Telemedicine Has a Social Impact: An Italian National Study for the Evaluation of the Cost-Opportunity for Patients and Caregivers and the Measurement of Carbon Emission Savings.

Background: Owing to COVID-19, all stakeholders have recognized the advantages of telehealth and they were available for its permanent implementation, both from the normative and economic point of view. It is, therefore, necessary to understand what were the real benefits created in society through telehealth. Objective: Develop a method to identify a social impact of telemedicine in Italy, considering the reduction on the patient moves with a consequent travel cost, time (opportunity costs), and carbon emission savings. Methods: Since March 2020, we have conducted a quality improvement study in 17 centers, collecting sociodemographic variables. To assess the social impact, we transform the data into outcome measures. The protocol used "Telemedicina Subito" allows the rapid implementation of telemedicine, using operating manual, structured according Health Technology Assessment approach. Results: We collected data related to 2,091 televisits, analyzing three different perspectives. First, one patient with a televisit had a saving equal to the median of EUR 97.16 (interquartile range [IQR]: 64.29-159.69), USD 113.88; considering that the median cost for the visit in presence was EUR 105.91 (p-value <0.05) and after the use of telehealth had a median of EUR 0 (mean: EUR 14.70; p-value <0.05). Second, informal caregivers have a median savings of EUR 65.06 (IQR: 55.52-89.21), USD 76.26. Finally, for one single telemedicine visits we can contribute with a median carbon emission savings of ∼13 kg (IQR: 6-24). Conclusions: The evaluation of the social impact on telemedicine facilitated the creation of an important framework for decision-makers.

From the lockdown to the new normal: individual mobility and local labor market characteristics following the COVID-19 pandemic in Italy.

Italy was among the first countries to introduce drastic measures to reduce individual mobility in order to slow the diffusion of COVID-19. The first measures imposed by the central authorities on March 8, 2020, were unanticipated and highly localized, focusing on 26 provinces. Additional nationwide measures were imposed after one day, and were removed only after June 3. Looking at these watershed moments of the pandemic, this paper explores the impact of the adoption of localized restrictions on changes in individual mobility in Italy using a spatial discontinuity approach. Results show that these measures lowered individual mobility by 7 percentage points on top of the reduction in mobility recorded in the adjacent untreated areas. The study also fills a gap in the literature in that it looks at the changes in mobility after the nationwide restrictions were lifted and shows how the recovery in mobility patterns is related to various characteristics of local labour markets. Areas with a higher proportion of professions exposed to diseases, more suitable for flexible work arrangements, and with a higher share of fixed-term contracts before the pandemic are characterised by a smaller increase in mobility after re-opening.

The COVID-19 Pandemic as an Opportunity to Improve Health Care Through a Nurse-Coordinated Multidisciplinary Model in a Headache Specialist Center: The Implementation of a Telemedicine Protocol.

Background: Due to coronavirus disease-19 (COVID-19) pandemic, Italian outpatient clinics were suspended in March-April 2020 and subsequently slowed down. Telemedicine was shown to be useful in headache clinics, despite absence of a detailed protocol for its development. Objective: To describe the implementation of a structured telemedicine protocol during COVID-19 pandemic. Materials and Methods: Since May 2020, we performed a quality improvement study in a Headache Specialist Center in central Italy. We involved patients who had in-person follow-up visits scheduled during suspension and initial reopening of clinics. Patients had two appointments with a nurse specialized in headache care and a headache physician, respectively, using Microsoft Teams®. The service is still active. We collected sociodemographic and clinical characteristics of patients, technical details of telemedicine visits, patient feedback, medical judgment about complexity of clinical decisions, and need for in-person re-evaluation. We also performed a Strengths-Weaknesses-Opportunities-Threats analysis to provide a realistic picture of the service. Results: We performed 207 telemedicine visits involving 100 patients with a median age of 44 (interquartile range [IQR]: 35-56) years; 76.0% were women and lived at a median of 68 (IQR: 24-109) km from the Center. Thirty-nine (39.0%) were visited for migraine without aura. Patients mostly used a computer (68.1% visits) with high audio-video quality in 93.2% of visits. First and second appointments lasted in median 20 (IQR: 14-25) minutes and 9 (IQR: 7-13) minutes, respectively. Interacting with patients was very easy in 66.7% of visits. Patients reported no difficulty in sharing documents and high satisfaction in 78.6% and 93.5% of visits, respectively. Perceived complexity of clinical decisions was generally low (86.5%), whereas 8.2% of cases required in-person re-evaluation. Conclusions: Telemedicine facilitated follow-ups, ensuring multidisciplinary care and high patient satisfaction, justifying its wider adoption in headache care.

Robots and risk of COVID-19 workplace contagion: Evidence from Italy.

This work investigates the cross-industry relationship between robot adoption and the risk of contracting COVID-19 in the workplace in Italy. Using a novel dataset on the risk of workplace contagion, we show that industries employing more robots tend to exhibit lower risks, thereby providing some empirical support for the widely held, but so far untested, hypothesis that robots can help mitigate the risk of contagion among workers by reducing the need for physical interactions. While we acknowledge the relevance of robots in the fight against COVID-19 and their possible role in enhancing the resilience of economic systems against future pandemics, we also thoroughly discuss a series of potential trade-offs between workplace safety and employment conditions that could arise (especially in the short run) due to a substantial increase in the rate of robot adoption.

Determinants of virtual water flows in the Mediterranean.

The aim of the paper is to investigate the main determinants of the bilateral virtual water (water used in the production of a commodity or service) flows associated with international trade in agricultural goods across the Mediterranean basin. We consider the bilateral gross flows of virtual water in the area and study what export-specific and import-specific factors are significantly associated with virtual water flows. We follow a sequential approach. Through a gravity model of trade, we obtain a "refined" version of the variable we aim to explain, one that is free of the amount of flows due to pair-specific factors affecting bilateral trade flows and that fully reflects the impact of country-specific determinants of virtual water trade. A number of country-specific potential explanatory variables, ranging from water endowments to trade barriers, from per capita GDP to irrigation prices, is presented and tested. To identify the variables that help to explain the bilateral flows of virtual water, we adopt a model selection procedure based on model averaging. Our findings confirm one of the main controversial results in the literature: larger water endowments do not necessarily lead to a larger 'export' of virtual water, as one could expect. We also find some evidence that higher water irrigation prices reduce (increase) virtual water 'exports' ('imports').