Acupuncture for pain and pain-related disability in deep infiltrating endometriosis.

Objectives: To evaluate the efficacy of acupuncture in relieving symptoms (dysmenorrhea, dyspareunia, pelvic pain and dyschezia) intensity, improving functional disability, reducing the number of days per months of dysmenorrhea, the frequency and the efficacy of analgesic use in deep infiltrating endometriosis (DIE). The safety profile was also evaluated. Methods: The study sample was 34 patients with DIE; for 2 months (T-2, T-1) the women recorded diary notes on the numbers of days of menstruation, the presence, intensity, and disability related to dysmenorrhea, dyspareunia, pelvic pain, and dyschezia. They then received a total of 15 acupuncture treatments over 6 months (T1-T6; once a week for 12 weeks, then once a month for 3 months). Results: Dysmenorrhea intensity was decreased during treatment. A decrease of at least 50% in number of days of dysmenorrhea, and a decrease in moderate-to-severe disability starting from T1 to T6 was recorded for 58.6% of patients. Dyspareunia intensity steadily decreased starting at T2; the percentage of women with moderate-to-severe disability declined from 73.3% at T-2, to 36.9% at T3, T4, and T5. A decrease in pelvic pain score was noted starting at T1; the percentage of disability decreased from 83.3% at T-2 to 33.3% at T3 and T6. The intensity of dyschezia decreased from T-2 to T3 and T4 and then increased slightly. Analgesic drug use was lower during treatment and its efficacy appeared to be greater. Conclusions: The limitations notwithstanding our study-findings show that acupuncture was safe and effective in reducing pain intensity and symptoms-related disability. Larger-scale studies are needed to compare acupuncture and pharmacotherapy for endometriosis-related pain.

Triptans utilization in Italian population: A real-life study in community pharmacies.

The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.

"To me, it was Just a Vice". Stigma and Other Barriers to Gambling Treatment in Piedmont, Italy.

In Piedmont (northwestern Italy), as in the rest of the Western world, only a small percentage of the estimated problem gamblers (10-20%) turn to a treatment service to overcome their addiction issues. The study sought to gain a better understanding of the cultural factors that stand in the way of seeking help, thorough qualitative in-depth individual interviews with gamblers both in and out of treatment. A total of 30 interviews were conducted in three different health districts, most via video-call. Data were then analyzed using an abductive approach. The findings appear to indicate that the processes of stigma affecting problem gamblers and public gambling treatment services are the main barriers to seeking help. According to the interviewees, awareness of the problem is a necessary but not sufficient motivator for embarking on treatment, since social stigmatization leads them to hide the problem. Moreover, self-stigmatization processes seem to undermine the sense of self-efficacy that plays a key role in recovery. To encourage help-seeking, the study thus suggests that priority should be given to efforts to reduce stigma, i.e., through informational and educational measures together with advocacy interventions, which aim primarily to reframe the gambling problem, shifting responsibility from the individual to the collective level.

Self-exclusion from gambling: A toothless tiger?

While there is evidence for self-exclusion (SE) as an individual-level harm reduction intervention, its effects on reducing harm from gambling at the population level remain unclear. Based on a review of national legal frameworks and SE programs, including their utilization and enforcement in selected high-income societies, the present analysis aims to explore the reach and strengths of SE in the protection of gamblers in these jurisdictions. It places particular emphasis on SE programs' potential to prevent and minimize gambling harm at the population level. The overview examined SE in Finland, Germany, Italy, Massachusetts (USA), Norway, Sweden, and Victoria (Australia). These jurisdictions differ considerably in how gambling is regulated as well as in how SE is implemented and enforced. The reach and extent of enforcement of SE apparently vary with the polity's general policy balance between reducing gambling problems and increasing gambling revenue. But in any case, though SE may benefit individual gamblers and those around them, it does not appear to be capable of significantly reducing gambling harm at the population level. To render SE programs an effective measure that prevents gamblers and those linked to them from financial, social, and psychological harm, utilization needs to be substantially increased by reforming legal regulations and exclusion conditions.

The safety of acupuncture for migraine prevention during pregnancy.

