[Social media and people with HIV: results from an Italian survey.] / Social media e persone con HIV: risultati di una indagine italiana.

HIV continues to be an important public health problem. The web, social media and new mobile technologies are gaining considerable potential in overcoming the stigma in order to promote continuity of care, the possibility to stay in contact with one's doctor and with the peer community, offering an alternative to traditional social structures. The purpose of this survey it was to investigate the opinions and behavior of people with HIV regarding the use of these technologies. METHODS: The survey was designed with the involvement of the main associations of patients and/or communities affected by HIV infection on the national territory, which have oriented the definition of objectives and research tools to a qualitative level. An exploratory survey was carried out aimed at all people with HIV in Italy who use Internet. The questionnaire could be completed online only and was distributed and administered by the associations through their websites, newsletters and general social media (Facebook, Twitter) for three months. RESULTS: 265 people responded on a national level. According to the patients the information obtained from the internet was not useful in the relationship with the infectiologist (70%) and social media is considered to be of little use as a communication tool with the doctor (33%). Only 7% communicate with the infectiologist through social media and only 3% use peer communities such as blogs and forums. The new mobile technologies are instead considered promising tools to support the treatment of the disease (70%). DISCUSSION: It is essential to strengthen peer communication and, as emerges from the perception of people with HIV, overcome the possible resistance of health professionals so that the opportunities offered by these tools can improve the care and support of people with HIV.

Joint and distinct risk factors associated with micro- and macrovascular complications in a cohort of type 2 diabetic patients cared through disease management.

We analysed the risk factors associated with diabetic complications in the cohort of patients assisted by a type 2 diabetes mellitus (T2DM) shared-care program. We analysed registry data from 16,136 T2DM patients. Of them, 4,781 had microangiopathy, 3,469 CV events. They were 70.5 ± 17.1 years old, 50% were male, disease duration 13.3 ± 7.8 years, BMI 28.7 ± 4.9 kg/m², HbA1c 7.08 ± 1.23%, FBG 134.7 ± 35.7 mg/dl, 2hPPBG 163.9 ± 47.8 mg/dl, 12.5% smokers. Cholesterol 202.5 ± 37.6 mg/dl, HDL 51.4 ± 20.4 mg/dl, LDL 126.5 ± 36.0 mg/dl, triglyceride 146.2 ± 72.4 mg/dl, SBP 137.8 ± 14.2 mmHg, DBP 80.7 ± 10.8 mmHg, 10-year CV risk score 13.7 ± 9.1; 70.4% had no microangiopathy-i.e. renal, retinal, peripheral nerve disease-and 78.5% of patients had no CV events. Age-adjusted risk factors associated with diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. FBG and SBP were associated with microangiopathy, whereas smoking with cardiovascular events. Optimal targets were reached in: FBG 17%, 2hPPBG 8%, HbA1c 21%, cholesterol 17%, HDL 8%, LDL 5%, triglyceride 20%, SBP 13%, DBP 30%. Drug profiles showed 13% using metformin, 28% sulphonilureas, 26% bitherapy, 4% insulin; 12% statins, 16% anti-platelets, 27% anti-hypertensives, 2% anti-coagulants. T2DM patients showed an acceptable CV risk profile. Joint risk factors for diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. Distinct risk factors were FBG and SBP for micro- and smoking for macrovascular disease. A targeted-to-treat approach needs more attention in the care of T2DM patients.

[Effectiveness of the kit Conversation Map in the therapeutic education of diabetic people attending the Diabetes Unit in Carpi, Italy]. / Un efficace strumento per l'autoeducazione terapeutica del paziente diabetico: la Conversation Map. L'esperienza del Centro di Diabetologia di Carpi.

We implemented the "Diabetes conversations", programme of the International Diabetes Federation-Europe, characterised by the use of the Conversation Map, an educational interactive kit addressed to groups of diabetic patients on: Living with diabetes, What is diabetes, Healthy diet and physical activity, Initiating insulin therapy. After at least three month from the end of the 4-session course, clinical data of 63 participants from the first 10 groups--age (mean +/- std dev) 61.7 +/- 10.2 years, 56% women, 18.5% T1DM-improved: fasting glycemia decreased from 152.9 +/- 55.2 to 138.2 +/- 38.9 mg/dl (P < 0.05), HbA1c from 8.2 +/- 1.2 to 7.8 +/- 1.4% (P < 0.01), BMI from 27.6 +/- 15.1 to 25.5 +/- 15.5 kg/m2 (P < 0.02). The patients' satisfaction about the topics and the educational materials was very high.The Conversation Maps are useful because: (a) contribute to improve glycometabolic control; (b) educate patients on the main topics related to diabetes; (c) give to the nurse a key and active role in patients'education; (d) facilitate the connection between knowledge and behaviour; (e) involve the volunteers of the diabetic association as tutors; (f) improve the relationship and the communication between the doctor/nurse and the patient.

[Prevention of diabetes mellitus complications and improvement of early diagnosis at a population level, through the implementation of integrated disease management in the Modena region]. / Prevenzione delle complicanze del diabete mellito e miglioramento della capacità di diagnosi precoce a livello di popolazione attraverso l'implementazione della gestione integrata nella provincia di Modena.

We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications.

Assessment of readability and learning of easy-to-read educational health materials designed and written with the help of citizens by means of two non-alternative methods.

OBJECTIVES: We compared two non-alternative methods to assess the readability and learning of easy-to-read educational health materials co-written by physicians, educators and citizens. METHODS: Data from seven easy-to-read materials were analyzed. Readability formulae, and ad hoc data on readability and learning were also computed. RESULTS: The respondents had a mean age of 48.5 +/- 8.3 (SD) years (range 31-57 years). More than two thirds of them were females. About half of the participants had a 'secondary' education or more. According to the readability scores - 54 on average - the booklets resulted to be "easy" for a reader who had received a 'secondary education' or more. Of the 747 participants, 70% of them found the booklet's language to be 'easy' or 'very easy' and 28% 'sufficiently easy' for laypersons to understand. About 98% of the readers found the booklets useful. After reading the booklet 92% (simple knowledge rate) of the readers answered the cognitive items correctly. The after-minus-before net increase in knowledge was 24 +/- 16% and ranged from 8 to 40% (cognitive or knowledge delta). CONCLUSIONS: The availability of readability scores is complementary and it does not replace the need to assess readability and learning by means of structured and tailored questionnaires.

Evaluation of easy-to-read information material on healthy life-styles written with the help of citizens' collaboration through networking.

The objective of this study was to evaluate if easy-to-read information material on the prevention of chronic-degenerative diseases through healthy lifestyle co-written by communicators, educators, physicians and citizens -using a networking strategy- could be judged comprehensible. Readability scores were computed. The survey involved 100 individuals attending our centralized booking centre for medical appointments during an "index week". They filled out an anonymous questionnaire, just before and after they had read the material. Readability and comprehensibility frequencies were calculated. The participants had a mean age of 59.1+/-15.1 (SD) years (range 19-81yrs), 62% were females. Twenty-six percent of them had received no education, 30% "primary", 28% "secondary", and 14% had a "degree". According to readability scores, the booklet was "readable" by all persons who had finished primary school. Of the 100 participants, 40 percent found the booklet's language to be "easy" or "very easy", 46% "sufficiently easy", and 14% "difficult" for laypersons to understand. Ninety-four percent of them found no unintelligible words in the text. Education levels showed no differences. Readers' answers were more correct after they had read the booklet. The pre-test showed that 61+/-26% of the readers answered the comprehensibility items correctly. After reading the booklet, 81+/-17% of them gave correct answers. The after-minus-before net increase in knowledge was +20% (95% CIs +8 to +32%). The booklet was designed and written using a networking strategy with the help of the local population. It was found to be easy to read and quite clear.

[GPs' self-perception of their own role compared with hospital, ambulatory, academic, and health organisation physicians]. / Auto-percezione del ruolo professionale in medicina generale nel confronto con il medico specialista.

Aim of the present study was to explore how the 76 general practitioners (GPs) - serving Carpi district (90,000 residents) - value their own role compared with the hospital, ambulatory, academic, and health organisation physicians'. GPs had a positive self-image only in comparison with health organisation doctors (7 vs 7 grades). GPs disappointed with themselves when comparing their role with ambulatory (-1.6 grades), academic (-1.9 grades) and hospital doctors (-2.2 grades). Secondarily, GPs perceived patients' valuing their professional role mostly 'subordinate' to the other physicians', except health organisation colleagues'.