The more you know, the better you act? Institutional communication in Covid-19 crisis management.

The plurality of communication channels and the spread of fake news are widespread phenomena in today's society. Those constituted a serious risk during the Covid-19 pandemic crisis management, increasing the confusion among the population. This research aims at assessing the effectiveness of institutional communication amid the management of the Covid-19 pandemic crisis in Italy. We first assessed the phenomenon by building a structured theoretical background stressing the concepts of risk communication, community engagement, and health literacy, highlighting the dynamic and continuously changing scenario of communication strategies, also due to the spread of social media and the mutation of conventional media outlets. We sent a questionnaire to a sample of citizens to assess the impact of three predictors, i.e., the perceived communication, the perceived knowledge, and the perceived information. Based on answers, we built an ordered logit model assigning continuous intervals as values for the dependent variables. The observed results enhanced the crucial role of the phenomenon of health literacy and the impact of asymmetric information on the effectiveness of institutional communication. Education played a fundamental role in understanding communication pillars and building an individual consciousness about health risks prevention.

The ability of lumbar spine DXA and phalanx QUS to detect previous fractures in young thalassemic patients with hypogonadism, hypothyroidism, diabetes, and hepatitis-B: A 2-year subgroup analysis from the Taranto Area of Apulia Region.

BACKGROUND: Osteoporosis is a leading cause of morbidity in patients affected by ß-thalassemia major or intermediate; we aimed to assess the association between demineralization observed in young thalassemic patients. METHODS: A total of 88 patients with ß-thalassemia were recruited at Microcitemia Center of Taranto Hospital under the Prevention Osteoporosis and Fractures research project from 2008 to 2010. All the patients were screened with both dual energy x-ray absorptiometry (DXA) and quantitative ultrasound (QUS). T score and Z score values were obtained for each subject. RESULTS: The overall prevalence of demineralization was 84% with DXA and 70% with QUS, whereas normality was found in 16% of patients screened with DXA and in 30% of cases with QUS. Hypogonadism, hypothyroidism, diabetes mellitus, hepatitis-B, and the presence of previous fragility fractures were significantly associated with the demineralization status (lower T scores values) both with DXA and QUS. CONCLUSION: Our data confirm that DXA and QUS examinations are both useful for detecting bone demineralization in thalassemic patients.

A systematic literature review on the determinants of sustainability reporting systems.

In the last decade, the use of sustainability reporting as a tool for communicating and reporting on the performance of sustainability objectives by companies has led to a growing awareness of its value and development in the corporate world. Therefore, exploring this phenomenon for a better understanding and identifying its characteristic elements is important. This study aims to systematically review the literature to establish the distinctive elements of sustainability reporting and provide a complete theoretical framework that allows the classification of the drivers that are crucial for adopting sustainability reporting. Through the analysis, we describe the characteristic elements of sustainability reporting in a homogeneous and concise summary. The drivers that result, may prove useful not only in the context of non-financial reporting but also in encouraging adequate economic-business reflections that may inspire new research trajectories for scholars in this field.

Pharmaco-economic issues in the treatment of severe osteoporosis.

INTRODUCTION: clinical guidelines recommend to identify and treat people at high risk of fracture. METHODS: we have carried out a simulation concerning pharmaco-economic issues in the treatment of severe osteoporosis and particularly those people with previous femoral fragility fractures, assuming that only 13.1% of hip fractured patients had started a proper antifracture therapy, as shown by the analysis of the Tuscany regional database. RESULTS: Annual costs sustained by the Italian healthcare system for treating hip fractured patients all over Italy have been estimated to range from 2 560 000 in year 2000 to 3 291 750 in year 2005, representing only 0,3% of the overall costs sustained because of hip fractures in Italy. CONCLUSIONS: Sixty percent of the pharmacological costs can be considered as ineffective from a therapeutic point of view because patients were assuming their drugs only for 6 months. There is a need for specific codification of osteoporotic fragility fractures at hospital admissions and for implementing regional strategies aimed to reduce hip re-fractures by increasing the number of patients on treatment and incrementing adherence to treatment.

The Impact of Internet Usage and Knowledge-Intensive Activities on Households' Healthcare Expenditures.

This paper examines the impact of the internet usage and knowledge intensive activities on households' healthcare expenditures Similarly, the paper aims to recognize and understand, from a value-creation perspective, the correlation between: internet access of households (IA), individuals frequently using the internet (IU), individuals searching on internet for health-related information (HI), payments made by households for healthcare (PHH), expressed as euro per inhabitant and employment in knowledge-intensive activities (KIA). The approach utilized in the present study consists of two steps. First, a theoretical framework was conducted to determine the existing relationship between major variables. Next, the Vector Autoregressive (VAR) approach was applied in a case study at European level to prove the three hypothesis we consider. By analyzing the connection between the major variables, a positive and long- lasting impulse response function was revealed, followed by an ascending trend. This suggests that a self-multiplying effect is being generated; and it reasonable to assume that the more individuals use the Internet, the more electronic acquisitions occur. We can thus reasonably conclude that the improvement of the internet usage and knowledge intensive activities on households' healthcare expenditures process is strongly dependent on people's capability. Improving IU and KIA is the new reading key in the decision-making process in health system approach.

Diagnostic and therapeutic path of breast cancer: effectiveness, appropriateness, and costs--results from the DOCMa study.

OBJECTIVE: An increase in breast cancer incidence has been documented in Italy and in other countries, and some women decide by themselves to undergo diagnostic examinations outside the official screening campaigns. The aim of this paper was to analyze - in terms of effectiveness, appropriate access, and related costs - the path spontaneously followed by a sample of Italian women for the early diagnosis of breast cancer. SUBJECTS AND METHODS: A total of 143 women who consecutively referred themselves to the breast cancer outpatient facilities at the Sant'Andrea University Hospital in Rome from May to June 2007 were enrolled in the study, gave their consent, and were screened according to their individual risk factors for breast cancer. The entire diagnostic and therapeutic path followed in the previous 2 years by each of them, either at Sant'Andrea or in other medical facilities, was reviewed and evaluated in terms of its operative efficiency and fair economic value. RESULTS: The subjects' mean age was 47.5 years (standard deviation 13.6 years); 55% of the women were <50 years old (28% <40 years), and were thus not included in the official screening campaigns; 97 women (70%) were requesting a routine control; and 49% of them had already undergone four to seven examinations before the enrollment, although no major risk factor was present in 73.5%. After enrollment in the study, nine of the patients had surgical interventions performed on them at Sant'Andrea's, identifying five invasive carcinomas and two ductal in situ carcinomas and two benign lesions. Operative efficiency and fair economic value were found to be optimal only in diagnostic/therapeutic paths followed at Sant'Andrea. CONCLUSION: The diagnostic path at Sant'Andrea's specialized center for breast cancer diagnosis and therapy is characterized by higher operative efficiency and more sustainable costs than at general hospitals, outpatient facilities run by local health authorities, or private medical centers. This result seems to confirm the present tendency to refer high-risk patients for breast cancer directly to breast units like the one at Sant'Andrea.

Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records.

OBJECTIVES: As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population. METHODS: We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820-821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433-434), and TIA (code 435) between 2001-2005. Cost analyses were based on diagnosis-related groups. RESULTS: The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005). CONCLUSION: The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.