[The medical specialty in Community Medicine]. / Lo specialista in medicina di comunità.

The A. describes synthetically the evolution of the job profiles of the GP in Italy as a consequence of the introduction of the NHS in 1978 and of the development of a new Primary Health Care (PHC) in the Health Districts of the Local Health Units. According to the national and regional Health Regulations the GP should adopt the holistic approach in the treatment of the patients with the involvement of the community for the PHC and with the integration of the formal and informal, private and public, social services. The efforts to change the traditional profile of the GP both for the global, holistic, approach to the patients and for the community approach to the health needs and for the health promotion of the individuals and of the community raised several continuing and basic educational problems. They showed the opportunity to introduce in Italy the accademic discipline Community Medicine and the post-graduated School of Community Medicine as a clinical specialization. The role and the functions of the specialist in Community Medicine are specifically connected with the development of the PHC.

Community care for patients with Alzheimer's disease and non-demented elderly people: use and satisfaction with services and unmet needs in family caregivers.

OBJECTIVE: This study measures and compares use of and satisfaction with medical and social services in addition to subjectively perceived needs of family supporters of patients with probable or possible Alzheimer's disease (AD) and family supporters of non-demented elderly people. Differences in judgement of services within the subpopulation of families of AD patients are also assessed by gender and burden level. METHODS: The main family supporters of 60 community-dwelling elderly (aged over 65) with Alzheimer's disease and of 60 age- and sex-matched controls were tested with a detailed questionnaire on use and satisfaction with services, any unmet needs and kinds of intervention perceived to be helpful. RESULTS: Supporters of elderly people with AD were significantly more involved in providing care than supporters of non-demented people. Judgement on the health, social relations and financial status of their families was significantly worse in AD supporters than in supporters of non-demented elderly people. Although the former made more use of available health and social services than the control population, they did appear to make little use of such services, not only because of lack of information but also for logistic reasons or because they would prefer a service with more specifically trained operators or more tailored intervention. AD family supporters would like to receive more information and support from their general practitioner, which confirms the importance of this figure in management of this pathology. They were less satisfied with the care provided than the control population, particularly those with a moderate-high burden. Irrespective of burden level, they also expressed a need for financial and psychological support and adequate intervention schemes, especially within the home. These should be provided by specially trained personnel and be tailored to specifically manage the individual patient's problems, especially in relation to behavioural disorders. This would help alleviate caregiver burden and allow patients to continue to be managed at home.

[Multidimensional diagnosis in general medicine. Comparative study of the use of various instruments]. / La diagnosi multidimensionale in medicina generale. Studio comparativo sull'uso di alcuni strumenti.

This study was performed to test three instruments for functional status assessment in General Practice: the Dartmouth Coop Charts (COOP Charts), the Functional Status Questionnaire (FSQ) and the Duke University Health Profile (DUHP). All the instruments covered a score of functional aspects in physical, mental and social areas, providing a multidimensional measure of health status. We used these three instruments, validated by international studies, to acquire information concerning their feasibility and acceptability among patients from rural communities needing primary care and to test their validity in differentiating between patient subgroups. The COOP Charts, the FSQ and the DUHP were administered by physicians respectively to 98, 100 and 97 patients, waiting for a visit in the ambulatories of their General Practitioner. Answers relating to each instrument were analyzed according to sex, age and education of patients. All the instruments seemed to be feasible and acceptable, but only the COOP Charts and the FSQ were able to discriminate between different sex, age and scolarity groups. Taking into account the need to elaborate answers according to a formula when using the FSQ, we concluded that the best instrument for General Practice to provide a multidimensional measure of health status seems to be the COOP Charts.

Patient counseling by general practitioners: Republic of San Marino's experience.

