COQ4 is required for the oxidative decarboxylation of the C1 carbon of coenzyme Q in eukaryotic cells.

Coenzyme Q (CoQ) is a redox lipid that fulfills critical functions in cellular bioenergetics and homeostasis. CoQ is synthesized by a multi-step pathway that involves several COQ proteins. Two steps of the eukaryotic pathway, the decarboxylation and hydroxylation of position C1, have remained uncharacterized. Here, we provide evidence that these two reactions occur in a single oxidative decarboxylation step catalyzed by COQ4. We demonstrate that COQ4 complements an Escherichia coli strain deficient for C1 decarboxylation and hydroxylation and that COQ4 displays oxidative decarboxylation activity in the non-CoQ producer Corynebacterium glutamicum. Overall, our results substantiate that COQ4 contributes to CoQ biosynthesis, not only via its previously proposed structural role but also via the oxidative decarboxylation of CoQ precursors. These findings fill a major gap in the knowledge of eukaryotic CoQ biosynthesis and shed light on the pathophysiology of human primary CoQ deficiency due to COQ4 mutations.

COQ4 is required for the oxidative decarboxylation of the C1 carbon of Coenzyme Q in eukaryotic cells.

Coenzyme Q (CoQ) is a redox lipid that fulfills critical functions in cellular bioenergetics and homeostasis. CoQ is synthesized by a multi-step pathway that involves several COQ proteins. Two steps of the eukaryotic pathway, the decarboxylation and hydroxylation of position C1, have remained uncharacterized. Here, we provide evidence that these two reactions occur in a single oxidative decarboxylation step catalyzed by COQ4. We demonstrate that COQ4 complements an Escherichia coli strain deficient for C1 decarboxylation and hydroxylation and that COQ4 displays oxidative decarboxylation activity in the non-CoQ producer Corynebacterium glutamicum. Overall, our results substantiate that COQ4 contributes to CoQ biosynthesis, not only via its previously proposed structural role, but also via oxidative decarboxylation of CoQ precursors. These findings fill a major gap in the knowledge of eukaryotic CoQ biosynthesis, and shed new light on the pathophysiology of human primary CoQ deficiency due to COQ4 mutations.

Electroclinical Features in Two Novel STRADA Patients and a Functional Yeast Assay for the Validation of Missense STRADA Mutations.

Loss of function of the STRADA gene, an upstream mTOR inhibitor, causes a rare neurodevelopmental disorder characterized by polyhydramnios, megalencephaly, and symptomatic epilepsy (PMSE syndrome). Patients display a homogeneous phenotype including early-onset drug-resistant epilepsy, severe psychomotor delay, multisystemic comorbidities, and increased risk of premature death. The administration of sirolimus, an mTOR inhibitor, is helpful in controlling seizures in this syndrome. We report the electroclinical phenotype of two novel patients and the development of a yeast model to validate the pathogenicity of missense variants. Patient 1 harbored a missense STRADA variant and had a peculiar electroclinical phenotype with a relatively mild epilepsy course. Patient 2 harbored a truncating STRADA variant and showed a typical PMSE phenotype and a favorable response to early treatment with sirolimus. When we modeled the p.(Ser264Arg) STRADA change in its yeast homolog SPS1, it impaired SPS1 function. The results underlie the importance of a timely molecular diagnosis in these patients and show that yeast is a simple yet effective model to validate the pathogenicity of missense variants.

Assessment of the correlation between wing size and body weight in captive Culex quinquefasciatus.

INTRODUCTION: Mass production of mosquitoes under laboratory conditions allows implementing methods to control vector mosquitoes. Colony development depends on mosquito size and weight. Body size can be estimated from its correlation with wing size, whereas weight is more difficult to determine. Our goal was to test whether wing size can predict the weight. METHODS: We compared dry weight and wing centroid size of Culex quinquefasciatus reared at different temperatures and four diets. RESULTS: Weight and wing size were strongly correlated. The diets did not influence wing size. CONCLUSIONS: Wing centroid size is a good predictor of Cx. quinquefasciatus body weight.

