Italian Provinces Research Articles

The Cost of Borrowing as a Limiting Factor of Non-Life Insurance Development: The Italian Case

We address the effect of local financial conditions on the demand for non-life insurance. We consider the spread between the interest rates faced by the insured on the local credit market and the return rates earned by the insurer on national or international financial markets, sketching how it influences the present value of an insurance policy; we then use the local invariance of the insurer’s returns to identify the effect on demand. Drawing on a panel of Italian provinces with ample variability in insurance density as well as borrowing conditions, we show that the demand for non-life insurance decreases with the borrowing rate. We separate between different non-life insurance lines, finding a stronger effect for the lines prevailing in advanced economic systems. Credit conditions turn out to be an important factor of non-life insurance development, and they help to explain the underdevelopment of insurance markets in Southern Italy.

2001-2021 Comparative Persistence of Oral Antipsychotics in Patients Initiating Treatment: Superiority of Clozapine in Time-to-Treatment Discontinuation.

Continuous antipsychotic (AP) therapy is crucial for managing psychotic disorders, and its early interruption reflects the drug's failure. Real-world epidemiological research is essential for confirming experimental data and generating new research hypotheses. The persistence of oral APs in a large population sample from 2000 to 2021 was analyzed by comparing AP prescriptions over this period across four Italian provinces, using dispensing data linked via a record-linkage procedure among regional healthcare utilization databases. We calculated personalized daily dosages and assessed time-to-treatment discontinuation over a 3-month period for patients initiating AP treatment. Treatment persistence was evaluated using Kaplan-Meier curves and Cox regression, with adjustments for age and sex. Second-generation antipsychotics (SGAs) were favored over first-generation antipsychotics (FGAs), with olanzapine as the most prescribed. Within the study time frame, 42,434 individuals were prescribed a new continuous AP regimen. The analysis revealed 24 significant differences within 28 comparisons. As a class, SGAs demonstrated better treatment persistence than FGAs (HR: 0.76; 95%CI: 0.73, 0.79). Clozapine stood out for its superior persistence, surpassing all other SGAs, notably olanzapine (HR: 0.85; 95%CI: 0.79-0.91) and risperidone (HR: 0.80; 95%CI: 0.74-0.87). Olanzapine and aripiprazole showed better results than both risperidone and quetiapine. Quetiapine showed inferior 3-month persistence in all pairwise comparisons. The study results provide insight into the performance dynamics among SGAs: clozapine, despite being one of the less frequently dispensed APs in our sample, emerged as a significant prescription choice. The significance of pharmacoepidemiological studies in complementing experimental findings is also underscored.

The very long-term risk of stroke after acute coronary syndrome and geographic differences. The ABC-10* study on heart disease

Abstract Background Little is known about the very long-term risk of stroke among acute coronary syndrome (ACS) survivors. Methods In this prospective study, we enrolled 535 ACS patients admitted to hospitals in three Italian provinces, discharged alive and followed for 24 years or death. The patient's residency was classified into three urban and three nearby rural areas. Results All patients completed the follow-up (6142 Perso-years). 85 (16%) patients suffered an acute stroke. Patients median age was 67 years, 70% were male, and 318 patients were residing in rural areas. Patients who had a stroke and those who had not shared most of the demographic and clinical characteristics. The incidence rate of overall stroke was 14/1000 person-year. Cox analyses showed older age (HR 3.13;95%CI 2.31-4.26), male gender (HR 1.88;95%CI 1.20-2.95), baseline diabetes (HR 2.25 95%CI 1.37-3.69), heart failure (HR 2.69;95%CI 1.71-4.24), and higher albumin/creatinine ratio (HR 1.75;95%CI 1.33-2.30) were all associated with an increased risk of stroke. while higher baseline eGFR, reperfusion, statin and beta-blockers treatment during follow-up were associated with a decreased risk; HR (0.55 (95%CI 0.42-0.72), 0.45(95%CI 0.29-0.71), 0.21(95%CI 0.13-0.34), and 0.37(95%CI 0.23-0.57), respectively). In the multivariate analysis, only older age (HR1.55;95%CI 1.08-2.21; p=0.02) was an independent predictor of stroke while statin treatment was independently associated with a lower risk (HR 0.35;95% CI 0.21-0.58; p<0.0001). However, all these variables did not predict the risk of stroke in competing risk regression analysis where death was treated as the competing event. A sub-analysis of the 43 patients who had a fatal stroke (FS) revealed 7/1000 person-year FS IR. The Cox regression and competing risk analyses of predictors of FS showed similar results. Interestingly, we observed an association between geographic areas of residence and the long-term FS risk as the risk increased going from rural to urban (HR 2.08;95%CI 1.14-3.80; p=0.02) areas and from north to middle and south provinces (HR 1.47;95%CI 1.00-2.15; p=0.04) in the univariate Cox regression analysis. Results kept true using multivariate Cox and Competing risk regression models. Conclusion This analysis reveals the significant urban-rural difference in the very long–term risk of fatal stroke among unselected ACS patients which highlights the importance of implementing a preventive policy based on area-specific knowledge.

