What is the gender gap?

Not availabl

Work stress and burnout among physicians and nurses in Internal and Emergency Departments

Burnout has been defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Work environment and working conditions exposes the individual to numerous factors of stress. Stress-related diseases are defined as burnout. The increased workload, the repeated reorganizations in the hospital with iterative downsizing suggestions and budget cuts, without any perspective of career progression, with a social culture of bureaucracy and blame, resulting both in subtracting direct care time with patients and in the fear by healthcare professionals from the burden of their responsibility, are the backgrounds on which more and more frequent cases of burnout may develop. We need to establish homogenous standards all over the national territory on workload and about the procedures that have to be implemented for the prevention of burnout in our wards

Peritoneal dialysis in older adults: evaluation of clinical, nutritional, metabolic outcomes, and quality of life

The number of older adults requiring dialysis is increasing worldwide, whereas the use of peritoneal dialysis (PD) in this population is lower respect to younger patients, despite the theoretical advantages of PD respect to hemodialysis. This is most likely due to the concern that older patients may not be able to correctly and safely manage PD. We aimed to prospectively compare clinical, nutritional and metabolic outcomes and measures of quality of life between younger (<65years old) and older (≥65years old) patients on PD. PD patients were enrolled and divided into 2 groups according to age (Group A < 65 years, Group B ≥ 65 years). Clinical and instrumental parameters, and quality of life were evaluated at baseline (start of PD) (T0) and at 24 months (T1). Technique survival, mortality, total number of hospitalizations, and the index of peritonitis (episodes of peritonitis/month) were also evaluated. Fifty-one patients starting PD were enrolled. Group A included 22 patients (48.7±8.3 years), and Group B consisted of 29 patients (74.1 ± 6.4 years). At baseline, the 2 groups showed no differences in cognitive status, whereas Group A showed higher total cholesterol (p=0.03), LDL (p=0.03), and triglycerides (p=0.03) levels and lower body mass index (p=0.02) and carotid intima media thickness (p<0.0001) with respect to Group B. At T1 Group B showed, compared to baseline, a significant reduction in albumin (p<0.0001) and phosphorus (p=0.045) levels, while no significant differences on body composition, technique survival, total number of hospitalizations, index of peritonitis and quality of life indices were observed. Our data do not show clinically relevant barriers to use PD in older adult patients, supporting its use in this population. Nutritional and metabolic parameters should be carefully monitored in older PD patients

The management of the patient with osteoporosis: from evidence to clinical practice

Osteoporosis is the most common bone disease and is an important problem of public health. In fact, it represents the main cause of age-related fractures and disabilities with a consequent increasing sanitary, social and economic impact. Unfortunately, often osteoporosis is not as thoroughly investigated as it would be desirable and it is underestimated in diagnosis and therapy. The aim of this monograph is to sensitize medical internists to a careful evaluation and an efficacious treatment of osteoporosis in order to reduce the risks of this disease, in particular the fractures, with a view to improving the quality of patients' life

Approach to leg edema

Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral) and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults

Lack of application of the European Work Time Directive: effects on workload, work satisfaction and burnout among Italian physicians

The Italian Parliament has excluded hospital physicians from the application of the European Work Time Directive (EWTD), which imposes a maximum workweek of 48 h and compulsory resting periods. This resulted in extended and excessive work time for the category. This paper is aimed at evaluating the impact of this legislation gap, by assessing the presence of excessive work-related stress and risk for burnout syndrome among Italian physicians working in public hospitals. This observational study is based on an on-line survey conducted on a sample of 1925 Italian doctors (covering a wide range of age, work experience and contractual positions) from October 2014 to February 2015. The questionnaire included 30 questions concerning their personal and professional life (e.g., assessment of workloads, number of uncomfortable or extra shifts, unused days-off, etc.). On the basis of the results, it can be inferred that the average Italian doctor working in public hospitals is under considerable stress at work with negative consequences on his health. He is exposed to high risk of suffering from sleep disorders and cardiovascular diseases (due to the lack of time for private practice and eating regular meals). Overall, his perception is that his job worsens his quality of life. This study shows the relevance of the risk of burnout among Italian physicians employed in public hospitals due to severe workload and work conditions. The resulting impact on the quality of care and the significant cost involved - both in human and economic terms - calls for significant emergency measures by the Italian health work organization. An important increase and prolonged working time is associated with a worsening of the objective cognitive performance and an increase of clinical risk, but also to an increased risk of diseases for operators and of the burnout syndrome. Our survey shows that lack of application of the EWTD has adverse effects on the quality of life and performance of Italian doctors. Failure to respond by all Italian doctors is the greatest limitation of our survey

Gender differences in chronic obstructive pulmonary disease: an analysis of hospitalization indicators

Compared to the last two decades, an increase in chronic obstructive pulmonary disease (COPD) prevalence, morbidity, mortality and disability has clearly emerged among women both in Europe and in all other countries. Despite this evidence, in the international guidelines for COPD there are no sex-specific recommendations. The aim of this study is to evaluate gender differences in patients hospitalized for COPD in Puglia (Italy), with regard to number of admissions, mean age, average length of stay in hospital (ALOS), hospital mortality, re-hospitalization and presence of comorbidities. To identify COPD hospitalized patients, we relied on the Puglia Hospital Discharge Register Database. We included all patients discharged with principal diagnosis of COPD with or without exacerbation (respectively ICD-9-CM codes 491.21 and 491.20) between 2005 and 2016. There has been an increase in the proportion of women’s hospitalizations for COPD, from 2005 [31.9%, 95% confidence interval (CI) 31.1-32.7] to 2016 (37.9%, 95%CI 36.0-40.0). Women need longer hospitalization and in 2016 the proportion of women’s re-hospitalization was greater compared to men. Despite these data, women are less treated with respiratory therapy (ICD-9- CM 93.9x) than men in all the examined years and wards. The prevalence of most common comorbidities is higher among women. The number of COPD hospitalized patients had been reduced in Puglia between 2005 and 2016, with an important increase of female COPD patients, female average age, ALOS and re-hospitalization. Women are treated less and have more comorbidities with a negative impact on clinical progression of COPD, survival and quality of life

Could clustering of comorbidities be useful for better defining the internal medicine patients’ complexity?

Internal medicine patients are mostly elderly with multiple comorbidities, usually chronic. The high prevalence of comorbidity and multimorbidity has a significant impact on both positive responses to treatment and the occurrence of adverse events. Clustering is the process of nosography grouping into meaningful associations with some index disease, so that the objects within a cluster have high similarity in comparison with one another. In the decision-making process it is imperative that, in addition to understanding the immediate clinical problems, we are able to explicit all the contextual factors that have to be taken into account for the best outcome of care. Cluster analysis could be leveraged in developing better interventions targeted to improve health outcomes in subgroups of patients

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Young FADOI internists: from evidence to clinical practice

Not require