A new risk-adjusted Bernoulli cumulative sum chart for monitoring binary health data.

To monitor a health event in patients with a specific risk of developing the event, a risk-adjusted cumulative sum chart is needed. The risk-adjusted cumulative sum chart proposed in the literature has some limitations. Setting appropriate control limits is not straightforward, there is no simple formula for constructing them, and they remain sensitive to changes in the underlying risk distribution and the baseline incidence rate. To overcome these limits, we propose a new risk-adjusted Bernoulli cumulative sum chart as a simple and efficient solution. Analyses of simulated and real data sets illustrate the performance and usefulness of the proposed procedure.

Padronização de técnica para produção em massa de 'Culex quinquefasciatus' (Diptera: Culicidae) / Standardization of technique for mass production of Culex quinquefasciatus (Diptera: Culicidae)

Estabelecer um método para produção em massa do mosquito Culex (Culex) quinquefasciatus em laboratório, com o intuito de fornecer subsídio ao controle populacional desta espécie por meio da liberação de machos estéreis. Métodos Foi fundada uma colônia de Cx. quinquefasciatus a partir de imaturos coletados em janeiro de 2013 no rio Pinheiros, São Paulo/SP, Brasil. Os mosquitos adultos tiveram seus pesos secos mensurados e o desenvolvimento avaliado como o tempo para atingirem o estágio de pupa e a fase adulta. No primeiro experimento foram testadas quatro dietas diferentes (ração de peixe, ração canina, mistura de 50 por cento de ração de peixe e 50 por cento de ração canina ou uma mistura de 33,33 por cento de ração de peixe, 33,33 por cento de ração canina e 33,33 por cento de leite em pó) e três temperaturas (27 ± 2°C, 23 ± 2°C e 20 ± 2°C). No segundo experimento testaram-se diferentes quantidades de ração de peixe, densidades larvárias, volume e altura da coluna dágua Resultados - No primeiro experimento não houve diferença estatística significante entre as quatro dietas testadas e o tempo de formação até a fase de pupas e para o peso seco dos adultos. No entanto a ração de peixe proporcionou a menor mortalidade. A maior temperatura (27 ± 2°C) diminuiu o tempo do ciclo de vida dos imaturos, porém gerou adultos com pesos secos menores. No segundo experimento, a condição 0,5 mg/larva, 5 ml/larva em 2,1 cm de coluna dágua e a 27 ± 2°C ofereceu boa produção...

To establish a method for mass rearing of Culex (Culex) quinquefasciatus mosquitoes in laboratory, in order to provide subsidy to the population control of this species through the release of sterile males. Methods - A colony of Cx. quinquefasciatus was founded from immature collected in January 2013 in the Pinheiros River, São Paulo/SP, Brazil. Adult mosquitoes had their dry weights measured and the development was evaluated as the time to reach pupae and adult phase. In the first experiment it was tested four different diets (fish food, dog food, a mix of 50 percent fish and 50 percent dog food or a mix of 33.33 percent fish 33.33 percent dog food and 33.33 percent milk powder) and three temperatures (27 ± 2°C, 23 ± 2°C and 20 ± 2°C). In the second experiment it was tested several conditions of food amounts (mg/day), larvae densities (ml of water/larva) and water column height that would generate high development rate, low immature mortality and high adult dry weight. Results - In the first experiment there was no statistically significant difference in the time for the development to pupae stage or in the total dry weight of adults among the four experimental diets. However, fish food provided less immature mortality. The highest temperature (27 ± 2°C) decreased the time of the immature life cycle, but generated adults with lower dry weights. In the second experiment, the condition 0.5 mg/larva, 5 ml/larva in 2.1 cm of water column and 27 ± 2°C offered good mass...

