Italian System Research Articles

Micro-elimination initiative for hepatitis C screening: insight into gender gaps and undiagnosed individuals

In 2023, the Italian healthcare system launched HCV screening targeting subjects born in 1968–1989. However, subjects > 50 yrs also need screening. In addition, existence of gender gaps in HCV diagnosis and treatment has been suggested. Our aim was to identify undiagnosed individuals outside the age groups to whom the screening is offered and to gather data about gender gaps. This is a prospective, opportunistic micro-elimination initiative based on a network between 24 Apulian pharmacies and our center. Between 01/07/2022 and 01/03/2024, subjects aged 55 to 85, accessing pharmacies were offered HCVOraQuick tests (F/M 1:1) and administered ad-hoc questionnaires. In total, 13,042 screening were carried out. Mean age was 64.9 (± 7.6), 51.1% females. Overall, 1.1% were anti-HCV positive: mean age 68.3 (± 10.3), 44.9% females. Seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and unknown transmission route (p = 0.0009). HCV-RNA was detectable in 67.4% of seropositive. They were 67.5 (± 10.7) yrs old, mainly males (55.1%). HCV-RNA prevalence was 0.8%, higher in elderly (p = 0.0003) and unknown transmission route (p = 0.0007). Overall, 90% were linked-to-treatment. Differences in patients profiles should be considered to guide policy and more inclusive treatment approaches. Gender differences in screening response and rates of active infections underscore the need for gender-targeted intervention.

Incremental lobbying reform: the patchy case of Italy

Abstract The regulation of lobbying serves the dual ambition of ensuring a level playing field for participation in policymaking while reducing risks of corruption and undue influence. International organisations, such as the EU, OECD and Council of Europe, have promoted this regulation by relying on such different agendas and frames. This variation is magnified within the Italian political system, where registers have been introduced in several institutions such as the Chamber of Deputies (Lower House), three ministries, and seven regions. By distinguishing two models of lobbying regulation, we trace the evolution of successive adoptions at the national and regional levels, characterised by the interplay between international organisations, domestic agenda-setting events and domestic policy entrepreneurs. The first group of lobbying regulation adopters concern what we define as the ‘participation agenda’, composed of voluntary rules and weak provisions for restricting legislator–lobbyist interactions. Following a sequence of influence-peddling scandals and the emergence of anti-corruption policy, a second wave of rules adoption reflects the ‘integrity agenda’ with a focus on mandatory registration requirements, disclosure requirements, and provisions on conflict-of-interest prevention. We observe that the sequence of adoptions is not separated and independent but rather characterised by policy layering whereby integrity instruments of the second period of adoption are added on to the participation goals of the first historical period.

IMPACT OF GREEN MOBILITY ON THE ELECTRIC POWER SYSTEM: A NUMERICAL ANALYSIS IN A 2030 SCENARIO

In this paper, a methodology is proposed to evaluate the impact on the Italian electric power system deriving from the increasing adoption of Battery Electric Vehicles (BEVs). To this purpose, a case study that involves the Lombardy region in a 2030 scenario is analyzed. To accurately estimate travel habits within the region, datasets publicly available were used, complementing them with suitable energetic models of BEVs. Detailed data about the journeys traveled by commuters in the region, distinguished by reason to move and modes of transport, were provided in input to an online routing machine to extract significant information about the vehicle’s instantaneous speed, length, and duration of each trip. This allowed for an accurate assessment of the energy and power requirements of private electric mobility in a 2030 scenario. The quantities in output to the analysis can be effectively used by transmission and distribution network operators to identify the issues that could arise on the grid due to increased demand related to electric vehicles. In addition, these analyses can support the proper design and planning of all the reinforcement actions needed on the electrical grid to improve its capability to supply the energy and power required during the charging processes.

