Multilevel Analysis in Household Survey: An Application to Health Condition Data

The aim of this thesis is to apply multilevel regression model in context of household surveys. Hierarchical structure in this type of data is characterized by many small groups. In last years comparative and multilevel analysis in the field of perceived health have grown in size. The purpose of this thesis is to develop a multilevel analysis with three level of hierarchy for Physical Component Summary outcome to: evaluate magnitude of within and between variance at each level (individual, household and municipality); explore which covariates affect on perceived physical health at each level; compare model-based and design-based approach in order to establish informativeness of sampling design; estimate a quantile regression for hierarchical data. The target population are the Italian residents aged 18 years and older. Our study shows a high degree of homogeneity within level 1 units belonging from the same group, with an intraclass correlation of 27% in a level-2 null model. Almost all variance is explained by level 1 covariates. In fact, in our model the explanatory variables having more impact on the outcome are disability, unable to work, age and chronic diseases (18 pathologies). An additional analysis are performed by using novel procedure of analysis :"Linear Quantile Mixed Model", named "Multilevel Linear Quantile Regression", estimate. This give us the possibility to describe more generally the conditional distribution of the response through the estimation of its quantiles, while accounting for the dependence among the observations. This has represented a great advantage of our models with respect to classic multilevel regression. The median regression with random effects reveals to be more efficient than the mean regression in representation of the outcome central tendency. A more detailed analysis of the conditional distribution of the response on other quantiles highlighted a differential effect of some covariate along the distribution.

L'attitudine alla comunicazione. Uno studio nel Corso di Laurea in Infermieristica

It is believed that the way of being and the communicative-relational skills of every individual have multifactorial origins, including the quality of primary relationships with caregivers. For some time, the need for health care professionals to possess specific communicative and interpersonal skills has been highlighted. To the degree course in Nursing, like to all other degree programs related to health, access is granted to students who have large individual differences, both in terms of personality, and in terms of relational skills. Each academic year, therefore, the people responsible for the didactic organization of every course, are faced with having to prepare a training plan capable of addressing communicative-relational aspects and, at the same time, of being adequate to the real attitudes of incoming students. Thus, the need for appropriate tools for measuring the personological and vocational traits considered specific to health professions was born. This study has a twofold objective. On one hand, it aims at selecting a battery of psychological tests to detect psychological and attitudinal patterns, to facilitate the coordinators of graduate courses in their didactic organization and planning of educational training; on the other hand, it seeks to assess the correlations between communicative-relational skills (Relational-Communicative style, according to the model of patient-centered medicine-TRS) (Mucchielli’s Test of Spontaneous Attitudes – usual kind of attitude in dual relationships), personality traits (Alexithymia), styles of attachment to parental figures (PBI), and the capability of recognizing facial emotions, in a sample of students enrolled in the first year of a degree in Nursing.

Essays in Health Economics

In the first chapter we develop a theoretical model investigating food consumption and body weight with a novel assumption regarding human caloric expenditure (i.e. metabolism), in order to investigate why individuals can be rationally trapped in an excessive weight equilibrium and why they struggle to lose weight even when offered incentives for weight-loss. This assumption allows the theoretical model to have multiple equilibria and to provide an explanation for why losing weight is so difficult even in the presence of incentives, without relying on rational addiction, time-inconsistency preferences or bounded rationality. In addition to this result we are able to characterize under which circumstances a temporary incentive can create a persistent weight loss. In the second chapter we investigate the possible contributions that social norms and peer effects had on the spread of obesity. In recent literature peer effects and social norms have been characterized as important pathways for the biological and behavioral spread of body weight, along with decreased food prices and physical activity. We add to this literature by proposing a novel concept of social norm related to what we define as social distortion in weight perception. The theoretical model shows that, in equilibrium, the effect of an increase in peers' weight on i's weight is unrelated to health concerns while it is mainly associated with social concerns. Using regional data from England we prove that such social component is significant in influencing individual weight. In the last chapter we investigate the relationship between body weight and employment probability. Using a semi-parametric regression we show that men and women employment probability do not follow a linear relationship with body mass index (BMI) but rather an inverted U-shaped one, peaking at a BMI way over the clinical threshold for overweight.