Stefano Mazzuco

Childbearing and well-being: a comparative analysis of European welfare regimes

Fertility rates in contemporary Europe have reached dramatically low levels. In light of this we are interested in the extent to which childbearing events may worsen individuals’ material well-being. Using a sample of women drawn from the European Community Household Panel Survey, we make a comparison of the impact of childbearing on well-being using a welfare-regime classification. Recognizing that poverty status is a poor proxy for well-being, we also derive several measures of well-being that are multidimensional in nature. These measures are referred to as deprivation indices and avoid the poor/non-poor dichotomy. We provide descriptive statistics of poverty status and deprivations indices, as well as an analysis of a more causal nature, the latter consisting of a Difference-in-Differences estimator combined with Propensity Score Matching techniques (DD-PSM). We find that independently of how well-being is defined, childbearing events never have a positive impact on individuals’ material well-being. But our estimates are largely consistent with welfare-regime theory: women in the social-democratic welfare states suffer the least as a result of childbearing, whereas women in conservative and Mediterranean states suffer significantly more. For the liberal welfare regime the results are more mixed, and depend on the definition of well-being.

Body mass index, lifestyles, physical performance and cognitive decline: the "Treviso Longeva (TRELONG)" study.

ObjectivesThe relative contributions of risk factors, as body mass index (BMI), depression, chronic diseases, smoking, and lifestyles (as physical and performance activity, social contacts and reading habit) to cognitive decline in the elderly are unclear. We explored these variables in relation to 7-year cognitive decline in long-lived Italian elderly.DesignSecondary data analysis of a longitudinal study of a representative, age-stratified, population sample.SettingThe TREVISO LONGEVA (TRELONG) Study, in Treviso, Italy.Participants120 men and 189 women, age 77 years and older (mean age 80.2 ± 6.9 years) survivors after seven years of follow up.MeasurementsCognitive decline measured as difference between Mini-Mental State Examination (MMSE) score in 2003 and in 2010; Body mass index (BMI), handgrip, Short Physical Performance Battery (SPPB) score, social contacts, reading habit, sight, hearing, schooling, mediterranean diet and multiple clinical and survey data recorded at baseline in 2003.ResultsIn separate univariate analyses, age, SPPB score < 5, depressive symptoms (GDS) and more comorbidities (CCI) were associated with greater cognitive decline. Otherwise higher BMI, higher handgrip, reading habit, non-deteriorated sight and hearing, and schooling were protective. In a final multivariate model, age and higher BMI were associated with greater cognitive decline while reading habits was protective. SPPB score < 5 tends, though weakly, to be associated with greater cognitive decline. These associations remained with multivariate adjustment for gender, schooling, Charlson co-morbidity index (CCI) and baseline MMSE.ConclusionAge and higher baseline BMI, independent of gender, and other confounding factors, are risk factors for cognitive decline. Reading habit plays a protective role seven years later among northern Italian adults aged 70 years or older. Low physical performance tends, though weakly, to be associated with greater cognitive decline.

Association between the Mediterranean-style Dietary Pattern Score and Physical Performance: Results from TRELONG Study.

ObjectivesTo determine the association between Mediterranean-Style Dietary Pattern Score and physical performance.DesignData analysis of a longitudinal study of a representative, age stratified, population sample.SettingThe TREVISO LONGEVA (TRELONG) Study, in Treviso, Italy.ParticipantsIn 2010, 123 men and 181 women, age 77 years and over (mean age 86.3 ± 6.8 years).MeasurementsPerforming a logistic regression in a multivariate analysis, hand grip strength and Short Physical Performance Battery (SPPB) were tested in relation to Mediterranean-Style Dietary Pattern Score (MSDPS).ResultsThe hand grip mean value was 10.9 kg (± 9.5) and the SPPB score was 6.3 (± 3.8). The MSDPS mean value in this study sample was 38.1/100 (± 8.1). A significant association (p=0.036) between a high adherence to the Mediterranean diet (fourth quartile) and higher performance lower limbs (SPPB>7) was found. No correlation was reported for the hand grip strength.ConclusionWe found an association statistically significant between a high adherence to the Mediterranean diet and higher physical performance.

