Mental health between present issues and future expectations

Based on a 2020 survey of more than 4000 working-age women, we investigate the main determinants of mental distress during the COVID-19 first wave in Italy. We address the role of two groups of drivers: present issues (e.g., present working status) and expectations about the future (e.g., fear of losing the job). Our results show that expectations do play a crucial role on mental distress. Younger women and those lacking a high school degree are in most distress. even controlling for individual fixed effects, and contextual factors which account for potential dynamics in the labor market. We investigate how expectations interact with several individual dimension, as age, level of education, sector of employment, and individual gender norms. Expectations of future employment is still among the main driver, but respondents with higher stereotype show higher distress due to uncertainty about the future employment of the partner, suggesting that the prevalence of a traditional breadwinner model is a source of additional distress on this population.

Job satisfaction among healthcare workers in the aftermath of the COVID-19 pandemic

Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, in addition to personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel yields the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency.

Neighborhoods, networks, and delivery methods

We examine the contribution of information transmission among pregnant women to geographic variation in C-sections in Lombardy, Italy. Defining networks as pregnant women living in the same municipality, we observe that if the incidence of C-sections within the womans network is one standard deviation higher over the 12 months preceding delivery, then her probability of delivering by C-section is 0.007 percentage points (3%) higher. This result is mainly a network effect on Italian women, while it arises from both network and neighborhood effects on foreign women. Both groups respond to additional information, such as the incidence of C-section complications. The selection of pregnant women across hospitals does not uniquely explain our results, which are robust to alternative sample selections and specifications.

Fee equalization and appropriate health care

Fee equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and efficiency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce overuse of c-sections by equalizing the DRGs for vaginal and cesarean deliveries. Using data from Italy and a difference-in-differences approach, we show that setting an equal fee decreased c-sections by 2.6%. This improved the appropriateness of medical decisions, with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fee equalization in avoiding c-sections, but highlights the marginal role of financial incentives in driving c-section overuse. The observed drop was only temporary and in about a year the use of c-sections went back to the initial level. We found a greater reduction in lower quality, more capacity-constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of Ob-Gyn specialists.

The importance of small saphenous vein reflux on chronic venous disease clinic

AIM

It is estimated that between 5% to 20% of the adult population in developed countries is affected by chronic venous insufficiency (CVI), thus being the most frequent vascular disorder. Recent studies show that, in most CVI patients, their junctions are competent and the correlated superficial reflux is present along the saphenous vein. Objective of the study was to correlate the presence and distribution of reflux in the saphenous vein with the signs and symptoms of CVI, through CEAP, in female patients.

METHODS

Record review of patients with CVI signs and symptoms who underwent clinical and ultrasound examinations in order to classify them according to CEAP. The sample was divided into three groups according to the presence of saphenous vein insufficiency: Group I-SSV, Group II-GSV, and Group III-SSV and GSV.

RESULTS

A total of 312 lower limbs of 259 female patients aged between 15 and 85 years were examined. The most prevalent clinical classes in the three groups were C2 (44.55%) and C3 (46.48%). Four patterns of reflux were identified in isolated SSV, with the highest incidence of proximal reflux (69.23%). SPJ impairment was most likely to occur in clinical cases of greater severity. Five patterns of reflux were identified in GSV, with the proximal one the most prevalent (64.42%).

CONCLUSION

There is a correlation between the clinical severity of CVI and the reflux along the SSV in association with GSV; the risk of moderate to high clinical severity in group III was 3.6 times higher than in group I and 4.6 times higher than group II.