PPP in Croatian tourism: chance for Croatian family hotels

In the last fifty years world tourism and hospitality industry experienced a phenomenal growth of international tourist arrivals, overnights and receipts. It is widely recognized that the tourism became one of the most dominating socio-economic activities at the beginning of the 21st Century. The example of Croatia speaks in favour of that statement. Tourism is the most prosperous industry and the essential development factor in Croatia. The great share of tourism results refers to family business that is of high importance to development strategy of Croatian tourism. Family business in Croatian tourism is based on households and family hotels. Family hotels are recognized on the tourism market by its original and identifiable service imbued with indigenous values and cultural heritage, diversity and individuality. Moreover, they are the most sound and prosperous segment of Croatian tourism and their top-level quality and high professionalism are basic elements of tourism development. Croatian strategic tourism development documents highlight the participation of private sector in tourism development. One of the possible ways of such participation is through public-private partnership (PPP). There are many examples of public-private partnerships in tourism around the world. According to world experiences, marketing and promotions and product development are the main areas where public-private partnership has developed. Despite the fact that tourism is very important economy generator, Croatian experiences with integral implementation of public-private partnerships in tourism are only at the beginning. The aim of this paper is to examine how Croatian family hotels could take a part in establishing public-private partnerships in tourism. Considering the world best practices on public-private partnership in tourism investment, the paper also suggests two acceptable partnership models. The first is related to existing tourism clusters while the second is more innovative and is related to the development of a new tourist complex. Proposed public-private partnership model for the new tourist complex development includes government (on local or/and national level) as public sector representative and family hotels as private sector representative. The paper also examines necessary prerequisite conditions for establishing such a partnership offering a win-win solution for all project stakeholders

Using linguistic methods in clinical communication education

Analysis and reflection are important components of clinical communication learning in undergraduate medical education. Current medical consultation models do not provide an effective means to analyze interaction during consultations, compromising a conversational approach to consultations. This paper introduces a conversational analytic framework: The Clin-Com Tool (CCT), drawing on interactional linguistics. Methods: 17 medical students and six communication tutors took part in an educational intervention. A mixed-methods evaluation was conducted to compare 1) participants’ abilities to analyze consultations pre- and post-intervention, and 2) elicit their perspectives of learning and using the CCT. Results: The findings showed an improvement in participants’ analytic skills in the post-intervention test (p<0.044, 95% Confidence Interval). Participants felt that the CCT heightened awareness of interactional features and socio-cultural effects on communication, and provided a systematic approach to analysis using a set of common language. Conclusion: The CCT emphasizes the development of students’ critical ability to judge and act upon the constantly changing interactional communicative situations. It transforms intuitive feelings into systematic and evidence-based analysis of interaction, enabling the development of more strategic and conversational communication with patients. The Tool can become a useful addition to other communication and consultation models used in undergraduate medial education

Mushroom polyphenols as immune system balancers: What's the mechanism behind it and possible interactions with dietary fibers?

