rubrica

Diseguaglianze

  • Chiara Marinacci1

  1. S.C. a D.U. Scuola di Sanità Pubblica, ASL TO3
Chiara Marinacci -

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Ricerca bibliografica periodo 02 giugno 2011 – 2 agosto 2011

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Database: Pubmed/MEDline
Stringa: ("socioeconomic factors"[MeSH Terms] OR "social class"[MeSH Terms] or "educational status"[MESH terms] OR inequalities[Title/Abstract] OR inequities[Title/Abstract] OR socioeconomic[Title/Abstract]) OR socio-economic[Title/Abstract]) AND "italy"[All Fields] AND ("2011/06/02"[PDAT]: "2011/08/02"[PDAT])

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Gruttadauria S, Grosso G, Mistretta A, Pagano D, Scianna G, Vizzini GB, Cintorino D, Spada M, Basile F, Gridelli B. Impact of recipients' socio-economic status on patient and graft survival after liver transplantation: The IsMeTT experience. Dig Liver Dis. 2011 Jul 26 [Epub ahead of print]
Is.Me.T.T. (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy;Department of Surgery, University of Pittsburgh, PA, USA; Department of Surgery, University of Catania, Catania, Italy.
Abstract
AIM:
We aimed to determine whether education level and socioeconomic status in a cohort of liver transplant recipients in the south of Italy were potential predictors of graft and patient survival.
METHODS: This retrospective study included 221 liver transplant recipients at Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione between January 2006 and September 2009. Donor gender and age, cold ischaemic time, extended criteria donors, recipient age, gender, body mass index, primary aetiology, Model for End-Stage Liver Disease score, co-morbidities, patient health score assessed on the basis of clinical follow-up, highest level of education achieved, and socioeconomic status were collected and analysed.
RESULTS: Kaplan-Meier analysis of survival measured by education level and socioeconomic status showed a higher survival rate in patients with higher education level (p=0.04) and socioeconomic status (p=0.01). After adjusting for all covariables, results of the multivariate Cox regression analyses showed that only socioeconomic status remained an independent and significant predictor of overall survival (Hazard Ratio=0.16, p=0.03).
CONCLUSION: Patient survival after liver transplantation was influenced by low income, low educational level, and lack of access to quality health care. Prospective clinical studies are necessary to fully identify the impact of socioeconomic status on long-term health outcomes, and to propose an evidence-based guide to clinical intervention.
2. Napoli C, Tafuri S, Chironna M, Quarto M, Da Molin G. Cervical cancer prevention and health inequalities: An ad-hoc survey in Italian women. Public Health. 2011 Jul 19. [Epub ahead of print]
Department of Biomedical Sciences, Hygiene Section, University of Bari 'Aldo Moro', Piazza Giulio Cesare, 11 - 70124 Bari, Italy.
Abstract
OBJECTIVE:
To assess knowledge and attitudes towards cervical cancer prevention in a sample of 2400 Italian women.
STUDY DESIGN: Cross-sectional study
METHODS: The study was conducted through a standardized questionnaire administered in the workplace.
RESULTS: Regular Pap testing was reported by 65.6% of the sample, and 86.9% were aware of the human papillomavirus (HPV) vaccine. Just over half of the women (51.8%) stated that they would pay for the vaccine for themselves or family members. Significant differences in responses were associated with monthly income and educational level. CONCLUSION:
Introduction of payment for the HPV vaccine may increase health inequalities significantly. For overall improvement in the quality of life, effective prevention and treatment services should be made available to all.
3. Carletti C, Pani P, Knowles A, Monasta L, Montico M, Cattaneo A. . Breastfeeding to 24 months of age in the northeast of Italy: a cohort study. Breastfeed Med. 2011 Aug;6:177-82.
Unit for Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo , Trieste, Italy .
Abstract
Aim:
This study assessed the prevalence and duration of breastfeeding up to 24 months and the associated socioeconomic determinants in a birth cohort of children.
Methods Four hundred infants born in a hospital in the north east of Italy were enrolled at birth and followed up for 36 months. Data on infant feeding were gathered through a feeding diary compiled at fixed intervals. Data were also gathered on type of delivery and weight, length, and health status at birth, as well as on selected socioeconomic indicators of the mothers. A multivariate logistic regression analysis was used to determine any association that exclusivity and duration of breastfeeding may have with selected socioeconomic variables and with health conditions of the infants at birth.
Results: Ninety-eight percent of mothers initiated breastfeeding, 69% of them exclusively. This rate, however, had declined to 6% by 6 months. There was a remarkable endurance of breastfeeding at 24 months (12%). The variables significantly associated with exclusive breastfeeding at 3 months and any form of breastfeeding at 12 months are mother's age (p = 0.007 at 3 months, p = 0.026 at 12 months) and postdischarge hospital admission (p = 0.029 at 3 months).
Conclusion: In this population, breastfeeding rates are higher than previously reported, but lower than recommended, especially as far as exclusivity is concerned. Full implementation of the World Health Organization-UNICEF Baby Friendly Initiatives in hospitals and communities is needed to improve them further. Monitoring systems should include the collection of data on breastfeeding beyond 12 months of age.
4. Roma P, Spacca PD, Pompili PD, Lester D, Tatarelli R, Girardi P, Ferracuti S. The epidemiology of homicide-suicide in Italy: A newspaper study from 1985 to 2008. Forensic Sci Int. 2011 Jul 14. [Epub ahead of print]
NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00198 Rome, Italy.
Abstract
Homicide-suicide is an event in which the murderer commits suicide after the homicide. There are at least 14 epidemiological studies on the topic, and all have found that homicide-suicide is more common among family members. The murderers are most often males and the victims females. There is no recent research on this phenomenon in Italy. The purpose of the study was to evaluate the incidence of homicide-suicide in Italy over a period of 24yrs and to compare Italian data with published international data. We used information gathered by press agencies and from the four major Italian newspapers. Between 1985 and 2008, 662 cases of homicide-suicide were identified, with 1776 deaths. The murderer was male in 84.6% of the cases, typically using a firearm. The most common motivation was romantic jealousy, followed by socio-economic stress. The rate of homicide-suicide was 0.04%. Comparison with international studies is not always possible due to the lack of information for certain categories. The common factors identified may be helpful for prevention.
5. Puddu PE, Menotti A, Tolonen H, Nedeljkovic S, Kafatos AG. Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study. Eur J Epidemiol. 2011 Jun 29. [Epub ahead of print]
Department of Cardiovascular Pathophysiology, Anaesthesiology and Surgery, Laboratory of Biotechnologies Applied to Cardiovascular Diseases, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy, paoloemilio.puddu@uniroma1.it. .
Abstract
If a few risk factors had predictive power for all-cause mortality in different geographical-cultural areas, then preventive efforts might be concentrated on these. Thirteen potential risk factors were measured in 6,554 men aged 40-59 around 1960 in Northern, Southern and Eastern European areas of the Seven Countries Study. In 40 years 85.3% of men died in the pooled areas (87.9, 81.8 and 87.9% in Northern, Southern and Eastern Europe, respectively). Six risk factors were significant predictors of events in all three areas: directly for age, smoking habits, mean blood pressure, heart rate and ECG abnormalities; inversely for forced expiratory volume. In a pooled model also father and mother life status, socio-economic status, and arm circumference (the last one in an inverse way) had significant coefficients that were not heterogeneous across areas (except for socio-economic status). Serum cholesterol was around significance. ROC curves had values of 0.833, 0.806 and 0.819 respectively in Northern, Southern and Eastern Europe, and 0.827 in the pooled areas. Correlation coefficients between observed and expected cases in deciles of estimated risk were between 0.98 and 0.99. Survivors after 40 years in the lower half of the estimated risk were 10.7, 23.6 and 13.3% in Northern, Southern and Eastern Europe, respectively. Under- or over-estimate of cross-applying risk functions did not exceed 15%. All-cause mortality and survival in middle aged men during 40 years were strongly associated with a few, mainly cardiovascular, risk factors, whose predictive power was similar in different cultures across Europe.
6. Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. Eur J Public Health. 2011 Jun 6. [Epub ahead of print]
Organisation for Economic Co-operation and Development, Paris, France.
Abstract
BACKGROUND: Evidence of inequalities in obesity and overweight is available mostly from national studies. This article provides a broad international comparison of inequalities by education level and socio-economic status, in men and women and over time.
METHODS: Data from national health surveys of 11 OECD countries were used. The size of inequalities was assessed on the basis of absolute and relative inequality indexes. A regression-analysis approach was used to assess differences between social groups in trends over time.
RESULTS: Of the countries examined, USA and England had the highest rates of obesity and overweight. Large social inequalities were consistently detected in all countries, especially in women. Absolute inequalities were largest in Hungary and Spain with a difference of 11.6 and 10% in obesity rates in men, and 18.3 and 18.9% in women, respectively, across the education spectrum. Relative inequalities were largest in France and Sweden with poorly educated men 3.2 and 2.8 times as likely to be obese as men with the highest education (18 and 17 times for women in Spain and Korea, respectively). Pro-poor inequalities in overweight were observed for men in USA, Canada, Korea, Hungary, Australia and England. Inequalities remained virtually stable during the last 15 years, with only small variations in England, Korea, Italy and France.
CONCLUSIONS: Large and persistent social inequalities in obesity and overweight by education level and socio-economic status exist in OECD countries. These are consistently larger in women than in men.

Breve commento a cura di Chiara Marinacci
I risultati di questa comparazione confermano come l’eccesso ponderale sia più frequente nei gruppi socio economicamente sfavoriti, soprattutto tra le donne e nel sud Europa. Negli ultimi 15 anni si è osservato un generale incremento nella frequenza di persone sovrappeso od obese, omogeneo in tutti gli strati della popolazione. Il nostro paese si colloca tra quelli con le diseguaglianze più pronunciate, soprattutto tra le donne. L’andamento temporale della frequenza di eccesso ponderale mostra inoltre, tra gli uomini, un incremento più elevato tra chi possiede una posizione sociale sfavorevole, lasciando immaginare un futuro inasprimento delle diseguaglianze anche tra gli uomini.

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