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Disuguaglianze

  • Chiara Marinacci1

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

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Ricerca bibliografica periodo dal 1 gennaio 2012 al 15 marzo 2012

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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 ("2012/01/01"[PDAT] : "2012/03/15"[PDAT])

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

1.Grosso G, Marventano S, Ferranti R, Mistretta A. Pattern of antibiotic use in the community: Νon-adherence and self-prescription rates in an Italian urban population. Mol Med Report. 2012 May;5(5):1305-10. doi: 10.3892/mmr.2012.818. Epub 2012 Mar .
Department 'G.F. Ingrassia', Hygiene and Public Health, University of Catania, Ι-95123 Catania, Italy. .

Abstract
The aim of the present study was to assess the pattern of antibiotic use in a community setting of an urban area of Italy and identify factors that affect adherence to their use. By using a questionnaire-based survey, we collected 1,269 interviews and performed analysis on those patients who had their last course of antibiotic within the past 12 months (956 subjects). Among the subjects reporting that they had not followed their last antibiotic course as prescribed, 14.7% stopped therapy early, 5.4% modified the dosage, and 5% changed the prescribed antibiotic. Approximately 23% of the subjects declared that they self-prescribed antibiotics. After adjusting for all covariates, major predictors for the self-prescription of antibiotics were younger age, female gender and higher socioeconomic and educational status. Conversely, both low educational and socioeconomic status were associated with a higher risk of non-adherence to physician indications. The findings of this study assessed the widespread pattern of poor antibiotic-taking behavior and provides important implications for understanding the targets of future educational campaigns to control the use and misuse of antibiotics.