Mushroom polyphenols have been proposed as a new therapy that can improve the immune system. Different immune cells express multiple types of polyphenol receptors that recognize and allow cellular uptake of polyphenols, which subsequently activate signaling pathways to initiate immune responses. Polyphenols can be useful for immunocompromised patients with malignancies, viral or bacterial infections and chronic disorders of organ systems, as well as for those whose immunity is naturally weakened. Cosmetic formulations rich in mushroom polyphenols have the potential to regulate inflammatory skin disorders, as well as eczema or atopic dermatitis and photocarcinogenesis. As primary antioxidants, polyphenols have an important role in preserving immune cells in a reduced environment and in protecting them against oxidative damages and immunosuppression as well as maintaining their suitable function. As signaling pathway modulators, mushroom polyphenols can affect immune cell regulation, cytokine synthesis, and gene expression, in both innate and adaptive immune responses. There are different pathways in the integrated immunomodulatory polyphenol response, such as: 1) the nuclear NF-κB signaling pathway leading to suppression of various inflammatory cytokines expression, and enzymes such as COX-2; 2) MAPK signaling pathways that play a key role in many fundamental cellular processes such as cell growth, proliferation, death and differentiation, and also regulate gene transcription and the activity of transcription factors involved in inflammation; 3) arachidonic acid signaling pathway leading to a decrease in the release of inflammatory mediators; and 4) the Nrf2 / ARE signaling pathway involved in the activation of genes encoding cytoprotective and antioxidant enzymes. Given that polyphenols represent great potential in the design of immune-boosting formulations in line with their widespread structural diversity, it should be noted that some functionality issues require further clarification. For instance different observations and conclusions were reported by the scientists in absence of enzymes involved in their biosynthesis steps. Concerning the dietary application of mushroom polyphenols, it is necessary to mention that after oral consumption they are recognized by the human body as xenobiotics and often a small amount is absorbed in the intestine. Likewise, there are significant differences between the activities of the metabolic form of phenols and their form in the mushroom nutraceutical matrix. For an example, dihydoferulic acid, a metabolite of the ferulic acid, expresses anti-inflammatory activity, opposite to metabolites derived after sulfation and glucuronidation. The scientific focus is on improving and increasing polyphenols bioavailability by designing colloidal systems and using nanosystems. Moreover many studies have found that polyphenols can interact with macromolecules like dietary fibers, i.e. chitin and β-glucans. It has been shown that these interactions can affect the bioaccessibility of polyphenols in a food matrix as well as in nutraceutical formulations. Therefore, chitin and β-glucans have an impact on polyphenols’ immunomodulating activities if they were applied together in commercial formulations. Another disadvantage in the commercialization of polyphenol-based formulations is quantitative and qualitative variations in their content among different mushroom species. As secondary metabolites with a protective role e.g. phenols, their content in mushrooms depends on the locality and environmental conditions of growth. Using extracts or preparations that are based on mycelia grown under controlled conditions may be the solution for the reduction of the natural variability in polyphenol composition. Integrated information on all aspects of functionality will confirm the use of polyphenol-rich mushroom formulations as effective enhancers of immunity

The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study

M.A.L.F. received support from the Instituto de Salud Carlos III, Madrid, Spain (grant/award no. CP17/00206-EU-FEDER). This work was supported by the Instituto de Salud Carlos III, Madrid, Spain [EU-FEDER-FIS PI-18/01593], the Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Publica), the Cancer Epidemiological Surveillance Subprogram (VICA) from the Instituto de Salud Carlos III, Madrid, Spain, and the Andalusian Department of Health [PI-0152/2017]. The funders had no role in the design and conduct of the study, data collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication.Aim: Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis. Methods: In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index. Results: We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1–1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1–1.8), when relevant confounding factors were considered. Conclusions: The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.Instituto de Salud Carlos III CP17/00206-EU-FEDER EU-FEDER-FIS PI-18/01593Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Publica)Cancer Epidemiological Surveillance Subprogram (VICA) from the Instituto de Salud Carlos III, Madrid, SpainAndalusian Department of Health PI-0152/201

Pancreatic cancer survival trends in the US from 2001 to 2014: a CONCORD-3 study

Background Survival from pancreatic cancer is low worldwide. In the US, the 5-year relative survival has been slightly higher for women, whites and younger patients than for their counterparts, and differences in age and stage at diagnosis may contribute to this pattern. We aimed to examine trends in survival by race, stage, age and sex for adults (15-99 years) diagnosed with pancreatic cancer in the US. Methods This population-based study included 399,427 adults registered with pancreatic cancer in 41 US state cancer registries during 2001-2014, with follow-up to December 31, 2014. We estimated age-specific and age-standardized net survival at 1 and 5 years. Results Overall, 12.3% of patients were blacks, and 84.2% were whites. About 9.5% of patients were diagnosed with localized disease, but 50.5% were diagnosed at an advanced stage; slightly more among blacks, mainly among men. No substantial changes were seen over time (2001-2003, 2004-2008, 2009-2014). In general, 1-year net survival was higher in whites than in blacks (26.1% vs. 22.1% during 2001-2003, 35.1% vs. 31.4% during 2009-2014). This difference was particularly evident among patients with localized disease (49.6% in whites vs. 44.6% in blacks during 2001-2003, 60.1% vs. 55.3% during 2009-2014). The survival gap between blacks and whites with localized disease was persistent at 5 years after diagnosis, and it widened over time (from 24.0% vs. 21.3% during 2001-2003 to 39.7% vs. 31.0% during 2009-2014). The survival gap was wider among men than among women. Conclusions gaps in 1-and 5-year survival between blacks and whites were persistent throughout 2001-2014, especially for patients diagnosed with a localized tumor, for which surgery is currently the only treatment modality with the potential for cure

