Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015.

BACKGROUND: The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants' healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. METHODS: Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25-64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. RESULTS: Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40-1.52) and Latin Americans (RR = 1.04, 95%CI 1.00-1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34-1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96-0.97) for the whole population, with differences among migrant subgroups, regardless of cause. CONCLUSIONS: This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.

Mortality Paradox of Older Italian-Born Men in Australia: The Concord Health and Ageing in Men Project.

Italian migrants are one of the largest groups of older migrants in Australia. Past research has found lower mortality rates in Italian migrants but it is unclear if this persists into older age. Data came from 334 Italian-born and 849 Australian-born men aged 70 years and over participating in a longitudinal study of men's ageing. Male Italian migrants were more likely to smoke, be overweight, and have lower socio-economic status (SES). They also had higher morbidity from diabetes, chronic pain, dementia and depressive symptoms but lower morbidity from heart disease and cancer. There was no age-adjusted mortality difference. However, adjusting for SES, lifestyle and morbidity differences revealed a 25% lower mortality rate (adjusted HR = 0.75; 95% CI 0.57, 0.98) in Italian-born men. Compared to their Australian-born counterparts, older Italian-born men have a lower mortality than expected considering their lower SES, higher smoking and higher morbidity.

Psychological distress among migrant groups in Australia: results from the 2015 National Health Survey.

PURPOSE: To understand the relationship between migration and psychological distress, we (a) calculated the prevalence of psychological distress in specific migrant groups, and (b) examined the association between specific birth groups and psychological distress, while controlling for confounding variables to understand vulnerabilities across migrant groups. METHODS: The prevalence of psychological distress, disaggregated by birthplace, was calculated using data from the Australian 2015 National Health Survey, which measures psychological distress via the Kessler Screening Scale for Psychological Distress (K10). Multivariable logistic regression models, with adjustments for complex survey design, were fitted to examine the association between country of birth and psychological distress once extensive controls for demographic, and socioeconomics factors were included. RESULTS: 14,466 individuals ≥ 18 years completed the K10. Migrants from Italy (20.7%), Greece (20.4%), Southern and Eastern European (18.2%), and North African and Middle Eastern (21.9%) countries had higher prevalence estimates of distress compared to Australian born (12.4%) or those born in the United Kingdom (UK) (9.5%)-the largest migrant group in Australia. After adjusting for demographics, SES factors, duration in Australia, a birthplace in Italy (OR = 2.79 95% CI 1.4, 5.7), Greece (OR = 2.46 95% CI 1.1, 5.5), India (OR = 2.28 95% CI 1.3, 3.9), Southern and Eastern Europe (excluding Greece and Italy) (OR = 2.43 95% CI 1.5, 3.9), North Africa and the Middle East (OR = 3.39 95% CI 1.9, 6.2) was associated with increased odds of distress relative to those born in the UK. CONCLUSIONS: Illuminating variability in prevalence of psychological distress across migrant communities, highlights vulnerabilities in particular migrant groups, which have not previously been described. Identifying such communities can aid mental health policy-makers and service providers provide targeted culturally appropriate care.

The contribution of Italian migrant women in the New World to health and safety at work.

BACKGROUND: Many Italian migrant women left Italy for the United States of America (USA) in the years 1881-1932. In the USA they could only find poor jobs such as home work or unskilled jobs in the developing American manufacturing industries. OBJECTIVES: Analysis of the contribution of Italian migrant women to the improvement of working conditions in the USA. METHODS: Five case-studies have been selected and analyzed by national and international literature. RESULTS: Case studies were: 1. Florence Kelley's research on insanitary working conditions among Sicilian home workers in Chicago (1899); 2. Death of forty-two Italian women in the Triangle Shirtwaist Factory fire in New York and the claim of Anna Gullo in the trial against the employers; 3. The report on the condition of Italian migrant women in the USA by Irene de Bonis dei Baroni de Nobili and the Women's Trade Union League (1911); 4. The Maggia sisters Amelia, Quinta and Albina and the trial for compensation of radium related diseases (1928); 5. The contribution of Italian migrant Geraldina "Jennie" Sirchio to the T-room experiment at the Hawthorne Works in Chicago (1928). CONCLUSIONS: Italian migrant women, among others, played an important role in the USA social and economic development. Women were particularly exposed to infectious disease, fire risk, radium painting, repetitiveness, etc. Important trials, inquiries and legislation together with recognition of occupational diseases were fostered thanks to their often unknown sacrifice. Today as yesterday migrant workers should be valued and prevention improved.

Maternal sociodemographic factors differentially affect the risk of behavioral problems in Brazilian and Italian preterm toddlers.

The main aim of the present study was to examine differences in behavioral problems in toddlers born very preterm in Brazil and Italy. The sample comprised 154 toddlers (18-24 months of age) born very preterm, including 76 toddlers from Brazil and 78 toddlers from Italy. The Child Behavior Checklist was used to assess behavioral problems. Specific sociodemographic factors (i.e., maternal age at childbirth and maternal education) and neonatal factors (i.e., gestational age, sex, and length of hospitalization) were tested as potential mediators of country-related differences in behavioral problems. Brazilian toddlers presented more internalizing, externalizing, and total behavioral problems compared with their Italian counterparts. The effect of country on the toddlers' internalizing and total behavioral problems was mediated by maternal age at childbirth and education. Independent effects of country, maternal age at childbirth, and maternal education emerged for externalizing behavioral problems. No significant effect emerged for neonatal variables. These findings suggest that sociodemographic factors, in addition to country-related differences, should be considered when assessing the risk of behavioral problems in preterm toddlers.

Why were Sardinians the shortest Europeans? A journey through genes, infections, nutrition, and sex.

Since ancient times the Mediterranean island of Sardinia has been known for harboring a population with an average body height shorter than almost every other ethnic group in Europe. After over a century of investigations, the cause(s) at the origin of this uniqueness are not yet clear. The shorter stature of Sardinians appears to have been documented since prehistoric times, as revealed by the analysis of skeletal remains discovered in archaeological sites on the island. Recently, a number of genetic, hormonal, environmental, infective and nutritional factors have been put forward to explain this unique anthropometric feature, which persisted for a long time, even when environmental and living conditions improved around 1960. Although some of the putative factors are supported by sound empirical evidence, weaker support is available for others. The recent advent of whole genome analysis techniques shed new light on specific variants at the origin of this short stature. However, the marked geographical variability of stature across time and space within the island, and the well-known presence of pockets of short height in the population of the southern districts, are still puzzling findings that have attracted the interest of anthropologists and geneticists. The purpose of this review is to focus on the state-of-the-art research on stature, as well as the factors that made Sardinians the shortest among Europeans.

Suicide mortality in Belgium at the beginning of the 21st century: differences according to migrant background.

Background: Suicidal behaviour has long been recognized to vary widely between countries. Yet, rates of suicidal behaviour do not only vary between, but also within countries. Gender and socioeconomic differences in suicidal behaviour are well established, but the literature on suicidal behaviour and migrants is sparse, particularly in Belgium. The present study maps out the occurrence of suicide mortality across three of the largest migrant groups (Italians, Turks and Moroccans) versus the native population in Belgium, and verifies whether this association persists after accounting for socioeconomic variables. Methods: Census-linked mortality follow-up data covering the period 2001­2011 were used to probe into suicide mortality. To compare absolute differences by migrant background, indirect standardisation analyses were carried out. To assess relative differences, Cox proportional hazards models were performed. Analyses were restricted to 18- to 64-year-olds. Results: Belgian men and women have the highest suicide mortality risk, persons of Moroccan/Turkish origin the lowest, and Italians are somewhere in between. When migration generation is considered, the risk is higher for second-generation groups compared to that of the first-generation. Accounting for socioeconomic determinants, the difference between the native population and the various nationality groups intensifies. Conclusion: Although the risk is generally lower for minorities compared to the majority population, the results across migration generations underscore minorities' increased vulnerability to suicide over time. Future research should focus on understanding the risks and protective factors of suicidal behaviour across different nationality groups. This way, tailored policy recommendations can be developed in order to tackle the burden of suicide.

