Alcohol Addiction: One Entity or Different Entities? A DSM-4-Based Attempt Toward a Geographicization of Alcohol Addiction and Abuse.

AIM: To examine whether in Europe perceptions of 'alcoholism' differ in a discrete manner according to geographical area. METHOD: Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing 'alcohol dependence' and 'alcohol abuse' were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis. RESULTS: The symptoms of 'alcohol dependence' and 'alcohol abuse', posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation. CONCLUSION: These patterns of perception seem to parallel the diverse drinking cultures of Europe.

Problematic drinking and health problems: an epidemiologic study through general practitioners in the Tuscany Region (Central Italy) and Friuli Venezia Giulia Region (Northern Italy). / Bere problematico e problemi di salute in Toscana e in Friuli Venezia Giulia: uno studio epidemiologico attraverso i medici di medicina generale.

"OBJECTIVES: to identify the differences among patients of general practictioners (GPs) in both Tuscany Region (Central Italy) and Friuli Venezia Giulia (FVG) Region (Northern Italy), which are different for drinking cultures, as to motivation of consultation, hazardous drinking and alcohol dependence, health problems, and use of health services. DESIGN: cross-sectional study by means of both a medical examination and a subsequent structured interview carried out with a questionnaire. Data were analysed using chi-square test, logistic regression and differences in prevalence. SETTING AND PARTICIPANTS: the study was implemented between July and November 2013 on a sample of 492 patients of 30 GPs in FVG, and 451 patients of 25 GPs in Tuscany. RESULTS: although patients in FVG were less likely to drink alcohol (66.7% vs. 70.9%), consumed lower amounts of alcohol on average per day per drinker (10.9 vs. 14.5 grams of alcohol), and were less likely to be hazardous drinkers (11.2% vs. 13.8%) compared to patients in Tuscany, they had a 3.6 to 4.7 times higher risk of alcohol dependence. In addition, the prevalence of diseases (in particular hepato-gastrointestinal diseases, hypertension, and psychiatric problems), smoking, and obesity/ overweighting was higher among clients of FVG, which exceed the Tuscan patients by 5-12 percentage points. Compared to Tuscany, FVG patients were more hospitalized and required more help to GPs or other people for their drinking problems. CONCLUSIONS: compared to Tuscan patients, GPs' patients in FVG has higher prevalence of alcohol addiction and other diseases, as well as of smoking and overweight/obesity, and higher need for health interventions as to their drinking problems."

[Changes in alcohol consumption from youth to adulthood in Italy]. / Le variazioni nel consumo di alcol in Italia dall'età giovanile a quella adulta.

BACKGROUND: alcohol consumption is a significant risk factor for health at all ages. Consumption patterns and associated risks vary across countries and cultures and are affected by socio-demographic characteristics. The objective of the study was to assess changes in alcoholic beverage consumption patterns from youth to adulthood in Italy, and specifically in the North, Central and South-Islands geographic areas. METHODS: subjects who consume wine, beer and spirits/bitters/alcoholic aperitifs, as recorded by the Istat Multipurpose surveys "Aspects of daily life", were grouped into non-drinkers, occasional drinkers and drinkers of at least one glass a day. The percentage distribution of consumers in the 14-24 year age group in 1998 was compared with that of the 30-39 year age bracket in 2013 through a multivariate logistic regression analysis. RESULTS: in 1998, 39.1% of subjects aged 14-24 years in Italy did not consume alcohol, with a higher prevalence in Central Italy (41.3%). The likelihood of being an alcohol drinker was greater in subjects aged 30-39 years in 2013 compared to those aged 14-24 in 1998, as regards both occasional consumption (OR=1.515; p<0.05) and daily consumption (OR=2.144; p<0.05), the latter more markedly in the central regions. Furthermore, the likelihood of being a daily wine drinker (OR=2.889; p<0.05) and beer drinker (OR=1.602; p<0.05) increased, above all in the central regions, as was the case for occasional consumption of the same drinks. Consumption of spirits/bitters/alcoholic aperitifs only showed significant increases with regard to occasional drinking. CONCLUSIONS: alcohol consumption in adulthood compared to in youth in Italy confirms the traditional Mediterranean characteristics in conjunction with the presence of patterns more typical of Northern Europe.

[Alcohol dependence in the Italian general population: diagnostic criteria according to general practitioners and to the Composite International Diagnostic Interview (CIDI)]. / L'alcoldipendenza nella popolazione generale: i criteri di diagnosi secondo i medici di medicina generale e secondo l'intervista Composite International Diagnostic Interview (CIDI).

