Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

[Costs of psychiatric services: a study performed at a public mental center in the Lombardy Region, Italy]. / I costi delle prestazioni in psichiatria: un'analisi condotta in un Centro Psico-Sociale (CPS) pubblico in Lombardia.

OBJECTIVE: The implementation of a simple methodology to estimate full costs of services provided by a public mental health centre. SETTING: CPS (NHS Mental Centre) Ussl 35, Magenta, Lombardy Region. METHOD: To estimate full costs of 16 types of service we followed a two step procedure. The first step was to estimate all costs attributable to the CPS. In the second one, we allocated this estimate to each type of service provided. We attributed to the CPS the following cost items: personnel, utilities (telephone, electricity, water, heating and cleaning), land & building, transports (for services provided outside the clinic) and a share of general cost of the USSL to which the CPS belongs. Full cost of each service was then calculated on the base of the yearly number of services provided and the time spent by each health professional. RESULTS: In 1995, the CPS provided 14,562 services. Total costs amounted to L 1,356 million, and more than three quarters of this amount was attributable to the personnel working at the CPS. Unit costs ranged from L 5,300 (drug administration) to L 442,400 (family therapy involving two professionals for 90 minutes) The unit cost of psychiatric visits, psychologist consultations and nurse domiciliary visits were L 105,300, L 106,600 and L 78,000, respectively. CONCLUSIONS: This approach requires accessible data and is relatively simple to manage. Some refinements are required, especially to improve the methodology for the determination and the allocation of overheads. However, we are convinced that this cost accounting procedure provides acceptable estimates of the services provided by the CPS. These estimates suggest that charges to be used to fund NHS providers may be too low, especially if fee-for-service will be the main funding source.

[Acute bacterial nephritis in diabetics (author's transl)]. / Nefrite acuta batterica in diabetico.

The AA. describe an unusual form of severe grahm negative bacterial infection of the renal parenchima that occurs infrequently in adult patients, most of whom are diabetics. During the acute phase, the kidney becomes smoothly enlarged, with marked impairment of contrast material excretion. The urographic and echographic findings simulated a renal neoplasm; on the contrary the selective renal angiography excluded the presence of a neoplastic blood circulation. This bacterial infection produces an inflammatory infiltrate surrounding and occluding the interlobular arteries in the cortex, with secondary ischemy. A precious and appropriate antibiotic therapy causes a rapid return of renal function; on the contrary this process may produce a globally small kidney in the long run.

Thyroid and obesity: survey of some function tests in a large obese population.

Tests of thyroid function in 493 obese patients were compared with thyroid function in 3076 non-obese patients. No differences in 131I uptake by the thyroid were observed at 6 h or 24 h; the frequency distribution was gaussian or normal in both populations; the frequencies of normal, high or low T3 and T4 values in the two populations were likewise comparable. Further, no correlation was found in the obese subjects between 131I uptake (6 h and 24 h), T3, T4 and overweight; on the other hand, there was a significant negative correlation between 131I uptake (6 h and 24 h) and age. It would appear that thyroid function is normal in obesity.

[Food consumption in a community of the Parma district (Langhirano). Clinico-metabolic considerations]. / Consumi alimentari in un comune del parmense (Langhirano). Considerazioni clinico-metaboliche.

Referring to the results of a "pilot" nutritional investigation carried out in a representative mixed sample of a small community of Parma district (Langhirano), the AA. underline the clinical and metabolic implications resulting from the not quite correct nutritional behaviour observed. In fact, in agreement with the national average data reported for italian population from ISTAT, caloric excess, particularly of dietary fat and proteins, was confirmed in this community too. Nevertheless, want of vitamins (D, B1, B2), and minerals (Ca) was paradoxically found. Considering in detail the results some immediate clinical and metabolic consequences come out: namely, want of Ca is prevailing in women and just in the critical age classes (20-40 and 50-59 years, that is in fertile and climacteric ages). When the recommended intake levels are higher. Ferthermore in male-populations, in the class aged 30-50 (that is more vulnerable as to atherosclerosis), was found the highest caloric intake besides in fat and particularly in cholesterol, as to the recommended safety levels. The A.A. conclude pointing out the importance and the necessity of a nutritional notions wide spreading, involving the various responsible public health and social politic organisation of the Country.

Epidemiological aspects and social importance of obesity. The situation in Italy compared with other developed countries.

Epidemiological aspects of obesity have been the object of few studies in Italy, and the results of these are reviewed and compared with those obtained in other developed countries. The prevalence of obesity has been investigated in pre-school and school-age children, in young conscripts and in workers at the Riuniti Hospital in Parma, and the results show that the problem of obesity in Italy is a serious one. More than 2000 obese subjects, attending the First Medical Clinic of Parma University, have been studied to establish how far overweight is responsible for pathological and disabling complications. Obesity was implicated as a major contributing factor in diabeties, atherosclerosis, hypertension, arthritis and many other disabling diseases. The social aspects of the problems of obesity are discussed, together with possible preventive and curative measures.

[Epidemiological study on coronary risk factors in a population of clerks in Parma. Methods of research and 1st results]. / Indagine epidemiologica sui fattori di rischio coronarico in una popolazione impiegatizia di Parma. Metodica di ricerca e primi risultati

After a review of current literature, the AA. present the purposes and the methods of an epidemiological study on coronary risk factors in selected bank-clerks of Parma, in view to correlate the dietary factors, possible methabolic alterations, psychical behaviour, social and environmental position and coronary risk evaluated by electrocardiographic stress test. In this respect, the AA. report and discuss, as example of the reliability and validity of the investigative model followed, the preliminary results observed in the 274 subjects up to this time controlled.