The contextual contribution to individual health

Background Many Countries consider health as a fundamental right for their citizens. In terms of health policy, this means equal opportunity of prevention and access to care guaranteed to all. Thus, a major concern in research has been given to health inequalities and their determinants. A body of evidence has shown that individual characteristics primary affect health, however contextual factors also substantially contribute to the final perception of health and/or mediate the effect of the individual determinants (Kawachi and Subramanian, 2005). Contextual factors could involve geographically the location where the person lives, but also networks to which the individual belongs in terms of culture, socio economic status, family ties. Geographical differences in health can occur as a response to many different characteristics of places, such as environmental conditions, economic background, social context, but also public health resources. Whether health resources have an affect on population health has been much debated (Joumard et al. 2008) and to date there is no conclusive evidence on this issue. At a lower level, the household also acts like a cluster, being the first grouping structure in the society. Family members exhibit similar patterns of morbidity (Johnson et al, 1965; Monden 2007; Merlo et al. 2012), health-related behaviors (Rice et al. 1998), help-seeking behavior (Cardol et al. 2005) and utilization of health services (Sepheri et al. 2008). On the one hand, household’s characteristics, such as socio-economic level of the family, housing conditions, household structure and the burden of care for ill-health member can be hypothesized as determinants of health for the household’s members. On the other hand, health perception itself can operate as a determinant for health status of other members within the same households. Stated differently mutual influences in health perception can be exerted within the households and they result in a high resemblance of health status for people living together. Very limited research have dealt with territorial and familial influences on health perception, and no studies of this kind have been carried out for the Italian context, where paradoxically the magnitude of the family on demographic behaviours is extremely pronounced. This research aims to provide an estimation of the influence that the context (both territorial and relational) has on self-perceived health and to gain a better understanding of the pathways through which this influence is exerted. Methods This is a population-based cross sectional study. Data come from the Italian Health Survey “Condizioni di salute e ricorso ai servizi sanitari” (2004/2005). The survey has a cluster sample design based on households and representative of the population at sub-regional level, with the definition of the so called “Large Areas”, an aggregation of neighboring Local Health Providers (ASL) constituting a unit for health planning. We selected three outcome variables to investigate perceived health: Physical Component Summary – PCS, Mental Component Summary – MCS and poor self-perceived health –poor SPH. The first two measures are a quantitative assessment of physical and mental health conditions as perceived by the respondent through a standardized questionnaire (SF-12), the latter is a binary variable indentifying people reporting “poor” and “very poor” health conditions in the WHO question “how is your health in general?”. Data have a hierarchical structure defined as individuals (level 1) living in different households (level 2), which are, in turns, located in different “Large Areas” (level 3). We adopted a multilevel approach which is entirely coherent with this structure of the data and allows to obtain unbiased . By means of this approach we have been able to capture determinants of perceived health at different levels and to disentangle the proportion of variability due to differences between individuals, households or Large Areas. According to the characteristics of the outcome we run linear and logistic multilevel models, with random intercepts at the household and Large Area level. Results: We documented a very limited, although always significant, impact of area of residence on self perceived health (0.3% for PCS, 0.6% for MCS and 2.3% for poor-SPH, adjusted for individual covariates). This result is partially in contrast with previous works illustrating a health gradient for objective and subjective health in Italy (Costa et al. 2003; Mazzuco 2009). However, researches that adopted a multilevel approach to investigate the Italian Regional/Large Area health heterogeneity came to our same conclusion, recognizing a proportion of variability at Large Area level lower than 3% for poor self-perceived health among the elderly population (Pirani and Salvini 2012b). By contrast, the relevance of household on perceived health was quite substantive. The 15% of variability in PCS is due to household differences, but MCS and poor-SPH show an even greater impact with, respectively, a 33% and 38% of variability at the household level. The characteristics of the household (e.g. economic resources, family structure, size of the municipality of residence) are significantly associated with perceived health, but they explain a very little amount of the overall variability between households. We hypothesized then that mutual influences between family members can have a role in explaining the heterogeneity in household health. We investigated this hypothesis by observing the pattern of health resemblance by family structure and found that the similarity in health status was higher in those circumstances where the link between members were expected to be tighter (2 components, marriage-like link, mono-nucleus families). These results are in line with findings from social psychology, which consistently documented a similarity in mental illness, depressive symptom and distress (Meyler et al. 2007; Monden 2007), and with those from sociology reporting a positive effect of partners interactions on well-being, happiness and life satisfaction (White 1983). By conducting the research by means of three health outcomes we were able to cross-validate the results and shed further light on the different profile of determinants for physical and mental conditions. More particularly, we illustrated how PCS is affected by very concrete agents such as age, education, economic conditions, whereas MCS is particularly linked to socio-relational dimensions at the individual and household level. This result is coherent with the knowledge about determinants of mental health, which include elements as social support, perceived stress and self esteem (Bovier et al. 2004). Conclusions With this research we provided evidence of the existence and the complexity of contextual factors influencing perceived health. Geographical differences seem to be overestimated when a multilevel approach is not taken into account. On the other hand, households are often neglected as a level affecting health perception, whereas they deserves as much attention as individual in the study of health

