Gianfranco Domenighetti

Psychoactive drug use among medical doctors is higher than in the general population

We surveyed a representative sample of practising physicians and a representative sample of subjects from the Swiss general population (SOMIPOPS Survey) concerning their annual use of sleeping pills and tranquillizers. 77% of the physicians (n = 466) and 72% of the general population (n = 4255) responded. After adjustment for age and sex 37.1% of the doctors (general population 21.1% P less than 0.001) claimed to have taken these drugs for therapeutic purposes. The proportion of psychiatrists who reported taking sleeping pills and tranquillizers daily (10.6%) were significantly greater than for the population of doctors as a whole and for the general population (P less than 0.05). Regular users (i.e. subjects taking one mood altering drug at least once a week) accounted for 11.1% of the medical population compared with 6.8% of the general population (P less than 0.01). This over-consumption was wholly due to the greater number of regular users of psychoactive drugs amongst doctors less than 50 years of age relative to the general population or to subjects in higher management (from P less than 0.05 to P less than 0.001). Without this specific over-use, members of the medical profession would not have been found to use more psychoactive drugs than the general population and the executives. This result suggests that it would be worth investigating the mechanisms of response and adjustment (coping) to the specific stress that appears to be inherent in the exercise of medical practice.

Temperature related mortality and ambulance service interventions during the heat waves of 2003 in Ticino (Switzerland).

Summary.ObjectivesThis study investigates a potential increase in mortality and in the demand for ambulance emergency services among the elderly in particular, in Ticino in the summer of 2003.MethodsMortality rates and emergency ambulance interventions rates were compared with records from the previous years. We considered the whole population, aged 65 and over, as well as 75 and over.ResultsThe 2003 mortality in the population was not signifi cantly different from the previous years. The number of deaths among the elderly showed a small but significant deviation from the expected values during the first heat wave in June 2003, with no significant impact on the seasonal results. The number of ambulance service interventions was larger than during the previous years.ConclusionThese results are consistent with findings in other studies. The heat waves (especially in June), were correlated with a higher number of ambulance callouts. In addition to some geographic, climatic, and social factors that had a protective impact, the response of the emergency services is likely to have contributed to a certain reduction in mortality.Zusammenfassung.Temperaturabhängige Sterblichkeit und Notfalleinsätze während der Hitzewellen im Jahr 2003 im Kanton Tessin (Schweiz)ZielDie Studie untersucht, ob im Kanton Tessin während der Sommermonate 2003 ein Anstieg der Sterblichkeit und der Anzahl Notfalleinsätze, besonders unter der älteren Bevölkerung, zu verzeichnen war.MethodenDie Sterblichkeitsraten und Notfalleinsätze wurden mit den Angaben des Vorjahres verglichen. Dabei wurde die Gesamtbevölkerung in Betracht gezogen sowie die Altersgruppe der über 65-Jährigen und der über 75-Jährigen.ErgebnisseDie Sterblichkeit im Jahr 2003 variierte nicht signi fikant gegenüber den Vorjahren. Bei der Gesamtbevölkerung wurde eine bedeutend höhere Sterblichkeit während der ersten Hitzewelle vom Juni 2003 beobachtet, ohne bedeutende Auswirkungen auf die Monats- und Saisonergebnisse. Die Anzahl der Notfalleinsätze war höher als in den Vorjahren.SchlussfolgerungDie vorliegenden Ergebnisse stimmen mit anderen Studien überein. Während der Hitzewellen (besonders derjenigen vom Juni) wurde ein Anstieg der Notfalleinsätze verzeichnet. Neben geographischen, meteorologischen und sozialen Aspekten, die eine schützende Wirkung hatten, war vermutlich auch der Einsatz der Notfalldienste für den Rückgang der Sterbefälle mit verantwortlich.Résumé.Mortalité liée à la température et interventions des services d’ambulances durant les vagues de chaleur de 2003 dans le canton du Tessin (Suisse)ObjectifsEnquêter sur une possible augmentation de la mortalité et de l’utilisation des services d’ambulances, en particulier pour les personnes âgées, durant l’été 2003 dans le canton du Tessin.MéthodesLes taux de mortalité et le nombre d’intervention des services d’ambulances ont été comparés avec les chiffres des années précédentes. L’étude a porté sur la population totale, sur les 65 ans et plus, ainsi que sur les 75 ans et plus.RésultatsLa mortalité de la population n’est pas significativement supérieure à celle des années précédentes. Les décès des personnes âgées mettent en évidence une déviation légère mais significative par rapport aux valeurs attendues durant la première vague de chaleur (juin 2003), mais sans impact sur les résultats saisonniers. Le nombre d’interventions des services d’ambulances a été supérieur à celui des années précédentes.ConclusionCes résultats corroborent les conclusions d’autres travaux. Les vagues de chaleur (surtout celle de juin), sont en lien avec un nombre plus élevé d’interventions des services d’ambulances. Outre certains facteurs géographiques, météorologiques et sociaux qui ont sans doute eu un effet protecteur, la réponse des systèmes d’interventions d’urgence a probablement aussi contribué à une certaine réduction de la mortalité.