Demographic implications on education: a case study in the province of Mantova

The decreasing birth rates in Italy are rapidly transforming the demographic landscape, with forecasts indicating a significant reduction in the youth population over the next ten years. In this work, using data provided by the National Institute of Statistics and the Ministry of Education and Merit, a statistical model has been developed to estimate the future composition of the student population in the province of Mantova. Specifically, demographic forecasts, school participation rates, and other relevant parameters were analyzed to create a robust predictive framework and answer the following types of questions: "How will the student population change in the province of Mantova, even at the level of school districts, over the next ten years? How many more or fewer classes will there be? What effects will this have on staffing?”. While focusing on the province of Mantova as a case study, the project aims to develop a solid methodology that can be used in all Italian provinces, leveraging the informative resources of official statistics and public administrations, at this historical moment when we are faced with digital innovation and the development of artificial intelligence. The results of the conducted analysis, besides providing a valuable contribution to local policy-level educational planning, can, once extended nationally, bring objective data into the debate on government educational policy choices, thus helping to prepare the Italian educational system for evolving demographic challenges.

Collecting data on migrants’ health status and access to health services: the experience of the mobile app “ComeStai”

Despite the process of migrant settlement in Italy, there is still a lack of data on migrant health and access to health services. We have developed the mobile app “ComeStai” to collect new data on this population. ComeStai collects new and original information on migrants' self-assessed health status and access to health care through short surveys. The main questionnaire includes questions about the respondent's immigrant status, health status and health habits, access to and use of health care, and socio-demographic characteristics. Every month, the app displays a follow-up survey to track key variables over time, including respondents' health status and experiences of barriers to accessing health care. After submitting the answers to the main questionnaire, the user can access an in-app platform that provides an overview of the Italian public health system and regulations, a brief description of the main public health services, and a list of NGOs providing health services or support in the Metropolitan area of Milan, as well as their location on a map. Our study aims to test the efficacy of a mobile application as a data collection tool. We present the fieldwork and discuss the advantages and challenges of such a tool. Our evaluation considers the sample size achieved, the heterogeneity and representativeness of the sample to the real population. Based on the results, we will evaluate whether to extend the research to a larger geographical scale.

Cost of illness of Heart Valve Diseases (HVDs): A real-world analysis in Italy.

Heart valve diseases constitute a significant public health challenge with substantial clinical and economic implications. The ageing population, coupled with advancements in surgical techniques, has led to increased hospitalizations for cardiac valve interventions over the past decade. Despite progress, the economic burden of heart valve diseases remains underexplored, particularly in the context of the Italian healthcare system. This study aims to comprehensively assess the economic burden of heart valve diseases in Italy through a real-world analysis. Using data from the national Italian Hospital Discharge Records (SDO), we identified the number of adult patients undergoing interventions on the aortic, mitral, and tricuspid valves, along with the associated costs borne by the National Health System. Additionally, we estimated indirect costs by analyzing social security benefit applications related to valve diseases from 2016 to 2019. A notable rise in hospitalizations for cardiac valve interventions, particularly for the aortic (+53.3%) and mitral valves (+29.5%) was revealed through the study period. In-hospital mortality rates declined, reflecting advancements in perioperative care. The economic burden of heart valve diseases in Italy was substantial, with hospitalization costs reaching €808 million in 2018. Social security benefit applications also increased, adding an annual cost of €29 million. Heart valve diseases represent a growing clinical and socio-economic challenge in Italy. This study underscores the imperative for a multidisciplinary approach to effectively manage these conditions. Emphasizing prevention, early diagnosis, and timely interventions is crucial to mitigate the economic impact and enhance the quality of life for patients.

