rubrica

Disuguaglianze

  • Chiara Marinacci1

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

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Ricerca bibliografica periodo dal 16 marzo 2012 al 31 maggio 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 ("2012/03/16"[PDAT] : "2012/05/31"[PDAT])

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

1 Barbadoro P, Cotichelli G, Chiatti C, Simonetti ML, Marigliano A, Di Stanislao F, Prospero E. Socio-economic determinants and self-reported depressive symptoms during postpartum period. Women Health. 2012 May;52(4):352-68.
a Section of Hygiene, Department of Biomedical Science , Polytechnic University of the Marches , Ancona , Italy.
Abstract
The researchers' aims were to estimate the prevalence of postpartum depressive symptoms in Italy. Cross-sectional data from the survey, "Health and use of health care in Italy" were analyzed. The authors focused on 5,812 women, pregnant some time during five years before the survey. Multiple logistic regression was used to evaluate risk factors independently associated with postpartum depressive symptoms. Evaluation of seasonal trends was also performed.In the total sample, 23.5% (n = 1,365) reported having suffered postpartum depressive symptoms: 20.7% experienced baby blues, and 2.8% postpartum depression. Factors significantly associated with baby blues were, among others, living in northern or central areas (adjusted odds ratio [aOR] 1.88; 95%CI 1.57-2.15 and 1.40; 95%CI 1.20-1.63, respectively), history of depression (aOR 1.34; 95%CI 1.15-1.56), and attendance at antenatal classes (aOR 1.13; 95%CI 1.04-1.22). Factors significantly associated with postpartum depression were: anamnesis of depression (aOR 3.32; 95%CI 2.69-4.09), gaining more than 16 kg of weight during pregnancy (aOR 1.48; 95%CI 1.03-2.12), and undergoing a cesarean section (planned: aOR 1.56; 95%CI 1.05-2.29; unplanned: aOR 1.78; 95%CI 1.16-2.73). Multiparity was a protective factor both for baby blues (aOR 0.80; 95%CI 0.70-0.91), and postpartum depression (aOR 0.71; 95%CI 0.51-0.98). No clear seasonality was observed for postpartum depression, while for baby blues a certain aggregation of events was registered during the central months of the year. The authors' study highlighted variables associated with baby blues and postpartum depression to target screening for women for postpartum depressive symptoms.
2 Carta MG, Mura G, Lecca ME, Moro MF, Bhat KM, Angermeyer MC, Hardoy M, Hakiskal HS. Decreases in depression over 20years in a mining area of Sardinia: Due to selective migration? J Affect Disord. 2012 May 8. [Epub ahead of print]
Centro di Psichiatria di Consultazione e Psicosomatica, Azienda Ospedaliero Universitaria di Cagliari, University of Cagliari, Italy.
Abstract
BACKGROUND The objective of the study was to determine if community surveys, conducted 3 times over a period of 20years in a small district of Sardinia (Italy), confirm the increase in depressive disorders reported in the recent literature. METHODS Three community surveys were carried out on randomized samples of the same Sardinian mining area in 1988, 1998 and 2008. The surveys were conducted using the interview "Present State Examination" in 1988 (depression diagnosed with ICD-IX) and the CIDI-S in 1998 and 2008 (major depression diagnosed with ICD-X). The three surveys produced estimates of one-month prevalence and of lifetime prevalence in 1998 and 2008. RESULTS Our work found a substantial decrease in depressive disorders from the survey conducted in 1998 to the survey in 2008 using a similar methodology, except in the youngest age group, which showed an increase in the rate. A decrease in the frequency of depressive disorders compared to what was found 20years ago was also observed. However, in this case the comparison is more problematic because of use of different diagnostic systems. DISCUSSION The research seems to show a decrease in depressive disorders over the past two decades. While the small population examined makes it difficult to generalize the overall findings, this study suggests that the hypothesis of an increase in the incidence of depressive disorders since the 1980s in western countries, should have exceptions. A complex interaction between socio-economic (mining closure and large migration) and biological factors (possible selective migration) is likely to influence changes in the prevalence of mood disorders. However, due to certain limitations of this study, this hypothesis may be considered from a heuristic perspective.
3 de Belvis AG, Ferrè F, Specchia ML, Valerio L, Fattore G, Ricciardi W. The financial crisis in Italy: Implications for the healthcare sector. Health Policy. 2012 Jun;106(1):10-6. Epub 2012 Apr 30.
Institute of Public Health and Preventive Medicine, Catholic University "Sacro Cuore" Rome, Largo Francesco Vito, 1, 00168 Roma, Italy.
Abstract
The global economic and financial crisis is having and impact on the Italian healthcare system which is undergoing a devolution process from the central government to regions and where about one third of the regional governments (mainly in the central and southern part of the country) are facing large financial deficits. The paper briefly describes the current macro scenario and the main responses taken to face the crisis and highlights the downside risks of introducing "linear" cuts in the allocation of resources. While justified by the risk of a national debt default, present fiscal policies might increase inequalities in access to care, deteriorate overall health indicators and population wellbeing, and sharpen existing difference in the quality of care between regions. Preliminary evidence shows that the crisis is affecting the quality of nutrition and the incidence of psychiatric disorders. During this difficult financial situation Italy is also facing the risk of a major reduction in investments for preventive medicine, Evidence Based Medicine infrastructures, health information systems and physical capital renewal. This cost-cutting strategy may have negative long term consequences Also, important achievement in terms of limiting waiting lists, improving continuity of care and patients' centeredness, and promoting integration between social and health care may be negatively affected by unprecedented resources' cuts. It is essential that in such a period of public funding constraints health authorities monitor incidence of diseases and access to care of the most vulnerable groups and specifically target interventions to those who may be disproportionally hit by the crisis.

