Health Concerns and Socio-Economic Determinants: Analysis and Evaluation in Italy and England

Lo scopo di questa tesi \ue8 di analizzare le differenti determinanti socio-economiche dell\u2019obesit\ue0 in due nazioni europee, Italia e Inghilterra. Queste nazioni sono interessanti da studiare per motivi molto diversi. Sebbene in notevole ritardo rispetto agli Stati Uniti e ad altre nazioni europee anche in Italia si \ue8 verificata una notevole crescita nei livelli di obesit\ue0. Difatti nel 2005 il 34.2% della popolazione \ue8 stata classificata come sovrappeso e il 9.8% come obesa. Queste percentuali inoltre variano notevolmente per individui con differente et\ue0, genere, educazione e reddito. Inoltre dati di fonte ISTAT mostrano come gli adulti classificati come obesi siano aumentati del 4% nell\u2019ultimo decennio. Tale misura diventa ancora pi\uf9 rilevante se consideriamo l\u2019ulteriore crescita registrata nella categoria dei sovrappeso. Nel Regno Unito il trend seguito dall\u2019obesit\ue0 \ue8 molto simile a quello registrato negli Stati Uniti. Nel 2007 la percentuale di obesi risultava pari al 24% della popolazione e si poneva come una tra le pi\uf9 alte in Europa. Il trend dell\u2019obesit\ue0 sia maschile che femminile \ue8 stato inoltre in notevole aumento negli ultimi 15 anni (con una crescita del 15% dal 1993). Questa crescita cos\uec persistente indica che alcune delle cause dell\u2019obesit\ue0 potrebbero essere divenute strutturali nella determinazione del livello di obesit\ue0 sia nel Regno Unito che in Italia. Le ragioni di questo incremento significativo nei livelli di obesit\ue0 per le due nazioni considerate nell\u2019analisi potrebbero essere di varia natura. Abbiamo quindi deciso di focalizzare la nostra attenzione sul ruolo dei prezzi degli alimenti in Italia, dove le propriet\ue0 benefiche della dieta Mediterranea hanno finora determinato i bassi livelli di obesit\ue0. Per questo motivo risulta di cruciale importanza documentare qualsiasi variazione nei comportamenti di consumo di alimenti che potrebbero essere responsabili per l\u2019aumento nei tassi di obesit\ue0 e sovrappeso. Invece, per quanto riguarda il Regno Unito questo lavoro fa riferimento ad un vasto numero di articoli empirici che testano l\u2019influenza di differenti cambiamenti socio-economici che potrebbero aver alterato le abitudini degli individui. In particolare \ue8 stato analizzato il ruolo del prezzo di alimenti sani (come frutta e verdura) e la densit\ue0 di fast-food e ristoranti, come anche mutamenti nel consumo di sigarette. Ci riferiamo inoltre anche agli effetti collegati a cambiamenti tecnologici, che sono responsabili di variazioni nell\u2019occupazione da settori agricoli e industriali ai servizi, implicando una notevole diminuzione nell\u2019intensit\ue0 dell\u2019attivit\ue0 fisica destinata al lavoro. Innovazioni in agricoltura sono inoltre responsabili per riduzioni nei prezzi del cibo e conseguentemente anche nella quantit\ue0 di calorie assunte. Un ulteriore importante determinante dell\u2019obesit\ue0 individuata dalla letteratura economica e medica \ue8 la recente diminuzione registrata nei consumi di sigarette. Molti studi hanno infatti determinato una inversione netta tra i trend della percentuale di fumatori, in costante riduzione negli ultimi decenni e la percentuale di obesi, che invece risulta in netta crescita. Tuttavia tutti i precedenti lavori non sono stati in grado di stimare in maniera precisa e unanime il segno e l\u2019intensit\ue0 di tale relazione. Per sorpassare queste limitazioni questo lavoro sfrutta l\u2019introduzione della recente riforma anti fumo in Italia, che dal 2005 proibisce di fumare nei luoghi pubblici. Per identificare l\u2019effetto della riduzione nel consumo di nicotina sul peso viene utilizzata la discontinuit\ue0 introdotta dalla riforma come misura di una variazione esogena nei consumi di sigarette. Nel caso del Regno Unito \ue8 stata invece sfruttata la natura longitudinale dei dati a disposizione, che raccolgono informazioni in differenti istanti temporali per lo stesso individuo. In questo modo