Guido Citoni’s research while affiliated with Sapienza University of Rome and other places

Background: a growing and broadly discussed literature has shown that the relationship between sleep duration and health is not linear. Not only are insomnia and insufficient sleep harmful to one's health, but excessive sleep too is also not beneficial. This study tests the association between selfrated state of health and the duration and pattern of sleep: we discuss the losses and costs in terms of quality of life deriving from excessive sleep time. Methods: we use an ordered probit specification, applied to the Italian Survey on the Use of Time (sample of Italians aged fifteen and over who keep a diary for a working day). Results: we show that greater sleep duration is negatively correlated both with self-reported state of health and with self-reported health satisfaction, while respondents' subjective perceptions of too much and too little sleep are associated with health conditions in the usual u-shaped way. ConclusionS: the negative impact of long sleep on self-reported health is confirmed. However, the effect of short sleep on health conditions is positive, while a measure of decreasing sleep quality - comprising number of interruptions of sleep, insomnia and napping - is correlated to some extent with decreasing health. The public health consequences are still to be explored: the potential gains from sleep restriction are substantial, but little is known about the causal link or the risks. Further research is needed before taking policy decisions.

The goals of this study were to examine the improvement in quality of life achieved after open surgical treatment of elbow stiffness and to verify the cost/utility ratio of surgery. Thirty-three patients (22 men and 11 women) underwent surgery. The etiologies of elbow stiffness were posttraumatic conditions (n=26), primary osteoarthritis (n=5), and rheumatoid arthritis (n=2). Surgery included 14 ulnohumeral arthroplasties, 6 ulnohumeral arthroplasties associated with radiocapitellar replacement, 5 ulnohumeral arthroplasties associated with radial head replacement, and 8 total elbow arthroplasties. All patients were evaluated pre- and postoperatively with the Mayo Elbow Performance Score, the Mayo Elbow Performance Index, the modified American Shoulder and Elbow Surgeons score, the Quick Disabilities of the Arm, Shoulder and Hand score, and the Short Form 36 after a mean follow-up of 26 months. Possible variables affecting clinical outcome and quality of life improvement were assessed. The cost/utility ratio was evaluated as diagnosis-related group reimbursement per quality-adjusted life year. Mayo Elbow Performance Scores and modified American Shoulder and Elbow Surgeons scores increased, on average, by 43 and 41 points, respectively (P<.0001). Quick Disabilities of the Arm, Shoulder and Hand scores decreased, on average, by 44 points (P<.0001). The improvement in the SF-36 physical and mental component summary score was 7.6 and 7, respectively (P=.0001 and .0018). The cost/utility ratio ranged between 670 and 817 Euro/quality-adjusted life year. A significant correlation was found between pain score and quality of life improvement. An inverse correlation emerged between pre- and postoperative quality of life score. The current study shows that open surgery significantly improves quality of life and elbow function. Selecting the surgical procedure that most effectively reduces pain appears to be the most relevant variable responsible for quality of life improvement. Surgery shows a satisfactory cost/utility ratio, justifying a health spending increase to reduce the social costs resulting from lingering elbow stiffness.

The aim of this chapter is to give an overview on the economic aspects related to tobacco smoking, including production and supply of tobacco products.

The so called free practice intra-moenia or ALPI (to be performed inside the public premises) is very popular among Italian doctors (quite so among patients). Our work aims to shed light both on true motives of such a success and on the degree of accomplishment of stated targets at its institution. We believe that its success among doctors is due both to the increase in providers' autonomy and to its economic advantages. Freedom of choice for patients is also increased (though just a minority of patients says that they have made recourse to intra-moenia because they wanted to choose the doctor). The reduction of queues, one of the stated targets of ALPI, did not happen (as could be anticipated). Intra-moenia may cause, moreover, induction of demand and defensive medicine. A regression analysis shows that the main explanatory factor of the recourse to ALPI is urgent need for treatment. The work, finally, in noting that there is a lack of sufficient administrative controls on ALPI, concludes that intra-moenia is hopefully a viable institution provided that more checks are done.

Purpose The purpose of this paper is to introduce this special issue on work organization, performance and health. Design/methodology/approach The authors provide a general review of the literature and describe the main findings of the papers appearing in this special issue. Findings This issue provides new evidence regarding the impact of work organization (essentially defined in terms of payment methods, teamwork, workforce age structure and labour contracts) on performance (measured through employment, productivity and sickness absenteeism indicators). It also sheds more light on the determinants of workers’ health by gender, with particular attention to working conditions and mobbing. Originality/value The papers collected in this special issue provide some fine examples of recent work at the crossroads of health and personnel economics.

In this article we address the issue, with a tentative empirical application to the Italian data, of the relationship, very debated mainly in north America, between abortion legalization and reduction of crime rates of youth. The rationale of this relationship is that there is a causal factor at work: the more unwanted pregnancies aborted, the less unwanted children breeding their criminal attitude in an hostile/deprived family environment. Many methodological and empirical criticisms have been raised against the proof of the existence of such a relationship: our attempt to test if this link is valid for Italy cannot endorse its existence. The data we used made necessary some assumptions and the reliability of official estimates of crime rates was debatable (probably downward biased). We conclude that, at least for Italy, the suggested relationship is unproven: other reasons for the need of legal abortion have been and should be put forward.

In this paper we present a theoretical framework for the analysis of the economic relevance of adaptation as an "happiness engine" in bad health conditions. Positing that for a given individual the level of health is quite separate from the degree of adaptation and its effect on happiness, we aim to verify if gaps between health and happiness do exist and which factors can be connected to them. Having provided a general model of health related happiness determination structured on three happiness components, we define the adaptation process and the relevance of its monetary and non-monetary costs. We then test some features of the model using data from the SHARE survey of health, ageing and retirement in Europe (Release 2.0.1, 2007). We eventually conclude with some suggestions for future research and present a number of actual options for health policy.

Using the data collected for the year 2004 in the Belgian Health Survey, we aim to show that, controlling for all the determinants of self-reported health state, there is a residual effect of geographic location on the self-assessed health, namely a more favourable scoring for individuals that are resident both in the region of Brussels and in the region of Walloonia, with respect to individuals that are resident in the Flanders. Regional effects do not change either if we take account of supply of health services or if we control for their utilization. Moreover the effect of past level of health is encompassed to test for habituation, and the results still hold. The above findings can be used both to construct “equivalent expected QALY’s or EEQ” ,i.e. the average quality adjusted life years that a newborn, taking account of the different average level of health at the regional level, can expect to experience in the different geographical areas of Belgium (the three regions have approximately the same EEQ), and to predict a “need factor” to be used either for equity analysis or to ascertain its evolution in time.

Using the data collected for 2004 in the Belgian Health Survey, we aim to show that, after examining all the elements used in determining a self-reported state of health, geographic location bears considerably on the results of self-assessed health, namely a more favourable scoring was registered for individuals that are resident both in the region of Brussels and in the region of Wallonia, with respect to a more negative outlook for individuals that are resident in Flanders. Regional effects do not change, however, even when taking into account the supplying of health services or when controlling their utilization. Moreover, the estimate also considered the adaptation behaviour, represented by health transition and these results still hold true. The above findings can be used both to construct “equivalent expected QALY’s or EEQ”, i.e. the average quality adjusted life years that a newborn, taking account of the different average level of health at the regional level, can expect to live in the different geographical areas of Belgium (the three regions have approximately the same EEQ), and to predict a “need factor” to be used either for equity analysis or to ascertain its development in time.