A discussion of epidemiologic researches for the evaluation of psychiatric care is presented. With regard to the Italian context the author stresses the importance of analytical studies over the descriptive ones. The main design options for the evaluation of quality of care are then considered in the psychiatric framework.

Objective - To describe the cooperation in mental health that, since ten years, the Institute for Pharmacological Research ≪Mario Negri≫, Milan, is carrying out in Latin America. The project has developed along three main lines: the training of the mental health services personnel, the promotion of an epidemiological approach to the mental health care, and the assistance to the local health authorities in the field of mental health policy. Results - The most relevant goals of the project have been the Caracas Conference on the Latin American psychiatric hospitals and the constitution of an European Consortium for the technical cooperation with Latin America in mental health. Most of the activities have been done in cooperation with WHO regional office (Organización Panamericana de la Salud). Furthemore the paper outlines the main results of two epidemiologic studies carried out in Central America. Conclusions - The psychiatric hospitals phasing out, the setting up of mental health community-based services and the close cooperation between psychiatric services and primary health care services are the main objectives of a project of cooperation in mental health; training and epidemiological research must be the methodological tools of this type of cooperation.

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objective – The aim of this paper is to analyse long-term care in an area (Portogruaro) monitorized with a Psychiatric Case Register. Design – A cohort composed by patients included in 1987 prevalence was followed in 1992. Three hypothesis have been tested: a) long-term patients (LT) have a better prognosis than long-stay patients; b) clinical and socio-demographical characteristics of LT are significantly different from those of non-LT patients included in the cohort; c) clinical and socio-demographical characteristics of LT that are also high-users are different from those LT that are not high-users. Main outcome measures – Analysis was performed using generalised linear models; principal clinical and socio-demographical characteristics were considered. Results – The results confirm the first hypothesis, and show that two variables (previous psychiatric contact and employment) were associated with patterns of care in 1992. Highly significant is the correlation between patterns of contacts in 1987 and 1992, showing that particularly long-term and high-user patients tend to confirm their pattern over the years. Conclusions – These results underline the necessity for psychiatric services to commit themselves to the care of this group of patients, that constitute the «new chronicity».

Objective - Gathering, comparing and, if possible, commenting on datas and experimental evidences which have emerged in the principal literary works about mortality and psychiatric patients' causes of death. Particularly finding an answer (and a possible explanation) to some of the most important questions about these matters: does a psychiatric patient die easier than a healthy man? Does a correlation exist between nosographic diagnosis and causes of death? Finally do factors of risk, which are connected with death, exist? Method - The principal bibliographies which exist in national and international literature, from the middle of the last century until present days, have been consulted. Results - Essential agreement among existing dates in literature have emerged. Psychiatric patients dies easier than healthy man: rates of mortality have fallen from 6-7 (SMR), value of the middle of 1800 to 1,5-3 which is the value of present days. Respiratory, cardiovascular and, still, infectious diseases are the most important causes of death. There is not agreement about deaths caused by cancer. Some researchers affirm the protective action of psychiatric disease against the rising and diffusion of cancer. Non natural deaths (in primis suicide and accidental deaths) are rapresented too. All diagnostic categories (from alcholism to homosexuality, from organic brain disorders to schizophrenia) have a high risk of death while affective disorders have to be studied further. Young people have the highest risk. Conclusions - The frequency of physical beside psychic disease suggests to pay more attention to patient's general conditions even by some diagnostic ascertainments (TAC, RMN, etc) which are able to identify the most disabling conditions for the prognosis (diabetes, arterial hypertension, organic cerebral syndromes, etc).

Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.