siamo in grado di tenere conto propriamente delle differenti attitudini che ciascuno potrebbe avere nei confronti della propria salute. In pi\uf9 vengono utilizzati un elevato numero di gruppi di controllo per eliminare distorsioni nella stima legate al problema dell\u2019endogeneit\ue0.This thesis analyses various aspects related to the economic determinants of obesity in two EU countries, Italy and the UK, which are of interest for different reasons. Although much later with respect to the United States and some continental European countries, the issue of the rise of weight has also become significant in Italy, where, 34.2% of adults were classified as overweight and 9.8% as obese in 2005. These percentages were found to differ greatly according to age, gender, years of education and income level. Moreover, the percentage of adults classified as obese has risen by 4 percentage points in the last decade as shown by ISTAT. This measure becomes more relevant when we consider that the obesity and overweight rate increased in the same period by 9 percentage points. In the UK, the increase in obesity is found to be similar to that of the United States although it started from a lower level. The percentage of obese individuals is about 24% in 2007 and is among the highest in Europe. The trends of obesity in aggregate have constantly risen over the last fifteen years (15% since 1993), similarly for both men and women. This persistent growth suggests that, at least, some causes may have become structural in determining obesity in the UK, but also in Italy. The reasons for the significant increase in the obesity levels for the two countries analysed may be of various nature. We decided to focus our attention on the role of food prices in Italy, where the healthy properties of the Mediterranean diet have, up to now, mostly influenced the low obesity rates in the country. It becomes then of crucial importance to document any significant variation, in terms of food onsumption, that may be responsible for the general increase in obesity and overweight rates. While for the UK, this research is related to a number of empirical papers testing overweight as the result of several socio-economic changes which have altered people\u2019s lifestyle choices. In particular, we examined the consequences of changes in relative prices and in the density of different types of restaurants on obesity, as well as the influence of cigarette consumption. We also refer to the effects of technological changes, which are responsible for shifts over time in employment from agricultural and manufacturing to services, implying a decrease in the strenuousness of jobs, and in the number of hours dedicated to physical exercise. Agricultural innovations are also responsible for reductions in the price of food and consequently of calories. Another very important determinant of the obesity epidemic is related, by the health economic literature, to the recent drastic reduction in smoking habits. Many previous works have documented a very clear inversion between the trends of smoking, which have constantly reduced, and BMI, which documented a sharp increase. However all these works did not provide a general agreement on the sign and the magnitude of these effects, and most importantly they did not provide a clear estimate of these effects on obese individuals. We take advantage of the introduction of the Clean Indoor Air Law, which prohibits smoking in public places, implemented in Italy as from 10 January 2005, to identify the relationship between smoking behavior and body weight within a regression discontinuity design. In the case of the UK, we took advantage of the longitudinal framework of the BHPS and estimate a difference-in-differences (DID) model to account for individual fixed-effects related to individual health concerns and estimate the parameters of the DID model using a battery of control groups. We also performed IV and IVQR estimates for the average treatment effects (ATEs) and quantile treatment effects (QTEs) estimators to take into account properly issues related to endogeneity

