In una recente intervista (Pincus & Ferris, 1993), Nancy C. Andreasen, nuovo editor dell' American Journal of Psychiatry (AJP), ha ricordato come la proposta di adottare il metodo della blind review, cioè della revisione degli articoli inviati per la pubblicazione da parte di referee ai quali non viene reso noto il nome degli autori, venga riproposta ad ogni riunione del Comitato Direttivo dell'AJP. Finora, dice Andreasen, il Comitato si è sempre espresso in senso contrario, sostanzialmente per due motivi: il primo è che alcune Unità di Ricerca ed alcuni gruppi sono noti per essere più rigorosi di altri e questa «autorevolezza» è utile al referee per prendere una decisione; il secondo dipende dalla difficoltà di fare una review veramente blind, in quanto lo stile, la bibliografia e altri elementi spesso rendono possibile o addirittura facile l'identificazione degli autori del lavoro. Ciò non è giusto per quelli che invece non vengono identificati.

Il problema di assicurare una valutazione equilibrata e non distorta degli articoli inviati potrebbe più semplicemente essere risolto: a) facendo in modo che la revisione «in aperto» da parte dei referee sia fatta da persone non solo competenti, ma anche disinteressate, attendibili e note per la loro correttezza; b) garantendo ampia possibilità di accesso alla pubblicazione anche ai gruppi «minori» o agli autori che lavorano fuori dalle istituzioni più note, purché ovviamente i loro articoli soddisfino gli standard di qualità della rivista in questione. Il punto cruciale, dunque, è la scelta dei referee, scelta che spetta quasi sempre al direttore della rivista.

Objective. - To test by means of ROC analysis the performance of the Symptom Questionnaire (SQ) of Kellner and Fava against an interview designed for making DSM-III diagnoses in 517 subjects. To analyse the trend of SQ scores at 3 months, 1 year and 2 years after the first interview in a sample of 112 persons. Design. - Cross-sectional and longitudinal analysis of the distributions of SQ scores in DSM-III cases and in non-cases. Setting. - General practice, hospital medical wards and emergency departments of Regione Emilia Romagna. Main outcome measures. - Symptom Questionnaire, Bech Mini-compendium to formulate DSM-III diagnoses. Results. - The SQ reached high sensitivity and specificity levels (80%, 76% in general practice, 86%, 74% in hospital medical wards, 83%, 85% in emergency departments with the cut-off scores of 24, 24 and 26, respectively). SQ scores show a similar trend in cases and in non-cases, with a significant drop at three months. Conclusions. - The SQ seems to be an adequate screening tool in the above-mentioned settings, but its length and the assistance sometimes needed during the compilation make its use in the emergency departments problematic.

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 - 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).