Geographical accessibility to upper secondary education: an Italian regional case study.

In this paper, a spatial analysis is performed to measure students' access to the upper secondary education system. Based on the definition of quantitative indicators, the adopted approach is applied to an Italian regional case by exploiting the capabilities of a GIS software and using census tracts' level data. The obtained results highlight geographical patterns of inequalities in access among students and shed light on the least served areas. Further analysis shows that accessibility reflects the degree of urbanization within the study region and that geographical distances are actual barriers to rural students since they are not compensated for by either economic status or the availability of digital infrastructures. The study offers empirical grounds to inform the decision-making process toward equity-in-access oriented interventions. Longer-term actions, as the activation of new schools (network expansion), the activation of new programs (service expansion) or the redistribution of their supply among the current network (network reorganization), as well as mid-term ones, like offering economic support for students' mobility, or reinforcing digital connectivity, emerge as relevant to mitigate social exclusion.

[Use of cinacalcet in clinical practice for the treatment of secondary hyperparathyroidism: analysis of the Italian data of the ECHO study]. / Utilizzo del cinacalcet nella pratica clinica per il trattamento dell'iperparatiroidismo secondario: analisi dei dati italiani dello studio osservazionale ECHO.

Several studies have shown that, compared with standard therapy, cinacalcet reduces parathyroid hormone (PTH) as well as calcium and phosphorus levels in dialysis patients with secondary hyperparathyroidism (SHPT). The ECHO study evaluated cinacalcet use in actual clinical practice. ECHO enrolled 1865 patients treated with cinacalcet at 187 sites in 12 European countries. In Italy 263 patients were enrolled at 20 sites. The primary objective of the study was to evaluate K/DOQI target achievement in SHPT dialysis patients after the introduction of cinacalcet. Patients on cinacalcet treatment between July 2005 and October 2006 were enrolled and data were collected from 6 months prior to starting cinacalcet up to 12 months after. No treatment algorithm was provided to the investigators. Italian patients had suboptimally controlled SHPT at baseline according to K/DOQI targets (median PTH 760 pg/mL, P 5.4 mg/dL, Ca 9.7 mg/dL). After 1 year of cinacalcet treatment a reduction of PTH (-53.4%), Ca (-7.3%), P (-4.6%) and Ca x P (-14.4%) was observed. The proportion of patients that reached the K/DOQI targets after 1 year of cinacalcet treatment was higher compared to baseline for all parameters (PTH 32% vs 5%; Ca 48% vs 35%; P 59% vs 55%, Ca x P 82% vs 64%). The Italian ECHO data show that cinacalcet treatment increases the proportion of patients achieving the K/DOQI targets for PTH, Ca, P and Ca x P, confirming the effectiveness of cinacalcet in clinical practice in Italy. These findings are consistent with the phase III study results on cinacalcet use in dialysis patients in Europe.

A spatial analysis to evaluate the impact of deregulation policies in the pharmacy sector: Evidence from the case of Navarre.

Community pharmacies represent unusual enterprises as their main function is intrinsically related to the provision of healthcare services. Hence, market competition in this sector needs to be regulated, in order to ensure equitable accessibility, efficiency and quality of services. However, recently a general deregulation trend may be observed in Europe. In this paper, we focus on location restrictions, i.e. on demographic and geographic constraints to open new pharmacies, and we evaluate the impact of their relaxation. In particular, we analyze the case of the city of Pamplona (ES), where a striking increase in the number of pharmacies occurred, after the introduction of a new regulatory system in 2000. We evaluate, thanks to an in-depth spatial analysis, the evolution of the system to date and the effects produced on the consumers, in terms of accessibility, and on the competitors, in terms of market shares distribution. By comparing the obtained results with the ones related to the case of a second Spanish city, characterized by more strict restrictions, it emerges that the deregulation risks to produce a limited improvement in terms of accessibility and to exacerbate differences among consumers. Moreover, an increasing number of competitors does not necessarily imply a more equitable distribution of market shares, thus putting at risk the desired effects in terms of cost reduction and service quality improvement.