Risk of labour market marginalisation among young refugees and non-refugee migrants with common mental disorders.

PURPOSE: Labour market marginalisation (LMM), i.e. long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension (DP), among young individuals with common mental disorders (CMDs) are a challenge for the welfare system, and refugees and non-refugee migrants seem particularly vulnerable. The aim was to investigate the risk of LMM in young adults with CMDs among refugees and non-refugee migrants compared to Swedish-born individuals and the role of country of birth, duration of residence and age at arrival. METHODS: A prospective cohort study was conducted including young adults (19-30 years) with inpatient or specialised outpatient healthcare due to CMDs and/or antidepressant prescriptions during 2009 (N = 69,515). Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals for the risk of LMM during 2010-2013. RESULTS: Both refugees and non-refugee migrants had a higher risk of LTU compared to Swedish-born individuals (HR refugees: Africa: 2.4; Asia: 2.2; Europe outside EU25: 1.6; South America: 1.4) with highest estimates in refugees from Afghanistan and Syria. Refugees from Africa and Asia had a lower risk of LTSA compared to Swedish-born individuals (HR: 0.6 and 0.7, respectively), particularly refugees from Afghanistan and Iraq. Especially among refugees, a longer duration of residence and a younger age at arrival were associated with a lower risk of LTU. CONCLUSIONS: The risk of LTU among refugees and non-refugee migrants was higher and the risk of LTSA was lower, compared to Swedish-born individuals. Duration of residence and age at arrival had an influence on the risk of LTU, particularly among refugees.

Trajectories of sickness absence, disability pension and unemployment in young immigrants with common mental disorders.

BACKGROUND: The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants. METHODS: A total of 28 971 young adults (19-30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R2 to measure the associations' strength. Immigrants were categorized into Western and non-Western immigrants. RESULTS: Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP. CONCLUSIONS: Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants.

Healthcare use among immigrants and natives in Sweden on disability pension, before and after changes of regulations.

Background: There is limited knowledge regarding psychiatric healthcare utilization around the time of granting disability pension (DP) due to common mental disorders (CMD) among immigrants and if this is related to social insurance regulations. The aim was to evaluate patterns of psychiatric healthcare utilization before and after DP due to CMD among immigrants and natives. A second aim was to evaluate if such patterns differed before and after changes in social insurance regulations in Sweden in 2008. Methods: All 28 354 individuals living in Sweden with incident DP due to CMD, before (2005-06; n = 24 298) or after (2009-10; n = 4056) changes in regulations of granting DP, were included. Patterns of psychiatric in- and specialized outpatient healthcare utilization during a 7-year window around DP granting were assessed by Generalized Estimating Equations estimating multivariate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Prevalence rates of psychiatric inpatient care were comparable among immigrants and natives, lower in non-Western immigrants (Africa, Asia and South-America). Three years after DP, non-Western immigrants in comparison to natives and Western immigrants had a stronger decrease in inpatient psychiatric healthcare: OR 0.48 (CI 0.38-0.62), 0.76 (0.70-0.83) and 1.01 (0.76-1.34), respectively. After 2008, a strong reduction in outpatient psychiatric healthcare after DP granting was observed, similarly in immigrants and natives. Conclusions: Non-Western immigrants showed a different pattern of inpatient specialized healthcare after DP granting in comparison to natives. After changes in social insurance regulations, the decline in outpatient psychiatric healthcare following DP granting was comparable in immigrants and natives.

Risk of disability pension in first and second generation immigrants: the role of age and region of birth in a prospective population-based study from Sweden.

