The decisional process for a family tourist experience: some evidence from a Sicilian sample

The tourist sector and above all the hotel one nowadays is more and more specialized in satisfying particular needs. To identify typical tourist needs of Sicilian families, and get a valuable product definition, we investigate the consumer behaviour, and before, the features of the persons that in a family take the decision to go on holiday and their motivations. But, who does decide inside the family? Which target the tourist operators should consider in defining family tourist services? We start our discussion by considering three hypotheses: H1) children influence the type (destination, accommodation, duration, etc.) of family vacation; H2) the way of influencing in connected to their age; H3) there is no difference in role between mother and father in the decision process. The empirical survey uses a questionnaire divided in different sections: demographic details (settlement, education, employment, etc.), type and evaluation of previous holiday experiences and reservation channels, persons involved in the choosing process and selecting items, services really included during the vacation. The considered sample involves 100 Sicilian families selected with the help of a not for profit association of parents: \u201cNoi Genitori. Famiglia e Societ\ue0\u201d. The results coming from a correlational analysis confirm the first and the second hypothesis but not completely the last one: mother and father play different role in connection with the different step of the decisional process. Coming from the data processing, the survey offers first advices to hotel entrepreneurs and managers in order to define in a more effective way their services and their communication strategies; the results highlight that an effective definition should consider, firstly, which conception of family inspires the target. The results emphasize that different persons with a specific family role usually occupy a particular position in the decision process (planning, selecting the destination and services, etc.). The results stress the importance of the vacation as an opportunity to make stronger the family mood

La responsabilità nella pandemia covid-19 a 360°: Dal datore di lavoro al laboratorio.

Il presente lavoro affronta il delicato tema della responsabilità del datore di lavoro nel contesto della pandemia di Covid-19, sorto in conseguenza della difficoltà di contenere il rischio di contagio negli ambienti lavorativi e della complessità di interpretazione e applicazione della normativa emergenziale. L’indagine inizia esplorando il quadro normativo generale relativo alla sicurezza sul lavoro e alle responsabilità del datore di lavoro, passando poi all’analisi della normativa emergenziale nata per affrontare e contenere la diffusione del virus e che ha incluso misure preventive e protocolli anti-contagio. In relazione a ciò, vengono analizzate le misure preventive adottate nei luoghi di lavoro, come l’uso di DPI e la sanificazione periodica dei locali aziendali, nonché la questione dell’aggiornamento del documento di valutazione dei rischi (DVR) in risposta al rischio biologico correlato al Coronavirus. Parte del lavoro è stata dedicata all’analisi del contributo dei laboratori nella lotta contro il virus SARS-CoV-2, con un focus sui test di laboratorio sviluppati per la rilevazione del virus. Il lavoro si concentra poi sui profili di responsabilità penale e civile dei datori di lavoro in caso di violazione degli obblighi di sicurezza, esaminando anche lo spinoso elemento del nesso causale tra l’evento dannoso e la condotta del datore di lavoro. Lo studio vuole sottolineare la complessità della gestione della responsabilità datoriale in un contesto emergenziale come quello pandemico, proponendo un’analisi critica delle disposizioni speciali in materia e osservando le sfide nella definizione della colpa e della causalità. L’assenza di una bibliografia ampia e la carenza di esperienze applicative rendono, questo, un campo in via di sviluppo, dove la dottrina e la giurisprudenza stanno ancora emergendo. L’obiettivo prossimo è quello di osservare come la giurisprudenza si evolverà nella valutazione di eventuali cambiamenti sul tema della responsabilità datoriale

PRIMARY ORAL MUCOSA MELANOMA: A REPORT OF AN UNUSUAL CLINICOPATHOLOGICAL CASE

Primary oral melanoma is a rare malignancy with an aggressive behaviour. Up to date, the wide clinicalhistological variability of this oncological entity does not clarify the etiopathogenetic characteristics of these cancers and limit the therapeutic strategies. We report a case of a 64-year-old white female referred to the Dept. of Surgical, Oncological and Oral Sciences for a pigmented lesion of the mandibular gingiva, already arising 20 years ago but dimensionally increased in the last three months. Clinically, a black plaque-like pigmentation of the vestibular alveolar mucosa of the mandible (from 3.6 to 3.3) was observed. This lesions was still painless. CT dentalscan and ecography of the head and neck lymph nodes have showed no signs of bone and lymph nodes involvement. An incisional biopsy of the lesion was performed under local anaesthesia. Histopathologic examination showed a nodular proliferation of atypical melanocytic elements with epithelioid aspect and nuclear alterations; numerous abnormal mitotic figures were evident and the malignant melanocytes were characterized by marked intra/extracellular pigmentation. Immunohistochemical staining showed strong and diffuse positivity for Melan A and HMB45, 40% positive for Ki67 and positive/negative result for p16. These histopathologic features were suggestive for animal-type invasive melanoma. After diagnosis, the patient was referred to the Dept. of Head and Neck Surgery for staging and chirurgical approach of the lesion. At the best of our knowledge, only a very small number of animal-type melanomas have been reported in the oral cavity and usually with a more indolent behavior than conventional melanoma and a better prognosis. However, future reports are necessary to characterize the features of this cancer and to determine any factors that may correlate with outcome

