rubrica

Disuguaglianze

  • Chiara Marinacci1

  1. Ministero della Salute, Dipartimento della programmazione e dell'ordinamento del Servizio sanitario nazionale, Direzione Generale della Programmazione Sanitaria.
Chiara Marinacci -

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Ricerca bibliografica periodo dal 16 gennaio – 31 marzo 2013

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

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 ("2012/11/01"[PDAT] : "2013/01/15"[PDAT])

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

1. Donisi V, Tedeschi F, Percudani M, Fiorillo A, Confalonieri L, De Rosa C, Salazzari D, Tansella M, Thornicroft G, Amaddeo F. Prediction of community mental health service utilization by individual and ecological level socio-economic factors. Psychiatry Res. 2013 Mar 23. pii: S0165-1781(13)00106-6. doi: 10.1016/j.psychres.2013.02.031. [Epub ahead of print]
Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Italy. Electronic address: valeria.donisi@univr.it.

Abstract Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly.

2. Vercelli M, Lillini R, Quaglia A, La Maestra S, Micale RT, Caldora M, De Flora S. Yearly variations of demographic indices and mortality data in Italy from 1901 to 2008 as related to the caloric intake. Int J Hyg Environ Health. 2013 Mar 7. pii: S1438-4639(13)00020-5. doi: 10.1016/j.ijheh.2013.02.003. [Epub ahead of print]
Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.

Abstract The aim of the present study was to evaluate, by Join Point regression method, the yearly variations in demographic indices and mortality data in Italy from 1901 to 2008, as related to the caloric intake. The relationships between mortality and caloric intake were studied by time series. The results showed that, from 1901 to 2008, the Italian population grew from 32.5 to 59.6 millions; the live births rates decreased from 31.8 to 10.1‰ (males) and from 33.3 to 9.0‰ (females); the infant mortality rates fell from 184.1 to 3.7‰ (males) and from 149.4 to 3.2‰ (females); males and females gained 35.7 and 40.6 years in life expectancy at birth, respectively. In 1901 the 61% of deaths occurred in the youngest, whereas in 2008 the elderly accounted for the 80%. In 1901, in terms of age-adjusted data, other and undefined causes overcame the specific causes of death, whose rank was: respiratory, digestive, infectious, cardiovascular, cerebrovascular, cancers, accidents, endocrine, and nervous system diseases. In 2008, undefined causes ranked 3rd (males) and 4th (females), while cancers became the leading cause of death, followed by cardiovascular, cerebrovascular, accidental, respiratory, endocrine, digestive, nervous system, and infectious diseases. The caloric intake showed a negative correlation with all-cause mortality, infant mortality, and mortality for a number of specific causes. These patterns reflect the progress in average nutritional status, lifestyle quality, socioeconomic level, and hygienic conditions.

3. Dallolio L, Lenzi J, Fantini MP. Temporal and geographical trends in infant, neonatal and post-neonatal mortality in Italy between 1991 and 2009. Ital J Pediatr. 2013 Mar 19;39:19. doi: 10.1186/1824-7288-39-19.
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, via San Giacomo 12, Bologna, 40126, Italy. laura.dallolio@unibo.it.

Abstract BACKGROUND: Infant mortality is a key indicator of child and population health. The aim of this study is to analyse the trends in infant mortality rates (IMRs) and their components (neonatal mortality rates-NMRs and post-neonatal mortality rates-PNMRs) from 1991 to 2009 both at the national level and across the three Italian large geographical macro-areas (North, Center, South). METHODS: Using data extracted from the Health for All-Italy database, IMRs, NMRs and PNMRs were calculated for the 19 Italian Regions and 2 Autonomous provinces for the years 1991-2009. Relative risks and attributable fractions were calculated for Southern and Central Italy compared with Northern Italy. Temporal trends were analysed using the robust polynomial Poisson regression models. RESULTS: During the study period there was a 54% decline in IMR (from 7.72/1000 to 3.55/1000), a 57% decline in NMR (from 5.87/1000 to 2.55/1000) and a 46% decline in PNMR (from 1.85/1000 to 1/1000). In particular, we found a strong decline in IMRs and NMRs from 1991 to 2000/2001, and a weaker decline starting from 2002/2003. Moreover, we found a slight decrease in PNMRs until 2001/2002, and no significant variations starting from 2003. Despite these reductions, important geographical variations persisted: in 2006-2009, the most recent data available, the excess of infant mortality in Southern Italy compared with the North was 27%. CONCLUSIONS: During the period 1991-2009 Italy experienced a significant decline in IMRs, NMRs and PNMRs. We observed the same pattern for the temporal trends of these indicators across the North, the Center and South of Italy. Despite this decline, geographical disparities persisted.

4. Melchiorre MG, Chiatti C, Lamura G, Torres-Gonzales F, Stankunas M, Lindert J, Ioannidi-Kapolou E, Barros H, Macassa G, Soares JF. Social support, socio-economic status, health and abuse among older people in seven European countries. PLoS One. 2013;8(1):e54856. doi: 10.1371/journal.pone.0054856. Epub 2013 Jan 30.
Centre of Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy. g.melchiorre@inrca.it

Abstract BACKGROUND: Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment. METHODS: The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). RESULTS: Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse. CONCLUSIONS: High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.

