Un nuovo approccio per le “sovvenzioni” al Trasporto Pubblico Locale (TPL)

Il TPL in Italia, come pure in molte altre nazioni – a livello europeo ma anche mondiale – viene fortemente supportato dalla mano pubblica perché ritenuto un servizio sociale di importanza vitale e perché rivolto prevalentemente ad un’utenza costituita dalle classi meno abbienti. Infatti, il TPL rappresenta, ad oggi, l’unica modalità per la mobilità di massa in grado di rendere decisamente meno elevate le diseconomie legate al trasporto in ambito locale. Inoltre, il TPL viene utilizzato in modo molto diffuso ed esclusivo da parte delle categorie meno abbienti, in quanto costa meno del trasporto privato. Queste motivazioni, che spiegano l’esigenza di sovvenzionare il trasporto pubblico locale, hanno trovato un’elaborazione teorica da parte di alcuni studiosi del settore e, nella letteratura internazionale. In Italia, il settore, nonostante l’ammontare delle risorse impiegate, risulta continuamente in crisi in quanto i costi risultano normalmente superiori alle entrate ed i servizi offerti di gran lunga inferiori alle complessive esigenze di mobilità. Il finanziamento al TPL si basa sul corrispettivo all’”offerta di trasporto” e cioè viene erogato dall’Ente, o organismo, concedente un contributo per ogni chilometro percorso dall’Azienda, o società, concessionaria del servizio. In molti altri paesi europei (Germania, Regno Unito, Olanda, Svezia etc.), il criterio non è quello di sovvenzionare l’offerta di servizio ma dare un contributo alle categorie meno abbienti, che non devono pagare l’intera tariffa. In sintesi, il sistema funziona in questo modo: l’Azienda gestisce una rete di TPL (o al limite una sola linea) garantendo una determinata percorrenza, con specifici orari, frequenze e capacità di trasporto. Pertanto, l’Azienda ha una conoscenza perfetta dei costi che andrà a sostenere e può, di conseguenza, calcolare le tariffe da applicare per raggiungere l’equilibrio di bilancio. L’Ente concedente fissa una soglia di reddito familiare sotto la quale si ha diritto ad una agevolazione per il TPL. Tutti gli aventi diritto ottengono dall’Azienda un abbonamento agevolato o carnet di biglietti scontati. L’Azienda, a sua volta, si fa rimborsare dall’Ente concedente la differenza tra la tariffa intera e quella agevolata. Premesso che, tale sistema scarica una rilevante parte della spesa dalla mano pubblica agli utenti del servizio, perché esso possa costituire un effettivo vantaggio nei termini di un aumento del surplus del consumatore, si devono verificare una serie di condizioni sia per gli enti pubblici, sia per le aziende e sia per gli utenti del servizio

Endocrinologic Control of Men's Sexual Desire and Arousal/Erection

Several hormones and neurotransmitters orchestrate men's sexual response, including the appetitive (sexual desire) and consummative (arousal and penile erection) phases. AIM: To provide an overview and recommendations regarding endocrinologic control of sexual desire and arousal and erection and their disturbances. METHODS: Medical literature was reviewed by the subcommittee of the International Consultation of Sexual Medicine, followed by extensive internal discussion, and then public presentation and discussion with other experts. The role of pituitary (prolactin, oxytocin, growth hormone, and α-melanocyte-stimulating hormone), thyroid, and testicular hormones was scrutinized and discussed. MAIN OUTCOME MEASURES: Recommendations were based on grading of evidence-based medical literature, followed by interactive discussion. RESULTS: Testosterone has a primary role in controlling and synchronizing male sexual desire and arousal, acting at multiple levels. Accordingly, meta-analysis indicates that testosterone therapy for hypogonadal individuals can improve low desire and erectile dysfunction. Hyperprolactinemia is associated with low desire that can be successfully corrected by appropriate treatments. Oxytocin and α-melanocyte-stimulating hormone are important in eliciting sexual arousal; however, use of these peptides, or their analogs, for stimulating sexual arousal is still under investigation. Evaluation and treatment of other endocrine disorders are suggested only in selected cases. CONCLUSION: Endocrine abnormalities are common in patients with sexual dysfunction. Their identification and treatment is strongly encouraged in disturbances of sexual desire and arousal