Evidence of field cancerization of oral squamous cell carcinoma: a case report

Objectives. From 1953 (1) the term “field cancerization” has been used to describe an “increased risk of cancer de- velopment in the entire upper aerodigestive tract due to multiple genetic abnormalities in the whole region after pro- longed exposure to carcinogen” (2). This phenomenon implies the occurrence of multiple primary tumors/potentially malignant disorders as results of cell-molecular aberrations in different independent sites (polyclonal theory) or from the same site through widespread expansion or later spread across the mucosa (monoclonal theory). Case report. A 63-year-old female patient referred in June of 2014 for exophytic/ulcerative lesion in the hard palate. At the same time, several teeth (1.5, 1.6 and 3.6) with poor prognosis and an incisional biopsy were per- formed. The histological examination reported a diagnosis of oral squamous cell carcinoma (G1) and the manage- ment (imaging and TNM staging) was scheduled. Unfortunately, 30 days after exodontia, one of alveolar sites (3.6) showed proliferative tissue and not healing. A new biopsy was carried out, revealing an histological diagnosis of “epithelium with marked parakeratosis, acanthosis and papillomatosis associated with areas of moderate dys- plasia (IIC: PanCK)”. Conclusions. The features described in different areas of the oral cavity led us to make a diagnosis of oral field can- cerization. This condition still must be analyzed in order to clarify the onset and development but, most importantly, a protocol for manage these patients have to be developed. Chemoprevention and cessation of smoking and alcohol may impact new tumors. Amelioration of surgery, radiotherapy, chemotherapy and gene therapy may influence the morbidity and mortality of oral cancer patients, even if a short follow up and the secondary prevention may warrant a life-long surveillance

Coupled plasma filtration and adsorption in septic shock: a multicentric experience

Introduction Recently extracorporeal removal of mediators and endotoxins improved haemodynamics, organ dysfunction and mortality in patients with abdominal sepsis [1]. Coupled plasma filtration and adsorption (CPFA), too, may improve haemodynamics, respiratory function and mortality through removal of proinfl ammatory mediator. The aim of this multicentric study is to evaluate the haemodynamic response and the respiratory function, and to evaluate the reduction of infl ammatory markers during CPFA.Methods Fifty-fi ve septic patients were enrolled in this study. Every patient had four CPFA treatments (LINDA; Bellco-Mirandola, Italy) for 8 hours with Qb = 200 ml/minute, Qultrafi ltration = 30 ml/kg/hour and Qplasma = 20% of Q b. At T0 (basal), T1 (after fi rst cycle), T2 (after second cycle), T3 (after third cycle)and T4 (after fourth cycle) we evaluated haemodynamic parameters, norepinephrine dosage, PaO2/FiO 2 ratio, plasma IL-6, and procalcitonin (PCT). The ANOVA test was used to compare changes during times study. P <0.05 was considered statistically significant. Results Patients enrolled in the study have been submitted to 256 CPFA treatments for 2,650 hours. Table 1 presents the main results of the study. IV quartile of IL-6 is shown in Table 1Conclusions In this large multicentric study, CPFA may improve haemodynamic status and respiratory function. Plasma fi ltration and adsorption of proinfl ammatory mediators may explain this improvement. Larger randomized controlled trials are indicated to confi rm these data. Reference 1.Cruz D, et al.: JAMA 2009, 23:2445-2452

The combination of laser-assisted surgery with PRP for the treatment of BRONJ in cancer patient. A pilot study

