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Geneva calling: WHO resolution on mental disorders
Corrado Barbui, Benedetto Saraceno
International Journal of Mental Health Systems , 2012, DOI: 10.1186/1752-4458-6-6
Abstract: Lack of political awareness and visibility of the resolution is a first major issue. Theoretically, Member States should be aware of the resolution and support its implementation at their respective national level, but in practice political commitment may not be high enough, and technical and financial resources made available may be limited. A second challenge is that the resolution suggests to work with Member States and technical agencies to promote academic exchange through which to contribute to policy-making in mental health. It is not straightforward, however, how such a statement may be effectively translated into action. A third key methodological aspect is how scientific evidence and factors other than scientific evidence will be handled. This seems particularly relevant in the field of mental health, where value-based decisions together with resource and feasibility considerations may be unavoidable.We argue that WHO and Member States should work together to increase the visibility of the resolution, ensuring that Ministries of Health and other relevant components of the health systems are aware of the resolution and its implications. As the resolution urges for academic exchange, WHO should develop a plan for an explicit, inclusive and open call for support and collaboration, so that partners willing to contribute are not kept out from the process. The production of an action plan for mental disorders should be based on scientifically sound methodology. Such a methodology should be transparently described, for example in a WHO process document, to make it clear how individual-level recommendations and policy-level guidance are developed. WHO should establish and maintain an open forum of experts, scientists, health officials and user groups worldwide to interact and agree on values, preferences, feasibility, acceptability, implementability, equity and economic issues that should inform the action plan.
Admissions for personality disorders in Italy from 1988 to 1998
Guaiana Giuseppe,Barbui Corrado
Clinical Practice and Epidemiology in Mental Health , 2006, DOI: 10.1186/1745-0179-2-20
Abstract: Background Personality disorders affect a substantial proportion of the population. It is unclear, however, whether the burden of personality disorders on modern mental health services has been increasing. To fill this gap, we analyzed trends in admissions for personality disorders in Italy from 1988 to 1998. Methods We used the yearly data from the Italian Central Institute of Statistics to analyse trends in the total number of admissions for personality disorders and in the total number of first admissions for personality disorders. Results The absolute number of admissions for personality disorders almost trebled from 1988 to 1998, as well as the proportion of all psychiatric admissions that were for personality disorders. Whilst there has been a marked increase in the absolute number of first admissions, the proportion of all first psychiatric admissions that were for personality disorders showed a steady but modest increase, from 5.7% to 7.6%. Conclusion In Italy, the burden of personality disorders on modern mental health services has been increasing. In terms of public health, these findings highlight the urgent need of developing policies to tackle the increasing demand of care of this difficult-to-treat patient population.
A New Approach to Psychiatric Drug Approval in Europe
Corrado Barbui ,Irene Bighelli
PLOS Medicine , 2013, DOI: 10.1371/journal.pmed.1001530
Using the needs of WHO to prioritise Cochrane reviews: The case of antipsychotic drugs
Marianna Purgato, Corrado Barbui, Clive E Adams
International Journal of Mental Health Systems , 2011, DOI: 10.1186/1752-4458-5-25
Abstract: We used the Cochrane Schizophrenia Group's register searching for all studies comparing the three antipsychotic drugs with each other and with all other pharmacological interventions listed on the Essential Medicines List (with the addition of 'placebo or no drug'). For each we also considered studies that focussed on administration, dose, withdrawal and use of that drug in specific circumstances administration. Data were then extracted on a number of studies, number of participants within those studies, and as to whether a maintained review already exists. Finally, every effort was made to consider as to whether there were possibilities for missing comparisons that no one had ever investigated.There has been considerable research activity involving the three 'essential' antipsychotics and also comparing those three drugs to others on the 'essential' list. We found 490 studies with 77957 participants for haloperidol, 316 studies with 29179 participants for chlorpromazine and 33 studies with 4503 participants for fluphenazine decanoate. Reviewing activity has also been considerable in this area but there are notable omissions which would necessitate new reviews to comprehensively cover the area.We have used the 'sample frame' of the WHO Essential drug list as a starting point. WHO prioritises for us those drugs that have universal accessibility but they may not be the compounds that are first choice if others are available. It is encouraging to see how many maintained reviews already exist to service those undertaking WHO guidelines. The needs of those guiding care can be taken as a means of prioritising research. For largest global impact WHO Essential Medicine list provides clear direction. By using this technique workload can be anticipated, prioritising can take place for new reviews and updates.The Cochrane Collaboration is a unique organisation producing as well as maintaining systematic reviews, mostly focussed on the effects of healthcare interventions [1]. T
Schizophrenia trials conducted in African countries: a drop of evidence in the ocean of morbidity?
