Sexual harassment and menstrual disorders among Italian university women: A cross-sectional observational study.

AIMS: Menstrual disorders and sexual harassment are common among young women and interfere with their life and activities. We aimed to describe the association of sexual harassment and menstrual disorders among female university students. METHODS: This cross-sectional, observational study examined the association between sexual harassment and menstrual disorders in a sample of 349 university students in Italy. Students answered an anonymous self-administered questionnaire. Descriptive bivariate analyses and logistic regression analyses were performed. Main outcome measures were associations between levels of exposure to sexual harassment (none, levels 1 and 2) and five menstrual disorders (premenstrual symptoms, heavy bleeding, pain, irregular cycles, and amenorrhea). RESULTS: Among the women interviewed (mean age 20.4 ± 1.45 years), 146 (41.8%) had experienced sexual harassment in the previous 12 months: 91 (26.1%) level 1 and 55 (15.7%) level 2. The frequency of premenstrual symptoms was 31.9% ( n=110); heavy bleeding, 35.3% ( n=124); pain, 51.4% ( n=181); irregular cycles, 55.5% ( n=195); and amenorrhea, 6.7% ( n=23). After adjustment for age, place of birth, being in a couple relationship and receiving hormone therapy, the frequency of menstrual disorders, except for amenorrhea, was increased with sexual harassment, with a regular gradient from no harassment to level 2 harassment. Introducing factors of depression, specific gynaecological problems and lifetime sexual violence did not change the results. For instance, the adjusted odds ratios of premenstrual symptoms were 2.10 [1.19-3.68] for women with level 1 harassment and 3.58 [1.83-7.03] for women with level 2 compared with women without harassment exposure. CONCLUSIONS: Sexual harassment is related to the prevalence of menstrual disorders. Healthcare providers should encourage dialogue with patients and address the issue of sexual violence or harassment.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample.

OBJECTIVE: To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth. DESIGN: Longitudinal cohort study. SETTING: Nine primary care centers in the Valencia Region (Spain). POPULATION: A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases. METHODS: A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence. MAIN OUTCOME MEASURE: Psychological IPV during follow-up. RESULTS: We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11). CONCLUSIONS: Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

[Earthquake in Abruzzo, public health interventions. Preliminary report]. / Interventi sanitari in occasione del sisma in Abruzzo. Rapporto preliminare.

On 6th April 2009, at 3.32 AM, there was in L'Aquila and in some neighbouring villages, after an earthquake swarm last some months, an earthquake of M(L) = 5.8 (Richter magnitude scale) on depth of 8.8 km. The event was sensed in a very broad area, till in Rome and Ancon. The operative committee of the Civil Protection Department immediately gathered and a first operating group was despatched in the epicentre; the voluntary association of civil protection were in a pre-alarm situation and then were activated. This work want describe all the activities from 6th April 2009 till 31th August 2009, giving too a synthesis of the normative lines in case of catastrophic events typology C, otherwise all that events impossible to manage without national intervention.

[Work and depression in women after the birth of a child]. / Lavoro e depressione delle donne dopo la nascita di un figlio.

OBJECTIVE: To analyze the main factors associated to depression at 8 months postpartum, looking more particularly at women's employment. METHOD: 352 women responded to a face-to-face questionnaire few days after the birth, at the Maternity Hospital "Burlo Garofolo" in Trieste, and 292 of them responded to a telephone interview 8 months later. Psychological distress 8 months after delivery was evaluated with the General Health Questionnaire (GHQ). RESULTS: 8 months postpartum, 5% of women were depressed. 32% of women were non-satisfied with their current working status, without differences among those working and those staying at home. 13% of sample reported problems related to work (such as being fired or no flexible working hours). The women's actual working status was not associated with depression, while the congruence between what the woman was doing (working/at home) and her wishes was. The relationship was still significant after adjusting for other factors associated with depression. CONCLUSIONS: Employment dissatisfaction is negatively associated with women's health after childbirth. To promote mothers' wellbeing, the question of women's employment after birth should be addressed.

Self perceived health and mental health among women flight attendants.