Relief from migraine attacks may be obtained through non-pharmacological therapy during pregnancy when most drugs are contraindicated. There is accumulating evidence for the efficacy and safety of acupuncture for migraine in the general population but very little to no data on acupuncture during pregnancy. With this retrospective study, we wanted to determine whether an association exists between acupuncture treatment and preterm delivery and side effects of therapy. The initial study group was 68 women with migraine (29.78% with aura and 70.21% without aura), 47 of which responded to a questionnaire on acupuncture safety within 6 weeks of delivery. A so-called Formula Acupuncture was used for all these patients in order to permit comparison. Influence of acupuncture on gestational age at birth was carried out according to number of treatment sessions (more than and fewer than 10) and stratifying the study sample by age group (over and under 30 years) and risk pregnancy. Analysis showed no statistically significant difference in gestational duration between the two groups or an association between the number of acupuncture sessions and preterm delivery. Symptoms during treatment were generally transient or mild. The most common symptoms were relaxation, pain at the insertion sites, mild bleeding, and paresthesia. Our preliminary data indicate that acupuncture may be safe during pregnancy in women with migraine.

Addressing gambling harms by reducing the supply of electronic gambling machines: a comparative study of Italy and Finland.

BACKGROUND: Electronic gambling machines (EGMs) are amongst the most harmful forms of gambling. The high availability of EGMs is also linked to increased consumption. To reduce the burden of EGMs on public health, policies to reduce their numbers have recently been introduced in Italy and Finland. This study compares the aims and justifications of these legislative changes, as well as their overall impacts on total consumption. METHODS: The objectives and justifications of policies to reduce the number of EGMs were based on qualitative media analysis. The impacts on total consumption were measured using financial figures provided by gambling providers in Italy and Finland. RESULTS: Results show that the reductions in EGM numbers were justified in terms of public health concerns in both countries, but the amplitude of policies varied. In Italy, the reductions were more ambitious than in Finland, and included reductions in the number of gambling locations. The financial data nevertheless indicated that the reductions may not have been significant enough. CONCLUSIONS: Public health concerns were initially highlighted in the media discussions, but eventually in both countries reduction policies were less ambitious due to industry lobbying and state revenue interests. The reductions therefore do not appear to have been effective in reducing total consumption and the burden on public health.

The gendered relationship with drunkenness among different generations in Mediterranean and Nordic countries.

The study adopts a qualitative comparative approach to better understand how different dimensions affect social norms regulating alcohol consumption. Female and male attitudes towards drunkenness were analysed on the basis of data from 27 focus groups involving a total of 166 participants from Italy, Finland and Sweden, grouped by age cohort (17-20 and 50-65 years) and educational level. Results suggest that gendered drinking norms may be affected more by the drinking culture than by the degree of gender equality, thus providing a possible explanation of why gender differences in drinking are not always consistent with broader gender inequalities.

Prevention, education and counselling: the worldwide role of the community pharmacist as an epidemiological sentinel of headaches.

Headache disorders are the third among the worldwide causes of disability, measured in years of life lost to disability. Given the pharmacies' importance in general in headache patient and, in particular in migraine patient management, various studies have been carried out in recent years dealing with this issue. Indeed, in 2014, our research group first analysed publications on a number of studies conducted worldwide. As five years have passed since our first analysis of the literature and having carried out a number of specific studies in Italy since 2014, we wish to analyse once again the studies carried out globally on this topic to evaluate how the situation has evolved in the meantime. The key words used for the bibliographic search were "community pharmacy" and "headache"; we considered articles published between 2014 and 2018. The selected studies regarded Sweden USA, Belgium, Ireland, Jordan and Ethiopia. From the analysis of the international research papers, it is evident that, despite the time that has passed since the previous analyses and the general agreement that pharmacists find themselves in an ideal position to offer adequate levels of counselling to headache patients, the knowledge of pharmacists is not yet sufficient. Clearly, there is a strong need to develop training programmes specifically focused on this subject. Regarding Italy, a national study, commenced in 2016, was designed as a cross-sectional survey employing face-to-face interviews between pharmacist and patient using a questionnaire drawn up by experts in compliance with best practice from scientific literature. Six hundred ten pharmacists followed a specific training course; 4425 questionnaires were correctly completed. The use of pharmacies as epidemiological sentinels, given their capillarity and daily contact with the local population in Italy, enabled us to obtain an epidemiological snapshot closer to the real-life situation compared to specialist headache centres. Over the course of this study, data on headaches were gathered in Italian pharmacies with the highest levels of numerosity in the world.

Self-medication for migraine: A nationwide cross-sectional study in Italy.