The role of circumstances in explaining health and income related inequalities in European countries

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Comparison of outcomes following transfemoral versus trans-subclavian approach for transcatheter aortic valve Implantation: a meta-analysis

Background The subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approach. Methods A systematic review was conducted on two online databases: Embase and Medline. The initial search returned 508 titles. Nine observational studies were included: n = 2938 patients (2382 TF and 556 TSc). Results Both TSc and TF groups were comparable for: 30-day mortality (Odds ratio, OR 0.75, 95% CI 0.49 – 1.16, p = 0.195); in-hospital stroke (OR 1.05, 95% CI 0.60–1.85, p = 0.859); myocardial infarction (OR 1.97, 95% CI 0.74–5.23, p = 0.176); paravalvular leaks (OR 1.20, 95% CI 0.76–1.90, p = 0.439); rates of postoperative permanent pacemaker implantation (OR 1.49, 95% CI 0.92–2.41, p = 0.105); in-hospital bleeding and meta-analysis demonstrated no significant difference between access points (OR 3.44, 95% CI 0.35–34.22, p = 0.292). Procedural time was found to be longer in the TSc group (SMD 1.02; 95% CI 0.815–1.219, p < 0.001). Major vascular complications were significantly higher in the TF group (OR 0.55, 95% CI 0.32–0.94, p = 0.029). Meta regression found no influence of the covariates on the outcomes. Conclusion Subclavian access is both a safe and feasible alternative access route for TAVI with lower risks of major vascular complications. This study supports the use of subclavian access as a viable alternative in patient groups where transfemoral TAVI is contraindicated

Impact of immigration on burden of Tuberculosis in Umbria: a low-incidence Italian region with high immigrants rates

Introduction. In Italy, Tubercolosis (TB) has increasingly become a disease for specific population subgroups such as immi- grants. The objective of this paper is to describe the trend in TB incidence from 1999 to 2008 in Umbria: a low-incidence Italian region with high immigrants rates. Methods. Data were obtained from the Regional Information System for Infectious Diseases. Using a linear regressions model we estimated trends for number of cases and incidence rates; with a logistic regression model we estimated the effect of a set of covariates on the probability of being affected by TB. Result. 590 TB cases were reported of whom 254 (43%) were foreign. In 2008 39.7 new cases per 100.000 were registered among foreign-born subjects. TB incidence among Italians was 3.8/100.000 Italians. But a linear regression analysis showed a statistically significant decreasing trend in the notification rate among foreign-born people (coef: -7.32, r2:0.57, p inf. 0.05). The probability to be affected by extra-pulmonary is significantly larger in foreign patients (OR = 0.72, CI = 0.48-1.07). Foreign unskilled workers report a higher probability to be affected by TB (OR = 19.05, CI = 6.01-60.4). Discussion. Increasing immigration rates may affect TB epide- miology. The analysis of incidence trends is an important tool for monitoring tuberculosis disease control and to identify specific sub-group at risk

BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting

Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation. In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced post-operative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping are both recommended as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments. A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider. The importance of pre-empting complications and dealing with adverse events are described, including re-exploration, conversion to sternotomy, uni-lateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases

Data-driven generation of 4D velocity profiles in the aneurysmal ascending aorta

Background and Objective: Numerical simulations of blood flow are a valuable tool to investigate the pathophysiology of ascending thoratic aortic aneurysms (ATAA). To accurately reproduce in vivo hemodynamics, computational fluid dynamics (CFD) models must employ realistic inflow boundary conditions (BCs). However, the limited availability of in vivo velocity measurements, still makes researchers resort to idealized BCs. The aim of this study was to generate and thoroughly characterize a large dataset of synthetic 4D aortic velocity profiles sampled on a 2D cross-section along the ascending aorta with features similar to clinical cohorts of patients with ATAA. Methods: Time-resolved 3D phase contrast magnetic resonance (4D flow MRI) scans of 30 subjects with ATAA were processed through in-house code to extract anatomically consistent cross-sectional planes along the ascending aorta, ensuring spatial alignment among all planes and interpolating all velocity fields to a reference configuration. Velocity profiles of the clinical cohort were extensively characterized by computing flow morphology descriptors of both spatial and temporal features. By exploiting principal component analysis (PCA), a statistical shape model (SSM) of 4D aortic velocity profiles was built and a dataset of 437 synthetic cases with realistic properties was generated. Results: Comparison between clinical and synthetic datasets showed that the synthetic data presented similar characteristics as the clinical population in terms of key morphological parameters. The average velocity profile qualitatively resembled a parabolic-shaped profile, but was quantitatively characterized by more complex flow patterns which an idealized profile would not replicate. Statistically significant correlations were found between PCA principal modes of variation and flow descriptors. Conclusions: We built a data-driven generative model of 4D aortic inlet velocity profiles, suitable to be used in computational studies of blood flow. The proposed software system also allows to map any of the generated velocity profiles to the inlet plane of any virtual subject given its coordinate set

