilians-Universität of Würzburg (JMU) (application number: 177/23-sc). The test will give feedback about the current cognitive status and possible cognitive impairments that should lead to the users seeking further diagnostic measures by medical professionals. It will be accessible free of charge in established app stores. The results of the validation study will be published in peer-reviewed journals.

Dall’anno accademico 2025/26, esclusivamente in lingua inglese

To the Editor In their article, Mr Romero and colleagues discussed the consequences of recent Supreme Court decisions on the possession of firearms, especially the possibility that declaring hospitals a firearm-free domain breaches Second Amendment rights. If that is true, then it applies to hospital staff as well as patients and their relatives. How will patients feel about their physician having an AR-15 on their desk during an examination?

In Reply In September 2024, a US appeals court struck down California’s prohibition on firearms in health care settings, citing the Supreme Court’s new requirement that modern gun laws be evaluated based on whether they are consistent with historical tradition rather than their ability to address the threat and reality of gun violence. Under this “originalist” approach, whether hospitals qualify as “sensitive places” where guns can be prohibited turns on whether judges believe hospitals to be sufficiently similar to places where guns have historically been prohibited.

Introduction
Mental health problems are the most significant cause of disability and have high annual economic costs; hence, they are a priority for the government, service providers and policymakers. Consisting of largely coastal and rural communities, the populations of Norfolk and Suffolk, UK, have elevated burdens of mental health problems, areas with high levels of deprivation and an increasing migrant population. However, these communities are underserved by research and areas with the greatest mental health needs are not represented or engaged in research. This National Institute of Health and Care Research-funded project aims to bring together key stakeholders to conduct extensive scoping work to identify mental health needs and priorities as a basis for conducting larger research to address the identified priorities over the next 5 years.

Methods and analysis
This 12-month mixed-methods research-priority-setting project consists of five phases. It is being conducted in Norfolk and Suffolk counties in the East of England, UK. Underpinned by Delphi methodology, it will adopt the James Lind Alliance approach to identify priorities for mental health research for the populations of Norfolk and Suffolk. The project will use multiple methods, including mapping and identification of stakeholders, online questionnaires, face-to-face focus groups and interviews, and consensus meetings with experts and mental health stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented, and a final top 10 research priorities will be identified to inform future research, policy and service provision.

Ethics and dissemination
This study was approved by the University of East Anglia’s Faculty of Medicine and Health Research Ethics Committee (reference: ETH2324-2542), Norwich, UK. Research findings will be disseminated through workshops with stakeholders and collaborators and via peer-reviewed scientific publications, presentations at academic societies, blogs and social media.

Introduction
Diagnostic errors in ear, nose and throat (ENT) diseases are prevalent among healthcare workers (HCWs) in resource-limited settings, yet comprehensive data that describe HCW knowledge, attitudes and practices (KAP) regarding ENT disease management remains scarce. Further, the impact of basic ENT training on HCW KAP in such settings is largely undetermined.

Objective
We assessed HCW KAP before and after basic training in ENT disease management.

Methods
This questionnaire-based pre-post-test cross-sectional survey employed HCW training in public hospitals in a resource-limited setting. We conducted a 2-day training, preceded by a pretraining survey, followed by immediate and 5-month post-training assessments using a prevalidated questionnaire. 416 HCWs participated and were selected through probability-proportionate-to-size random sampling. Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests were used to assess pre-post training KAP variations.

Results
At baseline, the median (IQR) percentage knowledge scores for HCWs in general ENT, ear, sinonasal and head and neck disease management were 60 (40), 55 (18), 58.3 (25) and 56 (22.6), respectively. Only 33.8% (133/394) of HCWs had access to an otoscope, 25.5% (101/396) to a headlight and 12.1% (48/397) to a nasal speculum. While 99.2% (390/393) of HCWs considered ENT important, 57.8% (226/391) of them lacked the confidence to correctly diagnose and manage most ENT conditions. At the immediate post-training assessment, HCWs’ median knowledge scores increased by 20%, 18%, 25% and 33% for general ENT, ear, sinonasal and head and neck disease management, respectively (p

Background
Burnout among healthcare providers affects their well-being and quality of care. Despite its importance, limited data exist on burnout among primary healthcare providers in Tanzania.

Objectives
To determine the prevalence of burnout and associated factors among healthcare providers in Kasulu district, Kigoma region, 2024.

Study design
Analytical cross-sectional study conducted from January to June 2024.

Study setting
Primary health facilities at Kasulu district in Kigoma region.

