Sussidiarita e sicurezza sociale: una prospettiva storica dell'approccio "a piu livelli". = Subsidiarity and social security: a historical perspective of the "multi-level". WP C.S.D.L.E. "Massimo D'Antona" N. 32/2005

No abstract

Health inequalities and inadequate housing. The case of exceptions to hygienic requirements for dwellings in Italy

Negli ultimi decenni, i requisiti igienici italiani per le abitazioni sono stati modificati da più deroghe. Scopo del presente lavoro è analizzare le deroghe introdotte a livello nazionale, regionale e locale. Le deroghe più importanti riguardavano l'uso abitativo di seminterrati e sotterranei e il restauro di edifici. Il documento descrive anche le norme in materia di indennità per violazione degli abusi nell'edilizia. Gli autori sottolineano la necessità di maggiore uniformità e chiarezza nella determinazione degli standard sanitari delle abitazioni, nonché di una semplificazione della legislazione esistente.In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation

Il ruolo delle Sottoprefetture nella tutela dell’igiene e della sanità pubblica in Italia, corsi e ricorsi storici

This work is based on 18-months eld research I carried out among Eritrean and Ethiopian Pentecostals in Rome (Italy). One of the topics of my work focused on the meaning they give to the evil: I collected different illness narratives and various cases. In this paper, I would like to shed light upon some dimensions of the sickness that go beyond the disease itself. By proposing a case of a woman who became sick during her high school period, because of a witchcraft attack, I will try to analyze the various stakes we can nd in the interpretation of the evil, in the etiology of the sickness and in her illness narratives. The various issues will be also analyzed by putting them in the wider picture of the con ict between Pentecostalism and local “tradition”, represented, in this case, by the local Orthodox (tewahdo) Church and its therapeutic practices, considered by Pentecostals to be devilish

Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica [Hygienic and sanitary aspects in urban planning: contradiction in national and local urban legislation regarding public health]

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection

Life After The Storm: The Effect of L’Aquila Earthquake on Marriage Rates

Natural disasters represent a challenge for policy-makers both for the immediate aftermath and for the mid- and long-term consequences. Knowing the reaction of the struck communities is an invaluable help for planning and implementing informed policies. Embracing such a perspective, this paper aims to provide empirical evidence about the effect that natural disasters exert on the marriage rates reported by the struck communities. The analysis is focused on L’Aquila earthquake that occurred in 2009 and stroke a number of municipalities in the Abruzzo Region in Southern Italy. We exploit a natural experiment setting via a difference-in-differences design, using highly disaggregate data (municipality level) in order to assess whether the shock caused by the L’Aquila earthquake in 2009 resulted in a substantial variation of the marriage rate in the municipalities hit more severely by the natural disaster. We find that the municipalities that payed a higher toll show an increasing higher marriage rate with respect to those that did not experienced major damages

Life After The Storm: The Effect of L’Aquila Earthquake on Marriage Rates

Natural disasters represent a challenge for policy-makers both for the immediate aftermath and for the mid- and long-term consequences. Knowing the reaction of the struck communities is an invaluable help for planning and implementing informed policies. Embracing such a perspective, this paper aims to provide empirical evidence about the effect that natural disasters exert on the marriage rates reported by the struck communities. The analysis is focused on L’Aquila earthquake that occurred in 2009 and stroke a number of municipalities in the Abruzzo Region in Southern Italy. We exploit a natural experiment setting via a difference-in-differences design, using highly disaggregate data (municipality level) in order to assess whether the shock caused by the L’Aquila earthquake in 2009 resulted in a substantial variation of the marriage rate in the municipalities hit more severely by the natural disaster. We find that the municipalities that payed a higher toll show an increasing higher marriage rate with respect to those that did not experienced major damages

The societal burden of chronic liver diseases: results from the COME study.

OBJECTIVE: Chronic liver diseases (CLDs) impose a significant socioeconomic burden on patients and the healthcare system, but to what extent remains underexplored. We estimated costs and health-related-quality-of-life (HRQoL) among patients with CLDs at different stages and with different aetiologies. DESIGN: A cost-of-illness study was conducted. Direct costs, productivity loss and HRQoL were estimated in patients with chronic hepatitis, cirrhosis hepatocellular carcinoma (HCC) or where orthotopic liver transplantation (OLT) had been performed, for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, or in those with liver disease from other causes. Patients were retrospectively observed for 6 months. The societal perspective was adopted to calculate costs. RESULTS: In total, 1088 valid patients (median age=59.5 years, 60% men) were enrolled. 61% had chronic hepatitis, 20% cirrhosis, 8% HCC and 12% underwent OLT. HCV infection was identified in 52% and HBV infection in 29% of the patients. Adjusted mean direct costs increased from €3000/patient-month in HBV infected patients with OLT. Antiviral treatment was the cost driver in patients with hepatitis, while hospital costs were the driver in the other subgroups. Absenteeism increased from HBV-infected patients with hepatitis (0.7 day/patient-month) to patients with OLT with other aetiologies (3.7 days/patient-month). HRQoL was on average more compromised in cirrhosis and patients with HCC, than in hepatitis and patients with OLT. HBV-infected patients generated higher direct costs, patients with other aetiologies generated the highest productivity loss and HCV-infected patients reported the worst HRQoL levels. CONCLUSIONS: The present study can be considered a benchmark for future research and to guide policies aimed at maximising the cost-effective of the interventions

