Aims – The aims of the study are to evaluate the prevalence rates for headache among an Italian sample of early-adolescents and the role of possible related factors (school stress and social support). Methods – The survey reported here is part of the larger Health Behaviour in School Aged Children (HBSC) trans-national study, which is co-ordinated by the European Office of the World Health Organization. The data were gathered through self-administered questionnaires filled out by a representative sample of 4, 386 (48.4% males) Italian students (11-, 13- and 15-year old). The main areas covered in the questionnaire were health and health behaviour. Results – The overall prevalence of frequent headache (at least once a week) was 40.5%. Boys are less at risk than girls and the prevalence increases with age. Moreover, school demands (positively) and teacher's support (negatively) showed a significant association with the outcome. Conclusions – Compared to other countries, results revealed how this symptom is very common among Italian's early adolescents. Further, results shows the relevance of the school setting, in terms of teacher's demands and support, for the prevention of this symptom among early adolescents.

Declaration of Interest: The HBSC study is partly funded by the University of Padova through a scholarship attributed to Dr. Alessio Vieno (Year 2001 - prot. CPDR013233).

Aims — Most of the available evidence on the relationship between socioeconomic indicators of social deprivation and patterns of use of mental health services has been produced in the United Kingdom, where the Ministry of Health has developed a resource allocation formula based upon the results of those studies. The main aim of the paper is to evaluate the replicability in the Italian context of such research, and of the resulting allocation strategies. Methods — Detailed description of the resource allocation method currently adopted in the United Kingdom, whose main purpose consists in reaching the best balance between available funding and patterns of need. Detailed description of resource allocation processes in Italy; discussion of the main methodological and statistical limitations restraining the replicability of the British formula in the Italian context. Conclusions — There is a growing interest in Italy towards the introduction of evidence-based methods in health decision making, in order to correct the overwhelming influence of political issues. What is needed is a better understanding of the relationship between higher levels of equity in health services access, and their effects in terms of better outcomes.

Declaration of Interest: the current paper has been developed within a Research Programme funded by the Agenzia Regionale per i Servizi Sanitari, Regione Piemonte (Deliberazione n. 54 del 31.07.02). None of the authors received any additional source of funding for the development of this paper as well as for the related research activities.

Objective – Cognitive Behavioural Therapy for the treatment of Social Phobia has proved effective through several controlled trials and meta-analyses. In spite of this the CBT has not spread in clinical field yet. Therefore our aim was to verify the effectiveness of the CBT in a public mental health service and to compare our results with those described by experimental research. Design and setting – Partecipants were 11 public mental health center clients, with a primary diagnosis of Social Phobia (according to DSM-IV criteria). The transportability of CBT to a common clinical setting was examined comparing treatment outcome data, at the end of the treatment and at a six months follow up, with results described in controlled efficacy studies. We employed self completion rating scales relating to both general health conditions and life satisfaction (SF36) and trend of symptoms (LSPS). Moreover we recorded the Clinical Global Impression (CGI) and Patient's Global Impression (PGI). Results – Despite differences in setting, clients and treatment providers, both the magnitude of change from pre treatment and maintenance of change at a six months follow up were comparable with the parallele findings in the efficacy studies. Conclusions –. The results attest the effectiveness of CBT even in a public mental health center setting so, in consideration of the fact that social phobia is a very common disease and involve high degree of severity, chronicity and disability, we hope that this effectual and relatively cheap therapy will be routinely applied in public mental health services.

Objective – This article critically reviews the European Agency for the Evaluation of Medicinal Products (EMEA) recommendations on the conduct of clinical trials in psychiatry. The EMEA is a regulatory body which provides the institutions of the European Community with the best possible scientific advice on the quality, safety, and efficacy of medicinal products. Method – Systematic review of recommendations, guide-lines and official documents available in the EMEA web site. Results – Out of nearly 400 documents, we identified 4 documents on the conduct of clinical trials in specific psychiatric disorders and 5 on the use of placebo or active comparator in evaluating a new drug's efficacy and on methodological issues in establishing difference and equivalence of effect. The EMEA recommends clinical trials to detect a difference between the compound under investigation and placebo, and to assess at least non-inferiority against an active comparator. A placebo arm is intended to validate the study. The EMEA supports the use of placebo only when there is no serious risk for the patient. In schizophrenia, depression and bipolar disorder the Agency suggests that a three-arm study is the design of choice, to demonstrate superiority against placebo and a similar balance against an active comparator. Conclusions – Despite the many effective therapeutic options available for the pharmacological management of psychiatric disorders, the EMEA regulatory process still relies on the demonstration of efficacy in absolute terms, against a placebo. We discuss this position and put at issue the possibility of developing a new generation of trials to demonstrate superiority of effect of new compounds over reference ones.

Aims – To compare different accreditation categories in Italy and to suggest some criteria to assess them. Methods – The A. compare specific characteristics of different model of normative and professional accreditation and suggest some criteria to distinguish different type of accreditation programme and to assess quality and usefulness of an accreditation programme. Results and Conclusions – Different types of accreditation are attributed to some basic criteria: voluntary/by law, high/low stan- dard, assessment object. Criteria to assess the usefulness are: check list accuracy, support to quality improvement, documental bur- den, services impact.

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.