La disuguaglianza socio-economica della salute come indicatore di benessere sociale

Obiettivo: Misurare il benessere sociale attraverso l’utilizzo della disuguaglianza socioeconomica della salute percepita dalle famiglie italiane e quantificare i contributi dei determinanti della salute alla disuguaglianza misurata. Materiali e metodi: Sono utilizzati i dati dell’indagine Istat sulle condizioni di vita (UDB IT-SILC), componente longitudinale. L’analisi è effettuata su un sotto-campione di 11.543 individui e 12 variabili, ottenuto dopo aver eliminato i dati mancanti per la variabile reddito e per le altre variabili rilevanti per la salute. E’ applicato il modello di regressione probit ordinale, per ottenere una misura continua della variabile salute, l’indice di concentrazione della salute, per misurare la disuguaglianza della salute, e infine la scomposizione della disuguaglianza, per calcolare il contributo di ciascun determinante. Le analisi sono a livello territoriale NUTS1. Risultati e conclusioni: La disuguaglianza di salute correlata al reddito è stimata pari all’1,18% a livello nazionale, mentre a livello territoriale il gradiente tra salute e reddito interviene solo al Sud. A livello territoriale, l’analisi rivela una disuguaglianza nella percezione della buona salute in tutte e cinque le ripartizioni territoriali, concentrata nel gruppo di individui avvantaggiati economicamente. La disuguaglianza nella salute è percepita maggiormente nel Nord Ovest (1,69%), seguita dal Nord Est (1,53%) e dal Sud (1,35%), Centro (1,21%); mentre la disuguaglianza della salute percepita non è significativa nelle Isole (-0,0012; IC95%=[-0,01; 0,01]). Emerge che in Italia nel 2010 si ha complessivamente una buona percezione della salute, che si concentra negli individui maschi, con una migliore posizione socioeconomica, istruzione più elevata, occupati; mentre esistono disuguaglianze nella malattia cronica e disabilità che penalizzano alcuni gruppi di popolazione svantaggiati economicamente con basso livello di istruzione e fuori dal mercato del lavoro

Socioeconomic inequality in non-communicable diseases in Europe between 2004 and 2015: evidence from the SHARE survey

Background The scope of this work was to investigate socioeconomic inequalities among European adults aged 50 or older in chronic diseases and behavioural risk factors for these diseases, namely, smoking habits, obesity and physical inactivity, between 2004 and 2015. Methods Data for this study were drawn from the Survey of Health, Ageing and Retirement (SHARE) in Europe, which is a panel database of microdata on health, socioeconomic status and social and family networks of people aged 50 years or older, covering most of the European Union. The predicted number of non-communicable diseases (NCDs) was used to estimate the concentration index and to find the contributions of determinants to socioeconomic inequalities in chronic diseases. Results The inequality disfavoured the poor in both years, but the effect was stable from 2004 (C = 120.071) to 2015 (C = 120.081). Inequality was shown to be attributed mostly to physical inactivity and obesity and this contribution increased during the study period. Among socioeconomic status (SES) determinants, education and marital status were the most concentrated in both years, while physical inactivity and obesity were the most concentrated behavioural risk factors in both years. Conclusions To prevent chronic diseases, health policy should aim not only to improve individual health behaviours in the population, but also to reduce socioeconomic inequality. Our study suggests promoting a healthy lifestyle in the most disadvantaged socioeconomic classes as a strategy to improve the health conditions of the whole population

Challenges in dental statistics: data and modelling

The aim of this work is to present the reflections and proposals derived from the first Workshop of the SISMEC STATDENT working group on statistical methods and applications in dentistry, held in Ancona (Italy) on 28th September 2011. STATDENT began as a forum of comparison and discussion for statisticians working in the field of dental research in order to suggest new and improve existing biostatistical and clinical epidemiological methods. During the meeting, we dealt with very important topics of statistical methodology for the analysis of dental data, covering the analysis of hierarchically structured and over-dispersed data, the issue of calibration and reproducibility, as well as some problems related to survey methodology, such as the design and construction of unbiased statistical indicators and of well conducted clinical trials. This paper gathers some of the methodological topics discussed during the meeting, concerning multilevel and zero-inflated models for the analysis of caries data and methods for the training and calibration of raters in dental epidemiology

Challenges in Dental Statistics: Data and Modelling

The aim of this work is to present the reflections and proposals derived from the first Workshop of the SISMEC STATDENT working group on statistical methods and applications in dentistry, held in Ancona (Italy) on 28th September 2011. STATDENT began as a forum of comparison and discussion for statisticians working in the field of dental research in order to suggest new and improve existing biostatistical and clinical epidemiological methods. During the meeting, we dealt with very important topics of statistical methodology for the analysis of dental data, covering the analysis of hierarchically structured and over-dispersed data, the issue of calibration and reproducibility, as well as some problems related to survey methodology, such as the design and construction of unbiased statistical indicators and of well conducted clinical trials. This paper gathers some of the methodological topics discussed during the meeting, concerning multilevel and zero-inflated models for the analysis of caries data and methods for the training and calibration of raters in dental epidemiology

Knowledge and attitudes towards smoking cessation counselling: an Italian cross-sectional survey on tertiary care nursing staff

Background: One of the most effective smoking cessation strategies involves care and advice from nurses due to their role in the front line of treatment. Lack of education on smoking cessation counselling may be detrimental, and adequate smoking cessation training during healthcare studies is needed. Objectives: The study aimed to examine nurses’ attitudes, belief, and knowledge of smoking cessation counselling; knowledge of the health risks associated with smoking was also assessed. Design: A cross-sectional survey on 77 nurses from the nursing staff of Cardiology, Cardiac Intensive Care and Surgical Oncology Units of two tertiary hospitals. Methods: Cronbach’s alpha was calculated to assess the questionnaire’s internal consistency, and three composite indicators were computed to assess the three dimensions of the questionnaire (knowledge, attitude, belief). Furthermore, a stepwise linear regression model was used to predict the attitude to be engaged in smoking cessation counselling, related to demographic and behavioural variables, as well as knowledge and belief indicators. The analysis was stratified by Unit. Results: Nurses from three Units had a significantly different attitude score (2.55 ± 0.93 for Cardiology, 2.49 ± 0.72 for Cardiac Intensive Care and 2.09 ± 0.59 for Surgical Oncology Unit) (P-value = 0.0493). Analogously, knowledge of smoking cessation counselling was reported to be higher for Cardiac Intensive Care Unit nurses (3.19 ± 0.70) compared to Surgical Oncology nurses (2.73 ± 0.74) (P-value = 0.021). At the multivariable analysis, attitude towards smoking cessation counselling was significantly related to the nurse’s belief about counselling, for Cardiology staff (coeff = 0.74, 95% CI [0.32–1.16], P-value = 0.002) and for Surgical Oncology staff (coeff = 0.37, 95% CI [0.01–0.72], P-value = 0.042). Conclusions: Incorporation of smoking cessation interventions in nurses’ and nursing managers’ education could improve the nursing staff’s attitude, belief, and knowledge regarding smoking cessation counselling, which would lead to the inclusion of tobacco prevention and cessation as an integral part of patient care

