The Italian psychiatric reform of 1978 shifted the care of the mentally ill from the asylum to the community, by prohibiting new admissions to asylums and providing new community-oriented services. Ten years later, the Italian government is reviewing the effects of the psychiatric reform and is considering drastic revisions of the Law. However, few data are available to evaluate the impact of the new legislation on a national basis. The present cross-sectional study, conducted in North-Central and Southern Italy, showed that a more socially disadvantaged patient population was treated in Southern Italian mental health services. In both geographic regions, the probability of being currently treated in mental hospitals as compared to community services was increased by poor education, being unmarried, having a schizophrenia or organic diagnosis, a long psychiatric history, a long previous hospitalization, or a poor prognosis. However, a long psychiatric history was the main factor associated with current mental hospital treatment in Southern Italy but not in the North-Center, thus suggesting that the psychiatric reform has had different impacts on Northern and Southern mental hospitals. The inadequate provision of community-oriented services in Southern Italy regions, and the presence of private mental hospitals that are publicly reimbursed, contribute importantly to the unsatisfactory situation of mental health care delivery in Southern Italy. The reinstitutionalization of mental patients is currently proposed by some political parties in Italy. This article argues that new legislation must address the provision of effective community services in the South, better definition of the role of the private sector, and the creation of an effective information system to monitor the implementation of the proposed measures.

Community Mental Health Services↗

PubMed1988

Expression of human epidermal growth factor precursor cDNA in transfected mouse NIH 3T3 cells.

Stable cell lines expressing the human epidermal growth factor (EGF) precursor have been prepared by transfection of mouse NIH 3T3 cells with a bovine papillomavirus-based vector in which the human kidney EGF precursor cDNA has been placed under the control of the inducible mouse metallothionein I promoter. Synthesis of the EGF precursor can be induced by culturing the cells in 5 mM butyric acid or 100 microM ZnCl2. The EGF precursor synthesized by these cells appears to be membrane associated; none is detectable in the cytoplasm. The size of the EGF precursor expressed by these cells is approximately 150-180 kDa, which is larger than expected from its amino acid sequence, suggesting that it is posttranslationally modified, presumably by glycosylation. The EGF precursor was also detected in the conditioned medium from these cells, indicating that some fraction of the EGF precursor synthesized by these transfected cells may be secreted. Preliminary data suggest that this soluble form of the EGF precursor may compete with 125I-labeled EGF for binding to the EGF receptor. These cell lines should be useful for studying the processing of the EGF precursor to EGF as well as determining the properties and possible functions of the EGF precursor itself.

Animals↗

PubMed1988