BACKGROUND: In several countries, immigrants have higher disability pension (DP) rates than natives. Reasons for this are poorly understood. The aim of this study was to investigate if the risk of diagnosis-specific DP differed in first, second, and second/intermediate generation immigrants compared to natives, in general and across regions of birth, and stratified by age. METHODS: A population-based prospective cohort study of all 3,507,055 individuals aged 19-50 years and living in Sweden in 2004 with a 6-year follow-up period. Hazard ratios (HR) and 95% confidence intervals (CI) for mental and somatic DP were estimated by Cox regression for first, second, and second/intermediate generation immigrants compared to natives, across regions of birth and stratified by age. RESULTS: After multivariate adjustment, HRs for both mental and somatic DP were higher at follow-up in the first generation compared to natives: mental HR 1.17 (CI 1.12-1.22) and somatic 1.15 (1.09-1.22) for individuals <35 years; 1.74 (1.69-1.79) and 1.70 (1.66-1.74) ≥35 years (median), respectively. Immigrants born in Europe outside EU25, and countries outside Europe had particularly elevated HRs. Also in the second generation, HRs were higher in mental 1.29 (1.21-1.37) and somatic DP: 1.30 (1.19-1.42) in those <35 years; and 1.18 (1.10-1.27); and 1.10 (1.03-1.17) for those ≥35 years, respectively. Among second generation immigrants there were no strong differences in HRs between regions of birth. CONCLUSIONS: Compared to natives, the risk of DP was higher in first and second generation immigrants. Higher estimates were seen for immigrants from Europe outside EU25 and from the rest of the world in the first generation. No considerable differences in estimates regarding mental or somatic DP diagnoses were found.

Oral Health Status and Oral Health-Related Quality of Life in Italian Deinstitutionalized Psychiatric Patients.

INTRODUCTION: The aim of this study is to investigate the oral health status and Oral Health-Related Quality of Life (OHRQoL, measured with OHIP- 14) in psychiatric patients assisted by the unique Italian mental health care system, in accordance to regulatory Law 180/78. MATERIALS AND METHODS: Demographic and medical variables were retrieved from institutional medical records. General health and oral health variables, oral health-related behavior and last dental contact were recorded. Clinical evaluation was performed on each patient. For oral health data collection, a standardized medical form was used. RESULTS: The study involved an overall number of 67 patients. Primary diagnosis of mental illness was at mean age of 29 years. The average number of teeth per patient was 25.45 ±6,55. The overall mean value of caries experience was 9.1 decayed, missing and/or filled teeth (DMFT Index). Among affected patients (60%, n=33) the mean value of DMFT for all age groups was 11.3 (range 2-27). The present study highlighted a direct linear relationship between caries experience and OHRQoL. As the caries level increased, pain, functional and psychological discomfort scores increased. DISCUSSION AND CONCLUSIONS: The overall caries experience value of 9.1 DMFT was lower than that reported in existing literature, which is usually related to traditionally institutionalized psychiatric patients, and most important of all, data on access to dental care is fairly good. These results, although derived from a pilot study on a limited sample, suggest that, where a psychosocial rehabilitative program is set out for psychiatric patients, as in the case of the Italian experience, the program can also determine an improvement in oral health status. It is important that programs for oral health promotion are developed in collaboration with mental health services and social measures are patient-centered as an integral part of the individual's rehabilitation program.

The relationship between physical activity and quality of life in prisoners: a pilot study.

INTRODUCTION: Imprisoned people have usually a poor health status in comparison with the general population. The aim is to investigate a possible association between the quality of life and physical activity level in male inmates. METHODS: A cross-sectional pilot study was carried out between 2010 and 2011. A questionnaire contained SF12 and International Physical Activity Questionnaire was administered. Mental Component Score (MCS) and Physical Component Score (PCS) were computed. The physical activity level was measured using Metabolic Equivalents score (MET). RESULTS: 121 inmates entered the survey. MCS is directly correlated to MET of physical activity (ß = 0.23; P = 0.03) and negatively to BMI variations (ß = -0.24; P = 0.02) and smoking status (ß = -0.24; P = 0.02). DISCUSSION: This pilot study suggests to improve the investigation to support the promotion of physical activity programs in Italian prisons in order to improve inmates QoL and allow a better social integration at the end of detention.

H1N1 pandemic influenza: habits and behaviour of the nurses. A public health issue.

BACKGROUND: One of the main concerns related to pandemic H1N1 influenza 2009 is the overwhelming burden on medical structures. The aim of this work is to study the behaviour and attitudes of Nurses in relation to the spreading pandemic in order to develop public health strategies. METHODS: During the spread of Pandemic, in winter 2009, an anonymous questionnaire online of thirty-four questions was available for participants. Data obtained were analyzed using descriptive, univariate and multivariate statistics. RESULTS: A total of 2313 nurses were interviewed. In univariate analysis 72.6% of 573 males (versus 63.9% of 1740 females) have been talk to a doctor (p<0.001). The female group appear less likely to get vaccinated (60.3% vs 51.1%, p<0.001). Multivariate analysis revealed that to be worried (OR=2.82 95% CI: 2.31-3.46), female (OR=0.62 95% CI: 0.51-0.77), age group 30-49 (OR=0.72 95% CI: 0.58-0.90) were associated with the willingness of Get vaccinated. CONCLUSIONS: Prevention, as washing hands and vaccination, are crucial in pandemics events. Given the low rates of acceptance of pandemic vaccination among nurses, public health bodies should consider campaign education, in order to prevent nosocomial transmission, to protect patients and the continuity of the essential health-care infrastructure.

[Randomized controlled trial on the promotion of healthy lifestyles among adolescents in the orthodontic setting: study protocol]. / Trial clinico randomizzato sulla promozione di corretti stili di vita tra gli adolescenti in ambito ortodontico: protocollo dello studio.

Many studies have shown that the bad lifestyles are the major factors thought to influence susceptibility to many diseases in our society and often these habits during the adolescence begin. The aim of the study was to evaluate the health promotion intervention effect in an orthodontic adolescent sample, in particular: deterring adolescents from smoking; discourage the use and abuse of alcoholic beverages; encourage the adherence to the Mediterranean style diet. A blinded randomized controlled trial will be performed. The participants will be adolescents aged 10 to 14 years that will receive a medical examination in the Complex Unit of Orthodontics. The sample will be followed for three years. The collected evidence would be a scientific support for decisions in public health, in order to increase the health of the young generations.

[Implementation of the stewardship model in public health: proposal of an assessment tool for the Italian national prevention plan]. / Implementazione della stewardship in sanità pubblica: proposta di una metodologia valutativa applicabile al piano nazionale della prevenzione.

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

Seasonal and pandemic influenza: the role of communication and preventive strategies.

Appropriate, timely, and data-driven health information is a very important issue in preventive strategies against influenza. Intuitively, a link between willingness to be vaccinated against seasonal influenza and against pandemic influenza exists, given the similarities in decision-making for this vaccine. International and national literature reviews suggest that progress has been made in order to incorporate and disseminate crisis risk communication principles into public health practice, as such investments in public health could be important for building capacity and practice which aid in the realization of countermeasures in response to a future pandemic and epidemic situation. This study emphasizes the lack of perception by Health Care Workers (HCWs) of the importance of being immunized against seasonal and pandemic influenza and the doubts concerning safety. In the future, particular efforts are needed during vaccination campaigns, to provide more information to HCWs and the general population regarding role and safety of such vaccines.

Knowledge about pandemic flu among Italian health care workers (HCWs): an Italian survey.