The night-a dangerous time to be born?

Summary. An analysis of perinatal mortality by hour of birth among 10 059 births in Canton Ticino (Switzerland) during the years 1979–1982 showed that fewer births occurred at night than during the day. The variations in number of births by hour of birth were attributed to obstetric practices. The perinatal mortality rate for night‐time births was more than twice as high as that for the daytime births (+127%, P<0·001) and the rates for night‐time births exceeded those for daytime births for 13 of the 19 causes of death examined. A higher proportion of the low and very‐low–birthweight babies (<2500g and <1500g) were born at night between 19·00 and 06·59 hours.

Italy's "Doing more does not mean doing better" campaign

Italy’s campaign “Doing more does not mean doing better” (Fare di piu non significa fare meglio) was launched by Italy’s Slow Medicine (www.slowmedicine.it), a movement of doctors, other health professionals, patients, and citizens.1 It aims to promote measured, respectful, and equitable care. Nine lists have already been published,2 and many other societies …

Socio-economic factors associated with infant mortality in Italy: an ecological study

IntroductionOne issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM). The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy.MethodsAssociations between infant mortality rates in the 20 Italian regions (2006–2008) and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15–64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM.ResultsThe Gini index and the total unemployment rate showed a positive strong correlation with IM (r = 0.70; p < 0.001 and r = 0.84; p < 0.001 respectively), mean household income showed a strong negative correlation (r = −0.78; p < 0.001), while female educational attainment presented a weak negative correlation (r = −0.45; p < 0.05). Using a multiple stepwise linear regression model, only unemployment rate was independently associated with IM (b = 0.15, p < 0.001).ConclusionsIn Italy, a high-income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.

Amenable mortality as a performance indicator of Italian health-care services

BackgroundMortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases.MethodsAmenable mortality rate was calculated as the average annual number of deaths in the population aged 0–74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006–08.ResultsDuring the study period (2006–08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = −0.64, p = 0.002; female: r = −0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = −0.70, p <0.001; female: r = −0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer.ConclusionsAmenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.

Corps médical et campagne de prévention primaire des maladies cardio-vasculaires dans le canton du Tessin

This study presents the results of a questionnaire research into the subjective perception of the free-practicing doctors in Ticino concerning the primary prevention programme against cardiovascular risk factors, directed to the whole cantonal population by the Social Welfare Department. 93% of the doctors (82% of the population) are aware of the programme and 82% of those interviewed judged it to be useful or very useful. Furthermore, the single initiatives of the programme (TV-advertisements and information-Leaflets) were also evaluated, as well as the frequency of preventive practices during medical visits (information on tobacco risks, blood pressure measurement, treatment of hypercholesterolemia). This study was also analyzed on the basis of questionnaire received before (response rate 41%) and after having sent out a further reminder (final response rate 61%). The results and conclusions did not differ with an increase in the reply rate.

