Services In Italy Research Articles

Institutional authorisation and accreditation of Transfusion Services and Blood Donation Sites: results of a national survey.

The aim of the survey described in this article was to determine decisional and strategic factors useful for redefining minimum structural, technological and organisational requisites for transfusion structures, as well as for the production of guidelines for accreditation of transfusion structures by the National Blood Centre. A structured questionnaire containing 65 questions was sent to all Transfusion Services in Italy. The questions covered: management of the quality system, accreditation, conformity with professional standards, structural and technological requisites, as well as potential to supply transfusion medicine-related health care services. All the questionnaires returned underwent statistical analysis. Replies were received from 64.7% of the Transfusion Services. Thirty-nine percent of these had an ISO 9001 certificate, with marked differences according to geographical location; location-related differences were also present for responses to other questions and were confirmed by multivariate statistical analysis. Over half of the Transfusion Services (53.6%) had blood donation sites run by donor associations. The statistical analysis revealed only one statistically significant difference between these donation sites: those connected to certified Transfusion Services were more likely themselves to have ISO 9001 certification than those connected to services who did not have such certification. The data collected in this survey are representative of the Italian national transfusion system. A re-definition of the authorisation and accreditation requisites for transfusion activities must take into account European and national legislation when determining these requisites in order to facilitate their effective applicability, promote their efficient fulfilment and enhance the development of homogeneous and transparent quality systems.

The Quality of Public Services in Italy

This paper provides a survey of a number of studies conducted in recent years, above all at the Bank of Italy, aiming at assessing the quality and the efficiency of public services in Italy. We consider services provided by the central government (education and civil justice), regional governments (health) and municipalities (local public transportation, waste disposal, water and gas supply, and childcare). The analysis shows in general that Italy lags behind noticeably compared with other countries and there are large regional differences in terms of both quality and efficiency, regardless of the level of government providing the service. The lags seem to be attributable, depending on the case, to agents’ incentives, citizens’ behaviour and the regulation. Furthermore, the analysis emphasizes the need for more information to enhance our understanding of the problems and improve the effectiveness of action taken to counter them.

Prison Libraries in Italy

This article deals with prison library services in Italy, highlighting national and regional developments over the last twenty-five to thirty years. The article is divided into six parts: (1) a brief history of Italian prison libraries; (2) the structure and organization of the first institutional libraries (in Turin, Rome, Padua, Ravenna, Milan, Treviso, and Sardinia); (3) considerations by the prison administration and support from the Italian Justice Ministry; (4) the role of the university (the Association of Prison Libraries [ABC] and the new Italian Library Association [AIB] special interest group on people with special needs); (5) newer prison libraries and future projects; and (6) some user data and final conclusions.

Asili nidi e livelli di governo: evidenze da una prima ricognizione dei comuni italiani

This paper is an empirical survey on both the provision and the funding of childcare services in Italy. To this purpose, national financial laws, regional laws as well as Italian municipalities’ budgets are analyzed. First of all we describe the funding mechanism of the service pointing out the relationship between different government levels. Secondly, we propose demand and supply indexes for 20 territorial clusters using data at the municipal level. The analysis shows that, de facto , the aim of the service is conceived in different ways by local governments. This implies uncoordinated policy interventions by the different levels of government as well as a huge unbalanced territorial distribution of both demand and supply. The characteristics of the local demand for the service seem to be crucial elements to promote an efficiency improvement of public expenditure for this service.

Evaluating the water sector in Italy through a two stage method using the conditional robust nonparametric frontier and multivariate adaptive regression splines

The aim of this paper is to assess the efficiency of the integrated water service in Italy in recent years, through a robust and flexible methodology. This paper, from a methodological point of view, enhances a ”two stage” method, based on ideas suggested by Florens and Simar (2005), which estimates the efficiency frontier through conditional robust models and bypasses, at the same time, the choice of a specific functional form in the second stage; the MARS (Multivariate Adaptive Regression splines) method, in fact, provides for approximate production function using linear splines without any assumption of a functional form. Applying this specific two stage method, despite poor assumptions of the production function form, we provide an estimate for the Italian water companies; we have found spatial and dimensional patterns, especially in metropolitan vs. low density areas.

The Provision of Social Services in Italy between Federalization and Europeanization

The Provision of Social Services in Italy between Federalization and Europeanization

Governance and control of externalized water service management: Comparing solutions adopted in Italy and Sweden.

