[Mortality amenable to health care services and health inequalities among Italian Regions]. / La mortalità riconducibile ai servizi sanitari e le disuguaglianze di salute nelle regioni italiane.

OBJECTIVES: to investigate differences in amenable mortality among Italian Regions using the lists of causes of death conceived by Nolte and McKee, and Tobias and Yeh, and assess whether these differences are in part attributable to the list used. We also estimated the contribution of amenable mortality to the gaps in all-cause mortality among North, Centre and South of Italy. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: Italian National Institute of Statistics (ISTAT) mortality data for the period 2006-2009. MAIN OUTCOME MEASURES: age- and gender-standardised amenable mortality rates. RESULTS: for the period 2006-2009, in Italy the Nolte and McKee mortality rate was 62.38 per 100,000 inhabitants, ranging from 54.92 in the Autonomous Province of Bolzano (Northern Italy) to 62.38 in Campania Region (Southern Italy). For the same period, the Tobias and Yeh mortality rate was 69.59 per 100,000, ranging from 60.06 in Marche Region (Central Italy) to 88.12 in Campania Region. Using Nolte and McKee's list, amenable mortality accounted for 40.65% of the differences in all-cause mortality between Northern and Southern Italy, and for 33.66% of the differences between Southern and Central Italy. Using Tobias and Yeh's list, amenable mortality accounted for 53.99% of the differences in all-cause mortality between Northern and Southern Italy, and for 42.62% of the differences between Southern and Central Italy. CONCLUSION: the findings here presented show that amenable mortality rates calculated using Tobias and Yeh's list were higher than rates calculated using Nolte and McKee's list. Geographical pattern of amenable mortality derived by the two lists were almost coincident. Moreover, amenable mortality makes a substantial contribution to inequalities in health among North, Centre and South of Italy.

Socio-economic factors associated with infant mortality in Italy: an ecological study.

INTRODUCTION: One issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM). The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy. METHODS: Associations between infant mortality rates in the 20 Italian regions (2006-2008) and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15-64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM. RESULTS: The Gini index and the total unemployment rate showed a positive strong correlation with IM (r = 0.70; p < 0.001 and r = 0.84; p < 0.001 respectively), mean household income showed a strong negative correlation (r = -0.78; p < 0.001), while female educational attainment presented a weak negative correlation (r = -0.45; p < 0.05). Using a multiple stepwise linear regression model, only unemployment rate was independently associated with IM (b = 0.15, p < 0.001). CONCLUSIONS: In Italy, a high-income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.

Amenable mortality as a performance indicator of Italian health-care services.

BACKGROUND: Mortality amenable to health-care services ('amenable mortality') has been defined as "premature deaths that should not occur in the presence of timely and effective health care" and as "conditions for which effective clinical interventions exist." We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases. METHODS: Amenable mortality rate was calculated as the average annual number of deaths in the population aged 0-74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006-08. RESULTS: During the study period (2006-08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = -0.64, p = 0.002; female: r = -0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = -0.70, p <0.001; female: r = -0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer. CONCLUSIONS: Amenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.

Ability to pay and equity in access to Italian and British National Health Services.

BACKGROUND: Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services. METHODS: Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries. RESULTS: 78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years. CONCLUSIONS: Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal 'free of charge' way of access.

Impact of job insecurity on sexual desire: an exploratory analysis.

PRINCIPLES: To explore, for the first time, the impact of job insecurity on sexual desire. METHODS: Cross-sectional analysis of a nationally representative sample of 7247 individuals aged 20-64 years working as full or part-time employees in Switzerland. RESULTS: The logistic regression analysis showed that workers aged 20-49 years perceiving high levels of job insecurity are exposed to a significantly higher risk of decrease of sexual desire compared to the reference group. The risk is 53% higher among men (OR 1.53; 95% CI 1.16-2.01) and 47% for woman (OR 1.47; 1.13-1.91). No increased risk was found for employees aged 50-64 years old. CONCLUSION: An increasing fear of job loss is associated with a deterioration in sexual desire. These first preliminary findings should promote further epidemiological and clinical prospective studies on the impact of job insecurity on intimate relationships and sexual dysfunction.

Temperature related mortality and ambulance service interventions during the heat waves of 2003 in Ticino (Switzerland).

OBJECTIVES: This study investigates a potential increase in mortality and in the demand for ambulance emergency services among the elderly in particular, in Ticino in the summer of 2003. METHODS: Mortality rates and emergency ambulance interventions rates were compared with records from the previous years. We considered the whole population, aged 65 and over, as well as 75 and over. RESULTS: The 2003 mortality in the population was not significantly different from the previous years. The number of deaths among the elderly showed a small but significant deviation from the expected values during the first heat wave in June 2003, with no significant impact on the seasonal results. The number of ambulance service interventions was larger than during the previous years. CONCLUSION: These results are consistent with findings in other studies. The heat waves (especially in June), were correlated with a higher number of ambulance callouts. In addition to some geographic, climatic, and social factors that had a protective impact, the response of the emergency services is likely to have contributed to a certain reduction in mortality.

[Contact with death or illness and career choice in non-medical healthprofessions and business students: a cross-sectional analysis]. / Contatto con morte, malattia e scelta della carriera nelle professioni sanitarie non mediche e negli studenti di economia: un'analisi trasversale.

