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The paper analyzes the optimal lockdown policy using the SQAIRD model over a network with three population groups (young, adult, and old). We show that different lockdown policies may be justified by different socioeconomic structures (objective cost functions that are either convex or concave). We also show that a lockdown policy is always better than a laissez-faire policy, and a targeted policy specific to each group outperforms a uniform policy. In our benchmark example, we consider the case of Italy. Our simulations show that: (a) a lockdown policy is always better than the laissez-faire policy because it limits the costs generated by the pandemic in an uncontrolled situation; (b) a group-specific targeted lockout policy is more effective than a uniform policy to the extent that the groups differ. The latter is a less expensive targeted policy (as it optimally minimizes direct, indirect, and vaccination costs), and it is equally effective in controlling the pandemic. One finding of particular interest is that the optimal lockdown rate should be higher for the young and elderly than for adults. This is motivated by the fact that younger individuals are more likely to spread the virus in question asymptomatically. [ABSTRACT FROM AUTHOR]

In a perfectly competitive labor market, wage rates are determined by labor productivity, so that wage dispersion reflects the marginal contribution to product of the different workers. Accordingly, wage inequality cannot be treated as an independent variable in a model of productivity, and thus economists have paid little attention to this relation. This paper studies the effects of wage inequality on labor productivity. We claim that wage inequality can lead to lower effort among workers who receive lower wages and hence lead in turn to lower aggregate labor productivity because of the lower aggregate effort level. To guide the empirical analysis, we look at aggregate panel data to investigate whether there is a relationship between wage inequality and average labor productivity. We use data for 34 OECD countries in the period 1995–2007, and by allowing country fixed effects, we exploit the longitudinal dimension of the data. We find that large wage inequality is associated with lower labor productivity. So the results suggest that higher levels of the Gini index of wage inequality are associated with lower labor productivity. Moreover, we study the question of whether wage inequality that causes productivity level or viceversa by assessing non-causal homogeneity in a panel Granger framework. [ABSTRACT FROM AUTHOR]

Aims: Diabetic foot syndrome (DFS) increases the risk for atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or mortality. The present study aims at ascertaining whether such DFS-related excess risk differs between genders, retrospectively investigating a population with diabetes from Tuscany, Italy, followed-up for 6 years (2011–2016). Methods: People with diabetes living in Tuscany on January 1st 2011 identified by administrative databases, were divided by baseline history of prior DFS hospitalizations, stratified by presence/absence of peripheral vascular disease and evaluating, by Cox regression analysis, whether adjusted DFS-related excess risk of incident ASCVD, CKD or mortality differed between genders. Results: In an overall population of 165,650 subjects with diabetes (81,829M/83,821F), basal prevalence of DFS was twice higher among males, who were moreover at a significantly greater risk of all considered outcomes along the 6-year period. On the contrary, baseline DFS significantly increased the hospitalization risk for ASCVD, CKD and mortality equally or at a slightly greater extent in females, while the risk for stroke was significantly associated with DFS only among females (HR: 1.622 (1.314–1.980); p = 0.0001 vs. HR: 1.132 (0.955–1.332); p = NS). This finding was even reinforced in non-vascular DFS, which was associated with a significant raised risk for stroke, heart failure or mortality exclusively in females. Conclusions: In this population, DFS prevalence and overall risk for ASCVD, CKD or mortality were significantly higher among males. Baseline co-presence of DFS, however, conferred a similar adjusted risk for all these outcomes between genders, and in case of non-vascular DFS the risk was significantly increased only among females. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether statins reduce the risk to first hospitalization of bacterial infections, in patients with or without diabetes taking into account prior or incident comorbidities. Methods: By using administrative databases, the effect of current statin use was measured on the risk of first hospitalizations due to bacterial infections in people living in Tuscany, Italy, in the period January 1, 2011-December 31, 2015, after excluding those with previous statins use. Population was stratified as with ( n = 128,207) or without diabetes ( n = 3,304,906), and the hospitalization risk was analyzed by a Cox proportional hazards regression analysis after adjusting for age, gender, previous comorbidities, chronic renal failure, and prior or incident cardiovascular diseases. Results: During the 5-year follow-up, 31,543 hospitalizations for bacterial infections were observed: 2.08(2.06-2.10) per 1000 person-year in non-diabetic and 5679: 9.13(8.94-9.32) per 1000 person-year in diabetic population. Diabetes conferred a greater risk of hospitalizations, independently from confounders [adjusted HR (95% CI) 2.04 (1.97-2.10); P < 0.0001]. Statin use decreased the risk by about 2.5% for each one month of therapy, at the same extent in subjects with or without diabetes, after adjusting for all covariates. Conclusions: In this population, diabetes was associated by a twofold increase in the 5-year risk of hospitalizations for bacterial infections. Statin use decreased this risk to a same extent in subjects without or with diabetes, after adjusting for main confounders including comorbidities, and previous or incident cardiovascular events. [ABSTRACT FROM AUTHOR]

