Epidemiologia & Prevenzione最新文献

Objectives: to analyse the prevalence and characteristics of the hikikomori phenomenon in Italy within a representative sample of students aged 15 to 19 years, assessing the factors associated with this behaviour to guide preventive interventions.

Design: cross-sectional study based on anonymous data collected through the ESPAD®Italia (European School Survey Project on Alcohol and other Drugs) survey using a self-administered questionnaire.

Setting and participants: a representative sample of Italian high-school students is selected annually to ensure the comparability of ESPAD®Italia estimates. In this study, the pooled 2021-2023 sample consists of 36,868 students (50.8% male), with an average age of 17.0 years (standard deviation: 1.4).

Main outcomes measures: the outcomes analysed are having experienced voluntary social withdrawal for at least six months over a lifetime (Lifetime Hikikomori) and the current behaviour of never leaving the house during the week (Current Withdrawal).

Results: in 2023, 2.0% of students reported having voluntarily isolated themselves for at least six months in their lifetime, with a slightly higher prevalence among girls. Current withdrawal involved 11.3% of students, a significant increase compared to the previous two years. In the pooled 2021-2023 sample, the analysis of independent variables showed that the hikikomori phenomenon is associated with the use of psychotropic drugs, cigarette smoking, having been a victim of cyberbullying, feelings of exclusion, dissatisfaction in friendships, risky behaviours related to internet and video game use, and belonging to non-traditional families. The current withdrawal is directly associated with cigarette smoking, lack of enjoyment in social interactions, overweight/obesity, and belonging to non-traditional families.

Conclusions: the study provided the first quantitative estimate of voluntary social withdrawal among Italian students aged 15-19 years, confirming that the phenomenon is widespread and concerning, especially among girls. Factors such as the perception of social exclusion, problematic online behaviours and the use of psychotropic drugs are strongly associated with the phenomenon. Future longitudinal research could further explore these relationships and support the development of integrated educational strategies in schools to identify and support at-risk students.

Background: the exposure-response relationship between pleural mesothelioma and asbestos has been traditionally described by models that predicted incidence to increase indefinitely by latency. Studies with long observation showed that the increase flattens out beyond 40 years of latency. It has been, therefore, proposed to introduce an exponential decay function into the models Objectives: to show characteristics and implications as to the relevance of remote and recent exposures, by conducting a simulation exercise based on data available from the literature.

Methods: the traditional and decay models that best fit mortality from pleural cancer during the initial 40 years of observation in the Italian pooled cohort of asbestos workers were selected. The mesothelioma incidence predicted by such models as a function of age at first exposure, exposure duration, and age at risk was compared. It was also compared the proportional weight assigned to remote, intermediate, and recent exposure, by dividing the whole exposure period in three parts of equal duration.

Results: the decay, but not the traditional, model fits well the trend observed after 40 years. According to the traditional model, remote exposures have maximum and recent exposures minimum weight: for instance, following an exposure starting at age 20 and lasting 18 years, the incidence at age 80 would be attributed to remote exposures by 47% and by 21% to the recent ones. The decay model predicts only minor differences and even of reversed weight: 34% and 31%, respectively, in this case.

Conclusions: remote exposures do not necessarily have overwhelming weight in determining pleural mesothelioma risk. The balance between different exposure periods depends on the time-distribution of exposure.

Background: urge urinary incontinence (UUI) is the involuntary loss of urine accompanied or immediately preceded by a sudden and strong desire to urinate that cannot be delayed or that is difficult to postpone. Data claim that UUI increases significantly from 40 to 65 years, which is why this specific age group, which has been little studied in the literature, deserves to be investigated. Moreover, they are socially active and working women who represent a social and economic resource for the country: therefore, their malaise is not only a personal problem, but also a problem for the society.

Objectives: to investigate the prevalence, quality of life, social impact, and costs of urinary incontinence in women aged 40 to 65 years.

Methods: a narrative review of the literature was performed through the following databases: PubMed, CINAHL, Web of Science, and Embase. The search string was processed using the PEO acronym. Source selection was conducted and reported according to the PRISMA flowchart, following the established inclusion and exclusion criteria. A total of 21 articles were included and analyzed in the review: 11 about the prevalence and 10 about quality of life, social impact, and costs.

Results: the prevalence of UUI varies according to the considered age group. In the 40-65-year age range, there is a progressive increase in the onset of UUI symptoms worldwide, with a prevalence of around one fifth of the female population. It also emerged that the quality of life of patients suffering from UUI is negatively affected: urine leakage is accompanied by feelings of embarrassment, frustration, and anxiety, which contribute to reduce the psychosocial, occupational and sexual activities of the affected patients, imposing high costs for the treatment, and management of the disorder and its comorbidities.