General practitioners (GPs) can play a unique role in improving individual health behaviors. To maximize this role, it is important to know what health education activities GPs are performing and where improvements can be made. This article presents data covering a one-year period regarding the health education/counseling activities of GPs in the Republic of San Marino, which has a National Health Service. The overall rate of health education interventions is 8.8 per 100 GP contacts. The diagnosis having the highest rate of health education counseling is lipid metabolism disorders (50/100). Other diagnoses having high rates are: anxiety, depression, irritable bowel syndrome, and disorders of stomach dysfunctions/gastritis (42, 40, 36, and 33/100 respectively). The lowest rate within the top 17 diagnoses receiving health education is uncomplicated hypertension (11.4/100). The range of provider variation in performing health education interventions ranges from 1.2 to 24.1 per 100 patients contacts. Such analyses permit identification of the specific areas where GPs may need assistance for increasing the appropriate use of effective health education interventions so that further progress can be made in meeting the health needs of communities.

Alternatives and options for funding continuing medical education: a debate.

There are four main categories for funding continuing medical education (CME) in Europe: public funding, industrial funding, private funding, and a combination of the three. Reasons behind funding are different in countries with a prevalent state or free-market economy; public funding should have public health as its main concern, while individual funding should have concern with individual benefits. This paper describes the main alternatives and options for funding CME in Italy, a European country with a national health service (NHS) and a free-market economy. In Italy CME is a legal obligation for permanent NHS staff and for doctors who participate in the NHS. A budgeted item in the Health Fund is assigned to CME, but few Regions have clearly set out a CME programme strategy.

[Total mercury levels in human milk from Italian mothers having not been particularly exposed to methyl-mercury]. / Livelli di mercurio totale nel latte umano di madri Italiane senza particolare esposizione al metil-mercurio.

Some researches have been carried out about the foetal and neonatal exposure to methylmercury among the epidemiological studies on the effects of the exposure to this compound with foodstuffs. From the whole of these studies it seems that newborns are particularly sensitive to organic mercury compounds. The health effects can also appear in newborn of mother without symptoms. Now we show the early results of a carried out survey on some mothers without stated exposure to methylmercury living in the area or near Padua (Italy). The analytical data are concerning the levels of total mercury, total fats, lactose and total proteins in the breast-milk. The data, on 33 women, are summarized in a table, as: the number of sample, the mother's age, the time-lag from the delivery and the beginning of milk collection (day after delivery), the levels of total mercury, total fats, lactose and total proteins in breast-milk. In the table, also, the smoking habits, the alcohol consumption and the frequency during the last weeks before the delivery of the consumption of fish, if available, are registered. All the samples of breast-milk were positive in the mercury level. The mean total mercury level was 13.94 +/- 12.94 micrograms/L. The range of values was among 1.63 micrograms/L and 52.5 micrograms/L. 11 mothers eat fish on average once a week, only 3 mothers eat fish twice a week. 12 mothers eat fish seldom, between twice a month or once every two months. Present Italian values don't differ significantly from that of Spain and of coastal areas of Alaska. Present Italian values are significantly higher than those of inner areas of Alaska, Poland, Iowa and Tokyo. No statistic significant correlation is between mercury levels and nutritional components of breast-milk. In order to assess the health risk, we utilize the calculated tolerance concentration of mercury in human milk by Jensen, as 4 ppb. Only 11 (33.3%) of the analyzed breast-milk samples have total mercury levels below 4 ppb. Nevertheless, the possible high intake of mercury is over estimated by PTWI.

Epidemiological study of long-term effects of pesticides on human health.

Two rural areas in Italy with different rates of pesticide usage were subjected to a cross-sectional investigation, based on the identification of organochlorine compounds in the environment and in human fatty tissues and on the determination of their concentration and a prospective investigation, based on the collection of data of past and present pathology and symptomatology from two stratified random groups of inhabitants of both areas.The cross-sectional investigation showed only small differences in environmental pollution and no differences in the storage of organochlorine compounds in fatty tissues in the two areas. The prospective investigation showed a higher prevalence of pathology and symptomatology in the population of the area where pesticides were used in larger quantities. Several haematochemical tests were used in an attempt to differentiate between populations at different levels of risk of toxic damage, but without success.