Contro il paternalismo giuridico

Il problema generale di cui paternalisti e antipaternalisti dibattono è se e fino a che punto una persona possa legittimamente disporre del proprio corpo o della propria vita, fino a che punto possa cagionare a se stessa (ciò che molti considerano) un “danno”. In particolare, paternalisti e antipaternalisti discutono di questioni morali e giuridiche molto controverse, ad esempio la liceità/illiceità della prostituzione, dei rituali religiosi di flagellazione della carne, della vendita e del consumo di sostanze stupefacenti, dell’eutanasia, del suicidio assistito, degli sport molto pericolosi, fino a casi estremi come la possibilità di commercializzare parti del proprio corpo. In estrema sintesi, il paternalismo giuridico sostiene che lo Stato abbia il potere di limitare la libertà dell’individuo, tramite la coazione, ad esempio la sanzione penale, per tutelare (ciò che si pretende sia) il bene dell’individuo medesimo, per impedire che egli cagioni un danno a sé stesso, anche se non cagiona danni a terzi. Secondo l’antipaternalismo giuridico, in estrema sintesi, lo Stato non può usare la coazione per limitare le scelte razionali e libere da costrizioni di un individuo adulto, anche ove queste scelte cagionino un danno, ad esempio fisico o psicofisico, all’individuo stesso. Purché non cagionino danni a terzi. Al paternalismo giuridico, alla sua “confutazione”, e alla difesa dell’antipaternalismo, è dedicato questo libro

Borderline personality in patients with poly-diagnoses treated for a Bipolar Disorder

Some patients with dysphoria, explosive behaviour, or suicidal ideation, may receive a diagnosis of, and treatment for Bipolar Disorder (BD) and, not infrequently. The coexistence of these two diagnoses has been explained in different ways. Some authors include the BPD in the bipolar spectrum; others are sceptical about the existence of real comorbidity, suggesting a misdiagnosis. This study aimed to assess the personality of this group of poly-diagnosed patients (PolyD) and hypothesised they had a pathological borderline organisation. Via the administration of the Schedler Westen Assessment Procedure (SWAP-200), we compared PolyD patients with those suffering from BPD or BD only. We performed two different MANCOVAs to test PolyD, BPD and BD patients' differences in PD-factors, Q-traits and age. The sample comprised 45 patients (Mean age=43.3, SD=15.7; Females 57.7%, N=26). BD patients (N=15) did not present any personality disorder, they had a higher functioning and Obsessive Q-traits, and a lower Histrionic PD-factor than both PolyD (N=20) and BPD (N=10) patients. Compared to PolyD patients, BD had inferior PD-Borderline, PD-Antisocial factor and Dependent-Masochistic Q-traits, but there were no other differences with BPD patients. PolyD did not differ from BPD patients in any of the PD-factors and Q-traits. Our results suggest that PolyD patients are different from BD patients and propose to consider the pathological borderline personality as a central core of their disease

Long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome treatment

Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea-hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery

FMECA methodology applied to two pathways in an orthopaedic hospital in Milan.

INTRODUCTION: Adverse events pose a challenge to medical management: they can produce mild or transient disabilities or lead to permanent disabilities or even death; preventable adverse events result from error or equipment failure. METHODS: IRCCS Istituto Ortopedico Galeazzi implemented a clinical risk management program in order to study the epidemiology of adverse events and to improve new pathways for preventing clinical errors: a risk management FMECA-FMEA pro-active analysis was applied either to an existing clinical support pathway or to a new process before its implementation. RESULTS: The application of FMEA-FMECA allowed the clinical risk unit of our hospital to undertake corrective actions in order to reduce the adverse events and errors on high-risk procedure used inside the hospitals

Fatty acid composition of salami made by meat from different commercial categories of indigenous dairy cattle

In autochthonous dairy cattle farms, the production of salami could represent an alternative commercial opportunity. Therefore, a study was carried out to investigate the fatty acid (FA) composition of salami made using the meat from grazing (GB) or housed (HB) young bulls and grazing adult cows (AC) of Cinisara breed. The products were manufactured by adding 20% of pork lard. Animal category influenced the FA composition, although the addition of lard mitigated the differences found in fresh meat. The salami from GB showed higher polyunsaturated FA content (p ≤0.01) and, in particular, a higher level of linoleic acid (p ≤0.05), than from other animal categories. Salami made from AC meat showed lower polyunsaturated/saturated FA ratio (p ≤0.05), but a better n-6/n-3 ratio compared to HB (p ≤0.05), due to the lower content of linoleic acid. Multivariate analysis showed an important influence of animal category on FA composition due to age, feeding system and meat fat content of animals, despite the addition of lard

Effects of Grazing Season on Physico-Chemical Characteristics and Fatty Acids of Nutritional Interest of Caciocavallo Palermitano Cheese

The aim of this work was to evaluate, in the different production seasons of the year, the physico-chemical quality of an artisanal cheese traditionally obtained from autochthonous grazing cows, with particular reference to fatty acids (FA) of nutritional interest that play an important role in the risk or prevention of some human pathologies. For this purpose, cheeses were sampled in 11 farms, repeating the samplings in 3 different periods of the year (summer, autumn–winter, and spring) when the productive conditions of the pastures varied. The cheeses produced in the spring period, when cows ingest a greater amount of grazed forage, resulted in a more adequate composition of the main FA, which are recognized as having a health effect, such as α-linolenic, trans-vaccenic, rumenic, docosapentaenoic (DPA) and docosahexaenoic (DHA) acids. Branched-chain FA were found in greater quantities in spring cheeses, as well as in summer ones. The FA composition of cheeses produced in the different seasons was reflected in some nutritional indexes that also resulted as more suitable in cheeses obtained in the spring period. The positive effects induced on the FA profile of cheeses are presumably linked to the diet of autochthonous cows, which is mainly based on forage from natural pastures. Therefore, the results obtained confirm the benefits of grazing, which is able to guarantee the production of healthier cheeses for consumers

Fatty acids as biomarkers of the production season of caciocavallo palermitano cheese

This experiment aims to evaluate the potential of fatty acids (FA) of Caciocavallo Palermitano cheese as biomarkers of production season and pasture-based diet. A total of 48 cheeses were made in the four seasons with milk from two farms that raised cows of Cinisara breed. The animals were fed on pasture with supplementation of wheat bran and wheat straw in the barn, and in summer also with Opuntia ficus-indica cladodes. The chemical composition and FA profile of cheese were influenced by the season and not by the farm. In particular, cheeses produced in spring were characterized by higher protein and lower fat, and showed higher contents in trans-vaccenic acid, α-linolenic acid, rumenic acid, n-3 polyunsaturated FA (PUFA), and total PUFA. In winter, the lower availability of grazing forage, requiring a higher level of feeding integration, was responsible for an increase of saturated FA (SFA). The multivariate analysis distinguished clearly the cheeses made in winter and spring, while those produced in autumn and summer showed some overlapping points. Further investigations should be carried out to evaluate the effects of type and level of feeding integration on the presence of FA more suitable to be used as biomarkers of period and diet