Padronização de técnica para produção em massa de 'Culex quinquefasciatus' (Diptera: Culicidae) / Standardization of technique for mass production of Culex quinquefasciatus (Diptera: Culicidae)

Objetivo - Estabelecer um método para produção em massa do mosquito Culex (Culex) quinquefasciatus em laboratório, com o intuito de fornecer subsídio ao controle populacional desta espécie por meio da liberação de machos estéreis. Métodos Foi fundada uma colônia de Cx. quinquefasciatus a partir de imaturos coletados em janeiro de 2013 no rio Pinheiros, São Paulo/SP, Brasil. Os mosquitos adultos tiveram seus pesos secos mensurados e o desenvolvimento avaliado como o tempo para atingirem o estágio de pupa e a fase adulta. No primeiro experimento foram testadas quatro dietas diferentes (ração de peixe, ração canina, mistura de 50 por cento de ração de peixe e 50 por cento de ração canina ou uma mistura de 33,33 por cento de ração de peixe, 33,33 por cento de ração canina e 33,33 por cento de leite em pó) e três temperaturas (27 ± 2°C, 23 ± 2°C e 20 ± 2°C). No segundo experimento testaram-se diferentes quantidades de ração de peixe, densidades larvárias, volume e altura da coluna dágua Resultados - No primeiro experimento não houve diferença estatística significante entre as quatro dietas testadas e o tempo de formação até a fase de pupas e para o peso seco dos adultos. No entanto a ração de peixe proporcionou a menor mortalidade. A maior temperatura (27 ± 2°C) diminuiu o tempo do ciclo de vida dos imaturos, porém gerou adultos com pesos secos menores. No segundo experimento, a condição 0,5 mg/larva, 5 ml/larva em 2,1 cm de coluna dágua e a 27 ± 2°C ofereceu boa produção em massa e gerou maiores taxas de desenvolvimento, menor mortalidade de imaturos e maior peso seco em adultos. Conclusão - Não foi definida uma dieta ideal para uso na produção em massa, considerando os parâmetros analisados. A dieta menos custosa é a ração canina, porém deve ser moída manualmente ou em máquina, tornando a ração de peixe mais eficiente para ser diretamente aplicada nas bandejas de produção. O estudo sugere que a melhor condição para a produção massa do Cx. quinquefasciatus foi 0,5 mg de ração de peixe/dia por larva num volume de 5 ml/larva em 2,1 cm de coluna dágua e a 27 ± 2°C. O estudo sugere que esta técnica pode auxiliar no controle populacional dessa espécie

Objective To establish a method for mass rearing of Culex (Culex) quinquefasciatus mosquitoes in laboratory, in order to provide subsidy to the population control of this species through the release of sterile males. Methods - A colony of Cx. quinquefasciatus was founded from immature collected in January 2013 in the Pinheiros River, São Paulo/SP, Brazil. Adult mosquitoes had their dry weights measured and the development was evaluated as the time to reach pupae and adult phase. In the first experiment it was tested four different diets (fish food, dog food, a mix of 50 percent fish and 50 percent dog food or a mix of 33.33 percent fish 33.33 percent dog food and 33.33 percent milk powder) and three temperatures (27 ± 2°C, 23 ± 2°C and 20 ± 2°C). In the second experiment it was tested several conditions of food amounts (mg/day), larvae densities (ml of water/larva) and water column height that would generate high development rate, low immature mortality and high adult dry weight. Results - In the first experiment there was no statistically significant difference in the time for the development to pupae stage or in the total dry weight of adults among the four experimental diets. However, fish food provided less immature mortality. The highest temperature (27 ± 2°C) decreased the time of the immature life cycle, but generated adults with lower dry weights. In the second experiment, the condition 0.5 mg/larva, 5 ml/larva in 2.1 cm of water column and 27 ± 2°C offered good mass rearing and generated higher development rate, lower immature mortality and higher adult dry weights. Conclusion No ideal diet was defined for mass rearing in the parameters analyzed. The less expensive diet was the dog food, but this should be milled by hand or machine, which makes the fish food more practical in the production trays. This study suggested that the best condition for mass rearing of Cx. quinquefasciatus mosquitoes was 0.5 mg of daily fish food/larva, 5 ml/larva in 2.1 cm of water column and 27 ± 2°C. The study suggests that this technique can assist in population control of this species

[Routine health statistics are unknown]. / Le statistiche sanitarie correnti, queste sconosciute!