Geographic differences in the effect of immigration on the native wage distribution: Evidence from Italian provinces

AbstractThis paper examines geographic differences in the effect of immigration on the wage distribution of native Italian workers. The results suggest an insignificant effect across the wage distribution in northern provinces, but large and significant effects in the lower and middle parts of the distribution in the south. This is entirely because immigration pushed up wages at the lower end of the female wage distribution in southern local areas. This result is consistent with increases in labor market participation of native women that went hand in hand with improvements of women's skills at the bottom of the wage distribution.

Exploring the nexus between exports’ economic complexity and institutional quality: insights from Italian provinces

ABSTRACT The present research aims to investigate the determinants of economic development and productivity by proposing an empirical analysis of the economic effects of institutional quality on the economic complexity of export at the intra-national level, focusing on 103 Italian provinces from 2004 to 2016. Using the System Generalised Method of Moments (System-GMM) estimator, the study assesses the influence of various institutional dimensions on provincial economic complexity, as measured by the Economic Complexity Index (ECI). The findings indicate that institutional quality, particularly rule of law, regulatory quality, and voice and accountability, significantly enhances economic complexity. Better formal and informal institutions such as completeness of contracts, social cohesion, contract enforcement, by reducing transaction costs and uncertainty, and by favouring knowledge dissemination and security of investments, are source of comparative advantage in complex industries that lead to diversified and sophisticated production, fostering economic growth and innovation. Moreover, the study emphasises the importance of related activities, which interact with institutions to support complex and innovative export-related activities through knowledge spillovers and related diversification. The analysis also highlights the pivotal role of human capital, social capital, and innovation, which should remain focal points for policymakers.

First Detection of Hepatitis E Virus RNA in Ovine Raw Milk from Herds in Central Italy.

HEV mainly enters animal and human hosts through the orofecal route, which presents a critical health concern alongside the associated environmental variable. Among products of animal origin, milk (both ovine and bovine) can harbor HEV RNA, which can potentially be transmitted to consumers. In this study, a total of 220 raw ovine milk samples were collected from Apennine breed subjects farmed (transhumance method) in three different Italian provinces, L'Aquila, Pescara, and Teramo, located in the Abruzzo region (Central Italy). All the specimens were screened using one-step real-time RT-qPCR and nested RT-PCR assays. Among them, 5/220 or 2.27% harbored HEV RNA fragments belonging to the ORF1 and ORF2 codifying regions of the genotype 3c. The average viral amount discovered was 102 GE/mL. These subjects represented 2/57 or 3.51% of the Pescara herd, and 3/105 or 2.86% of the Teramo herd. Although HEV RNA was discovered in sheep fecal samples, the original data obtained in the present study represent the first HEV RNA detection in ovine raw milk from Italy.

A Population-Based Analysis of the Cancer Incidence in Individuals under 50 in a Northern Italian Province: Focusing on Regional Disparities and Public Health Implications.

