Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting.

OBJECTIVES: Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually. STUDY DESIGN: This is a linked cross-sectional study. METHODS: In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested. RESULTS: The best health expenditure predictors proved to be PCS and SI (R2 = 0.15 and R2 = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R2 = 0.19). CONCLUSIONS: A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.

Environmentally sensitive molecular probes reveal mutations and epigenetic 5-methyl cytosine in human oncogenes.

There is currently an unmet need for reliable tools that allow for direct detection and quantification of modifications in genomic DNA. For example, in cancer research and clinical diagnostics, target DNA has to be amplified and sequenced in order to reveal mutations. For 5-methylcytosine detection, bisulfite treatment of DNA is applied for the analysis, which often leads to poor specificity and reproducibility of the results. Herein we describe a simple approach that specifically detects clinically significant modifications in the human oncogenes BRAF and KRAS. We prove that this can be done using a fast and reliable hybridization assay applying novel internally labelled oligonucleotide probes and optical detection methods.

[Respiratory disease caused by MMVF fibers and yarn]. / Patologia respiratoria da fibre e filato di MMVF.

The non-carcinogenic effects of vitreous fibres on the human respiratory apparatus have been the subjects of numerous studies on large exposed populations. No evidence seems to have been produced of the existence of a fibrogenic effect. However, no definite and agreed opinion has yet been expressed by the main Agencies and Institutions working in the field of prevention. As a contribution to the discussion, the paper presents the experience of the Clinica del Lavoro of Milano involving 1000 subjects who underwent broncho-alveolar lavage during assessment and checking for suspected occupational respiratory disease. A group of 23 cases was selected who were exposed to vitreous fibres without other significant exposures to factors considered hazardous for the respiratory apparatus, especially asbestos. We observed 7 cases of alveolitis; 6 cases with pleural thickening; 2 cases of interstitial disease. On the basis of the nature of exposure (duration, latency from beginning and from the end of hazardous occupation), of the data obtained from the examination of the bronchial lavage liquid (presence of vitreous fibres, siderocytes, cellularity), and of the clinical and laboratory data (X-ray, PFR), the view expressed is tendentially reassuring concerning the possible effects of vitreous fibres on the respiratory apparatus. Although the existence of an irritative type of lesion that manifests in the form of alveolitis and localised pleural thickening seems possible, albeit in a limited number of cases, it does however appear much more difficult to admit the existence of a fibrogenic effect.

[Auditory thresholds in young Italians from 18-19 years of age]. / La soglia uditiva in giovani italiani di 18-19 anni.

The aim of the study was to assess the state of hearing levels in young Italian subjects via an epidemiological study, and also, by means of a questionnaire, to assess the attitude of young people to music, how they listen to music and how they perceive the risk of noise-induced hearing damage. The sample studied consisted of 391 youths undergoing their first medical examination for military service. The hearing threshold was assessed by means of a semiclinical tonal audiometry with sound-proof earphones calibrated to ISO Standard 389 following the method of ISO Standard 6189. At the end of the study 315 youths were judged eligible for the study, 81% of whom lived in the city of Milan. 63% said they went to a discotheque 1-4 times a week and 3% said they listened to music with earphones at maximum volume. These conditions are considered to be potentially dangerous for hearing since among youths leaving discotheques disorders have been observed that are indicative of hearing fatigue: lowering of the hearing level 7%, buzzing in the ears 37%, sense of muffled sound 12%. In the group studied, environmental noise was a factor of disturbance for sleep (13%), for study and reading (43%), listening to the radio, to music and watching TV (29%). Only 7 youths said their hearing was "not normal", but the thresholds were all higher than audiometric zero, which are clearly worse than the values observed in similar studies reported in the literature. This study reports the mean values, SD, minimum and maximum and centile values of the distribution of hearing thresholds, separately for right and left ears. A comparison was made between the hearing in the group least exposed: a significant difference was observed only for the right ear while for the left ear there was only a tendency. The authors conclude that hearing in young people to-day is worse than in the past, whatever be the causes, and that due account should be taken of this state of affairs, by encouraging prevention programmes for noise-induce hearing loss at all levels and on every possible occasion.

[Validation of the Italian version of the Kjellberg and Iwanowski's Mood Scale]. / Validazione della versione Italiana della Mood Scale di Kjellberg & Iwanowski.

Two questionnaires were administered to evaluate stress risk factors in 1652 employees of the Milan Town Council (772 Social Service personnel and 880 administrative staff). The study was focused on cardiovascular diseases. The Mopsy questionnaire is a selection of scales selected by the World Health Organization for international multicenter studies on cardiovascular morbidity, while the Mood Scale of Kjellberg & Iwanowski (1989) is a brief scale translated from Swedish used to measure "actual" stress and arousal state in neurotoxicology. The aim of the present study was to validate the Italian version of the Mood Scale for its possible use in health surveillance and research on stress and arousal changes at work. Appropriate statistical data analyses were applied to study the construct validity (factor analysis), concurrent validity (correlations with the Mopsy scale) and internal consistency (Cronbach alpha). The data confirm the Swedish results on the Mood Scale factor analysis. A good face and construct validity and a good internal consistency were observed. Nevertheless, the Mood Scale does not allow collection of demographic, anamnestic and personal data as does the Mopsy questionnaire.