Openness to mystical experience and psychological type : a study among Italians

This study examines Ross’ thesis that intuitive types are more open than sensing types to mystical experience among a sample of 1,155 Italians who completed the Francis Psychological Type Scales alongside the Mystical Orientation Scale. The data supported Ross’ thesis. Intuitive types recorded a significantly higher mean score than sensing types on the index of mystical orientation. Ranking the sixteen complete types according to their mean mystical orientation scores located INFPs with the highest scores and ISTJs with the lowest scores

Price discrimination in the Italian medical device industry: an empirical analysis

In this paper we ascertain that the Italian market for medical devices is characterized by significant price dispersion. We have, therefore, carried out an econometric analysis, as well as a Bayesian network analysis to verify if price dispersion is due to price discrimination. We have found that ASLs (Aziende Sanitarie Locali) incur higher procurement costs than AOs (Aziende Ospedaliere), which purchase larger quantities as Centralized purchasing agencies do. Consequently, second-degree price discrimination may be one of the causes of price differences. Price levels are also inversely related to product age because of intense innovative activity, making product differentiation more likely than price discrimination. Public procurement agents located in Southern Italy pay higher prices than those located in Northern or Central Italy. This is due to the higher probability for Southern procurement agents to purchase from independent wholesalers, rather than from producers, implying a double marginalization effect which raises final prices. It is also more likely that obsolete medical devices are sold to Southern health care providers

Work-related psychological health among Catholic religious in Italy : testing the balanced affect model

Drawing on the classic model of balanced affect, the Francis Burnout Inventory (FBI) conceptualised good work-related psychological health among religious leaders in terms of negative affect being balanced by positive affect. In the FBI negative affect is assessed by the Scale of Emotional Exhaustion in Ministry (SEEM) and positive affect is assessed by the Satisfaction in Ministry Scale (SIMS). A sample of 156 religious leaders (95 men and 61 women) serving with the Roman Catholic Church in Italy completed SEEM and SIMS together with an independent measure of wellbeing. The results confirm the hypothesis that high SIMS scores reduced the negative effects of high SEEM scores on the independent measure of wellbeing

