1,720,978 research outputs found
Processi economici di esclusione urbana
No full textIl legame fra le specificità morfologiche di una città e il tema della salute è un aspetto imprescindibile di ogni modello insediativo sviluppatosi nel tempo. Lo stato di salute della popolazione è da sempre, direttamente e indirettamente, influenzato dalle caratteristiche delle città stesse. Le scelte che vengono intraprese in termini di pianificazione, di progettazione urbana, di tutela e valorizzazione ambientale e per quanto riguarda le politiche sociali, possono infatti condizionare, positivamente o negativamente, la salute degli abitanti della città contemporanea.
Nello specifico, tra i fattori che influenzano la “salute urbana” vengono riconosciute non solo le caratteristiche socio-culturali della popolazione e gli aspetti demografici ed economici, ma anche la morfologia urbana, la presenza di ambiente naturale e aree verdi attrezzate, di adeguati spazi pubblici e servizi per i cittadini, di sistemi di mobilità sostenibile e a favore del trasporto attivo, di una buona gestione delle emergenze, di un buon servizio sanitario e socio-assistenziale, etc.
Diviene quindi prioritario effettuare tali scelte in maniera consapevole, prediligendo le opzioni capaci di limitare i fattori di rischio in funzione del completo stato di benessere dei cittadini e a favore dell’adozione di corretti stili di vita, alla luce del fatto che il Dipartimento “Population Division” delle Nazioni Unite stima che, entro il 2050, oltre il 70% della popolazione mondiale vivrà in contesti fortemente urbanizzati e che l’aumento della densità sarà una delle principali tendenze globali, con impatti significativi sulla salute. Le ricerche nel campo dei fattori determinanti la salute hanno spostato quindi l’attenzione da un modello medico, focalizzato sull’individuo, ad un modello sociale in cui la salute è la risultante di diversi fattori socio-economici, culturali e ambientali e quindi direttamente o indirettamente connessi alle specificità dell’insediamento urbano. Pertanto, la salute non è più un tema esclusivo dell’ambito ristretto della sanità, ma è un obiettivo prioritario fortemente influenzato dal contesto in cui si vive e conseguentemente dalle strategie attuate dai governi locali
Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study
Full text linkObjectives Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study.
Design Cohort study.
Setting Rome, capital of Italy.
Participants We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15–65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition.
Main outcome measures We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women.
Results We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively).
Conclusions This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment
Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia
No full textIntendendo la salute come un diritto umano fondamentale che non si esaurisce alla dimensione biologica ma si estende a quella sociale, economica e politica, gli autori, dopo aver descritto brevemente le politiche che a livello europeo sono state emanate per tutelare la salute dei migranti, analizzano l’esperienza italiana alla luce delle direttive internazionali. L’Italia rappresenta infatti un caso particolare ed avanzato di tutela della salute dei migranti; la sua politica sanitaria decisamente inclusiva riconosce parità di diritti e doveri ai cittadini regolarmente presenti ed ammette ampie possibilità di protezione ed assistenza anche per gli immigrati privi di permesso di soggiorno. Tuttavia, anche in un contesto avanzato come quello italiano, è necessaria un’evoluzione da un approccio di tipo assistenzialistico ad uno più ampio di promozione della salute attraverso politiche di natura intersettoriale, alla luce della teoria dei determinanti sociali di salute. Affrontare la tematica della salute del popolo migrante rappresenta un’occasione per rendere i servizi sanitari in particolare e le politiche migratorie in generale più attente ad ogni persona, alla sua storia e al contesto nel quale essa vive.Understanding health as a fundamental human right, not limited only to the biological dimension, but including the social, economic, and political ones, the authors, after briefly describing the politics enacted at the European level to protect migrant health, analyzethe Italian experience in the light of international guidelines. Italy is, in fact, a specific and
advanced case of migrant health protection; it’s very inclusive health policy recognizes the equality in rights and responsibilities of legal citizens and offers protection and assistance to immigrants without legal authorization to reside in the country. However, even in an advanced context such as the Italian, it is important to transition from an assistance-based approach to a broader one of health promotion through intersectoral policies in light of the theory of the social determinants of health. Addressing the issue of migrant health represents an opportunity for the health services and, in general, for migration policies to become more focused on each person, his/her history, and the context in which he/she lives in
Social vulnerability in urban and suburban hospitalized patient: the importance of an early detection
No full textThe “Triage Sociale” project was developed by “Sapienza – University of Rome” and the regional institution – “Regione Lazio”, and implemented in nine hospitals of Rome, six Hospital Trusts (Aziende Ospedaliere) and three smaller District Hospitals (Presidi Ospedalieri), five in the suburbs and four in the inner city. The project aimed at hindering the transversal social vulnerability that can cause inequality in the health care services. The purpose of this partnership was to enhance the hospital awareness regarding the importance of inserting a social evaluation concurrent, in the first day of admission, to the health assessment of hospitalized patient.