2.Martiello MA, Giacchi MV. Ecological study of isolation and suicide in Tuscany (Italy). Psychiatry Res. 2012 Mar 2. [Epub ahead of print]
Abstract
The purpose of the paper is to investigate the association between suicide and demographic and socio-economic measures in Tuscany. Data on standardized rates of suicide from 1997 to 2005 in addition to census-derived variables, income and abstention were derived from the Mortality register, the 2001 Census, the Tax Agency and the Regional Electoral Office databases. Pearson's correlation and stepwise multiple regression analyses (unweighted and weighted by population) were used to analyze the association between suicide rates and demographic and socio-economic measures for the 34 health districts for both males and females. The correlation analyses showed that suicide was significantly associated with many variables in men, but only with old age in women. The multiple regression analyses showed that the best predictors in men were education, single person households and isolated houses (only education and single person households in the weighted model). For women, the best predictors were the proportion of elderly people and income (this was also true for the weighted model, but in the opposite order). An ecological correlation between suicide and measures of economic deprivation and social fragmentation was found in both men and women. Among the best predictors, isolated houses may act as a marker for remoteness and isolation on a small scale.
3. Riccardo F, Dente MG, Kojouharova M, Fabiani M, Alfonsi V, Kurchatova A, Vladimirova N, Declich S. Migrant's access to immunization in Mediterranean Countries. Health Policy. 2012 Apr;105(1):17-24. Epub 2012 Mar 3.
Istituto Superiore di Sanità (ISS National Institute of Health), National Centre for Epidemiology, Surveillance and Health Promotion, Viale Regina Elena, 299 00161 Rome, Italy.
Abstract
Countries bordering the Mediterranean are part of a major migration system. The aim of this study is to assess the main access barriers to immunization of mobile populations in the region and propose an action based framework to decrease health access inequalities. A survey on formal and informal barriers to immunization among mobile communities was conducted among public health officials formally appointed as focal points of the Epi South Network by 26 Mediterranean countries. Twenty-two completed the questionnaire. Thirteen countries reported at least one vaccine preventable disease (VPD) outbreak occurring among mobile populations since 2006 even though their legal entitlement to immunization is mostly equivalent to the general population's. Informal barriers, particularly lack of information and lack of trust in authorities, and disaggregation of data collection are the major issues still to be addressed. Mediterranean countries need to fill the gap in immunization coverage among pockets of susceptible individuals in order to prevent VPD outbreaks. Having for the most part ensured free entitlement, introducing more migrant friendly approaches, increasing information availability among mobile communities, building trust in public health services and disaggregating data collection to monitor and evaluate service performance among mobile groups are key aspects to address in the region.
4. Deli R, Macrì LA, Radico P, Pantanali F, Grieco DL, Gualano MR, La Torre G. Orthodontic treatment attitude versus orthodontic treatment need: differences by gender, age, socioeconomical status and geographical context. Community Dent Oral Epidemiol. 2012 Feb;40 Suppl 1:71-6. doi: 10.1111/j.1600-0528.2011.00669.x.
Orthodontic Department, Institute of Dentistry, Catholic University of the Sacred Heart, Rome, Italy Epidemiology and Biostatistics Unit, Institute of Hygiene, Catholic University of the Sacred Heart, Rome, ItalyPublic Health and Infectious Diseases Department, Sapienza University of Rome, Rome, Italy. Abstract
Objectives: To investigate the relationship between the attitude towards orthodontic treatment and the objective level of orthodontic need, and variables like gender, socioeconomic status and geographical context, among 6- to 16-year-old children. Methods: The attitude of 2284 Italian children towards orthodontics was assessed using the Child Orthodontic Attitude Survey (COAS) questionnaire, previously validated for Italian-speaking children. The level of orthodontic need was evaluated by using the Risk of Malocclusion Assessment (ROMA) Index while socioeconomic status (SES) was based on parental job activities. The univariate analysis was performed using chi-square tests to find differences between groups for categorical variables, while multivariate analyses were conducted using logistic regression models. Results: Individuals with a higher SES had a statistically significant lower need of orthodontic treatment (P=0.003). Children with a very high SES were from northern (20.8%) and central Italy (65.9%), while only 13.3% lived in southern Italy (P<0.001). Logistic regression showed that females, older children, in-treatment subjects and children from the region of Puglia were more likely to have orthodontics (OR=2.09; 95% CI: 1.66-2.64, OR= 1.08; 95% CI: 1.01-1.15, OR = 1.48, 95% CI: 1.11-1.97, OR=1.43; 95% CI: 1.05-1.95, respectively). Conclusions: The orthodontic treatment attitude largely depends on age, gender and geographical context but is not influenced by the real level of orthodontic therapy need.
5. Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction. 2012 Feb 23. doi: 10.1111/j.1360-0443.2012.03853.x. [Epub ahead of print]
Department of Health and Sport Sciences, University of Cassino, Via S. Angelo snc (località Folcara) 03043 Cassino (FR), Italy Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Rotterdam, The Netherlands Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Abstract
Aims: To estimate the immediate as well as the longer term impact of the 2005 smoke-free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. Design:  Interrupted time series analyses of 11 cross-sectional nationally representative surveys Setting:  Italy, 1999-2010 Participants:  Adults aged 20-64 Measurements:  For each year we computed the prevalence of current smoking, the quit ratio, and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. Findings:  Among males, smoking prevalence decreased by 2.6% (p = 0.002) and smoking cessation increased by 3.3% (p = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both high and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (p = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (p < 0.001). However, these favourable trends reversed over the following years. Among high-educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long-term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. Conclusion:  The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long-term, and they may have limited effects on inequalities in smoking.

Commento a cura di C. Marinacci:
Non è noto se le politiche anti-fumo possano avere un impatto differenziale per condizione socioeconomica. Si sostiene che i programmi di popolazione possano addirittura allargare le disparità sociali, a meno che i più deprivati rappresentino il target di specifici interventi. Questo studio analizza la serie temporale di indicatori di abitudine al fumo ricavati dalle Indagini Istat Multiscopo annuali dal 1999 al 2010, per valutarne eventuali cambiamenti attribuibili alla legge Sirchia del 2005. I risultati evidenziano soltanto effetti a breve termine della legge sulla prevalenza di fumatori e sui tentativi di cessazione, effetti omogenei su tutta la popolazione maschile mentre, solo tra le donne, a carico delle meno istruite. I pochi esempi di valutazioni d’impatto degli interventi di popolazione, e i risultati spesso poco incoraggianti sulle disparità sociali, rappresentano un elemento di forte criticità nel contrasto delle diseguaglianze nei fattori di rischio comportamentali, su cui la ricerca è prioritariamente stimolata a confrontarsi.