Competitive and polyphonic reactivity to accountability pressures in digital public sector reporting: insights from Italian state museums

PurposeThis study investigates the reactions of public sector organisations to the accountability pressures of online dashboards and the impact of this reactivity on reporting systems. This study explores the concept of “reactivity,” which explains changes in organisational behaviours in reaction to being evaluated, observed or measured.Design/methodology/approachThis study adopts a case study methodology to investigate organisations’ reactivity to an online dashboard within the Italian system of state museums. Data were gathered through a real-time dashboard initiated in 2019, complemented by interviews, participant observations and secondary sources collected over a period of three years.FindingsThe results indicate that online dashboards provoke a divergent but coexistent response: competitive reactivity when museums modify their behaviours to improve performance disclosed in the online dashboard, and polyphonic reactivity when museums question the algorithm’s validity and accuracy on the basis of the online dashboard. This finding reveals the emergence of layered accountability, with organisations balancing public expectations and hierarchical standards through manipulation and boycott, thereby giving rise to a decoupled system of measures.Originality/valueThis research contributes to the literature on public sector accountability by highlighting the dual nature of reactivity, both conforming to and resisting the imposed metrics. This study enhances our understanding of the interplay between digital accountability mechanisms and organisational responses, offering insights into the complexities of adapting to real-time, data-driven environments in the public sector.

Exploring the role of digital platforms in promoting value co-creation: evidence from the Italian municipal solid waste management system

Purpose This study aims to explore how digital platforms (DPs) contribute to value co-creation in municipal solid waste (MSW) management systems. Design/methodology/approach The present paper conducts an explorative analysis using single case study methodology. The case in question involves a DPs operating in Italy. Findings Empirical analysis shows that DPs help engage citizens in MSW and reduce the fragmentation in waste management systems by fulfilling a brokerage role that connects citizens, municipalities and waste management companies. The development of bidirectional knowledge and resource flow among actors contributes to better waste recycling processes, as well as fosters economic, environmental and social value co-creation in a complex public service. Research limitations/implications This research is limited to a single case study within the Italian context, which may influence the generalizability of the findings. Future research could expand the scope to include multiple case studies across different geographical regions. Practical implications For practitioners and policymakers, this paper underscores the strategic benefits of adopting DPs in MSW management systems and thereby improving public service delivery. Social implications The case analysis highlights that DPs can assist public actors in achieving numerous sustainable development goals by enhancing recycling rates and activating learning mechanisms among citizens. Originality/value This study contributes to literature by connecting different fields of research (i.e. waste management and public management) and using network theory to show how DPs can contribute to the economic, environmental and social sustainability of MSW while generating relevant benefits for the actors involved.

Assessing the approaches to nausea and vomiting in pregnancy: insights from a nationwide survey of Italian gynecologists (PURITY light).

Nausea and vomiting in pregnancy (NVP) affect approximately 70-85% of pregnant women, starting between weeks 6 and 8 and often subsiding by week 20. This study evaluates the therapeutic approaches of Italian gynecologists in the treatment of NVP. In the Italian healthcare system, gynecologists play a central role in prenatal care and are the primary healthcare providers for pregnant women, unlike in other countries where midwives may have a more prominent role. From June to September 2022, a survey of Italian gynecologists was conducted during 15 scientific conferences. The questionnaire collected demographic data and information on clinical practices to support the management of NVP. Statistical analysis assessed the effect of demographic characteristics on clinical behavior. Data from 157 participants, mainly women (72.61%) and professionals from the Public Health System (63.69%), were analyzed. 77.71% always checked NVP during the first visit, based on patients' reports (84.71%). 54.78% prescribed medication in mild cases, mainly the doxylamine/pyridoxine combination (64.97%). The results show varied practices influenced by demographic and professional factors. Many physicians treat only severe cases of NVP, perceiving it as a transient discomfort, which may lead to poor management. Balanced care is needed to improve the quality of life for pregnant women with NVP.

Integrating BRCA testing into routine prostate cancer care: a multidisciplinary approach by SIUrO and other Italian Scientific Societies

