A Multisectoral Analysis for economic policy: an application for healthcare systems and for labour market composition by skills

L\u2019Agenda Digitale Europea stabilisce il ruolo chiave delle tecnologie dell\u2019informazione e della comunicazione (TIC) grazie a un mercato digitale unico basato su internet veloce e superveloce e su applicazioni interoperabili, al fine di ottenere vantaggi socioeconomici sostenibili COM(2010)245. Le TIC producono un'innovazione di prodotto e cambiamenti strutturali all'interno di tutto il sistema economico e possiamo affermare che dal punto di vista multisettoriale hanno un ruolo moltiplicativo sulla crescita economica, poich\ue9 l\u2019aumento della domanda di TIC stimola a sua volta tutte le altre produzioni. Inoltre come riscontrato in letteratura economica, nelle istituzioni internazionali, nonch\ue9 confermate dai dati periodici rilasciati dagli uffici statistici nazionali, una maggiore incidenza della popolazione attiva formalmente istruita in associazione con l'adozione delle TIC \ue8 altamente correlata ad una crescita robusta, sostenibile ed equa. In questo quadro \ue8 importante valutare il ruolo delle TIC nel sistema economico, in particolare verr\ue0 analizzato il ruolo delle TIC sia rispetto ad un particolare settore quello della sanit\ue0, che dal lato dei soggetti che dovrebbero essere parte attiva nella gestione delle TIC ovvero la situazione delle abilit\ue0 digitali dei lavoratori dipendenti. Il primo articolo si focalizza sul ruolo delle TIC nella determinazione dell\u2019output del settore sanitario, utilizzando il database WIOD (World Input Output Database), di 24 paesi nell\u2019arco temporale 2000-2014, tenendo conto anche dei differenti sistemi sanitari nazionali. La produzione del settore \u201cSanit\ue0 e Servizi Sociali\u201d assume, almeno in alcuni paesi specifici, il ruolo di stimolo all\u2019innovazione che compensa ampiamente quello di peso sul bilancio pubblico. Nel secondo articolo analizziamo come l\u2019uso delle TIC stia progressivamente aumentando nel sistema sanitario italiano e in particolare come l'introduzione del Fascicolo Sanitario Elettronico (FSE), strumento di condivisione dei dati sanitari del singolo cittadino, potrebbe determinare cambiamenti nella produzione sui servizi sanitari. Verranno analizzati gli eventuali cambiamenti strutturali dei processi produttivi e della produzione totale applicando l'Analisi Strutturale di Decomposizione (SDA). La base dati di riferimento sar\ue0 la tavola di Input-Output riferita a due diversi periodi al fine di individuare i risultati sia degli effetti tecnologici sia della domanda finale a livello settoriale. Infine l\u2019ultimo articolo ha l\u2019obiettivo di valutare le conseguenze dei cambiamenti nella composizione dell'occupazione per competenza digitale all\u2019interno del flusso di produzione e distribuzione del reddito. Verr\ue0 costruita una Matrice di Contabilit\ue0 Sociale (SAM) che consente di rappresentare le relazioni tra i cambiamenti di produzione delle attivit\ue0 e i cambiamenti di compensazione dei dipendenti per competenze, grado di digitalizzazione e genere. LA SAM sviluppata nel documento \ue8 relativa all'Italia nel 2013; il lavoro \ue8 disaggregato in competenze formali / non formali / informali e, inoltre, competenze digitali / non digitali. Le abilit\ue0 digitali del lavoro seguono la definizione di \u201ccompetenza formale\u201d della Commissione Europea (2000): i) competenza formale a seconda del livello di istruzione e formazione; ii) competenza non formale acquisita sul posto di lavoro e attraverso le attivit\ue0 delle organizzazioni e dei gruppi della societ\ue0 civile; iii) competenza informale non acquisita intenzionalmente durante la vita. In questo quadro \ue8 stata introdotta un'ulteriore classificazione di input di lavoro basata sull'uso / non utilizzo di computer collegati a Internet. Sulla base della SAM, \ue8 stato implementato un modello multisettoriale esteso. Infine, verr\ue0 individuata una struttura adeguata di domanda finale che consente di ottenere i migliori risultati in termini di valore aggiunto distribuiti a lavoratori pi\uf9 qualificati con una elevata competenza digitale

The impact of new surgical techniques on geographical unwarranted variation: The case of benign hysterectomy

Since the 1980s, the international literature has reported variations for healthcare services,especially for elective ones. Variations are positive if they reflect patient preferences, while ifthey do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the mostfrequent elective surgical procedures in developed countries, and, in recent years, it has beenincreasingly delivered through minimally invasive surgical techniques, namely laparoscopic orrobotic. The question therefore arises over what the impact of these new surgical techniques onavoidable variation is. In this study we analyze the extent of unwarranted geographical variation oftreatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in anItalian regional healthcare system. We assess the impact of the surgical approach on the provision ofbenign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (bymeasuring the post-operative complications). Geographical variation was observed among regionalhealth districts for treatment rates and waiting times. At a provider level, we found differences forthe minimally invasive approach. We found a positive and significant association between rates andthe percentage of minimally invasive procedures. Providers that frequently adopt minimally invasiveprocedures have shorter average length of stay, and when they also perform open hysterectomies,fewer complications

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

Objective This study aimed to estimate healthcare costs of diabetic foot disease (DFD) in a large population-based cohort of people with type-2 diabetes (T2D) in the Tuscany region (Italy). Data sources/study setting Administrative healthcare data of Tuscany region, with 2018 as the base year. Study design Retrospective study assessing a longitudinal cohort of patients with T2D. Data collection/extraction methods Using administrative healthcare data, DFD were identifed using the International Classifcation of Diseases, Ninth Revision, Clinical Modifcation codes. Methods We examined the annual healthcare costs of these clinical problems in patients with T2D between 2015 and 2018; moreover, we used a generalized linear model to estimate the total healthcare costs. Principal fndings Between 2015 and 2018, patients with T2D experiencing DFD showed signifcantly higher average direct costs than patients with T2D without DFD (p<0.0001). Among patients with T2D experiencing DFD, those who experienced complications either in 2015–2017 and in 2018 incurred the highest incremental costs (incremental cost of € 16,702) followed by those with complications in 2018 only (incremental cost of € 9,536) and from 2015 to 2017 (incremental cost of € 800). Conclusions DFD signifcantly increase healthcare utilization and costs among patients with TD2. Healthcare costs of DFD among patients with T2D are associated with the timing and frequency of DFD. These fndings should increase awareness among policymakers regarding resource reallocation toward preventive strategies among patients with T2

Aprendizajes y prácticas educativas en las actuales condiciones de época: COVID-19

“Esta obra colectiva es el resultado de una convocatoria a docentes, investigadores y profesionales del campo pedagógico a visibilizar procesos investigativos y prácticas educativas situadas en el marco de COVI-19. La misma se inscribe en el trabajo llevado a cabo por el equipo de Investigación responsable del Proyecto “Sentidos y significados acerca de aprender en las actuales condiciones de época: un estudio con docentes y estudiantes de la educación secundarias en la ciudad de Córdoba” de la Facultad de Filosofía y Humanidades. Universidad Nacional de Córdoba. El momento excepcional que estamos atravesando, pero que también nos atraviesa, ha modificado la percepción temporal a punto tal que habitamos un tiempo acelerado y angustiante que nos exige la producción de conocimiento provisorio. La presente publicación surge como un espacio para detenernos a documentar lo que nos acontece y, a su vez, como oportunidad para atesorar y resguardar las experiencias educativas que hemos construido, inventado y reinventando en este contexto. En ella encontrarán pluralidad de voces acerca de enseñar y aprender durante la pandemia. Este texto es una pausa para reflexionar sobre el hacer y las prácticas educativas por venir”.Fil: Beltramino, Lucia (comp.). Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Escuela de Archivología; Argentina

Managing the performance of general practitioners and specialists referral networks: A system for evaluating the heart failure pathway

Abstract High quality chronic disease management requires coordinated care across different healthcare settings, involving multidisciplinary teams of professionals, and performance evaluation systems able to measure this care. Inter-organizational performance should be measured considering the professional relationships between general practitioners (GPs) and specialists, who are usually linked through informal referral networks. The aim of this paper is to identify and evaluate the performance of naturally occurring networks of GPs and hospital-based specialists providing care for congestive heart failure (CHF) patients in Tuscany, Italy. The analysis focuses on the identification and classification of networks, following CHF patients (n = 15,841) through primary care and inpatient care using administrative data, and on the assessment of process and outcome indicators for CHF patients in these referral networks. We demonstrate the existence of informal links between GPs and hospitals based on patterns of patient flow. These networks which are not geographically based vary in the intensity of relationships and quality of care. Such referral networks may represent the most effective accountability level for chronic disease management, since they encompass the multiple care settings experienced by patients. Overall, an integrated approach to evaluation and performance management that considers the naturally occurring links between professionals working in different settings may enable more efficient, integrated care and quality improvements

The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications

Calcareous plankton bio-chronostratigraphy and sedimentology of the "I Sodi" section (Siena Basin, Italy): a key section for the uppermost Neogene marine deposition in the inner northern Apennines

6noreservedThe “I Sodi” section is exposed in the homonymous quarry in the northern sector of the Siena Basin, one of the most extended Neogene-Quaternary post-collisional basins of the northern Apennines. The section is composed almost exclusively of marine mudstone containing a rich fossil assemblage and has been extensively investigated in past and recent times. It represents a key section to define the time interval of marine deposition in the Siena Basin and more generally in the inner northern Apennines, with important structural and stratigraphic implications. The marine infill of the Siena Basin is traditionally attributed to the Zanclean-Piacenzian (Pliocene) age. However, recently published data provided a more recent age for the “I Sodi” section (Calabrian, Lower Pleistocene) and, consequently, for the Siena Basin. This paper provides new data on this scientific debate, from sedimentological and biostratigraphical investigations. Analyses of planktonic foraminifera and calcareous nannofossils have been carried out in order to better constrain the depositional age of the section. As a result, this section is now dated more accurately to the Piacenzian. and possibly to the lowermost Gelasian in its upper part.mixedMartini, Ivan; Foresi, Luca Maria; Bambini, Anna Maria; Riforgiato, Federica; Ambrosetti, Elisa; Sandrelli, FabioMartini, Ivan; Foresi, Luca Maria; Bambini, Anna Maria; Riforgiato, Federica; Ambrosetti, Elisa; Sandrelli, Fabi