Wine tourism policies and wine tourist profile: the case Campania (Italy)

L’evoluzione dell’enoturismo, inteso come componente autonoma dell’offerta delle aziende vitivinicole o quale possibile integrazione del turismo rurale e tematico, ha determinato l’affermazione di un ben identificato settore del turismo di nicchia, generando un interesse della comunità scientifica ed orientando la ricerca su aspetti e componenti riferiti alla domanda del suo consumo. L’obiettivo del presente lavoro di ricerca, consiste nell’elaborare una profilazione dell’enoturista, attraverso gli attributi socio-demografici, comportamentali e motivazionali, nei diversi luoghi di consumo dell’esperienza turistica e nelle diverse modalità di fruizione del prodotto turístico nella regione Campania. Dopo aver inquadrato la letteratura scientifica sul tema, si è realizzata una ricerca applicata in vari luoghi e forme dell’esperienza enoturistica (festivals, degustazioni, cene tematiche), il cui scopo è l’approfondimento di attitudini, comportamenti e motivazioni dell’enoturista che possono assumere un ruolo strategico nelle possibili evoluzioni dell’enoturismo e nell’identificazione di azioni e strumenti per la affermazione della regione Campania quale destinazione enoturistica. L’elaborazione dei dati, nella parte empirica del lavoro, ha permesso un’analisi degli aspetti motivazionali e comportamentali dell’enoturista. Attraverso la somministrazione di un questionario strutturato a risposta chiusa, si sono ottenute 441 risposte valide. L’analisi statistica, elaborata con il programma SPSS v. 23 e JASP 0.14.0.0, ha previsto lo sviluppo di analisi fattoriale (EFA) e confirmatoria (CFA). Prendendo come riferimento le dimensioni motivazionali tratte dall’EFA, è stata utilizzata la tecnica multivariante di accorpamento dei casi (conglomerati gerarchici e conglomerati Kmedi) aventi l’obiettivo di analizzare similitudini o somiglianze esistenti tra le interviste. A partire dai gruppi o segmenti ottenuti sono state applicate statistiche e misure di associazione che forniscono informazioni necessarie per studiare i possibili modelli di associazione esistenti tra le variabili sulla base di una tabella di contingenza bidimensionale (Rho-Spearman e Tau de Kendall). Analogamente, sono state utilizzate procedure statistiche non parametriche, per analizzare differenze significative tra i gruppi del campione (H de Krustal-Wallis y la U de Mann-Whitney). I risultati definiscono quattro clusters così denominati: 1. Enoturista occasionale, 2. Enoturista enologico, 3. Enoturista di evasione, 4. Enoturista di convenienza. Per ognuno dei clusters si registrano differenti stimoli motivazionali nella partecipazione agli eventi, e dunque, una caratterizzazione funzionale alla profilazione dell’enoturista. Il complesso delle evidenze ottenute comporta una possibile differenziazione delle azioni di marketing territoriale e consente la formulazione di un modello di rifermento che, in base ai vari clusters, individua attori, azioni e strumenti per l’affermazione della regione Campania quale destinazione enoturistica.The evolution of wine tourism, as an autonomous component of the supply of wineries or a possible integration of rural and thematic tourism has led to the affirmation of a well-identified niche tourism sector, generating an interest of the scientific community and addressing research on aspects and components related to the “demand” of its consumption The purpose of the research work, as a whole, is expressed in a cognitive proposal of the profiling of wine tourists, implemented through behavioral and motivational socio-demographic attributes, in the different places of consumption of the tourist experience and in the different ways of using the tourist product in the Campania region. Through, this analysis research aims to acquire cognitive elements useful for the definition of a reference model. The scope is identifying homogeneous segments of wine tourists in order to compare the resulting profiles After having framed the scientific literature on the topic, research has been carried out in various places and forms of the wine tourism experience (festivals, tastings, thematic dinners), focusing on the deepening of attitudes, behaviors and motivations of the wine tourist. These psychographic aspects assume a strategic role in the possible evolution of wine tourism and in the identification of actions and tools for the affirmation of the Campania region as a wine tourist destination. The empirical part of this work provides a collection of data, through the administration of an interview, for a reworking quantitative motivational and behavioral aspects of wine tourists. Through the administration of a structured questionnaire with closed answers, 441 valid answers were obtained. The statistical analysis was carried out with the application program SPSS v. 23 and JASP 0.14.0.0. The questionnaire replies were validated in the reliability with Alpha de Cronbach