vera solidarieta come alternativa all abbandono terapeutico e all eutanasia

morale per esprimere le varie dimensioni del ragionamento morale e descrivere le condizioni necessarie perché si possa porre un atto, in tutte quelle situazioni in cui capita di dover scegliere di compiere un dato bene, accettando, accanto agli effetti positivi voluti, gli effetti negativi collaterali che possono derivare dalla scelta di quel bene. L'ambito di applicazione di tale principio è assai vasto ed esso è stato accolto anche all'interno della bioetica e applicato in relazione alle questioni di inizio e fine vita (particolarmente nell'ambito della bioetica clinica), della ricerca scientifica e della difesa dell'ambiente. Il ricorso a tale principio, tuttavia, non è esente da fraintendimenti, in primo luogo, di carattere metodologico: il processo di applicazione, infatti, è di per sé equivoco nel momento in cui il principio stesso si pone come giustificazione morale dell'atto, piuttosto che come criterio guida. L'obiettivo di questo articolo è quello di chiarire quale sia l'utilità del PADE e, soprattutto, se ed in quali termini si debba ricorrere ad esso in bioetica, al fine di arrivare alla soluzione di taluni problemi dall'agire morale che sorgono nell'ambito medico. Attraverso una disamina di alcuni casi paradigmatici, l'Autore sottolinea il valore essenzialmente strumentale del PADE, mettendo in luce come il contributo maggiore che viene da questo principio è quello di essere fondamentalmente un aiuto per affinare l'analisi dell'atto, in quelle situazioni in cui l'esito di talune azioni può produrre degli effetti collaterali. ---------- The principle of the act with double effect (PADE) rises in moral theology to express the various dimensions of the moral reasoning and to describe necessary conditions so that an action can be set, in all those situations in which it happens one must choose to achieve a given good, accepting, besides the intended positive effects, the negative side effects that can derive from the choice of that good. The sphere of application of such principle is wide and it has also been welcomed into bioethics and applied in relationship to the issues of beginning and end of life (particularly within the clinical bioethics), scientific research and environmental protection. The recourse to such principle, yet, is not exempted by methodological misunderstanding: the process of application, in fact, is by itself equivocal in the moment in which the same principle sets it as moral justification of the action, rather than as guide criterion. The aim of this paper is to clarify what the utility of the PADE is and, above all, whether and in what terms it must be used in bioethics, to reach the solution of some moral problems rising from medical context. Through an examination of some paradigmatic cases, the author underlines the instrumental value of the PADE, showing how the main contribution that comes from this principle is that of being basically an aid to sharpen the analysis of the act in all those situations in which the result of some actions can produce some side effects

Eating episode frequency and fruit and vegetable consumption among Italian university students

Objective: To analyze breakfast consumption, regularity of meals, fruit and vegetable consumption in the Italian University Student population on a national level.Design: Descriptive analysis evaluating data taken from the “Sportello Salute Giovani” questionnaire.Participants: 12.000 university students who self-administered a confidential survey. 8292 questionnaires were analyzed.Variables measured: Age; sex; self-reported economic status; BMI; number of breakfast and portions of vegetables and portions of fruit usually consumed per week; number of eating episodes per day; intended weight loss.Analysis: Descriptive and logistic regression analyses were conducted. Gender and age differences were tested by Chi2 and Mann-Whitney tests.Results: 15.8% of males and 26.3% of females declared to consume at least one portion of fruit every day. Similar results were found for vegetable consumption. Age does not influence fruit or vegetables consumption, frequency of eating episodes or breakfast habit. Both a regular breakfast and a higher number of eating episodes are significantly associated both with a higher frequency of fruit and vegetables intake.Conclusions and implications: This study underlines the need to promote nutritional education campaigns to increase adherence to nutritional guidelines

