Pathways to labour market marginalisation : aspects of common mental disorders, migration status and age

Background: Labour market marginalisation (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differs between young immigrants and natives in several countries. The aim of this project was to investigate the risk of LMM among immigrants, second generation immigrants, and refugees and if the risk differed with region/country of birth, age, generation, refugee status and before and after a diagnosis of common mental disorder (CMD). A second aim was to assess psychiatric healthcare utilization before and after DP due to CMD among immigrants and natives, and if it differed before and after changes in social insurance regulations in Sweden in 2008. Methods: Four studies were conducted, all based on Swedish nationwide register data. Study I: a cohort study of all 3 507 055 individuals living in Sweden in 2004 (19-50 years), with a 6- year follow-up. Hazard ratios (HR) and 95% confidence intervals (CI) for DP were estimated by Cox regression for first and second generation immigrants compared to natives, across regions of birth and stratified by age. Study II: individuals with incident DP due to CMD (n=28 354), before or after the introduction of stricter social insurance rules, were included. Patterns of psychiatric in- and specialised outpatient healthcare utilization during a 7-year window before and after being granted DP were assessed by Generalized Estimating Equations. Study III: A total of 28,971 individuals (19-30 years) with an incident CMD in 2007 were included. Groupbased trajectory models were utilised to identify trajectories of annual months of LMM three years before and six years after the diagnosis. Study IV: A prospective cohort study including individuals (19-30 years) with CMDs during 2009 (N=69,515). Cox regression was used to calculate HR for future LMM (2010-2013). Results: In the first generation immigrants compared to natives, HRs for DP were higher (range: 1.17 to 1.74). Also in the second generation immigrants, HRs were higher (range: 1.10 to 1.30) (study I). Prevalence rates of psychiatric inpatient healthcare were comparable among immigrants and natives, lower though in non-Western immigrants. Three years after granted DP, non-Western immigrants in comparison to natives and Western immigrants had a stronger decrease in inpatient psychiatric healthcare. After 2008, a strong reduction in outpatient psychiatric healthcare after granted DP was observed, similarly in immigrants and natives (study II). Young natives and immigrants showed similar trajectories of SA/DP in individuals with CMDs. A higher proportion of non-Western immigrants (21%) followed trajectories of high levels of unemployment compared to Western immigrants (15%) and natives (17%). Educational level and duration of residence in Sweden discriminated trajectories of both SA/DP and unemployment (study III). Regarding subsequent unemployment, both refugees and nonrefugee immigrants with CMDs had a higher risk compared to natives. Regarding subsequent SA, refugees from Africa and Asia showed a lower risk compared to natives (study IV). Conclusions: Immigrants differed in comparison to natives in LMM in terms of a higher level of DP in both generations, in lower levels of inpatient psychiatric healthcare after DP granting, particularly among non-Western immigrants, in higher unemployment trajectories after a CMD and in higher unemployment risk and lower SA risk, particularly among refugees. Educational level, psychiatric comorbidity and duration of residence are relevant factors in discriminating differences in LMM trajectories among immigrants and natives

Low level of attention to health inequalities in prevention planning activities of the Italian Regions

Background: Health promotion and prevention activities should tackle health inequalities to reduce disparities in health among disadvantaged populations. This study aimed to assess the extent to which the Italian Regions considered health inequalities during the planning of prevention activities, to detect geographical differences and to identify the possible determinants of differences in attention to health inequalities. Methods: The 19 Regional Prevention Plans (RPPs) developed by Italian Regions within the National Prevention Plan (NPP) 2010-2013 were assessed using a specific tool to address the level of attention to health inequalities. Univariate and multivariate analyses were performed to identify regional characteristics associated with a higher level of attention to health inequalities. Results: Of the 702 projects included in the 19 RPPs, only 56 (8.0 %) specifically addressed issues related to health inequalities. The results of the multivariate analysis showed that a higher level of attention was associated with the macroarea of intervention 'prevention in high-risk groups', with the higher quality of the Strategic Plan Section of the RPP and with the higher percentage of migrants in the Region in 2010. Moreover, projects that addressed the topic of health inequalities were more likely to be developed in the Northern Regions, in Regions with a lower level of 'linking social capital' and with a Higher Regional Health Care Expenditure (RHCE) as a percentage of Regional Gross Domestic Product (RGDP) in 2010. Conclusions: The level of attention to health inequalities in the regional planning process of prevention activities 2010-2013 in Italy is low. The results of this study supported the new round of prevention planning in Italy, and highlight the urgent need to increase the number of policies and interventions able to reduce health inequalities

Problematic mobile phone use in adolescence:a cross-sectional study

Aim: In recent years, mobile phone use has become increasingly common among Italian youth, while a growing scientific literature has been identifying the occurrence of a problematic mobile phone use which seems to share some features of other conditions often referred to as behavioural addictions. The study aimed to assess the prevalence of problematic mobile phone use in a population of Italian adolescents and its association with other behavioural addictions. Subjects and methods: The Mobile Addiction Test (MAT) was administered to 2,790 high school students from Barletta, an Italian town, together with the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA), the Compulsive Buying Scale (CBS), the Internet Addiction Test (IAT), the Exercise Addiction Inventory (EAI), the Work Addiction Risk Test (WART). Results: MAT scores fitted a Gaussian distribution model. Scores ≥ 17 was found as a cut-off value over which identifying problematic mobile phone users. Overall prevalence of problematic mobile phone use was 6.3%; this condition was associated with other behavioural addictions like compulsive buying. Conclusion: Problematic mobile phone use in adolescence should become a public health issue, and it could be a cause of health problems and social costs. © 2011 Springer-Verlag