UNLABELLED: . Contact with death or illness and career choice in non-medical health professions and business students: a cross-sectional analysis. PURPOSE: It is anecdotally reported that a personal severe illness or the death of a significant person might be key reasons for the choice of a career in the non-medical health professions. AIM: The aim of the questionnaire was to explore past relevant life events before starting professional studies (severe personal illness; severe illness or death of a significant person; drug addiction of a relative or friend) by comparing students of nursing or other non medical health professions with business students. METHODS: An anonymous questionnaire with standardized closed questions was distributed in 2010 to a group of bachelor students of non-medical health professions (nursing, physiotherapy, occupational therapy and rescue care) and to a control group of business students at the University of Applied Sciences and Arts of Southern Switzerland. RESULTS: Students of non-medical health professions had been, compared to business students, significantly more exposed to severe illnesses or the death of a relative (OR 3.070, CI95% 1.716-5.494), to personal severe illness (OR 3.950, CI95% 1.384-11.279) and to addiction of a relative or friend (OR 2.672, CI95% 1.316-5.422) before starting their professional studies. CONCLUSIONS: This cross-sectional analysis suggests that exposure to a severe illness or death may play an important role in the choice of career, probably by supporting intrinsic motivations. Further research should explore the role of those past life experience in professional behavior.

Women's perception of the benefits of mammography screening: population-based survey in four countries.

BACKGROUND: Screening programmes are often actively promoted to achieve high coverage, which may result in unrealistic expectations. We examined women's understanding of the likely benefits of mammography screening. METHODS: Telephone survey of random samples of the female population aged > or =15 years in the US, UK, Italy, and Switzerland using three closed questions on the expected benefits of mammography screening. RESULTS: A total of 5964 women were contacted and 4140 women (69%) participated. Misconceptions were widespread: a majority of women believed that screening prevents or reduces the risk of contracting breast cancer (68%), that screening at least halves breast cancer mortality (62%), and that 10 years of regular screening will prevent 10 or more breast cancer deaths per 1000 women (75%). In multivariate analysis higher number of correct answers was positively associated with higher educational status (odds ratio [OR] = 1.44, 95% CI: 1.25, 1.66) and negatively with having had a mammography in the last 2 years (OR = 0.86, 95% CI: 0.73, 1.01). Compared with US women (reference group) and Swiss women (OR = 0.98, 95% CI: 0.82, 1.18) respondents in Italy (OR = 0.61, 95% CI: 0.50, 0.74) and the UK (OR = 0.73, 95% CI: 0.60, 0.88) gave fewer correct answers. CONCLUSION: In the US and three European countries a high proportion of women overestimated the benefits that can be expected from screening mammography. This finding raises doubts on informed consent procedures within breast cancer screening programmes.

Does provision of an evidence-based information change public willingness to accept screening tests?

OBJECTIVE: To investigate whether the willingness of the general population to undergo a screening test of questionable effectiveness for pancreatic cancer is influenced by the quality and the extent of the information provided. DESIGN: Randomised study. SETTING: Switzerland. PARTICIPANTS: Representative sample (N=1000) of the general population aged over 20. INTERVENTIONS: Participants were randomly allocated into two groups (N=500 each), with one group to receive basic and the other extended quality of information. The information was presented in two hypothetical scenarios about implicit and explicit benefits and adverse events of the screening test. Response rates were, respectively, 80.2% (N=401) and 93.2% (N=466). MAIN OUTCOME MEASURES: Stated willingness to undergo the screening test. RESULTS: Out of the 401 participants receiving the basic information scenario, 241 (60%) stated their willingness to accept the test, as compared to the 63/466 (13.5%) exposed to the extended one (P < 0.001). After adjusting for respondent characteristics through a logistic regression model, the 'information effect', expressed in terms of odds-ratio (OR), shows that provision of additional information was related to a 91% (OR 0.09; 95CI: 0.07 - 0.13) relative reduction in the likelihood of accepting the screening test. CONCLUSION: The quality and the extent of the information provided about the implicit and explicit benefits and adverse events on hypothetical scenarios of a screening test may dramatically change the willingness of people to participate in the testing. This study suggests that provision of full information on the yield of health care interventions plays an important role in protecting the public from being exposed to procedures of questionable effectiveness.

[The physician/population ratio in Switzerland: the impact of its regional variation on mortality, health expenditures and user's satisfaction]. / Influence de la variation des densités médicales régionales en Suisse sur la mortalité, les dépenses de santé et la satisfaction des usagers.

An opinion survey conducted in 1997 in the various Swiss "cantons" produced the following findings: 1. The satisfaction of the population concerning the provision of ambulatory care does not increase when the physician/population ratio increases. It is not clear whether a decrease of "oversupply" gives raise, at least in the short term, to a feeling of dissatisfaction. 2. The perception of signs of shortened supply does not increase when the physician/population ratio decreases. 3. When the cantons are grouped by level of physician/population ratio, the different groups show nearly the same health performance as measured by the rate of avoidable mortality. 4. The number of consultations per capita increases clearly in the "cantons" having high physician/population ratios. Increased ratios have clearly an impact on health expenditures.

Health effects of fear of unemployment among employees in the general population

It investigates the consequences of job insecurity, anticipation of job change and downsizing techniques on the health of the individuals exposed to these conditions. It presents bibliographic references.