method. Exploratory factor analysis (EFA) has been used as a technique of data reduction, in relation to the objective of identifying homogeneous dimensions for the motivations of the experiences of participation in the events. In order to validate the reliability of the factors derived from the EFA, the confirmatory factor analysis (CFA) technique has been applied. Taking the motivational dimensions taken from the EFA as a reference, the multi-variant case-amalgamation technique (hierarchical conglomerates and K-medium conglomerates) was used with the aim of analyzing similarities or similarities between the interviews. Statistics and association measures have been applied to the groups or segments obtained providing the information necessary to study the possible models of association existing between the variables on the basis of a two-dimensional contingency table (Rho-Spearman and Tau de Kendall). Similarly, non-parametric statistical procedures were used to analyze significant differences between sample groups. (H de Krustal-Wallis y la U de Mann-Whitney). The aforementioned techniques have led to the emergence of four clusters identified as follows: 1. Occasional wine tourist, 2. Oenological wine tourist, 3. Evasion wine tourist, 4. Convenience wine tourist. According this study, there are different reasons to participate in the events for each of the clusters and therefore a characterization that can be functional to the profiling of the wine tourist. The overall evidence described implies a possible differentiation of territorial marketing actions in the setting of factors qualifying the wine tourism experience in the Campania region.La evolución del enoturismo, entendido como unidad autónoma de la oferta de las empresas vinícolas o de cualquier integración posible del turismo rural y temático, se ha revelado como una actividadsector claramente identificado como turismo de exclusividad, generando un interés en lacomunidad científica que orienta el estudio a los aspectos y componentes referidos a la demanda. El objetivo de esta tesis doctoral es analizar el perfil del enoturista a través del perfil sociodemográfio y las motivaciones para visitar distintos lugares de la región de Campania (Italia) con la finalidad de conseguir una experiencia única de carácter enológica. La revisión de la literatura se ha basado en la búsqueda de estudios que aborden tanto el estudio del enoturismo en diferentes lugares como las diferentes formas existentes en cuanto a las experiencias enoturisticas (festivales, catas, cenas temáticas). La finalidad de esta búsqueda de la literatura científica converge en el examen de las actitudes, de los comportamientos y de las motivaciones que pueda asumir el papel estratégico de las posibles evoluciones del enoturismo y en la identificación de las acciones y los instrumentos empleados con el objetivo de fortalecer la región Campania como destino enoturistico. Una vez realizada la revisión de la literatura científica, se ha desarrollado un trabajo de campo consistente en pasar un cuestionario, habiéndose obtenido 441 respuestas válidas. La elaboración de los datos ha permitido un análisis de los aspectos motivacionales y comportamentales del enoturista encuestado. El análisis estadístico ha sido elaborado con el programa aplicativo SPSS v. 23 y con JASP 0.14.0.0. El estudio empírico ha consistido en el desarrollo de un análisis factorial exploratorio (EFA) y confirmatorio (CFA). Así, y tomando como referencia las dimensiones motivacionales obtenidas del EFA, se emplea la técnica multivariable de agrupación de los casos (grupos jerárquicos y grupos K-medi) con la finalidad de analizar similitudes o semejanzas existentes entre las entrevistas. A partir de los grupos o segmentos obtenidos, se ha aplicado las estadísticas y medidas de asociación que proporcionan informaciones necesarias para el estudio de posibles modelos de asociación existentes en las variables en base a una tabla de contingencia bidimensional (Rho-Spearman y Tau de Kendall). De forma análoga se han utilizado procesos estadísticos no paramétricos para analizar diferencias significativas entre los grupos de muestra (H. De Krustal-Wallis y la U. de Mann-Whitney). Los resultados obtenidos definen cuatro grupos que se han denominado: 1. Enoturista ocasional; 2. Enoturista enológico; 2. Enoturista de evasión; 4.Enoturista de conveniencia. Para cada uno de estos grupos se registran diferentes estímulos motivacionales en la participación de los eventos, y, por lo tanto, una caracterización funcional para la perfección del perfil del enoturista. El conjunto de las evidencias obtenidas en esta investigación posibilita una posible diferenciación de las acciones de marketing territorial y consiente la formulación de un modelo de referencia que, en base a los distintos grupos, permite a los actores, tanto públicos como privados, de la región de Campania, diseña acciones e instrumentos para reforzr esta región como destino enoturístico

