Relationship between pathological gambling, alcoholism and drug addiction.

The aim of this survey was to evaluate the distribution of pathological gamblers treated in an alcohol or drug addiction treatment program run by the Italian National Health Service providing assistance to alcohol and drug abusers in Venice (North east Italy) from September 1 to December 31, 2001. Each drug- or alcohol-dependent patient retained for treatment for at least one month was administrated an anonymous precoded questionnaire to collect personal and socio-demographic features. The South Oaks Gambling Screen (SOGS) was used to measure pathological gambling and the Symptom Checklist-90-Revised (SCL-90-R) to measure psychological distress levels and psychiatric symptoms. Among the 113 enrolled subjects we found a greater prevalence of pathological gamblers among drug users than among alcoholics and drug abusers were younger than alcoholics; moreover, there was a prevalence of single status, low schooling, and a low-medium income despite full-time occupation. Only pathological gamblers revealed a significant positive correlation with a family history of gambling and reached positive scores (>1.5) for some likely psychiatric symptoms. Abuse disorders and pathological gambling are frequently associated with multidependence personality traits. Preventing substance abuse may reduce the pathological gambling rates and better results can be obtained with educational campaigns beginning earlier in life.

Diabetes outcomes within integrated healthcare management programs.

AIM: The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care. METHODS: The study was conducted at the "Vicentino Ovest" Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥ 20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care. RESULTS: The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group. CONCLUSIONS: The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition.

The risk of inadvertent intrauterine device insertion in women carriers of endocervical Chlamydia trachomatis.

The most important complication attributed to the use of intrauterine device (IUD) is pelvic inflammatory disease (PID), often associated with Neisseria or Chlamydia infection. Consequently, the IUD should not be inserted in women at risk of infection or with symptoms of endocervicitis. To evaluate the effectiveness of such a policy, a systematic investigation of Chlamydia and Neisseria was carried out among 407 contraceptive acceptors. Twenty-seven cases were positive for Chlamydia and none were positive for Neisseria. There were no statistical differences in the proportion of women with and without Chlamydia who had vulvovaginal or cervical signs or symptoms, although twice as many women had pain at pelvic exam in the Chlamydia-infected group. In 29 women in whom infection was clinically suspected, two were found to be infected with Chlamydia. IUD were not inserted in women suspected of having infection, but 19 of 327 IUD acceptors were subsequently found to have a positive Chlamydia test result. Two women returned with symptoms of PID and 17 were asymptomatic, but all were treated. PID was not suspected in any other subject. These results reinforce the need for careful selection of IUD acceptors and for thorough counseling for symptoms of PID and the need for immediate consultation.

Uniject as a delivery system for the once-a-month injectable contraceptive Cyclofem in Brazil.

This study assessed the administration of Cyclofem using prefilled Uniject devices. A total of 480 injections were administered divided equally between standard syringes and Uniject. The majority of women (82%) reported that they felt anxious prior to receiving the injection with Uniject. After injection, more than 80% expressed no anxiety about the appearance of Uniject or about the technique of injection. A total of 96.3% of the participants reported slight to no pain with Uniject. In comparison to the standard syringe, 5.6% expressed having had more pain with Uniject. Ninety percent of the service providers reported that Uniject was easy to activate and inject and that it was reassuring for users to know that the syringe and needle had never been used previously. Only two service providers demonstrated difficulties in activating the device. No accidental punctures occurred during the manipulation, and incomplete emptying of the Uniject was not observed. In conclusion, Uniject is a good device for the administration of the injectable contraceptive Cyclofem. It is likely to be appropriate for the delivery of other injectable contraceptives after the necessary stability tests have been performed.

Self-administration with UniJect of the once-a-month injectable contraceptive Cyclofem.