Caesarean section is a topic of particular attention and interest both for woman and newborn health, and for its economic implications. Unfortunately, there is inadequate information arising from Certificates of Attendance at Birth and Nosological Cards Discharge Hospital, in order to enable possible measures for reducing the excess of caesarean section as an alternative method to vaginal delivery. Moreover, the existing current health surveys do not distinguish properly between the various reasons of performing caesarean section, and do not provide a correct and exhaustive framework of the collateral aspects of this practice and the dramatic consequences which may result from maneuvers, such as manual fundal pressures, performed during delivery. Further investigations confirm the presence of unexplained, and therefore unjustifiable, discrepancies.

[Equity of access to percutaneous transluminal coronary angioplasty (PTCA) among patients with acute myocardial infarction in Tuscany Region (Central Italy), 2001-2008]. / Equità nell'accesso all'angioplastica coronarica transluminale percutanea (ACTP) nei pazienti con infarto miocardico acuto in Toscana, 2001-2008.

OBJECTIVE: assessing the equity in the access to the percutaneous transluminal coronary angioplasty (PTCA) and in its time trend among patients with ST-elevation acute myocardial infarction. DESIGN: observational study based on regional administrative data: Hospital Discharge Registry, Health Registry, and 2001 Census data. Two indexes were used as deprivation measure: deprivation status at small area level (as proxy of the individual deprivation) and deprivation status at Local Health Agency level. The residence in a mountain municipality was used as extra measure of contextual deprivation. SETTING AND PARTICIPANTS: patients with first emergency hospital admission for acute myocardial infarction (AMI) with ST-elevation, resident in Tuscany Region (Central Italy) and hospitalized during the period 2001-2008. MAIN OUTCOME MEASURES: relative risk (RR) of the PTCA utilization. RESULTS: multivariate analysis by multilevel multiple logistic regression showed a significant lower PTCA utilization in females (RR: 0.91, p <0.0001), in patients with high deprivation status at Local Health Agency level (RR: 0.71, p <0.0001), in residents in a mountain municipality (RR: 0.90, p <0.0001), and in patients with comorbidity (RR: 0.98, p =0.006; RR: 0.87, p <0.0001; RR: 0.69, p <0.0001 for Charlson comorbidity index equal to 1, 2, ≥3, respectively). The PTCA utilization over time has grown significantly (p <0.0001), from 26.6% in 2001 to 57.4% in 2008. This increase was more pronounced in patients with high deprivation status at Local Health Agency level (RR: 4.01, p <0.0001 for year 2008 vs. 2001), with consequent reduction of the initial differential with respect to patients with low deprivation status at Local Health Agency level (RR: 0.40, p <0.0001 in 2001 and RR: 0.93, p =0.114 in 2008). However, the differential associated with gender and residence in a mountain municipality persisted over time. DISCUSSION: In Tuscany during the period 2001-2008 a significant reduction of the differential in the PTCA utilization associated with the deprivation status at Local Health Agency level was observed. This finding could be explained by the diffusion and organization of suitable invasive cardiology units in the region, the organizational models of care, the different propensity to the PTCA utilization by the referral hospitals.

An inflatable ergonomic 3-chamber fundal pressure belt to assist vaginal delivery.