Headache disorders are considered the second leading cause of years lived with disability worldwide, and 90% of people have a headache episode at least once a year, thus representing a relevant public health priority. As the pharmacist is often the first and only point of reference for people complaining of headache, we carried out a survey in a nationwide sample of Italian pharmacies, in order to describe the distribution of migraine or non-migraine type headaches and medicines overuse among people entering pharmacies seeking for self-medication; and to evaluate the association, in particular of migraine, with socio-demographic and clinical characteristics, and with the pathway of care followed by the patients. A 14-item questionnaire, including socio-demographic and clinical factors, was administered by trained pharmacists to subjects who entered a pharmacy requesting self-medication for a headache attack. The ID Migraine™ Screener was used to classify headache sufferers in four classes. From June 2016 to January 2017, 4424 people have been interviewed. The prevalence of definite migraines was 40%, significantly higher among women and less educated people. About half of all headache sufferers and a third of migraineurs do not consider their condition as a disease and are not cared by any doctor. Among people seeking self-medication in pharmacies for acute headache attacks, the rate of definite or probable migraine is high, and a large percentage of them is not correctly diagnosed and treated. The pharmacy can be a valuable observatory for the study of headaches, and the first important step to improve the quality of care delivered to these patients.

Depoliticising addiction: Who gets to speak in European press reporting, 1991-2011?

AIMS: The article presents an analysis of sources of information employed in mainstream print media reporting on addiction problems in Finland, Italy and Poland in the 1990s and 2000s. METHOD: A quantitative content analysis of frequency of different sources employed in articles in daily newspapers from Finland (N = 258), Italy (N = 296), and Poland (N = 212) from the years 1991, 1998 and 2011. Semantic units were coded in Atlas.ti. The societal spheres represented were identified using a common coding scheme broadly inspired by Boltanski and Thévenot's typology of polities of worth. Transformations were identified in line with van Leeuwen's framework for trends in discourse salience over time. RESULTS: The study highlights different patterns of coverage of addictions in the three countries. Over time, increased salience is given to the individuals affected by addictions and experts who represent biomedical sciences. This process occurred with varying intensity and expressiveness in all countries under study. CONCLUSIONS: Social and political sources were employed to less extent over time. The media focus seemed to shift to the affected individuals and scientific expertise. This confirms results from previous studies on a general move towards individualisation and an increased focus on more personal and technical aspects of addiction problems in the mass media.

Community pharmacies as epidemiological sentinels of headache: first experience in Italy.

Migraine is a disabling neurovascular syndrome which affects 12-15% of the global population and it represents the third cause in years lived with disability in both males and females aged 15-49 years. Among migraineurs, the symptomatic drug abuse may be a risk factor in the development of medication overuse headache (MOH). Detecting cases of MOH is not straightforward; community pharmacists may, therefore, be in a strategic position to identify individuals who self-medicate, particularly with respect to prevent the development of MOH. In 2014, our group published the results of a survey conducted in Piedmont, Italy, on the patterns of use and dispensing of drugs in patients requesting assistance from pharmacists for relief of a migraine attack. We decided, now, to expand the scope of the model to a national level. The study is based on cross-sectional face-to-face interviews using questionnaires, presented in this paper, consisting of a first part regarding the socio-economic situation and a second part which aimed to classify the disease and any excessive use of drugs. Of the 610 pharmacists trained with an online course, 446 gathered a total of 4425 correctly compiled questionnaires. The participation of community pharmacies has highlighted various criticalities especially of an organisational nature; however, it also revealed the power of this method as a means of gathering epidemiological data with a capillarity which few other methods can match. The objective was also to identify each territory's requirements and facilitate the decision-making process in terms of understanding what patients/citizens actually require.

What causes addiction problems? Environmental, biological and constitutional explanations in press portrayals from four European welfare societies.

Press items (N = 1327) about addiction related problems were collected from politically independent daily newspapers in Finland, Italy, the Netherlands, and Poland from 1991, 1998, and 2011. A synchronized qualitative coding was performed for discerning the descriptions of the genesis to the problems in terms of described causes to and reasons for why they occur. Environmental explanations were by far the most common and they varied most between the materials. The analysis documents how the portrayals include traces of their contextual origin, relating to different media tasks and welfare cultural traditions. Meaning-based differences were also assigned to the kind of problems that held the most salience in the press reporting. A general worry over societal change is tied into the explanations of accumulating addiction problems and underpins the press reporting in all countries.

The Italian politics of alcohol: The creation of a public arena at the end of the 20th century.