Is Cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study

Abstract BACKGROUND: Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England. METHODS: From population-based surveys (n=35?308), using the Cancer Research UK Cancer Awareness Measure, we calculated the age- and sex-standardised symptom awareness and barriers scores for 52 primary care trusts (PCTs). These measures were evaluated in relation to the sex-, age-, and type of cancer-standardised cancer survival index of the corresponding PCT, from the National Cancer Registry, using linear regression. Breast, lung, and bowel cancer survival were analysed separately. RESULTS: Cancer symptom awareness and barriers scores varied greatly between geographical regions in England, with the worst scores observed in socioeconomically deprived parts of East London. Low cancer awareness score was associated with poor cancer survival at PCT level (estimated slope=1.56, 95% CI: 0.56; 2.57). The barriers score was not associated with overall cancer survival, but it was associated with breast cancer survival (estimated slope=-0.66, 95% CI: -1.20; -0.11). Specific barriers, such as embarrassment and difficulties in arranging transport to the doctor's surgery, were associated with worse breast cancer survival. CONCLUSIONS: Cancer symptom awareness and cancer survival are associated. Campaigns should focus on improving awareness about cancer symptoms, especially in socioeconomically deprived areas. Efforts should be made to alleviate barriers to seeking medical help in women with symptoms of breast cancer.British Journal of Cancer advance online publication 18 August 2016; doi:10.1038/bjc.2016.246 www.bjcancer.com

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England

Background: Ethnic differences in cancer symptom awareness and barriers to seeking medical help in the English population are not fully understood. We aimed to quantify these differences, to help develop more effective health campaigns, tailored to the needs of different ethnic groups. Methods: Using a large national data set (n=38492) of cross-sectional surveys that used the Cancer Research UK Cancer Awareness Measure, we examined how cancer symptom awareness and barriers varied by ethnicity, controlling for socio-economic position, age and gender. Data were analysed using multivariable logistic regression. Results: Awareness of cancer symptoms was lower in minority ethnic groups than White participants, with the lowest awareness observed among Bangladeshis and Black Africans. Ethnic minorities were more likely than White British to report barriers to helpseeking. South Asians reported the highest emotional barriers, such as lack of confidence to talk to the doctor, and practical barriers, such as worry about many other things. The Irish were more likely than the White British to report practical barriers, such as being too busy to visit a doctor. White British participants were more likely than any other ethnic group to report that they would feel worried about wasting the doctor’s time. Overall, Black Africans had the lowest barriers. All differences were statistically significant (P<0.01 level), after controlling for confounders. Conclusions: Our findings suggest the need for culturally sensitive and targeted health campaigns, focused on improving recognition of cancer symptoms among ethnic minorities. Campaigns should tackle the specific barriers prevalent in each ethnic group

Antioxidants of Edible Mushrooms

Oxidative stress caused by an imbalanced metabolism and an excess of reactive oxygen species (ROS) lead to a range of health disorders in humans. Our endogenous antioxidant defense mechanisms and our dietary intake of antioxidants potentially regulate our oxidative homeostasis. Numerous synthetic antioxidants can effectively improve defense mechanisms, but because of their adverse toxic effects under certain conditions, preference is given to natural compounds. Consequently, the requirements for natural, alternative sources of antioxidant foods identified in edible mushrooms, as well as the mechanistic action involved in their antioxidant properties, have increased rapidly. Chemical composition and antioxidant potential of mushrooms have been intensively studied. Edible mushrooms might be used directly in enhancement of antioxidant defenses through dietary supplementation to reduce the level of oxidative stress. Wild or cultivated, they have been related to significant antioxidant properties due to their bioactive compounds, such as polyphenols, polysaccharides, vitamins, carotenoids and minerals. Antioxidant and health benefits, observed in edible mushrooms, seem an additional reason for their traditional use as a popular delicacy food. This review discusses the consumption of edible mushrooms as a powerful instrument in maintaining health, longevity and life quality