Overall prevalence of epilepsy ranges from 4 to 10 cases per 1000. Italy lacks recent epidemiological studies on large populations. In the present study, prevalence of epilepsy has been assessed in Tuscany, an Italian Region with 3,750,000 habitants, implementing an algorithm based on administrative data from the Regional Information Health System. To identify patients with epilepsy, we used at least one the following criteria: (a) at least one EEG and at least two dispensations of any antiepileptic drug (AEDS) at a minimum distance of 12 months; (b) at least two dispensations of one "specific" AED (authorized for use only for patients with epilepsy) at a minimum distance of 12 months; and (c) hospital admission for epilepsy or recurrent relapses (cod. ICD-IX-345.*). This algorithm was validated through comparison with lists of true patients with epilepsy and subjects without neurological disorders (gold standard). 35,950 cases were identified. Total crude prevalence was 9.6/1000. Prevalence increased in older patients up to 16/1000 without gender differences. Overall sensitivity of the algorithm was 87.3%, and specificity was 99.9%. This algorithm identifies patients with epilepsy with acceptable sensitivity and specificity and can be used to assess the burden of disease and for monitoring health services. [ABSTRACT FROM AUTHOR]

Aims: This study was designed to answer the question whether surgery due to newly diagnosed cancer may modify quality of diabetes' management, as suggested by current guidelines. Methods: Adherence to guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was evaluated between years 2011-2012 and 2014-2015 in 158,069 diabetic patients living in Tuscany, Italy, on 1 January 2011 and surviving on 31 December 2015, of whom 661 were hospitalized in index year 2013 for a surgery procedure due to a newly incident cancer. Difference in GCI modification (DELTA_GCI) of these patients was compared with that of diabetic people without cancer, strictly matched for main confounders by means of a propensity score. Results: In diabetic patients with cancer, GCI adherence increased by about 8 % between years 2011-2012 and 2014-2015. When compared with controls, DELTA_GCI increased by 6 % in cancer group compared with controls ( p < 0.05), but any significance was lost after matching the groups by propensity score (3 %; p = NS). Conclusions: Our study suggests that a hospitalization for a surgical procedure due to a newly diagnosed cancer does not influence the compliance to a quality process indicator of diabetes care such as GCI. [ABSTRACT FROM AUTHOR]

This paper tests the hypothesis that democratisation is conducive to less environmental depletion due to human activity. Using interrupted time series design for a panel of 47 transition countries and two indexes of pollution, CO $$_{2}$$ emissions and PM10 concentrations, I find that democracies and dictatorships have two different targets of environmental quality, with those of democracies higher than those of dictatorships. Income inequality may as well alter this targets, but with opposite effects in the two different regimes. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a major worldwide public health problem with a prevalence that is expected to increase dramatically in the coming decades. Because administrative data are useful for epidemiologic and health service studies, we aimed to define procedural algorithms to identify PD patients (on a regional basis) using these data. We built two a priori algorithms, respecting privacy laws, with increasing theoretical specificity for PD including: (1) a hospital discharge diagnosis of PD; (2) PD-specific exemption; (3) a minimum of two separate prescriptions of an antiparkinsonian drug. The two algorithms differed for drugs included. Sensitivities were tested on an opportunistic sample of 319 PD patients from the databases of 5 regional movement disorders clinics. The estimated prevalence of PD in the sample population from Tuscany was 0.49 % for algorithm 1 and 0.28 % for algorithm 2. Algorithm 1 correctly identified 291 PD patients (sensitivity 91.2 %), and algorithm 2 identified 242 PD patients (sensitivity 75.9 %). We developed two reproducible algorithms demonstrating increasing theoretical specificity with good sensitivity in identifying PD patients based on an evaluation of administrative data. This may represent a low-cost strategy to reliably follow up a large number of PD patients as a whole for evaluating the effects of therapies, disease progression and prevalence. [ABSTRACT FROM AUTHOR]