OBJECTIVES: to identify the criteria used by general practitioners (GPs) for the diagnosis of alcohol dependence (AD) and to compare them with the criteria of the Composite International Diagnostic Interview (CIDI). DESIGN: cross-sectional correlational study. SETTING AND PARTICIPANTS: the 55 GPs of Friuli Venezia Giulia Region (Northern Italy) and Tuscany Region (Central Italy) who took part in the research conducted a clinical evaluation of the first 40 patients who came for a medical examination. MAIN OUTCOME MEASURES: prevalence of AD diagnosed by GPs and CIDI and their association with sociodemographic variables, other diseases, and alcohol consumption. RESULTS: AD prevalence assessed by the GPs was 5.4%, while AD prevalence assessed by the CIDI was 4.4%, with an overlap of about 26%. Patients identified as AD by the GPs were older and more frequently suffering from liver disease and hypertension than patients identified by the CIDI. CONCLUSIONS: the limited overlap between diagnoses of AD made by GPs and the one made by the CIDI is problematic. GPs appear to identify mainly more severe forms of AD, in which excessive consumption of alcohol is associated with the presence of liver disease, while the CIDI could identify younger patients who have not yet developed diseases. GPs' recognition of AD could be increased by using their expertise along with standardised questionnaires which measure alcohol consumption.

Uptake of cervical cancer screening among the migrant population of Prato Province, Italy.

OBJECTIVE: To determine the level of participation in cervical cancer screening among the migrant population of Prato Province, Italy. METHODS: A retrospective cross-sectional study was conducted using data for women aged 25-64 years who were resident in one of the municipalities of Prato Province and had received at least one invitation to undergo a cervical cancer screening test. Data were extracted from both the Local Health Unit Serviceable Registry and cervical cancer screening archives for the period July 1, 2004, to June 30, 2007. RESULTS: Of the 69 459 residents eligible for cervical cancer screening, 7339 (10.6%) did not have Italian citizenship. Adherence with cervical cancer screening among the migrant population was lower than that of the Italian resident population: uptake increased from 52.4% in 2004 to 57.3% in 2007 among the Italian resident population, but decreased from 31.4% to 28.2% among migrants. CONCLUSION: The migrant population of Prato Province has decreased adherence with cervical cancer screening.

[Acute intoxications and poisonings in Italian Emergency Rooms]. / Intossicazioni acute e avvelenamenti nei Dipartimenti di Emergenza e Urgenza in Italia.

The analysis of 2402 prospective records of subjects consecutively attending eleven Emergency Rooms located in Northern, Central and Southern Italy, during the November 2002-May 2003 period, because of acute intoxication and poisoning (AI), shows that 10 admissions per 1000 are due to AI, accounting at national level for over 240,000 yearly admissions. Six AI of ten are caused by alcohol, alone or in combination with drugs and other poisonings, 2 by drugs and 2 by other types of AI. AI are more frequent among males (65%) and 20-40 ages. AI due to alcohol and drugs are more typical of young males, living in Central and Northern Italy, while those due to medicines are proportionally more represented among females of Southern Italy.

Impact of use of oral anticancer drugs on activity of Italian oncology practices: results of a survey conducted by the Italian Society of Medical Oncology (AIOM).

AIMS AND BACKGROUND: In recent years, the number of oral anticancer drugs used in clinical practice has rapidly increased. The Italian Society of Medical Oncology (AIOM) conducted a survey to describe the impact of the use of oral anticancer drugs on the daily activity of Italian oncology practices. METHODS AND STUDY DESIGN: A survey questionnaire was distributed to the coordinators of the regional sections of AIOM. A 6-month period was considered, from January 1, 2010 to June 30, 2010. The survey addressed (1) quantitative aspects of the use of oral anticancer drugs; (2) practical aspects in the management of patients treated with these drugs; (3) issues related to treatment costs and reimbursement procedures. RESULTS: Thirty-six questionnaires were received from institutions distributed throughout the Italian territory. Oral anticancer drugs (both chemotherapy and molecularly targeted agents) accounted for a significant proportion (17%) of prescribed treatments. Among the responding institutions, there were different dispensation procedures of oral drugs to patients: drugs were dispensed by the pharmacist (57%) or directly by the medical oncologist (23%) or nurse (20%). The medical oncologist played a major role in the communication with patients (73% alone and a further 24% in cooperation with other professional figures) and was the point of reference in the event of side effects in 97% of cases. In most cases, the reimbursement of drug costs was separated ("File F" procedure) from the flat fare received by the hospital for outpatient visits or day-hospital access. CONCLUSIONS: Optimal organization of oral anticancer treatment warrants the cooperation and integration of multiple professional figures. At least three figures are involved in patient management in the hospital: the medical oncologist, the nurse, and the hospital pharmacist. Oral anticancer treatments are associated with specific reimbursement issues: in the majority of cases, the cost of the drug is reimbursed separately from the cost of patient access.

