Analisi spaziale sui dati 1992-2006 del Registro Toscano Difetti Congeniti.

not availableIntroduzione: Il registro dei difetti congeniti (DC) rappresenta uno strumento epidemiologico fondamentale per la conoscenza del fenomeno malformativo e per l\u27identificazione delle fluttuazioni temporali e spaziali a fini di sorveglianza. Nonostante l\u27eziologia risulti prevalentemente multifattoriale, alcuni DC risultano associati, sulla base della letteratura esistente, a differenze socio-economiche o a fattori di rischio ambientali. Obiettivi: approfondire la distribuzione spaziale del tasso di DC sul territorio toscano e identificare eventuali aggregati comunali con eccessi significativi di DC. Metodi: L\u27analisi ? stata effettuata sui dati del Registro Toscano Difetti Congeniti relativi ai casi individuati nel periodo 1992-2006 tra i nati e le interruzioni di gravidanza a seguito di diagnosi prenatale di DC (IVG), su un totale di 418.573 nati residenti sorvegliati in 287 comuni toscani. Sulla base della probabile associazione a fattori di rischio ambientali o a svantaggi socio-economici sono stati selezionati i seguenti gruppi di DC: sistema nervoso, cardiopatie congenite, schisi orofacciali, genitali, urinario, arti, muscoloscheletrico, anomalie cromosomiche. I denominatori utilizzati sono stati ricavati da fonte Regione Toscana. L\u27analisi di clustering per identificare aggregati comunali ? stata effettuata mediante la tecnica Spatial Scan Statistic di Kulldorff. Per ogni gruppo di DC analizzato il metodo identifica gli aggregati comunali con SMR statisticamente significativi con p<0,05 (comprendenti fino ad un massimo del 5% dei nati) in base al test di likelihood ratio (LRT). La morbosit? attesa ? calcolata utilizzando come riferimento il tasso regionale del gruppo oggetto di studio. I cluster saranno visualizzati in mappe contenenti tutti i comuni della macroarea. Risultati: L\u27analisi di clustering ha identificato alcuni aggregati di comuni con eccessi di DC per i casi totali (nati + IVG) (tabella 1). Inoltre, tra i soli nati sono stati individuati i seguenti cluster: 7 comuni nella zona della Valle del Serchio (Lucca) con 9 casi osservati e SMR=513 per il gruppo "anomalie cromosomiche"; 11 comuni nella zona Empolese-Alta Val d\u27Elsa-Alta Val di Cecina (Pisa, Firenze, Siena) con 58 casi osservati e SMR=172 per il gruppo "cardiopatie congenite"; 23 comuni nella zona Aretina, Val d\u27Arno, Val di Chiana, Senese (Arezzo, Siena) con 33 casi osservati e SMR=266 per il gruppo "sistema nervoso"; un comune in provincia di Pisa (Calcinaia) con 6 casi osservati e SMR=773 per il gruppo "sistema nervoso". Conclusioni: I risultati ad oggi disponibili in tema di inquinamento ambientale e DC, seppure non conclusivi, appaiono caratterizzati da alcuni eccessi di rischio di debole entit? per le popolazioni residenti in aree con criticit? ambientali. Questo studio geografico descrittivo non ha fornito risultati su associazioni di tipo causale, in considerazione dei limiti dello studio. La disponibilit? di un sistema di sorveglianza su base comunale ha consentito di valutare eterogeneit? spaziali e individuare la localizzazione di eventuali addensamenti inusuali di DC (cluster), in particolare in aree toscane con presenza di criticit? ambientali. In questo senso i risultati conseguiti nelle aree di Val di Cornia, Val di Cecina, Livorno, Prato, tutte includenti aree a rischio ambientale, sono evocative di possibili approfondimenti. Alcuni degli scostamenti individuati dalle analisi possono anche essere dipendenti da un effetto di sotto o sovranotifica dei DC. I risultati emersi forniscono indicazioni per approfondimenti tramite studi microgeografici che utilizzano matrici ambientali e tramite studi caso-controllo che utilizzano dati individuali (biomarcatori ambientali, storia residenziale e confondenti)

Board tasks in small firms: The importance of motivation and evaluations

The attention to board of directors in small firms is increasing. Traditionally they have been considered to be passive and labeled paper boards or aunt boards. However, boards in small firms are now undergoing major changes. In this paper we test hypotheses of what makes boards active and allows them to contribute to value creation. Activity is seen in relation to board task involvement. Predictions based on agency theory, resource dependence theory and the resource based view of the firm are used to explore board task involvement. In a sample of 347 small firms we got strong support for hypotheses highlighting the use of the knowledge of the board members and various board maintenance tools, such as regular board evaluations, to increase board task involvement. Various contextual variables were included as control variables, but few were significantly related to board task involvement. Actionable advice to boards in small firms is provided