An increase in the levels of middle surface antigen characterizes patients developing HBV-driven liver cancer despite prolonged virological suppression

: Hepatitis B virus (HBV) contains three surface glycoproteins-Large-HBs (L-HBs), Middle-HBs (M-HBs), and Small-HBs (S-HBs), known to contribute to HBV-driven pro-oncogenic properties. Here, we examined the kinetics of HBs-isoforms in virologically-suppressed patients who developed or did not develop hepatocellular carcinoma (HCC). This study enrolled 30 chronically HBV-infected cirrhotic patients under fully-suppressive anti-HBV treatment. Among them, 13 patients developed HCC. Serum samples were collected at enrolment (T0) and at HCC diagnosis or at the last control for non-HCC patients (median (range) follow-up: 38 (12-48) months). Ad-hoc ELISAs were designed to quantify L-HBs, M-HBs and S-HBs (Beacle). At T0, median (IQR) levels of S-HBs, M-HBs and L-HBs were 3140 (457-6995), 220 (31-433) and 0.2 (0-1.7) ng/mL. No significant differences in the fraction of the three HBs-isoforms were noticed between patients who developed or did not develop HCC at T0. On treatment, S-HBs showed a >25% decline or remained stable in a similar proportion of HCC and non-HCC patients (58.3% of HCC- vs. 47.1% of non-HCC patients, p = 0.6; 25% of HCC vs. 29.4% of non-HCC, p = 0.8, respectively). Conversely, M-HBs showed a >25% increase in a higher proportion of HCC compared to non-HCC patients (50% vs. 11.8%, p = 0.02), in line with M-HBs pro-oncogenic role reported in in vitro studies. No difference in L-HBs kinetics was observed in HCC and non-HCC patients. In conclusion, an increase in M-HBs levels characterizes a significant fraction of HCC-patients while under prolonged HBV suppression and stable/reduced total-HBs. The role of M-HBs kinetics in identifying patients at higher HCC risk deserves further investigation

Determinants of worse liver-related outcome according to HDV infection among HBsAg positive persons living with HIV: Data from the ICONA cohort

Objectives: We aimed to study hepatitis D virus (HDV) prevalence and risk of progression to severe liver-related events (SLRE) in HBsAg positive people living with HIV (PLWH) in Italy; role of HDV-RNA copy levels, HCV coinfection and nadir CD4 counts were also investigated.Methods: People living with HIV (PLWH) from Italian Foundation cohort Naive antiretrovirals (ICONA) with available HBsAg and HDV Ab were enrolled. HBsAg, HDV Ab, HDV-RNA and HDV genotypes were tested. Primary end-point: time from first HDV screening to Severe Liver Related Events (SLRE: decompensated cirrhosis, liver transplantation, HCC). Fine-grey regression models were used to evaluate the association of HDV Ab, HDV-RNA, HDV/HCV coinfection, CD4 nadir and outcome. Secondary end-points: time to SLRE or death; HDV Ab and HDV-RNA prevalence.Results: A total of 152/809 (18.8%) HBsAg positive PLWH showed HDV Ab reactivity; 63/93 (67.7%) were HDV-RNA positive. Being male, persons who inject drugs (PWID), HCV Ab positive, with FIB-4 > 3.25 were independent factors of HDV Ab positivity. In a median follow-up of 5 years, 37 PLWH (4.1% at 5-year) developed SLRE and 97 (12.0%) reached the SLRE or death end-point. HDV-RNA positive (independently from HDV-RNA copy level) PLWH had a 4.6-fold (95%CI 2.0-10.5) higher risk of SLRE than HDV negatives. PLWH positive for both HCV Ab and HDV Ab showed the highest independent risk of SLRE (ASHR: 11.9, 95%CI: 4.6-30.9 vs. HCV neg/HDV neg). Nadir CD4 < 200/mL was associated with SLRE (ASHR: 3.9, 95% 1.0-14.5).Conclusions: One-fifth of the HBsAg positive PLWH harbour HDV infection, and are at high risk of progression to advanced liver disease. HCV contributes to worse outcomes. This population needs urgently effective treatments