The objective of this study was to evaluate women's acceptance of and ability to self-administrate the injectable contraceptive Cyclofem using prefilled UniJect devices. A total of 102 women were invited to participate in the study. Fourteen women (13.7%) refused to participate. Of the remaining 88 women, 32 women (31.4%) consented to participate and were trained using oranges but were still afraid of the procedure and ultimately refused to self-administer the injections. Only 56 women (55%) ultimately self-injected Cyclofem with UniJect. They performed a total of 144 injections, all of them on the ventral side of the thigh. When nurses evaluated women's ability to activate the devices, they found that more than 80% were successful in both the group of women that later self-administered the injections and the group that did not. The evaluation of the self-administered injection technique showed that more than 90% of the women correctly self-administered the contraceptive using UniJect. With respect to the opinion of the women about the self-administration of the contraceptive, more than 50% (32 of 56) of women who self-injected preferred to self-administer the injection and said that they wished to continue with the self-administration, one-third (17) reported that they were afraid, and seven women (12.5%) expressed the opinion that the injection in the thigh was more painful than the administration in the buttocks or arm. In conclusion, our study showed that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to UniJect.

PIP: Women's capability to self-administer the monthly injectable contraceptive, Cyclofem, through use of prefilled UniJect devices was evaluated in 88 volunteers recruited from three Brazilian health clinics. After training in self-injection in which oranges were used for practice, only 56 of these women (55%) elected to continue with the study. They performed a total of 144 injections on the ventral side of the thigh. When nurses evaluated women's ability to activate the UniJect device, they found more than 80% of women trained in the method and 93% of those who actually performed self-injection used the technique correctly in an angle of 90 degrees. 32 (57.1%) of the 56 women who self-injected indicated they preferred this method and wished to continue to self-inject at home, another 17 (30.4%) reported they liked the method but were afraid to perform it on their own, and seven (12.5%) complained of pain associated with injection in the thigh compared with the buttocks or arm. Self-administration of injectable contraception, a popular method in Latin American countries, has the potential to increase contraceptive coverage as well as reduce costs associated with transportation to a source of contraception. If women are to perform self-injection at home rather than at a clinic, they will require reminders about the dates of reinjection and the importance of aseptic procedures and proper disposal of injecting equipment.

Attempted suicides in the municipality of Padua (Italy): a retrospective survey (1996-2000).

UNLABELLED: This study was conduced to determine attempted suicide (AS) rates in Padua between 1996 and 2000, to compare them with Italy and other Veneto areas. MATERIALS AND METHODS: It's an analysis of Police and Carabinieri reports. For each case, they indicate age, sex, marital status, mental and physical disorders, emotional disorders, alcoholism, drug addiction and method of attempted suicide. RESULTS: The annual rate of AS between 1996-2000 ranged from 14.3 (1996) to 3 (2000) per 10(5) inhabitants, with the highest rates in early Autumn; 57.7% of suicide attempts involved females. There is a peak between ages 25 and 34 years, with a higher incidence among females (p < 0.05). Divorce and single status appear to be important risk conditions, especially in females. Mental disorders (especially depression) are the most important condition prior to AS. Both genders have attempted suicide especially by poisoning or falling. CONCLUSION: In Padua AS rates are rather high by comparison with the regional average, but lower than in Verona. Marital status and loneliness (with various age-related peculiarities) influence AS rates and relational problems, inability to overcome frustration (in 10-44 year-olds) may play an important part. The use of educational tools, beginning in the early school years is very important, paying special attention to personal and family distress.

Seroprevalence of HIV infection among pregnant women in the Veneto region (north-east Italy).