OBJECTIVE: To evaluate whether Baby-guard-a new medical device with an ergonomic 3-chamber inflatable abdominal belt-can reduce complications associated with vaginal delivery. METHODS: A randomized controlled single-blind prospective study of 80 pregnant women delivering at term was conducted at San Giuseppe Hospital, Empoli, Italy. In the study group (n=40), the abdominal belt was inflated to optimal therapeutic pressures. In the control group (n=40), the abdominal belt was inflated to minimal, non-therapeutic pressures. Factors relating to maternal, fetal, and labor complications during vaginal delivery were evaluated. RESULTS: Compared with the control group, women in the study group experienced a lower incidence of perineal and cervical lacerations (P<0.001); reduced use of the Kristeller maneuver (P<0.001); shorter duration of the second stage of labor (P<0.001); less psychologic and physical fatigue (P<0.001); fewer maternal requests for cesarean delivery during labor (P<0.001); fewer vacuum extractions (P<0.01); and fewer cesarean deliveries (P<0.02). No neonatal intensive care unit admissions were recorded in the study group versus 7 in the control group (P<0.012). CONCLUSION: Use of the ergonomic 3-chamber inflatable abdominal belt system reduced the incidence of risks associated with vaginal labor. Clinical trials.gov identifier: NCT01566331.

New records of mosquitoes carrying Dermatobia hominis eggs in the state of São Paulo, southeastern Brazil.

We found 4 species of mosquitoes bearing eggs of the human botfly, Dermatobia hominis, in the Reserva Municipal de Trabiju, Pindamonhangaba, São Paulo, Brazil. The mosquitoes were simultaneously collected in landing-biting catches by 2 collectors. From a total of 6,902 specimens collected from January through April 2010, the 15 females carrying D. hominis eggs belonged to Aedes scapularis, Limatus durhamii, Onirion personatum, and Wyeomyia confusa. The first 3 species are new reports of phoresy among mosquitoes and the human botfly.

[Socio-economic determinants of cancer survival in the municipality of Florence]. / I determinanti socio-economici della sopravivenza per i principali tumori nel comune di Firenze.

OBJECTIVE: The aim of the present paper is to evaluate cancer survival in patients resident in the municipality of Florence according to different deprivation levels. DESIGN: We used data from the Tuscan Cancer Registry and data from the national census 2001. We used a deprivation index, measured as a continue variable, classified in tertiles according to the distribution of the resident population. We compared more deprived patients (category 3) vs less deprived ones (category 1-2). MAIN OUTCOME MEASURES: 10-year relative survival has been computed for patients diagnosed with 27 different cancer sites during 1997-2002, for different deprivation categories. Cancer sites were split into three groups of the same dimension, on the basis of 10-year survival (bad, intermediate and good prognosis). For each category the relative excess risk of death (RER) for most deprived patients has been computed using a Generalized Liner Model. We evaluated also the effect of marital status, classified as married and non-married. RESULTS: We analysed 14 549 invasive cancer cases (out of skin epithelioma). Overall bad prognosis cancers did not show any RER of dying for most deprived patients. For intermediate prognosis cancers RER was 1.13 (1.02 ; 1.24). A excess occurs in the most disadvantaged tertile for tumors diagnosed under 50 years. For good prognosis cancers the RER was 1.06 (0.89 ; 1.26). We found a relative excess of mortality for non-married vs married. CONCLUSIONS: In the area of Florence there is an effect of deprivation level of survival for median-better prognosis cancers, for tumours diagnosed under 50 years and for unmarried people compared to unmarried ones.

Axillary block by "selective" injections at the nerves involved in surgery using a peripheral nerve stimulator: a comparison with a "standard" triple-injection technique.