Psychological, Relational, and Biological Correlates of Ego-Dystonic Masturbation in a Clinical Setting

AbstractIntroductionAttitudes toward masturbation are extremely varied, and this practice is often perceived with a sense of guilt.AimTo evaluate the prevalence of ego-dystonic masturbation (EM), defined as masturbation activity followed by a sense of guilt, in a clinical setting of sexual medicine and the impact of EM on psychological and relational well-being.MethodsA series of 4,211 men attending an andrology and sexual medicine outpatient clinic was studied retrospectively. The presence and severity of EM were defined according to ANDROTEST items related to masturbation, determined by the mathematical product of the frequency of masturbation and the sense of guilt after masturbation.Main Outcome MeasuresClinical, biochemical, and psychological parameters were studied using the Structured Interview on Erectile Dysfunction, ANDROTEST, and modified Middlesex Hospital Questionnaire.ResultsThree hundred fifty-two subjects (8.4%) reported any sense of guilt after masturbation. Subjects with EM were younger than the remaining sample (mean age ± SD = 51.27 ± 13.43 vs 48.31 ± 12.04 years, P < .0001) and had more psychiatric comorbidities. EM severity was positively associated with higher free-floating (Wald = 35.94, P < .001) and depressive (Wald = 16.85, P < .001) symptoms, and subjects with a higher EM score reported less phobic anxiety (Wald = 4.02, P < .05) and obsessive-compulsive symptoms (Wald = 7.6, P < .01). A higher EM score was associated with a higher alcohol intake. Subjects with EM more often reported the partner's lower frequency of climax and more problems achieving an erection during sexual intercourse. EM severity was positively associated with worse relational and intrapsychic domain scores.ConclusionClinicians should consider that some subjects seeking treatment in a sexual medicine setting might report compulsive sexual behaviors. EM represents a clinically relevant cause of disability, given the high level of psychological distress reported by subjects with this condition, and the severe impact on quality of life in interpersonal relationships

Assessing the biomass of shrubs typical of Mediterranean pre-forest communities

One of the most outstanding issues of current environmental research is the need of reliable assessments of carbon stock (i.e. above-ground (a.g.) and below-ground biomass, deadwood, litter, and organic soil matter) within forest ecosystems. Although shrub vegetation plays an important role in accumulating carbon in many Mediterranean environments, there is still very little knowledge on the carbon they store. In this article, we analyze the a.g. carbon stock of several Mediterranean shrubby communities in Sicily (Italy), dominated by Pistacia lentiscus, Chamaerops humilis, Euphorbia dendroides and Spartium junceum. Plant samples for each species were selected, and morphometric attributes (height, crown diameter, diameter at breast height, etc.) were measured to establish models for estimating a.g. biomass. Dendrometric data were also used to support the assessment of shrub biomass at community level by coupling them with the coverage of the considered woody species estimated from several hundreds of phytosociological releve´s carried out on pre-forest Sicilian communities. Although the results of such an approach have to be considered as rough assessments, the trial proves interesting, given the lack of information on stand biomass of pre-forest vegetation within the Mediterraean region.L'articolo è disponibile sul sito dell'editore http://www.tandfonline.co

Testosterone Replacement Therapy and Cardiovascular Risk: A Review

Recent reports in the scientific and lay press have suggested that testosterone (T) replacement therapy (TRT) is likely to increase cardiovascular (CV) risk. In a final report released in 2015, the Food and Drug Administration (FDA) cautioned that prescribing T products is approved only for men who have low T levels due to primary or secondary hypogonadism resulting from problems within the testis, pituitary, or hypothalamus (e.g., genetic problems or damage from surgery, chemotherapy, or infection). In this report, the FDA emphasized that the benefits and safety of T medications have not been established for the treatment of low T levels due to aging, even if a man's symptoms seem to be related to low T. In this paper, we reviewed the available evidence on the association between TRT and CV risk. In particular, data from randomized controlled studies and information derived from observational and pharmacoepidemiological investigations were scrutinized. The data meta-analyzed here do not support any causal role between TRT and adverse CV events. This is especially true when hypogonadism is properly diagnosed and replacement therapy is correctly performed. Elevated hematocrit represents the most common adverse event related to TRT. Hence, it is important to monitor hematocrit at regular intervals in T-treated subjects in order to avoid potentially serious adverse events