Aim. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known potential complication of bisphosphonates (BPs) therapy and its treatment could reckon on different approaches. Recently, encouraging results for BRONJ were showed from some clinical studies using Er, Cr: YSGG laser-assisted surgery. Platelet-Rich Plasma (PRP), a new approach to promote tissue regeneration and healing, may be a promising complementary therapy. The aim of this pilot study is to study the effectiveness, in terms of clinical healing, of a combined treatment (laserassisted surgery and topical PRP) for BRONJ in a group of cancer patients. Methods. Ten oncological patients (3 males, 7 females; aged 69-89 years, mean age 76.2±5.8) with BRONJ were consecutively recruited. BRONJ was classified (T0) according to. All patients underwent pre- and peri-operatory antibiotic prophylaxis, and preparation of autologous PRP; the following combined surgical protocol was applied: i) exposure of the surgical area, through the creation of surgical edges; ii) courettage of the necrotic bone and, if present, sequestrectomy, by using a Er, Cr: YSGG laser; iii) application of autologous PRP over the entire bone cavity; iiii) suture of surgical flaps. All patients performed a CT after 3 months from surgery (T1) in order to re-stage of the disease. Successful treatments were considered the complete healing and the radiological improvement (transition from a higher stage to a lower one). Results. At T0 6/10 patients were stage IB, 2/10 were stage IIA and 2/10 were stage IIB. At T1, 3/10 (30%) cases (2 cases IB and 1 case IIB) showed no clinical and radiological signs of BRONJ relapse; 5/10 (50%) cases (4 cases IB and 1 case IIB) showed clinical improvement, whereas 2/10 (20%) (both IIA) showed no-improvement. Conclusion. The association of laser-assisted surgery and topical PRP, firstly investigated in this study, seems useful in BRONJ healing among cancer patients. Further investigation is necessary in order to validate these preliminary result

Triple simultaneus oral squamous cell carcinoma in a heavy smoker patient: a case report

Introduction. The presence of multiple malignancies in the aerodigestive tract is a rare disorder defined as multiple primary carcinoma (MPC)1, which lesions must be at different sites separated by normal mucosa and histologically confirmed, and should not be metastatic disease from the index carcinoma2. The reported incidence of MPC in the oral cavity has been reported to be 1.4%. MPC can be simultaneous (diagnosed at the same time as the index tumour), synchronous (additional primaries diagnosed within 6 months of the index tumour), or metachronous (primaries that develop more than 6 months after the index tumour)2. Case report. A 79-year-old edentulous male patient presented 3 different oral lesions: a) an erythro/leukoplasic le- sion on the soft palate and uvula (2,5x1cm), b) a verrucous/ulcerative lesion on the floor of the mouth (1x1cm), c) an exophytic/ulcerative lesion on the edentulus ridge of the 4th sextant (3,5x1cm). Lesions were not associated to any symptoms; the lesions b and c were bleeding and fixed to the underlying tissue. The patient reported no health concerns; he referred a 10-pack-year of cigarettes history followed by 50-pack-year of cigars. All the lesions presented a dark royal blue aspect after the toluidine blue staining3. Incisional biopsies were made and the histological examination reported a diagnosis of “oral squamous cell carcino- ma” in each of the tissue samples. Patient was referred to the Department of Oral Maxillofacial and Plastic Surgery for the TNM staging and the management. Conclusion. The MPC pathogenesis is uncertain involving genetic susceptibility, tumor immunity and environmental factors. Moreover, multiple cancers have a poor prognosis, 3-year survival rate of 50%, underlining that secondary prevention should be promoted and supported in adult heavy smokers, as the early diagnosis of oral carcinoma aris- es the probability of successful treatment

Improving the cancer adult patient support network (iCAN): a pilot study on a communication model and modified focus group

BackgroundMany consider that cancer has the greatest impact of any disease in the world, and it can drastically limit patients' quality of life. Combating such a life-threatening disease can pose many challenges to daily life, highlighted by demonstrating the need to discuss one's health status within a focus group and encourage treatment compliance.Aimthe purposes of this study were to share the authors' experience of a modified focus group in an Oral Medicine Unit, termed "Improving Cancer Adult Patients Support Network" (iCAN), and to evaluate how effective communication could improve patients' quality of life and empower them by virtue of enhanced knowledge and an awareness of cancer management.Methodsthe paper adhered to the COREQ checklist regarding its reporting procedures. The iCAN format was precisely reproduced four times with four groups, consisting of 12 adult male and female patients with solid cancers. They discussed several main topics relating to cancer treatment, as chosen by a majority of the participants. Four specialists were involved in the discussion of the selected topics The iCAN format was faithfully reproduced during each meeting, with the participants in the roles of moderator and health specialists. Finally, a satisfaction questionnaire was administered.Resultsthe most reliable results demonstrated a marked change in lifestyle and eating habits in more than 50% of participants. More than 80% were unaware of the side effects of cancer treatments in general and the oral mucosa in particular. Each meeting reported a maximum degree of satisfaction experienced by the participants.ConclusioniCAN focus group meetings appear to have facilitated a process of narrative interviewing, thereby improving the doctor-patient relationship underlying the humanization of the care process

Longstanding Endobronchial Foreign Body

There are many circumstances in which the diagnosis of endobronchial inhalation of a foreign body (FB) can be missed. Generally, in such cases, within weeks or at most months from the event, clinical bronchopulmonary symptoms develop which allow a correct diagnosis to be made and significant complications to be avoided. We report the case of a patient in whom an endobronchial FB remained undiagnosed, because of lack of symptoms, for almost three years, and then caused signifiicant complications before being identified and removed. Problems related to diagnosis and therapy are discussed