Human rights conflicts experienced by nurses migrating between developed countries.

BACKGROUND: Some developed countries have recently changed their role in the context of international recruitment, becoming donors due to socio-economical and political factors such as recessions. This is also the case in Italy, where there has been a flow of immigrant nurses out of the country that has been documented over the past several years. In a short time, it has become a donor country to other developed European countries, such as the United Kingdom. AIMS: To advance knowledge in the context of human rights conflicts and ethical implications of the decision-making process of nurses who migrate between developed countries, such as from Italy to the United Kingdom, during times of recession. RESEARCH DESIGN: A case study based on the descriptive phenomenological approach was undertaken in 2014. Participants and research context: A total of 26 Italian newly graduated nurses finding a job in the United Kingdom were interviewed via Skype and telephone. Ethical considerations: The Internal Review Board of the University approved the project. FINDINGS: In accordance with the descriptive phenomenological approach undertaken, three main themes emerged: (1) escaping from the feeling of being refused/rejected in order to be desired, (2) perceiving themselves respected, as a person and as a nurse, in a growth project and (3) returning if the country changes its strategy regarding nurses. DISCUSSION: Ethical implications in the context of human rights, such as autonomy of the decision, social justice and reciprocal obligation, non-maleficence and double effect, have been discussed. CONCLUSION: The call for investing in nurses and nurses' care in developed countries facing recession is urgent. Investing in nurses means respecting individuals and citizens who are at risk of developing health problems during the recession.

Accounting for ethnic-cultural and linguistic diversity in neuropsychological assessment of patients with drug-resistant epilepsy: A retrospective study.

Neuropsychological assessment is critical in both diagnosis and prognosis of patients with epilepsy. Beyond electrophysiological and anatomical alterations, other factors including different ethnic-cultural and linguistic backgrounds might affect neuropsychological performance. Only a few studies considered migration and acculturation effects and they typically concerned nonclinical samples. The current study aimed at investigating the influence of ethnic background and time spent in Italy on a full neuropsychological battery administered to both Italian and foreign-born patients and at providing a brief interview for obtaining relevant information on each patient's transcultural and language-related history. Clinical reports from 43 foreign-born patients with drug-resistant epilepsy were collected from the archives of Milan Niguarda Hospital. Epileptogenic zone, age, education, profession, illness duration, seizure frequency, handedness, and gender were considered in selecting 43 Italian controls. Ethnicity (Italian/foreign-born) and years spent in Italy were analyzed as main predictors on 21 neuropsychological scales by means of General(ized) Linear Models. An additional analysis studied two composite scores of overall verbal and nonverbal abilities. Ethnicity significantly affected the following: the verbal overall score, Verbal Fluency, Naming, Token-test, Digit Span, Attentional Matrices, Trail-Making-Test, Line-Orientation-Test, and Raven matrices; no effects were found on the nonverbal overall score, Word Pairs Learning, Episodic Memory, reading accuracy, visual span, Bells test, Rey Figure, and face memory and recognition. No significant effects of years spent in Italy emerged. While years spent in Italy does not predict neuropsychological performance, linguistic background had a strong impact on it. With respect to Italian-speaking patients, those who were foreign-born showed large task-related variability, with an especially low performance on language-related tests. Hence, language tests should not be considered as valid measures of neuropsychological impairment in this population, not even in foreign-born patients with good Italian fluency. Clinicians should consider such asymmetries in order to improve the accuracy of neuropsychological assessment of foreign-born patients.

Italian families and family interventions.

