Suchergebnisse

- Measuring the relative socio-economic disadvantages has been representing a useful tool to study the relationship between socioeconomic factors and health conditions for at least 25 years. In the last years the possibility to develop epidemiological studies in large populations increased thanks to the availability of databases containing health information and databases containing information on socio-economic status (SES). In epidemiological literature we often find multidimensional measures of SES: deprivation indexes. They usually refer to geographical aggregations and are used as proxy of personal conditions; indexes allow to identify and estimate the existing relationship with different health outcomes. Keywords: indexes, socioeconomic status, deprivation, small areas, national census, epidemiology. Parole chiave: indici, stato socioeconomico, deprivazione, piccole aree, censimento, epidemiologia.

- Scientific literature provides substantial evidence on how socioeconomic circumstances influence health, showing that this association holds with any indicator of socioeconomic position, independently of the theoretical approach on which is based. The open question on the indicators used to represent socioeconomic position is: are they equal proxy of a third variable, social classification or stratification, or do they capture specific dimensions of this stratification, the impact of which would be measurable independently of the others? This paper gives a tentative answer, from the epidemiological point of view, examining the indicators of socioeconomic position most used in health research (education, employment status, occupational class, income and goods), particularly focusing on their meaning, i.e. what they intend to measure, together with how data are elicited and the validity and limitations of the indicators. Keywords: indicators, education, social class, income, sources, epidemiology, social determinants of health. Parole chiave: indicatori, istruzione, classe sociale, reddito, fonti, epidemiologia, determinanti sociali di salute.

il contributo, elaborato sulla base di una vasta letteratura, si concentra su tre punti e presenta una proposta operativa. Il primo punto è che i rischi e i danni per la salute nel lavoro sono in ampia misura evitabili. L'aspetto più interessante che emerge dalle ricerche è che esiste la possibilità, in molti contesti sociali e tra questi negli ambienti di lavoro, di ridurre le conseguenze negative per la salute agendo sul rapporto tra le persone e l'organizzazione. Il secondo punto riguarda i cardini di una possibile strategia, utile a promuovere la competitività, ma contemporaneamente il benessere diffuso delle persone, e quindi l'equità di salute. Il terzo punto si occupa dell'equità dei cambiamenti in corso. Molte delle tendenze in atto nel lavoro sono fortemente ambivalenti. A seconda di come sono gestite, guidate, implementate, possono ridurre o aumentare le disuguaglianze. Il contributo quindi propone modalità di HEA per progettare e valutare le politiche del lavoro, della formazione, del miglioramento continuo, della conciliazione, del welfare aziendale.

Le mamme che lavorano hanno un maggior rischio infarto di cuore che cresce all'aumentare del numero di figli a carico, in particolare se maschi. A Torino, come nel resto del Paese, il carico di lavoro domestico della donna che lavora è molto maggiore rispetto a quello del loro partner. I figli maschi rappresentano un carico supplementare più oneroso, per il loro minore contributo al lavoro domestico. Questo risultato, molto originale nel panorama della ricerca scientifica internazionale, sollecita l'attivazione di politiche di conciliazione dei tempi di cura e di lavoro sia da parte del mondo del lavoro (contratti di lavoro flessibili e part-time), sia da parte dell'offerta dei servizi per l'infanzia, sia da parte della società in termini di ripartizione equa dei compiti domestici e di cura in famiglia.

Abstract
Purpose
Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt.

Methods
The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture.

Results
During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified.

Conclusions
The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.

Abstract Background Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme. Methods Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000–2010 were more favourable as compared to the period 1990–2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position. Results After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000–2010 in England were not more favourable than those observed in the period 1990–2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries. Conclusions In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.

Background: Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme. Methods: Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position. Results: After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries. Conclusions: In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities. ; Peer reviewed

Objectives In the face of economic downturn and increasing life expectancy, many industrial nations are adopting a policy of postponing the retirement age. However, questions still remain around the consequence of working longer into old age. We examine mortality by work status around retirement ages in countries with different welfare regimes; Finland (social democratic), Turin (Italy; conservative), and England and Wales (liberal). Methods Death rates and rate ratios (RRs) (reference rates = 'in-work'), 1970 s–2000 s, were estimated for those aged 45–64 years using the England and Wales longitudinal study, Turin longitudinal study, and the Finnish linked register study. Results Mortality of the not-in-work was consistently higher than the in-work. Death rates for the not-in-work were lowest in Turin and highest in Finland. Rate ratios were smallest in Turin (RR men 1972–76 1.73; 2002–06 1.63; women 1.22; 1.68) and largest in Finland (RR men 1991–95 3.03; 2001–05 3.80; women 3.62; 4.11). Unlike RRs for men, RRs for women increased in every country (greatest in Finland). Conclusions These findings signal that overall, employment in later life is associated with lower mortality, regardless of welfare regime.