Fertility of immigrant women in Italy: outcomes from unconventional data

This paper contributes to the debate on the immigrant population’s reproductive behaviors using an unconventional survey not designed for demographic analysis. Applying the own-child method of young co-residing children, who are unlikely to have left home, we describe the patterns of the numbers of births realized after migration to women aged 15-40 years old and we look at the main determinants of fertility fitting a Poisson model. According to the literature, among immigrant women the migratory patterns , the gender roles and the country/area of origin represent important determinants of migrants’ fertility after migration, while the individual characteristics and destination contexts seem less important

Foreigners’ contribution to the evolution of fertility in Italy: a re-examination on the decade 2001-2011

The aim of our article is to describe the evolution of migrants’ fertility in Italy in the inter-census period (2001-2011) and to estimate its impact on the change of total fertility and mean age at childbearing at national and regional level. Making use of decomposition models we demonstrate as the recovery of TFR (concentrated in the period 2004-2008) was determined by Italians’ fertility recovery and by the increasing weight of foreign women. The younger age pattern of foreign fertility, together with the growing contribution to total fertility, have generally slowed down the process of increasing mean age at childbearing of female residing in Italy

Understanding preferences for nature based and sustainable tourism. The role of personal values and general and specific environmental attitudes

This paper reports the results of a study which investigated the social psychological correlates of people’s preferences for sustainable and unsustainable tourism activities. Two-hundred-eighty-two participants from two Italian cities responded to a questionnaire which recorded their tourism preferences, their general pro-environmental attitudes and values, and their specific attitudes towards sustainable tourism. Results showed positive correlations among the constructs considered. Groups of participants differing in their tourism preferences were also identified and the paper discusses the way in which the social psychological variables considered here may be used to plan adequate strategies and management instruments able to address crucial issues of sustainability in tourism, including, for example, tourists’ ecological behaviors “on site” and their educational needs

Development and Initial Validation of a Questionnaire to Measure Health-Related Quality of Life of Adults with Common Variable Immune Deficiency: The CVID_QoL Questionnaire.

BACKGROUND: Generic health status quality of life (QoL) instruments have been used in patients with common variable immune deficiency (CVID). However, by their nature, these tools may over- or underestimate the impact of diseases on an individual's QoL. OBJECTIVE: The objective of this study was to develop and validate a questionnaire to measure specific-health-related QoL for adults with CVID (CVID_QoL). METHODS: The 32-item content of the CVID_QoL questionnaire was developed using focus groups and individual patient interviews. Validation studies included 118 adults with CVID who completed Short Form-36, Saint George Respiratory Questionnaire, General Health Questionnaire-12, and EuroQol-5D questionnaire in a single session. Principal component and factor analysis solutions identified 3 scores to be similar in number and content for each solution. Validation of 3 factor scores was performed by construct validity. Reproducibility, reliability, convergent validity, and discriminant validity were evaluated. Matrices consisting of correlations between the 32 items in the CVID_QOL were calculated. RESULTS: Factor analysis identified 3 dimensions: emotional functioning (EF), relational functioning (RF), and gastrointestinal and skin symptoms (GSS). The instrument had good internal consistency (Cronbach's alpha, min. 0.74 for GSS, max. 0.84 for RF, n = 118) and high reproducibility (intraclass correlation coefficient, min. 0.79 for RF, max 0.90 for EF, n = 27). EF and RF scores showed good convergent validity correlating with conceptually similar dimensions of other study scales. Acute and relapsing infections had a significant impact on EF and RF. CONCLUSIONS: This study provides evidence of the reliability and construct validity of the CVID_QoL to identify QoL issues in patients with CVID that may not be addressed by generic instruments

Optimization of synthetic oscillatory biological networks through Reinforcement Learning