INTRODUCTION: In case of pandemics, healthcare workers (HCWs) are the main actors and, at the same time, one of the main targets of preventive measures. This is what occurred in 2009 during the A/HINI pandemic flu. The aim of our survey was to get information about HCWs' knowledge of the A/HINI pandemic flu prevention. MATERIALS AND METHODS: A survey of 32 questions, 11 of which about knowledge towards A/H1N1 pandemic flu, created on the basis of a similar one by the Harvard School of Public Health, was made available on the Italian Journal of Public Health website during the month of October 2009. The survey was advertised with links from various professional websites and by emailing to HCWs' addresses taken from the Italian Society of Hygiene and Public Health (SItI) databases. Descriptive and univariate analyses were conducted in order to assess whether differences exist on the level of knowledge of HCWs (specifically Nurses and Physicians) about preventive measures against the A/H1N1 pandemic flu. RESULTS: 1,960 HCWs answered to the questionnaire, 1,711 (87.3%) Nurses and 249 (12.7%) Physicians. Both Nurses and Physicians seemed to have a high or moderately high interest for A/H1N1 pandemic flu (86.1% vs. 91.2% respectively, p = 0.03). Nurses indicated national newscasts (38.6%) and communications within hospitals or other workplaces (33.8%) as the source of most information about A/H1N1 pandemic flu. On the other hand Physicians got information mostly from Internet (41.8%), but also from communications within their hospital or other workplace (34.5%) (p < 0.001). Not all the Nurses and Physicians knew that contagion is possible by close contact (less than 1 metre) wit someone affected (74.0% and 88.0% respectively, p < 0.001), while 82.3% of Nurses and 71.1% of Physicians reported that face masks protected from getting infected (p < 0.001). CONCLUSION: Information and awareness campaigns on the influenza pandemic should be conducted firstly among HCWs, because of their importance--especially in case of pandemics--as a valuable resource at risk, as a contagion vehicle and as a source of information for the general population.

Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009.

A survey on attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 was carried out during the month of October 2009 in Italy through an online questionnaire adapted to the Italian situation from a similar survey of the Harvard School of Public Health in the United States (US). Results show that the intention to get vaccinated against pandemic H1N1 influenza 2009 is generally low and that there are differences in attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 between physicians and nurses, especially concerning vaccination. Differences relate also to sex, region of residence and marital status.

[What do we talk about when we talk about immigrant's health in Europe? Considerations from the 2nd Conference of Migrant Health in Europe]. / Di cosa si parla quando si parla di salute degli immigrati in Europa? Considerazioni dalla 2" Conferenza sulla Salute dei Migranti in Europa.

The present contribution aims to highlight the trends in current research at a European level with regard to immigrant's health. With this aim we analyzed the Abstract Book contributions of the "2nd Conference of Migrant Health in Europe" organized in Malmö, Sweden (May 2008), by the 'Migrant Health' section of the European Public Health Association (EUPHA). The analysis of these abstracts permitted to identify the major tipping points and challenges connected with immigration phenomenon in health care systems in hosts countries. In the 141 abstracts, the most discussed issues were: 'Inequalities' (22.6%), 'Maternal child and sexual reproductive health' (14.5%), 'Mental health' (11.3%) and 'Life style and chronic diseases' (10.9%). Further analysis of Inequalities category shows that the most discussed level was maternal-child, with particular reference to pre-birth child health among immigrants and mixed relationship. These studies confirmed inequalities in most cases (68%). Health inequalities between immigrant and native population in maternal child field appeared to be the most discussed issue with regard to immigrant's health in Europe. Juridical differences related to the possibility of obtaining citizenship between ius soli (in force in the majority of European countries) and ius sanguinis (in force in Italy), could probably explain the importance of this research-line.

[Closing the gap in a generation: health equity through action on the social determinants of health. A challenge for the international community]. / Closing the gap in a generation: l'equità nella salute attraverso l'azione sui determinanti sociali della salute. Una sfida per la comunità internazionale.

The aim of this contribution is to present the Report of 'Commission on Social Determinants of Health' (Who) published in August 2008, 30th Alma Ata Conference anniversary. The Report highlights major inequalities in life expectancy and rates of disease between rich and poor within countries as well as among different parts of the world. The report makes wide ranging recommendations in order to 'close the gap in a generation', emphasizing action on living conditions, access to services, social support, information and research. We will discuss the echoes from the scientific and media world and their impact on national and global scale.