Albumin excretion in acute myocardial infarction: A guide for long-term prognosis

BACKGROUND Albumin excretion rate has been found to be associated with increased risk of mortality in several clinical settings. We assessed the relationship between urinary albumin and 7-year mortality in a cohort of patients with acute myocardial infarction (AMI). METHODS In this prospective study, we examined 505 white patients admitted with AMI to the intensive care unit of 3 hospitals. Main end points were nonearly all-cause and cardiovascular (CV) mortality. Albumin-to-creatinine ratio (ACR) was measured by radioimmunoassay on the first, third, and seventh days after admission. Risk estimates were made using Cox proportional-hazard model and relative odds. Forty patients (7.9%) died early inhospital, and 175 (34.7%) died during the rest of the follow-up (nonearly mortality). RESULTS The ACR measured on the third day predicted the occurrence of 7-year nonearly all-cause and CV mortality. Hazard ratios for ACR > or =0.97 mg/mmol were 3.0 (95% confidence limit 2.2-4.1), P < .0001, for nonearly all-cause mortality and 3.5 (95% confidence limit 2.5-5.0), P < .0001, for CV mortality. Correspondent fully adjusted hazard ratios were 1.9 (95% CI 1.4-2.6), P < .0001, and 2.2 (95% CI 1.5-3.2), P < .0001, respectively. By adding ACR to the 18-variable predictive model, ACR improved significantly both the goodness of fitting of the model for nonearly all-cause (P < .0001) and CV mortality (P < .0001) and the C-statistic value (P < .0001 and P = .002 for nonearly all-cause and CV mortality, respectively). Similar results were obtained for ACR measured on the first day or the seventh day. CONCLUSIONS An early increase of urinary albumin in AMI is a strong independent predictor of long-term adverse clinical outcome. The ACR improved clinical prediction over and above baseline traditional multivariable risk models.

An empirical investigation into the effect of childbearing on economic wellbeing in Europe

This paper investigates the extent childbearing among couples in Europe affects their level of economic well being. We do so by implementing a propensity score matching procedure in combination with a difference-in-difference estimator. Using data from European Community Household Panel Survey (ECHP), we compare how the impact of childbearing on wellbeing varies among countries. We use several measures for wellbeing, including poverty status and various deprivation indices that take into account the multidimensionality of individuals‘ assessment of wellbeing. Not unexpected we find childbearing tend to worsen the economic wellbeing of households, but with important differences in magnitude across countries. In Scandinavian countries the effect is small and rarely significant, it is strong in the UK and also significant in Mediterranean countries. Depending on the measure of wellbeing, we find important differences among countries that are similar in terms of welfare provision.

Health inequalities in Europe: new insights from European Labour Force Surveys

Background Socio-economic inequalities in health have become a major public health concern in Europe. The measurement of health inequalities over time and across countries does, however, remain a challenge. Previous European evidence found that health inequalities have been increasing in most countries, with greatly varying degrees. Methods The authors use the European Labour Force Survey (ELFS), with its unprecedented coverage of years and countries, as a potential complementary source for the measurement of health inequality. The ELFS provides information on sickness absence or reduced labour supply attributable to ill health. After constructing four separate and one overall health indicator, the authors compute health inequality indices for all countries and years, and analyse their trends. The authors also examine the sensitivity of the health inequality measures to different proxies of socio-economic status and. Results Health inequalities in the working age population have been increasing for several countries, but also decreasing in about as many countries, while they remained stable in a minority of countries. These results are not too sensitive to the various proxies for socio-economic status we employ, but they are sensitive to the specific health indicator from which the inequality index is derived. Conclusions While not without its problems, the ELFS may offer a useful additional and hitherto unexploited resource for the measurement of socio-economic inequalities in health across European countries and over time. Future research should try to understand how and why health inequality trends differ between different surveys as much as they appear to do in light of the present findings.

Insulin-like growth factor 1 receptor polymorphism rs2229765 and circulating interleukin-6 level affect male longevity in a population-based prospective study (Treviso Longeva--TRELONG).