International studies have shown an increase in cancer incidence among young adults, raising public concern. This study aims examines trends in the cancer incidence among individuals aged 15-49 years in a province of Northern Italy, covering diagnoses from 1996 to 2021, and compares the annual percentage change (APC) with national and international data. In males, the overall cancer incidence showed a modest increase between 1996 and 2013 (APC 1.6), followed by a decline in the subsequent years (APC -2.5). In females, there was a modest increase over the entire period (APC 1.0). The lung cancer incidence decreased in both sexes (APC -3.9 in males and APC -3.3 in females), while a decrease was observed for colorectal cancers in women (APC -2.4). Since 2015, the thyroid cancer incidence declined significantly in females (APC -10.2), while an increase was noted in males (APC 2.5). The testicular cancer incidence rose in males (APC 1.5), and the melanoma incidence increased in both sexes (APC 3.4 in males and APC 3.9 in females). The breast cancer incidence remained stable (APC 0.3). These results underline the importance of promoting healthy lifestyles even among younger generations to address emerging cancer trends and support cancer prevention efforts.

<i>Speck</i>: a traditional culinary specialty from the Italian Alps. A microbiological, molecular and chemical evaluation

South Tyrol is the northernmost Italian province; its history, geography, and closeness to other European countries, such as Austria and Switzerland, have influenced both culture and food production. Among the South Tyrolean culinary specialties, a type of dry-cured ham called Südtiroler Speck/Speck Alto Adige (Speck) plays a relevant role and has gained increasing significance both on a national and international level over the last 2 decades. Despite it being a common culinary product in Italian and international markets, there is not much published data regarding the microbiological and chemical features of Speck. This study describes the analytical results obtained during a period of 7 years, during which the main pathogens and contaminants were considered.

Links between the sustainable development goals: An analysis for Italy

AbstractThe article reviews the links between the Sustainable Development Goals (SDGs), examining how progress in one is related to the others and what factors determine the progress. While most previous work is at the national level, this article focusses at the sub‐national level for one country, namely Italy. After reviewing the evidence from the literature, the paper utilizes an unbalanced panel data collected for Italian provinces, covering the period 2004–2022 and reports descriptive statistics. On the positive side, we see a decline in ambient air pollution, and an increase in indicators of gender equality. There are also big gains in tertiary education and a decline in occupational injuries. These are common to almost all provinces. On the health side, life expectancy has risen across the country. Less positive are the changes in endocrine, metabolic, and nutrition disease rates and in availability of hospital beds. The inter‐province indicator of inequality has also increased. Furthermore, the overall level of inequality has gone up and the difference in inequality between provinces has not fallen. There has been no increase in green spaces or efficiency of courts. There has been progress in poverty reduction but not enough to meet the SDG target by 2030 and regional differences in poverty remain stark. The Italian data are subjected to estimation of causal linkages between indicators using a system of equations. Two‐stage least squares estimation is carried out on the panel data set for provinces in Italy. The empirical modeling finds a positive impact of wealth on life expectancy and of income on poverty. There is an effect of an increase in income on poverty at the sub‐national level. There is also a negative impact of NGOs on land under construction, which is something not observed elsewhere as far as we are aware.

A longitudinal analysis of local innovation in Italy: How do proximity measures matter?

ABSTRACT This paper investigates the factors influencing local innovation from a longitudinal perspective while assessing geographical, economic and technological proximity. The research hypotheses concern spatial interactions, spillover effects and proximity measures that best fit innovation patterns and territorial interactions in Italy. The estimation strategy is the spatial Durbin panel model. The optimal specification to handle cross-sectional dependence in the data was derived from statistical tests evaluating (i) individual-specific effects, (ii) time-specific effects and (iii) both individual and time effects. The model was estimated using data from 107 Italian provinces over 2010–2019. The results show that both endogenous and exogenous interaction effects drive innovation processes and the underlying spillovers are global. Economic proximity explains local innovation patterns more effectively than geographical contiguity and technological proximity.

Trends in cervical cancer: A decade‑long analysis of incidence, survival and demographic disparities in a Northern Italian province.