Prostate cancer (PCa) ranks among the most prevalent malignancies in men, with notable associations to Hereditary Breast and Ovarian Cancer Syndrome (HBOC) and Lynch Syndrome, both linked to germline likely pathogenetic variant/pathogenetic variant (LPV/PV) in genes involved in DNA repair. Among these genes, BRCA2 in PCa patients is the most frequently altered. Despite progresses, challenges in BRCA carriers detection persist, with a quarter of PCa cases lacking family history.To address these challenges, a multidisciplinary expert panel from six Italian Scientific Societies, formulated a care pathway to integrate BRCA testing into routine clinical practice in different Italian geographical areas.The development process, promoted by the Italian Society of Uro-Oncology (SIUrO), involved three key stages. A preliminary meeting convened teams from different Italian regions to establish minimal requirements for a mini-counseling program (defined as a pre-test consultation carried out by clinicians responsible of patients’ management) and propose care pathway models. At the same time, a comprehensive survey was launched to highlight regional variations in BRCA testing and identify eventual obstacles to testing activities. A subsequent meeting synthesized care pathway proposals and formulated a unified framework, acknowledging regional legislative variations as enriching factors. Lastly, implementation of the unified framework was promoted by the project faculty and identified regional team leaders.Survey results revealed significant regional disparities in BRCA testing, reimbursement policies, and access to genetic counseling. The proposed mini-counseling program outlined essential steps for patient identification, information provision, and multidisciplinary review, aiming to streamline BRCA testing processes.Expert recommendations emphasized offering tumor genetic testing to metastatic PCa patients eligible for PARP-i treatment and outlined criteria for genetic counseling and germline testing. Key considerations included family history and tumor characteristics.In conclusion, the proposed care pathway represents a critical step towards integrating BRCA testing into routine PCa care, aiming to optimize patient management and familial risk assessment within the constraints of the Italian healthcare system.

A Model for Sustainable Development in Territorial Production Systems

ABSTRACTThe territorial production system demand innovation and adaptability to provide the majority of decisions, especially when splitting up available resources among productive sectors by the lens of sustainable development. The system's economic units evolve in dimensional profile, technical execution, and management of productive process to approach the worldwide benchmark for sustainability, taking into account not only the environment, society, and economy, but also the twin transition to digitalisation. The study addresses the issue of allocation resources across territory's productive sectors by an inter‐sectorial model that accounts for both external and endogenous sustainability performance criteria. The model is developed starting from the Leontief input–output system and tested in the Italian production system. The sustainability perspective's individualization of the sector's top performer and the quantity of resources to be allocated in response to their respectable sustainable performance are provided as outputs. The political repercussions, model's potential and strengths, and its limits with regard to the sustainable development of territorial production frame are discussed in the conclusions.

Direct and indirect healthcare costs of ocular diseases in Italy: a literature review on glaucoma, diabetic retinopathy, and macular degeneration.

Glaucoma, diabetic retinopathy, and age-related macular degeneration impose substantial economic burdens on healthcare systems due to their high prevalence and chronic nature. Nevertheless, comprehensive Italian data is limited. This study aims to collect Italian evidence on the economic impact of these conditions to support more effective healthcare planning. Systematic review. A systematic literature search was conducted in accordance with PRISMA guidelines across PubMed, Scopus, Web of Science, and EMBASE databases. Studies reporting cost evaluations of managing glaucoma, diabetic retinopathy, and age-related macular degeneration in Italy were included. Direct, indirect and non-medical costs were considered. The review included 23 studies exhibiting considerable heterogeneity in timeframes, regions, and economic evaluation approaches. For glaucoma, annual direct costs ranged from €788.70 for early-stage cases to €8,368.51 for advanced cases requiring surgery. Annual costs associated with diabetic retinopathy ranged from €4,050 to €5,799 per patient, depending on disease severity and treatment approach. The financial burden of age-related macular degeneration varied considerably, with costs ranging from €1,399.20 for early-stage cases to €3,973.30 for advanced stages. Although non-medical and indirect costs, such as lost productivity and caregiving expenses were less frequently assessed, they represented a significant contributor to the overall financial burden. This study highlights the substantial economic burden ocular diseases place on the Italian healthcare system. Early intervention and preventive strategies could reduce the long-term costs of managing diabetic retinopathy and age-related macular degeneration. Further research into indirect costs and cost-effective interventions is necessary to support more efficient healthcare resource allocation.

