Health status, resource consumption, and costs of dysthymic patients in Italian primary care

Aims – To describe the health status, resource consumption and costs of patients with dysthymic disorder in the Italian primary care setting. Methods – A total of 79 general practitioners (GPs) participated the study. Diagnosis was based on each GP's clinical assessment. At entry the Mini-International Neuropsychiatric Interview (MINI) was used as a supporting diag- nostic aid. Health status was measured with the SF-36 questionnaire. Resource consumption and costs regarded the six months before enrolment. Results – Out of 598 patients enrolled by GPs according to their clinical assessment, 503 fulfilled the MINI cri- teria and 95 did not. The latter had a better perception of their health than the former. Resource consumption was similar in the two groups; and the total per patient six-month costs did not differ significantly. Conclusions – The study confirms there may be a gap between standardised criteria for defining dysthymia and everyday clinical practice. All dysthymic patients diagnosed by GPs might be considered together from a health policy perspective.

Declaration of Interest: this research was partly supported by a contribution from Sanofi-Synthelabo Italy.

A six-year study of hydroxyapatite-coated root-form dental implants

BACKGROUND

The effect of hydroxyapatite coating of dental implants is controversial. The long-term fate of hydroxyapatite-coated implants has been the subject of some criticism.

PURPOSE

The aim of this retrospective study was to assess the clinical outcome of hydroxyapatite-coated cylindrical root-form endosseous Impladent dental implants (LASAK Ltd, Prague, Czech Republic) during a six-year course.

METHODS

Three-hundred and ninety-one consecutively placed implants were used in 169 patients and followed for four to six years. Interval and cumulative success of implants and prostheses survival was tabulated. Marginal bone loss was measured

RESULTS

Of the total number of implants, 98.5% achieved initial osseointegration. The cumulative success was 98.3% after one year, 97.0% after three years, 92.8% after five years and 90.4% after six years. The prostheses survival at the end of the study was 100% for fixed bridges totally supported by implants, 96.5% for fixed bridges with combined implant and tooth support, 94.2% for single crowns, 90.9% for mandibular overdentures and 81.3% for maxillary overdentures. Marginal bone loss averaged 2.4 +/- 0.8 mm at the end of five years.

CONCLUSION

The success rate of the investigated hydroxyapatite-coated implants was comparable with the data presented in the literature and with the results of the similar implants without hydroxyapatite-coating. However, the marginal bone loss was of interest. Longer monitoring of the implants is necessary.

Pain in primary care: an Italian survey

BACKGROUND

Pain is a universal symptom of various pathologies and largely affects human well-being. Pain is therefore commonly observed by general practitioners (GPs) and its management is a useful indicator of quality. In our study we investigated the epidemiology and management of pain in Italian general practice.

METHODS

Participating GPs were asked to record the first out of every two contacts with pain during two working weeks between November 2000 and February 2001. They entered information on type of pain, pain-related diagnosis, certainty of diagnosis and types of prescription.

RESULTS

89 GPs participated in the study. About one third of all reported contacts were with pain. The number of contacts analysed was 1432. Nearly half the cases were diagnosed as acute. The main complaints were of musculoskeletal and abdominal origin. Pain was 1.5 times more frequent in women than men and the female to male ratios for acute and chronic pain were 1.2:1 and 1.8:1 respectively. The most frequent site of pain was the limbs. 'Arthropathies and related disorders', 'dorsopathies' and 'rheumatism excluding the back' were the commonest groups of diagnoses. Approximately two thirds of contacts with pain led to a drug prescription.

CONCLUSIONS

The study identified a high proportion of contacts with pain in Italian general practice, with widespread use of drugs. The distribution of chronic and acute pain was rather similar and musculoskeletal pain was the most frequent form. Most types of prescriptions were closely related to certainty of diagnosis.

Pharmaceutical policy in Italy: towards a structural change?