We have developed an evaluative tool, capable of promptly detecting potential social vulnerabilities. These issues are indeed prone to be overlooked during the hospitalization, which cause frequently admission to hospital or prolonged recoveries with delayed discharges. The study has been conducted through 8,282 forms, filled out by properly trained nurses at the bedside. We collected 1,005 positive forms of the total 8,282. It means that the 12% of admitted patients could have a potential exposure to social fragility (regarding the dimensions of: housing, income or informal support network).
We found a statistically significant difference (p<0.001) in the proportion of positive forms between hospitals, and a statistically significant difference (p<0.001) between Hospital Trusts and District Hospitals. On the other way there is no statistical difference between inner hospitals and suburban hospitals.
This is probably because, two of the four suburban hospitals are Hospital Trusts. We could ascribe this difference of positive cases between different kind of structure is due to the different complexity of cases treated in those structures. Further statistical elaborations need to be performed, but we could reasonably suppose that the absence of differences between inner and suburban hospitals is due to the overlapping of the catchment area of those hospitals
Health System Response during the European Refugee Crisis. Policy and Practice Analysis in Four Italian Regions
Full text linkThe decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration
Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market // Differenziali di mortalità a Roma: il ruolo dell’istruzione e dei prezzi immobiliari del quartiere di residenza
No full textOBIETTIVI: studiare l’associazione tra livello di istruzione, prezzi degli immobili nel quartiere in cui si risiede e mortalità per tutte le cause.
DISEGNO: studio di coorte.
SETTING E PARTECIPANTI: dalla coorte censuaria del 2011 sono stati selezionati i residenti a Roma, viventi (da fonte anagrafica) all’indirizzo del censimento, di età compresa tra i 18 e i 99 anni. I soggetti sono stati seguiti, attraverso record linkage con database amministrativi, fino a dicembre 2016. I dati includono informazioni individuali quali genere, età, istruzione, quartiere di residenza, data di morte. I quartieri sono stati classificati secondo il prezzo degli immobili (euro/m2).
PRINCIPALI MISURE DI OUTCOME: mortalità per tutte le cause, analizzata con modelli di Cox.
RISULTATI: sono stati inclusi 2.051.376 individui (54% donne, 22,5% con un alto livello di istruzione). Durante il follow-up, sono morte 127.352 persone. L’istruzione è un forte determinante della mortalità. Tenendo conto di età, genere, stato civile e prezzo degli immobili nel quartiere di residenza, rispetto a chi ha un livello di istruzione alto, le persone con un’istruzione media hanno un hazard ratio (HR) di 1,16 (IC95% 1,14-1,19) e quelle con un’istruzione bassa hanno un HR di 1,35 (IC95% 1,32-1,37). Tenendo conto degli stessi fattori e del titolo di studio, a ogni mille euro di aumento del prezzo al m2 degli immobili corrisponde un HR di 0,96 (IC95% 0,96-0,97).
CONCLUSIONI: entrambi gli indicatori utilizzati sono associati alla mortalità per tutte le cause. Un semplice indicatore come il prezzo immobiliare può essere utilizzato per mettere in luce disuguaglianze nello stato di salute.OBJECTIVES: to investigate the association between real estate prices, education, and mortality. DESIGN: cohort study. SETTING AND PARTICIPANTS: residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. MAIN OUTCOME MEASURES: adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. RESULTS: the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). CONCLUSIONS: there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities
Geographical Inequalities in Health in Public Housing Districts in the Context of Rome: An Observational Study on the Territory of Local Health Unit Roma 1
No full textIn tackling social inequalities in health, the first step is to analyze and understand the territory, especially in urban contexts. In this sense, the Municipality of Rome represents an interesting case study due to its peculiar urban and social stratification. The large territory over which it extends is characterized by various types of urban patterns, from the dense city of the most central areas to the dispersed city that extends in all directions. The public housing projects built in the last sixty years are part of this complex urban system. The Local Health Unit Roma 1 is developing its own Health Equity Plan. Starting from this and from previous analysis carried out in the area of the Local Health Unit Rome 1 (comprising six municipalities, for an area of over 500 km2 and a population exceeding one million inhabitants), an observational study was carried out with the aim of identifying any inequalities in the use of second-level services. These were measured in terms of hospitalization and access to the Emergency Department and the resident population in the Public Building areas, delimited in Rome by the Zoning Plans. The study shows that there are significant differences for many of the areas analyzed, which could lead to inequalities in access to health services, especially those of primary health care. Analyzing these results in the light of the evolution of the urban fabric of the city, also in accordance with the field experience of the Local Health Unit operators, should guarantee a better understanding of the phenomenon with a view to providing epidemiological support to health planning
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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