Marianna Purgato, Clive Adams, Corrado Barbui
International Journal of Mental Health Systems , 2012, DOI: 10.1186/1752-4458-6-9
Abstract: We searched the Cochrane Schizophrenia Group Register, which contains 16,000 citations to 13,000 studies relating only to people with schizophrenia or schizophrenia-like illness, to identify schizophrenia trials conducted in Africa without time limitation.A total of 38 trials met the inclusion criteria and were included in our analysis. Of the 54 countries of Africa, only 8 produced at least one trial: South Africa produced the majority of trials (20 out of 38 trials, 53%), followed by Nigeria (7 out of 38 trials, 18%) and Egypt (4 out of 38 trials, 11%). The majority of studies investigated the efficacy of pharmacological interventions, were short in duration, and employed a double-blind design. The quality of reporting was generally poor. We found six trials comparing antipsychotics from the WHO Essential List of Medicine versus new generation antipsychotics. In terms of efficacy and acceptability, these studies failed to show any advantage of newer antipsychotics over first-generation agents.We observed an impressive mismatch between the number of individuals with schizophrenia living in African countries, estimated to be around 10 million, and the overall number of patients included in African trials, which is less than 2,000. These few trials were of low quality and appeared not to reflect the real needs of the population. We argue that the concept of pragmatism should be introduced into the design of randomized trials in African countries. Pragmatic trials should investigate whether treatments, given in real-world circumstances, really have clinically meaningful effects.
Forty-five years of schizophrenia trials in Italy: a survey
Marianna Purgato, Clive Adams, Corrado Barbui
Trials , 2012, DOI: 10.1186/1745-6215-13-35
Abstract: The aim of this study is to quantify trialing activity in Italy from 1948 until 2009 and to describe characteristics of these trials. In addition, we evaluated change over time in three keys aspects: sample size, follow-up duration, and number of outcomes.We used the Cochrane Schizophrenia Group's register that contains 16,000 citations to 13,000 studies relating only to people with schizophrenia or schizophrenia-like illness. Randomized controlled trials and controlled clinical trials undertaken in Italy and involving pharmacological interventions were included.The original search identified 155 records of potentially eligible studies, 74 of which were excluded because do not meet inclusion criteria. A total of 81 studies were included in the analysis. The majority of trials were conducted in north Italy, and published in international journals between 1981 and 1995. The majority of studies (52 out of 81) used standardized diagnostic criteria for schizophrenia disorder. They were defined as randomized and used blind methods to administer treatment. However, most failed to report detail regarding methodological procedures and it is difficult to ascertain which studies are associated with a low risk of bias.Trials should be designed to address the needs of everyday care with the aim of following large samples of typical patients in the long term. The Italian tradition in the area of trialing treatments for people with schizophrenia is not as strong as in many other similar countries and Italy should be producing more, better, independent, and clinically relevant trials.Good mental health research is critical to guide healthcare professionals to make informed decisions about the effects of most interventions. Early examples do exist of attempts at fair evaluation of healthcare, including several from Italy [1,2]. However, in 1948 the UK MRC Streptomycin randomized trial was published and remains a landmark of modern healthcare evaluation [3]. After that many specialti
Conhecimento do cliente diabético em rela??o os cuidados com os pés
Barbui, Elaine Cristina;Cocco, Maria Inês Monteiro;
Revista da Escola de Enfermagem da USP , 2002, DOI: 10.1590/S0080-62342002000100014
Abstract: the objective of this research is to evaluate how much the clients that frequently went to the diabetes ambulatory, knew about their own ill, and the feet care. in the sample - diabetes type 2 - the majority were people with more than fifty years old and 71.8% were diabetics for more than ten years. so the conclusion that could be taken is that the clients knew about the care that they must have with their feet to don't have complications, but the "own care" is not well done. to insert it in the rightly on their day-by-day they must have acess to the information about diabetes, participation of the family, motivation and their own hability.
Diagnosis of invasive fungal infections
Anna Maria Barbui,Corrado Girmenia,Giorgio Limerutti
Reviews in Health Care , 2013, DOI: 10.7175/rhc.42931s15-25
Abstract: A proper diagnostic strategy of invasive fungal infections (IFI) is a very important component in the management of infectious complications in hematological patients. A good diagnostic approach should be adapted to the patient in relation to the underlying disease, stage of disease, localization of infection and immune status. None of the diagnostic markers can be entirely adopted for medical decision making, and sometimes it’s useful to use the combination of several microbiological tests.The diagnosis of IFI must therefore have a multidisciplinary approach that includes clinical suspicion, microbiological results and radiological evidence.
Treatment Choices in Women with Bipolar Disorder Seeking Pregnancy: A Clinical Case Illustration
Corrado Barbui,Andrea Bertolazzi,Batul Hanife,Andrea Cipriani
Case Reports in Psychiatry , 2013, DOI: 10.1155/2013/630732
Abstract: After ten years of successful maintenance treatment with lithium and olanzapine, a 40-year-old woman with bipolar disorder expressed concerns about continuing the use of medicines, as she was planning a pregnancy. In the past, she had suffered from five severe manic episodes with hospital admissions. After consultations with the treating psychiatrist, gynaecologist, and family doctor, olanzapine was stopped and lithium was gradually withdrawn. After few months, the patient, still in treatment with lithium 300?mg/die, experienced a new manic episode with hospital admission. Treatment with lithium and olanzapine was restored, and she progressively recovered. This case suggests that the risk of manic recurrence after ten years of maintenance treatment may be as high as the well-known risk of recurrence after few years of maintenance treatment, a consideration that doctors may find useful in the light of a complete absence of evidence on treatment choices after five years of successful maintenance treatment. 1. Introduction This case highlights concerns around treatment choices in women with bipolar disorder seeking pregnancy [1]. While there is evidence that maintenance pharmacological treatment decreases the risk of recurrence, continuing treatment in women actively seeking a pregnancy bears a potential teratogenic risk for the foetus and is also associated with adverse effects. These concerns are particularly challenging in women who have been stable on maintenance treatment without manic or depressive episodes for several years, as after five years it becomes less clear if treatment continues to exert a protective effect [2]. Another challenge is that maintenance treatment with lithium may be particularly problematic to discontinue, with high rates of recurrence upon discontinuation [3]. 2. Case Presentation In March 2012, a 40-year-old woman with a long history of bipolar disorder discussed with the treating psychiatrist the possibility of planning a pregnancy. The patient had been free of manic episodes for ten years. She was on maintenance treatment with lithium 1,200?mg/die and olanzapine 2.5?mg/die and was worried about the potential teratogenic effects of lithium as well as the potential adverse effects of olanzapine during pregnancy. In the past, she had suffered from five severe manic episodes that had always led to hospital admission (Figure 1). Each episode was characterised by persistent elevation of mood, increased energy and activity, psychomotor agitation, aggressiveness, a decreased need for sleep, marked distractibility, and flight of
The CYTO-PV: A Large-Scale Trial Testing the Intensity of CYTOreductive Therapy to Prevent Cardiovascular Events in Patients with Polycythemia Vera
Roberto Marchioli,Guido Finazzi,Giorgina Specchia,Arianna Masciulli,Maria Rosaria Mennitto,Tiziano Barbui
Thrombosis , 2011, DOI: 10.1155/2011/794240
Abstract: Polycythemia vera (PV) is a chronic myeloproliferative disorder whose major morbidity and mortality are thrombohaemorragic events. Current guidelines advise maintaining hematocrit (HCT) level below 45% in males and 42% in females. Such targets lean on pathophysiological reasoning, while evidence from ECLAP and PVSG-01, the two largest prospective studies in this disease, suggests no difference in the rate of thrombosis in patients maintained at different HCT values below 50%–52%. Cytoreductive therapy in PV (CYTO-PV) is a multicenter, randomized, and controlled trial assess the benefit/risk profile of cytoreductive therapy with phlebotomy or HU aimed at maintaining HCT < 45% versus maintaining HCT in the range 45%–50%. CYTO-PV is being conducted in the framework of the Gruppo Italiano Malattie Ematologiche nell'Adulto (GIMEMA) and is funded by the Italian Drug Agency (AIFA). It is an independent trial with broad recruitment criteria to mimic clinical practice. We describe here the study and its advancement status. Conclusions. Clinical research in rare disease can be carried out with limited funds, provided a research hypothesis is felt as clinically relevant by a scientific community willing to share knowledge on the outcome of clinical practice, thus producing scientific results useful to improve treatment and prognosis of patients.
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