AIMS: The authors investigated associations of work related risk factors with self perceived health as less than "good" and psychological distress among Italian women flight attendants. METHODS: The authors conducted a cross sectional survey on health and mental health among 1955 former and current flight attendants, using a postal questionnaire. RESULTS: More current than former flight attendants reported self perceived health as fair to poor and psychological distress measured as a GHQ-12 score of six or more. Among current flight attendants, reporting health as fair to poor was associated with low job satisfaction (OR 1.89) and recent experiences of sexual harassment by passengers (OR 2.83). Psychological distress was associated with low job satisfaction (OR 2.38) and frequent tension with partner over childcare (OR 1.79). CONCLUSIONS: Perceived health as fair to poor and psychological distress were greater among current flight attendants and were related to job characteristics and family difficulties. Perceived poor health has been shown in the literature to be related to mortality, high job strain, and early retirement, and psychological distress is associated with work absence. The effect of sexual harassment by passengers on perceived health of flight attendants may be relevant to other working women dealing with the public. The health effects of family/work conflicts, low job satisfaction, and sexual harassment should be explored more in depth, using qualitative as well as quantitative methods among working women in various occupations.

Integrating qualitative methods into occupational health research: a study of women flight attendants.

AIMS: To identify possible work related sources of psychosocial stress in order to develop pertinent questionnaire items for a cross-sectional health survey of 3000 Italian women flight attendants, and to solicit suggestions on improving survey participation. METHODS: Qualitative study in which 26 current and former women flight attendants participated: three focus groups of 6-7 participants each and six in-depth individual interviews. The session themes included positive and negative aspects of the job; relationships with colleagues, superiors, and passengers; perception of occupational risk for serious diseases; compatibility of work and family; and experiences of work related sources of stress and their effect on health. A transcript based analysis of the focus groups and interviews was used to identify emerging themes related to risk factors for mental health problems. RESULTS: The participants indicated that mental health was a major concern. Several work related risk factors possibly related to adverse outcomes, such as depression and anxiety, were highlighted. These included isolation and solitude, fears of being inadequate partners and mothers due to job demands, passenger relationships, and lack of protection by employers with respect to workplace exposures and violent passengers. The information gained was used to develop a mental health module for inclusion in the health survey questionnaire which included questions on history of severe depression or anxiety, suicidal ideation or attempt, substance abuse, workplace sexual harassment, social support, leisure time activities, relationship with a partner, and role as mother. CONCLUSIONS: Employing qualitative methods to identify work related sources of psychosocial stress enabled development of pertinent questionnaire items for a cross-sectional epidemiological study of women flight attendants. Follow up qualitative research may be necessary in order to put the cross-sectional study findings into context and to explore actions or strategies for preventing work related health problems evidenced from the survey.

Finance modeling in the delivery of medical care in tertiary-care hospitals in the Department of Veterans Affairs.

BACKGROUND: In the mid-1990s, the Department of Veterans Affairs (DVA) implemented the Veterans Equitable Resource Allocation (VERA), a new financial model developed to attempt to better distribute the approximately $18 billion annual budget among roughly 170 Veterans Administration Medical Centers (VAMCs). VERA is based on a Health Maintenance Organization (HMO) model. VERA provides reimbursement to each of the 22 regional Veterans Integrated Service Networks (VISNs), and subsequent VISN distribution to individual VAMCs is based on an individual medical center's enrollment of unique social security numbers (uniques). In HMO vocabulary these are individual "covered lives." METHODS: Currently available demographic and staffing information regarding the DVA's 23 tertiary hospital systems (Category 7 hospitals) on the KLF database (DVA Austin Data Base) and published information on the DVA website were reviewed. The following was obtained: (1) staffing information-physician and nurse full-time employment equivalent (FTEE) staffing; (2) patient demographics and hospital workload-facility uniques (u), outpatient facility uniques, average daily census (ADC), discharges, and outpatient clinic visits. The following staffing ratios were calculated for both physician and nursing: FTEE/(u/1000), FTEE/(discharges/1000), FTEE/(clinic visits/1000), FTEE/ADC. For all categories the means +/- SD were calculated and correlation coefficients were calculated on pertinent pairings. RESULTS: Although categorized as similar tertiary care facilities, the 23 "Group 7" VA hospitals are anything but equivalent when reviewed using the VERA financing model with respect to physician staffing, nurse staffing, and facility uniques. Using VERA methodology, average physician FTEE and total nursing FTEE staffing/(u/1000) are 3.67 +/- 0.89 and 15.53 +/- 3.77, respectively. Correlation statistics of staffing versus unique SSNs demonstrated correlation coefficients of 0.46 and 0.59 with respect to physician and nurse staffing, respectively. On the other hand, when physician FTEE and nursing FTEE staffing were compared with VAMC workload parameters (total ADC, discharges, and outpatient visits), correlation coefficients were more consistent, ranging from 0.62 to 0.86. CONCLUSIONS: In the VERA model, the reward of a larger annual budget for an individual VAMC or the regional VISN is realized when staffing of VAMCs is minimized, overall provided medical services (especially costly tertiary services) are limited, and the number of covered lives is maximized. A VAMC staffing system that equates medical services delivered in a tertiary VAMC setting based on an HMO model like VERA (where the user population is skewed toward the sicker, older patient) shows decreased correlation when compared with VAMC workload model parameters.