Exercise training in patients with chronic heart failure: A new challenge for Cardiac Rehabilitation Community

Exercise training (ET) is strongly recommended in patients with chronic stable heart failure (HF). Moderate-intensity aerobic continuous ET is the best established training modality in HF patients. In the last decade, however, high-intensity interval exercise training (HIIT) has aroused considerable interest in cardiac rehabilitation community. In HF patients, HIIT exerts larger improvements in exercise capacity compared to moderate-continuous ET. Since better functional capacity translates into symptoms relief and improvement in quality of life in patients with HF, this training modality is collecting growing interest and consensus, not revealing major safety issues. HIIT should not replace other training modalities in HF but should rather complement them. Inspiratory muscle training, another promising training modality in patients with HF, exerts beneficial effect on inspiratory muscle strength and inspiratory endurance, on exercise capacity and quality of life. In conclusion, taking into consideration the complecity of HF syndrome, combining and tailoring different ET modalities according to each patient's baseline clinical characteristics (i.e. exercise capacity, comorbidity, frailty status, personal needs, preferences and goals) seem the most wily approach for exercise prescription

Profiling wine tourists: a comparison between rural and city Wine Festivals in Campania, Italy.

Wine tourism (oenotourism) is becoming progressively important for wine producers and it is beginning to contribute billions of dollars annually to the global economy. Wine tourism is thus growing in relevance in the international scenario and it is considered to be at least one of the most important emerging segments of the global tourism sector. This opens a series of questions related to a better understanding of its tourism demand. The close connection between a knowledge of wine tourists’ profiles and the role of a wine festival are the strategic factors examined in this study. The research was based 220 interviews conducted with wine tourists attending the most representative rural and city wine festivals held in the Italian region of Campania (Avellino–Salerno). The aim of the paper was to perform a comparative analysis of the wine tourists’ profiles in relation to the different kind of events attended, in order to stimulate a fitted customer-driven strategy addressed to wine tourism stakeholders and to thus promote sustainability in this important sector

The Q-LAMP Method Represents a Valid and Rapid Alternative for the Detection of the BCR-ABL1 Rearrangement in Philadelphia-Positive Leukemias

Molecular detection of the BCR-ABL1 fusion transcripts is necessary for the genetic confirmation of a chronic myeloid leukemia diagnosis and for the risk classification of acute lymphoblastic leukemia. BCR-ABL1 mRNAs are usually identified using a conventional RT-PCR technique according to the BIOMED-1 method. In this study, we evaluated 122 BCR-ABL1-positive samples with the Q-LAMP assay to establish if this technology may represent a valid alternative to the qualitative BIOMED-1 PCR technique usually employed for the detection and the discrimination of the common BCR-ABL1 transcripts (p190 and p210 isoforms). We found a 100% concordance rate between the two methods. Specifically, the p190- and p210-positive samples were amplified by Q-LAMP with a median threshold time (Tt) of 26.70 min (range: 24.45-31.80 min) and 20.26 min (range: 15.25-34.57 min), respectively. A median time of 19.63 was observed in samples displaying both (e13a2/e14a2) p210 isoforms. Moreover, the Q-LAMP assay allowed recognition of the BCR-ABL1 e13a2 and e14a2 isoforms (median Tts 18.48 for e13a2 vs. 26.08 min for e14a2; p < 0.001). Finally, 20 samples harboring rare BCR-ABL1 isoforms (e1a3, e13a3, e14a3, and e19a2) were correctly identified by the Q-LAMP assay. We conclude that the Q-LAMP assay may represent a faster and valid alternative to the qualitative BIOMED-1 RT-PCR for the diagnosis at BCR-ABL1-positive leukemias, especially when samples are analyzed in centers with restricted resources and/or limited technical expertise

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Combined liver and kidney transplantation: analysis of Padova experience.

BACKGROUND/AIM: The main indications for combined liver and kidney transplantation (CLKT) are as follows: (1) cirrhosis with renal damage dependent or not upon liver disease, (2) renal failure with dialysis and concomitant liver end-stage disease, (3) congenital diseases, and (4) enzymatic liver deficiency with concomitant renal failure. The aim of this study was to evaluate our results with CLKT both in adult and pediatric patients. METHODS: From September 1995 to September 2006, 15 CLKT (2.8%) among 541 liver transplantations included 4 pediatric patients (27%). The main indications for CLKT were hepatitis C virus (HCV) and polycystic diseases in adult patients, and primary hyperoxaluria in pediatric patients. RESULTS: The double transplantation was performed from the same donor in all cases. All adult patients received whole liver grafts, whereas 3 split transplants and 1 whole liver graft were transplanted in the pediatric patients. Median liver and kidney cold ischemia times were 468 and 675 minutes, respectively. After a median follow-up of 36 months (range, 1-125), the overall survival rate was 80%. Five-year patient and graft survival rates were 100% for adult CLKT, whereas they were 50% for pediatric patients. We observed only 2 cases (18%) of delayed renal function, requiring temporary hemodialysis with progressive graft improvement. There was only 1 case of kidney retransplantation due to early graft nonfunction in a pediatric patient. CONCLUSION: Although CLKT is related to major surgical risks, results after transplantation are satisfactory with an evident immunological advantage

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention