IntroductionEating disorders (EDs) are serious mental illnesses with multifactorial pathogenesis and biological, psychic, family, and sociocultural aspects. EDs are difficult-to-treat disorders that usually require strong therapeutic efforts implying high costs. The highest direct costs -in ED, as in mental health in general -are due to hospitalization. In Italy these costs are estimated on the bases of the Diagnosis Related Groups (DRG): 25 homogeneous groups of diagnoses with the same average production cost and the same refunding amount. Such a system does not reflect real costs and it does not enhance effectiveness of treatments. A good alternative to DRG could be an effective cost-benefit analysis.ObjectivesThis study aimed to: a) quantify effective costs of ED hospitalization and determine if DRG refunds are appropriate -referring to estimates of the Piedmont Region; b) structure an analysis of cost-effectiveness using an assessment performed with QALYs (Quality Adjusted Life Years, i. e. 1 QALY = 1 year in good health); c) determine if the cost of an hospitalization is adequate, as related to clinical progress and inpatient outcome.MethodsThe sample comprised 101 women with a severe ED diagnosis, hospitalized at the Psychiatry ward of Turin University ED Center between Jan 1st, 2006 and Jan 1st, 2008. Both at admission and discharge, patients were assessed with a version of the EQ-5D (EUROQOL) that has been modified using the CGI to determine the cost-quality ratio of the intervention and to calculate the variation in QALYs. The after-discharge course was assessed after 6 months on the basis of tests, symptomatology and Body Mass Index (BMI). Results The average cost per day multiplied by the average days of hospitalization (23.68) resulted in the cost of an average hospitalization, i. e., _ 9,235. Currently hospitalizations for anorexia nervosa are refunded with _ 2,231.85 and for bulimia nervosa with _ 1,959.64. At discharge was observed an average increase of 0.2 QALYs; a good outcome at the 6-month follow-up correlated with a higher increase in QALYs (Table I). QALYs at discharge indeed were associated with different therapeutic interventions after discharge.ConclusionsThe analysis of the value for money could represent an appropriate instrument to monetize inpatient interventions. This is already adopted by several Countries like UK, New Zealand, Australia, Sweden, etc. Hospitalizations in ED are advantageous, because on the average they show a statistically significant improvement of QALYs: unfortunately, the difference between the effective cost of hospitalization and the one of DRG is on average _ 7,300 per hospitalization. The DRG weight, calculated in ED hospitalizations (around 0.7), explains this difference: hospitalization for EDs indeed is considered to need the same resources as hospitalization for bronchitis (0.74 points) or for routine appendicectomy (0.72 points). The modified EQ-5D and the assessment with QALYs proved to be useful instruments in evaluating hospitalization also according to a predictive perspective. Clinical and economical implications are also discussed.

In 1999, renovation work in the 16(th) century crypt in Saint Peter's Cathedral, Bologna (Italy), uncovered a capuchin-type grave probably from the Early Middle Ages, containing commingled bones belonging to several individuals. A study of the osteoarchaeological material by the Laboratory of Bioarchaeology and Forensic Osteology of the University of Bologna identified two skulls of young males, both presenting signs of direct traumatic lesions produced peri mortem: one on the frontal, the other on the left parietal. The aim of the present study was to examine the lesions in relation to possible aetiological factors, Copyright (C) 2007 John Wiley & Sons, Ltd.

BACKGROUND AND OBJECTIVES:To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery. METHODS:Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment. RESULTS:No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups. CONCLUSION:When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Lesions attributable to Hyperostosis Frontalis Interna (HFI) were examined in two skulls (from graves 100 and 113) from the Early Middle Ages necropolis of Vicenne-Campochiaro (Molise, Italy). Both skeletons were of older individuals and it was difficult to sex them using standard anthropological methods. We discuss the sex identification of the skeletons in relation to the presence of HFI, as well as the usefulness of this pathological condition as a sex marker, underlining the importance of the relationship between palaeopathological and clinical-forensic studies. Our study is a further contribution to the case history of HFI in osteoarchaeological material. Copyright (c) 2006 John Wiley & Sons, Ltd.

Examination of the skeleton of an adult male from the Celtic necropolis of Casalecchio di Reno (Bologna, Italy; 4th–3rd century BC) revealed some lesions on the feet, especially bilateral acro-osteolysis of the metatarsals, and on the tibia, fibula and hand. The morphological and radiographic characteristics of the bones are consistent with a diagnosis of leprosy. Other features of the rhinomaxillary region support this diagnosis. As far as we know, this case could represent the oldest skeletal evidence of leprosy in Europe, indicating the early spread of this disease toward the Western world. Copyright © 2005 John Wiley & Sons, Ltd.

Analysis of the skeleton from tomb 144 of the early medieval necropolis of Vicenne-Campochiaro in Central Italy revealed several features indicative of leprosy. The skeleton belongs to a male estimated to be between 20 and 25 years of age at death. The distal halves of the 1st and 2nd left metatarsals present acro-osteolysis and both legs show severe subperiosteal bone reaction. The facial skeleton shows changes compatible with a chronic inflammatory process, possibly due to an infectious disease. The anatomical distribution of the lesions and their association with other skeletal lesions seems to be compatible with a near-lepromatous form of leprosy. A differential diagnosis is made, and the skeletal traits pathognomonic of leprosy are discussed. Copyright © 2005 John Wiley & Sons, Ltd.

Enthesopathies are alterations that could be present at entheses. Two types of enthesopathies have been defined: osteophytic (OF) and osteolytic (OL). In the present paper, we propose a standardized method to score the degree of development of each form of enthesopathy. With this method, the intra- and interobserver errors are less than 50%. The standard was used to study a sample (113 individuals) deriving from osteological collections from the late XIX-early XX century. Information about the age, sex and occupation of the individuals is available. This study demonstrated an effect of age on the form and the degree of development of enthesopathies. The influence of factors related to sex and occupation cannot be excluded. Therefore, functional interpretations of data on enthesopathies in osteoarchaeological series must take account of the estimated age and sex of the specimens and the distribution of the lesions within a single skeleton.

The paper will analyze some linguistic, primarily onomastic evidence of still existent or extinct crafts and occupations within the framework of the former social structure. Many one time crafts became extinct in the course of time, but traces of their former diffusion and importance can be reconstructed from their onomastic, primarily, anthroponomastic reflections. Similar surnames motivated by occupation can be found all across Europe. Some surname statistics in various European countries are given in the paper.

In recent years a number of studies of personality have been performed in subjects with Eating Disorders (EDs) to investigate the clinical differences between controls and ED patients and among EDs subtypes, and its role in the development and course of symptoms. The Tridimensional Personality Questionnaire (TPQ) and the Temperament and Character Inventory (TCI) have been widely used at this purpose, allowing the description of specific temperament and character profiles for EDs. High Harm Avoidance (HA) and low Self-Directedness (SD) are shared by all EDs. Slight differences on some facets have been found among ED subgroups. Nevertheless, HA is influenced by mood and both high HA and low SD are personality traits shared by many mental disorders, whose specificity is rather low. Restrictor anorectics are characterized by high Persistence (P) and a relatively higher SD, and bulimics by higher Novelty Seeking (NS) and the lowest SD, while binge/purging and purging anorectics share some traits with anorexia and some with bulimia. Though current data justify the discrimination among anorexia subtypes, they are not in contrast with the thesis of a continuum in ED personality traits. Since some personality traits display a prognostic value with regard to therapy and clinical outcome, further studies are needed on treatments and prognostic factors in EDs. Moreover, studies attempting to define the neurobiological and genetic correlates of temperament should be supported by clinical pharmacological trials.

Cribra orbitalia and cribra cranii are considered good indicators of the health and nutritional status of ancient populations, as their presence is often associated with chronic acquired anaemia. The distribution of these lesions in two Roman samples from the Ravenna area and Rimini was considered as a measure of health in relation to their respective environments. Enamel hypoplasia was also assessed as it is symptomatic of childhood physiological stresses such as malnutrition, infectious diseases, physiological traumas, and the like. The differential analysis suggests that the lesions observed are due to chronic acquired anaemia, probably caused by a poor diet, worm infestation, infections and parasitic diseases. Copyright © 2004 John Wiley & Sons, Ltd.

In this study, we used standardized methods to investigate masticatory and non-masticatory dental alterations (chipping, notches, interproximal grooves) in teeth from the epipalaeolithic necropolis of Taforalt (Morocco, about 12,000-11,000 BP). The particular distribution of some of the alterations could be related to avulsion of the upper central incisors, a systematic ritual characterizing all adult individuals of the necropolis. Because of this practice, the functions of the anterior teeth (cutting and tearing portions of food while eating, holding objects, etc.) likely shifted to the posterior teeth. Copyright 0 2004 John Wiley Sons, Ltd.

A research program financed by the MIUR (1998–2000) was carried out with the participation of eight Research Units of Italian Universities: Bologna (Coordinator: Fiorenzo Facchini), Ferrara (Coordinator: Carlo Peretto), Pisa (Coordinator: Carlo Tozzi), Rome (Coordinator: Pietro Passarello), Milan (Coordinator: Leone Fasani), Turin (Coordinator: Giacomo Giacobini), Bari (Coordinator: Vittorio Pesce Delfino), Siena (Coordinator: Arturo Palma di Cesnola).

The concept of frame size has not undergone a thorough evaluation in non-Caucasian populations. Using data from the Central Asia High Altitude Population (CAHAP) study, we tested whether: (1) the relationship between frame size and body composition is different in high-, medium- and low-altitude populations; (2) elbow breadth is a better index of frame size than biacromial and biiliac breadth; and (3) measures of frame size are associated with blood pressure, cholesterol and triglycerides. A number of 334 male subjects aged 33±10 years (mean±standard deviation) were selected from the CAHAP population (n=384) on the basis of the availability of breadth measurements. The subjects were 85 high-altitude Kirghizs, 105 medium-altitude Kazakhs, 79 low-altitude Kirghizs and 65 low-altitude Uighurs. A detailed anthropometric evaluation and blood pressure, cholesterol and trygliceride measurements were performed on all individuals. Among breadths, elbow had the lowest correlation with arm fat area, thigh fat area, calf fat area and the sum of trunk skinfolds (r≤⃒0.196, P<0.01). Even if elbow breadth did not have the highest correlation with muscularity indexes, its constantly lower association with adiposity indexes shows that it is a better measure of frame size than biacromial breadth and biiliac breadth. The relationship between frame size and body composition did not differ in high-, medium- and low-altitude subjects (P=not significant, analysis of co-variance). Only a weak association was present between breadths, blood pressure, cholesterol and triglycerides (r≤⃒0.230, P<0.01) and it was not influenced by altitude (P=not significant, analysis of co-variance). Elbow breadth was significantly correlated only with diastolic blood pressure (r=0.121, P<0.05). In conclusion: (1) the relationship between frame size and body composition is similar in high- and low-altitude populations; (2) elbow breadth is an index of frame size independent of altitude; and (3) elbow breadth is correlated with diastolic blood pressure, but this correlation is of doubtful biological relevance.

In order to focus the situation of Kazakhstan today in relation to the processes of modernization and transition to a market economy and to evidence their effects on the biology and health status of the population of Kazakhstan, we have reviewed recently available data for this region (1993-1999). Kazakhstan is still characterized by a pyramid shaped age distribution of its population and by a high incidence of not communicable diseases and lack of nutrient and micronutrients, especially among children. However, the population of Kazakhstan seems to be not immune to the diseases of the modernization. I.e., among women obesity is more frequent than underweight, especially in the urban areas. In rural populations the frequency of clinically relevant hypertension resulted low in the more isolated and traditionally living communities but it increased to 20% in the less isolated one. Although it is expected a strong increase of urbanized population in the next 25 years, currently, modernization is probably influencing life style and nutritional habits of almost only a minority of the inhabitants of Kazakhstan.