Study population, questionnaire, data management and sample description

Introduction. This article describes methodological issues of the “Sportello Salute Giovani” project (“Youth Health Information Desk”), a multicenter study aimed at assessing the health status and attitudes and behaviours of university students in Italy. Materials and methods. The questionnaire used to carry out the study was adapted from the Italian health behaviours in school-aged children (HBSC) project and consisted of 93 items addressing: demographics; nutritional habits and status; physical activity; lifestyles; reproductive and preconception health; health and satisfaction of life; attitudes and behaviours toward academic study and new technologies. The questionnaire was administered to a pool of 12 000 students from 18 to 30 years of age who voluntary decided to participate during classes held at different Italian faculties or at the three “Sportello Salute Giovani” centers which were established in the three sites of the Universita Cattolica del Sacro Cuore (Catholic University of the Sacred Heart of Rome). Results. The final study sample was composed by 8516 university students. The mean age of responders was 22.2 (Standard Deviation 2.0) and 5702 (67.0%) were females. According to the distribution in age classes, 3601 (43.3%) belonged to the 18-21 one, 3796 (44.5%) to the 22-24 class and 1019 (12.2%) to the 25-30 class. With respect to socio-economic status, data were available for 8410 responders and showed that 50.3% of students belonged to the middle class. Discussion. The project took into consideration a large number of individuals from different regions of the country and therefore may be considered representative of the general population of Italian university students. Furthermore, it is the first to address, at the same time, several issues, in particular attitudes and behaviours toward health, in Italian university students. Conclusion. The analysis of data from such a large sample of university students sets the basis for identifying the most appropriate interventions in order to address the specific needs of this population

Operational resilience of reservoirs to climate change, agricultural demand, and tourism: A case study from Sardinia

Copyright © 2015 Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in Science of the Total Environment. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Science of the Total Environment (2015), DOI: 10.1016/j.scitotenv.2015.04.066Many (semi-) arid locations globally, and particularly islands, rely heavily on reservoirs for water supply. Some reservoirs are particularly vulnerable to climate and development changes (e.g. population change, tourist growth, hydropower demands). Irregularities and uncertainties in the fluvial regime associated with climate change and the continuous increase in water demand by different sectors will add new challenges to the management and to the resilience of these reservoirs. The resilience of vulnerable reservoirs must be studied in detail to prepare for and mitigate potential impacts of these changes. In this paper, a reservoir balance model is developed and presented for the Pedra e' Othoni reservoir in Sardinia, Italy, to assess resilience to climate and development changes. The model was first calibrated and validated, then forced with extensive ensemble climate data for representative concentration pathways (RCPs) 4.5 and 8.5, agricultural data, and with four socio-economic development scenarios. Future projections show a reduction in annual reservoir inflow and an increase in demand, mainly in the agricultural sector. Under no scenario is reservoir resilience significantly affected, the reservoir always achieves refill. However, this occurs at the partial expenses of hydropower production with implications for the production of renewable energy. There is also the possibility of conflict between the agricultural sector and hydropower sector for diminishing water supply. Pedra e' Othoni reservoir shows good resilience to future change mostly because of the disproportionately large basin feeding it. However this is not the case of other Sardinian reservoirs and hence a detailed resilience assessment of all reservoirs is needed, where development plans should carefully account for the trade-offs and potential conflicts among sectors. For Sardinia, the option of physical connection between reservoirs is available, as are alternative water supply measures. Those reservoirs at risk to future change should be identified, and mitigating measures investigated.European Commission Seventh Framework Project ‘WASSERMed’ (Water Availability and Security in Southern EuRope and the Mediterranean

Using terrestrial LiDAR for monitoring canopy structure in cork oak trees

The main aim of this work was to assess the capabilities of terrestrial laser scanner in measuring both changes by the time and differences among trees of canopy characteristics of Quercus suber L. (cork oak) plants

The burden of the knowledge-to-action gap in acute appendicitis

Background The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance.MethodsData were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG.ResultsFrom 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%).Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units.ResultsFrom 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%).Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units.ConclusionsWe confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required

Detection of post-traumatic abdominal pseudoaneurysms by CEUS and CT: A prospective comparative global study (the PseAn study)-study protocol

