La percezione dell'etichettatura nutrizionale: un'indagine empirica nel comune di Pisa.

Il tema della sicurezza alimentare è importante e sempre in continua evoluzione, tanto che è considerato una questione di primaria importanza in materia di diritto dei consumatori. Negli ultimi anni si è assistito ad un crescente numero di prodotti che promuovono, con indicazioni sull’etichetta o nella pubblicità, proprietà nutrizionali o di salute. Gli alimenti con tali indicazioni possono essere percepiti dal consumatore come portatori di un beneficio nutrizionale, fisiologico o, in generale, positivo per la salute e tale da differenziali da altri prodotti convenzionali presenti sul mercato. Questo crea un indubbio vantaggio commerciale perché può incidere direttamente sugli acquisti. La Commissione Europea ha pertanto ritenuto necessario intervenire stabilendo principi generali applicabili per la pubblicità ed etichettatura di questa particolare tipologia di alimenti, al fine di garantire un elevato livello di tutela dei consumatori e la piena consapevolezza delle scelte di acquisto. Obiettivo ultimo è quello di rendere le etichette dei prodotti sempre più comprensibili ed affidabili, diventando un essenziale strumento di informazione per i consumatori. Spesso, infatti, il compratore è più attratto dalla convenienza che dalla qualità e dal valore merceologico del prodotto, anche contro il proprio interesse. Affinché venga garantita la sicurezza del consumatore in materia alimentare è fondamentale che il consumatore conosca il prodotto e che sia informato correttamente sulle caratteristiche di ciò che acquista. Per tale motivo, ci si può chiedere se i consumatori siano consapevoli delle proprietà nutrizionali dei prodotti alimentari che acquistano e sappiano leggere e comprendere l’etichetta. In questa ricerca è stato analizzato il ruolo dell’etichetta nutrizionale nella scelta degli alimenti, con un questionario volto a rilevare la comprensione delle informazioni nutrizionali riportate sulla etichetta dei prodotti da parte dei consumatori e se e come questi ultimi utilizzano le loro conoscenze e suddette informazioni nella fase di acquisto. Analoghe ricerche sono state svolte in ambito europeo da EUFIC (European Food Information Council ) con i progetti FLABEL (Food Labelling to Advance Better Education for Life) e CLYMBOL (Role of health-related claim and symbols in consumer behaviour) che si occupano di comprendere l’utilizzo delle etichette nutrizionali al fine di apportare miglioramenti normativi a tutela dei consumatori. Il presente lavoro di tesi si articola in 3 capitoli, nel primo capitoli vengono descritte le varie modalità di presentazione delle informazioni nutrizionali su prodotti alimentari con approfondimenti specifici sulla normativa vigente. Nel secondo vengono riportati i risultati dell’analisi della letteratura sui precedenti studi volti a rilevare la comprensione dei consumatori dell’informativa nutrizionale. A seguire nel terzo, e ultimo, capitolo presenta l’indagine sul campo effettuata per rilevare il profilo del consumatore in relazione all’utilizzo dell’informativa nutrizionale per le scelte di consumo. Infine la tesi si conclude con alcune osservazioni sul reale contributo dell’etichette nutrizionali alla corretta composizione della dieta quotidiana

Helicopter Vibratory Loads Alleviation through Combined Action of Trailing-Edge Flap and Variable-Stiffness Devices

The aim of this paper is the assessment of the capability of controllers based on the combined actuation of flaps and variable-stiffness devices to alleviate helicopter main rotor vibratory hub loads. Trailing-edge flaps are positioned at the rotor blade tip region, whereas variable-stiffness devices are located at the pitch link and at the blade root. Control laws are derived by an optimal control procedure based on the best trade-off between control effectiveness and control effort, under the constraint of satisfaction of the equations governing rotor blade aeroelastic response. The numerical investigation concerns the analysis of performance and robustness of the control techniques developed, through application to a four-bladed helicopter rotor in level flight. The identification of the most efficient control configuration is also attempted