Conclusions: considering the wide prevalence of UUI in women aged 40-65 years and given the growth prospects of the phenomenon, it is important to increase the attention of women and health professionals regarding this disorder. In order to support the clinical practice with scientific evidence, it would be appropriate for future research to focus on the predictors of UUI and their prevention, too. The development of new educational and rehabilitative programmes is necessary to increase awareness, prevention, diagnosis, and UUI effective management.

In humanitarian crises, quantifying the number of victims contributes to estimating the needs for assistance, advocating for additional resources, promoting diplomatic actions, supporting transnational justice, and informing political decisions. It also provides a clearer understanding of the severity of a crisis within its historical, geographical, political, and social contexts. However, data collection in conflict settings is frequently hindered by insecurity and political barriers.Relevant studies of war mortality have used epidemiological methods, such as prospective community surveillance, body count, retrospective household surveys, capture-recapture analysis, and key informant interviews. The present paper describes the advantages and limitations of each of these approaches. Subsequently, it summarises and tabulates estimates of mortality indicators in 19 humanitarian crises taking place in African countries, Syria, Iraq, and Yemen over the last twenty years. Most estimates were based on household surveys. Attention is brought to the difficulties in the assessment of indirect war-related mortality.Mortality indicators are politically sensitive. As a result, politicisation of numbers in armed conflicts has not been uncommon: cases of data manipulation to serve political goals are described.Improvements in humanitarian practice and public health interventions have contributed to the decline of reported mortality rates in recent years. However, challenges in measurement and data standardisation still need to be addressed. Public health information remains an underfunded and under-prioritised part of humanitarian assistance, despite the growing emphasis by donor governments on the importance of quantitative evidence to inform decision-making and justify aid budgets.

Objectives: to describe the 'IDA' study, which aims to estimate the prevalence of School Readiness Vulnerability (SRV) in children at the beginning of primary school and the associated socioeconomic characteristics, to stimulate the attention of decision-makers on the consequences of the COVID-19 pandemic and the need for specific and timely interventions by the school community, thus preventing negative effects on children's present and future health.

Design: cross-sectional study based on a random sample of children extracted using the cluster sampling technique on the first primary school classes.

Setting and participants: in October 2022, the IDA study assessed the SRV prevalence and associated risk factors in 628 children of the Lazio Region, aged 67-89 months, 328 males and 292 females.

Main outcomes measures: the individual school readiness score was calculated by a validated questionnaire (Early Identification of Learning Difficulties, IPDA); socioeconomic characteristics were measured by administering a questionnaire to parents (child's age, kindergarten attendance, parents' education, parents' occupation).

Results: the SRV prevalence was 44.9%. The most affected development areas were motor skills, pre-mathematics, and pre-literacy. SRV was associated with low educational levels of the mother, father, or both parents, and maternal and paternal unemployment. The comparison with reference values (pre-pandemic) places the subjects studied one year behind in terms of psycho-motor development.

Conclusions: because of potential negative effects, institutions and stakeholders need to intervene to promote children's reinforcement activities and equity of access to education.

Background: Italy, as many other developed Countries, is experiencing a deepening decline in birth rates, turning it into a structural issue that has led many Maternity Units to operate below the minimum delivery threshold. To ensure safe access to maternal healthcare, the 2010 State-Regions Agreement set a minimum target of 500 births per year for facility in areas with significant geographic challenges.

Objectives: to describe the model developed by the Italian National Agency for Regional Healthcare Services (AgeNaS) which intend to assess accessibility to Maternity Units, considering both potential service areas and existing territorial coverage, and to allow for the simulation of network reconfiguration scenarios.

Design: a gravity model was adopted and tailored to the healthcare setting. The model is the Modified Three-Step Floating Catchment Area, divided into three stages: 1. calculation of access probability (using Huff's probability model); 2. estimation of the hospital bed capacity of the regional network of Maternity Units; 3. calculation of an accessibility index for each area to the Maternity Unit network. To implement the gravity model, AgeNaS designed and developed a software application to process distance matrices based on road networks, which allow for accurate calculation of travel times and distances from municipalities to hospitals Results: the model highlights that activity data and territorial characteristics can redefine both current and potential future service areas, offering a transparent and replicable assessment. The potentiality of the AgeNaS model was demonstrated through a series of case studies: Montevarchi (Tuscany), Iglesias (Sardinia), and Orvieto (Umbria).

Conclusions: the AgeNaS methodology is a valuable tool for regions and the central level, both applicable to the network of Maternity Units and to other territorial healthcare networks. This approach is flexible, adaptable, and can be standardized through known parameters, making it suitable for replicable analysis.