Are young practising Catholics less at risk of AIDS

The possible influence on morbidity and mortality of the active practice of a religion has been the subject of a number of studies 1,2 which focused upon whether attitudes toward the consumption of toxic substances (tobacco, alcohol, drugs) and sexual behaviour might be modified by religious attitude 3.4, 5 The use of injectable drugs, and promiscuous sexual activity, are known to be direct risk factors for AIDS, while the consumption of soft drugs, alcohol and tobacco are believed to favour risk behaviours since they cause loss of inhibition and thus neglect of certain precautions 6, 7,8 and are often precursors of habituation to stronger toxic substances 9, lo, 11, t2, including tobacco 9. In the course of a study investigating the state of health of adolescents in the canton of Tessin (the Italian-speaking part of Switzerland) 13 we endeavoured to assess whether there was a relationship between their religious practices and certain risk factors (the use of alcohol, tobacco and drugs and promiscuous sexual behaviour) for HIV infection. The study population consisted of a representative sample of 1423 students and apprentices from 13 to 20 years of age. In the spring of 1989 a questionnaire, to be filled in anonymously by the study participants themselves, was distributed through intermediaries in their schools. The response rate was 99%. The questions concerning religious practices and consumption of tobacco, alcohol and drugs were the same for all of the students, but the youngest (13-15 years) were not questioned about sexual behaviour. 999 questionnaires completed by Catholics only were used in the analysis of these variables in relation to religious practice. Boys were 55 % and girls 45 % of the study population. The distribution of practising and non-practising Catholics according to age is shown in table 1. A statistically significant reduction of practising Catholics as a function of increasing age (p < 0.001) can be observed. Table 2 shows attitudes toward alcohol, tobacco, drugs and sex in relation to religious practices in

Contatto con morte, malattia e scelta della carriera nelle professioni sanitarie non mediche e negli studenti di economia: un’analisi trasversale

Abstract . Contact with death or illness and career choice in non-medical health professions and business students: a cross-sectional analysis. PURPOSE: It is anecdotally reported that a personal severe illness or the death of a significant person might be key reasons for the choice of a career in the non-medical health professions. AIM: The aim of the questionnaire was to explore past relevant life events before starting professional studies (severe personal illness; severe illness or death of a significant person; drug addiction of a relative or friend) by comparing students of nursing or other non medical health professions with business students. METHODS: An anonymous questionnaire with standardized closed questions was distributed in 2010 to a group of bachelor students of non-medical health professions (nursing, physiotherapy, occupational therapy and rescue care) and to a control group of business students at the University of Applied Sciences and Arts of Southern Switzerland. RESULTS: Students of non-medical health professions had been, compared to business students, significantly more exposed to severe illnesses or the death of a relative (OR 3.070, CI95% 1.716-5.494), to personal severe illness (OR 3.950, CI95% 1.384-11.279) and to addiction of a relative or friend (OR 2.672, CI95% 1.316-5.422) before starting their professional studies. CONCLUSIONS: This cross-sectional analysis suggests that exposure to a severe illness or death may play an important role in the choice of career, probably by supporting intrinsic motivations. Further research should explore the role of those past life experience in professional behavior.

THE NIGHT - A DANGEROUS TIME TO BE BORN?

An analysis of perinatal mortality by hour of birth among 10,059 births in Canton Ticino (Switzerland) during the years 1979-1982 showed that fewer births occurred at night than during the day. The variations in number of births by hour of birth were attributed to obstetric practices. The perinatal mortality rate for night-time births was more than twice as high as that for the daytime births (+127%, P less than 0.001) and the rates for night-time births exceeded those for daytime births for 13 of the 19 causes of death examined. A higher proportion of the low and very-low-birthweight babies (less than 2500 g and less than 1500 g) were born at night between 19.00 and 06.59 hours.