Impact of the COVID-19 pandemic on Italian students' mental health and relationships: differences between adolescent males and females

BACKGROUND

The negative effects of the COVID-19 pandemic on the mental health of young people have been reported, often with possible differences between the sexes. This study explores the impact of the COVID-19 pandemic on the differences in mental health status and healthy behaviors between adolescent males and females.

METHODS

An online questionnaire exploring sociodemographic characteristics, living conditions, mental health, behaviors, and relationships during the implementation of the COVID-19 social restriction measures, was administered to 16-18 years old high school students living in the metropolitan area of Turin. The World Health Organization-5 Well-Being Index (WHO-5) questionnaire was used to evaluate self-perceived psychological health status. Descriptive analyses of the sample were carried out by sex. Chi-squared test and the associated P value were evaluated. The spatial sign method was used to assess multivariate differences by sex.

RESULTS

Seventy-two Italian high school students completed the questionnaire. Sixty-eight percent of the students reported psychological problems, more often females (86% vs. 50%). Those living with multiple cohabitants and in dwellings with less personal space reported lower well-being. Females were also more likely to report stress when talking about COVID-19, difficulties in concentration and in falling asleep, daytime sleepiness, less physical activity, and concerns about losing control of eating. Finally, females spent more time with family members and, compared to males, found it harder to spend time and share experiences with friends and schoolmates.

CONCLUSIONS

The pandemic has greatly impacted adolescents in terms of their mental well-being, routines, relationships with friends, and sleeping and eating patterns. Females reported more stress, boredom, bad mood, eating concerns, reduced relationships with friends, and possible difficulty in falling asleep than did males. These issues should be addressed when developing and promoting support programs, particularly at school.

Newly arrived migrants did not represent an additional COVID-19 burden for Italy: data from the italian information flow

BACKGROUND

During the COVID-19 pandemic, migrants arriving in host countries irregularly have not infrequently been perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route and, during the pandemic, all migrants who landed on Italian shores were COVID-19 tested and quarantined. Our study aimed to investigate the impact of the SARS-CoV-2 infection among migrants who landed on the Italian coasts by analyzing both incidence and health outcomes.

METHODS

A retrospective observational study has been designed. The population of interest was represented by 70,512 migrants (91% male, 99% <60 years old) who landed in Italy between January 2021 and 2022. SARS-CoV-2 incidence rate per 1,000 (with 95%CI) in migrants and the resident population in Italy of the corresponding age group was computed. The incidence rate ratio (IRR) was used to compare the incidence rates in migrants and the resident population.

RESULTS

2,861 migrants out of those landed in Italy during the observation period tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. During the same period, 177.6 (177.5-177.8) cases per 1,000 were reported in the resident population, with an IRR of 0.23 (0.22-0.24). 89.7% of cases were male and 54.6% belonged to the 20-29 age group. 99% of cases reported no symptoms, no relevant comorbidities were reported and no cases were hospitalized.

CONCLUSIONS

Our study found a low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population. Thus, irregular migrants who arrived in Italy during the observation period did not increase the COVID-19 burden. Further studies are needed to investigate possible reasons for the low incidence observed in this population.

Two years of COVID-19. Impacts on accessibility of a mental health service for immigrants and individuals in socio-economic difficulties

OBJECTIVES

Mental health services utilization decreased dramatically during the COVID-19 pandemic. For persons who are highly vulnerable and at risk of health and social care exclusion, restrictions negatively affected the accessibility to treatments and their mental conditions.

METHODS

All psychiatric and psychological interviews carried out at National Institute for Health, Migration and Poverty (INMP) Italy from January 2018 to February 2022 were included in the study. To measure services use, an interrupted time-series analysis using March 2020 as the starting data of COVID-19 pandemic period was considered, and first visits vs follow-up session numbered.

RESULTS

A significant decrease was observed in March 2020 due to the lockdown restrictive measures (p<0.001). Later on, the number of psychological interventions significantly increased (p<0.05), whereas the increment of the psychiatric interventions was not significant. By the end of February 2022 the number of visits returned to pre-COVID-19 levels, although recovery was slower than expected, especially for psychiatric visits.

CONCLUSIONS

After a dramatic drop during the lockdown, access to mental health out-patient clinics slowly returned to pre-pandemic levels in the next two years. Considering that mental health needs have increased during the pandemic, mental health services should improve their efforts to reduce barriers of access and to implement outreach referral.

Do newly arrived migrants represent a COVID-19 burden? Data from the Italian information flow

Background

Migrants who reach host countries irregularly are often perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route. During the pandemic, all migrants who disembarked on the Italian shores have been COVID-19 tested and quarantined. To investigate the incidence of SARS-CoV-2 infection in this population, the INMP, together with the Italian Ministry of the Interior, set a specific information flow collecting data about the infection and possible outcomes.

Methods

The observation period was from January 2021 to January 2022. COVID-19 tests used were molecular and antigenic. Positive cases detected both at the arrival and during the quarantine period, have been registered on an ad hoc INMP online platform. Migrants’ SARS-CoV-2 incidence rate (per 1,000) - with 95% CI - was therefore calculated. The Incidence Ratio (IR) was used to compare the migrants’ incidence rate with that of the resident population in Italy, in the same period and corresponding age group.

Results

Among 70,512 migrants (91% males and 9% females, all &lt;60years old) who landed in Italy during the observation period, 2,861 tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. In the same period, an incidence rate of 177.6 (177.5-177.8) has been recorded in the resident population, with an IR of 0.22 (0.22-0.23). 89.9% of cases were males and almost half (49.6%) belonged to the age group 25-39years old. 99% of cases reported no symptoms, no relevant comorbidity has been reported and no cases have been hospitalized.

Conclusions

Our findings clearly highlight the low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population, encouraging the opportunity to investigate the reasons for such an observation. Moreover, our study confirms the “healthy migrant effect” in migrants reaching Italy by sea.

Key messages

Italian survey on the use of a multidisciplinary approach for age assessment of UAM

Issue

Many methods are used to assess the age of unaccompanied foreign minors (UAM). In Italy, in the frame of a new legislative asset, a multidisciplinary protocol has been adopted in July 2020 with the aim of ensuring that all UAMs are assessed uniformly throughout the country when their age is in doubt. The assessment is based on a multidisciplinary - social, psychological and physical - evaluation performed by a team of specialists. The local health authorities (ASL) carry out the assessment when requested by the Juvenile Court.

Description

One year after the establishment of the protocol, INMP launched a national survey, through an online questionnaire, to investigate the formal adoption of the protocol by the ASL and their adherence in practice. The survey started on 10 January 2022 and closed on 8 March 2022.

Results

Out of 118 ASL that were asked to participate, 102 (85%) answered. 37 declared to have a multidisciplinary team for age assessment. Of them, 18 use the formal protocol, 11 use an approach “in line” with the protocol and 8 have a forensic team, out of the rules of the protocol. Of the 65 that did not set up the team, 22 declared that they were ready to do so. 846 age assessment requests were reported and 687 were carried out. 398 migrants were recognized as minors, 222 migrants were not recognized as minors, and the age of 67 migrants remained uncertain.

Lessons

The pandemic period prevented the effective adoption of the protocol by the ASL, that were strongly engaged in the COVID 19 response. There is still great variability in the way the age assessment of UAMs is conducted and in order to counteract the use of inadequate/outdated practices, it is necessary to actively promote and support the adoption of the protocol. In addition, a continuous comparison/dialogue between the multidisciplinary teams, the Juvenile Court, and the Police Headquarters is also needed, so that the procedure is requested only when necessary and carried out properly.