Italian pharmaceutical policy has recently moved towards a "two lanes" approach, with regulation differing according to a drug's patent status. This study analyses the Italian regulatory framework, focusing on policies related to "off-patent" drugs. Three main regulatory innovations have been examined: (i) generics, introduced in Italy for the first time in 1996; (ii) the reference pricing (RP) scheme, under which consumers pay part of the cost of high-priced products; (iii) pharmacists' right of substitution, supported by a regressive margins system. The recent reforms are already producing some worthwhile results, at least in terms of competitive pressure on the (few) substances that run out of patent protection. However, further intervention could be required to achieve long-term sustainability.

Direct medical costs of mycosis fungoides in specialized Italian hospital departments

The objective was to analyze direct medical costs of managing mycosis fungoides (MF). We conducted a retrospective observational study in five Italian specialized departments. The 58 patients enrolled had a confirmed diagnosis of MF stage IIB or worse in 1999. The mean cost per patient was 9,231.40 euro.

Direct medical costs of monitoring and treating patients with Takayasu arteritis in Italy

The study provides the first overall estimate of the costs of Takayasu arteritis (TA) monitoring and treatment in Italy and highlights the differences in cost components across defined subgroups of patients. We estimated resource consumption and direct costs from the Italian National Health Service perspective. We conducted a multicenter, prospective study in 12 medical departments. All the 67 patients recruited met the American College of Rheumatology 1990 criteria for the classification of TA and were followed up for 1 year. For the purpose of analysis they were divided into two groups: "active TA" (patients who had taken at least one drug specific for TA treatment, i.e., corticosteroids and/or cytotoxics), and "inactive TA" (all the remaining patients). The average cost per year was Euro 4,079. Patients with active TA (Euro 5,055) had a significantly higher mean cost per year than those with inactive TA (Euro 1,328). In particular, significant differences were found for costs in general practitioner consultations, laboratory tests, and hospital admissions. These findings suggest that patients not only experience more complications requiring hospital admissions but also see general practitioners more often during the active stage of the disease, presumably in order to obtain a prescription for laboratory tests.

Experimental Design: Computer Simulation for Improving the Precision of an Experiment

An interactive computer-assisted learning program, ExpDesign, that has been developed for simulating animal experiments, is introduced. The program guides students through the steps for designing animal experiments and estimating optimal sample sizes. Principles are introduced for controlling variation, establishing the experimental unit, selecting randomised block and factorial experimental designs, and applying the appropriate statistical analysis. Sample Power is a supporting tool that visualises the process of estimating the sample size. The aim of developing the ExpDesign program has been to make biomedical research workers more familiar with some basic principles of experimental design and statistics and to facilitate discussions with statisticians.

Sample Power and ExpDesign: tools for improving design of animal experiments

Proper experimental design, involving the correct number of animals, should be a basic skill for any scientist working with animals. The authors describe a university-developed and freely available tutorial program and an interactive computer-assisted learning program, both of which guide students through the steps necessary for designing animal experiments and estimating optimal sample sizes.

Evaluation of stability of titanium and hydroxyapatite-coated osseointegrated dental implants: a pilot study

An endosseous implant is described as osseointegrated when it is immobile in function. Objective measures of stability testing have been described. The Periotest is a commercially available device that is used for this purpose. This study was designed to measure stability of endosseous implants placed in the mandible. Implants were placed in the mandibular canine or first premolar area to support an overdenture prosthesis. Stability was evaluated through the use of a Periotest device at the time of implant placement and following one year of functional loading. Implant designs were either a screw-shaped titanium alloy or a hydroxyapatite-coated cylinder. A total of 54 implants were placed, 37 were titanium screw-shaped implants, while the remaining 17 were hydroxyapatite cylinders. Initial measurements of stability showed no difference due to implant type. Following one year of functional loading, titanium screw-shaped implants were more stable than hydroxyapatite implants (P < 0.05). The difference in implant rigidity following a period of functional loading may be an indication of a difference in osseointegration between the two implants used in this study.