FGIDs can be diagnosed and managed in primary care. Prospective studies in primary care allow assessment of compliance of pediatricians and implementation of what is learned in courses developed in continuing medical education. Informed reassurance and availability of FPs are more useful than over-the-counter drugs, which are often used for FGIDs.

BackgroundWe aimed at assessing the factors that can influence results of the dissemination of an already validated, new generation commercial Point-of-Care Test (POCT) for detecting celiac disease (CD), in the Mediterranean area, when used in settings where it was designed to be administered, especially in countries with poor resources.MethodsPragmatic study design. Family pediatricians at their offices in Italy, nurses and pediatricians in Slovenia and Turkey at pediatricians’, schools and university primary care centers looked for CD in 3,559 (1-14 yrs), 1,480 (14-23 yrs) and 771 (1-18 yrs) asymptomatic subjects, respectively. A new generation POCT detecting IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop was used. Subjects who tested positive and those suspected of having CD were referred to a Celiac Centre to undergo further investigations in order to confirm CD diagnosis. POCT Positive Predictive Value (PPV) at tertiary care (with Negative Predictive Value) and in primary care settings, and POCT and CD rates per thousand in primary care were estimated.ResultsAt tertiary care setting, PPV of the POCT and 95% CI were 89.5 (81.3-94.3) and 90 (56-98.5) with Negative Predictive Value 98.5 (94.2-99.6) and 98.7% (92-99.8) in children and adults, respectively. In primary care settings of different countries where POCT was performed by a different number of personnel, PPV ranged from 16 to 33% and the CD and POCT rates per thousand ranged from 4.77 to 1.3 and from 31.18 to 2.59, respectively.ConclusionsInterpretation of POCT results by different personnel may influence the performance of POC but dissemination of POCT is an urgent priority to be implemented among people of countries with limited resources, such as rural populations and school children.

In paediatric coeliac disease (CD), symptoms may not be a reliable factor in the diagnosis of coeliac disease as described by Rosen et al, 1 and thus, recommendations for reviewing CD screening criteria were suggested. 2 Apart from the costs, an important limiting factor in paediatric population mass screening using conventional immunoglobulin (Ig) A tissue transglutaminase (tTGIgA) may be the low compliance of asymptomatic children to be referred for testing. On the other hand, the alternative approach, the CF strategy, relies on

Environment and health We are too slow in health protection actions from air pollution; this is the premise of Legambiente' s annual report Mal'aria di città 2023. This report highlights how air pollution is decreasing too slowly, putting the health of Italian citizens at risk with critical issues for some cities related to the days of exceeding the daily limit for PM10. Considering that attention should also be put to the level of other pollutants like such as those of PM2.5 and NO2. WHO has reported recent scientific evidence on the limits of concentrations not to be exceeded, and the European Air Quality Directive proposes downward limits (20 μg/mc) that should be complied with from January 2030 and that are to be considered an intermediate step from the WHO indications (15μg/mc). So there are 7 years to comply, but despite the mitigation actions put in place and tangible emission reductions, there has been no steady decline in air pollutant concentrations in virtually any city; in fact, the average rate of reduction in concentrations nationwide is only 2% for PM10 and 3% for NO2, too slow to reach the target set by the European directive for 2030. Polluted air is still being breathed for too long. As in previous issues, the main articles published in the monitored journals are summarized here, among which numerous are precisely those related to air pollution. All articles and editorials deemed worthy of attention are listed divided by topic, with a brief commentary. This issue is based on systematic monitoring of the publications of November and December 2022.

well as on the duration of use of anticoagulant and antiarrhythmic drugs and hospital stays. Carto Thermocool Smarttouch catheter; amiodarone, sotalol, propafenone; rivaroxaban, dabigatran and apixaban were the treatment approaches used for the cost analysis in this study. The cost analyses were made based on the perspective of the Social Security Institution in Turkey. RESULTS: The costs per AFib patient of drug therapy versus catheter ablation were as follows: antiarrhythmic drug (4.0088 TRY vs 112 TRY), function tests (1.194 TRY vs 0 TRY), physician visits (837 TRY vs 78 TRY), heart tests (4.918 TRY vs 683 TRY), anticoagulant drug (21.502 TRY vs 392 TRY), medical devices and procedures (0 TRY vs 14.615 TRY) and hospital stay (1.620 TRY vs 312 TRY). The number of threedimensional radio frequency catheter ablation procedures performed in Turkey in 2017 is 500. The total cost of AFib treatment for 500 patients was 17.079.30 TRY with drug therapy and 8.096.386 TRY with three-dimensional complex mapping catheter ablation. CONCLUSIONS: These results propose that catheter ablation requires less costly treatment than drug therapy for AFib patients in Turkey.