Mitigation strategies can alleviate power system vulnerability to climate change and extreme weather: a case study on the Italian grid

Abstract This study explores compounding impacts of climate change on power system’s load and generation, emphasising the need to integrate adaptation and mitigation strategies into investment planning. We combine existing and novel empirical evidence to model impacts on: (i) air-conditioning demand; (ii) thermal power outages; (iii) hydro-power generation shortages. Using a power dispatch and capacity expansion model, we analyse the Italian power system’s response to these climate impacts in 2030, integrating mitigation targets and optimising for cost-efficiency at an hourly resolution. We outline different meteorological scenarios to explore the impacts of both average climatic changes and the intensification of extreme weather events. We find that addressing extreme weather in power system planning will require an extra 5–8 GW of photovoltaic (PV) capacity, on top of the 50 GW of the additional solar PV capacity required by the mitigation target alone. Despite the higher initial investments, we find that the adoption of renewable technologies, especially PV, alleviates the power system’s vulnerability to climate change and extreme weather events. In fact, renewable energy sources are generally less vulnerable to the impacts of climate change, such as rising temperatures and shifting precipitation patterns, compared to thermal power and hydropower generation. Furthermore, enhancing short-term storage with lithium-ion batteries is crucial to counterbalance the reduced availability of dispatchable hydro generation.

Flexible Demand and Its Impacts on Future Utility‐Scale Photovoltaic Integration and Generation Costs: Case Study on the Italian Energy Transition

The energy transition implies an increase in electrical demand, which shall be met primarily by renewable energy sources, potentially raising costs for the system and the community. However, increasing consumption flexibility has the potential to reduce these additional costs by minimizing the risk of curtailment and reducing the need for new storage and grid line capacity. Few studies have been conducted to examine the techno‐economic implications of improving consumption flexibility from an energy system perspective, but none have determined how these gains may affect future solar power integration costs. In this study, it is aimed to fill the gap by assessing the economic effects of flexible demand on solar integration and generation costs. Different scenarios for 2030 and 2040 of the Italian energy system are investigated taking into account future flexible demand availability and geographical distribution. In the results, it is shown that enabling a 12 h flexible demand can lower powerline transport capacity by up to 14%, and storage capacity by up to 25% in the 2040 scenarios. This corresponds to a reduction in photovoltaic (PV) generation costs from 11 to 13% by lowering overall PV integration costs, with peaks of up to 20% in some cases.

Costs of Oral Corticosteroid Use in Patients with Severe Asthma With/Without Chronic Rhinosinusitis with Nasal Polyps: Data from the Italian SANI Registry.

The burden of severe asthma on patients, especially on those with concomitant chronic rhinosinusitis with nasal polyps (CRSwNP), is substantial. Treatment intensification with oral corticosteroids is a common strategy for managing severe asthma exacerbations; however, prolonged exposure to systemic corticosteroids is associated with multisystem toxicity. This study aimed to quantify the association between oral corticosteroid use and annual asthma-related costs in patients with severe asthma with or without CRSwNP. This pharmacoeconomic analysis was based on data from the Severe Asthma Network in Italy (SANI) registry. Asthma-related costs were estimated in the context of the Italian healthcare system and included exacerbations requiring treatment intensification, unplanned visits, admissions to hospital and emergency/intensive care units, and lost workdays. For each item, the mean annual cost per patient was estimated based on national tariffs and the frequency of the event. To quantify the association between oral corticosteroid treatment and costs, the study cohort was stratified according to oral corticosteroid use in the 1-year preceding inclusion in the SANI registry. A total of 669 patients from the SANI registry were included in the present analysis, 255 of whom had concomitant CRSwNP. Corticosteroid use was associated with significantly higher annual disease-related costs per patient compared with no corticosteroid use. Compared with the overall study cohort and patients without CRSwNP, patients with CRSwNP had higher disease-related costs (higher by €1307 and €1869, respectively). Use of corticosteroids, in particular systemic corticosteroids, is associated with an increase in asthma-related costs. The concomitant presence of CRSwNP impacts negatively on costs. This study suggests that a thorough analysis of costs, expected benefits, and occurrence of adverse events is required when selecting treatment intensification strategies for managing uncontrolled severe asthma.

Community Connections: Understanding Local Dynamics in Italian Asylum Policy Implementation

Italy hosts significant numbers of forced migrants throughout its territory. The implementation of asylum policy thus occurs in diverse and sometimes fraught contexts, presenting different resources and obstacles. This paper examines how local context shapes the experiences and practices of street-level bureaucrats (SLBs) implementing policy in the Italian statutory asylum system. Semi-structured interviews with workers in two projects, one in a conservative rural area and one in a progressive urban area, show that the urban/rural divide alone is not an appropriate predictor of similarities and differences in policy implementation and outcomes, which are largely shaped by context-specific sociocultural and relational elements. Workers’ off-duty mediation in interpersonal contact between migrants and community members fosters positive encounters that could partially offset traditionally conservative political cultures and hostile attitudes; however, the same cultures and attitudes cause workers to feel isolated and alienated from their community. Furthermore, SLBs’ decision-making practices in both projects are always collegial and constrained by exhaustive rules, largely eliminating the need for individual discretion typical of SLBs and creating instead “group discretionary” bureaucrats. In light of these findings, I argue for increased attention to locality beyond the simple urban versus rural lens, and increased focus on asylum SLBs as a distinct category of “doubly embedded” SLBs participating in both policy implementation and local context.

Telephone calls to emergency medical service as a tool to predict influenza-like illness: A 10-year study.

Influenza-like illness (ILI) refers to the set of symptoms associated with seasonal influenza infection. In Italy, the syndromic surveillance system RespiVirNet uses both epidemiological and virological data to monitor ILI incidence with a weekly cadence. To estimate ILI incidence in real time, several countries adopted surveillance systems which include data from the emergency-urgency (E-U) system. The aim of this study was to evaluate the relationship between the number of calls for respiratory symptoms to the E-U system and the regional incidence of ILI cases identified by the Italian syndromic surveillance system. Retrospective observational cohort study METHODS: We analyzed data in the Lombardy region for the flu season from 2014 to 2024, excluding the COVID-19 pandemic period (from 2020 to 2022). We performed a linear regression analysis considering ILI incidence as the dependent variable and the percentage of respiratory calls to the E-U system as the independent variable. Statistical analysis showed a positive correlation (r=0.70), with a statistically significant coefficient of 1.34 (p-value <0.001) and R2 of 0.50. The observed correlation highlights the potential use of prehospital E-U system data in the surveillance systems of infectious diseases by using real-time data, encouraging future research to explore the limits and possibilities of an integrated surveillance system.

Third Long-March 5B re-entry campaign through Italian space surveillance radars

Third Long-March 5B re-entry campaign through Italian space surveillance radars

The Italian health data system is broken

The Italian health data system is broken

The Rorschach Test: An Investigative Tool for Assessing Parenting Skills in Narcissistic Personality Disorder

In the Italian legislative system, the technical assessment by an expert appointed by the court is conceived as a psychological and psychodiagnostic investigation aimed at exploring the relational situation between the various members of the family, in particular between parents and children, and assessing the parental suitability for providing the judge with useful indications for the protection of the child&amp;apos;s welfare. Given the increasing importance attached to the quality of the parent-child relationship, a wide debate has opened in the scientific literature regarding the concept of parenting skills. These are seen in the light of evolving development processes, necessarily influenced by the personological style of the subject. The complexity of mental processes has led psychology to use increasingly refined techniques in order to expand the cognitive data related to the study of personality development. These techniques certainly include the Projective Tests, with the Rorschach Test in particular being recognized as the most accurate and &amp;quot;reliable&amp;quot; scientific tool for assessing personality as well as cognitive, affective-adaptive, and relational functions of the individual. The purpose of the research study discussed in this presentation is to observe, investigate and demonstrate through the Rorschach Test how narcissistic personality disorder specifically, negatively affects parenting skills.