87 research outputs found
Tax Morale, Slippery-Slope Framework and Tax Compliance: A Cross-section Analysis
Following two important strands of tax compliance literature, this empirical paper develops a cross-section analysis in order to test both the role of tax morale on tax compliance decisions and the main predictions of the slippery slope framework. Using data from the World Value Surveys (WWS), we find empirical support for the slippery slope framework, since trust in and power of tax authorities are negatively and significantly related to a proxy for tax non-compliance behavior given by the size of the hidden economy. In particular, trust in tax authorities exerts a larger effect on shadow economy than the power of tax authorities. Instead, the relation between tax morale and our proxy for tax evasion is not statistically significant.
Data report on work attitudes - Background paper
This report aimed to assess the main dimensions of work attitudes in the European Union and in a selected sample of extra-EU countries, by analysing several data sources in a comparative way. Some preliminary conclusions can be drawn. It seems that countries at different stages of industrial development experience different combinations of preference for work, job characteristics, work ethics and life satisfaction. Developing countries seem to put work before family and leisure time, while assigning a lower overall importance to social life and relational goods. On the other hand, advanced, post-industrial economies seem to assign a higher relevance to social life, while showing a preference for intangible job characteristics, higher levels of life satisfaction and weaker work ethics
Portugal e as reformas da governança europeia
UIDB/00183/2020 UIDP/00183/2020publishersversionpublishe
Robot-assisted resection of gastric duplication cysts in a child: a detailed case report.
Gastric duplication cysts (GDCs) represent 4-9% of alimentary tract duplications. Early diagnosis and surgical excision are essential to avoid morbidity or neoplastic degeneration. Roboticassisted excision of GDCs has never been described in childhood. We report an asymptomatic male patient with 2 gastric cystic masses at ultrasonography (US)-study (diameter 25mm and 8mm), increasing in size at follow-up. At 20 months of age, magnetic- resonance-imaging-scan confirmed 2 round gastric masses (44Ă35mm and 16Ă12mm, respectively). Two months later, an elective robotic-assisted excision of GDCs was completed without complications. The patient was discharged at day 6 after procedure. Histology confirmed the diagnosis of GDCs. At a 2-year follow- up, US-study did not evidence any issue. In this first reported case of robotic-assisted cystectomy for CGD in childhood, the procedure seems safe, effective, and feasible. This approach improves the movements of the surgical instruments with better 3- D visualization in comparison with the laparoscopic approach
Rectal atresia and rectal stenosis:the ARM-Net Consortium experience
Purpose: To assess the number, characteristics, and functional short-, and midterm outcomes of patients with rectal atresia (RA) and stenosis (RS) in the ARM-Net registry. Methods: Patients with RA/RS were retrieved from the ARM-Net registry. Patient characteristics, associated anomalies, surgical approach, and functional bowel outcomes at 1 and 5-year follow-up were assessed. Results: The ARM-Net registry included 2619 patients, of whom 36 (1.3%) had RA/RS. Median age at follow-up was 7.0Â years (IQR 2.3â9.0). Twenty-three patients (63.9%, RA n = 13, RS n = 10) had additional anomalies. PSARP was the most performed reconstructive surgery for both RA (n = 9) and RS (n = 6) patients. At 1-year follow-up, 11/24 patients with known data (45.8%, RA n = 5, RS n = 6) were constipated, of whom 9 required stool softeners and/or laxatives. At 5-year follow-up, 8/9 patients with known data (88.9%, RA n = 4, RS n = 4) were constipated, all requiring laxatives and/or enema. Conclusion: RA and RS are rare types of ARM, representing 1.3% of patients in the ARM-Net registry. Additional anomalies were present in majority of patients. Different surgical approaches were performed as reconstructive treatment, with constipation occurring in 46% and 89% of the patients at 1 and 5-year follow-up. However, accurate evaluation of long-term functional outcomes remains challenging.</p
Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study
open15noAbstract
Background: The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the
surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery
rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide
for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric
patients across the country, focusing on indications, limitations, development, and training acquired by national experience
and in comparison to the literature.
Methods: We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed
a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children
between 2013 and 2019.
Results: We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A
total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed
interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%),
and fundoplication (30%).