While cervical cancer is relatively uncommon in Western countries, it continues to pose significant concern due to its high mortality rates. Intraepithelial forms [cervical intraepithelial neoplasia (CIN) 2 and CIN 3] are more prevalent in regions with comprehensive screening coverage, particularly in areas that use the Papanicolaou test and HPV detection. The present study aims to characterize the trends of precancerous lesions and infiltrating tumors over a decade, assessing survival rates by age, stage and country of origin. A total of 1,752 CIN 2/3 lesions and 152 infiltrating cancers were recorded in the Reggio Emilia Cancer Registry between January 2008 and December 2018. A clear increase in CIN 2/3 lesions was observed over the years while infiltrating tumors remained rare and the numbers of cancer cases declined. The 5-year survival rate was found to be 67%, with survival closely correlated with stage (88, 82, 74 and 12% for stages I, II, III and IV, respectively) and age (84, 80 and 37% for ages <40, 40-65 and 65+, respectively). Multivariable analysis confirmed an excess risk for advanced stages III (HR 3.1; 95% CI, 1.3-7.3) and IV (HR 19.6; 95% CI, 8.2-46.7), as well as in women 65+ (HR 2.8; 95% CI, 1.0-8.1). Analysis of national origins revealed comparable stage distribution for Italians and non-Italians at stage I (41 vs. 47%), while a notable disparity emerged for stage IV (28 vs. 6%). This difference could be attributed to the average age of Italians compared to non-Italians (59 vs. 49 years). Overall, the present study underscored the importance of continued surveillance and intervention strategies targeting advanced-stage disease, particularly in older populations and among non-Italian patients. Efforts to enhance screening coverage and access to timely interventions remain critical in reducing the burden of cervical cancer and improving survival outcomes.

The downward spiral entangling soil sealing and hydrogeological disasters

Abstract The frequency of occurrence of hydrogeological disasters (HGDs), as well as the persistence of their impacts, are not evenly distributed. Hazardous areas, by definition, are more prone to extreme events, while in densely urbanized regions, the impacts of these events tend to be more severe. The objective of this study is to investigate statistical relationships between urban and natural environment features and HGD occurrences. Taking Italian provinces as a comprehensive case study, we assessed the coefficient of determination, the χ 2 test, and the p-value to determine the degree of statistical correlation between impact indicators and 57 hazard/risk/land management indicators, such as extension of at-risk areas or soil sealing. We discovered that HGDs persistence and frequency correlate best with an indicator describing the amount of soil sealing (i.e. urbanized soil) in medium-hazard areas. Building on that, a further dynamic analysis was carried out to investigate whether soil sealing trends changed significantly after the provinces were struck by HGDs. Our findings hold significant implications, challenging current policy norms. European directives and Italian national laws impose strict development restrictions in ‘high-hazard’ areas, but generally allow for urbanization in ‘medium-hazard’ areas, with only minor limitations. Moreover, a paradoxical positive urbanization trend is observed in the most sensitive areas, greater than in safer areas and generally unchanged after HGDs. This outcome highlights a critical gap in risk perception that reflects into territorial planning, decision-making processes, and existing policies.

Integrating a Strategic Framework to Improve Health Education in Schools in South Tyrol, Italy.

This narrative review addresses the integration of health education into school curricula in South Tyrol, an Italian province with significant cultural and linguistic diversity. This review's objective is to analyze current health education initiatives and propose a strategic framework to enhance school-based health education, aiming to improve student well-being post-pandemic. The review synthesizes global examples and recent local studies, highlighting the importance of comprehensive teacher training, mindfulness-based interventions, culturally sensitive health education, and community engagement. The key findings indicate that current health education programs in South Tyrol are insufficient to meet immediate public health needs, such as low vaccine uptake and mental health challenges exacerbated by the COVID-19 pandemic. The proposed strategic framework seeks to align educational strategies with the diverse needs of South Tyrol's student population, thereby improving health literacy and behavior and strengthening the region's public health infrastructure.

A Critical Analysis of All-Cause Deaths during COVID-19 Vaccination in an Italian Province.

