A randomised controlled trial of the effectiveness of a program for early detection and treatment of depression in primary care.

OBJECTIVE: There is considerable uncertainty about whether depression screening programs in primary care may improve outcomes and what specific features of such programs may contribute to success. We tested the effectiveness of a program involving substantial commitment from local mental health services. METHODS: Prospective, randomised, patient- and evaluator-masked, parallel-group, controlled study. Participants were recruited in several urban primary care practices where they completed the PC-SAD screener and WHOQOL-Bref. Those who screened positive and did not report suicidal ideation (N=115) were randomised to an intervention group (communication of the result and offer of psychiatric evaluation and treatment free of charge; N=56) or a control group (no feedback on test result for 3 months; N=59). After 3 months, 100 patients agreed to a follow-up telephone interview including the administration of the PC-SAD5 and WHOQOL-Bref. RESULTS: Depression severity and quality of life improved significantly in both groups. Intent-to-treat analysis showed no effect of the intervention. As only 37% of patients randomised to the intervention group actually contacted the study outpatient clinic, we performed a per-protocol analysis to determine whether the intervention, if delivered as planned, had been effective. This analysis revealed a significant positive effect of the intervention on severity of depressive symptoms, and on response and remission rate. Complier average causal effect analysis yielded similar results. CONCLUSION: Due to the relatively small sample size, our findings should be regarded as preliminary and have limited generalizability. They suggest that there are considerable barriers on the part of many patients to the implementation of depression screening programs in primary care. While such programs can be effective, they should be designed based on the understanding of patients' perspectives.

Comparison of the performance of hip implants with data from different arthroplasty registers.

This study evaluated the feasibility of using published data from more than one register to define the performance of different hip implants. In order to obtain estimates of performance for specific types of hip system from different register, we analysed data from the annual reports of five national and one Italian regional register. We extracted the number of implants and rates of implant survival at different periods of follow-up. Our aim was to assess whether estimates of cumulative survival rate were comparable with data from registers from different countries, and our conclusion was that such a comparison could only be performed incompletely.

[Rare diseases: general principles, specific problems, and health interventions]. / Malattie rare: concetti generali, problemi specifici ed interventi sanitari.

Rare diseases are a large group of about 5000 diseases, 90% of which are genetically determined, which potentially involve all human organs and are characterized by a low prevalence in the population; this is frequently associated to problems in achieving a rapid and correct diagnosis and an adequate treatment. Up to now, a generally accepted definition or classification of rare diseases is not available. The Programme of Community Action 1999-2003 on rare diseases within the framework for action in the field of public health gives the following definition for rare diseases: diseases with a prevalence in the European Union (EU) population of less than 5 per 10,000. Notwithstanding the low prevalence of each disorder, rare diseases are very numerous and, when considered overall, they are a significant public health problem in many countries (e.g. Italy, Europe, USA); in fact rare diseases are often chronic and invalidating or cause early mortality. In this report, we illustrate some general concepts and specific problems regarding rare diseases as well as public health activities being undertaken in the USA, EU and Italy.

[Nocardia asteroides: a case of subcutaneous abscess]. / Nocardia asteroides: un caso di ascesso sottocutaneo.

A case of subcutaneous abscess caused by Nocardia asteroides in an immunocompromised patient is described. A specific antibiotic therapy was successful. Details of the isolation procedures, clinical significance and epidemiological aspects related to the pathogen strain are reported.

[A case of melanoderma erroneously considered to be addisonian]. / Un caso di melanodermia erroneamente considerata addisoniana.

A case characterized by a dark pigmentation of the skin with an initial hypotension and a lung tuberculosis in the remote anamnesis is described. The skin pigment was formed by lipofuscin and emosiderin, but only the former was found in the liver biopsy. Anyway, the pigment was not melanine and the surrenalic function of the patient was completely normal; therefore, an Addisonism syndrome is excluded. The patient was treated for a very long time with DOCA: this caused hypertension, probably supported by the hypervolemia triggered by the DOCA depending retenction of sodium and water. A sure diagnosis of the case was not made, but an Addisonism syndrome was certainly excluded.