Participants
Healthcare providers working in Kasulu district for more than 6 months before study.

Primary outcome
Burnout.

Results
Among 266 healthcare providers with a response rate of 99%, 59.4% were male. The median age was 32 years (IQR 27–37). Burnout prevalence was 54.5% (95% CI 48.5% to 60.4%), higher among nurses (61.3%), those living off-site (69.6%) and those considering leaving their careers (86.2%). Significant factors included age 21–30 years (adjusted prevalence ratio (aPR) 1.55, 95% CI 1.06 to 2.27), nursing profession (aPR 2.19, 95% CI 1.07 to 4.48), off-site residence (aPR 1.23, 95% CI 1.02 to 1.49), 6 months to 2 years of experience (aPR 1.44, 95% CI 1.12 to 1.86), dissatisfaction with salary (aPR 1.77, 95% CI 1.02 to 3.07), poor colleague relationships (aPR 1.25, 95% CI 1.03 to 1.51), ≥4 night shifts/week (aPR 2.54, 95% CI 1.33 to 4.86), attending ≥41 patients per day (aPR 1.52, 95% CI 1.06 to 2.19) and lack of academic growth opportunities (aPR 1.62, 95% CI 1.15 to 2.29).

Conclusion
Rural settings like Kasulu face unique challenges, including limited resources and heavy workloads, exacerbating burnout among healthcare providers. Over half of healthcare providers experienced burnout, with younger providers, nurses, those living off-site, less experienced staff, poor colleague relationships and high patient loads at higher risk. To mitigate burnout, authorities should provide career counselling, onsite housing, mental health support and increased staffing.

Ordinaria di Medicina interna a Perugia, si insedierà nel 2028

‘Necessario un modello organizzativo dipartimentale’

Introduction
Cerebral palsy (CP) presents a complex neurodevelopmental disorder with a spectrum of motor impairments stemming from early brain injury. Whereas CP is traditionally viewed as a non-progressive condition, emerging evidence suggests a progressive decline in mobility and function, particularly in adulthood. Despite the prevalence of self-reported age-related gait decline in adults with CP, objective evidence supporting this phenomenon remains limited. Moreover, mechanistic insights into these functional alterations and their comparison with typically developing (TD) peers are lacking. To address this gap, our study aims to objectively assess age-related changes in gait performance among individuals with CP while examining physiological differences compared with TD peers.

Methods and analysis
This protocol will compare the mobility of individuals with and without CP within two age groups (18–25 and 35–50 years old). Participants at Gross Motor Function Classification System levels I–II at age 18 will be invited to partake in the study. Every participant will be invited to complete four visits investigating a wide range of mobility related measures: walking performance, muscle strength, cardiopulmonary performance, fatigability, cost of walking and quantitative gait analysis. Through this comprehensive analysis encompassing gait performance metrics, self-reported outcomes, muscle strength, biomechanics and metabolical cost of walking, and fatigability, we seek to elucidate the underlying mechanisms driving age-related gait decline in adults with CP and inform targeted interventions to maintain function and quality of life.

Ethics and dissemination
The study has been approved by the French ethics board (#2022-A02510-43) and will be communicated through conferences, articles and to participants through layman terms.

Trial registration number
NCT06163950.

Introduction
The allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health.
Stress due to AL can influence the development and outcomes of cardiovascular diseases. AL increases the risk of coronary and peripherical artery diseases. AL emerges from the detection of emotional dimensions related to the disease, low psychosocial functioning and high rates of psychopathological signs in patients with hypertension or coronary heart disease.

Method and analysis
The primary endpoint of the PLAY-UP protocol is the implementation of a multidimensional model underlying the clinical treatment of patients with cardiovascular disease through the integration of medical and psychological clinical variables.
PLAY-UP is a cohort study that will last for 24 months. 200 participants will be recruited and divided into three groups: early disease, midterm disease and long disease. All patients will undergo a clinical evaluation based on the detection of biological, medical and psychological indicators and variables. The evaluation battery will comprise three types of measurements: medical, psychological and pharmacological treatments. Clinical and psychological measurements will be processed in an integrated manner through the combination of all variables examined, elaborating the Allostatic Load Index from a longitudinal time perspective. The Allostatic Load Index will be calculated by measuring the z-score.

Ethics and dissemination
Ethical Committee Approval was obtained from CEtRA Abruzzo Region (IT) (ID 0461499/23). The results of the present project will be published in peer-reviewed journals, disseminated electronically and in print, and presented as abstracts and/or personal communications during national and international conferences.