Domestic violence and suicide attempt among married women: A case‐control study

The aim of this study was to investigate the impact of domestic violence‐related factors on suicide attempt in married women. Suicide is a global public health concern that poses significant burden on individuals, families and communities. There is limited research on factors predicting suicide attempt in women. A retrospective case‐control design was adopted. Using a convenience sampling method, 610 participants, admitted to a teaching referral hospital in Northwest of XXX, were recruited to the study and assigned to case or control groups based on whether or not they had attempted suicide. The participants in two groups were matched in the terms of important demographic characteristics. Domestic violence‐related factors were considered as independent variables and suicide attempt as dependent variable. Descriptive statistics, simple and multivariate logistic regression analysis were used to analyze the data. Odd ratios (OR) of domestic violence related factors were compared between the groups. We used STROBE checklist as an EQUATOR in this study. The mean age of participants in the case and control groups was 28.4 years and 29.45 years, respectively. The infidelity was the strongest predictor of suicide attempt in women (OR 44.57, 95%CI 6.08‐326. 63, p<0.001), followed by being threatened to physical assault by husband (OR 37.01, 95%CI 11.54‐118.67, p<0.001), jealousy of husband (OR 23.46, 95%CI 11.63‐47.30, p<0.001), and previous attempts to divorce (OR 16.55, 95%CI 5.91‐46.31, p<0.001). Suicide attempt was significantly lower in women who reported a sense of peace in life or lived with their mother or father‐in‐law (p<0.001). To reduce the risk of suicide in women, violence against women should be condemned and appropriate prevention measures be taken by health professionals. Recognizing risk, assessment and referral of victims of domestic violence should be an integral part of health care systems.N/

Mobilities of Ti and Fe in disordered TiFe-BCC assessed from new experimental data

Pure titanium has an HCP structure and lacks mechanical properties for many industrial purposes. The BCC phase of Ti is required to make alloys with increased strength compared to pure Ti. Iron is the most potent element for stabilising the BCC phase. However, the addition of Fe to Ti causes segregation issues during solidification, which can be avoided by diffusion-driven solid-state alloying. To predict the diffusion kinetics, the interaction mobility parameters of Ti and Fe in the disordered BCC phase of Ti are necessary. In this work, these parameters are optimised based on new experimental data from Ti-Fe diffusion couples produced by the Field Assisted Sintering Technology (FAST). Diffusion couples were held at 1173K and 1273K for one hour. High-resolution Fe concentration profiles are obtained from Electron Probe Micro Analyser (EPMA). Ternary mobility interaction parameters are assessed based on binary endmembers with a DICTRA sub-module, and results are compared to earlier assessments of mobilities of the disordered BCC TiFe system