In Italy, as in many countries, relatives are closely involved in caring for persons with physical and mental disorders. The Italian scenario lends itself to routine involvement of family members in psychiatric treatment because, despite becoming smaller and smaller, Italian families keep close ties, and men and women do not leave the parental home until relatively late. The authors describe the impact of international family psychosocial research on the Italian mental health services (MHSs) and the main psychosocial interventions currently in use, including family psychoeducational interventions and the "Milan family therapy approach." They also highlight the contribution Italian researchers have given to the study of important variables in integrated mental disorder care, such as family burden of care, relatives' attitudes, family functioning, and satisfaction with the MHSs. Finally, they discuss the difficulties of implementing and disseminating family interventions within the Italian MHS, despite the growing evidence of their effectiveness.

[Barriers in the attendance of health care interventions by immigrants]. / Subjektiv erlebte Barrieren von Personen mit Migrationshintergrund bei der Inanspruchnahme von Gesundheitsmaßnahmen.

AIM: Analysis of barriers regarding attendance at the health care system under consideration of cultural and migration-related factors. METHOD: Cross-sectional survey with immigrants from Turkey (n = 77), Spain (n = 67), Italy (n = 95) and German resettlers from the former Soviet Union (n = 196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations. RESULTS: Spanish and Italian immigrants mainly search for help within their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influencing factors were German language proficiency and the subjective wellbeing in Germany. CONCLUSION: The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.

Padrões de nupcialidade na economia cafeeira de São Paulo (1860-1930) / Marriage patterns in São Paulo coffee economy (1860-1930) / /Patrones de nupcialidad en la economía cafetera de Sao Paulo (1860-1930)

O objetivo deste trabalho é apresentar e discutir as pautas matrimoniais vigentes em um município típico da economia cafeeira paulista, entre 1860 e 1930, tomando tal variável como indicador do vigor da identidade étnica e do grau de assimilação dos estrangeiros na sociedade local. São Carlos foi fundado em 1857 e conformou-se, a partir da penúltima década do século XIX, como um município bastante representativo da economia cafeeira que se desenvolveu no Estado. De fato, com uma mão de obra inicialmente composta por escravos negros, a partir dos anos 1880 o município passou a receber expressivas levas de imigrantes europeus - italianos, portugueses, espanhóis e outros numericamente menos significativos - para trabalhar nas plantações de café, a ponto de, em 1894, ter recebido o maior contingente de imigrantes de todo o interior paulista. A partir de uma análise dos 15.011 registros paroquiais de casamento observados no período, o trabalho discute a evolução das preferências matrimoniais desses diversos grupos que, ao lado de brasileiros brancos e negros, conformaram uma população estimada em 60 mil indivíduos em 1930. Os dados analisados indicam que a origem nacional atuou como condicionante muito significativo das opções matrimoniais efetivamente concretizadas até pelo menos final dos anos 1920. Assim, as evidências colhidas apontam que pelo menos as primeiras duas gerações de indivíduos de origem imigrante, que viveram em São Carlos até a Grande Depressão do final da década de 1920, mostraram-se bastante resistentes ao processo de assimilação, pelo menos sob o ângulo das pautas matrimoniais.

This paper discusses marriage patterns in a representative city in the state of São Paulo during the coffee economy of 1860-1930. It takes these patterns as indicators of the strength of ethnic identities and of the assimilation of European immigrants in the local society. The city of São Carlos was founded in 1857 and by the late 19th century, it can be seen as fairly typical of the coffee economy that developed in the state of São Paulo. In fact, with a workforce initially composed of African slaves, from the 1880s the city began to receive significant waves of European immigrants - Italians, Portuguese, Spanish and other less numerically significant - for work on coffee plantations, to the point that, in the year of 1894, it received the highest number of immigrants in all of the state, except for the capital. From an analysis of 15,011 parish registers of marriage observed in the period, this paper discusses the evolution of marriage preferences among diverse groups that, alongside black and white Brazilians, conformed an estimated population of 60,000 individuals in 1930. The data analyzed indicate that national origin served as very significant determinant of marital options effectively implemented until at least the late 1920s. Thus, the evidence gathered indicates that at least the first two generations of persons of immigrant origins, living in São Carlos until the Great Depression in the late 1920s, were quite resistant to the process of assimilation, at least in regards to marriage patterns.