BACKGROUND AND OBJECTIVES: A triple-injection technique (injections at the median, musculocutaneous, and radial nerves) for axillary block affords a high incidence of complete block (all the nerves below the elbow). However, in certain surgeries, only 1 or 2 nerves are involved in the surgical field. The aim of this prospective randomized study was to test the effectiveness of surgical anesthesia of a "selective" approach in which only the nerves involved in surgery were electrically located and injected. METHODS: Three types of surgery were selected. Type 1 included surgery on the fifth finger, type 2 included superficial surgery (without bone involvement) on the palm or on the dorsum of the hand, and type 3 included any surgery on the first 3 fingers. For each type, 138 patients were enrolled and divided into 2 groups: group SEL in which only the nerves involved in the surgical field (1 or 2) were located and injected and group TNS in which a standard triple-nerve stimulation technique was used. RESULTS: A lower rate of surgical anesthesia (84% vs 92%; P G 0.05)was recorded in group SEL considered as a whole: this was mainly due to the significant difference recorded in type 2 surgery (75% vs 93%;P G 0.05). More patients needed intravenous administration of fentanyl for tourniquet pain (18% vs 8%; P G 0.005) and of midazolam for intraoperative anxiety (20% vs 8%; P G 0.005) in group SEL considered as a whole. In type 1, improved patient comfort at block performance(P G 0.05), a 7-min saving on total anesthetic time (P G 0.001), and a higher need for midazolam administration (P G 0.05) were recorded in group SEL. In type 2, a higher need for midazolam administration(P G 0.05) was recorded in group SEL. In type 3, no clinically significant differences between the groups were recorded. CONCLUSIONS: A standard triple-nerve stimulation technique seems to be preferable to the selective approach even when a limited number of nerves are involved in the surgical field.

Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma.

BACKGROUND: The oncologic safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor and on the possibility of obtaining negative surgical margins (SMs). OBJECTIVE: To investigate the PS and SMs after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SMs. The risk of PS invasion related to other clinical and pathologic variables was also evaluated. DESIGN, SETTING, AND PARTICIPANTS: Between September 2006 and December 2007, data were gathered prospectively from 187 consecutive patients who had kidney surgery. Overall, 90 consecutive patients who had TE for RCC were eligible for the study. All specimens were evaluated using an image analyzer by a dedicated uropathologist. INTERVENTION: TE was done by blunt dissection using the natural cleavage plane between the tumor and the normal parenchyma. MEASUREMENTS: PS, SM, and routinely available clinical and pathologic variables were recorded. RESULTS AND LIMITATIONS: In 60 RCC tumors (67%) the PS was intact and free from invasion (PS-) while in 30 (33%) there were signs of penetration within its layers, with or without invasion beyond it. Indeed, 26.6% had PS that had been penetrated on the parenchymal side and 6.6% had penetration on the perirenal fat tissue side. The odds of having PS penetration increased significantly with an increase in clinical tumor size. PS penetration was also significantly associated with pathologic tumor dimensions and grade. In all cases the SMs were negative after TE. The present patients, followed for >2 yr, will enable us to correlate the risk of local recurrence with PS status. CONCLUSIONS: The risk of PS penetration is associated with clinical and pathologic tumor dimensions and grade. If there is PS invasion into normal parenchyma, the presence of a thin layer of tissue allows for negative SM even if a TE is performed.

[Health Search--Research Institute of the Italian Society of General Practice: the creation of a research database in general practice]. / Health search--Istituto di ricerca della Società italiana di medicina generale: la realizzazione di un database per la ricerca in medicina generale.