Key messages

• In case of doubt, the age of all UAM has to be assessed in a uniform manner throughout the country.

• The adoption of the multidisciplinary protocol has to be actively promoted and supported to counter the use of inadequate or outdated assessment practices.

Mental health in migrants contacting the mental health operational unit of the National Institute for Health, Migration and Poverty (NIHMP): preliminary data

Aim

Migration can lead to an increase in stress rates and can impact mental health, especially in certain migrant groups. Nonetheless, mental health needs and the importance of public health are not well captured in most studies using national samples. This study aimed to show the correlation between mental disorders, socio-demographic and cultural aspects among migrants.

Subject and methods

One hundred nineteen migrants, applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, were recruited.

Results

Migrants frequently reported mood disorders (mainly women). Men reported PTSD, somatization and adjustment disorders.

Conclusions

Over time, diverse factors may produce a decline in an initially healthy migrant status. The research unveils a new focus on the psychopathology of migrants accessing the NIHMP, with important implications for migrants’ mental health treatment and prevention.

Platelet Derivatives and the Immunomodulation of Wound Healing

Besides their primary role in hemostasis, platelets contain a plethora of immunomodulatory molecules that profoundly affect the entire process of wound repair. Therefore, platelet derivatives, such as platelet-rich plasma or platelet lysate, have been widely employed with promising results in the treatment of chronic wounds. Platelet derivatives provide growth factors, cytokines, and chemokines targeting resident and immigrated cells belonging to the innate and adaptive immune system. The recruitment and activation of neutrophils and macrophages is critical for pathogen clearance in the early phase of wound repair. The inflammatory response begins with the release of cytokines, such as TGF-β, aimed at damping excessive inflammation and promoting the regenerative phase of wound healing. Dysregulation of the immune system during the wound healing process leads to persistent inflammation and delayed healing, which ultimately result in chronic wound. In this review, we summarize the role of the different immune cells involved in wound healing, particularly emphasizing the function of platelet and platelet derivatives in orchestrating the immunological response.

Male and Female Differences in Homicide Mortality: Results of an Italian Longitudinal Study, 2012–2018

Introduction

Italy has one of the lowest homicide rates in Europe. However, while it is decreasing overall, the proportion of murdered women is increasing. This study aimed to analyze the demographic and socioeconomic characteristics associated with homicide mortality in Italy, focusing specifically on male and female differences.

Methods

Using a longitudinal design, the Italian 2011 General Census population was followed up to 2018. Deaths from homicide were retrieved by a record linkage with the Causes of Death Register. Age-standardized mortality rates, stratified by sex, citizenship, education, and geographic area of residence were calculated. The association between sociodemographic characteristics and homicide mortality was evaluated using quasi-Poisson regression models.

Results

Between 2012 and 2018, 1,940 homicides were recorded in Italy: 53% were females over age 55, 10% were immigrant females, 34% were males aged 40–54 years, 76% had a medium-low education level, and 57% lived in the South and Islands. Foreign citizenship increased a female's risk of dying from homicide (adjusted rate ratio (RRadj): 1.85; 95% CI: 1.54–2.23), while no differences between Italian and immigrant males were found. An inverse association between education and mortality was observed for both sexes, stronger for males (RRadj: 3.68; 95% CI: 3.10–4.36, low vs. high) than for females (RRadj: 1.38; 95%CI: 1.17–1.62, low vs. high). Moreover, a male residing in the South or the Islands had almost 2.5 times the risk of dying from homicide than a resident in the North-West. Finally, old age (over 75) increased a female's risk of being murdered, whereas the highest risk for males was observed for those aged 25–54 years.

Conclusions

Male and female differences in homicide mortality profiles by age were expected, but the results by residence, citizenship, and education highlight that living in disadvantaged socioeconomic contexts increases the risk of dying from homicide, suggesting the need to implement specific prevention and intervention strategies.

Nationwide longitudinal population-based study on mortality in Italy by immigrant status

A systematic analysis of the mortality of immigrant residents throughout Italy has never been carried out. The present study aimed to evaluate differences in mortality by immigrant status. A longitudinal study of the Italian resident population (native and immigrants) recorded in the 2011 National Institute of Statistics Census was conducted. This cohort was followed up from 2012 to 2018 until death, emigration, or end of the study period. The exposure variable was the immigrant status, measured through citizenship, dichotomized into Italian and immigrant. The main outcome was overall and cause-specific mortality. Age-standardized mortality ratios (SMRs) were calculated. The SMRs among immigrants were half that of Italians, both for men (SMR 0.52) and women (SMR 0.51), with the lowest SMRs observed for subjects from North Africa and Oceania. For some causes of death, mortality was higher among immigrants: tuberculosis in both men (SMR 4.58) and women (SMR 4.72), and cervical cancer (SMR 1.58), complications of pregnancy, childbirth, and puerperium (SMR 1.36), and homicide (SMR 2.13) for women. A multivariable quasi-Poisson regression analysis, adjusted for age and macro area of residence in Italy, confirmed a lower all-cause mortality for immigrants compared to Italians, both for men (RR 0.46) and women (RR 0.44). Although immigration to Italy is no longer a recent phenomenon, and the presence of immigrants is acquiring structural characteristics, our study confirms their health advantage, with a lower mortality than that of Italians for almost all causes of death and for all areas of origin.

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

INTRODUCTION

The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care.

METHODS

Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016-2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents.

RESULTS

Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4).

CONCLUSIONS

In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.

Education inequalities in cardiovascular and coronary heart disease in Italy and the role of behavioral and biological risk factors

BACKGROUND AND AIMS

Behavioral and biological risk factors (BBRF) explain part of the variability in socioeconomic differences in health. The present study aimed at evaluating education differences in incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) in Italy and the role of BBRF.

METHODS AND RESULTS

All subjects aged 30-74 years (n = 132,686) who participated to the National Health Interview Surveys 2000 and 2005 were included and followed-up for ten years. Exposure to smoking, physical activity, overweight/obesity, diabetes and hypertension at baseline was considered. Education level was used as an indicator of socioeconomic status. The outcomes were incident cases of CVD and CHD. Hazard ratios by education level were estimated, adjusting for sociodemographic covariates and stratifying by sex and geographic area. The contribution of BBRF to education inequalities was estimated by counterfactual mediation analysis, in addition to the assessment of the risk attenuation by comparing the models including BBRF or not. 22,214 participants had a CVD event and 6173 a CHD event. After controlling for sociodemographic factors, the least educated men showed a 21% higher risk of CVD and a 17% higher risk of CHD compared to the most educated (41% and 61% among women). The mediating effect (natural indirect effect) of BBRF between extreme education levels was 52% for CVD and 84% for CHD among men (16% among women for CVD).

CONCLUSIONS

More effective strategies aiming at reducing socioeconomic disparities in CVD and CHD are needed, through programs targeting less educated people in combination with community-wide initiatives.

