La Responsabilità Sociale d’Impresa prospettive teoriche nel dibattito italiano

This paper is meant as a discussion of different methodological approaches to the analysis of corporate social responsibility (CSR), sorted out through a scrutiny of the literature that has emerged from the recent Italian debate. The first stream of literature is embedded in the neo-classical approach that adapts – to the contemporary economic environment - the famous Milton Friedman’s statement that the social responsibility of the firm is to make profits (Friedman, 1970). The second stream refers to a neo-contractualist approach, mainly developed by Lorenzo Sacconi (2004, 2005), that can be considered as an insightful application of incomplete contracts theory, strongly characterized by a contractualist-oriented ethical perspective. The third stream is the relational approach developed by Bruni and Zamagni (2004), which takes the issue of social reproduction into account in the description of the economic system, thereby looking at firms as producers of socially provided goods. Finally, we propose an integration between these different perspectives through the adoption of a conventionalist definition of CSR

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement From the American Heart Association and the American Diabetes Association

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Cities of a feather flock together: a study on the synchronization of communication between Italian cities

Abstract Due to the rise of communication technologies and economic globalization, modern large cities are becoming more and more interconnected and this phenomenon leads to an increasing synchronization in activities and communication patterns. In our work, we explore the communication synchronization between 76 Italian cities of different sizes by using mobile phone data. Our results show that both the spatial distance and the size of the city influence the synchronization: larger cities are more similar to larger cities in communication rhythms than medium cities are to medium cities, and medium cities are more similar to medium cities than smaller cities are to smaller cities. Furthermore, for all the cities' sizes we observe a drift in similarity due to spatial distance. Interestingly, the drift due to distance over similarity is less strong in large cities, that act as gateway nodes for the Italian economical system, hence having an emerging strongly connected and synchronized network, than for medium and small cities, that are more bounded to local industries. Finally, our results also show that highly synchronized cities are richer and more attractive for foreign-born population

Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities

Diabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic stroke, affecting up to a third of individuals with cerebrovascular diseases. Beyond being a risk factor for stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic stroke. Hyperglycaemia during the acute ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with heart failure and chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments. Graphical Abstract

Primary Prevention of Cardiovascular Events With Low-Dose Aspirin and Vitamin E in Type 2 Diabetic Patients

OBJECTIVE—We investigated in general practice the efficacy of antiplatelets and antioxidants in primary prevention of cardiovascular events in people with type 2 diabetes. RESEARCH DESIGN AND METHODS—The Primary Prevention Project (PPP) is a randomized, open trial with a two-by-two factorial design aimed to investigate low-dose aspirin (100 mg/day) and vitamin E (300 mg/day) in the prevention of cardiovascular events in patients with one or more cardiovascular risk factors. The primary end point was a composite end point of cardiovascular death, stroke, or myocardial infarction. A total of 1,031 people with diabetes in the PPP, aged ≥50 years, without a previous cardiovascular event were enrolled by 316 general practitioners and 14 diabetes outpatient clinics. RESULTS—The PPP trial was prematurely stopped (after a median of 3.7 years) by the independent data safety and monitoring board because of a consistent benefit of aspirin compared with the control group in a population of 4,495 patients with one or more major cardiovascular risk factors. In diabetic patients, aspirin treatment was associated with a nonsignificant reduction in the main end point (relative risk [RR] = 0.90, 95% CI 0.50–1.62) and in total cardiovascular events (0.89, 0.62–1.26) and with a nonsignificant increase in cardiovascular deaths (1.23, 0.69–2.19). In nondiabetic subjects, RRs for the main end point, total cardiovascular events, and cardiovascular deaths were 0.59 (0.37–0.94), 0.69 (0.53–0.90), and 0.32 (0.14–0.72), respectively. No significant reduction in any of the end points considered could be found with vitamin E in either diabetic or nondiabetic subjects. CONCLUSIONS—Our data suggest a lower effect of primary prevention of cardiovascular disease (CVD) with low-dose aspirin in diabetic patients as opposed to subjects with other cardiovascular risk factors. If confirmed, these findings might indicate that the antiplatelet effects of aspirin in diabetic patients are overwhelmed by aspirin-insensitive mechanisms of platelet activation and thrombus formation, thus making the balance between benefits and harms of aspirin treatment unfavorable. Further large-scale trials investigating the role of aspirin in the primary prevention of CVD in diabetic patients are urgently needed

Oesophageal stenosis due to heterotopy of gastric mucosa: a rare case of dysphagia in paediatric age

