1,721,387 research outputs found
Endometriosis: What a pain it is
No full textThe contrasting findings obtained in the studies that have attempted to correlate the stage of endometriosis with severity of pain symptoms suggest that some specific characteristics of the lesions are move implicated in the genesis of pain than disease extension per se. Thus, fresh, metabolically active, intraperitoneal implants may cause functional pain symptoms such as dysmenorrhea, whereas infiltrating, nodular and fibrotic lesions are responsible for organic-type pain such as deep dyspareunia. Women with symptomatic endometriosis seem to have reduced peripheral beta-endorphin production in comparison with pain patients without the disease, although neuroendocrine modulation of pelvic nociceptive stimuli is far from clear. There is little evidence to support the notion that specific psychiatric features render some women move vulnerable to developing endometriosis, as results from investigations performed on women with asymptomatic lesions are very similar to normative data. Moreover, it appears that the psychological profile of symptomatic patients with the disease is no different from those with pain and a normal pelvis or other gynecological conditions. Consequently, the local biochemical and physical effects of lesions seem to be the most important factors in determining frequency and severity of symptoms
Chi paga le “liaisons dangereuses” tra medici e industria? = Who pays the "dangerous liaisons" between doctors and industry?
No full textIl problema dell’influenza che l’industria può
avere sui medici mediante pagamenti di vario tipo non
è esclusivamente etico, bensì ha importanti implicazioni
pratiche. Tramite il denaro, l’industria può distorcere le
abitudini prescrittive a favore dei propri prodotti, generalmente
più costosi e non sempre più sicuri, efficaci e tollerati.
Inoltre, l’industria ha tutto l’interesse ad ampliare
il numero di persone cui possono essere prescritti i propri
farmaci, allargando così il mercato. Se i medici non si
oppongono a queste lusinghe, a pagare sono i pazienti
e il Sistema Sanitario Nazionale (SSN) fondato sulle tasse
dei cittadini. Ogni elargizione proveniente dalle divisioni
Sales & Marketing delle case farmaceutiche è pagata,
indirettamente e tramite un ampio ritorno in termini di
aumento di prescrizioni, dai cittadini. Negli USA questo è
ora dimostrato dall’analisi dei primi dati relativi ai trasferimenti
di denaro dall’industria ai medici resi pubblicamente
disponibili dall’implementazione del Physician Payment
Sunshine Act.The problem regarding the influence that industry may exert on physicians through various types of payments is not of exclusively ethical nature, but has also important practical implications. Using money, industry may distort prescribing habits in favor of their own products, generally more costly, but not always more effective or better tolerated. Moreover, industry is interested in increasing the number of people to whom their products could be prescribed, thus widening the market. If physicians do not oppose these enticements, the patients and the citizens' tax funded National Health Service will pay the bill. In fact, any largesse from the Sales & Marketing divisions of pharmaceutical industries is paid, indirectly and via major financial returns related to an increase in prescriptions, by citizens. In USA this is now demonstrated with the analysis of the first data on transfers of money from industry to physicians made publicly available after the implementation of the Physician Payment Sunshine Act
Endometriosis : the elusive gray area between evidence-based and evidence-biased medicine
No full textIntroduction : management of endometriosis : towards a problem-oriented and patient-centered approach
No full textEndometriosis is a protean disease, and its manifestations, associated clinical problems, and possible treatments are numerous. Deep endometriosis that infiltrates multiple pelvic organs should be considered a severe endometriotic disease that poses the most difficult therapeutic uncertainties in both infertility and pelvic pain symptoms thus, limiting quality of life. The available evidence demonstrates that endometriosis is not only a gynecologic disorder but, contrary to previous belief, its impact extends into pregnancy, delivery, and the post-partum period. The old clinical tenet that pregnancy is a cure for endometriosis may be revealed as fallacious. Safe and effective modalities to reduce the risk of the recurrence of symptoms and lesions after conservative surgery for endometriosis are now available. These treatment options should be offered post-operatively to women not immediately seeking conception. Endometriosis is associated with a moderate increase in ovarian cancer risk. However, as there are no definitive demonstrations that endometriosis constitutes per se a pre-neoplastic condition, it seems currently unwise to set-up a screening program to detect undiagnosed endometriosis in asymptomatic women. Endometriosis is not a cancer; therefore a paradigm shift from treatment of lesions to treatment of symptoms is warranted. Management should be shaped on the main clinical problem, taking into consideration a woman's preferences and priorities. Quantitative information should be provided to describe the potential benefits, potential harms, and costs of each treatment alternative. Counseling should be complete and transparent, and the duty of the caring gynecologist is to inform the woman on the pros and cons of each option and support her in the shared decision-making process. The physician should be able to look the patient in the eye and explain in detail all the available treatments, and not only those that the physician prefers or is able to offer
Uterine fibroids : from observational epidemiology to clinical management
Full text linkAccording to this systematic review of epidemiological studies, fibroid prevalence varied widely, with no consistent association across studies between observed estimates and country, methodology, and population. Fibroid incidence was higher in black than in white women independently of other risk factors, suggesting a racial predisposition. A genetic influence was confirmed also by the association with a positive family history. The association with age and menopausal status maybe interpreted in terms of varying degrees of oestrogen exposure, which could explain also the association with food additives and soybean consumption. Along this line, the "anti-oestrogenic" effect of smoking was observed only in women with low BMI. Association were observed also with reproductive factors (parity and time since last birth) and oral/injectable contraceptives
Minimal and mild endometriosis. Is there anything new under the sun?
No full textResearch on endometriosis in patients with minimal or mild lesions is marred by our ignorance of the prevalence of limited stages in the asymptomatic female population of reproductive age. Laparoscopic studies performed on women undergoing tubal sterilization suggest that 2-8% are affected. However, the estimates may be unreliable because the studies were retrospective and misdiagnosis of subtle endometriosis cannot be excluded. In a recent prospective study of 86 asymptomatic women, more than 40% had minimal or mild lesions at laparoscopy. The data available do not support the suggestion that limited forms must always be treated to prevent disease progression, nor do they demonstrate worsening in all cases of minimal and mild endometriosis. Furthermore, there is no definitive evidence that the medical and surgical cytoreductive treatments available are effective in preventing eventual progression of the disease in some of the patients. We still do not know the prevalence of minimal and mild endometriosis in the healthy population, the percentage of progression towards severe stages or the risk factors of evolution of the disease. The hypothesis to test is that minimal endometriosis is partly a paraphysiologic condition that is frequently self-limited or resolves spontaneously
L’accesso ai dati della ricerca : una luce in fondo al tunnel?
No full textRiassunto. The recent update of a systematic review conducted by a group of researchers from the Cochrane Collaboration showed modest effectiveness of neuraminidase inhibitors in reducing hospitalizations in patients with influenza, and an even smaller impact of these drugs on overall mortality. However, the relevance of this systematic review mainly relies on the revolutionary methodology with which it was performed, as it included among the evidence considered findings from unpublished clinical study reports submitted by pharmaceutical companies to regulatory agencies. The paper by Jefferson et al. published in the BMJ as well as the campaigns supported by the same journal open a new phase that should bring greater transparency in the relationship between researchers, industry and government to the benefit of citizens
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