In the medieval necropolis of Vicenne (Italy) among 130 skeletons, thirteen horsemen, recognized on the basis of the contextual burials with horse, have been found. This rite, rarely found in Europe, recalls an Asian rite, attested from the Iron Age to the Age of Migration in nomadic Asian populations. Local and Germanic goods were also found. In order to study the anthropological composition of this population, some morphometrical skeletal features have been analyzed. Heterogeneity both in the horsemen and in the other males of the necropolis has been observed. Besides the multicultural context testified by archaeological data, a multiethnic society seems to emerge by the anthropological analysis. In these Italian territories, involved by migrations, Asian and Germanic population probably crossed with the local ones.

The aptitude for symbolization, characteristic of man, is revealed not only in artistic representations and funerary practices. It is exhibited by every manifestation of human activity or representation of natural phenomena that assumes or refers to a meaning. We can recognize functional symbolism (tool-making, habitative or food technology), social symbolism, (language and social communication) and spiritual symbolism (funerary practices and artistic expressions). On, the basis of these concepts, research into symbolism in prehistoric man allows us to recognize forms of symbolism already in the manifestations of the most ancient humans, starting with Homo habilis (or rudolfensis). Toolmaking, social organization and organization of the territory are oriented toward survival and the life of the family group. They attest to symbolic behaviors and constitute symbolic systems by means of which man expresses himself: lives and transmits his symbolic world. The diverse forms of symbolism are discussed with reference to the different phases of prehistoric humanity.

To evaluate adaptive responses to high-altitude environment, we examined three groups of healthy adult males from Central Asia: 94 high-altitude (HA) Kirghiz subjects (3,200 m above sea level); 114 middle-altitude (MA) Kazakh subjects (2,100 m), and 90 low-altitude (LA) Kirghiz subjects (900 m). Data on chest size (chest perimeter and chest diameter), lung volume (forced expiratory volume (FEV) and forced expiratory volume in 1 sec (FEV1)), and hematological parameters (hemoglobin, erythrocytes, hematocrit, and SaO(2)) are discussed. The results show that 1) chest shape is less flat in the samples living at higher altitude. In the HA sample, chest perimeter is lower but chest excursion is high. 2) In the highlanders, forced vital capacity (FVC) and FEV1 are no higher than in the other samples, even when corrected for stature and body weight. The negative correlation between FVC-FEV1 and age decreases with increasing altitude. 3) The HA and MA samples have higher values of hemoglobin, erythrocytes, and hematocrit. The HA sample has lower SaO(2) and higher arterial oxygen content than the LA sample. No association between hematocrit and age was detected in the four samples. The results indicate that the high-altitude Kirghiz present features of developmental acclimatization to hypobaric hypoxia which are also strongly influenced by other major high-altitude environmental stresses.

The teeth uf 94 individuals from the Celtic necropolis of Casalecchio di Reno (Bologna) (4th-3rd c. BC) were analysed to obtain information about the dietary habits, nutritional status and type of economy of the population. Dental wear, caries, tartar, ante mortem tooth loss (AMTL), abscesses and hypoplasia were considered. The frequencies of caries and tartar indicate a fairly well balanced diet. On the other hand, the low frequencies of AMTL and abscesses and the low degree of tooth wear indicate a rather good oral health. In addition, the low frequency of hypoplasia suggests a good general health in childhood. The homogeneous distribution of dental pathologies in the population implies little social differentiation, at least concerning dietary choices. It appears that the population had an economy based both on wild and cultivated vegetable products and on animal products from rearing and/or hunting.