OBJECTIVES: To evaluate the distribution and scope of papers published in the world in otolaryngology (ORL) journals and to compare the impact of this research among different countries. METHODS: Papers published in the 29 ORL journals screened by the Institute for Scientific Information (ISI, Philadelphia, PA, USA) in the 6-year period 1995–2000 were considered. The journal impact factor (IF), the source country population, and gross domestic product (GDP) were recorded. All key words, both those assigned by the authors and those attributed by ISI, were identified and their frequency was calculated using a special-purpose program. RESULTS: The total number of papers in the ORL literature during the period 1995–2000 increased from 2036 to 3705. A percentage varying between 47.7% (1995) and 36.1% (2000) was published by EU authors whereas the USA accounted for a percentage varying between 28.1% (1995) and 38.8% (2000). In 2000, the leading countries were the USA, the EU, Japan, Canada, and Australia. In Europe the UK (28.5% of papers), Germany (26.2%), Italy (7.2%), Sweden (5.8%), France (5.5%), and the Netherlands (4.9%) showed a very good performance trend. In the same year, the mean IF of EU papers was 0.8 in comparison with 1.1 for Australia and the USA and 0.9 for the world. In 1997, 1341 key words attributed by the authors and 696 attributed by ISI appeared in the ORL literature. Less than a tenth of them were cited more than twice. The leading key words were “cancer” for disease and “surgery” for treatment. CONCLUSIONS: Bibliometric findings are useful to follow research trends. Our data show high scientific production of relatively small countries. Dispersion of key words should be avoided and journal editors should promote their standardization.

Objective: Arthritis is often associated with comorbidities. For many of them, such as hypertension, cardiovascular disease, chronic pulmonary disease, and upper gastrointestinal disease, arthritis and its treatment may also represent a risk factor. This study is concerned with an evaluation of the frequency of comorbidities in a cohort of patients with rheumatoid arthritis (RA). Methods: The discharge diagnoses of patients with RA during the period 1 January 1997 to 31 December 2000 were retrieved from the database of the Department of Internal Medicine of the University of Genova, Italy. The diagnosis of RA was made if the patient’s discharge record contained the code 714 of the International Classification of Diseases, IX revision, as first 3 numbers. The other diagnoses were also recorded along with demographic data, type and duration of hospital stay, and performed procedures. Results: During the study period, 427 patients with RA were admitted to the hospital for a total number of 761 admissions, which represented 2.2% of total admissions. Ninety-one (21.3%) patients did not have comorbidities, whereas 336 (78.6%) had one or more comorbidities. The most frequently observed comorbidities were cardiovascular diseases (34.6%), including hypertension (14.5%) and angina (3.5%), followed by gastrointestinal (24.5%), genito-urinary (18.7%) and respiratory (17%) diseases. There was a male predominance (p=0.004) within patients with comorbidities, who were significantly older (64.2±3.2 years vs. 57.2±4.2 years; p<0.001) and required longer periods of hospital stay (22.7 days vs. 12.5 days; p<0.001). Conclusions: Comorbidities are present in nearly 80% of RA inpatients. Comorbidity is a good predictor of health outcome, health services utilization, and medical costs. Because RA comorbidity can act as confounder, it should be considered in epidemiologic studies and clinical trials

The Polymyalgia Rheumatica (PMR) is a cronic inflammatory syndrome that affects the elderly population and whose diagnosis is mainly based on clinical criteria taking little advantage of the latest innovatory methods of diagnostic imaging, for instance ultrasonography. Although it is generally characterised by increasing of inflammation values as well as pain and stiffness on the shoulder and pelvic girdles, there is a significant percentage of patients with PMR whose erythrocyte sedimentation rate (ESR) is normal; in this case to make a diagnosis is difficult. The purpose of our study is to demonstrate how useful ultrasound investigations on the shoulders joints could be in order to make a diagnosis of PMR, especially for those patients with atypical normal ESR. Our case control study included 23 patients with atypical PMR and 88 patients with standard symptomatic PMR; both groups underwent shoulder ultrasound scans before receiving steroid therapy. As it has been previously shown, the ultrasound method is able to detect distinctive aspects in the joints and tissues of the patients with PMR; so that we could find that 90% of the patients with PMR of both groups suffered from bilateral subdeltoid bursitis. This disorder is seldom found in healthy people and consequently its presence could be considered a useful diagnostic test/check for/of PMR independently from ESR values

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Objectives: Goals of epidemiological studies are the description of the measures of frequency of diseases, the attempt to clarify possible etiopathogenic mechanisms, and the provision of data to support health policy decisions. To increase the familiarity of rheumatologists toward epidemiology, we describe the methodology used in a prevalence study of musculoskeletal complaints performed in Chiavari, Italy. Methods: A questionnaire, originally developed by the Epidemiology Unit of the Arthitis Research Council in Manchester, UK, to investigate the prevalence of rheumatoid arthritis, was used after translation and validation. 4456 subjects aged 16 years or more listed in four general practices were invited to participate in the study and to fill the ARC questionnaire. The 3294 responders reported a) any past occurrence of joint swelling lasting more than four weeks and the distribution of the swollen joints on a mannequin; b) any joint pain lasting more than four weeks; c) current joint pain or swelling; d) morning stiffness; e) whether they had been previously told by a doctor they had arthritis. Results: Four steps were necessary to obtain a 74% response, i.e. direct contact, two mailings and a phone interview. The performance of the different questions was good. The prevalence of the most common conditions among patients answering positively to the questions regarding morning stiffness and symmetrical swelling of joints was as follows: osteoarthritis 2.60%, fibromyalgia 1.30%, carpal tunnel syndrome 1.14%, rheumatoid arthritis 0.31%, and psoriatic arthritis 0.10%. Conclusions: Methodological issues regarding the selection of the population and sample to study, the development of a questionnaire, and the problems in obtaining valid informations are discussed