Women's health after childbirth: a longitudinal study in France and Italy.

OBJECTIVE: To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner. DESIGN: Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries. POPULATION: Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded. RESULTS: The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one-third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently. CONCLUSION: Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day-to-day life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well-coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer from them. They should counsel the women in their care, in order to help them to find the best solution, be it medical or social in nature.

Unemployment and psychological distress one year after childbirth in France.

STUDY OBJECTIVE: To analyse the relation between unemployment and the psychological distress of mothers one year after childbirth. DESIGN: Multicentric survey concerning births occurring between September 1993 and July 1994. SETTING: In France: two maternity units in the Parisian area and one in Champagne-Ardennes, in the east of France, comprising both urban and rural areas. PARTICIPANTS: Primipara and secondipara women were interviewed three times: at birth by a face to face interview, five months and 12 months after the birth, by postal questionnaires, with a 83% response rate for the two postal questionnaires. The analysis includes 632 women who answered all three stages of the survey. MEASUREMENTS: Psychological distress was mainly assessed one year after birth by the 12-item General Health Questionnaire. RESULTS: After adjustment for unwanted pregnancy, marital conflicts, marital status, hospitalisation of the baby during the last year, lack of confiding relationship, depressive or anxious troubles before pregnancy, age, educational level and parity, unemployed women had an excess of psychological distress compared with employed women (OR = 1.87; 95% CI = 1.12, 3.13). The ratios for housewives were very close to those of employed women. Among the unemployed women, 60% had recently been without a job, since a few months before or after the birth. An excess of psychological distress among unemployed compared with employed women was observed in all social groups defined by the current or last occupation, but with various extents. Psychological distress was specially linked to the employment status in the group of women with the more qualified occupations. CONCLUSION: Even after a birth, when women are very much involved in their maternal role, those seeking a job have worse mental health than those in a stable situation, either employed or housewives. In France, the unemployment rate among young women is high. It is specially important that social regulations protecting employment during and after pregnancy are adequately applied. Employers, legislators, such as medical doctors, have to be aware to this situation.

What makes new mothers unhappy: psychological distress one year after birth in Italy and France.

The aim of this report is to present results on the factors associated with psychological distress in 724 Italian and 629 French women 12 months after birth. The prevalence of distress was ascertained by the 12-item Goldberg Health Questionnaire (GHQ), using a cut-off score of > 5. Results show that, in both countries, after controlling for previous psychological health, the variables significantly associated with mothers' distress were: an unsatisfactory couple relationship; lack of a confidante; a baby with serious health problems, financial worries. In Italy, also being an older mother and a discrepancy between actual and desired employment status were associated with a high GHQ score. These results point out to the high prevalence of mothers' psychological distress in Latin countries too, and stress the role played by family and social factors.

[Marital violence after birth]. / Violence conjugale après une naissance.