A heterogeneous population of 4396 consecutive pregnant women (86.6% indigenous, 13.4% immigrants) attending the Department of Obstetrics and Gynecology of the University of Padua (north-east Italy) were counselled and tested for HIV infection between September 1995 and December 1997. Sociodemographic and sanitary data were collected on each case. Anti-HIV prevalence was 0.57%. Intravenous drug use and foreign birth accounted for 28% and 24%, respectively, of the anti-HIV positive cases; 44% of the HIV-positive subjects reported no risk factors. In the logistic regression HIV positivity proved independently associated with intravenous drug use (adjusted OR 76. 6), sexually transmitted diseases (adjusted OR 13.2), unmarried status (adjusted OR 4.8), birth outside the European Union (EU) (adjusted OR 3.1) and age (adjusted OR 1.1). Heterosexual HIV spread appears to be a major concern. The monitoring of trends in HIV infection among subgroups should be continued in order to control the AIDS epidemic appropriately both by promoting HIV counselling and individual care, and by watching for changes in the social background.

The influence of human chorionic gonadotrophin administration upon the next ovarian cycle.

We examined the influence of human chorionic gonadotrophin (HCG), used as an ovulation inducer and/or for supporting the luteal phase, on the next ovarian cycle. Four women received 10,000 IU of HCG at mid-cycle and another four received the same dose plus 1500 IU on the 17th, 19th and 21st days of the cycle. In the menstrual cycle prior to our experiments, venous blood samples were collected and vaginal ultrasound of the ovaries was performed every other day from day 21-28; the same data were also collected on days 1-10 of the experiment cycle. In such a way, control values were obtained. After the administration of HCG, venous blood samples were collected and ultrasound was performed in the same way and on the same days as in the controls. Follicle stimulating hormone (FSH) and luteinizing hormone were determined by radioimmunoassay in all blood samples, and HCG only in samples collected after the experiment. The results showed that only FSH was lower in the late luteal phase after the administration of 10,000 IU of HCG. Follicular diameters were higher during the follicular phase than during the previous cycle only in women who received the low dose of HCG. In addition, one woman presented with detectable HCG in the following ovarian cycle. The use of HCG in the preceding cycle may reduce FSH and develop persistent follicles in the subsequent cycle. We suggest that an ultrasound of the ovaries should be performed before starting a new ovulation induction cycle in a woman who has received HCG in the previous cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Performance of copper intrauterine devices when inserted after an expulsion.

A total of 124 women who re-inserted a TCu-200B intrauterine device (IUD) following an expulsion were followed up for 1 year after the IUD re-insertion. The cumulative expulsion rate at 6 months was 21.7 and 31.4 per 100 women at the end of the first year. Women who expelled the first IUD within the first 3 months of use had a significantly higher expulsion rate with the second IUD. Our conclusion is that women who expelled a copper IUD are at a significantly higher risk of expelling the re-inserted IUD than the first IUD. Health workers must also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.

PIP: Researchers analyzed retrospective data on 124 women aged 16-35 who had experienced spontaneous expulsion of the copper T-200 B IUD and then re-insertion of the same type of IUD at the family planning clinic of the State University of Campinas in Brazil during August 1986-December 1992. They were followed for 12 months after IUD re-insertion. Two senior nurses/midwives and two senior physicians performed 86 and 38 of the IUD re-insertions, respectively. Even though the re-expulsion rate was higher when performed by physicians than nurses (34.2% vs. 26.7%), the difference was not statistically significant. The net cumulative re-expulsion rates at 6 and 12 months were high (21.7% and 31.4%, respectively). There were few removals for medical and personal reasons. The 12-month continuation rate stood at 64.3%. Women who had experienced the first expulsion within 3 months after insertion had a significantly higher re-expulsion rate than those whose first expulsion occurred 3 months after insertion (41% vs. 18%; p 0.001). Both these re-expulsion rates were higher than the expulsion rate during the first period of IUD use in the same family planning clinic (3.1-3.9%). These findings suggest that women who have already experienced expulsion of a copper IUD face a much higher risk of expelling the re-inserted IUD than the first IUD. They also indicate that an expulsion after IUD re-insertion due to an earlier expulsion is more likely to happen than after a re-insertion due to life-span expiration. Providers should perform careful follow-up and adequate counseling to all IUD women who have had an IUD re-inserted after expulsion during the first year. The providers should also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.