[The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area]. / Attivazione del Presidio Territoriale di Assistenza Primaria per affrontare la carenza di medici di medicina generale nel territorio del Basso Vicentino.

. The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area. INTRODUCTION: The demographic and epidemiological changes of Western societies lead to the implementation of new organizational models based on prevention and health promotion interventions mainly oriented to chronic patients. This approach promotes people's living places as the privileged place of care. AIM: To guarantee, in a rural area, the care of patients without a general practitioner, through the activation of the Primary Care District Clinic. METHODS: After having mapped the main chronic health problems of the catchment area, an outpatient care service based on an integrated medical-nursing approach was implemented. The Family and Community Nurse was responsible for the stratification of subgroups of patient according to their health problem, ensuring an integrated care of patients with chronic diseases or frail conditions, by education and symptoms monitoring. A convenience sample of 100 patients was selected, to analyze the degree of satisfaction with the care offered, by administering a questionnaire. RESULTS: Six months after its implementation, 4,000 patients accessed to the District Clinic. Those who answered the questionnaire declared high levels of satisfaction for the care received. The main needs were requests for repeated prescriptions and prescriptions for specialist examinations or visits for acute symptoms. CONCLUSIONS: The implemented model is promising, the patients were satisfied with the care received but would prefer to have contacts with the same nurse over time.

Pediatric social anxiety disorder: predictors of response to pharmacological treatment.

OBJECTIVE: Pediatric social anxiety disorder (SAD) is associated with an increased risk of comorbid mental disorders, with implications for prognosis and treatment strategy. The aim of this study is to explore predictors of treatment response, and the role of comorbidity in affecting refractoriness. METHODS: One hundred and forty consecutive youths (81 males, 57.9%), ages 7-18 years (mean age 13.7 ± 2.5 years, mean age at onset of SAD 10.6 ± 2.7 years) met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for SAD as primary diagnosis, according to a structured clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version [K-SADS-PL]). All received a pharmacological treatment with serotonin reuptake inhibitors (SSRIs) targeted to SAD, associated with additional medications for comorbidities (mood stabilizers in 27.1%, antipsychotics in 12.8%) and 57.9% received an additional psychotherapy. RESULTS: Eighty-nine patients (63.6%) responded to treatments after 3 months, namely 72.8% with psychotherapy plus medication and 50.8% with medication only. Nonresponders had more severe symptoms at baseline in terms of both clinical severity and functional impairment, and had more comorbid disruptive behavior disorders. The backward logistic regression indicated that clinical severity and functional impairment at baseline, comorbid disruptive behavior disorders, and bipolar disorders were predictors of nonresponse. CONCLUSION: Our data suggest that SSRIs can be effective in pediatric SAD, but that the more severe forms of the disorder and those with heavier comorbidity are associated with poorer prognosis.

Pre- and postprandial electroencephalography in glucose transporter type 1 deficiency syndrome: an illustrative case to discuss the concept of carbohydrate responsiveness.

Glucose transporter type 1 deficiency syndrome is an inborn error of glucose transport across the blood-brain barrier with hypoglychorrachia. Patients usually present developmental delay, movement disorders, seizures, and acquired microcephaly, variously associated and leading to different phenotypes. We report a 3-year-old girl affected by glucose transporter type 1 deficiency syndrome with carbohydrate responsiveness. Her history was characterized by worsening of ataxia with an increasing interval to the last food intake, occurrence of seizures in the morning before breakfast, slowing of electroencephalogram (EEG) background activity with the appearance of epileptiform discharges during preprandial recordings, and improvement of the electroclinical picture after food intake. By adding a new case to the pertinent literature, we stress the role of pre- and postprandial EEG recordings for the identification of individuals potentially affected by glucose transporter type 1 deficiency syndrome. We also provide a possible physiopathological interpretation of EEG changes related to food intake.