PRELIMINARY ANALYSES FROM A HOSPITAL BASED STUDY ON 3154 WESTERN SICILIAN PATIENTS WITH ORAL MUCOSAL LESIONS

Objectives: Diagnosis of the wide variety of lesions that occur in the oral cavity is an essential part of dental practice. The objective of this study was to explore the demographic and behavioural profiles of patients affected by oral cavity diseases on a wide spectrum. Methods: Demographic and behavioural data of 3154 patients with at least one oral cavity disease among those consecutively visited between 2004 and 2009 at the Unit of Oral Medicine, were recorded: gender, age, smoking status, alcohol consumption, drugs use. Analysis was restricted to the eleven more frequent oral cavity diseases. Firstly, Multiple Correspondence Analysis (MCA) was applied as a descriptive tool to geometrically characterize which diseases are more or less similar in terms of their demographical and behavioural profiles in a sub-space of low-dimensionality (Benzecri, 1992; Greenacre, 1993); Secondly, the simultaneous marginal homogeneity hypothesis (SMH) for the multivariate distributions associated to the detected profiles was tested (Agresti and Klingenberg, 2005; Lang, 2004). Results: On the first principal MCA axis, similar profiles were found for the couples Carcinoma-Leucoplachia, Alitosi-SAR and for the couple BMS-ONM. The score-type test of SMH and the goodness-of-fit tests of SMH models confirmed that profiles of some oral cavity disorders could not be considered significantly different at a significance level of 5%. Conclusion: Simultaneously modelling joint and marginal distributions of multivariate binary response contributed a very important issue to preventive oral medicine, in other words some oral mucosal lesions can be considered similar in terms of demographical and behavioural profiles

Radiation dose from multidetector CT studies in children: results from the first Italian nationwide survey

Background Multidetector CT (MDCT) scanners have con- tributed to the widespread use of CT in paediatric imaging. However, concerns are raised for the associated radiation exposure. Very few surveys on radiation exposure from MDCT studies in children are available. Objective The aim of this study was to outline the status of radiation exposure in children from MDCT practice in Italy. Materials and methods In this retrospective multicentre study we asked Italian radiology units with an MDCT scanner with at least 16 slices to provide dosimetric and acquisition param- eters of CT examinations in three age groups (1–5, 6–10, 11– 15 years) for studies of head, chest and abdomen. The dosi- metric results were reported in terms of third-quartile volu- metric CT dose index (CTDIvol) (mGy), size-specific dose estimate (SSDE) (mGy), dose length product (DLP) (mGy cm), and total DLP for multiphase studies. These results were compared with paediatric European and adult Italian published data. A multivariate analysis assessed the association of CTDIvol with patient characteristics and scanning modalities. Results We collected data from 993 MDCT examinations performed at 25 centres. For age groups 1–5 years, 6–10 years and 11–15 years, the CTDIvol, DLP and total DLP values were statistically significantly below the values observed in our analogous national survey in adults, although the difference decreased with increasing age. CTDIvol variability among centres was statistically significant (variance = 0.07; 95% confidence interval = 0.03–0.16; P < 0.001). Conclusions This study reviewed practice in Italian centres performing paediatric imaging with MDCT scanners. The variability of doses among centres suggests that the use of standardised CT protocols should be encourage

Italian Deprivation Index and Dental Caries in 12-Year-Old Children: A Multilevel Bayesian Analysis

Evidence from the literature has shown that people with a lower socioeconomic status enjoy less good health than people with a higher socioeconomic status. The Italian deprivation index (DI) was used with the aim to evaluate the association between the DMFT index and risk factors for dental caries, including city population and DI. The study included 4,305 12-year-old children living in 38 cities classified by demographic size as small, midsize and large. Zero-inflated negative binomial multilevel regression models were used to assess risk factors for DMFT and to address excess of zero DMFT and overdispersion through a Bayesian approach. The difference in the average level of DMFT among children living in cities with different DI quintile was not statistically significant (p = 0.578). The DI and ln(population), included as city-level fixed effects in the two-level variance components model, were not statistically significant. Consuming sweet drinks on average increased the mean DMFT of a susceptible child, while having a highly educated mother reduced it. Un-observed heterogeneity among cities was detected for the probability to be non-susceptible to caries (city-level variance = 0.26 with 95% credibility interval 0.09–0.57), while no territorial effect was found for the mean DMFT of the susceptible children. Our results suggest that the DI and city population did not play a role in explaining between-city variability. Interventions against social deprivation can be influential on the perception of oral health in Italian 12-year-old children to the extent that they can also affect individual level factors

Adult exposures from MDCT including multiphase studies: first Italian nationwide survey.

OBJECTIVES: To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population. METHODS: This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest–abdomen–pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDIvol) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure. RESULTS: The 75th percentiles of CTDIvol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen–pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen–pelvis and CAP acquisitions respectively. CONCLUSION: The results of this survey could help in the definition of updated diagnostic reference levels (DRL)