The success of non-operative management in trauma increased with the availability of new-generation CT scan machines, endoscopy, and angiography, becoming the standard of care in hemodynamically stable trauma patients with abdominal solid organ injuries, with a success rate of 78% to 98%. Post-traumatic pseudoaneurysms (PAs) can develop at any region of an injured artery and they may cause delayed bleeding in splenic or hepatic trauma, with an incidence in patients treated with NOM of 2%-27% and 1.2%-6.1% respectively. Diagnosis is made by angiography, contrast-enhanced computer tomography (CT), or Doppler Ultrasound (US) while the use of contrast-enhanced ultrasound (CEUS), has increased in recent years although few data are available about CEUS feasibility in the follow-up setting. The PseaAn study has been designed to assess the role of CEUS in the follow-up of abdominal trauma by defining its sensitivity, specificity and predictive values compared with abdominal CT scan. The PseAn study is a multi-centric international diagnostic cross-sectional study initiated by the Level I Trauma Center of the Niguarda Ca' Granda Hospital in Milan, Italy. To study the role of CEUS in detecting post-traumatic splenic, hepatic, and renal PAs compared with the gold standard of CT with intravenous contrast at different follow-up time points, and whether it can replace CT scan in the follow-up of solid organ injuries, patients with OIS III and above will undergo a follow-up with both a CEUS and CT scan to detect post-traumatic parenchymal pseudoaneurysm within two to five days from injury. The use of CEUS in the follow-up of abdominal trauma follow-up (particularly blunt trauma) has increased, to minimise the use of ionizing radiation and contrast media and encouraging results have been published during the last decade showing that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. Conclusions We think that CEUS, which is underused worldwide, is a useful and safe tool that may replace CT scan in follow-up with the major advantage of reduced radiation. Our current study may give stronger evidence to support this view

Infected pancreatic necrosis : outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Peer reviewe

Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study

High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (>= 4.7 mg/dL) and CVM (>= 5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40], p < 0.001) and CVM (1.31 [1.11-1.74], p < 0.001) in the whole study population, and according to TG strata: ACM in normotriglyceridemia (HR 1.26 [1.12-1.43], p < 0.001) and hypertriglyceridemia (1.31 [1.02-1.68], p = 0.033), and CVM in normotriglyceridemia (HR 1.46 [1.23-1.73], p < 0.001) and hypertriglyceridemia (HR 1.31 [0.99-1.64], p = 0.060). Exploratory and sensitivity analyses confirmed our findings, suggesting a substantial role of SUA in normotriglyceridemia and hypertriglyceridemia. In conclusion, we report that SUA can predict ACM and CVM in cardiometabolic patients without established cardiovascular disease, independent of TG levels

Serum uric acid and left ventricular mass index independently predict cardiovascular mortality: The uric acid right for heart health (URRAH) project

A relationship between serum uric acid (SUA) and cardiovascular (CV) events has been documented in the Uric Acid Right for Heart Health (URRAH) study. Aim: of this study was to investigate the association between SUA and left ventricular mass index (LVMI) and whether SUA and LVMI or their combination may predict the incidence of CV death. Methods: Subjects with echocardiographic measurement of LVMI included in the URRAH study (n=10733) were part of this analysis. LV hypertrophy (LVH) was defined as LVMI > 95 g/m2 in women and 115 g/m2 in men. Results: A significant association between SUA and LVMI was observed in multiple regression analysis in men: beta 0,095, F 5.47, P 5.6 mg/dl in men and 5.1 mg/dl in women) and LVH (log-rank chi-square 298.105; P<0.0001). At multivariate Cox regression analysis in women LVH alone and the combination of higher SUA and LVH but not hyperuricemia alone, were associated with a higher risk of CV death, while in men hyperuricemia without LVH, LVH without hyperuricemia and their combination were all associated with a higher incidence of CV death. Conclusions: Our findings demonstrate that SUA is independently associated with LVMI and suggest that the combination of hyperuricemia with LVH is an independent and powerful predictor for CV death both in men and women