PASSI d’Argento (Silver Steps): the main features of the new nationwide surveillance system for the ageing Italian population, Italy 2013-2014

Background:Italyis particularly concerned by population ageing. The costs for society are substantial. In this context a national, representative surveillance system, Passi D'Argento (PDA), was implemented in 2009 to monitor "active aging" and health status in people aged over 64 and to develop preventive health programs to reduce frailty. Methods/Design: PDA recruited a representative sample of 24,129 individuals (March 2012-January 2013) aged over 64 who were interviewed by trained staff using a standardized questionnaire. The PDA collects information about participation in society and employment, independent living, health conditions, safety and living environment. Indicator values are used to obtain population health profiles and to compare different LHUs’ profiles within the same region or between different regions. Discussion: The PDA surveillance system proved to be feasible and to be a powerful and innovative local and national tool for monitoring health status, frailty inItaly’s elderly population and the essential levels of care currently provided to the elderly.

Perfis de ajustamento psicossocial de estudantes: uma análise baseada em clusters

The end of the middle school is characterized by interpersonal and academic challenges, in addition to high levels of school dropout and failure. However, there are few studies that aim to investigate this period of the educational trajectory, in order to identify personal and contextual resources. Thus, this study aimed to analyze psychosocial adjustment profiles of students, considering risk factors (exposure to violence and daily discrimination), protection (social support and school climate) and adjustment indicator (life satisfaction). 709 students who attended the 7th, 8th and 9th grade of public schools participated. Through cluster analysis, profiles were identified: resilient, with high values of risk indicators with good adjustment; vulnerable, with high-risk indices and low adjustment. It is concluded that investing in the reduction of risk factors and enhancement of protective factors, through preventive programs, is essential for the development.Los últimos años de la escuela secundária se caracterizan por desafíos interpersonales y académicos, además de altos niveles de deserción y fracaso escolar. Sin embargo, son pocos los estudios que tienen como objetivo investigar este período de la trayectoria educativa, con el fin de identificar recursos personales y contextuales. El objetivo fue analizar perfiles de ajuste psicosocial de los estudiantes, considerando factores de riesgo (exposición a la violencia y discriminación diaria), protección (apoyo social y clima escolar) y ajuste indicador (satisfacción con la vida). Participaron 709 estudiantes que cursaban los grados 7º, 8º y 9º de escuelas públicas. Análisis de cluster identificaron perfiles: resiliente, con valores altos de indicadores de riesgo con buen ajuste; vulnerable, con índices de alto riesgo y bajo ajuste. Se concluye que invertir en la reducción de factores de riesgo y potenciación de factores protectores, a través de programas preventivos, es fundamental para el desarrollo.Les dernières années du primaire sont caractérisées par des défis interpersonnels et scolaires, en plus de niveaux élevés de décrochage et d’échec scolaires. Cependant, peu d’études visent à investiguer cette période du parcours scolaire, afin d’identifier des ressources personnelles et contextuelles. Ainsi, cette étude visait à analyser les profils d’adaptation psychosociale des étudiantes, en tenant compte des facteurs de risque (exposition à la violence et à la discrimination quotidienne), de la protection (soutien social et du climat scolaire) et de l’indicateur d’adaptation (satisfaction de la vie). 709 étudiantes qui fréquentaient les 7e, 8e et 9e années des écoles publiques y ont participé. Grâce à l’analyse de cluster, des profils ont été identifiés: résilients, avec des valeurs élevées d’indicateurs de risque avec un bon ajustement ; vulnérables, avec des indices à haut risque et un faible ajustement. Il est conclu qu’investir dans la réduction des facteurs de risque et l’amélioration des facteurs de protection, par le biais de programmes de prévention, est essentiel pour le développement.Os anos finais do Ensino Fundamental são caracterizados por desafios interpessoais e acadêmicos, além de elevados níveis de abandono e reprovação escolar. Porém, há poucas pesquisas que visam investigar esse período da trajetória educativa, de modo a identificar recursos pessoais e contextuais. Assim, este estudo teve por objetivo analisar perfis de ajustamento psicossocial de estudantes, considerando fatores de risco (exposição à violência e discriminação cotidiana), proteção (apoio social e clima escolar) e indicador de ajustamento (satisfação de vida). Participaram 709 alunos que frequentavam o 7º, 8º e 9º ano escolas públicas. A análise de clusters indicou dois perfis: resiliente, com valores altos de indicadores de risco e bom ajustamento; vulnerável, com índices altos de risco e baixo ajustamento. Conclui-se que investir na redução dos fatores de risco e potencialização de fatores de proteção, por meio de programas preventivos, mostra-se essencial ao desenvolvimento

Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)

Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18–64 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010–13 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008–13, 13 659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29·7% (95% CI 27·2–32·4) in 2007–08 to 19·9% (18·0–22·1) in 2012–13. During 2010–13, the overall proportion of vaccinated people with a chronic disease was 25·6% (24·5–26·7). Vaccine coverage of people with diabetes (34·3%, 31·7–36·9) or cardiovascular diseases (31·8%, 29·6–34·2) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26·5% [22·5–30·7], 24·9% [23·2–26·7], 22·2% [20·0–24·6], and 20·6% [17·5–24·6], respectively). Vaccination coverage increased with age (from 13·1% [11·0–15·5] in the 18–34 year age group to 33·4% [31·9–35·1] in people aged 50–64 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health

Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)

Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18\u201364 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010\u201313 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008\u201313, 13\u2008659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29\ub77% (95% CI 27\ub72\u201332\ub74) in 2007\u201308 to 19\ub79% (18\ub70\u201322\ub71) in 2012\u201313. During 2010\u201313, the overall proportion of vaccinated people with a chronic disease was 25\ub76% (24\ub75\u201326\ub77). Vaccine coverage of people with diabetes (34\ub73%, 31\ub77\u201336\ub79) or cardiovascular diseases (31\ub78%, 29\ub76\u201334\ub72) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26\ub75% [22\ub75\u201330\ub77], 24\ub79% [23\ub72\u201326\ub77], 22\ub72% [20\ub70\u201324\ub76], and 20\ub76% [17\ub75\u201324\ub76], respectively). Vaccination coverage increased with age (from 13\ub71% [11\ub70\u201315\ub75] in the 18\u201334 year age group to 33\ub74% [31\ub79\u201335\ub71] in people aged 50\u201364 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health

The metamorphic heritage : dissemination and mediation of urban heritage in french towns and lands of art and history

Cette recherche se donne pour objectif de questionner la circulation du patrimoine au cœur de l’espace social dans un contexte de développement des politiques locales du patrimoine. Le label Villes et pays d’art et d’histoire conçu il y a trente ans par le ministère de la Culture et de la Communication fait office d’analyseur ; la ville d’Annecy de terrain emblématique. Une poétique du patrimoine urbain est mise au jour, dépassant la forme traditionnelle du centre historique pour révéler trois régimes d’opérativité symbolique : l’unicum, le typicum et le totum. Chacun et ensemble, ils fabriquent la dimension patrimoniale de la ville : le premier mobilise le monument historique, le deuxième le centre historique, le troisième la ville patrimoniale. L’analyse de la circulation du patrimoine est ensuite mesurée comme polychrésique à partir des discours produits sur le patrimoine par des acteurs locaux considérés dans toutes leurs diversités (associations, secteurs touristique, culturel, patrimonial). Elle montre que le patrimoine constitue, pour chacun, l’argument d’un discours d’accompagnement spécifique justifiant leur place dans le réseau local : chaque acteur se caractérise par la mobilisation de différentes facettes du patrimoine pour légitimer son activité. L’interrogation des médiations prend pour point de départ l’objet patrimonial. Elle se concentre sur des stratégies communicationnelles distinctes : les centres d’interprétation de l’architecture et du patrimoine construisent le discours en l’absence d’objet patrimonial et l’espace urbain est mis en exposition à partir des objets patrimoniaux in situ. Leur analyse combinée révèle deux régimes de patrimonialisation : au régime de la trace qui convoque une relation indicielle de l’objet avec son monde d’origine s’adjoint un régime de la ressemblance exprimant une relation iconique. À un second niveau, une circulation de la figure de l’objet de musée apparaît, tant dans l’espace d’exposition par le développement d’une méta-communication, qu’en dehors de celui-ci à travers la mobilisation des caractéristiques habituelles de cette figure. Ces résultats nous permettent d’établir une dimension métamorphique du patrimoine apparaissant tant dans les parts polychrésiques de l’objet que par ses transformations successives au sein des médiations.This thesis questions how the idea of heritage disseminates among the social space in a context of increasing heritage policies, with a focus on the policy of “Villes et pays d’art et d’histoire” and the city of Annecy (France). The preliminary analysis of urban heritage goes beyond the traditional form of the historic district and reveals three forms (unicum, typicum, totum). Each one of them uses different operators to build the heritage of the city: historical monument for the first, historic district for the second and the whole city as heritage for the third. The analysis of this dissemination reveals a “polychresic” heritage through the study of multiple local actors’ discourses (associations, touristic business, cultural and heritage fields, etc.). These discourses about heritage allow each group of actors to insure itself a significant spot in the local network. Each actor distinguishes himself from the others by using its own perception of heritage to improve and secure its activity. The last part of the thesis interrogates two communicational strategies about cultural heritage focusing on the role of objects. On one hand the interpretation centres for architecture and heritage set up a discourse about local heritage and urban space through a documentary exhibition but without object. On another hand, objects (such as monuments) are parts of an in situ exhibition. From the combined analysis of these strategies results two processes of “heritagisation”: object as a relic (index) connecting its present days to its original age, and resemblance as a visual connection (icon). The features of an exhibit finally disseminate in the exhibition venue by initiating a meta-communication and by transferring its characteristics to heritage objects in the urban space. These results allow us to notice a metamorphic dimension of heritage in the various ways it is seen, transformed and featured