Breve commento a cura di Chiara Marinacci
Lo studio si basa sui dati della survey multicentrica ABUEL, rivolta ad una campione europeo di anziani residenti in contesti urbani. Il supporto sociale è stato misurato attraverso 12 items raggruppabili in 3 scale, a seconda della tipologia di rete (famiglia, amici, altri). Il campione è stato altresì sottoposto a rilevazione di sintomi fisici e psicologici, patologie e contatti con operatori sanitari, eventuali episodi di violenza subita. Il sotto-campione italiano si caratterizza, dopo il Portogallo, per il minor grado di supporto sociale.

5. Guidetti D, Spallazzi M, Rota E, Morelli N, Immovilli P, Toni D, Baldereschi M, Polizzi BM, Ferro S, Inzitari D. Monitoring the implementation of the State-Regional Council agreement 03/02/2005 as to the management of acute stroke events: a comparison of the Italian regional legislations. Neurol Sci. 2013 Jan 26. [Epub ahead of print]
Department of Neurology, G. da Saliceto Hospital, Via Cantone del Cristo 40, 29121, Piacenza, Italy, d.guidetti@ausl.pc.it.

Abstract Access to effective acute stroke services is a crucial factor to reduce stroke-related death and disability, but is limited in different parts of Italy. Our study addresses this inequality across the Italian regions by examining the regional legislations issued to adopt and implement the State-Regional Council agreement 03/02/2005 as to the acute stroke management. All decrees and resolutions as to acute stroke were collected from each region and examined by the means of a check list including quantitative and qualitative characteristics, selected in accordance with the recommendations from the State-Regional Council document. Each completed check list was then sent to each regional reference person, who filled in the section on the implementation of the indications and compliance, with the collaboration of stroke specialists if necessary. The study was carried out from November 2009 to September 2010. The documents and information were collected from 19 regions. Our survey revealed disparities both in terms of number of decrees and resolutions and of topics covered by the regional legislations about stroke care. Most legislations lacked practical and economical details. This feedback from national and regional stroke regulations revealed a need of more concrete indications. Involvement of various stakeholders (legislators, consumers, providers) might possibly ensure that policies are actually adopted, implemented and maintained. Although considerable challenges are present to the development of standard and optimal stroke care more widely across Italian regions, the potential gains from such developments are substantial.

6. Colais P, Agabiti N, Fusco D, Pinnarelli L, Sorge C, Perucci CA, Davoli M. Inequality in 30-day mortality and the wait for surgery after hip fracture: the impact of the regional health care evaluation program in Lazio (Italy). Int J Qual Health Care. 2013 Jan 18. [Epub ahead of print]
Department of Epidemiology, Regional Health Service, Lazio Region, Italy.

Abstract OBJECTIVE: INTERVENTIONS: that address inequalities in health care are a priority for public health research. We evaluated the impact of the Regional Health Care Evaluation Program in the Lazio region, which systematically calculates and publicly releases hospital performance data, on socioeconomic differences in the quality of healthcare for hip fracture. DESIGN: /st>Retrospective cohort study. SETTING: and participants. We identified, in the hospital information system, elderly patients hospitalized for hip fracture between 01 January 2006 and 31 December 2007 (period 1) and between 01 January 2009 and 30 November 2010 (period 2). MAIN OUTCOME MEASURES: /st>We used multivariate regression models to test the association between socioeconomic position index (SEP, level I well-off to level III disadvantaged) and outcomes: mortality within 30 days of hospital arrival, median waiting time for surgery and proportion of interventions within 48 h. RESULTS: /st>We studied 11 581 admissions. Lower SEP was associated with a higher risk of 30-day mortality in period 1 (relative risk (RR) = 1.42, P = 0.027), but not in period 2. Disadvantaged people were less likely to undergo intervention within 48 h than well-off persons in period 1 (level II: RR = 0.72, P < 0.001; level III: RR = 0.46, P < 0.001) and period 2 (level II: RR = 0.88, P = 0.037; level III: RR = 0.63, P < 0.001). We observed a higher probability of undergoing intervention within 48 h in period 2 compared with the period 1 for each socioeconomic level. CONCLUSION: /st>This study suggests that a systematic evaluation of health outcome approach, including public disclosure of results, could reduce socioeconomic differences in healthcare through a general improvement in the quality of care.

Breve commento a cura di Chiara Marinacci
la pubblicizzazione delle statistiche di performance delle strutture e gli interventi che ne conseguono (audit clinici, individuazione e soluzione di criticità nei processi e negli aspetti organizzativi) sembra poter influire significativamente sugli stessi indicatori di esito e sulla loro eterogeneità per sottogruppi di popolazione. Pur non disponendo di un gruppo di riferimento comparabile non sottoposto all’intervento, questo studio dà riscontro di un potenziale effetto, anche sulle differenze sociali, derivante dalla pubblicizzazione di indicatori di esito, con riferimento al trattamento di pazienti anziani con frattura d’anca.

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