OBJECTIVE: The purpose was to estimate the prevalence of marital violence during the year after childbirth in France. METHODS: a survey has been carried out in three maternity units among primipara and secondipara women in 1993-1994. The women were interviewed in the three days after the delivery and they received a postal questionnaire 5 and 12 months later. The analysis includes 706 women. RESULTS: the prevalence of marital violence during the 12 months after childbirth is equal to 4.1% (2.6%-5.6%). This percentage is higher among women living an unstable relationship with their partner or when the partner has not a job. These women who reported marital violence had a higher prevalence of previous miscarriage. They used more often psychotropic drugs and reported more often depressive symptoms than the other women. CONCLUSION: physicians may be helpful by listening and counseling these women who receive low emotional and social support.

[Responses to a postal survey on women's health after birth: importance of repeated mailings and characteristics of non-respondents]. / Réponses à une enquête postale sur la santé des femmes après une naissance: importance des relances et caractéristiques des non-répondantes.

A longitudinal survey was carried out in three maternity units in France in 1993-1994. At the first contact, within the four days following the delivery, 761 women were included in the survey with a face-to-face interview. The second and the third contacts took place five and twelve months after the birth. These contacts were postal questionnaires at home, with a first mail followed by three reminders, if necessary. This paper analyses the response rate to a postal survey and the efficiency of repeated mails in the context of a research about women's health after childbirth. The characteristics of non responders and those of late responders are compared with initial stage responders. Twelve months after the birth, 57% of the women had returned the questionnaire after the first mail and 86% after all the mailings. Non responders were younger and were more often in unfavorable family or social conditions than responders. The late responders had more often a non French nationality, they reported more often psychotropic drugs consumption and wished for this pregnancy less often than the initial stage responders. For some characteristics as educational level, employment or financial concerns late responders had an intermediate position between the initial stage responders and the non responders. Repeated mailings strongly improve the final response rate. Nevertheless non responders remain a particular group that is imperfectly represented by the late responders.

[Communication in the neonatal intensive therapy unit: the opinions of parents and of medical personnel compared]. / La comunicazione in terapia intensiva neonatale: opinioni dei genitori e del personale sanitario a confronto.

Within the framework of an European international project, the issue of parents-staff communication in Neonatal Intensive Care Units was explored. 5 Italian unit participated in the project. 80 mothers and 62 fathers of singleton, not malformed, very low birthweight babies were interviewed during the fourth week of their baby's life, while the views of the health personnel (60 doctors and 106 nurses) were collected through an anonymous, self-administered questionnaire. Most of the staff feels that parents should be informed completely about their baby's conditions and prognosis, while the actual practices about transmission of information are reported differently according to professional status: more nurses than doctors feel that the information is not as complete as it should be. Uncertainty of prognosis is the most commonly quoted reason for restricting the information. Parents, on the other hand, are generally satisfied about the information received, although some of them complain about the style of communication, and especially the need to ask repeatedly in order to be informed. These results show some of the gaps existing in communication both within the staff and with parents, and suggest possible ways of improvement.

Mothers' health after the birth of the first child: the case of employed women in an Italian city.

While the number of mothers resuming employment soon after the birth of a child is growing, knowledge about the effect that having both a baby and a job has on mental and physical health is still scarce. In this paper, we studied the health of 141 Italian first-time mothers, who were all employed during pregnancy. When their child was 15 months old, 84% were back at work; 24-36% suffered from lack of sleep, extreme tiredness and backache; more than half had experienced some feelings of depression since the birth. Considering the whole sample, poorly educated and unmarried mothers reported more physical health problems. Being employed per se showed no influence, but poorly educated mothers and those with a less qualified job reported more problems. On the basis of our results, we suggest that future research on new mothers, work and health should systematically include "domestic" variables and the characteristics of the paid job; and should analyze more thoroughly the influence of marriage status and educational level on health.

Work and health in mothers of young children.

Although most mothers of young children work, we do not know much about the effect of this work on the mothers' health. The aim of this article is to review and discuss some of the findings on this subject, in order to understand whether paid and unpaid work are associated with mothers' health. Results from available studies show that, while employment tends to be associated with better physical and mental health in mothers, its effects are inconsistent when mothers of babies or young children are specifically examined. For physical health, employment is likely to have a negative effect for working-class mothers and a positive effect for middle-class ones. For mental health, the trend is unclear; mothers' psychological well-being is negatively affected, however, by the presence of one or more preschoolers, a lack of involvement by the husband, difficulties linked to child care, and the women's preferences concerning their professional status. Moreover, variables such as education, income, social class, housing, and marital status are likely to affect the health of mothers of young children, just as they affect the health of other women.