The phosphoinositide-3-kinase (PI3K)-delta inhibitor seletalisib impairs monocyte-derived dendritic cells maturation, APC function, and promotes their migration to CCR7 and CXCR4 ligands

PI3K pathway plays a crucial role in dendritic cells (DCs) functions, as it regulates different cellular processes, such as maturation and cytokines production. However, the specific role of PI3K p110δ isoform in human DCs has not been thoroughly addressed. In this study, we analyze the effects of seletalisib, a potent and specific inhibitor of PI3K p110δ, on phenotype and antigen-presenting functions of monocyte-derived DCs undergone maturation via LPS. Seletalisib treatment reduced membrane HLA-DR as well as CD83 and CD40 costimulatory molecules, whereas CD80 and CD86 expression was only partially affected. Additionally, DCs cultures showed reduced TNF-α, IL-10, and IL-12 and increased IL-23 secretion levels. This resulted in a reduced capacity of DCs to prime allogeneic T cells, with a strong decrease of Th1 differentiation. On the other hand, PI3K p110δ inhibitor seletalisib increased CXCR4 and CCR7 expression and augmented the DCs migration toward CCL19 and CXCL12 ligands. At molecular level, inhibition of PI3K p110δ isoform by seletalisib significantly down-regulated the phosphorylation of AKT and other downstream signaling molecules, such as ribosomal protein S6, 4E-BP1, and NF-κB p65. In contrast, seletalisib did not affect p38 MAP kinase phosphorylation or TLR-associated adapter molecule TIRAP in DCs. Our results indicate that PI3K p110δ can serve as an important regulatory signal for DCs, and selective inhibition of PI3K p110δ isoform by seletalisib could be used for the prevention of exaggerated and harmful immune responses occurring in pathologic conditions, such as autoimmune disorders.

Psychopathological effects of the Coronavirus (Sars-CoV-2) imposed lockdown on vulnerable patients in treatment in a mental health outpatient department for migrants and individuals in poor socioeconomic conditions

BACKGROUND

The effects of Sars-Cov-2 pandemic may increase vulnerability of migrants.

AIMS

To investigate the effects of the governmental lockdown on the mental health of vulnerable migrants in treatment at an outpatient department.

METHOD

In a telephone survey post-migration living difficulties and psychopathological symptoms were investigated, particularly post-traumatic thoughts and nightmares, anxiety, depression, feelings of tension and irritability, other sleep problems, as well as COVID-19 related fears. Psychopathological changes during the lockdown were detected and rated by clinicians. Rates of treatment discontinuation and reasons why were also recorded.

RESULTS

Of 103 eligible patients, 81 answered the phone call and were included in the study. Mental symptoms were frequent but not as severe as expected. About 32% of patients in psychopharmacological treatment and almost 52% of patients in psychotherapy had discontinued treatment. Patients who were globally considered to have worsened if compared to their pre-coronavirus mental health conditions had in fact higher scores on several mental symptoms but mild specific fears about coronavirus issues, similar to those of patients improved or stable. Worsening was significantly associated with unemployment, lack of VISA, and treatment discontinuation. Shifting the way of providing psychotherapy into a web-based modality was significantly more frequent in stable/improved patients.

CONCLUSION

Findings suggest that concrete life problems and treatment discontinuation more than the coronavirus fear, have predominantly affected the mental health conditions of our patients.

Support Asylum and Vulnerabilities through e-health: SAVe as a healthcare continuity tool

Issue

Migrants and refugees (M&Rs) could present different vulnerabilities and health conditions. The high geographical and setting mobility of migrants within the reception system as well as the legal and administrative variability can impact negatively the continuity of care of eventual vulnerabilities and diseases.

Description of the practice

The Italian National Institute for Health Migration and Poverty developed an IC platform to take care of migrant's health over its migration pathway in the hosting country. SAVe guarantees both the health assessment at the border and the following steps of clinical care. It offers specialized tools guiding health professionals to evaluate M&Rs' vulnerabilities as well as infectious and chronic diseases. The electronic system is compliant with the EU-GDPR and includes validated tools such as the WHO (Five) WBI, the EASO tool for special needs identification, the Italian guidelines on Border health checks and the Italian protocol for the unaccompanied minors' age assessment.

Results

The system is being implemented in 4 Italian Regions, where over 28,000 migrants are hosted in reception structures and is expected to be used in the whole Italian reception system. The migrant person is also given the opportunity to save, store and use his health records even in case of relocation to another country.

Lessons

SAVe is turning out as an innovative tool to evaluate vulnerabilities and health of M&Rs who are present in Italy. The use of validated and evidence-based tools improves the confidence of doctors in detecting vulnerabilities and social determinants of health. Its spread at National level is expected to guarantee the continuity of care. Further, the interoperation between SAVe and the National Health File would allow health data collection from the first arrival of migrant until its full integration in the country.

Key messages

SAVe is designed to evaluate comprehensively the health of M&Rs, increase the continuity of care and optimize the healthcare resources. Its socio-health and evidence based approach encourages the use as a benchmark for health data collection and health information sharing.

Managing the pandemic in the reception system for migrants: the Italian experience

Issue

Italy represents a well-known European transit and destination country for Migrants and Refugees (M&Rs) with more than 77.000 migrants currently hosted in the reception system. Pandemic did not impact the M&Rs' influx with more than 30.000 disembarked in 2020. In line with the WHO and international organizations alerts to protect the health of M&Rs, Italy included M&Rs in its pandemic response.

Description of the practice

With the mandate of the Ministry of Health and thanks to the collaboration with the Ministry of the Interior and other institutional and governmental bodies, the Italian National Institute for Health, Migration and Poverty developed a comprehensive strategy to protect M&Rs' health in Italy during the COVID-19 pandemic, either into the reception system and outside.

Results

Interim evidence - based operating procedures including instructions regarding the early detection and the management of potential suspected and confirmed COVID-19 cases, from the first arrival throughout the entire reception system path, have been published. A national survey on the incidence of COVID-19 cases in the reception system has been performed in 2020. Dedicated information flows on the incidence of COVID-19 cases at the arrival in Italy and in the reception system and a periodic monitoring of the implementation of the afore-mentioned operating procedures have been established in 2021. Data collected have shown a daily mean incidence ratio lower for migrants hosted in the reception system than for the general population, as well as the same regarding the new COVID-19 cases among newly arrived migrants.

Lessons

The strategy adopted was found to be effective in protecting M&Rs' health during the pandemic. In particular, the Italian reception system has globally shown a good performance in limiting the COVID-19 spread. Moreover, the influx of newly arrived migrants did not represent an additional epidemiological risk in terms of burden of infection.

Key messages

The production of evidence-based procedures and the establishment of effective information flows have proved to be effective in managing and monitoring the pandemic in regards to M&Rs. The Italian reception system has turned to play as a protective factor in limiting the COVID-19 spread and the systematic screening of newly arrived M&Rs did not shown an additional COVID-19 burden.

A systematic review of economic evaluations of neonatal and maternal healthcare in immigrant and ethnic minority women

BACKGROUND

less access to appropriate care during pregnancy for immigrant/ethnic minority women can lead to worse health outcomes and higher costs for health services.

OBJECTIVES

to conduct a systematic review of studies on the economic evaluation of maternal and child healthcare among immigrants and racial/ethnic minority groups in advanced economy countries.

METHODS

the main biomedical/economic bibliographic databases and institutional sources were searched. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

encouraging breastfeeding and reducing inappropriate hospital use/length of hospital stay proved potentially able to reduce costs. Most studies showed a cost reduction if immigrant and ethnic minority women were included both in national and targeted programmes, such as nutritional programmes or case management. Screening campaigns targeting immigrants and ethnic minority groups were more cost-effective than broader, universal or non-screening strategies. Screenings were cost-effective when extended to newborns/relatives of pregnant women (Chagas disease) and were cost-effective for unvaccinated women in low-vaccination rates regions (rubella), immigrant women reporting no/uncertain vaccination history (varicella), and first-generation immigrants (HCV).

DISCUSSION

promoting inclusion in pregnancy healthcare programmes or in targeted screening campaigns could be effective in cost saving for health services.