ESSAY IN HEALTH ECONOMICS AND INDUSTRIAL ORGANIZATION

Industrial organization focuses on imperfectly competitive markets to understand the behavior of firms and the resulting welfare effects. This is a broad definition as most markets are imperfectly competitive and industrial organization research can then focus on a wide variety of topics. Imperfect competition may be due to many reason. Perfect competition in fact requires: a large number of firms and consumers, free entry and exit, marketability of all goods and service including risk, symmetric information with zero search cost. Moreover the list includes no increasing returns, no externalities, and no collusion. Health care markets are a good example for imperfect competition as generally they violate all requirements included in the previous list. If we focus only on some violation like asymmetric information and no marketability, then health care markets fail in a more clear way than other markets. This justifies the often made claim that the health care market is \u201cdifferent\u201d and implies that any evaluation of its performance must be based on models that explicitly take into account its deviations from the assumption required for perfect competition. The model of perfect competition can still serve as the benchmark of optimal performance, but generally it cannot be used to analyze how health care markets work. For this reason the common thread of this thesis is to analyze health care markets using the theoretical and empirical tools provided by industrial organization. This thesis is composed by three essays. In the first one I am going to propose a theoretical framework to analyze product differentiation with consumers misperception and information disparities. The model is an extension of standard vertical product differentiation (Gabsewictz and Thisse, 1979 and Shaked and Sutton, 1982), where I relax the assumption of perfect information. As I said before asymmetric information is one of the big problem to deal with in health economics. And if products are credence goods, as in case of drugs, many consumers may lack the expertise to ascertain the quality differential with respect to cheaper standard brands, even after purchase. In that case consumers face a risky decision and to the extent they lack information about the true quality differential they may carry out purchase decision according to misperceptions about product quality. In this paper I extend the analysis of Cavaliere (2005) to include the quality choice by firms, when providing higher quality requires a costly effort, and propose to analyse the case of a duopoly with vertically differentiated products with consumers\u2019 misperceptions and information disparities. Consumers are actually split between uninformed and informed consumers. Uninformed consumers are characterized by consumers\u2019 misperceptions as they can underestimate or overestimate the quality differential. As a minimum quality standard is imposed by the Government even uninformed consumers expect that any product sold in the market at least complies with the standard. As low quality can be said to be verifiable, even uninformed consumers can be confident about low quality products: firms are expected to provide at least the minimum quality standard. This last assumption well fits the case of pharmaceutical products. Actually every developed country has a national institution that enforces and verifies drug\u2019s minimum quality standard. The aim of this paper is to shed light on how firm set price and quality when consumers are characterized by asymmetric information and mispercemption obout quality. We do not analyze information decisions by consumers, which are exogenously given, therefore firms follow a Stackelber behavior vis \ue0 vis consumers. However we can analyze quality and price competition between firms for the full range of information disparities, i.e. for any split between informed and uninformed consumers that can affect demand functions. Furthermore we distinguish between the case of optimistic misperceptions (uninformed consumers overestimate the quality differential) and the case of pessimistic consumers (uninformed consumers underestimate the quality differential). Competition between firms is represented by a two stage game, in the first stage the two firms compete in qualities, given the market split between informed and uninformed consumers. In the second stage price competition takes place. We will show that both price and quality are strictly depend on asymmetric information as expectation and number of informed consumer affect firm\u2019s choice. For different quality expectations and share of informed consumer we found market failure. In some cases uninformed consumers are cheated by high quality firm when they purchase high quality product, in other cases, for different information level and expectations, adverse selection arises endogenously in the model. The second paper consists in a theoretical model where I analyse incentives for cooperative behaviour when heterogeneous health care providers are faced with regulated prices under yardstick competition. Providers are heterogeneous in the degree to which their interests match to those of the regulator. The basic idea behind yardstick competition is that the price (or price cap) faced by each provider is dependent on the actions of all the other providers (Schleifer, 1985; Laffont and Tirole, 1993). According to Schleifer\u2019s rule, the price each provider faces is based on the costs of all other providers in the industry but not its own. This creates strong incentives for cost control. When there is a large number of providers, this is unlikely to be a problem, mainly because the cost of collusion rises, but even in larger countries, provision might be concentrated among a handful of providers, as is likely for utilities, rail or postal services and for specialist health services, such as bone marrow or lung transplantation. The innovation with respect to the standard model of yardstick competition is the introduction of heterogeneity in the degree to which the provider\u2019s interests correspond to those of the regulator. Because the incentive to collude with other providers will depend on the objectives of the providers, particularly the extent to which their objectives correspond with those of the price-setting regulator. We use \u201caltruism\u201d to describe the behavior of providers whose aims are closely related to those of the regulator and \u201cself-interested\u201d to describe providers whose interests are more divergent from those of the regulator. If we consider the different ownership types in health services this heterogeneity in \u201caltruism\u201d is evident since we observe full public ownership i.e. altruistic providers and full private hospital i.e. self-interested providers. This paper aims then to analyse incentives for collusive behaviour when heterogeneous providers are faced with regulated prices under yardstick competition. We analyse the choice of cost when providers do not collude and when they do, and we consider incentives to defect from the collusion agreement Our results suggest that under the yardstick competition each provider\u2019s choice of cooperative cost is decreasing in the degree of the other provider\u2019s altruism, so a self-interested provider will operate at a lower cost than an altruistic provider. The prospect of defection serves to moderate the chosen level of operating cost. More general results show that collusion is more stable in homogeneous than in heterogeneous markets. The third paper is an empirical analysis where I test the hypotheses of physicians\u2019 altruism and ex-post moral hazard using a large national panel dataset of drug prescription records from Finland. We estimate the probability that doctors prescribe generic versus branded versions of statins for their patients as a function of the shares of the difference in prices between what patients have to pay out of their pocket and what are covered by insurance. The role of physicians and insurance in health care markets has been of interest to economists since the seminal contribution of Arrow (1963). Pioneering the economic analysis of physician behavior in the context of health care, Arrow (1963) noticed that doctors may have motives and objectives that differentiate them from purely profit-maximizing agents. The original \u2018ex-post moral hazard\u2019 hypothesis, predicts that health insurance increases the consumption of health care and leads to excessive consumption of services even in a competitive health care market. Ex-post moral hazard has since then been the focus of various empirical and theoretical studies in health economics (see e.g. Feldstein, 1973; Leibowitz, Manning, and Newhouse, 1985; Manning, Newhouse, Duan, Keeler, Leibowitz, and Marquis, 1987; Dranove, 1989; Zweifel and Manning, 2000). We simultaneously test both altruism and ex-post moral hazard in drug prescription behavior using a large national panel of administrative data from Finland. We first develop a theoretical model on physician decision-making, which, in line with Hellerstein (1998) and Lundin (2000), then use a large national panel dataset with all statin prescriptions in Finland between 2003 and 2010 (n=17 858 829 prescriptions) to test the physicians\u2019 altruism and ex-post moral hazard hypotheses, while controlling for a large range of physicians, patients, and drug characteristics. Taking advantage of the panel structure of our national administrative dataset, we directly observe the repeated prescriptions of statins by physicians over time. We find that although the estimated coefficients associated with ex-post moral hazard and altruism are statistically significantly different from zero, their size is very close to zero and the orders of magnitude is smaller than the effects associated with other key explanatory factors. We also find robust and strong evidence of prescription habit-dependency

