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Background The European region achieved interruption of malaria transmission during the 1970s. Since then, malaria control programs were replaced by surveillance systems in order to prevent possible re-emergence of this disease. Sporadic cases of non-imported malaria were recorded in several European countries in the past decade and locally transmitted outbreaks of Plasmodium vivax, most probably supported by Anopheles sacharovi, have been repeatedly reported from Greece since 2009. The possibility of locally-transmitted malaria has been extensively studied in Italy where the former malaria vector An. labranchiae survived the control campaign which led to malaria elimination. In this study, we present paradigmatic cases that occurred during a 2017 unusual cluster, which caused strong concern in public opinion and were carefully investigated after the implementation of the updated malaria surveillance system. Methods For suspected locally-transmitted malaria cases, alerts to Ministry of Health (MoH) and the National Institute of Health (ISS) were mandated by the Local Health Services (LHS). Epidemiological investigations on the transmission modes and the identification of possible infection’s source were carried out by LHS, MoH and ISS. Entomological investigations were implemented locally for all suspected locally-transmitted cases that occurred in periods suitable to anopheline activity. Molecular diagnosis by nested-PCR for the five human Plasmodium species was performed to support microscopic diagnosis. In addition, genotyping of P. falciparum isolate was carried out to investigate putative sources of infection and transmission modalities. Results In 2017, a cluster of seven non-imported cases was recorded from August through October. Among them, P. ovale curtisi was responsible of one case whereas six cases were caused by P. falciparum. Two cases were proved to be nosocomial while the other five were recorded as cryptic at the end of epidemiological investigations. Conclusions The epidemiological evidence shows that the locally acquired events are sporadic, often remain unresolved and classified as cryptic ones despite investigative efforts. The “cluster” of seven non-imported cases that occurred in 2017 in different regions of Italy therefore represents a conscious alert that should lead us to maintain a constant level of surveillance in a former malaria endemic country.

The analysis of health commodity typically focuses on the efficiency and equity of its market or on the quality of its production and often on the sustainability of its approach to financing. The paper aims to emphasize the importance of health commodity in the process of creation and distribution of income. The methodology is based on the construction of the Social Accounting Matrix with particular attention to health output. We first perform the dispersion analysis in order to evaluate the backward and forward linkages of the health production and then, we simulate different key policies favourable to health commodity aiming to quantify their impacts on the main macroeconomic aggregates.

La spesa per anziani è uno dei comparti della spesa pubblica maggiormente compresso da venti anni a questa parte. Le ragioni che spingono oggi a riconsiderare la spesa per cura e assistenza alla popolazione anziana come volano di crescita e sviluppo poggiano non soltanto su fattori sociali ma anche su considerazioni di tipo squisitamente economico. In questa prospettiva la possibilità di misurare la rilevanza di tale genere di servizi nel determinare le performance del sistema economico diviene cruciale. L’impostazione proposta in questo lavoro fa riferimento alla possibilità di ricondurre il fenomeno della produzione di servizi di cura e assistenza agli anziani all’interno degli schemi tradizionali di contabilità nazionale, in particolare la matrice di contabilità sociale. Una volta implementata, essa permette di utilizzare uno strumento metodologico evoluto, vale a dire il modello multisettoriale biregionale, che consente di quantificare gli effetti sul reddito generati dalla produzione di cura e assistenza agli anziani.

The economic value of culture production depends on the territory and the social structure of the economy. The cultural district imposes the transition from the single-chain to the multi-chain system of production in order to evaluate the relations with the sectors of the culture production process and with all the other traditional sectors. In this prospective economic models and accounting schemes able to describe the economic/social/environmental relations between the agents are required. As in the tourism, using open multisectoral models and disaggregated accounting schemes, allows to respond to this exigency. Indeed such instruments provide a full detailed description of production processes and an accurate disaggregation of economic agents according to spatial and social characteristics. This allows developing a general analysis with the possibility to identify the direct and indirect interrelations between the economic activities and institutional sectors connected to culture. In this paper we provide an ex-ante and ex-post evaluation of public programs to support the production of culture in order to quantify the socio-economic effects of such expenditure and suggest alternative destinations for public resources.

Una differente allocazione tra i soggetti istituzionali della spesa in assistenza per anziani non autosufficienti può rappresentare una opportunità di crescita per sistema economico se è in grado di attivare processi produttivi che stimolano la produzione complessiva o l’occupazione. La possibilità di rivedere la spesa sanitaria come spesa produttiva all’interno del sistema economico ci spinge dunque ad analizzare gli impatti di diversi scenari di politica sanitaria all’interno del flusso circolare del reddito attraverso del modello computazionale di equilibrio economico generale (CGE), adattato alla matrice bi regionale di contabilità sociale (SAM) per l’Italia. In particolare, l’esigenza di testare gli impatti delle politiche di spesa sanitaria sull’occupazione impone di inserire all’interno del modello CGE l’ipotesi di disoccupazione involontaria ed identificare all’interno della SAM i flussi relativi alle prestazioni sanitarie di assistenza considerate di rilievo. Tre sono le categorie di spesa individuate: l’assistenza domiciliare integrata (ADI), l’assistenza residenziale in strutture private accreditate (ARA) e l’assistenza residenziale in strutture pubbliche (ARP). In quest’ottica, dato il quadro economico italiano disaggregato in due macro-regioni (Nord-Centro/Sud-Isole), l’ampio dettaglio sulla spesa sanitaria ed un mercato del lavoro con disoccupazione, il modello consente di analizzare gli effetti diretti ed indiretti di una politica di riduzione della spesa ADI a favore di una maggiore spesa in ARA, operata secondo due diverse modalità. Nel primo scenario proposto la riallocazione della spesa è in capo alle regioni, che riducono il finanziamento di ADI in favore di ARA; nel secondo scenario le regioni trasferiscono le risorse liberate dalla riduzione della spesa in ADI, alle famiglie per finanziare la domanda di servizi ARA. Entrambe le manovre sono a parità di bilancio.