Strings attached : socioemotional wealth mixed gambles in the cash management choices of family firms

Altres ajuts: Acord transformatiu CRUE-CSICFamily owners differ from other types of owners due to the presence of socioemotional wealth (SEW) concerns. We take a closer look at this distinctive aspect by examining the impact of family control and influence dimension of SEW on the cash management choices of family firms, conceptualizing it as a mixed gamble choice. Our empirical analysis of 195 Italian firms listed on the Milan Stock Exchange between 2003 and 2015 shows that family firms derive more value and incur lower costs than nonfamily firms when they increase their cash holdings. We then delve deeper into family firms' cash management choices by exploring how different levels of family control and influence as well as types of board governance arrangements moderate this relationship. The empirical results indicate that the positive effects of family ownership are more pronounced under a high level of family control and influence and with separation of the board chair and CEO positions

Board leadership and strategy involvement in small firms: a team production approach

"Research Question/Issue: Boards' involvement in strategy is generally seen to be an indicator of board effectiveness but less is known about the relationship between board leadership and strategy involvement, especially in small firms. This study analyses board leadership from a team production perspective as an antecedent to board strategy involvement in small firms. Research Findings/Insights: Using survey data from 140 small firms in Norway collected in two different time periods, we demonstrate that leadership behaviors and processes have a greater impact on boards' strategy involvement than structural leadership characteristics alone. Theoretical/ Academic Implications: The study provides empirical support for a team production perspective on boards. Our data show that: 1) board members' knowledge, board development and board chairperson leadership efficacy positively influence boards' strategy involvement, and 2) chairperson leadership efficacy enhances boards’ strategy involvement under structural conditions of combined CEO/ chairperson leadership and changes in board composition. These findings expand the traditional understanding of structural leadership conditions. Practitioner/ Policy Implications: The study offers insights to small business owners and managers on how to improve the strategy involvement of boards. For policy makers, the study has implications for the content of codes of good governance practice relevant to small firms, specifically in relation to board development initiatives and board evaluations." (author's abstract

Case-Control Study on Congenital Malformation Risk in the Petrochemical Area of Gela (Sicily-Italy)

Objective: A study on congenital malformations (CMs) prevalence in newborns residing in the Gela municipality over 1991 to 2002 showed statistically significant excesses of total CMs, spina bifida, microcephaly, heart defects, hypospadias, if compared with the Italian EUROCAT registries (Bianchi, 2006). Many environmental and occupational risk factors reported as potentially associated with CMs have been documented in Gela and other similar industrial areas. Among toxic substances documented in the Gela site several are known as teratogenic and mutagenic (heavy metals, chloro- and organophosphates solvents, PCBs, aromatic polycyclic hydrocarbons), some of which are documented or suspected to be endocrine disruptors. A case-control study was carried out to evaluate whether among malformed subjects there was risk excess due to environmental, occupational, or lifestyle exposures, particularly eating habits. Material and Methods: Among 91 cases with malformations found in excess, 77 were selected by specialty medical visits; 91 matched controls were included. The questionnaire included information on pregnancy, parents\u27 work (particularly in the industrial plants) before and during pregnancy, parents\u27 eating habits, purchase place (shop, street vendor, growing own food plants/fishing). Statistical analyses were performed for all CMs and for hypospadias only. Results: Significant risk associations resulted for consumers of fish, fruit, and vegetables if purchased at street vendors or for fishing and growing own food plants (OR from 6.0 to 51.3). Conclusions: Results on food consumption suggest a possible reproductive risk for fish, fruit, or vegetables purchased at street vendors or for fishing or growing own food plants potentially locally contaminated either by men (eg, pesticides) or by substances released in the environment. Notwithstanding the impossibility of making a distinction between effects of the 2 potential contamination sources and the possible bias and misclassification problems typical of retrospective studies, results obtained still represent major concern on food chain and on possible effects on reproductive health

Internal representation and factional faultlines as antecedents for board performance in social enterprises

There is an increasing scholarly interest in how social enterprises manage their hybrid nature. As hybrid organizational forms, social enterprises combine mission-driven social goals and revenue generating activities in a variety of organizational constellations and in diverse institutional contexts. Acknowledging the potentially conflicting demands that institutional environments impose on social enterprises there is an increasing research interest in the existence and proliferation of these conflicting demands at the organizational level. Some researchers have pointed to the importance of particular management practices and governance characteristics – such as authority relations and internal representation – as mechanisms to deal with the conflicting demands at the organizational level. This paper adds to this stream of literature by taking into account the organizational level dynamics of internal representation and the proliferation of factional groups in the boards of directors of hybrid organizational forms and their impact on board performance, ultimately influencing the organizational performance

Amyotrophic Lateral Sclerosis: results from Tuscany Registry of Rare Diseases.