Breve commento a cura di Alessio Petrelli
L’articolo descrive l’impatto della crisi economica sul sistema sanitario italiano. Dapprima vengono elencate le misure adottate negli ultimi tre anni per il ripianamento dei deficit regionali (piani di rientro) e per l’incremento delle entrate finanziarie (tickets sui consumi della specialistica e della farmaceutica). Successivamente vengono evidenziati numerosi indizi che lasciano ipotizzare effetti che direttamente (minore disponibilità di risorse economiche) e indirettamente (adozione di stili di vita meno salutari e limitazioni nell’accesso ai programmi di prevenzione primaria), potrebbero incidere negativamente sulla salute della popolazione e potenziali rischi di incremento di iniquità nell’accesso ai servizi sanitari. I fenomeni di incremento di barriere all’accesso potrebbero acuirsi in relazione all’attualità legata all’adozione delle misure per la spending review. Anche in relazione all’intensità e alla durata della crisi economica, risulta fondamentale attivare strumenti informativi e gruppi di lavoro che operino per il monitoraggio dell’impatto sulla salute e l’assistenza sanitaria.

4. Richter M, Rathman K, Gabhainn SN, Zambon A, Boyce W, Hurrelmann K. Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries. Sociol Health Illn. 2012 Apr 12. doi: 10.1111/j.1467-9566.2011.01433.x. [Epub ahead of print]
Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Halle, Germany Hertie School of Governance, Berlin, Germany Berlin Graduate School of Social Sciences, Humboldt University Berlin, Germany Health Promotion Research Centre, National University of Ireland, Galway, Ireland Department of Public Health, University of Turin, Italy Department of Community Health & Epidemiology, Queen's University, Kingston, Canada.
Abstract
Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the 'Health Behaviour in School-aged Children' study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.
5. Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol. 2012 Mar 27;4(3):68-73.
Elisabetta Franco, Laura Zaratti, Department of Public Health, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy.
Abstract
Hepatitis A is the most common form of acute viral hepatitis in the world. Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. The anti-hepatitis A virus (HAV) seroprevalence rate is presently decreasing in many parts of the world, but in less developed regions and in several developing countries, HAV infection is still very common in the first years of life and seroprevalence rates approach 100%. In areas of intermediate endemicity, the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection. As the severity of disease increases with age, this has led to outbreaks of hepatitis A. Several factors contribute to the decline of the infection rate, including rising socioeconomic levels, increased access to clean water and the availability of a hepatitis A vaccine that was developed in the 1990s. For populations with a high proportion of susceptible adults, implementing vaccination programs may be considered. In this report, we review available epidemiological data and implementation of vaccination strategies, particularly focusing on developing countries.
6. Sammon JD, Morgan M, Djahangirian O, Trinh QD, Sun M, Ghani KR, Jeong W, Jhaveri J, Ehlert M, Schmitges J, Bianchi M, Shariat SF, Perrotte P, Rogers CG, Peabody JO, Menon M, Karakiewicz PI. Marital status: a gender-independent risk factor for poorer survival after radical cystectomy. BJU Int. 2012 Mar 27. doi: 10.1111/j.1464-410X.2012.10993.x. [Epub ahead of print]
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI Department of Urology, Weill Medical College of Cornell University, New York, NY, USA Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada Martini-Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
Abstract
STUDY TYPE Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Married individuals have lower morbidity and mortality rates for all major causes of death. Cancer-specific survival is better in married patients with testis cancer, prostate cancer, breast cancer, cervical cancer, as well as head and neck cancers. We have found the effect of marital status on outcomes after radical cystectomy to be variable, depending on gender and the outcome addressed. Being married is predictive of lower all-cause mortality for both men and women relative to their separated, divorced or widowed (SDW) or never-married counterparts. It is also predictive of lower bladder-cancer-specific mortality relative to SDW individuals. Marriage also exerts a protective effect on men regarding non-organ-confined disease, with those never having married having significantly higher rates. OBJECTIVES To examine the effect of marital status (MS) on the rate of non-organ-confined disease (NOCD) at radical cystectomy (RC) To assess the effect of MS on the rate of bladder-cancer-specific mortality (BCSM) and all-cause mortality (ACM) after RC for urothelial carcinoma of the urinary bladder (UCUB). MATERIALS AND METHODS A total of 14 859 patients, who underwent RC for UCUB, were captured within the Surveillance, Epidemiology, and End Results database, between 1988 and 2006. Logistic regression analysis was used to assess the rate of NOCD (T(3-4) /N(I-3) /M(0) ) at RC and Cox regression analyses were used to assess BCSM and ACM. Analyses were stratified according to gender; covariates included socio-economic status, tumour stage, age, race, tumour grade and year of surgery. RESULTS Never-married males had a higher rate of NOCD at RC (odds ratio = 1.22, P= 0.004), an effect not found in never-married females. Separated, divorced or widowed (SDW) males (hazard ratio [HR]= 1.18, P= 0.005) and females (HR = 1.16, P= 0.002) had higher rates of BCSM than their married counterparts. SDW and never-married males had higher rates of ACM than their married counterparts (HR = 1.22, P < 0.001 and HR = 1.26, P < 0.001, respectively). SDW and never-married females also had higher rates of ACM than married females (HR = 1.24, P < 0.001 and HR = 1.22, P= 0.01, respectively). CONCLUSIONS For both men and women, being SDW conveyed an increased risk of BCSM after RC. SDW and never marrying had a deleterious effect on ACM. Unfavourable stage at RC was also seen more commonly in never-married males.

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