In this paper the challenges imposed on corporate governance of water services in Italy and Sweden are analyzed and compared. From the comparative analysis we notice that with externalization of services ore stakeholders become involved in the provision of the services. These stakeholders have common as well as divergent interests and the challenges thus become to find an alignment of interest among stakeholders in order to secure a sustainable provision of the services. The comparative analysis indicates that such lignment is especially difficult when stakeholders have heterogenous background (public and private sector).

Branding relationships in financial services: Paradigm shift in Mediterranean countries

In the service industry, a long-term relationship with customers is the key success factor that is increasing enormously. Service encounters can be viewed as a social exchange, with the interaction between the service provider and the customer being a crucial component of satisfaction, and providing a strong reason for continuing a relationship. This article tries to identify the key brand dimensions in financial services, as few financial service brands have emotional values that can differentiate the company even though they call for credibility and sincerity in their choice. Financial services in Italy have been analysed, as they have experienced several changes over the last decades with a growing attention to customer needs. A questionnaire has been submitted to understand the factors that affect customer loyalty, especially those related to brand. This study highlights that in the area of the study, a Mediterranean region, social and local habits seem to affect consumer behaviour. In fact, consumers pay more attention to human contact, therefore stressing the importance of a vis a vis relationship, and thus demonstrating a Mediterranean approach to financial services.

Do Social Enterprises Finance Their Investments Differently from For-profit Firms? The Case of Social Residential Services in Italy

We develop a theoretical framework, based on a moneylender–firm relationship with moral hazard, to investigate whether enterprise capital structure differs between for-profit and nonprofit sectors. The nondistribution constraint of the nonprofit organizations increases the fraction of own capital on total investment: according to our theoretical predictions, this reduces leverage, defined as the amount borrowed over the total investment. By contrast, the intrinsically high commitment of nonprofit entrepreneurs weakens the moral hazard problem: this augments leverage. We then analyze a longitudinal data set of balance sheets of 504 firms operating in the social residential sector in Italy. Our empirical analysis shows that once controlled for observable characteristics, for-profit companies have a leverage 6% higher than nonprofit enterprises, even if the latter face lower credit costs. We explain this finding by arguing that the effect of the nondistribution constraint prevails over the effect of the social entrepreneurs' intrinsic motivation.

Knowledge Management in Locating the Patient in an Emergency Medical Service in Italy

This study examines an Emergency Medical Service in order to analyze the composite set of activities and instruments directed at locating the patient. The good management of information about the location of the emergency is highly relevant for a reliable rescue service, but this information depends on knowledge of the territory that is socially distributed between EMS operators and callers. Accordingly, the decision-making process often has to go beyond the emergency service protocols, engaging the operator in undertaking an open negotiation in order to transform the caller's role from layman to "co-worker". The patient's location turns out to be an emerging phenomenon, collaborative work based on knowledge management involving two communities--the callers and the EMS operators--that overlap partially. Drawing examples from emergency calls, the study analyzes the practice of locating a patient as a complex and multi-layered process, highlighting the role played by new and old technologies (the information system and the paper maps) in this activity. We argue that CSCW technologies enable the blended use of different kinds of instruments and support an original interconnection between the professional localization systems and the public's way of defining a position.

Exploratory evaluation of an obese population seeking bariatric surgery in an Italian public service

Obesity is a difficult to treat multi-problematic disease. Bariatric surgery (BS) has been regarded as the most effective therapeutic option, however the outcomes strongly depend on baseline conditions and further behavioural modifications. Our aim was to assess the characteristics of severely obese patients seeking BS in a Public Health Service in Italy. Socio-demographic characteristics, eating habits and the presence of stressful situations associated to weight increase, as well as psychiatric disorders of 111 outpatients attending our BS Program were assessed. Twenty-seven percent of patients have familiar history of obesity (FHO). Differences between patients having or not having a FHO were found for several psychiatric conditions, including lower Bulimic symptoms (p=0.025) and lower use of Alcohol (p=0.045). A total of 28.8% of the participants reported a BED; those patients do not differ in BMI (p=0.437) from non-BED patients but had higher psychological disorders associated to eating disorder, as for example Bulimic symptoms (p=0.000), higher BES scores (p=0.000) and psychological distress, such as Depression (p=0.000). Nearly 50% of patients had any psychiatric disorders and depression was the most common disturbance (32.4%); anxiety disorder was present in 15.3% of patients. Moreover, patients who have disclosed traumatic episodes (11.7%) presented higher distress associated to eating disorder variables, such as BES (p=0.001) and EDI-2 BU scores (p=0.000) and presence of BED (p=0.001), and women are more likely to be in this group (p=0.043). Our report proposes that multiple causative factors play a role in obesity, and we need to take them all into account to plan a comprehensive pre- and post-surgical treatment plan.

Unintended Transplantation of Three Organs from an HIV-Positive Donor: Report of the Analysis of an Adverse Event in a Regional Health Care Service in Italy

In February 2007, three organs from an human immunodeficiency virus (HIV)–positive donor were transplanted at two hospitals in the Tuscany Regional Health Care Service, owing to a chain of errors during the donation process. The heart-beating donor was a 41-year-old woman who died as a result of head trauma. The patient's history did not highlight any risky behavior. The available data on previous hospital admissions reported a negative result on HIV testing. During the donation process, the result of the lab test performed for evaluation of organ suitability was mistakenly transcribed from positive to negative. This wrong negative result was then included in the donation record without any cross-check. Therefore, the Regional Transplant Center allocated the liver and both kidneys. The patient also donated tissues, and a second laboratory conducted an evaluation of suitability for the tissue banks. During this process, only 5 days after the successful transplantation procedures, the positive HIV result was fed back to the Regional Transplant Center and the previous error discovered. Transplanted patients were immediately assessed and then treated with antiretroviral medications. A national commission soon performed a systems analysis of the adverse event. Besides the active error committed during the manual transcription for the HIV lab test result, the commission also identified technological factors, such as the lack of integration between the lab machine, the laboratory information system (LIS), and the donor record, as well as organizational factors, such as the distribution to two different labs of the suitability evaluation for organs and tissues. Recommendations included: automatic transmission of lab test results from the lab machine to the LIS and to the donor record, centralization of lab tests for suitability evaluation of organs and tissues, a training program to develop a proactive quality and safety culture in the regional network of donation and transplantations.

Simona Tobia, Advertising America: The United States Information Service in Italy (1945–1956)

Simona Tobia, <i>Advertising America: The United States Information Service in Italy (1945–1956)</i>

“An Apostle for His Work” : The Death of Lieutenant Edward Michael Mckey

Lieutenant Edward Michael McKey delivered food and drink to Italian soldiers in the trenches during World War I. At Fossalta di Piave, on 16 June 1918, McKey became the first Red Cross man killed in Italy. Three weeks later, Lieutenant Ernest Hemingway was wounded in Fossalta while performing the same duties. First in a poem and then in A Farewell to Arms , Hemingway described battlefield deaths that resembled McKey’s. Using the papers of Captain Robert W. Bates, head of the Red Cross ambulance service in Italy, this article depicts McKey and his work in the canteen service.

Short and Long Term Evaluations of Public Employment Services in Italy

In the last decade the European Employment Strategy strongly recommended reforms of active labour market policies, reforms that have generated a spread of evaluation exercises for most of European countries. This paper fills the gap in the literature concerning the Italian case, assessing the efficacy of Public Employment Services (PESs) -after the reforms of 1997, 2000,2003- in increasing the unemployment to employment transition probabilities, through matching techniques. Exploiting the longitudinal dimension of the Labour Force Survey data we design an evaluation structure that allows observing outcomes in both the short (at most 3 months) and the long run (at most 12 and 15 months). In this framework, PES users show a lower probability of finding a job in the short term, because of a lock-in effect, while in the long term this probability turns out to be positive. We also show that PES effects in the long term are much less pronounced when considering as outcome variable the probability of finding a permanent job, a proxy for the quality of the job, suggesting that PES impacts are to a large extent driven by the use of temporary contracts. Furthermore, to deal with issues related to selection on unobservables we carry out two different sensitivity analysis, which confirm our baseline findings.

Utilisation of Hospital Services in Italy: A Comparative Analysis of Immigrant and Italian citizens

In Italy, immigrants from Less Developed Countries (LDCs) have doubled every 10 years since the 1970s and this number grew to 330,000 at the end of 1981, and to more than 1,300,000 in 2001. As the presence of immigrants increases, it becomes ever more important to assess their health needs and utilisation of health services, in order to promote adequate programmes and policies. This study was aimed to compare the patterns of hospital use by immigrants from LDCs living in the Lazio Region, Italy, with those of the resident Italians. The study was based on the hospital discharge data collected by the Lazio Region Hospital Information System. Discharges of immigrants from acute hospitals in Lazio during 2005 were compared with discharges of resident Italians. Age- and sex-specific hospitalisation rates (per 1,000) were also calculated for legal immigrants and Italians aged 18 years and over. Of 56,610 foreign patients from LCDs admitted to hospitals in Lazio during 2005, 88% were legally residing in the region. The immigrants were younger than the Italians (mean age 30.6 and 51.7 years, respectively), more than half were female and single, and about 1/3 had studied for 9 or more years. Among males, a similar pattern of hospital use by age was observed for foreigners and Italians, with the rates for foreigners in acute care being higher among young people (due to traumatic accidents) and lower among the oldest. Differently, among foreign females, the admission rates for both acute and day care settings varied with women's age, the pattern of hospital use being strongly influenced by reproductive events. The main reason for hospitalisation of foreign males in acute care was injuries (approximately 1/4 of all discharges), and in day care was neoplasms; among females, more than half of the admissions were for childbirth in acute or induced abortions in day care. Injuries for males and induced abortions for females were identified as critical areas for migrants' health, in which public health interventions may be promoted.

Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy

BackgroundThere is a lack of knowledge concerning the relationship between two closely-linked multidimensional variables: frailty and quality of life (QOL). The aim of this study was to investigate dimensions and correlates of QOL associated with frailty status among community-dwelling older outpatients.MethodsWe conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009. Participants underwent a comprehensive geriatric assessment, including assessment of their frailty status according to the Study of Osteoporotic Fractures (SOF) criteria, and QOL, which was evaluated by using the Older People's QOL (OPQOL) questionnaire. One-way ANOVA and chi-squared tests were used to find correlates of frailty, including QOL dimensions, after stratification of participants in the "robust" (n = 72), "pre-frail" (n = 89) and "frail" (n = 78) groups. Multiple linear regression analyses were performed to find correlates of QOL in the overall sample and among "frail" and "robust" participants.ResultsA negative trend of QOL with frailty status was found for almost all dimensions of QOL (health, independence, home and neighbourhood, psychological and emotional well-being, and leisure, activities and religion) except for social relationships and participation and financial circumstances. Independent correlates of a poor QOL in the total sample were "reduced energy level" (SOF criterion for frailty), depressive status, dependence in transferring and bathing abilities and money management (adjusted R squared 0.39); among "frail" participants the associations were with depressive status and younger age, and among "robust" participants the association was with lower body mass index.ConclusionsFive out of seven dimensions of QOL were negatively affected by frailty, but only one SOF criterion for frailty was independently related to QOL, after correction for age, functional status and depression. A more advanced age as well as a better affective status were correlates of a better QOL among frail elders. Interventions targeting the QOL in frail community-dwelling older outpatients should consider as outcomes, not only health-related QOL, but also other domains of the QOL.

Public Health Transfers in Kind: Measuring the Distributional Effects in Italy

The aim of the paper is to translate into a monetary amount the benefits received by the provision of health related public services in Italy, analyze their incidence and relevance and study their implications on the distribution of income amoung individuals. Beyond the traditional insurance-based approach, we propose an alternative method, which assigns health related transfers according also to the individual income and self-assessed health status. We apply the two approaches to Italy in 2003. In addition, we test for equality of health opportunities among citizens.

Four-Year Follow-Up of Long-Stay Patients Settled in the Community After Closure of Italy's Psychiatric Hospitals

Four-Year Follow-Up of Long-Stay Patients Settled in the Community After Closure of Italy's Psychiatric Hospitals

Stroke in neurological services in Italy

To assess the stroke workload of Italian neurological services and to correlate it with indicators of each hospital’s emergency setting. A semi-structured questionnaire was sent to the 220 neurology units (NU) located in hospitals with an emergency room (ER) (155 responders, 71%). Stroke was the most common discharge diagnosis (29%) (273 patients/year/NU on average) and condition requiring consultation in ER (28%). A stroke unit was available in 28% of NU, bedside monitors in 45%, a 24 hour/day and 7 day/week (24/7) CT scan in 90%, a 24/7-MRI in 32%, a 24/7 on-duty neurologist in 36%. The stroke workload was correlated only with the number of ER consultations per year, and marginally to the presence of stroke units and the number of monitored beds in the univariate, but not in the multivariate analysis. The stroke workload in Italian NU is very high, but is largely unrelated to their structural and functional characteristics, in contrast with the international indications requiring several essential criteria for the best hospital management of all stroke patients.