BACKGROUND: Political concern with alcohol as a social problem arose in Italy only at the end of last century, when consumption and the death rate from alcohol-related causes had both been trending down for decades. The main aim of this case study is to investigate - applying Wiener's theoretical framework - the role of different stakeholders in the process that led to the approval of the first alcohol framework law in 2001. METHODS: Fourteen individual interviews with stakeholders were conducted, covering all the main topics involved in Italian alcohol policies. In addition, 19 bills introduced in the Italian parliament were analysed to reconstruct the legislative process. Stakeholders' role was analysed, assessing their positions, contrasts and coalitions. The rhetoric employed in the course of public debate was also deciphered. RESULTS: All three of the main processes used by Wiener to describe the building of a public arena around alcohol - animating the problem, legitimizing it and demonstrating it - were found. The Club of Alcoholics in Treatment and professionals working with alcoholics in Local Addiction Services appeared to be the most active groups in supporting the law. They did so by establishing a strong alliance, even if their visions about the problem and how to solve it differed. CONCLUSIONS: The study showed that a shared vision is not as essential as 'combining for strength' in order to create a public arena around a social problem. Furthermore, not even scientific data are essential for demonstrating a problem, as the use of rhetoric seems to be more effective in building ideologies.

From criminals to celebrities: perceptions of "the addict" in the print press from four European countries from nineties to today.

The article reviews portrayals of "the addict" in press items from Italy, Finland, Poland, and The Netherlands. The dataset consists of 1,327 items from four national newspapers published in 1991, 1998, 2011. The portrayals varied according to country, period, and type of addiction problem. Results can be read as four cases where different conceptualizations ("the sinner," "the sick," "the social problem," "the criminal," and "the famous") assume diverse importance. These conceptual frames-of-reference are clearly neither unambiguous nor fixed. They are constantly modified and part of different trends.

The efficacy and tolerability of frovatriptan and dexketoprofen for the treatment of acute migraine attacks.

Frovatriptan is a triptan characterized by a high affinity for 5-HT1B/1D receptors and a long half-life contributing to a more sustained and prolonged action than other triptans. Dexketoprofen is a nonsteroidal anti-inflammatory drug with a relatively short half-life and rapid onset of action, blocking the action of cyclo-oxygenase, which is involved in prostaglandins' production, thus reducing inflammation and pain. Both drugs have been successfully employed as monotherapies for the treatment of acute migraine attacks. The combination of these two drugs (frovatriptan 2.5 mg plus dexketoprofen 25 or 37.5 mg) has been tested in migraine sufferers, showing a rapid and good initial efficacy, with 2-h pain free rates of 51%, and a high persistence in the 48-h following the onset of pain: recurrence occurred in only 29% of attacks and sustained pain free rates were 43% at 24- and 33% at 48-h.

Stakeholders' role in contemporary "substitute drug" prescribing policies in Italy.

This article, part of a comparative research project (WP2) funded by FP7 ALICE RAP, is based upon a review of literature and documents and 18 individual interviews with Italian national stakeholders (SHs) conducted in 2012. The goal was to identify the main shifts in opioid "substitution drug" treatment policies and understand the role played by different SHs during the last 30 years. The study confirms that opioid "substitution drug" treatment is a particularly suitable theme for improving knowledge in the field of SH analysis, even if results show that changes in policies are mainly due to external factors rather than to the action of SHs.

Migraine and pregnancy: an internet survey.

Data in the literature show that migraine tends to improve during pregnancy in most migrainous women. The aim of this Internet survey was to obtain the most likely cross section of the situation in the general population with respect to the presence and course of migraine in pregnancy. All women who participated were asked to answer questions pertaining to their history of pregnancy and headache. One thousand and eighteen women participated in the survey; only 775 met the eligibility criteria for inclusion. One hundred and ninety-five women (25.2 %) reported having had a headache only before pregnancy, 425 (54.8 %) before and during pregnancy, and 155 (20.0 %) only during pregnancy. Women suffering from headache before and/or during pregnancy were much more likely to have headaches with more migrainous features at the ID Migraine Screener test when compared to women whose headache began during pregnancy. "Definite migraines" were 277/620 (44.7 %) and 26/155 (16.8 %), respectively, in the two groups (p < 0.0001). Among the 620 females that suffered from headache before pregnancy, 375 (60.5 %) improved, 195 (31.5 %) showed complete resolution of the disorder, and 180 (29.0 %) had a reduction in headache frequency. Moreover, the multinomial logistic model (with headache pattern as dependent variable) proved fetal presentation as significant (p = 0.0042). Women with "new headache" (No/Yes pattern) had an OR (95 % CI) of 1.9 (1.2-3.0) of breech presentation at delivery versus those with a stable pattern of headache (Yes/Yes). Finally, women with not recent pregnancy stated they suffered from headache less than the women with recent pregnancy.