OBJECTIVE: To describe a database used in general practice by analysing the characteristics of the physicians providing the data and the completeness of the data recording on the basis of the indicators of interest (smoking habits, weight, height, and the prevalence of hypertension). DESIGN: Descriptive study and multiple linear regression analysis of the relationships between structural variables and outcomes. SETTING: General practitioners (GPs) belonging to the Italian Society of General Medicine (SIMG), and enrolled in Health Search (HS). POPULATION: Six hundred and ninety-five voluntarily enrolled GPs and their patients. PRINCIPAL OUTCOMES: Descriptive statistics (mean and median values, standard deviation, frequencies) concerning the general characteristics of the GPs, the ways in which they connect to the network and their use of the clinical data management software, and epidemiological measures concerning the prevalence of hypertension among their patients, and the recording of weight, height and tobacco smoking habits. RESULTS: The geographic distribution of the GPs is homogeneous: 317 in Northern Italy (12.52 physicians per 10(6) patients), 134 in Central Italy (12.30 physicians per 10(6) patients) and 244 in Southern Italy and the Islands (11.89 physicians per 10(6) patients). Five hundred and ninety-five (85.6%) are males; their mean age is 46.7 years (SD +/- 3.8); the mean number of patients per physician is 1128; 69% have at least one post-graduate specialisation; 49% practise alone; and they work for a mean of 30 hours per week (SD +/- 13). Five hundred and fifty-three GPs were actually connected to the network as of January 2003. The data relating to the years 2000-2001 show an increase in the number of connected physicians (34 in 2000 and 261 in 2001) and in the number of connections (a median of 12 in 2000 and 17 in 2001). The GPs contact more than 80% of their patients every year. The frequency of the recording of data concerning smoking habits, weight and height increases in proportion with the frequency of connections. The prevalence of hypertension among the patients included in the survey is 5.4%. Multiple regression analysis showed that the variability in the prevalence of hypertension was not influenced by the frequency of PC use but by the different structure of the age classes of the patients. CONCLUSIONS: This study of the variables relating to GPs, their clinical practices, and their use of computerised records (examined by means of the chosen indicators) shows that the regular and complete recording of the principal data of health interest is feasible insofar as it is not biased by the characteristics of the GPs, and advantageous. The construction of the database therefore represents a first step towards the initiation of routine research into general practice in Italy.

[Efficiency of guidelines and educational program: a training process for the diagnosis of low back pain]. / Applicabilità di linee guida e formazione: un percorso diagnostico per il mal di schiena.

BACKGROUND: The Italian National Health Plan has included low back pain (LBP) among the pathologies for which clinical guidelines should be created and disseminated. A change in the clinical behaviour of doctors requires forms of intervention whose efficiency is not fully known. OBJECTIVES: This study proposes to evaluate the efficacy of a multifaceted intervention, including educational materials, lectures, workshops and local consensus processes, in order to modify the General Practitioners' (GP) clinical treatment of LBP. METHODS: Changes in diagnostic capacity have been evaluated through a controlled (before/after) trial based on the frequency of etiological diagnoses of LBP, the testing of clinical knowledge with multiple choice tests, and on priorities given in confronting problems of treatment of LBP by the three GP's groups that had voluntarily adhered to the study. RESULTS: A statistically significant increase of diagnostic capacity (the frequency of exact responses in the multiple choice test) was achieved. There was also a shifting of priorities in confronting problems in the treatment of LBP, from the diagnosis as a primary issue before intervening, to communication with the patient. CONCLUSIONS: Within the Italian context, the study also confirms the efficiency of a multifaceted intervention based on a training process aimed at modifying the clinical behaviour of the GP with respect to LBP.

Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases.

BACKGROUND: The aim of this study was to describe population and primary care morbidity and to examine how the differences vary across the diseases and are influenced by patients' demographic characteristics. METHODS: A comparison of the prevalence of four chronic conditions for 432747 patients from the Health Search Database (HSD) and 119799 individuals from a Health Interview Survey was carried out. A linear regression was performed to study the associations between age and difference in morbidity. RESULTS: Similar prevalence was found for diabetes and hypertension, whereas for chronic obstructive pulmonary disease (COPD) and gastroduodenal ulcer lower HSD prevalence was reported. Among females, age was always associated with morbidity difference. Among males, significant associations were found only for COPD (R2 = 0.81; p = 0.001) and gastroduodenal ulcer (R2 = 0.93; p < 0.001). CONCLUSIONS: The difference between population and primary care morbidity is affected by disease under investigation and patients' demographic characteristics. Therefore, in choosing the more cost-effective approach to collect data such evidence should be taken into account, and results should be interpreted with great caution.