In the expanding realm of computational biology, Reinforcement Learning (RL) emerges as a novel and promising approach, especially for designing and optimizing complex synthetic biological circuits. This study explores the application of RL in controlling Hopf bifurcations within ODE-based systems, particularly under the influence of molecular noise. Through two case studies, we demonstrate RL’s capabilities in navigating biological systems’ inherent non-linearity and high dimensionality. Our findings reveal that RL effectively identifies the onset of Hopf bifurcations and preserves biological plausibility within the optimized networks. However, challenges were encountered in achieving persistent oscillations and matching traditional algorithms’ computational speed. Despite these limitations, the study highlights RL’s significant potential as an instrumental tool in computational biology, offering a novel perspective for exploring and optimizing oscillatory dynamics within complex biological systems. Our research establishes RL as a promising strategy for manipulating and designing intricate behaviors in biological networks

Experimental analysis of masonry ring beams reinforced with composite materials

It is known that the application of a ring beam is an effective method to prevent an out-of-plane collapse mechanism of perimeter wall panels. However this effective reinforcing method presents some problems. In order to address this, this paper describes the problems associated with this reinforcing method and studies a new technique for reinforcing historic masonry buildings by realizing a new type of ring beam made of recycled old stones or bricks reinforced at the bed joints with glass-fibre sheets, GFRP (Glass Fiber Reinforced Polymer) grids or/and PBO (polybenzoxazole: poly-p-phenylene benzobisoxazole) cords. An experimental investigation has been carried out on 8 full-scale rubble-stone or brickwork masonry ring beams tested in bending. The testing included the use of composite materials inserted into the mortar joints during the fabrication phase of the beams and pinned end conditions (four-point bending configuration). Beams were reinforced with different reinforcement layout

Resilience in the face of pelvic pain: A pilot study in males and females affected by urologic chronic pelvic pain

Aims Resilience represents a fundamental element in the experience of pain, as it allows adaptation to suffering and increases psychological social well-being and quality of life (QoL). We investigated resilience in patients affected by urologic chronic pelvic pain (UCPP) and the relationships with pain severity and distribution, catastrophizing and psychological distress.Methods Forty-eight consecutive UCPP patients were classified on a pain body map as being affected by pelvic pain only or widespread pain (WP), and underwent the evaluation of resilience with the 14-item Resilience Scale (RS-14), with higher scores indicating high resilience levels; scores < 56 denote very poor resilience. Pelvic and nonpelvic pain intensity and the bother of urinary symptoms on QoL were measured by means of Pain Numerical Rating Scale (PNRS) and Visual Analog Scale (VAS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) investigated catastrophizing and psychological conditions.Results Overall, RS-14 mean +/- SD total score was 50.2 +/- 12.5 in patients with pelvic pain only and 40.2 +/- 10.2 in those with WP. Significant relationships were observed between low resilience levels and high scores of pelvic and nonpelvic PNRS, VAS, pain catastrophizing scale and depression and anxiety, stress scale (for all: p < 0.001). Significantly lower RS-14 scores were detected in females and in patients with WP.Conclusions A very poor resilience has been identified in UCPP patients, particularly in those with greater catastrophizing and mood alterations. WP and female gender were mostly affected. In UCPP patients, low resilience appears as a crucial factor in pain experience

URINARY AND BOWEL DISFUNCTION IN AUTISM SPECTRUM DISORDER: A PROSPECTIVE, OBSERVATIONAL STUDY

Background: Vesico- sphincter and bowel dysfunction have been frequently detected in Autism spectrum disorder (ASD) patients, but to date no consistent information exist on adults affected by the disease. We evaluated the prevalence and types of bladder and bowel disfunction (BBD) in young and adult patients affected by ASD. Subjects and methods: Twenty- seven adults and 20 children/teens with ASD and a matched group of typically developing subjects were enrolled. Daily pads use and episodes of urinary incontinence (UI) were recorded in a 3- day voiding diary. Patients underwent also the measurement of post-void urinary residual volume and 3- day bowel diary. In addition, type and duration of the pharmacological agents assumed by the patients were accurately recorded. Results: Any type of UI was observed in 85.1% of adults and in 90% of children/teens. In adults, nocturnal enuresis (NE, 62.9%) and diurnal intermittent UI (37%) were the most frequently observed bladder dysfunction while in children/ teens were NE (75%) and diurnal continuous UI (40%). In all patients was demonstrated a significant relationship between urinary symptoms and pharmacological agents, particularly NE and clotiapine (p<0.004) and periciazine (p<0.008). Conclusions: Young and adult patients with ASD present with a high prevalence of BBD and concomitant antipsychotic medications could to play a contribution in induction and/or maintaining of BBD