Immortal time bias (ITB) is common in cohort studies and distorts the association estimates between the treated and untreated. We used data from an Italian study on COVID-19 vaccine effectiveness, with a large cohort, long follow-up, and adjustment for confounding factors, affected by ITB, with the aim to verify the real impact of the vaccination campaign by comparing the risk of all-cause death between the vaccinated population and the unvaccinated population. We aligned all subjects on a single index date and considered the "all-cause deaths" outcome to compare the survival distributions of the unvaccinated group versus various vaccination statuses. The all-cause-death hazard ratios in univariate analysis for vaccinated people with 1, 2, and 3/4 doses versus unvaccinated people were 0.88, 1.23, and 1.21, respectively. The multivariate values were 2.40, 1.98, and 0.99. Possible explanations of this trend of the hazard ratios as vaccinations increase could be a harvesting effect; a calendar-time bias, accounting for seasonality and pandemic waves; a case-counting window bias; a healthy-vaccinee bias; or some combination of these factors. With 2 and even with 3/4 doses, the calculated Restricted Mean Survival Time and Restricted Mean Time Lost have shown a small but significant downside for the vaccinated populations.

Impact of Digital Media, School Problems, and Lifestyle Factors on Youth Psychosomatic Health: A Cross-Sectional Survey.

Post-pandemic psychosomatic complaints in children and adolescents have been underreported. This study investigated psychosomatic complaints in children and adolescents in Northern Italy in 2023, with the aim of identifying changes in predictors and vulnerable subgroups. Cross-sectional data representative of scholars from a northern Italian province were analyzed using the Health Behavior in School-aged Children (HBSC) checklist. The sum scores, count data, and dichotomized data were examined, and predictor effects were expressed using a linear regression model for the sum scores. Data from 4525 participants (aged 7-19 years, 50.5% girls) were analyzed. Psychosomatic symptoms remained unchanged after the pandemic. Significant gender differences were noted, especially in older age groups, with girls reporting more complaints. Factors such as children's health, digital media use, and school problems significantly influence psychosomatic outcomes. While migration background negatively affected girls' psychosomatic well-being, boys showed improvement through sports. The psychosomatic well-being of children and adolescents did not improve after the pandemic. These findings indicate the need for targeted interventions, improved health literacy, and ongoing monitoring to support the mental well-being of this vulnerable population. Reducing screen time remains a critical strategy for enhancing youth well-being.

Study of the lipid fraction of Moroccan and Italian carobs (Ceratonia siliqua L.)

AbstractCarob (Ceratonia siliqua L.) is a characteristic fruit from the Mediterranean area, composed of a hard pulp and numerous seeds that have been unfairly undervalued and underutilized over time. To enhance the Mediterranean's biodiversity and support food production from sustainable resources, the carob has recently received attention for its nutritional value, and it has advantageously served as a healthy ingredient of many food products. Hence, in this study, the composition of the Mediterranean carob was further deepened by investigating its lipid fraction on a dry weight basis in relation to the fruit part (i.e., pulp and seeds) and the geographical origin (i.e., different Moroccan and Italian provinces). On average, lipids of pulp and seeds amounted to 1.71% and 2.46%, respectively. Predominant fatty acids were palmitic, oleic, and linoleic acids. Palmitic and oleic acids were higher in pulp (20.21%–26.50% and 37.63%–44.49%) than seeds (13.93%–17.26% and 31.92%–36.66%), whereas linoleic acid showed an opposite accumulation trend (pulp: 8.32%–15.46%, seeds: 38.19%–43.45%). Among sterols, β‐sitosterol (57.49%–72.47%), Δ‐5‐avenasterol (10.26%–21.27%), and stigmasterol (3.97%–8.11%) accounted for more than 70% of total sterols of pulp, whereas β‐sitosterol alone represented more than 70% of sterols in seeds. Considering tocopherols, γ‐tocopherol was the most abundant isomer both in pulp (10.37–22.78 mg/100 g) and seeds (4.95–22.86 mg/100 g). Carob also resulted in a good source of squalene, which on average was 2.17 mg kg−1 in pulp and 19.07 mg kg−1 in seeds. A principal component analysis pointed out that the study of the lipid fraction of carob can help in discriminating samples based on their Moroccan or Italian origin.Practical Applications: The study provides further insights into the still‐little‐explored lipid fraction of Mediterranean carob and fills a relevant gap in the literature by contributing to a more exhaustive framework of the nutritional and functional value of this fruit. In a wider perspective, it can be of practical help in the formulation of carob‐based products and in the establishment of a more informed market of carob and carob‐based products.