Self-perceived workplace discrimination and mental health among immigrant workers in Italy: a cross-sectional study

BACKGROUND

The process of immigration is associated with poor mental and physical health. While the workplace represents an important context of social integration, previous studies evaluating the effect of discrimination experienced in the workplace found worse mental health status among immigrants. The aim of this study was to investigate whether self-perceived workplace discrimination has any role in the mental health status of immigrants living and working in Italy, evaluating the contribution of other personal experiences, such as loneliness and life satisfaction.

METHODS

A cross-sectional study was conducted on a sample of 12,408 immigrants (aged 15-64) living and working in Italy. Data were derived from the first national survey on immigrants carried out by the Italian National Institute of Statistics (Istat). Mental health status was measured through the Mental Component Summary (MCS) of the SF-12 questionnaire. A linear multivariate linear regression was carried out to evaluate the association between mental health status, self-perceived workplace discrimination, and sociodemographic factors; path analysis was used to quantify the mediation effect of self-perceived loneliness, level of life satisfaction, and the Physical Component Summary (PCS).

RESULTS

Mental health status was inversely associated (p < 0.001) with self-perceived workplace discrimination (β:-1.737), self-perceived loneliness (β:-2.653), and physical health status (β:-0.089); it was directly associated with level of life satisfaction (β:1.122). As confirmed by the path analysis, the effect of self-perceived workplace discrimination on MCS was mediated by the other factors considered: self-perceived loneliness (11.9%), level of life satisfaction (20.7%), and physical health status (3.9%).

CONCLUSIONS

Our study suggests that self-perceived workplace discrimination is associated with worse mental health status in immigrant workers through personal experiences in the workplace and explains the effect of the exposure to workplace discrimination on immigrants' psychological well-being. Our findings suggest that an overall public health response is needed to facilitate the social integration of immigrants and their access to health services, particularly those services that address mental health issues.

Sociodemographic Characteristics Associated with Harmful Use of Alcohol Among Economically and Socially Disadvantaged Immigrant Patients in Italy

In many contexts, individuals with lower socioeconomic status, especially immigrants, have a higher burden of negative alcohol-related consequences and a higher probability of receiving a psychiatric diagnosis. This study aimed at exploring sociodemographic and clinical characteristics associated with harmful use of alcohol (HUA) among immigrant patients. A cross-sectional study was conducted in Rome (Italy) on a sample of 330 immigrant patients admitted to the gastroenterology outpatient clinic of the INMP (March 2013–October 2014). HUA was evaluated through the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. The presence of psychiatric disorders was diagnosed through SCID I–II interviews. The association between sociodemographic characteristics and psychiatric disorders and HUA was evaluated through a multivariate log-binomial regression model. HUA was associated with unemployment, longer stay in Italy, mood disorder and not being married, especially among African immigrants. We provide original findings about a selected, hard-to-investigate population, suggesting priorities in interventions on HUA among specific vulnerable subgroups.

Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups

Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.

Anthropological study on Chagas Disease: Sociocultural construction of illness and embodiment of health barriers in Bolivian migrants in Rome, Italy

INTRODUCTION

Chagas Disease (CD) is endemic in many Latin-American countries, Bolivia in particular. It is now spreading in Italy as a host country for transcontinental migrants and becoming an emerging health problem. This anthropological action-research, as part of a wider medical project on Neglected Tropical Diseases, has the purpose of analyzing the sociocultural construction of CD and its representation in Bolivian people living in Rome as well as barriers, such as the stigma about the illness, to access the National Health Service for those potentially affected.

METHODS

The ethnographic study was carried out from 2016 to 2018 by a medical anthropologist at the National Institute for Health, Migration and Poverty (INMP) on 72 Bolivian migrants (47 women and 25 men) living in Rome. The study was carried out through: a territorial mapping of Bolivian networks and communities aimed at recruiting people, participant observation, and application of semi-structured and unstructured interviews. The interviews were hold in Spanish and proposed to all participants before or during medical examination, or during events organized by the Bolivian community in Rome. The interview consisted of 16 items and covered four macro areas: personal and migration history, health status, access to the Italian National Health Service and knowledge about CD; plus 5 items for those who received a diagnosis of Chagas Disease in Italy.

RESULTS

The sociocultural construction and the deep stigma about the illness built by participants and their families could hinder both diagnosis and treatment. Institutional barriers also contributed to reduce adherence to screening tests: often, opening hours of the outpatient clinic were incompatible with participants' precarious employments. To guarantee participant's access to public health services and their adherence to the diagnostic protocol, we implemented a profound revision of our cultural and institutional approach to them.

CONCLUSIONS

The analysis evidenced the limitations of the conventional approach applied by the Italian National Health Service to this migrant community, such as the absence of socio-cultural and linguistics competences that can help understanding patients' perception and representation of the illness. The multidisciplinary approach instead-with clinicians using the ethnographic results to adjust their work to the participants' needs-was a successful attempt to ensure therapeutic alliance.

Prevalence of latent tuberculosis infection, hepatitis B, hepatitis C, and syphilis among newly arrived unaccompanied minors living in reception centers in Rome

OBJECTIVE

This study aimed to address the prevalence of infectious diseases in a population of unaccompanied immigrant minors living in reception centres of Rome, Italy.

METHODS

The study was carried out from January 2013 to January 2019. All unaccompanied immigrant minors were screened for hepatitis B, hepatitis C, syphilis and latent tuberculosis infection.

RESULTS

A total of 879 unaccompanied immigrant minors, 858 males and 21 females, aged 13-18 years old were studied. Of these, 615 were from Africa, 179 from Asia and 84 from Eastern Europe. A low prevalence of HBsAg carriage (2.5%) was observed as was very low prevalence of hepatitis C (0.72%) and latent syphilis (0.4%); latent tuberculosis, defined as tuberculin skin test (TST)+ X-ray case, was diagnosed in 102 (12%) minors.

CONCLUSIONS

Similar to previous studies, these data demonstrate that migrant minors are generally healthy. However, given the relatively high prevalence of hepatitis B and latent tuberculosis, systematic screening for these diseases among immigrant minors immigrants is highly recommended for early detection and treatment of potentially transmissible diseases.

Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties

Objectives

Lockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19–related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties.

Study design

The design of this study is a retrospective cross-sectional study.

Methods

All patients who visited the mental health outpatient service in the months of February and March in the years 2017–2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year.

Results

The number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017–2019 to 17.53% in March 2020.

Conclusions

The lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.

•

Lockdown can have serious mental health effects on vulnerable groups.

•

These population subgroups also have greater difficulties in accessing health services and maintaining treatment adherence.

•

Access to mental health services and follow-up compliance dramatically dropped as a consequence of lockdown.

•

Vulnerable groups are at risk of unmet mental health needs, treatment discontinuation and possible relapse.

•

Proactive alternative strategies need to be developed to reach these vulnerable populations.

Resilience, trauma, and hopelessness: protective or triggering factor for the development of psychopathology among migrants?

BACKGROUND

Recently, many studies have investigated the role of migration on mental health. Nonetheless, only few focused on the consequences of childhood trauma, hopelessness, and resilience on migrants' psychopathology, including psychiatric disorders and symptoms.

METHOD

119 migrants were recruited between May 2017 and April 2018, among those applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy. Assessment included the following: Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), Connor-Davidson Resilience Scale (CD-RISC), Childhood Trauma Questionnaire (CTQ), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Hopelessness Scale (BHS), Beck's Suicide Intent Scale (SIS), Brief Aggression Questionnaire (BAQ), Deliberate Self-Harm Inventory (DSHI).