EVIDENCE OF OPPORTUNISTIC FEEDING BETWEEN ICHTHYOSAURS AND THE OLDEST OCCURRENCE OF THE HEXANCHID SHARK NOTIDANODON FROM THE UPPER JURASSIC OF NORTHERN ITALY

In 2016, two fossil marine reptiles were re-discovered in the collections of the Museo Civico di Storia Naturale di Verona. Originally recovered near Asiago, Vicenza province (northern Italy) from an outcrop of the Rosso Ammonitico Veronese Fm. (Middle-Upper Jurassic), they were never described. Morphological analysis carried out under UV-light allowed enhancing contrast with the surrounding matrix and better identifying some anatomical details. Both specimens consist of partially articulated postcranial elements from two distinct ichthyosaurs, including vertebrae, ribs, and some fragmentary elements of the appendicular skeleton. The first specimen V7101 is here tentatively assigned to Ophthalmosauridae based on a combination of features shared with other taxa in this family, such as the regionalization of the vertebral column. Taphonomical analysis suggests a long exposure of the carcass on the sea floor before burial; two teeth of the hexanchiform shark Notidanodon found near the ribcage could indicate scavenging. An ichthyosaur tooth most probably not belonging to the same specimen was found stuck on a rib and can also be attributed to scavenging – the first ever record of this interaction between two ichthyosaurs. The second specimen V7102 is represented by a poorly preserved partial vertebral column and is here referred to Ichthyosauria indet. due to the absence of taxonomically significant characters. Calcareous nannofossil data and microfacies analyses allow us to assign both specimens to the basal Kimmeridgian. This makes the two Notidanodon teeth associated with V7101 the oldest recorded occurrence of this genus

Ultrasound imaging of the axilla

: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. To the best of our knowledge, in the pertinent literature, a detailed sonographic protocol to comprehensively assess the axillary region in daily practice is lacking. In this sense, the authors have briefly described the anatomical architecture of the axilla-also using cadaveric specimens-to propose a layer-by-layer sonographic approach to this challenging district. The most common sonographic pathological findings-for each and every anatomical compartment of the axilla-have been accurately reported and compared with the corresponding histopathological features. This ultrasound approach could be considered a ready-to-use educational guidance for the assessment of the axillary region. CRITICAL RELEVANCE STATEMENT: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. The aim of this review article was to describe the anatomical architecture of the axilla, also using cadaveric specimens, in order to propose a layer-by-layer sonographic approach to this challenging district

The Impact of Company Grade Officer Self-Sacrificial Behavior on Subordinate Assessments of Leader Charisma

Newly commissioned officers in the U.S. Army are taught to lead their soldiers from the front and to voluntarily make personal sacrifices in the service of the nation. Although this facet of military culture is seen as critical to the integrity of the force, there are few research studies describing the impact of leader self-sacrifice in the U.S. Army. Research evolving from the transformational leadership literature indicates that civilian leaders who engage in self-sacrificial behavior are viewed as more charismatic than their counterparts and that this perception is particularly pronounced in crisis situations. The current study extended this research to a military population utilizing a quantitative experimental research design. Respondents were randomly assigned to written vignettes that manipulated leader self-sacrifice and the combat environment and then provided assessments of the company grade officer\u27s attributed charisma. Currently serving enlisted and commissioned officers in the California Army National Guard (n = 218) took part in the research, and ANOVA test results indicated that both self-sacrifice and the experience of combat significantly increase perceptions of a company grade officer\u27s attributed charisma. No significant interaction was found between leader self-sacrifice and combat. This study indicated that the self-sacrificial leadership model may have broad applicability across organizations and provides strong support for the Army\u27s emphasis on selfless service. This research can spur positive social change by fostering a more aspirational form of leadership within the Army that builds the psychological resilience of soldiers and results in stronger teams

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population