Contextual factors and efficiency gains in Italian tourist destinations

The paper investigates the efficiency of 103 Italian provinces and some contextual factors that influence the competitiveness of a territorial tourist destination, defined as an ensemble of different historical, economic, environmental, and social traditions. Non-parametric Data Envelopment Analysis and semi-parametric bootstrapping extensions are applied over the period 2012-2019. The findings demonstrate that tourism destinations are considerably technically and scale inefficient, and that the total factor productivity is decreasing over time. The results also present a great heterogeneity of Italian provinces regarding their efficiency levels, suggesting that the traditional North-South regional divide of Italy does not apply in the tourism sector. Regarding the role of contextual factors as sources of efficiency gains, the cultural attractions, cultural public expenditures, and the rule of law increase technical efficiency of Italian provinces, whilst provinces with higher income and higher pollution receive negative gains.

The impact of COVID-19 on the tourism sector in Italy: A regional spatial perspective

The recent COVID-19 pandemic crisis affected all economic sectors, but tourism was hit the hardest. However, the resilience of tourism has also been recognized. In this context, the aim of the paper is (i) to analyze the impact of COVID-19 on tourism flows in Italy, by looking at NUTS-3 level data on national and international tourism arrivals and (ii) to understand whether, and to what extent, some “alternative” destinations benefited during the pandemic. Spatial autocorrelation analysis (global and local) and spatial regression models are used to capture the determinants of the variation in tourism flows in 2020 and 2021. Results demonstrate that tourism demand has different patterns across Italian provinces after COVID-19; both types of tourism have a significant path of spatial dependence that was stronger in 2020; international tourism has a more evident North/South divide and, the short-term resilience depends on the characteristics of the destination.

Spatial ideologies on official bilingualism and co-located schools in Finland and South Tyrol, Italy

In countries with several official languages, language separation often remains a structural principle in institutional education. Co-located schools, in which two autonomously administered schools with different languages of instruction share a physical space, may challenge this separation. Such schools have existed for a long time, but increasingly insert themselves into an architectural trend that leans toward multipurpose spaces. In this paper, we utilize previous research to analyze policy discourses and educational practices that arise around bilingualism in Finland and the Italian province of South Tyrol. We introduce and analyze co-located schools through the notion of spatial ideologies, i.e. beliefs about the connection between language policies and the material organization of space. We show that in both contexts, the separation of the official languages – Finnish and Swedish in Finland and Italian and German in most of South Tyrol – is reconstructed through policy, public discourse, and material practices. The educational system maintains separate tracks for the recognized language groups. While attempts to deconstruct the parallel system are often deemed problematic, the premise of language separation is also increasingly questioned and renegotiated. Therefore, co-located schools can be viewed as contested spaces where discourses and practices promoting linguistic diversity but also parallel monolingualism circulate.

Quantifying the mortality impact of Il Piano Marshall

Abstract The Marshall Plan is often hailed as history’s most successful structural adjustment program. However, its direct impacts and its impact on public health outcomes, particularly mortality rates, remain uncertain. Using data for Italian provinces, I find that each additional million dollars in the Italian European Recovery Program was related to a decrease of one to two deaths per 1,000 people or a decline in the Italian crude death rate by 3–7 percent. The effect is driven by the grants in food and drugs (rather than reconstruction grants). This finding is robust to a range of specifications using models in levels and differences, region dummies, placebo tests, a difference-in-differences framework, coarsened exact matching, and a border-municipal research design. The largest mortality reductions came from drops in communicable and infectious diseases.