RESULTS

53.39% of migrants scored above the PCL-5 cut-off score (mean score was 39.45). SDS scores below the cutoff suggested the presence of depression in 42.37%, while According to SAS scores anxiety levels were low in 38.98% of migrants. During childhood, physical abuse and neglect were reported respectively by 56.78 and 69.49% of migrants.

CONCLUSION

We found that Post Traumatic Stress Disorders play the role of mediators for the relation between the childhood traumatic experiences and aggressiveness, anxious and depressive symptomatology, while hopelessness is a mediator between the childhood traumatic experiences and the development of depression in adulthood. Hopelessness seems to influence the strength of the relation between childhood traumatic experiences and the individual's current intensity of suicidal attitudes, plans, and behaviors. Further developments and future perspectives of the research project are to address key gaps in the field of resilience by means of a longitudinal evaluation study in migrants, including a native population control group, acceding to NIHMP.

Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

BACKGROUND

Higher levels of hospital admissions among people with lower socioeconomic level, including immigrants, have been observed in developed countries. In Europe, immigrants present a more frequent use of emergency services compared to the native population. The aim of our study was to evaluate the socioeconomic and citizenship differences in the hospitalisation of the adult population in Italy.

METHODS

The study was conducted using the database created by the record linkage between the National Health Interview Survey (2005) with the National Hospital Discharge Database (2005-2014). 79,341 individuals aged 18-64 years were included. The outcomes were acute hospital admissions, urgent admissions and length of stay (1-7 days, > = 8 days). Education level, occupational status, self-perceived economic resources and migratory status were considered as socioeconomic determinants. A multivariate proportional hazards model for recurrent events was used to estimate the risk of total hospital admissions. Logistic models were used to estimate the risk of urgent hospitalisation as well as of length of stay.

RESULTS

Low education level, the lack of employment and negative self-perceived economic resources were conditions associated with the risk of hospitalisation, a longer hospital stay and greater recourse to urgent hospitalisation. Foreigners had a lower risk of hospitalisation (HR = 0.75; 95% CI:0.68-0.83) but a higher risk of urgent hospitalisation (OR = 1.36; 95% CI:1.18-1.55) and more frequent hospitalisations with a length of stay of at least eight days (OR = 1.19; 95% CI:1.02-1.40).

CONCLUSIONS

To improve equity in access, effective primary, secondary and tertiary prevention strategies must be strengthened, as should access to appropriate levels of care.

Influence of post-migration living difficulties on post-traumatic symptoms in Chinese asylum seekers resettled in Italy

BACKGROUND

Little is known about mental health and resettlement difficulties of Chinese asylum seekers fleeing China due to religious persecutions.

AIM

This study explores main post-migration living difficulties (PMLD) in this population, with a focus on their role in post-traumatic stress disorder (PTSD).

METHODS

A total of 67 patients (95.52% women, mean age 34.75 ± 7.63) were included in the study. The Harvard Trauma Questionnaire (HTQ) was used to assess PTSD, the List of Migration Experiences (LiMEs) was used for pre-migration and post-migration experiences (potentially traumatic events as well as living difficulties). The t-test was used to examine the differences in pre-migration and post-migration mean scores. Logistic regression was used to test the effect of pre-migration traumatic experiences (PMTE) and most frequent PMLD on having a PTSD.

RESULTS

A total of 49 patients scored above the HTQ cut-off score for PTSD. As expected, traumatic experiences were concentrated in the pre-migration phase, while living difficulties were present in both phases but more frequently in the post-migration period. PMTE were significantly related to PTSD (OR 1.29, p = .01). However, three PMLD ('Feeling that you do not know where you will lend up tomorrow', 'Loneliness and boredom' and 'Not being able to find work') showed a significant interaction with PMTE, suggesting that their presence in the post-migration phase has a modulation effect by increasing the likelihood of PTSD.

CONCLUSION

This study extends to Chinese asylum seekers the previous evidence that PMLD have a significant role in the likelihood to have a PTSD after landing in the host country.

The geography and economics of forgoing medical examinations or therapeutic treatments in Italy during the economic crisis

Background

In Italy, the number of individuals who have forgone medical examinations or treatments for economic reasons is one of the highest in Europe. During the global economic crisis of 2008, the restrictive policies concerning access to healthcare and the quality of these services, which differs widely throughout the country, may have accentuated the territorial differences in unmet needs, thereby penalizing the more disadvantaged segments of the population.

The study aimed at evaluating the geographical and socioeconomic differences, in particular the risk of poverty, that influence forgoing healthcare services in Italy.

Methods

Cross-sectional Italian data from the 2004–2015 European Survey on Income and Living Conditions (EU-SILC) were used.

Hierarchical logistic models were tested, using as the outcome unmet needs for medical examinations or treatment in the preceding 12 months, and as risk factor the condition of being at risk of poverty. Age, sex, citizenship, educational level, presence of chronic or severely limiting diseases and self-perceived health were used as adjustment factors. Analyses were stratified over three time periods: pre-crisis (2004–2007), initial phase of the crisis (2008–2012) and second phase of the crisis (2013–2015).

Results

In Central Italy and particularly in Southern Italy, a marked increase (9.9% in 2013–2015) was seen in the overall rate of unmet needs as well as in that of unmet needs due to economic reasons. The probability of unmet needs was higher, and increased over time, for those at risk of poverty (aOR = 1.54 in 2004–07, aOR = 1.70 in 2008–12, aOR = 2.21 in 2013–15). Individuals with a low educational level, who had a chronic or severely limiting disease, who perceived their health as not good and immigrants had a higher risk of forgoing healthcare. The regions in Southern Italy had a significantly higher probability of unmet needs.

Conclusions

A strong association was found between the probability of forgoing medical examination or treatment and being at risk of poverty. Study results underline the need for healthcare policies aimed at facilitating access to healthcare services, particularly in the South, by developing a progressive mechanism of contribution to healthcare costs proportional to income and by guaranteeing free access to the poor.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7502-x) contains supplementary material, which is available to authorized users.

Infectious and dermatological diseases among arriving migrants on the Italian coasts

Background

Since 2008 Italy has been the destination of the 'central Mediterranean route', used by migrants to reach Europe. The aim of this study is to describe demographic characteristics and health problems of migrants at the time of arrival on the Italian coasts, focussing on dermatological and infectious diseases.

Methods

Cross-sectional study of data routinely collected (n = 6, 188) by the National Institute for Health Migration and Poverty (INMP) in the centres for migrants of Lampedusa and Trapani-Milo (2015-16). Logistic models were performed to identify factors associated with scabies, varicella and the occurrence of two or more not related diagnosis.

Results

The average age was 21.6 years; 83.5% of the patients were males. The most frequent countries of origin were Eritrea, Nigeria, and Somalia. The most frequent diagnosis was scabies (58% of patients), skin infections, pediculosis and dermatitis; respiratory infections and varicella were the most represented infectious diseases. The diagnosis of scabies was more probable among Somalis (OR: 11.60) and Eritreans (OR: 10.05); the diagnosis of varicella was more probable among Ghanaians (OR: 13.58) and Nigerians (OR: 9.79). Somalis (OR: 4.10) and Eritreans (OR: 3.32) were the patients more likely to receive two or more diagnosis.

Conclusions

The majority of the diseases affecting migrants is in most cases, related to the migration experience and is likely not to represent a major threat for public health. Up-to-date information regarding the burden of diseases is needed in order to identify the health needs of incoming migrants and to arrange the appropriate response in terms of health services provision.