Conclusions: Since its first application in Italy, about 10 years ago, several considerations were made about application
and feasibility of robotics in children.openAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, MarioAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, Mari
Inter- and Intraobserver Variation in the Assessment of Preoperative Colostograms in Male Anorectal Malformations: An ARM-Net Consortium Survey
Aim: Male patients with anorectal malformations (ARM) are classified according to
presence and level of the recto-urinary fistula. This is traditionally established by a
preoperative high-pressure distal colostogram that may be variably interpreted by
different surgeons. The aim of this study was to evaluate the inter- and intraobserver
variation in the assessment by pediatric surgeons of preoperative colostograms with
respect to the level of the recto-urinary fistula.
Materials and Methods: Sixteen pediatric surgeons from 14 European centers
belonging to the ARM-Net Consortium twice scored 130 images of distal colostograms
taken in sagittal projection at a median age of 66 days of life (range: 4â1,106 days).
Surgeons were asked to classify the fistula in bulbar, prostatic, bladder-neck, no
fistula, and âunclear anatomyâ example. Their assessments were compared with the
intraoperative findings (kappa) for two scoring rounds with an interval of 6 months
(intraobserver variation). Agreement among the surgeonsâ scores (interobserver variation)
was also calculated using Krippendorffâs alpha. A kappa over 0.75 is considered
excellent, between 0.40 and 0.75 fair to good, and below 0.40 poor. Surgeons were
asked to score the images in âpoorâ and âgoodâ quality and to provide their years of
experience in ARM treatment.
Results: Agreement between the image-based rating of surgeons and the intraoperative
findings ranges from 0.06 to 0.45 (mean 0.31). Interobserver variation is higher
(Krippendorffâs alpha between 0.40 and 0.45). Years of experience in ARM treatment
does not seem to influence the scoring. The mean intraobserver variation between
the two rounds is 0.64. Overall, the quality of the images is considered poor. Images
categorized as having a good quality result in a statistically significant higher kappa
(mean: 0.36 and 0.37 in the first and second round, respectively) than in the group of
bad-quality images (mean: 0.25 and 0.23, respectively).
Conclusions: There is poor agreement among experienced pediatric colorectal
surgeons on preoperative colostograms. Techniques and analyses of images need to be
improved in order to generate a homogeneous series of patients and make comparison
of outcomes reliable
FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years
Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years.
Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003-2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months.
Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001).
Conclusion: Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate
Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula:An ARM-Net consortium study
Background: Outcome of patients operated for anorectal malformation (ARM) type rectovestibular fistula (RVF) is generally considered to be good. However, large multi-center studies are scarce, mostly describing pooled outcome of different ARM-types, in adult patients. Therefore, counseling parents concerning the bowel function at early age is challenging. Aim of this study was to evaluate bowel function of RVF-patients at preschool/early childhood age and determine risk factors for poor functional outcome. Methods: A multi-center cohort study was performed. Patient characteristics, associated anomalies, sacral ratio, surgical procedures, post-reconstructive complications, one-year constipation, and Bowel Function Score (BFS) at 4â7 years of follow-up were registered. Groups with below normal (BFS < 17; subgroups âpoorâ ⤠11, and âfairâ 11 < BFS < 17) and good outcome (BFS ⼠17) were formed. Univariable analyses were performed to detect risk factors for outcome. Results: The study included 111 RVF-patients. Median BFS was 16 (range 6â20). The âbelow normalâ group consisted of 61 patients (55.0%). Overall, we reported soiling, fecal accidents, and constipation in 64.9%, 35.1% and 70.3%, respectively. Bowel management was performed in 23.4% of patients. Risk factors for poor outcome were tethered cord and low sacral ratio, while sacral anomalies, low sacral ratio, prior enterostomy, post-reconstructive complications, and one-year constipation were for being on bowel management. Conclusions: Although median BFS at 4â7 year follow-up is nearly normal, the majority of patients suffers from some degree of soiling and constipation, and almost 25% needs bowel management. Several factors were associated with poor bowel function outcome and bowel management. Level of Evidence: Level III
How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons
COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; pâ<â0.0001) and diagnostic evaluations (16.4% vs. 42.2%; pâ<â0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; pâ<â0.0001) or urgent (20.4% vs. 38.5%; pâ<â0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; pâ<â0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice
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