Maria Daniela Giammanco

An economic analysis of rotavirus vaccination in Italy

We have evaluated health and economic benefits of a universal infant vaccination with two rotavirus vaccines registered in Italy, on the bases of the burden of rotavirus gastroenteritis (RVGE) in a birth cohort of 520,000 Italian infants followed until 5 years of age. Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives of the Italian National Health Service (NHS) and society. According to our estimates, a universal rotavirus vaccination program would avoid 10,679 hospitalizations, 39,202 emergency visits, and 44,223 at home visits. At 65.6 euro per vaccination courses, the program would cost 30,700,800 euro and realize a net loss of 9,057,928 euro from the Italian NHS perspective. On the contrary, the program would provide a net savings of 24,324,198 euro from the societal perspective. From the Italian NHS perspective, the break-even price per vaccination course should be reduced at least to 46.25 euro to achieve a zero cost-effectiveness ratio.

Hospital safety climate and safety behavior: A social exchange perspective

BACKGROUND Safety climate is considered beneficial to the improvement of hospital safety outcomes. Nevertheless, the relations between two of its key constituents, namely those stemming from leader-subordinate relations and coworker support for safety, are still to be fully ascertained. PURPOSE This article uses the theoretical lens of Social Exchange Theory to study the joint impact of leader-member exchange in the safety sphere and coworker support for safety on safety-related behavior at the hospital ward level. Social exchange constructs are further related to the existence of a shame-/blame-free environment, seen as a potential antecedent of safety behavior. RESEARCH DESIGN A cross-sectional study including 166 inpatients in hospital wards belonging to 10 public hospitals in Italy was undertaken to test the hypotheses developed. METHODOLOGY Hypothesized relations have been analyzed through a fully mediated multilevel structural equation model. This methodology allows studying behavior at the individual level, while keeping into account the heterogeneity among hospital specialties. FINDINGS Results suggest that the linkage between leader support for safety and individual safety behavior is mediated by coworker support on safety issues and by the creation of a shame-free environment. PRACTICAL IMPLICATIONS These findings call for the creation of a safety climate in which managerial efforts should be directed not only to the provision of new safety resources and the enforcement of safety rules but also to the encouragement of teamwork and freedom to report errors as ways to foster the capacity of the staff to communicate, share, and learn from each other.

Coping, uncertainty and health-related quality of life as determinants of anxiety and depression on a sample of hospitalized cardiac patients in Southern Italy

ObjectivesBeing hospitalized often causes psychological distress and compromises patients’ psychological well-being, thereby augmenting the burden of illness. The aim of this paper is to investigate two possible determinants of anxiety and depression among hospitalized cardiac patients, namely uncertainty in illness, and coping strategies, controlling for the perceived health-related quality of life, and distinguishing between borderline and pathological levels of anxiety and depression.MethodsData on anxiety, depression, coping style, uncertainty in illness and self-assessed quality of life concerning 200 cardiac inpatients from a university hospital were collected through validated questionnaires. A biprobit analysis, whose dependent variables are hospital anxiety and depression, was carried out.ResultsUncertainty in illness has a significant impact on the possibility of crossing the borderline level of both anxiety and depression. The coping strategy of Positive Reappraisal and Growth is inversely and significantly correlated to anxiety and depression, be it borderline or pathological; the Restraint Coping strategy is positively and significantly related to borderline anxiety.ConclusionsThe reduction of uncertainty in illness and the development of adequate coping strategies should be promoted in order to decrease the patients’ risk of crossing the borderline threshold of anxiety and depression.

Scarcity of Resources in a Sraffian Framework of International Trade

This paper deals with the theory of differential rent within a Sraffian small open economy. Its aim is to study the determination of the wage rate, the rent rates and the activity level of each productive process when the profit rate is given, and either the vector of final demand, or the available homogenous labour, is exogenously set. It also analyses the relation between the total value of the net product and the labour employed and shows that it is not monotonic.

Work engagement in public hospitals: a social exchange approach

Abstract We develop and test a model that envisages work engagement in public services as determined by interactions with supervisor and co-workers. Specifically, we apply the framework of Social Exchange Theory to explore the impact of Leader–Member exchange (LMX) and Team–Member exchange (TMX) on Work Engagement in the provision of health care in public hospitals. Our investigation suggests that both LMX and TMX represent significant factors associated with work engagement among the hospital medical staff.

An initial validation of the Italian Mishel Uncertainty Illness Scale (MUIS) for relapsing remitting multiple sclerosis patients

Multiple sclerosis is a chronic disease, likely to condition patients’ daily living and quality of life: given the unpredictability of frequency and severity of the attacks, patients experience a high level of uncertainty. While there have been many analyses whose purpose was to monitor multiple sclerosis (MS) patients’ quality of life, the role of uncertainty, that is peculiar to the disease, has not been adequately considered so far. The present study is aimed at filling this gap by validating for Italian MS patients the Mishel’s Uncertainty Illness Scale (MUIS). The MUIS has been developed in the USA context in order to assess four aspects of uncertainty: ambiguity, complexity, inconsistency and unpredictability. It has been largely applied in the cancer, cardiac and chronic illness population. Data employed in this study have been collected at two neurological centres in Messina (IRCCS Centro Studi Neurolesi “Bonino Pulejo” and Policlinico di Messina) in the first semester of 2013 and refer to 120 MS patients. The confirmatory factor analysis described in this study validates two of the four dimensions of MUIS, namely ambiguity and inconsistency. The validation, though partial, of the MUIS, allows the use of this instrument in studies investigating quality of life for Italian patients.

Linking Organizational Climate to Work Engagement: A Study in the Healthcare Sector

ABSTRACT Using a two-level structural equation approach, this article investigates the links between organizational climate and work engagement in a sample of public hospitals in Italy. Drawing from the Job Demands-Resources model, the model posits a positive association between work engagement and a climate promoting worker’s autonomy, empowerment, and well-being, whereas it suggests that a climate based on efficiency and goal attainment is not favorable for engagement. Results support the hypotheses and suggest that performance based models implemented in recent years as part of public sector reforms are not conducive to engaged workers. Implications for research on work engagement in the public sector and for public management are drawn.

La misurazione del clima organizzativo in sanità: un’applicazione all’analisi delle unità operative ospedaliere

The study of the antecedents and consequences of organizational climate is particularly relevant for the management of health care organizations. In fact, managers may be interested in changing the existing culture and climate with the aim of improving both service quality and economic-financial performance. This paper presents and validates for the hospital sector the Organizational Climate Measure, a quantitative tool for climate measurement, which has its theoretical underpinnings in the Competing Value Framework and which exhibits high flexibility and comprehensiveness. The validated questionnaire has been applied to the analysis of organizational climate of 21 hospital wards, belonging to 4 health organizations. The analysis shows the possible ways in which this tool may be used by the management in order to define appropriate organizational actions.