Geographical and socioeconomic differences in uptake of Pap test and mammography in Italy: results from the National Health Interview Survey

OBJECTIVE

The Italian National Health Service instituted cervical and breast cancer screening programmes in 1999; the local health authorities have a mandate to implement these screening programmes by inviting all women aged 25-64 years for a Pap test every 3 years (or for an Human Papilloma Virus (HPV) test every 5 years) and women aged 50-69 years for a mammography every 2 years. However, the implementation of screening programmes throughout the country is still incomplete. This study aims to: (1) describe cervical and breast cancer screening uptake and (2) evaluate geographical and individual socioeconomic difference in screening uptake.

METHODS

Data both from the Italian National Health Interview Survey (NHIS) conducted by the National Institute of Statistics in 2012-2013 and from the Italian National Centre for Screening Monitoring (INCSM) were used. The NHIS interviewed a national representative random sample of 32 831 women aged 25-64 years and of 16 459 women aged 50-69 years. Logistic multilevel models were used to estimate the effect of socioeconomic variables and behavioural factors (level 1) on screening uptake. Data on screening invitation coverage at the regional level, taken from INCSM, were used as ecological (level 2) covariates.

RESULTS

Total 3-year Pap test and 2-year mammography uptake were 62.1% and 56.4%, respectively; screening programmes accounted for 1/3 and 1/2 of total test uptake, respectively. Strong geographical differences were observed. Uptake was associated with high educational levels, healthy behaviours, being a former smoker and being Italian versus foreign national. Differences in uptake between Italian regions were mostly explained by the invitation coverage to screening programmes.

CONCLUSIONS

The uptake of both screening programmes in Italy is still under acceptable levels. Screening programme implementation has the potential to reduce the health inequalities gap between regions but only if uptake increases.

[Differences in mortality by educational level in Italy (2012-2014)]

OBJECTIVES

to evaluate socioeconomic inequalities in mortality by educational level in Italy.

DESIGN

cohort study based on the record linkage between the 2012-2014 archives of mortality and the 2011 Italian population Census.

SETTING AND PARTICIPANTS

Italian population registered in the 2011 Census.

MAIN OUTCOME MEASURES

life expectancy by educational level, age-standardized mortality rates, mortality rate ratios (MRRs) for overall mortality, and 12 groups of causes of death.

RESULTS

life expectancy at birth was 80.3 years among men and 84.9 among women. High-educated men were expected to live 3 years longer than lower educated men, while the gap was narrower in women (1.5 years). Lower educated men had a higher mortality from any cause (MRR: 1.34; 95%CI 1.33-1.35) with larger differentials for lung, upper aerodigestive, and liver cancers, respiratory system diseases, AIDS and accidents. Socioeconomic inequalities were larger in the North-West of the Country for lung and liver cancer. Educational inequalities were smaller among women for all-cause mortality, but remarkably larger for circulatory system diseases (MRR: 1.40; 95%CI 1.38-1.42), particularly in the South (MRR: 1.46; 95%CI 1.42-1.50).

CONCLUSIONS

this study documented socioeconomic inequalities in mortality in Italy for many causes of death; some of them resulted heterogeneous by area of residence. Most of the inequalities can be counteracted with specific measures aimed to improve behavioural risk factors among less educated people.

[Perceived discrimination at work for being an immigrant: a study on self-perceived mental health status among immigrants in Italy]

BACKGROUND

exposure to discrimination is widely understood as a social determinant of psychophysical health and a contributing factor to health inequities among social groups. Few studies exist, particularly in Italy, about the effects of discrimination among immigrants at workplace.

OBJECTIVES

to analyse the association between perceived discrimination at work for being an immigrant and mental health status among immigrants in Italy.

SETTING AND PARTICIPANTS

a sub-sample of 12,408 immigrants residing in Italy was analysed.

MAIN OUTCOME MEASURES

data came from the survey "Social conditions and integration of foreign citizens in Italy", carried out in 2011-2012 by the Italian National Institute of Statistics (Istat). Self-perceived mental health status was measured through mental component summary (MCS) of SF-12 questionnaire, assuming as worse health status MCS score distribution ≤1st quartile. In order to evaluate the probability of poor health status, a multivariate log-binomial model was performed assuming: discrimination at work for being an immigrant as determinant variable; age, gender, educational level, employment status, area of origin, residence in Italy, length of stay in Italy, self-perceived loneliness and satisfaction about life as potential confounding variables.

RESULTS

among immigrants, 15.8% referred discrimination at his/her workplace in Italy for being an immigrant. Higher probability of poor mental health status was observed for immigrants who referred discrimination at workplace (Prevalence Rate Ratio - PRR: 1.16) who arrived in Italy since at least 5 years (PRR: 1.14), for not employed subjects (PRR: 1.31), and for people from the Americas (PRR: 1.14). Lower probability of poor mental health status was found in immigrants from Western- Central Asia (PRR: 0.83) and Eastern-Pacific Asia (PRR: 0.79). Compared to immigrants residing in North-Eastern Italy, higher probability of worse mental health status was observed in people who resided in Northern-Western (PRR: 1.30), Central (PRR: 1.26), and Southern (PRR: 1.15) Italian regions.

CONCLUSIONS

our findings confirm that discrimination at workplace for being an immigrant is a risk factor for self-perceived mental health among immigrants in Italy, suggesting that an overall public health response is essential in addition to work-based interventions. Improving working conditions, promoting organisational strategies to support coping behaviours, and challenging discrimination can improve mental health status of immigrants.

[Factors associated to medical visits: comparison among Italians and immigrants resident in Italy]

OBJECTIVES

to evaluate the role of factors potentially associated with the use of medical visits by the immigrant population living in Italy, making a comparison with the Italian population.

DESIGN

cross-sectional study based on the representative sample of the population residing in Italy considered in the Survey "Health and use of health services" conducted by the Italian National Institute of Statistics (Istat) in 2013.

SETTING AND PARTICIPANTS

the study was conducted on a sample of citizens aged 18-64 years (72,476 individuals) representing a population of 37,290,440 residents in Italy (33.9 million Italians and 3,390,440 foreigners) in 2013.

MAIN OUTCOME MEASURES

an indicator on the use of medical visits has been used as an outcome, based on people who had replied affirmatively to the question: «In the last four weeks, have you been examined by the family doctor, by the pediatrician, or by medical specialists, as an eye doctor, dentist, etc.?». Starting from this outcome, the question «Can you indicate the main reason of the visits made in the last 4 weeks?» was used to build two additional outcome variables for separately evaluating the use of medical examinations for "diseases or disorders" from the use of medical examination for "health check in the absence of diseases or disorders". For each outcome, a logistic regression model was fitted, considering as independent variables information related to socioeconomic status and to the respondent's health condition.

RESULTS

21.4% of foreigners (18-64 years) living in Italy used medical visits during the four weeks before the interview, a percentage lower than the one recorded among Italian citizens (27.0%). Taking into account the socioeconomic characteristics, lifestyle and health status of respondents, the results of logistic regression models showed that foreigners have a lower probability than Italians to make a medical examination, both for visits motivated by any health problems (OR: 0.80; 95%CI 0.73-0.87), and in case of medical examination carried out for preventive purposes (OR: 0.72; 95%CI 0.64-0.82).

CONCLUSION

the more the time living in the host Country increases, the more immigrants residing in Italy tend to have the same health problems of the most disadvantaged groups of the autochthonous population, maybe beacuse of the deterioration of the so-called "healthy immigrant effect". In this context, they should be considered as more vulnerable in terms of health, and special attention must be paid to prevention. The lower use of medical visits highlights inequities in access to services. In order to reduce health inequalities, barriers that affect equitable access to health care should be removed, taking into account the heterogeneity of these sub-groups, characterized by different cultures and attitudes towards the health system.