The relationship between physical activity and quality of life in prisoners: a pilot study

IntroductionImprisoned people have usually a poor health status in comparison with the general population. The aim is to investigate a possible association between the quality of life and physical activity level in male inmates. MethodsA cross-sectional pilot study was carried out between 2010 and 2011. A questionnaire contained SF12 and International Physical Activity Questionnaire  was administered. Mental Component Score  (MCS) and Physical Component Score   (PCS) were computed. The physical activity level was measured using Metabolic Equivalents score (MET)Results121 inmates entered the survey. MCS is directly correlated to MET of physical activity (r= 0.23; P=0.03) and negatively to BMI variations (r= -0.24; P= 0.02) and smoking status (r= -0.24; P= 0.02).DiscussionThis pilot study  suggests to improve the investigation to support the promotion of physical activity programs  in Italian prisons in order to improve inmates QoL and allow a better social integration at the end of detention

The relationship between physical activity and quality of life in prisoners: a pilot study

IntroductionImprisoned people have usually a poor health status in comparison with the general population. The aim is to investigate a possible association between the quality of life and physical activity level in male inmates. MethodsA cross-sectional pilot study was carried out between 2010 and 2011. A questionnaire contained SF12 and International Physical Activity Questionnaire  was administered. Mental Component Score  (MCS) and Physical Component Score   (PCS) were computed. The physical activity level was measured using Metabolic Equivalents score (MET)Results121 inmates entered the survey. MCS is directly correlated to MET of physical activity (r= 0.23; P=0.03) and negatively to BMI variations (r= -0.24; P= 0.02) and smoking status (r= -0.24; P= 0.02).DiscussionThis pilot study  suggests to improve the investigation to support the promotion of physical activity programs  in Italian prisons in order to improve inmates QoL and allow a better social integration at the end of detention

A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy

Aim: A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents. Subject and methods: The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later. Results: The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p = 0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue "because smokers are fools" (p = 0.004 for children; p < 0.001 for adolescents) and "because smokers are irresponsible" (p ≤ 0.001 for both children and adolescents) in the experimental groups. Conclusion: The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention

A pilot application of a questionnaire to evaluate visually induced motion sickness in spectators of tri-dimensional (3D) movies

Background: The increasing popularity of tri-dimensional (3D) movies has raised public concern and media interest about the safety of projected images for spectators. No specific instrument exists to assess the occurrence of visually induced motion sickness (VIMS) symptoms in 3D movie spectators in movie theaters. Methods: We developed a questionnaire containing 20 items divided into socio demographics, individual characteristics, movie vision characteristics and VIMS symptoms (during, right after, and at two hours from the viewing of the movie). The questionnaire was self administered to 38 subjects, asking them to report time taken for its completion, comments and eventual difficulties in interpreting items. Results: Poor understanding or problems in identifying the correct item choice were noted for 4 questions belonging to the socio demographics section that were simplified in the final version of the questionnaire. Two other questions were merged into one after homogeneity analysis. Most VIMS symptoms were observed during the movie and quickly thereafter. Tired eyes was the symptom most often reported (39.5% of responders) followed by headache (18.4%), dizziness (18.4%) and nausea (15.8%). Double vision and palpitation were reported with very low frequency (respectively 5.3% and 2.3%) and vomit was not reported by any respondent. Homogeneity of symptom items was good (Cronbach alpha= 0.69). Reliability analysis showed satisfactory item-total correlations (alpha coefficient ranging from 0.61 to 0.73). Conclusions: The refined survey questionnaire can be applied in future studies to assess the frequency of VIMS symptoms in spectators of 3D movies and to identify the risk factors connected to inter-individual differences in susceptibility and to the characteristics of the movie viewing

A survey of visually induced symptoms and associated factors in spectators of three dimensional stereoscopic movies

Background: The increasing popularity of commercial movies showing three dimensional (3D) computer generated images has raised concern about image safety and possible side effects on population health. This study aims to (1) quantify the occurrence of visually induced symptoms suffered by the spectators during and after viewing a commercial 3D movie and (2) to assess individual and environmental factors associated to those symptoms. Methods: A cross-sectional survey was carried out using a paper based, self administered questionnaire. The questionnaire includes individual and movie characteristics and selected visually induced symptoms (tired eyes, double vision, headache, dizziness, nausea and palpitations). Symptoms were queried at 3 different times: during, right after and after 2 hours from the movie. Results: We collected 953 questionnaires. In our sample, 539 (60.4%) individuals reported 1 or more symptoms during the movie, 392 (43.2%) right after and 139 (15.3%) at 2 hours from the movie. The most frequently reported symptoms were tired eyes (during the movie by 34.8%, right after by 24.0%, after 2 hours by 5.7% of individuals) and headache (during the movie by 13.7%, right after by 16.8%, after 2 hours by 8.3% of individuals). Individual history for frequent headache was associated with tired eyes (OR = 1.34, 95% CI = 1.01-1.79), double vision (OR = 1.96; 95% CI = 1.13-3.41), headache (OR = 2.09; 95% CI = 1.41-3.10) during the movie and of headache after the movie (OR = 1.64; 95% CI = 1.16-2.32). Individual susceptibility to car sickness, dizziness, anxiety level, movie show time, animation 3D movie were also associated to several other symptoms. Conclusions: The high occurrence of visually induced symptoms resulting from this survey suggests the need of raising public awareness on possible discomfort that susceptible individuals may suffer during and after the vision of 3D movies