Prostitutes and chimney sweeps both have problems: towards full integration of both sexes in the study of occupational health.

Recently, natural and social scientists have pointed out that the need to make scientific results apply to both sexes is not met by simply adding women as research subjects. They suggest that the social and biological specificity of both sexes must be recognized and adjustments made to the ways questions are asked, hypotheses are generated, research subjects are chosen, and data are analysed. It is important to examine the definitions, concepts and methods used in research in occupational health to see whether they obstruct recognition of women's occupational health problems or interfere with gender-neutral standard setting. Unravelling the effects of sex on occupational health is complicated by the fact that women and men do not, by and large, work at the same jobs. Definitions of "work" must in some cases be adjusted to take account of women's occupations, just as definitions involving "health" must include women's biological specificity. Appropriate changes must be made to generate sex-inclusive definitions of exposures to occupational hazards and of health effects. Methods for evaluating exposures typical of women's work must be developed. Women and their work must be appropriately included when standards for occupational exposures are set. If these adjustments are not made, women's occupational health problems will be seriously underestimated and understanding of health problems of both sexes will be hindered. Sociological analysis should also be done to reveal the mechanisms by which biased concepts and procedures develop and are reinforced.

Fair law, unfair practices? Benefiting from protective legislation for pregnant workers in Italy and France.

Protective Maternity Legislation (PML) for pregnant workers is well established in Italy and France, but little is known about the way it fulfils some of its aims, such as the protection of mothers' and babies' health and of the rights of women workers. In this paper, we present the results of two surveys, one carried out in Italy and the other in France, concerned with the implementation of these regulations. Results show that women who were regularly employed generally could benefit from PML, while non-eligible workers, most of them holding manual jobs, were not protected at all. Among eligible workers, inequalities existed: women with less qualified jobs and those employed in the private sector were less likely to benefit from the protective measures considered. A number of specific measures, such as the possibility of taking an early maternity leave for work reasons and of being moved to another job within the same firm were underused in both countries. Some limitations of PML are discussed, namely the fact it covers some but not all pregnant workers, that it ignores domestic work and the tendency to remove the pregnant worker rather than to modify her working conditions.

Social history of a research project: a study on early post-partum discharge.

This paper has a two-fold aim: first we report the results of a study in which 66 recently-delivered women were asked their opinion about a possible program of early post-partum discharge, and about their recent experience of birth and hospital stay. The data show that, while most of the mothers were critical of a number of aspects related to personnel behaviour and hospital organization, only a minority would have appreciated early post-partum discharge. The second aim was to present and discuss the social history of this research project: the reasons why the authors carried out the study, the difficulties in interpreting the results and, above all, the obstacles encountered in trying to have them circulated, discussed and applied. It was felt that these problems were not specific to this study, and that it was therefore worthwhile to discuss them openly.

She ate not the bread of idleness: exhaustion is related to domestic and salaried working conditions among 539 Québec hospital workers.

Hospital workers completed a questionnaire on domestic and professional working conditions and health symptoms. Workers were asked to estimate the number of domestic work hours, and the degree of sharing of laundry, cleaning, meal preparation and childcare. Responses from the 532 women workers showed an average professional work week of 31.2 hours and an average domestic work week of 19.2 hours. The length of the domestic work week increased with the number of children, and the degree of sharing diminished. Among couples with children, the reported length of the domestic work week correlated highly with an index calculated from the degree of sharing of domestic tasks, and the number and ages of children. Exhaustion and insomnia were associated with work speed and shift work, respectively, at the hospital job, but also with the number of hours of domestic work. Backache, which was related to lifting weights in the workplace, was not associated with the number of reported hours of domestic work. Due to errors in formulating some questions, the study underestimates total hours of domestic work, and, probably, effects of domestic work on health. However, it is the first North American study to show the combined effects of domestic work and paid work on physical health symptoms among women.