• Chiara Marinacci1

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

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Ricerca bibliografica periodo dal 16 ottobre 2011 al 27 dicembre 2011

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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]) OR disparities[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2011/10/16"[PDAT] : "2012/12/27"[PDAT])
1. Cattaneo A.

Academy of Breastfeeding Medicine Founder's Lecture 2011; Inequalities and
Inequities in Breastfeeding: An International Perspective.

Breastfeed Med. 2011 Dec 14. [Epub ahead of print] .

Unit for Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo , Trieste, Italy .

Breastfeeding is the biological norm for infant feeding but is also a social construct. As such, its rates and practices are determined by the same social determinants that shape health inequalities and inequities. In the past 30 years, several reports have drawn attention to the changing pattern of breastfeeding inequalities across countries and population groups. Breastfeeding rates tend to fall and rise following a similar pattern everywhere, although at different times and speed. The role of women within families and societies, the routines of maternity hospitals and other healthcare services, and the pressure exerted by the baby food industry are among the factors that influence the time and speed of changes in breastfeeding rates and practices across countries and population groups. Inequities (i.e., inequalities considered unfair and avoidable by reasonable action) can be redressed by interventions for the protection, promotion, and support of breastfeeding. Evidence-based and quality-implemented support and promotion activities, if applied without an equity lens, may increase inequities. Activities for the protection of breastfeeding (e.g., implementation and enforcement of the International Code of Marketing of Breastmilk Substitutes; legislations, regulations, and policies to remove obstacles and barriers to good-quality breastfeeding support and to protect women and mothers in the workforce; elimination of obstacles and barriers to breastfeeding anywhere, anyhow, and anytime mothers want) apply to all women and are less dependent on take up by the target population. If well designed and enforced, protective interventions contribute to reducing inequalities and inequities and to delivering promotion and support activities more effectively.

2. Moroni L, Bianchi I, Lleo A.

Geoepidemiology, gender and autoimmune disease.

Autoimmun Rev. 2011 Nov 28. [Epub ahead of print]

Center for Autoimmune Liver Diseases, Division of Internal Medicine, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.

Autoimmune diseases include more than 70 different disorders affecting over 5% of the population of the Western countries. They are mainly characterized by female predominance and have great impact on the quality of life of affected subjects. It is generally accepted that ADs are the result of a complex interaction between genetic and environmental factors; however the mechanisms involved in the loss of tolerance remain unknown. Studying the distribution of these conditions across various global regions and ethnic groups by means of geoepidemiology might readily provide epidemiological data and also advance our understanding of their pathogenesis. Indeed, geoepidemiology demonstrates that genetic susceptibility interacts with lifestyle and environmental factors, which include socioeconomic status, infectious agents (triggering or protective agents), environmental pollutants, and vitamin D (dependent on sunlight exposure), in determining the risk of developing autoimmunity and in the understanding of their female prevalence. To properly understand the geoepidemiology of human autoimmunity, it is important to consider the many pleiotropic factors which lead to its initiation. In most studies the focus has been on genetics and environment. However, in this review the focus is primarily on gender. Overall, autoimmune diseases are well known to have female predominance, but there is significant variation in geographic area. Further, the mechanisms that influence female predominance are relatively unknown. Hence the attempt in this review is to focus on these critical issues.

3. Chiavarini M, Bartolucci F, Gili A, Pieroni L, Minelli L.

Effects of individual and social factors on preterm birth and low birth weight: empirical evidence from regional data in Italy.

Int J Public Health. 2011 Oct 19. [Epub ahead of print]

Department of Medical and Surgery Specialities and Public Health, University of Perugia, Perugia, Italy.

OBJECTIVES: We examine the effects of mother's characteristics and socioeconomic condition on weight at birth and preterm delivery in an Italian region (Umbria).
METHODS: The study concerns all live-born singleton infants in 2007 with at least a gestational age of 22 weeks. Information derived from the Standard Certificate of Live Birth was linked to information from census statistics, so as to obtain a deprivation index.
RESULTS: On the basis of the fitting of two separate logistic regression models, we conclude that all individual socioeconomic factors are strongly associated with the outcomes at birth, apart from the deprivation index. Older and less educated mothers, and those with lower occupational level, have a higher probability to run into preterm delivery with respect to the other mothers. The relative risk ratios for low birth weight are significantly higher for older mothers, non-European, and not married. Lower weight rates are found in infants from complicated pregnancy and non-spontaneous conception.

CONCLUSIONS: Effects of mother's characteristics on weight at birth and weeks of gestation are confirmed. The deprivation index does not affect these outcomes, showing the proper implementation of the Health System.

Commento a cura di C. Marinacci:
Lo studio utilizza informazioni ricavate dai CEDAP dei nati in Umbria nel 2007 e analizza il ruolo delle condizioni socioeconomiche materne e contestuali (attraverso un indice di deprivazione comunale costruito ad hoc) sul rischio di nascere pretermine o sottopeso, a parità di età materna, storia riproduttiva e decorso clinico della gravidanza. Bassa scolarità materna (al massimo 8 anni di istruzione) e occupazione manuale sembrano associarsi ad un maggior rischio di nascere prima di 37 settimane di età gestazionale, con effetto trascurabile del contesto di residenza. Il rischio di nascite con peso molto basso (inferiore a 1500 grammi) risulta significativamente maggiore in presenza di madri con bassa istruzione, non coniugate o con cittadinanza extra-UE. I meccanismi potrebbero legarsi a condizioni di salute, stili di vita e fattori di rischio materni non rilevati, così come al percorso assistenziale ricevuto in gravidanza. Lo studio fornisce dunque un’ulteriore prova di come le diseguaglianze sociali nella salute possano caratterizzare la storia di un individuo sin dalle fasi più precoci della sua vita. Con conseguenze che interessano tutto il suo ciclo di vita: lo stato di salute nei primi anni di vita costituisce, infatti, un noto determinante della traiettoria sociale e del benessere psicofisico di un individuo in età adulta, risultato dunque dell’interazione di processi biologici e sociali che si susseguono durante le diverse fasi della vita.

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