Иммунопатогенез формирования атопических заболеваний

The aim of this investigation is the comparative study of changes in the surface phenotype of lymphocyte in patients with different forms of atopic diseases and latent sensitization.Materials and methods. The study was conducted on peripheral blood lymphocytes from 22 latent sensitization patients, 30 pollinosis patients, 44 atopic bronchial asthma patients and 36 atopic dermatitis patients. The control group consisted of 26 healthy people.The results of our studies demonstrate that atopic diseases are different not only in clinical manifestations, but also in mechanisms of disturbances in the functions of the immune system. Comparative study of surface markers of lymphocytes in patients with different forms of atopic diseases revealed a significant increase of surface changes of lymphocyte phenotype according to the severity of the clinical manifestations of the disease. All patients with studied forms of atopy had an increase in content of B-lymphocytes expressing CD72 marker in the peripheral blood and of lymphocytes expressing early activation antigens CD23, CD25, CD71 and adhesion receptor CD54. The developments of pollinosis, atopic bronchial asthma and atopic dermatitis are accompanied by an additional increase levels of lymphocytes expressing the late activation marker HLADR, the CD38+ precursors of plasma cells, and of lymphocytes carrying surface immunoglobulins in peripheral blood. In the blood of patients with atopic disease during exacerbation with evident clinical symptoms revealed a significant increase in all the studied populations and subpopulations of B-lymphocytes. Patients with latent sensitization had increasing blood lymphocytes expressing the CD95 receptor of Fas inducing apoptosis and low content of cells expressing its ligand CD178. Content of CD95+ lymphocytes in peripheral blood at atopic bronchial asthma and atopic dermatitis patients is reduced, and CD178+ lymphocytes increased, reflecting infringement of Fas-dependent apoptosis in severe atopic diseases.Цель работы – сравнительное изучение изменений поверхностного фенотипа лимфоцитов крови у больных с различными формами атопических заболеваний и латентной сенсибилизацией.Материал и методы. Исследование проведено на лимфоцитах периферической крови 22 больных с латентной сенсибилизацией, 30 больных поллинозом, 44 больных атопической бронхиальной астмой и 36 пациентов с атопическим дерматитом. Контрольную группу составили 26 здоровых людей.Результаты проведенных исследований убедительно свидетельствуют, что атопические болезни различаются не только клиническими проявлениями, но и механизмами нарушений функций иммунной системы. Сравнительное изучение поверхностного фенотипа лимфоцитов у больных с различными формами атопии позволило выявить существенное нарастание изменений их субпопуляционного состава по мере усиления тяжести клинических проявлений заболеваний. У больных всеми исследованными формами атопии отмечалось повышение содержания в периферической крови В-лимфоцитов, экспрессирующих маркер CD72, и лимфоцитов, несущих ранние активационные антигены CD23, CD25, CD71 и рецепторы адгезии CD54. Развитие поллиноза, атопической бронхиальной астмы и атопического дерматита сопровождалось дополнительным повышением содержания в периферической крови лимфоцитов, экспресси- рующих поздний маркер активации HLA-DR,предшественников плазматических клеток и лимфоцитов CD38+, несущих поверхностные иммуноглобулины. В крови у больных атопией с выраженными клиническими проявлениями выявлено достоверное повышение содержания всех изученных субпопуляций В-лимфоцитов. У больных с латентной сенсибилизацией зарегистрировано повышенное содержание в крови лимфоцитов, экспрессирующих CD95-рецептор запуска Fas-индуцированного апоптоза, и снижение количества клеток, экспрессирующих его лиганд – рецептор CD178. У больных с атопической бронхиальной астмой и атопическим дерматитом содержание в крови CD95+ лимфоцитов, напротив, снижено, а CD178+-лимфоцитов – повышено, что отражает нарушение Fas-зависимого апоптоза при тяжелых атопических заболеваниях.

Assessment of Indoor Air Pollution in Homes with Infants

Infants spend most of their indoor time at home; however, residential air quality is poorly understood. We investigated the air quality of infants’ homes in the New England area of the U.S. Participants (N = 53) were parents of infants (0–6 months) who completed telephone surveys to identify potential pollutant sources in their residence. Carbon monoxide (CO), carbon dioxide (CO2), particulate matter with aerodynamic diameter ≤0.5 µm (PM0.5), and total volatile organic compounds (TVOCs) were measured in 10 homes over 4–7 days, and levels were compared with health-based guidelines. Pollutant levels varied substantially across homes and within homes with overall levels for some homes up to 20 times higher than for other homes. Average levels were 0.85 ppm, 663.2 ppm, 18.7 µg/m3, and 1626 µg/m3 for CO, CO2, PM0.5, and TVOCs, respectively. CO2, TVOCs, and PM0.5 levels exceeded health-based indoor air quality guidelines. Survey results suggest that nursery renovations and related potential pollutant sources may be associated with differences in urbanicity, income, and presence of older children with respiratory ailments, which could potentially confound health studies. While there are no standards for indoor residential air quality, our findings suggest that additional research is needed to assess indoor pollution exposure for infants, which may be a vulnerable population