Cohort profile: the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS), a multicentre cohort for socioeconomic inequalities in health monitoring

PURPOSE

The Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS) is a system of integrated data on health outcomes, demographic and socioeconomic information, and represents a powerful tool to study health inequalities.

PARTICIPANTS

IN-LiMeS is a multicentre and multipurpose pool of metropolitan population cohorts enrolled in nine Italian cities: Turin, Venice, Reggio Emilia, Modena, Bologna, Florence, Leghorn, Prato and Rome. Data come from record linkage of municipal population registries, the 2001 population census, mortality registers and hospital discharge archives. Depending on the source of enrolment, cohorts can be closed or open. The census-based closed cohort design includes subjects resident in any of the nine cities at the 2001 census day; 4 466 655 individuals were enrolled in 2001 in the nine closed cohorts. The open cohort design includes subjects resident in 2001 or subsequently registered by birth or immigration until the latest available follow-up (currently 31 December 2013). The open cohort design is available for Turin, Venice, Reggio Emilia, Modena, Bologna, Prato and Rome. Detailed socioeconomic data are available for subjects enrolled in the census-based cohorts; information on demographic characteristics, education and citizenship is available from population registries.

FINDINGS TO DATE

The first IN-LiMeS application was the study of differentials in mortality between immigrants and Italians. Either using a closed cohort design (nine cities) or an open one (Turin and Reggio Emilia), individuals from high migration pressure countries generally showed a lower mortality risk. However, a certain heterogeneity between the nine cities was noted, especially among men, and an excess mortality risk was reported for some macroareas of origin and specific causes of death.

FUTURE PLANS

We are currently working on the linkage of the 2011 population census data, the expansion of geographical coverage and the implementation of the open design in all the participating cohorts.

[Self-perceived health status among immigrants in Italy]

OBJECTIVES

to evaluate self-perceived health status of immigrants in Italy.

DESIGN

cross-sectional study based on the representative national samples of the multipurpose surveys "Health conditions and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat).

SETTING AND PARTICIPANTS

the study was conducted on the age group of 18-64: No. 80,661 in 2005, among which 3.2% were immigrants, and No. 72,476 in 2013, among which 7.1% were immigrants.

MAIN OUTCOME MEASURES

prevalence rate ratios (PRR) calculated through log-binomial regression models, stratified by survey edition and gender, by evaluating the association between the Physical Component Score (PCS), the Mental Component Score (MCS), and the overall health index and citizenship. Adjustment for the following confounding factors was performed: age, educational level, working condition, perceived economic resources, body mass index (BMI).

RESULTS

in 2005, immigrants had a lower probability of poor-perceived physical health, both among men (PRR: 0.79; 95%CI 0.70-0.89) and women (PRR: 0.89; 95%CI 0.82- 0.97), compared to Italians. In 2013, the perceived health advantage of immigrants was reduced for both genders (PRR males: 0.87; 95%CI 0.80-0.95; PRR females: 0.94; 95%CI 0.88-0.99). In the considered period, the prevalence of people with worse mental health conditions increases, with lower PRR among immigrants, compared to Italians. Higher probability of «NOT good» overall perceived health was also observed among immigrants residing in Italy for at least 10 years (PRR men: 1.24; PRR women: 1.15) and among immigrants men from America (PRR: 1.35).

CONCLUSIONS

from 2005 to 2013, immigrants seemed to maintain a better perception of health status than Italians. Nevertheless, study results show a decrease in self-perceived health, particularly mental health, in the considered period - apart from demographic, socioeconomic, and lifestyle factors - as well as a worse overall self-perceived health status among immigrants who stayed in Italy longer. Such results lead to suppose that the "healthy migrant effect" tends to disappear over time, maybe due to the world financial crisis. Unemployment increases and lower income also made the access to medical care more difficult, particularly among the most fragile population groups, including migrants. In this context, it is essential to promote health policies supporting equity of access to healthy lifestyles and effective health services, which are fundamental to reduce health inequalities.

Distribution of IL28B Polymorphism in a Cohort of Italians and Immigrants with HCV Infection: Association with Viraemia, Stage of Fibrosis and Response to Treatment

Aims of the study are to investigate, in a cohort of patients affected by HCV chronic hepatitis with genotypes 1 and 4, the prevalence of interleukin 28B (IL28B) genotypes, the possible association between IL28B polymorphism and severity of liver damage, the role of IL28B CC as a predictor of outcome. 365 patients with HCV infection were observed between 2013 and 2014. Demographic, virological, biochemical, and genetic characteristics of each patient were investigated. Liver fibrosis was assessed by transient elastometry. Mean age of the patients (72.9 % males, 27.1 % females) is 50 years. 91.5 % % of patients are Caucasian, 8.5 % African. In the patients with HCV1 and HCV4 a higher frequency of IL28B CT is observed with a prevalence of 52.1 and 61.8 % respectively. As regards ethnic group, African people have a prevalence of 35.5 % for CC, while Caucasians have a prevalence of 23.8 % for CC. In our cohort, IL28B polymorphism does not show significant differences among ethnic groups and in HCV1 and HCV4 genotypes. As described in literature, IL28B CC genotype is confirmed as predictor of sustained virological response in both Caucasians and Africans. A significant correlation between liver fibrosis and IL28B polymorphism emerges.

The variation in the health status of immigrants and Italians during the global crisis and the role of socioeconomic factors

BACKGROUND

The effects of the recent global economic and financial crisis especially affected the most vulnerable social groups. Objective of the study was to investigate variation of self-perceived health status in Italians and immigrants during the economic global crisis, focusing on demographic and socioeconomic factors.

METHODS

Through a cross-sectional design we analyzed the national sample of multipurpose surveys "Health conditions and use of health services" (2005 and 2013) conducted by the Italian National Institute of Statistics (ISTAT). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, derived from SF-12 questionnaire, were assumed as study outcome, dichotomizing variables distribution at 1^st quartile. Prevalence rate ratios (PRR) were estimated through log-binomial regression models, stratified by citizenship and gender, evaluating the association between PCS and MCS with surveys' year, adjusting for age, educational level, employment status, self-perceived economic resources, smoking habits, body mass index.

RESULTS

From 2005 to 2013 the proportion of people not employed or reporting scarce/insufficient economic resources increased, especially among men, in particular immigrants. Compared with 2005 we observed in 2013 among Italians a significant lower probability of worse PCS (PRR = 0.96 both for males and females), while no differences were observed among immigrants; a higher probability of worse MCS was observed, particularly among men (Italians: PRR = 1.26;95%CI:1.22-1.29; immigrants: PRR = 1.19;95%CI:1.03-1.38). Self-perceived scarce/insufficient economic resources were strongly and significantly associated with worse PCS and MCS for all subgroups. Lower educational level was strongly associated with worse PCS in Italians and slightly associated with worse MCS for all subgroups. Being not employed was associated with worse health status, especially mental health among men.

CONCLUSIONS

Our findings support the hypothesis that economic global crisis could have negatively affected health status, particularly mental health, of Italians and immigrants. Furthermore, results suggest socioeconomic inequalities increase, in economic resources availability dimension. In a context of public health resources' limitation due to financial crisis, policy decision makers and health service managers must face the challenge of equity in health.

