'You've got m@il: fluoxetine coming soon!': accessibility and quality of a prescription drug sold on the web.

BACKGROUND: The increasing phenomenon of online pharmacies has potential for serious public health problems. This study aimed to evaluate the possibility of accessing a prescription drug in the absence of a prescription for an Italian purchaser. METHODS: Fluoxetine pills were ordered from several online pharmacies. The study included website analysis, and the quality of the received product including packaging, chemical and microbiological analyses. RESULTS: Orders could be placed correctly on 61 of the 98 selected websites, and a sales transaction was concluded successfully on 17 websites. Thirteen drug samples were eventually received. In one case it was necessary to fill in a questionnaire before ordering the drugs. All websites displayed aggressive marketing strategies. There was wide variation in terms of domain registration, company base (when declared) and manufacturer's location (mostly India). All pills were delivered in sealed blister packs showing the lot number and manufacturer's details. A leaflet was enclosed in one case only. In three cases we received more pills than ordered, and in one case Viagra pills as a free gift. Pharmacopoeia microbiological requirements were satisfied. Chemical analysis revealed that the active principle was always present, although many samples did not meet the Pharmacopoeia "other impurities" or "total impurities" criteria. Heavy metals and solvents regulated by the Pharmacopoeia did not exceed the set limits; some of the non-regulated ones were also assessed, in some cases with a positive result (e.g. styrene). CONCLUSION: About 20% of purchase attempts resulted in delivery of the drugs, even in the absence of a medical prescription. Traceability was poor and drug quality was generally worse compared to conventional pharmacy-purchased products. Based on all these broad-spectrum results, user safety appears not to be globally guaranteed.

[Health on front page: a content analysis of the main Italian newspapers in two months of 2009]. / La salute in prima pagina: una content analysis delle principali testate giornalistiche italiane in due mesi del 2009.

UNLABELLED: The increasing availability of health information appears to be associated with new citizen and patient behaviours and opinions, with repercussions on medicalization and the allocation of resources; consequently, the mass media's focus on health topics is greatly talked-about. THE AIMS OF OUR STUDY WERE: 1) to verify and quantify overall health news in the main Italian newspapers, 2) to quantify the presence of the same news on the front page, 3) to identify health news types, and 4) highlight the tone of the headlines. The July and November 2009 issues of the Italian newspapers with the highest circulations were taken into consideration. Most of the newspapers published at least one health item per issue; each day at least one daily paper showed some news concerning health; more than 10% of these items appeared on the front page. A negative connotation was found in more than 50% of the headlines. Health was confirmed as a leading topic, and a constant presence in everyday life in Italy. The number of health news items was higher in November probably as a result of the H1N1 flu virus.

[Public health professionals and the Internet: usage patterns and perception]. / I professionisti di sanità pubblica ed Internet: pattern di utilizzo e percezione del fenomeno.

The internet has deeply changed our way to communicate, transforming society, and the world of health has been consequently influenced by this communicational revolution. Aim of the study was to investigate the web utilization and perception by the Italian health professionals, using an online questionnaire. A sample of 490 health professionals responded to the questionnaire. Almost all the responders use the internet, for work and leisure, and they are aware that this communication tool influences a lot both their knowledge and opinions. Internet is perceived as a useful and positive mean for accessing and spreading information by health professionals and health institutions, even if a worried attitude is expressed regarding to access to online health information by the general population. The broaden access to health information through the web opens new scenarios to future health systems. This evolving communication change poses to public health the challenge to get the benefits that internet can potentially generate, minimising the risks that at the same time can arise.

Do mechanical doctors dream of electric sheep? Using science fiction to look into the future of public health.

At a first glance, it may seem that science fiction (SF) and public health have not much in common. To enlighten that this could be untrue, this paper starts up from their shared 'community perspective' and focuses on several implications of technological development, which can have a great impact on health and have been in some ways anticipated by SF stories. For example, SF has-more or less directly-discussed about the complex relationship between society, medicine and happiness, and it has anticipated several reflections in the field of advances in genetic technology. Beside tackling specific issues, SF has made a deep reflection about technology itself, the way it frightens and the way it could potentially change people and society. While facing these issues, SF raises questions that can be useful to public health as well, in order to rediscover its role in a world rapidly changing.

Alcohol and coffee drinking and smoking habit among subjects with HCV infection.

BACKGROUND/AIMS: The aims were to estimate among patients with hepatitis C virus (HCV) infection the prevalence of alcohol and coffee intake and smoking habit, the reliability of these self-reported data and the possible change of patients' habit after their first contact with a Viral Hepatitis Service. METHODS: 229 patients were initially interviewed personally at the Viral Hepatitis Service and after 6 months they were re-interviewed by phone in regard to their alcohol, coffee drinking and smoking habits. RESULTS: Alcohol drinkers were 55.5% of males and 35.3% of females. Most subjects drank coffee daily, both men (90.0%) and women (84.9%). The proportion of current smokers was higher in males (43.6%) than females (26.9%). We found a fair to good reliability of self-reported data regarding patients' habits, alcohol and coffee intake, and number of cigarettes smoked daily. We observed a statistically significant decrease in alcohol and coffee intake and cigarettes smoked between baseline and follow-up interviews. CONCLUSION: We found a fairly high proportion of HCV-infected patients who regularly drink alcohol and coffee beverages and smoke cigarettes, especially among males. The reliability of self-reported data on these habits seems satisfactory. More decisive action to modify these habits, especially alcohol intake, is required in these patients.

Evaluation of chlorite and chlorate genotoxicity using plant bioassays and in vitro DNA damage tests.

In the last few years chlorine dioxide has been increasingly used for disinfecting drinking water in many countries. Although it does not react with humic substances, chlorine dioxide added to water is reduced primarily to chlorite and chlorate ions, compounds that are under investigation for their potential adverse effects on human health. The aim of this research was to study the genotoxicity of chlorite and chlorate and their mixtures. The end-points included two plant tests (chromosomal aberration test in Allium cepa and micronucleus assay in Tradescantia, carried out at different times of exposure) and two genotoxicity tests in human HepG2 cells (comet assay and cytokinesis-blocked micronucleus test). Preliminary toxicity tests were carried out for both plant and HepG2 assays. The results showed that chlorite and chlorate are able to induce chromosomal damage to plant systems, particularly chromosomal aberrations in A. cepa root tip cells, even at concentrations lower than the limit established by Italian normative law and WHO guidelines. In HepG2 cells increased DNA damage was only observed for chlorate at the lowest concentration. No increase in micronuclei frequency was detected in any of the samples tested in human HepG2 cells.