BackgroundThe challenges posed by the rapidly ageing population, and the increased preponderance of disabled people in this group, coupled with the rising level of public expenditure required to service the complex organization of long term care (LTC) delivery are causing increased pressure on LTC systems in Europe. A pan-European survey was carried out to evaluate whether patterns of LTC can be identified across Europe and what are the trends of the countries along them.MethodsAn ecological study was conducted on the 27 EU Member States plus Norway and Iceland, referring to the period 2003-2007. Several variables related to organizational features, elderly needs and expenditure were drawn from OECD Health Data and the Eurostat Statistics database and combined using Multiple Factor Analysis (MFA).ResultsTwo global Principal Components were taken into consideration given that their expressed total variance was greater than 60%. They were interpreted according to the higher (more than 0.5) positive or negative correlation coefficients between them and the original variables; thus patterns of LTC were identified. High alignment between old age related expenditure and elderly needs characterizes Nordic and Western European countries, the former also having a higher level of formal care than the latter. Mediterranean as well as Central and South Eastern European countries show lower alignment between old age related expenditure and elderly needs, coupled with a level of provision of formal care that is around or slightly above the average European level. In the dynamic comparison, linear, stable or unclear trends were shown for the studied countries.ConclusionsThe analysis carried out is an explorative and descriptive study, which is an attempt to reveal patterns and trends of LTC in Europe, allowing comparisons between countries. It also stimulates further researches with lower aggregated data useful to gain meaningful policy-making evidence.Please see related article: http://www.biomedcentral.com/1741-7015/9/124

BackgroundStatins are among the most commonly prescribed drugs worldwide in the prevention of cardiovascular diseases and their effectiveness is largely acknowledged. The consumption of statins increased four-fold during the 2000–2010 decade in Italy and national and regional control policies were developed. Restrictions to reimbursement were fixed at the national level, whereas co-payment was introduced in some, but not all, regions. The aim of the present study is to assess the impact of such policies on the consumption of statins in Italy between 2001–2007 among outpatients.MethodsThe statin use was measured in terms of defined daily doses per 1,000 inhabitants per day (DDD/1000 inh. day) from May 2001 to December 2007. The study was conducted in 17 out of 21 regions, nine of which had implemented a co-payment policy. Time trends in consumption before and after the introduction of co-payment policies and reimbursement criteria were examined using segmented regression analysis of interrupted time-series, adjusting for seasonal components.ResultsThe consumption of statins increased by 22.9 DDD/1000 inh. day in May 2001 to 54.7 DDD/1000 inh. day in December 2007. On average, there was a 1.7% increase in statin use each month before the national guideline changed while the increase was about 0.5% afterwards. The revision of the reimbursement criteria was associated with a significant decrease in level (coefficient = −2.80, 95% CI −3.70 to −1.90 p-value <0.001) and trend (coefficient = −0.33, 95% CI −0.37 to −0.29 p-value <0.001). The introduction of co-payment was associated with a significant change in trend of consumption so that the overall use of the drug increased by 0.04 (95% CI 0.02 to 0.07, p-value < 0.001) DDD/1000 inh. day per month in the post-intervention period, but there was no evidence of a change in level of consumption (p-value = 0.163).ConclusionsConsumption of statins in Italy increased almost three-fold during the study period. The restriction to reimbursement Interventions was associated with an immediate drop and a decrease in trend of statin use, while the regional copayment was associated with a small increase in trend of statin use.

The implementation of copayment policies in Italy affected both the use and expenditure of SSRIs between 2001 and 2007 to only to a minor extent.

Introduction. The navicular bone is the keystone of the foot medial longitudinal arch and is an active participant in the transverse tarsal locking mechanism. The fusion of the talonavicular joint has been demonstrated to significantly reduce the motion of the subtalar and the calcaneocuboid joint and severely limit the excursion of the posterior tibial tendon. Navicular fractures are quite rare injuries, but, because of the importance of this bone in foot motion, undiagnosed, mismanaged, or delayed diagnosed fractures can cause serious complications. Nowadays, the literature that describes the management of the navicular fractures is limited; open reduction and internal fixation is the gold standard for treatment of navicular fractures, but there is no consensus about the preferred technique to use in these fractures. Case report. Two cases of navicular fracture associated with other mid-foot fracture treated with cerclage are presented. The navicular fractures were fixed with screws and a cable-wire passed circumferentially to the navicular bone through a trochanteric cable passer in order to prevent radial displacement of the fragments. Discussion. Review of the literature analyzing the management of acute navicular fractures including surgical management and post-operative treatment. Conclusions. The use of cerclage with cable-wire and trochanteric cable passer is a good option of treatment for navicular fractures, but the availability of different tools and hardware studied for these fractures can help guide the surgeon to use less invasive and more conservative techniques, such as cerclage, an evolving and easily reproducible technique.