<b><i>Topoisomerase 1</i></b> Promoter Variants and Benefit from Irinotecan in Metastatic Colorectal Cancer Patients

Objective: Topoisomerase 1 (topo-1) is an important target for the treatment of metastatic colorectal cancer (CRC). The aim of the present study was to evaluate the correlation between topo-1 single-nucleotide polymorphisms (SNPs) and clinical outcome in metastatic CRC (mCRC) patients. Methods: With the use of specific software (PROMO 3.0), we performed an in silico analysis of topo-1 promoter SNPs; the rs6072249 and rs34282819 SNPs were included in the study. DNA was extracted from 105 mCRC patients treated with FOLFIRI ± bevacizumab in the first line. SNP genotyping was performed by real-time PCR. Genotypes were correlated with clinical parameters (objective response rate, progression-free survival, and overall survival). Results: No single genotype was significantly associated with clinical variables. The G allelic variant of rs6072249 topo-1 SNP is responsible for GC factor and X-box-binding protein transcription factor binding. The same allelic variant showed a nonsignificant trend toward a shorter progression-free survival (GG, 7.5 months; other genotypes, 9.3 months; HR 1.823, 95% CI 0.8904-3.734; p = 0.1). Conclusion: Further analyses are needed to confirm that the topo-1 SNP rs6072249 and transcription factor interaction could be a part of tools to predict clinical outcome in mCRC patients treated with irinotecan-based regimens

Functional Tricuspid Regurgitation Repair at the time of Left-Sided Valve Surgery. the Impact on the Cardiac Rehabilitation Program

Objective: to compare the early post-operative functional status and the efficacy of the cardiac rehabilitation program (CRP) after isolated left-sided valvular surgery or with concomitant tricuspid valve repair (TVR). Methods: we retrospectively enrolled patients admitted to the Cardiac Rehabilitation Unit of our institution from January 2014 to January 2019, following mitral or aortic valve surgery. In agreement with current guidelines, concomitant tricuspid annuloplasty was added to patients with severe functional tricuspid regurgitation (TR) and in those with mild to moderate TR when annulus dilatation was present. A 6-minute walk test (6mWT) was performed within the second day of admission and repeated predischarge. The distances walked on the 6mWT were reported as absolute value and as a percentage of the predicted value, taking into account anthropometric variables. Changes in the 6mWT performance and Barthel index (BI) were assessed to evaluate the impact of CRP on exercise tolerance and functional independence, respectively. Results: of 117 patients, 62 (53%) had isolated left-sided valvular surgery and 55 (47%) had concomitant TVR. There were no significant differences between the two groups in the baseline 6mWT performance and its improvement at the end of CRP. TVR was associated with a worse BI on admission, but with a greater improvement after the CRP and a pre-discharge BI comparable to isolated left-sided surgery. Upon linear regression analysis, diabetes and chronic renal disease were predictors of the baseline 6mWT performance. Conclusion: TVR does not affect the early post-operative functional status and the efficacy of the CRP after valvular surgery

Psychological predictors of professional burnout among priests and religious sisters in Italy : the dark triad versus the bright trinity?

Drawing on data provided by 287 Catholic priests, religious brothers, and religious sisters from different parts of Italy (130 men and 157 women), this study explored the effect of three dark psychological variables and three bright psychological variables on levels of professional burnout as assessed by the two scales of the Francis Burnout Inventory (emotional exhaustion and satisfaction in ministry). The three dark psychological variables assessed by the Short Dark Triad were Machiavellianism, subclinical Narcissism, and subclinical Psychopathy. The three bright psychological variables were purpose in life, emotional intelligence, and religious faith. After controlling for personal factors (age and sex) and personality factors (extraversion and emotionality), the data demonstrated that all three bright psychological factors (purpose in life, emotional intelligence, and religious faith) served as independent and cumulative predictors of higher levels of satisfaction in ministry, and that the three dark psychological factors had no effect on satisfaction in ministry. Two of the three dark psychological factors (Machiavellianism, and subclinical Psychopathy) served as independent and cumulative predictors of higher levels of emotional exhaustion in ministry, and purpose in life served as a predictor of lower levels of emotional exhaustion in ministry