El objetivo de este trabajo es presentar y discutir las pautas matrimoniales vigentes en un municipio típico de la economía cafetera paulista, entre 1860 y 1930, tomando tal variable como un indicador del vigor de la identidad étnica y del grado de asimilación de los extranjeros en la sociedad local. San Carlos fue fundado en 1857 y se convirtió, a partir de la penúltima década del siglo XIX, en un municipio bastante representativo de la economía cafetera que se desarrolló en el estado de Sao Paulo. De hecho, con una mano de obra inicialmente compuesta por esclavos negros, a partir del año 1880 y en adelante, el municipio pasó a recibir ingentes masas de inmigrantes europeos - italianos, portugueses, españoles y otros numéricamente menos significativos- para trabajar en las plantaciones de café, hasta el punto de que, en 1894, había recibido el mayor contingente de inmigrantes de todo el interior del estado de Sao Paulo. A partir de un análisis de los 15.011 registros parroquiales de matrimonio observados en el período, el trabajo discute la evolución de las preferencias matrimoniales de esos diversos grupos que, junto a los brasileños blancos y negros, conformaron una población estimada en 60 mil individuos en 1930. Los datos analizados indican que el origen nacional actuó como un condicionante muy significativo en las opciones matrimoniales, efectivamente consumadas en matrimonios, hasta por lo menos final de los años veinte del siglo pasado. Así pues, las evidencias recogidas apuntan a que por lo menos las primeras dos generaciones de individuos de origen inmigrante, que vivieron en San Carlos hasta la Gran Depresión del final de la década de 1920, se mostraron bastante resistentes al proceso de asimilación, por lo menos bajo el ángulo de las pautas matrimoniales.

Reproductive behavior during the pre-transitional period: evidence from rural Bologna.

A longitudinal, micro-level study of the effect of socioeconomic transformations on fertility mechanisms in the rural hinterland of Bologna between 1818 and 1900 (the beginning of the demographic transition) demonstrates that the premature death of a last-born child reduces the interval between two consecutive childbirths. Thus does it confirm the importance of breast-feeding in determining birth spacing. Women living in complex sharecropping households experienced a significantly higher risk of childbirth than did women in families headed by daily wage earners. In addition, the reproductive behavior of sharecroppers seemed to be substantially invariant to short-term ºuctuations in prices, whereas the laborers' group experienced a negative price effect. Both descriptive and multivariate analyses indicate a slight and gradual decrease in fertility levels during the period in question.

Tacit consent: the Church and birth control in northern Italy.

This article employs novel documentation to examine ways in which the Church's moral rules on contraception were (or were not) communicated to parishioners in a predominantly Catholic context in a period of rapid fertility decline: the diocese of Padua, in the northeastern Italian region of Veneto, during the first half of the twentieth century. The account is based on documents that have until now been overlooked: the moral cases discussed during the periodic meetings among Padua priests in the years 1916­58, and the written answers provided by priests in response to a question asked of them concerning their efforts to combat the limiting of births. This documentation reveals the limited effect on the reproductive behavior of the position of the Catholic Church against birth control.

Going to the USA--a US headache center from an Italian perspective.

During a period I spent at the UCSF Headache Center in the USA, I noted striking differences between the US health-care system and the Italian one in which I was trained. Here, I aim to outline some of these differences from a scientific-and, more importantly, from a sociocultural-point of view. Awareness of these aspects may help us to better understand different approaches to the diagnosis and treatment of various diseases, including headache.

Translating Fanon in the Italian context: rethinking the ethics of treatment in psychiatry.

Based on two years of ethnographic fieldwork at the Centro Frantz Fanon, an ethnopsychiatric clinic in Northern Italy, this article traces the theoretical and clinical genealogy of Italian ethnopsychiatry as it is conceived and practiced at this clinic. The clinic draws explicitly from the work of Fanon and French ethnopsychologist Tobie Nathan. This genealogy provides a basis for reflection on the ways in which current ethnopsychiatry re-articulates older questions about difference and healing, culture and suffering, and the political dimensions of psychiatry. Although ethnopsychiatry is currently focused on the care of migrants, key issues related to the impact of colonialism on mental illness and the recognition of cultural difference characterized the Italian debate long before the 1980s when increasing numbers of migrants and political refugees started to arrive in Italy.

Clerical "concubines" in northern Italy during the fourteenth century.

This essay reconstructs the lives of a neglected group of women in the Christian church during the later Middle Ages. So-called clerical "concubines" were well-known in their communities, but their lived experience has been largely ignored by modern historians. Yet studying clerical concubines sheds light not only on the women themselves, but also on the social organization of the medieval Christian church. Drawing on information gathered from notarial acts across the northern Italian peninsula, I argue that concubines were not a unitary group. Their experiences varied instead according to their status and the regions they inhabited. For instance, while laywomen who became priests' concubines moved into their lovers' homes, nuns retained cells in their religious houses during these relationships. Furthermore, concubines in cities such as Treviso could openly live with their lovers and share their property, while in other places, such as Bergamo, severe legal restrictions on concubines made them a particularly vulnerable group.

Ethnicity and falls in older men: low rate of falls in Italian-born men in Australia.

BACKGROUND: past research suggests that fall rates in older persons may differ by ethnicity. The aim of this study was to compare the incidence of falls between older male Italian-born immigrants and their Australian-born counterparts. METHODS: this study analysed data from 335 Italian-born and 848 Australian-born men aged 70 years and over participating in the Concord Health and Ageing in Men Project (CHAMP). Prospective falls data were collected by 4 monthly phone calls (mean follow-up time: 26.7 months). Negative binomial regression compared falls incidence rate ratios (IRR) between the two groups of men. RESULTS: there were 37 (11%) Italian-born men and 185 (22%) Australian-born men who had two or more falls during follow-up (P < 0.001). Negative binomial analysis demonstrated that Italian-born men had half the incidence rate of falls compared with Australian-born men (IRR = 0.51, 95% CI = 0.38-0.67). After adjustment for falls risk factors, Italian-born men remained significantly less likely to fall with a 43% lower fall rate (IRR = 0.57, 95% CI = 0.39-0.85). CONCLUSION: older male Italian-born immigrants are less likely to fall than their Australian-born counterparts. Differences in fall rates between the two groups are not explained by established falls risk factors.

Radio campaign to promote quality use of medicines among Italian, Mandarin and Cantonese speaking seniors in Australia.

ISSUE ADDRESSED: The objective of this study was to evaluate the effectiveness of a radio campaign in promoting the quality use of medicine (QUM) among Italian, Mandarin and Cantonese-speaking seniors. METHODS: One hundred and eight six in-language radio advertisement spots and nine interviews were broadcasted during eight ethnic language radios programs in September and October 2008. Immediately before and after the campaign, telephone interviews were conducted with 1,200 (600 before and 600 after) randomly selected Italian, Mandarin and Cantonese-speaking seniors aged 50 or older. RESULTS: Awareness of QUM was increased by 6%.The mean number of correct answers regarding QUM increased from 5.2 before the campaign to 5.7 after the campaign (p<0.001). The proportion of people who had correct answers to six or more questions (out of nine) increased by 12% (p<0.001). The increase was largest among the Cantonese-speaking seniors (27%), followed by the Mandarin (8%) and Italian seniors (4%, p<0.001). CONCLUSIONS: The radio campaign was effective in increasing awareness and knowledge of QUM among seniors. However, the effectiveness of the campaign varied between language groups.