Clinical Practice and Knowledge in Caring: Breastfeeding Ties and the Impact on the Health of Latin-American Minor Migrants

In the context of the project "Clinical and social evaluation of medical practices in the treatment of infectious diseases in pediatrics for children of vulnerable population" carried out in 2013 by a multidisciplinary team at the National Institute for Health, Migration and Poverty (NIHMP) in Rome, a study in medical anthropology on the incorporation of illnesses that mothers feel they transmit to their children through breastfeeding was conducted. The results of the anthropological study, that targeted 34 children and adolescents from the age of 3 to the age of 17, all immigrants from Latin America residing in Italy, show that some forms of suffering in minors are described by women as being connected to factors such as susto ("fright"), coraje, muina, enojo ("anger") and mal de ojo ("evil eye"), and are in relation to a specific cultural frame. It is clear that barriers that prevent the access to the healthcare system must be removed, barriers that are accentuated by linguistic and cultural incomprehension, through adequate multidisciplinary healthcare settings such as the one we are presenting, composed of a medical doctor, an anthropologist and a cultural mediator.

Effects of Repeated Screw Tightening on Implant Abutment Interfaces in Terms of Bacterial and Yeast Leakage in Vitro: One-Time Abutment Versus the Multiscrewing Technique

Screw loosening can damage the interfaces of implant components, resulting in susceptibility to contamination of the internal parts by microorganisms. The aim of this study was to investigate the impact of abutment screw retightening on the leakage of two different types of bacteria, Streptococcus sanguinis and Fusobacterium nucleatum, and of the yeast Candida albicans. Two types of implant-abutment systems with tube-in-tube interfaces were tested. Groups A and B each used a different type of system that consisted of 20 different pieces that were assembled according to the manufacturer's torque recommendations; four samples in each group were closed just one time, four samples three times, four samples five times, four samples seven times, and four samples nine times. The implants of groups A and B were contaminated with 0.1 μL of microbial solution just before being assembled for the last time to minimize the possibility of contamination. Results showed a direct correlation between the number of colony-forming units grown in the plates and the closing/opening cycles of the implant-abutment systems. Within the limitations of this study, the results indicate the possibility that repeated closing/opening cycles of the implant-abutment unit may influence bacterial/yeast leakage, most likely as a consequence of decreased precision of the coupling between the abutment and the internal part of the dental implant. These findings suggest that a one-time abutment technique may avoid microbiologic leakage in cases of implant-abutment systems with tube-in-tube interfaces.

Prospective study of hepatitis B virus reactivation in patients with hematological malignancies

BACKGROUND AND AIM

The best strategy for managing patients with resolved hepatitis B virus infection (HBsAg negative, anti-HBc antibodies positive with or without anti-HBs antibodies) and hematological malignancies under immunosuppressive therapies has not been defined. The aim of this study was to prospectively analyze the risk of hepatitis B virus reactivation in these patients.

MATERIAL AND METHODS

Twenty-three patients (20 positive for anti-HBs) were enrolled. Eleven patients underwent hematopoietic stem cell transplantation (autologous in 7 cases, allogeneic in 4 cases) while the remaining 12 were treated with immunosuppressive regimens (including rituximab in 9 cases).

RESULTS

During the study no patient presented acute hepatitis. However, three anti-HBc/anti-HBs positive patients who were treated with allogeneic hematopoietic stem cell transplantation demonstrated hepatitis B virus reactivation within 12 months from transplant. No one of the remaining patients showed hepatitis B virus reverse seroconversion.

CONCLUSIONS

Allogeneic hematopoietic stem cell transplantation is a high risk condition for late hepatitis B virus reactivation in patients with resolved infection. Reverse seroconversion seems to be a rare event in anti-HBc/anti-HBs positive patients submitted to autologous hematopoietic stem cell transplantation or systemic chemotherapy with or without rituximab.

Unusual case of B cell lymphoma after immunosuppressive treatment for psoriasis

Lymphomas may be induced by the systemic immunosuppressive therapies used to treat psoriasis, such as ciclosporin, methotrexate and tumour necrosis factor (TNF)-α blockers. The biologic agents currently used in psoriasis include alefacept, efalizumab, and the TNF-α antagonists etanercept, infliximab, and adalimumab. Infections and cancer are the main possible consequences of intended or unexpected immunosuppression. We report a 59-year-old man with a history of severe psoriasis vulgaris treated with traditional immunosuppressant drugs followed by anti-TNF-α therapy; the patient was firstly hospitalized for an acute cholestatic toxic hepatitis, which we supposed to be related to adalimumab. The first liver biopsy showed active disease with severe hepatocellular damage caused by heavy lymphocytes infiltrate in portal tracts at in the interface with a not conclusive diagnosis of lymphoproliferative disease. The correct diagnosis of T cell/histiocyte- rich large B cell lymphoma (T/HRBCL) was only reached through a gastric biopsy and a second liver biopsy. T/HRBCL is an uncommon morphologic variant of diffuse large B-cell lymphoma not described until now in psoriatic patients receiving immunosuppressive biologic agents. In psoriatic patients, treated with biologic immunosuppressive agents, the suspect of abdominal lymphoma should always be included as differential diagnosis. Abdominal ultrasound evaluation need therefore to be included in the pre-treatment screening as in the follow-up surveillance.

Prevalence of latent tuberculosis, syphilis, hepatitis B and C among asylum seekers in Malta

BACKGROUND

In the last few years, Malta has witnessed increasing immigration flows from the Libyan coasts. Public health policies are focused on screening migrants for tuberculosis, whereas no systematic actions against STIs are implemented. The aim of this study is to define the epidemiological profile of asylum seekers in Malta as regards syphilis, hepatitis B, C and latent tuberculosis, thus supporting screening policies.

METHODS

Five hundred migrants living in open centres were screened between December 2010 and June 2011.

RESULTS

83.2% of people was from Somalia, 81.2% males, average age 26.5 years. The tuberculin skin test (TST) was positive in 225 migrants (45%). Latent syphilis was diagnosed in 11 migrants, hepatitis C in 3 and 31 migrants were HBsAg positive.

CONCLUSION

Systematic screening for asymptomatic migrants in Malta is not recommended for hepatitis C and syphilis, given the low prevalence observed. On the contrary, it should be considered for hepatitis B. TST could be indicated as the first step of a two step screening for migrants from countries with high TB incidence. Efficacy and cost-effectiveness could be achieved by further targeting screening to specific subgroups at higher risk of reactivation, such as people living with HIV and subjects affected by chronic diseases.

Occurrence of Candida species colonization in a population of denture-wearing immigrants

Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. albicans is the most common pathogen; however, other emerging Candida species are also responsible for this condition. Few data are available about the occurrence of Candida species in the oral cavities of denture-wearing immigrants to Italy. In this study, we compare the Candida species found in the oral mucosa and on dentures from a population of denture wearing immigrants to Italy to a matched Italian group. Oral swabs were collected from dentures and the underlying mucosa of patients enrolled in the study and were then cultured to test for the presence of Candida species in each sample. Out of 168 patients enrolled (73 Italians and 95 immigrants), 51 Italians (69.8 percent) and 75 immigrants (78.9 percent) tested positive for the presence of Candida. Candida albicans was the most frequently observed species overall; however, we found a higher occurrence of C. glabrata among immigrants than among Italians. In addition, immigrants displayed a higher incidence of Candida – associated stomatitis and a lower mean age than Candida-positive individuals from the Italian group. Immigrants are more prone to longer colonization of the oral mucosa and dentures by Candida. In these patients, dentures must be checked periodically to prevent the presence of Candida.

Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009

Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.

An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report

Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.