We describe the case of a three-year-old child who presents recurrent vomiting, dysphagia for solids, and weight deficit. Besides the poor general clinical conditions, the kid presents also retrosternal pyrosis. The laboratory tests show the presence of sideropenic anaemia, but it is possible to make a diagnosis only after endoscopy of the superior gastrointestinal tract, which reveals a chronic inflammation due to heterotopy of gastric mucosa. In the suspect of this kind of disease, this test should always be performed, and, if the proton pump inhibitors (PPIs) aren't effective enough, the Savary-Gilliard® dilators provide a safe and effective therapeutic solution

EFFECTIVENESS OF SWITCHING FROM ORAL ZIPRASIDONE TO RISPERIDONE IN A PATIENT WITH COMORBID AUTISTIC DISORDER, PROFOUND INTELLECTUAL DISABILITY, GILBERT SYNDROME, AND EXACERBATION OF PSYCHOSIS

Autism and intellectual disability may hinder any other coexisting psychiatric diagnosis. Diagnoses are often based on behavioral observations, directly ob- tained or reported by family members or operators in frequent contact with the patient, and non-verbal communications, as well as on the psychological and physical symptoms manifested by the patient. We describe the case of a 28-year-old Italian man, hospitalized in one of our long-term care wards for comorbid profound intellectual disability (IQ<25), autistic and psychotic disorders, and Gilbert syndrome, who manifested a severe exacerbation of psychosis, for which ziprasidone was prescribed. This condition para- doxically further deteriorated after the introduction of this drug. A subsequent switch to risperidone greatly and rapidly improved both psychosis-related and symp- toms emerging after the introduction of ziprasidone

Extension of lymphadenectomy for gastric cancer:Audit at European specialist centres.

Gastric cancer is still one of the leading causes of cancer-related deaths worldwide, and its treatment management differs between Eastern Asia and Western countries. Screening program, early diagnosis, and surgical treatment was primarily established in Japan and was rapidly disseminated to other countries. In other parts of the world, such as the USA and Western Europe, the incidence of gastric cancer has declined, and efforts for screening and early detection have not been an issue of higher priority over the management of other diseases. Thus, gastric cancer in the West is often more advanced and is either inoperable or needs more radical surgery for resection. The only treatment method that can potentially cure gastric cancer is the surgical approach. Depending on the extension of the tumor, surgeons may execute an operation that involves removing all or part of the stomach with some nearby lymph nodes (lymphadenectomy). Lymphadenectomy is a crucial step during surgical operation that involves the removal of one or more lymph nodes located in the drainage area of a tumor, in which there is a high possibility of lymph node metastasis. The Japanese guidelines define the criteria of lymphadenectomy procedure into D1 D1+ or D2 according to the type of gastrectomy executed. The extent of lymphadenectomy has long been a subject of debate. Indeed, Japanese surgeons introduced extended lymphadenectomy (D2), which has also been progressively adopted in Europe and included in almost all international guidelines. However, the procedure requires a long learning curve, which involves a high volume of interventions; therefore, US guidelines do not recommend the D2, and many Italian and European centres do not yet perform this procedure. Indeed, the current European Consensus guidelines recommend D2 dissection in regional specialist centres for patients with moderate comorbidity. However, compliance with guidelines is unclear, and in some recent RCTs, the standard approach of surgical treatment is at the "surgeon's discretion." This study aims to evaluate the current practice of D2 lymphadenectomy in Europe to determine any variation in practice and compare it with the Japanese guidelines. The study consists of two parts: first, a questionnaire based on hypothetical clinical scenarios was administered to expert surgeons belonging to European Chapter of the International Gastric Cancer Association from high-volume European centers. They were asked to select the appropriate lymphadenectomy extension for each hypothetical case and the associated lymph node stations to remove. In the second part of the study, the same surgeons were asked to collect their data about gastric cancer gastrectomies performed in 2015 for comparative analysis. The study results show that the expert surgeons of high-volume centres are quite in agreement with the choice of D2 lymphadenectomy in the different clinical scenarios. The surgical choice seems to have been influenced by the tumor stage, site, and histology of the tumor. More specifically, the D2 procedure is recommended for cases with diffuse histology compared to tumors with intestinal histology. However, the selection of the D2 dissection procedure rarely conformed to Japanese guidelines: the choice of lymph node stations revealed the presence of a wide variation in execution. In the review of the gastrectomy experience, it was observed that a high surgical standard was achieved: in fact, in 97% of gastric cancer gastrectomies after D2, an adequate number of lymph nodes (≥15 nodes) were removed. In conclusion, even if an adequate lymphadenectomy was obtained in almost all cases in dedicated centers, there is still significant variability in the number of recovered lymph nodes. The histology of the tumor largely influences the surgeon's choice regarding the extent of the lymphadenectomy; however, the role of histology in the planning of surgical procedures is not considered in the current guidelines and must be verified in prospective studies