Insulin-like growth factor 1 (IGF-1) signaling modulation has been associated with increased lifespan in model organisms, while high levels of circulating interleukin-6 (IL-6) are a marker of disability and mortality. In the prospective, population-based “Treviso Longeva”− TRELONG Study from Italy (n = 668, age range 70–105.5 years at baseline, followed for seven years) we investigated the effects of survival on the IGF-1 receptor (IGF-1R) gene polymorphism rs2229765, the IL-6 gene promoter polymorphism rs1800795, and plasma concentrations of IGF-1 and IL-6, alone or in combination. We found a sex-dependent effect for the IGF-1R rs2229765 polymorphism, as male carriers of the homozygous A/A genotype survived longer, while the IL-6 rs1800795 genotype did not influence overall or sex-specific longevity. Higher IL-6 levels were more detrimental for survival among males than females, while IGF-1 had no dose–response effect. These findings sustain the hypothesis that sex-specific longevity relies on detectable differences in genetic and biochemical parameters between males and females.

The treviso dementia (TREDEM) study

P3-244 THE TREVISO DEMENTIA (TREDEM) STUDY Maurizio Gallucci, Stefano Mazzuco, Andrea Zanardo, Gianluigi Forloni, Diego Albani, Deborah Gustafson, Francesco Di Paola, Matteo Bendini, Stefano Curtolo, Paolo Boldrini, Piero Antuono, General Treviso Hospital Cognitive Impairment Center, Treviso, Italy; University of Padova, Padova, Italy; General Hospital Treviso, Treviso, Italy; Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; SUNY-Downstate Medical Center, Brooklyn New York, New York, United States; 6 The Medical College of Wisconsin, Milwaukee, Wisconsin, United States.

Melatonin and the Charlson Comorbidity Index (CCI): The Treviso Longeva (Trelong) Study:

Introduction It has been reported that elderly subjects have a compromised ability to produce melatonin nightly, and that reduced melatonin levels may be a risk factor for cancer. The purpose of this study was to evaluate the relationship between melatonin levels and chronic diseases in a cohort of elderly subjects using the Charlson comorbidity index (CCI). Design We performed a secondary data analysis of a longitudinal study of a representative, age-stratified, sample population. Setting The Treviso Longeva (Trelong) study, in Treviso, Italy. Participants A total of 114 men and 146 women, aged 77 years and older, still alive after 7 years of follow-up. Measurements As an estimation of serum melatonin secretion levels, urinary 6-sulfatoxymelatonin (aMT6s) was assayed in the urine of 260 elderly subjects using an enzyme-linked immunosorbent assay (ELISA) kit (product 01-EK-M6S, ALPCO Immunoassays, Windham, NH). All aMT6s levels were creatinine standardized ([aMT6s]/[creatinine]), and the CCI was calculated. Results The melatonin levels decreased with aging despite not reaching statistical significance, and the decrease was more evident in males than in females (40.5 ng vs 47.0 ng aMT6s/mg creatinine, ns). Melatonin levels were significantly lower in patients reporting insomnia (p=0.05). The CCI score was inversely correlated with the levels of melatonin (p=0.03). Melatonin levels of subjects affected by CCI pathologies were significantly lower than those of healthy subjects (p=0.03) and of subjects suffering from diseases not included in the CCI and, therefore, less severe (p=0.03). Conclusion Melatonin appears to be a marker of disease state and severity, as well as of sleep disorders, in the elderly. These early findings would confirm the protective role of melatonin against several chronic diseases. The benefits of this agent as a possible medication should be more thoroughly clinically tested.

A mortality model based on a mixture distribution function

A new mortality model based on a mixture distribution function is proposed. We mix a half-normal distribution with a generalization of the skew-normal distribution. As a result, we get a six-parameter distribution function that has a good fit with a wide variety of mortality patterns. This mixture model is fitted to several mortality data schedules and compared with the Siler (five-parameter) and Heligman–Pollard (eight-parameter) models. Our proposal serves as a convenient compromise between the Heligman–Pollard model (which ensures a good fit with data but is often overparameterized) and the Siler model (which is more compact but fails to capture ‘accident humps’).