While patients without lesions reported a better QoL than patients with bullae/erosions, their Skindex-17 scores remained elevated. Dermatologists should be aware that a clearing of the skin manifestations does not mean 'perfect health' for the patient.

Health-related quality of life (HRQoL) in common variable immunodeficiency diseases (CVID) was evaluated by different tools, which were mainly used to compare different schedules of immunoglobulins administration in cross-sectional or short-term longitudinal studies. We assessed the HRQoL and psychological status of CVID patients in a longitudinal study over a 6-year period by a generic, non-disease-specific instrument (SF-36), and by a General Health Questionnaire (GHQ-12) for the risk of depression/anxiety. At baseline, 96 patients were enrolled. After 1 year, a second assessment was performed on 92 patients and, after 6 years, a third assessment was performed on 66 patients. Eighteen patients died during the study time. HRQoL was low, with mental health scales less affected than physical scales. A decline in the score on SF-36 scales was observed between the first and the third assessment for the Physical Functioning, Body Pain, General Health, Social Functioning, and Role-Emotional scales. The General Health scale showed a lower score in these patients, when compared to patients with other chronic diseases. Approximately one-third of the patients were at risk of anxiety/depression at all observation times, a percentage that reached two thirds of the patients, considering only the group of females. Over the 6 years of the study, the health condition of 11/66 patients worsened, passing from “GHQ-negative” to “GHQ-positive”; their score on SF-36 scales also decreased. A decrement of one point in each of the Physical Functioning, Vitality, Social Functioning, and Mental Health SF-36 scales increased the risk of developing anxiety/depression from three to five percent. A negative variation of the Physical Functioning score increased the risk of psychological distress. In a survival analysis with dichotomized variables, Physical Functioning scores <50 were associated with a relative risk (RR) of 4.4, whereas Social Functioning scores <37.5 were associated with a RR of 10.0. In our study, it was the clinical condition, as opposed to the different treatment strategies with immunoglobulins, which had a major role on the deterioration of HRQoL. Moreover, in a quality-of-life evaluation, disorders such as anxiety/depression should be assessed, as they yet often go unrecognized. Our results might be helpful in the interpretation of currently available data on quality of life in CVID patients.

Overall, the results suggest that PiNG is suitable for children in the age range considered to evaluate language abilities. It can be used together with other tools with clinical and theoretical objectives also to describe lexical abilities in atypical populations, such as children with cognitive and/or language impairment, as well as with late-talking children. Finally, the four subtests can be administered separately or combined, which provides flexibility in clinical use, in that the individual child's linguistic and/or cognitive characteristics and level can be taken into consideration.

The QS4-G seems to be a valid tool for identifying 4-year-old children at risk for low or borderline cognitive development and/or problematic behaviour who need a complete assessment. It can describe individual neuropsychological profiles. QS4-G is not a diagnostic tool. It is useful for outcome studies in preterm children and in other pathologies. It could also be useful for preschooler prevention programmes.

No abstract

This study provides evidence of the reliability and construct validity of the CVID_QoL to identify QoL issues in patients with CVID that may not be addressed by generic instruments.

Background In the framework of targeted action for continuous safety monitoring, we aimed to evaluate the consistency of indicators derived from available databases for regular reporting. Methods We used a quality of care interpretative model to select characteristics from five national databases, aggregated and linked by homogeneous groups of providers. The target population included all subjects admitted to public hospitals for acute care in four regions of Italy between 2011 and 2013. The association between structures, processes and safety-related outcomes was investigated using odds ratios from generalized estimating equations logistic regression. Outcome measures included claims of malpractice and five patient safety indicators calculated from discharge abstracts using standardized algorithms. Results Over 3 years, claims of malpractice and sepsis increased, whereas deep vein thrombosis and pulmonary embolism decreased. Hospitals with high vs. low volume of discharges were associated with −16% lower rates of claims, but +12% increased risk of sepsis. Compared with research institutes, university clinics had −17% lower rates of claims and −41% cases of dehiscence, with a +32% increased risk of deep vein thrombosis. Local health care authorities recorded −49% deep vein thrombosis, −26% pulmonary embolism, −40% sepsis and +37% risk of claims. Hospitals submitting cases of safe practices and implementing safety recommendations showed significantly higher rates for most outcome measures. Conclusions Indicators from regular databases can be conveniently used to develop a national safety monitoring system for hospital care. Although deeper analysis is needed, institutions with a higher propensity to implement safe practices and recommendations consistently showed higher rates of adverse events.

Direct medical costs were estimated using tariffs for laboratory tests, diagnostic exams, visits, and prices for drugs. Procedure and inpatient cost data were collected at Center level. Non medical costs included costs for travel and accommodation, domestic help and informal care. The loss of productivity of patients have been estimated using the human capital approach. The incremental effects of having comorbidities on social costs were estimated by multivariate Generalized Linear Models (log link, Gamma family) adjusting for gender, age, BMI, type of intervention and complications. Costs are expressed in Euro 2013. Results: Among 301 patients enrolled, 108 (36%) had hypertension, 53 (18%) T2DM and 47 (16%) ADD. The raw social cost of intervention were € 8,749 (± € 2,359), € 9,511 (± € 2,292) and € 8,999 (± € 2,275) for patients with hypertension, T2DM and ADD. A significant incremental effect of having T2DM was found on social cost of intervention (€ 751, 95%CI: 242-1,259, p= 0.004). 1 year after intervention reductions of 48%, 81% and 15% were observed for hypertension, T2DM and ADD. The raw social annual costs estimated were € 2,461 (± € 1,490) for hypertension, € 2,424 (± € 951) for T2DM and € 3,582 (± € 2,017) for ADD. Direct non medical costs and indirect costs represent the main component of social cost in patients with hypertension and ADD. ConClusions: Bariatric surgery led to reductions of obesity-related comorbidities. One year after, the economic burden is mainly sustained by patients, their families and the productivity system.