Amyotrophic Lateral Sclerosis: results from Tuscany Registry of Rare Diseases. Anna Pierini, Federica Pieroni, Fabrizio Minichilli, Michela Rial and Fabrizio Bianchi Unit of Environmental Epidemiology, Institute of Clinical Physiology-CNR, Pisa Introduction: Amyotrophic Lateral Sclerosis (ALS) is the most common motor neuron disease with an incidence in Europe of approximately 2 per 100,000 per year. As the average disease duration from clinical onset is 3 years, prevalence is estimated at 6 per 100,000. In 90-95% of cases ALS occurs sporadically while 5-10% of cases are familiar. The specific cause of sporadic ALS is unknown while it has been hypothesized that some interactions can occur between genetic, environmental, and age-dependent risk factors. The Tuscany Registry of Rare Diseases (TRRD) was set up in 2005 and involves in data collection all public health centers in Tuscany. The Institute of Clinical Physiology-National Research Council (IFC-CNR) manages the TRRD which is part of the National Network for Rare Diseases leaded by Italian Health Institute. Objectives: To produce knowledge on ALS epidemiology: prevalence/incidence/survival, in Tuscany region. Methods: Age-standardized prevalence and incidence were calculated. Survival analysis was carried out by Kaplan-Meier method. Analysis was performed by Stata v.10. Results: In the period 2005-2009, it comes out in the TRDD are included 282 new patients with definite ALS, 234 of whom resident in Tuscany (122 men-112 women). The standardized average annual incidence in the study period (153 patients, age 20-99) is 0.81/100,000, the highest is 1.15/100,000 in 2006; the highest average incidence rate (2.41/100,000) is amongst patients aged 60-79. On 31 December 2009 (mortality data updated to 2008), the standardized prevalence was 5.36/100,000 (the highest registered is 5.87/100,000 in 2007). Survival rates at 1, 2, 3, 4 and 5 years after the onset were 86%, 70%, 58%, 48% and 44%, respectively. Conclusions: The results of the present study indicate that the incidence and prevalence of ALS in the Tuscany population seems to be lower compared to other populations and the survival of patients was longer than previously reported

COMPARATIVE EFFECT OF APHERESIS vs ATORVASTATIN/APHERESIS ON MARKERS OF INFLAMMATION IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Objective: Patients with Familial Hypercholesterolemia (FH) have increased cardiovascular events. Clinical trials have demonstrated that lowering circulating lipid levels by LDL-apheresis has beneficial effects on prognosis. However, whether apheresis vascular effects in FH are related to modulation of pro- and anti-inflammatory cytokines, and whether the combination of apheresis with atorvastatin is able to enhance the putative anti-inflammatory effect of apheresis remains unknown. We examined, in a intra-patient study, the effect of atorvastatin/apheresis vs. apheresis alone on the releasing of circulating pro- and anti-inflammatory markers. Methods: 9 heterozygous patients (56+11 years) with FH (mean cholesterol 385+42 mg/dL) were treated with apheresis alone and afterwards with apheresis plus atorvastatin 40 mg/d. Lipid profiles, serum C-reactive protein, CK, GOT, GGT, the antiinflammatory markers IL-4 and IL-10 and the pro-inflammatory markers INFg and IL-6 were determined before and at 2, 4, 6 and 8 days after apheresis and atorvastatin/apheresis. Results: Treatment with atorvastatin/apheresis significantly reduced lipid profile more than LDL-apheresis alone at each scheduled time. When compared to apheresis alone, combined treatment statistically decreased cholesterol by more than 25-35% at all times and relatively increased IL-4 concentration. The levels of cholesterol in atorvastatin/apheresis patients were inversely correlated with those of IL-4 and IL-10 and positively correlated with IFNg. Conclusion: The combination of atorvastatin with LDL-apheresis decreased serum cholesterol levels more than apheresis alone. Apheresis had an anti-inflammatory effect and the effect of the drug reducing cholesterol levels affects the balance between proand anti-inflammatory cytokines in favor of anti-inflammation contribute