Spatial agglomeration and business groups: new evidence from Italian industrial districts

This paper is a first attempt to analyse the relationship between spatial agglomeration and firms’ organizational structures. It takes advantage of a large data set on Italian business groups that allowed us to analyse the differences in the presence and characteristics of business groups between districts and non district areas. Overall the result confirms the hypothesis that spatial agglomeration of business activities influences firms’ organization. Groups are more widespread in industrial districts than in non-district areas; moreover groups in industrial districts are less diversified and more spatially concentrated than groups outside industrial districts. Key words: business groups, industrial districts, spatial agglomeration, firm’s organizational forms JEL Classification: L22, R12

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Comparison Between First Line Target Therapy and Immunotherapy in Different Prognostic Categories of BRAF Mutant Metastatic Melanoma Patients: An Italian Melanoma Intergroup Study

BackgroundBRAF and MEK inhibitors target therapies (TT) and AntiPD1 immunotherapies (IT) are available first-line treatments for BRAF v600 mutant metastatic melanoma patients. ECOG PS (E), baseline LDH (L), and baseline number of metastatic sites (N) are well-known clinical prognostic markers that identify different prognostic categories of patients. Direct comparison between first-line TT and IT in different prognostic categories could help in first line treatment decision. MethodsThis is a retrospective analysis conducted in 14 Italian centers on about 454 metastatic melanoma patients, divided in 3 groups: group A-patients with E = 0, L within normal range, and N less than 3; group B-patients not included in group A or C; group C-patients with E > 0, L over the normal range, and N more than 3. For each prognostic group, we compared TT and IT in terms of progression free survival (PFS), overall survival (OS), and disease control rate (DCR). ResultsIn group A, results in 140 TT and 36 IT-treated patients were, respectively, median PFS 35.5 vs 11.6 months (HR (95% CI) 1.949 (1.180-3.217) p value 0.009); median OS not reached vs 55 months (HR (95% CI) 1.195 (0.602-2.373) p value 0.610); DCR 99% vs 75% p value <0.001). In group B, results in 196 TT and 38 IT-treated patients were, respectively, median PFS 11.5 vs 5 months (HR 1.535 (1.036-2.275) p value 0.033); median OS 19 vs 20 months (HR 0.886 (0.546-1.437) p value 0.623); DCR 85% vs 47% p value <0.001). In group C, results in 41 TT and 3 IT-treated patients were, respectively, median PFS 6.4 vs 1.8 months (HR 4.860 (1.399-16) p value 0.013); median OS 9 vs 5 months (HR 3.443 (0.991-11.9) p value 0.052); DCR 66% vs 33% p value 0.612). ConclusionsIn good prognosis, group A-TT showed statistically significant better PFS than IT, also in a long-term period, suggesting that TT can be a good first line option for this patient category. It is only in group B that we observed a crossing of the survival curves after the 3rd year of observation in favor of IT. Few patients were enrolled in group C, so few conclusions can be made on it

Spatial agglomeration and business groups: New evidence from Italian industrial districts

Cainelli G., Iacobucci D. and Morganti E. (2006) Spatial agglomeration and business groups: new evidence from Italian industrial districts, Regional Studies 40, 507-518. This paper is a first attempt to analyse the relationship between spatial agglomeration and firms' organizational structures. It takes advantage of a new and large data set at firm and business group level that allows one to analyse the differences in the presence and characteristics of business groups between districts and non-district areas. Overall, the results confirm the hypothesis that spatial agglomeration of business activities influences firms' organization. Groups are more widespread in industrial districts than in non-district areas; moreover, groups in industrial districts are less diversified and more spatially concentrated than groups outside industrial districts. Cainelli G., Iacobucci D. et Morganti E. (2006) L'agglomeration geographique et les groupes commerciaux: de nouvelles preuves provenant des districts italiens, Regional Studies 40, 507-518. Cet article constitue une premiere tentative d'analyser le rapport entre l'agglommeration geographique et les structures organisationnelles des entreprises. On profite d'une nouvelle banque de donnees importante aupres des entreprises et des activites commerciales qui permet l'analyse des differences de la presence et des caracteristiques des groupes commerciaux implantes dans les districts par rapport a ceux qui sont implantes dans d'autres delimitations geographiques. Tout considere, les resultats confirment l'hypothese suivant: l'agglomeration des activites commerciales influent sur l'organisation des entreprises. Les groupes s'averent plus eparpilles dans les districts industriels qu'ils ne le sont ailleurs. Qui plus est, les groupes situes dans les districts industriels sont moins diversifies et plus concentres geographiquement que ne le sont les groupes situes en dehors des districts industriels. Groupes commerciaux, Districts industriels, Agglomeration geographique, Formes d'organisation des entreprises Cainelli G., Iacobucci D. und Morganti E. (2006) Raumliche Ballung und Betriebsgruppen:neue Beweise aus italienischen Industriegebieten, Regional Studies 40, 507-518. Dieser Aufsatz stellt einen ersten Versuch dar, die Beziehung zwischen raumlicher Ballung und den organisatorischen Strukturen von Firmen zu analysieren. Er macht sich eine neue und umfassende Datenreihe auf Firmen- und Betriebsgruppenebene zu Nutze, die gestattet, die Unterschiede im Vorhandenseins und Eigenschaften von Betriebsgruppen zwischen Distrikten und nicht-Distrikten-angeho rigen Gebieten zu analysieren. Insgesamt bestatigen die Ergebnisse die Hypothese, dass raumliche Ballung von geschaftlichen Unternehmen die Organisation von Firmen beeinflusst: Gruppen sind in Industriegebieten weiter verbreitet als in nicht industriell gepragten Gebieten;daruber hinaus sind Gruppen in Industriegebieten weniger differenziert und raumlich starker konzentriert als Gruppen ausserhalb der Industriegebiete Betriebsgruppen, Industriegebiete, raumliche Ballung, Organisationsformen von Firmen Cainelli G., Iacobucci D. y Morganti E. (2006) Aglomeracion espacial y grupos comerciales: nuevo ejemplo de zonas industriales en Italia, Regional Studies 40, 507-518. En este ensayo pretendemos analizar por primera vez la relacion entre la aglomeracion espacial y las estructuras organizativas de las empresas. Con ayuda de un nuevo y exhaustivo grupo de datos sobre empresas y negocios, analizamos que diferencias existen en cuanto a la presencia y las caracteristicas de grupos comerciales en zonas industriales comparado con otras areas no industriales. En general los resultados confirman la hipo tesis de que la organizacion de las empresas se ve influenciada por la aglomeracion espacial de las actividades comerciales. Se observa que son mas comunes los grupos en zonas industriales que en areas no industriales. Ademas, los grupos en zonas industriales estan menos diversificados y espacialmente mas concentrados que los grupos de otras areas no industriales. Grupos comerciales, Zonas industriales, Aglomeracion espacial, Formas organizativas de empresasBusiness groups, Industrial districts, Spatial agglomeration, Firm's organizational forms,

Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients

Background: Hypertension management in older patients represents a challenge, particularly when hospitalized. Objective: The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients. Methods: A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge. Results: Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. Conclusions: Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients