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The reforms that have reshaped the public health care systems have often been coupled with devolution. However, this process has frequently been accompanied by widespread soft budget constraint policies. In this paper we argue that the soft budget constraint arises from a cooperative game between local authorities that force Central Government to bail them out. Our theoretical model is tested using data for Italian regions for the period 2002-2006 and our hypothesis is verified. Although the model uses Italy as a benchmark, we believe that the framework we propose could be extended to other federal contexts where resources are distributed unevenly and preferences are asymmetric. [ABSTRACT FROM AUTHOR]

In this paper, an analysis of air quality data is provided for the municipal area of Taranto (southern Italy) characterized by high environmental risks as formally decreed by the Italian government in the 1990s with two administrative measures. This is due to the massive presence of industrial sites with elevated environmental impact activities along the NW boundary of the city conurbation. The aforementioned activities have effects on the environment and on public health, as a number of epidemiological researches concerning this area reconfirm. The present study is focused on particulate matter as measured by PM10 concentrations at 13 monitoring stations, equipped with analogous instruments based on the Beta absorption technology, either reporting hourly, two-hourly, or daily measurements. Daily estimates of the PM10 concentration surfaces are obtained in order to identify areas of higher concentration (hot spots), possibly related to specific anthropic activities. Preliminary analysis involved addressing several data problems: (1) due to the use of two different validation techniques, a calibration procedure was devised to allow for data comparability; (2) imputation techniques were considered to cope with the large number of missing data, due to both different working periods and occasional malfunctions of PM10 sensors; and (3) reliable weather covariates (wind speed and direction, pressure, temperature, etc.) were obtained and considered within the analysis. Spatiotemporal modelling was addressed by a Bayesian kriging-based model proposed by Le and Zidek () characterized by the use of time varying covariates and a semiparametric covariance structure. Advantages and disadvantages of the model are highlighted and assessed in terms of fit and performance. Estimated daily PM10 concentration surfaces are suitable for the interpretation of time trends and for identifying concentration peaks within the urban area. [ABSTRACT FROM AUTHOR]

High ambient temperatures have been associated with increased mortality across the world. Several studies suggest that timely preventive measures may reduce heat-related excess mortality. The main aim of this study was to detect the temporal modification of heat-related mortality, in older adults (aged 65-74) and in elderly ≥75 years old, in the Florentine area by comparing previous (1999-2002) and subsequent (2004-2007) periods to the summer of 2003, when a regional Heat-Health Warning System (HHWS) was set up. Mortality data from 1999 to 2007 (May-September) were provided by the Mortality Registry of the Tuscany Region ( n = 21,092). Weather data were used to assess daily apparent temperatures (AT). Case-crossover time-stratified designs and constrained segmented distributed lag models were applied. No significant heat-related mortality odds ratio (OR) variations were observed among the sub-periods. Nevertheless, a general OR decrease dating from 1999-2002 (OR 1.23; lack of HHWS) to 2004-2005 (OR 1.21; experimental HHWS running only for Florence) and to 2006-2007 (OR 1.12; official HHWS extended to the whole Florentine area) was observed when the maximum AT was considered. This modification was only evident in subjects ≥75 years old. The heat effect was higher and sustained for more days (until lag 9) during the period 1999-2002 than 2004-2007. The decrease of the excessive heat effect on mortality between periods with the absence and existence of a HHWS is also probably due to the mitigation of preventive measures and the implementation of a HHWS with specific interventions for safeguarding the health of the 'frail elderly'. [ABSTRACT FROM AUTHOR]

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8-55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes. [ABSTRACT FROM AUTHOR]

When the construction of the Lyon-Turin segment of the new European high-speed rail network was first publicly announced at the beginning of the 1990s, it immediately found fierce opposition from the inhabitants of Susa Valley, Italy, one of the areas to be cut across by such infrastructure. At issue were the project’s potential environmental impact and its consequences on public health. This study intends to clarify environmental risk perception and public debate between the national government, local advocacy groups, and the inhabitants of Susa Valley. Two major phases of public reaction were identified: (1) an initial rebellious period of no real dialog among the project’s major stakeholders (exemplified by the popular “No TAV” [No High Speed Train] movement), followed by (2) a yielding period of intense multilateral negotiations centered on the activities of the “Lyon-Turin Environmental Observatory.” The results of a qualitative cross analysis of the residents’ perception of the proposed high-speed rail revealed that public acceptance of risk in Susa Valley was influenced by the characteristics of hazards perceived by the residents and by the communicative approach used by the project’s various stakeholders. It also emerged that early dialog among all the parties involved was critical in forming a personal viewpoint on risk, which, once consolidated, defied new information and perspectives. Likely, a greater and earlier care taken by the other stakeholders to inform and consult the local population about the railway would have greatly eased the public debate. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder causing vascular dysplasias. About 70–80% of HHT patients carries mutations in ENG or ACVRL1 genes, which code for a TGFβ receptor type III and I respectively. Molecular data on a large cohort of Italian HHT patients are presented, discussing the significance of missense and splice site mutations. Mutation analysis in ENG and ACVRL1 genes was performed using single strand conformation polymorphisms (SSCP), denaturing high performance liquid chromatography (DHPLC) and subsequent direct sequencing. Overall, 101 mutations were found, with ACVRL1 involved in 71% of cases. The highest number of mutations (28/101 subjects, 14/76 different mutations referring to both genes) was in ACVRL1, exon 3. Mutation analysis was then extended to a total of 356 family members, and 162 proven to carry the mutation. New polymorphisms were identified in both genes, and evidence that ENG P131L change is not a disease-causing mutation was also provided. An in silico analysis was performed in order to characterize splice-site mutations. These results were compared to other European national studies and data from Italy, France and Spain were consistent for an higher incidence of ACVRL1 mutations. [ABSTRACT FROM AUTHOR]

In the framework of the EXPOLIS study in Milan, Italy, 48-h carbon monoxide (CO) exposures of 50 office workers were monitored over a 1-year period. In this work, the exposures were assessed for different averaging times and were compared with simultaneous ambient fixed-site concentrations. The effect of gas cooking and smoking and different methods of commuting on the microenvironment and exposure levels of CO were investigated. During the sampling the subjects completed a time-microenvironment-activity diary differentiating 11 microenvironments and three exposure influencing activities: gas cooking, smoking and commuting. After sampling, all exposure and time allocation data were stored in a relational database that is used in data analyses. Ambient 48-h and maximum 8-h distributions were similar compared to the respective personal exposures. The maximum 1-h personal exposures were much higher than the maximum 8-h exposures. The maximum 1-h exposures were as well higher than the corresponding ambient distribution. These findings indicate that high short-term exposures were not reflected in ambient monitoring data nor by long-term exposures. When gas cooking or smoking was present, the indoor levels at “home-” and in “other indoor” microenvironments were higher than without their presence. Compared with ambient data, the latter source was the most affective to increase the indoor levels. Exposure during commuting was higher than in all other microenvironments; the highest daily exposure contribution was found during “car/taxi” driving. Most of the CO exposure is acquired in indoor microenvironments. For the indoor microenvironments, ambient CO was the weakest predictor for “home indoor” concentrations, where the subjects spent most of their time, and the strongest for “other indoor” concentrations, where the smallest fraction of the time was spent. Of the main indoor sources, gas cooking, on average, significantly raised the indoor exposure concentrations for 45?min and tobacco smoking for 30?min. The highest exposure levels were experienced in street commuting. Personal exposures were well predicted, but 1-h maximum personal exposures were poorly predicted, by respective ambient air quality data. By the use of time-activity diaries, ETS exposure at the workplaces were probably misclassified due to differences in awareness to tobacco smoke between smokers and nonsmokers.Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 312-322. doi:10.1038/sj.jea.7500327 [ABSTRACT FROM AUTHOR]

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The article reflects the opinion of the author on the challenges encountered with the nomination for the president of Istituto Superiori di Sanita (ISS), the public health institute of Italy. The author said, the nomination made by health minister Livia Turco to Enrico Garaci for his third term as president of ISS was due to the situation Turco was facing wherein she was caught in a web of power politics. Likewise, he added that many has regarded the nomination as problematic.