6. Rasulo D, Spadea T, Onorati R, Costa G. The impact of migration in all-cause mortality: The Turin Longitudinal Study,1971-2005. Soc Sci Med. 2012 Mar;74(6):897-906. Epub 2012 Jan 17.
Regional Epidemiology Unit, ASL TO3 Piedmont Region, Via Sabaudia 164, 10095 Grugliasco, Turin, Italy. Abstract
North-western Italy has a long history of domestic influx, however little is known on how migrant mortality compares to mortality at the local level. While geographic mortality gradients may play a role, conceptualizations developed for international migration may also be relevant. Using this theoretical framework, the study investigated immigrant-native differentials in the north-western city of Turin through a 34-year follow-up that was facilitated by the Turin Longitudinal Study. The study population comprised inhabitants of age 30-74 years at the 1971 census. Survival trajectories were modelled through the Gompertz distribution and were examined for nativity status, birthplace, length of stay and age at arrival (the last two variables were combined). All estimates were adjusted for socio-economic factors. Overall, the risk of dying for internal migrants was lower, compared to locals, and consistent with geographic gradients. However, this pattern hid significant differences mediated by both age at arrival and length of stay. The advantage appeared to be exclusive to young and adult migrants, despite differentials narrowing over time. Immigrants who arrived after age 44 suffered instead a progressively greater excess risk, compared to natives, as residence increased. The dissipation of the health advantage found in internal migrants, along with poor health outcomes amongst people older at arrival, raises concern about immigrants from developing countries who need to endure a more demanding journey and adjustment to the new environment. The study indicated, through lengthy longitudinal data, that immigrant-native differentials were best explained by the stratified variable 'length of stay by age at arrival' and this should inform future studies.

Commento a cura di C. Marinacci:
il presente studio utilizza l’esteso patrimonio informativo dello Studio Longitudinale Torinese (SLT) per analizzare i profili di mortalità dei flussi storici di migranti a Torino dal resto d’Italia, confrontati con quelli della popolazione autoctona. I risultati confermano l’effetto migrante sano soltanto per chi immigra prima dei 45 anni; i vantaggi di salute si perdono più rapidamente tra i più giovani nei primi anni dall’immigrazione; l’effetto migrante sano sembrerebbe inoltre meno pronunciato per le coorti di nascita più recenti. Torino rappresenta un contesto paradigmatico e lo SLT un sistema idoneo per descrivere i meccanismi di selezione e adattamento dei flussi migratori storici nazionali, con riferimento ai loro indici di salute. Tali meccanismi possono trovare riscontro, almeno in parte, nelle nuove generazioni di migranti dall’estero e la loro conoscenza può contribuire a prevedere le dinamiche dei bisogni di salute di queste popolazioni.

7. Damiani G, Federico B, Basso D, Ronconi A, Bianchi CB, Anzellotti GM, Nasi G, Sassi F, Ricciardi W. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health. 2012 Feb 3;12(1):99. [Epub ahead of print]
Abstract
BACKGROUND: Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS: A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15,486 women aged 50-69 years for mammography and one of 35,349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS: Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.91; 95% CI = 1.72-2.13). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS: Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.
8. Di Maio M, Signoriello S, Morabito A, Rossi A, Maione P, Piantedosi F, Bilancia D, Cigolari S, Barbera S, Gebbia V, Daniele B, Robbiati SF, Illiano A, Ceribelli A, Carrozza F, Favaretto A, Piazza E, Piccirillo MC, Daniele G, Giordano P, Costanzo R, Sandomenico C, Rocco G, Gallo C, Perrone F, Gridelli C. Prognostic impact of education level of patients with advanced non-small cell lung cancer enrolled in clinical trials. Lung Cancer. 2012 Jan 30. [Epub ahead of print]
Clinical Trials Unit, National Cancer Institute, Napoli, Italy.
Abstract
BACKGROUND: Socioeconomic status can potentially affect prognosis of cancer patients. Our aim was to describe potential differences in demographic and clinical characteristics, treatment, and survival by education level in patients with advanced non-small cell lung cancer (NSCLC) enrolled in clinical trials of first-line treatment. METHODS: Individual data of Italian patients with advanced NSCLC (stage IV, or IIIB with supraclavicular nodes or malignant pleural effusion), ECOG performance status (PS) 0-2, enrolled in four phase III randomized trials conducted between 1996 and 2005 were pooled. Information about education was available for 1680 of 1709 patients (98.3%). Patients were divided in two groups according to education level: high (patients with at least high school diploma) or low (those with less than high school diploma). Survival analyses were stratified by treatment arm within trial. RESULTS: There were 312 (19%) and 1368 (81%) patients with high and low education, respectively. Education level was significantly different among birth cohorts, with a time-trend toward higher education level. Patients with high education were significantly younger (median age 65 vs. 70), were less frequently unfit at diagnosis (ECOG PS2 5% vs. 16%), and their tumor type was more frequently adenocarcinoma (47% vs. 37%). Number of treatment cycles received was not significantly different between education groups. Median survival was 9.4 and 7.6months in high and low education, respectively (p=0.012). At multivariable analysis, female sex, better PS and high education level (Hazard Ratio 0.85, 95%CI 0.73-0.99, p=0.03) were independently associated with longer survival. CONCLUSIONS: In Italian patients enrolled in four randomized trials of first-line chemotherapy for advanced NSCLC, high education was significantly more frequent among younger patients, and was associated with lower proportion of PS2 patients. Education level did not significantly affect number of chemotherapy cycles received. Overall survival was longer in patients with high education, after adjustment for PS and other prognostic factors. The exact underlying mechanisms of the independent prognostic role of education level are substantially unknown, but lead-time bias (anticipation in diagnosis and time to inclusion in the trial), differences in adherence to care outside the trial procedures, differences in comorbidities and life-style factors may all contribute.
9. Rodin D, Stirbu I, Ekholm O, Dzurova D, Costa G, Mackenbach JP, Kunst AE. Educational inequalities in blood pressure and cholesterol screening in nine European countries. J Epidemiol Community Health. 2012 Jan 12. [Epub ahead of print]
Erasmus Medical Centre, Rotterdam, the Netherlands.
Abstract
Background To perform the first European overview of educational inequalities in the use of blood pressure and cholesterol screening. Methods Data were obtained on the use of screening services according to educational level from nationally representative cross-sectional surveys in Belgium, Czech Republic, Denmark, Estonia, Finland, Hungary, Italy, Latvia and Lithuania. Screening rates were examined in the preceding 12 months and 5 years, for respondents 35+ years (45+ for women). ORs comparing low- to high-educated respondents were estimated using logistic regression controlling for age. Results Inequalities in cholesterol screening favouring higher socioeconomic groups were demonstrated with statistical significance among men in four countries, whereby men with higher education were more likely to receive screening, with 1.22 as the highest OR. Among women, a similar pattern was found. Inequalities in blood pressure screening were even smaller and less often statistically significant. Hungary was the only country with higher rates of both types of screening in the low-educated group. In other countries, pro-high inequalities were slightly increased after controlling for self-rated health. Conclusions All European countries in this study had small educational inequalities in the utilisation of blood pressure and cholesterol screening. These inequalities are smaller than those previously observed in the USA. Further comparative studies need to distinguish between screening for preventive purposes and screening for treatment and control.

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