Disparity in the "time to patient access" to new anti-cancer drugs in Italian regions. Results of a survey conducted by the Italian Society of Medical Oncology (AIOM).

AIMS AND BACKGROUND: In 2009, the Italian Society of Medical Oncology (AIOM) conducted a survey to describe the impact of regional pharmaceutical formularies on the disparity of access to eight new drugs among cancer patients treated in Italian regions. The survey documented some regional restrictions for some anti-cancer drugs. In the study, we analyzed the "time to patient access" to new anti-cancer drugs in Italian regions. METHODS: In March 2010, we analyzed the availability of 17 new anti-cancer drugs at a regional level, specifically the coherence of regional authorizations compared with national authorizations approved by the Italian Medicines Agency (AIFA). In the regions with pharmaceutical formularies, we analyzed the characteristics of technical-scientific committees for the evaluation of inclusion of hospital drugs in these formularies. We also analyzed the time from EMA (CMPH) authorization to AIFA marketing authorization, the time from AIFA marketing authorization to patient availability, and the total time from EMA (CMPH) authorization to patient availability of the drugs in all Italian regions, for 11 of these drugs. RESULTS: Some drugs were included in all the regional pharmaceutical formularies, without restrictions, whereas other drugs were not included in one and others were not included in more than one formulary. Median time from EMA to AIFA was 11.2 months (range, 2.9-17.1). Median time from AIFA to patient availability was 1.4 months (range, 0.0-50.5) in regions with drug formularies versus 0.0 months in regions without drugs formularies. Median total time from EMA to patient availability was longer in regions with formularies (13.3 months; range, 2.9-65.3) than in regions without formularies (11.2 months; range, 2.9-24.0), where drugs are immediately available after AIFA marketing authorization. Moreover, the interval was very long (range, 2.9-65.3) for some drugs in regions with formularies. CONCLUSIONS: The analysis confirmed that the presence of multiple hierarchical levels of drug evaluation can create disparity in drug availability for Italian citizens.

Adjuvant chemotherapy in completely resected gastric cancer: a randomized phase III trial conducted by GOIRC.

BACKGROUND: Complete surgical resection of gastric cancer is potentially curative, but long-term survival is poor. METHODS: Patients with histologically proven adenocarcinoma of the stomach of stages IB, II, IIIA and B, or IV (T4N2M0) and treated with potentially curative surgery were randomly assigned to follow-up alone or to intravenous treatment with four cycles (repeated every 21 days) of PELF (cisplatin [40 mg/m(2), on days 1 and 5], epirubicin [30 mg/m(2), days 1 and 5], L-leucovorin [100 mg/m(2), days 1-4], and 5-fluorouracil [300 mg/m(2), days 1-4] in a hospital setting. Frequencies and severity of adverse events were determined. Overall survival (OS) and disease-free survival (DFS) were compared between the treatment arms using Kaplan-Meier analysis and a Cox proportional hazards regression model. All statistical tests were two-sided. RESULTS: From January 1995 through September 2000, 258 patients were randomly assigned to chemotherapy (n = 130) or surgery alone (n = 128). Patient characteristics were well balanced between the two arms. Among those who received chemotherapy, grade 3 or 4 toxic effects including vomiting, mucositis, and diarrhea were experienced by 21.1%, 8.4%, and 11.8% of patients, respectively. Leucopenia, anemia, and thrombocytopenia of grade 3 or 4 were experienced by 20.3%, 3.3%, and 4.2% of patients, respectively. After a median follow-up of 72.8 months, 128 patients (49.6%) experienced recurrence and 139 (53.9%) deaths were observed, one toxicity-related. Relative to treatment with surgery alone, adjuvant chemotherapy did not increase disease-free survival (hazard ratio [HR] of recurrence = 0.92; 95% confidence interval [CI] = 0.66 to 1.27) or overall survival (HR of death = 0.90; 95% CI = 0.64 to 1.26). CONCLUSIONS: Our results failed to provide proof of an effect of adjuvant chemotherapy with PELF on overall survival or disease-free survival. The estimated effect of chemotherapy (10% reduction in the hazard of death or relapse) is modest and consistent with the results of meta-analyses of adjuvant chemotherapy without platinum agents.