OBJECTIVES: to quantify the impact of heat on mortality, in terms of heat attributable deaths in 6 Italian cities included in the CCM Climactions project (Turin, Genoa, Bologna, Rome, Bari, Palermo) and to estimate the p...OBJECTIVES: to quantify the impact of heat on mortality, in terms of heat attributable deaths in 6 Italian cities included in the CCM Climactions project (Turin, Genoa, Bologna, Rome, Bari, Palermo) and to estimate the potential health co-benefits by considering temperature reduction scenarios in urban areas proposed in the project case studies in terms of urban nature-based solutions measures and albedo variation of impervious surfaces. DESIGN: city-specific time series models and impact assessment. SETTING AND PARTICIPANTS: daily mortality counts and average temperature data in six Italian cities (Turin, Genoa, Bologna, Rome, Bari, Palermo) included in the CCM CLIMACTIONS project Main outcome measures: overall mortality. Non-linear distributed lag models were used to estimate risk and attributable deaths for increments between the 75th and the 99th percentiles of the mean temperature distribution (lag 0-3) over the period 2006-2015. To estimate the benefits of the intervention scenarios proposed in Climactions to reduce temperatures in urban areas, the deaths attributable to heat with and without this reduction were calculated and the difference between the two estimates corresponds to the potential change in the impact due to scenario measures introduced. RESULTS: the study reports a reduction in heat attributable deaths between 25% and 35% and between 40% and 60% in all cities, respectively, for the two scenarios of average temperature mitigation equal to 1.3°C and 2°C. CONCLUSIONS: although only referring to simulation scenarios, the study provides further evidence of how urban nature-based solutions and the variation in the albedo of surfaces can be beneficial at an urban level both for the environment and populations health, supporting the implementation of climate change adaptation measures.
Badaloni C, Caranci N, de'Donato F
… +9 more, De Sario M, Zengarini N, Cernigliaro A, Ranzi A, Nannavecchia AM, Campese E, Bisceglia L, Adorno V, Michelozzi P
OBJECTIVES: to identify environmental, socioeconomic, and territorial characteristics in five urban areas (Turin, Bologna, Rome, Bari, Palermo) and to identify areas characterized by high environmental and socioeconomic...OBJECTIVES: to identify environmental, socioeconomic, and territorial characteristics in five urban areas (Turin, Bologna, Rome, Bari, Palermo) and to identify areas characterized by high environmental and socioeconomic vulnerability. DESIGN: geographical study. SETTING AND PARTICIPANTS: study domain on five Italian cities, each city was characterized at the urban-area level. MAIN OUTCOME MEASURES: for each urban area or neighbourhood, multiple spatial indicators were constructed concerning the main environmental (air pollution, urbanisation, temperature, altitude and presence of rivers and watercourses, greenery, road and rail networks), and socioeconomic (deprivation index) aspects. These characteristics have been synthesised into a composite indicator with a geographically weighted principal component analysis in order to characterise environmental and socioeconomic vulnerability in a single measure that can be more easily interpreted compared to a set of individual indicators. RESULTS: the involved cities have numerous databases suitable for mapping the main environmental and socioeconomic characteristics. Turin is the most populous of these cities and the one which has the highest average daily PM10 value (29.7±1.4 µg/m3). Together with Palermo, it is the city with the highest density of local roads. Data on residential land cover show a South-North gradient, from 50% in Palermo and Bari to 24,5% in Rome. Low-density residential areas prevail in all cities. The synthetic value of the indicator captures the spatial variability of the territory, highlighting the areas of greatest urban vulnerability in each city under study. Bologna and Roma are the cities with the highest percentage of residents in the high environmental, climate, and socioeconomic vulnerability level, respectively 38% and 29%, while Bari and Palermo show the highest fraction of population living in low vulnerability areas. CONCLUSIONS: in this study, five Italian cities were characterised from an environmental, socioeconomic, and spatial perspective. Furthermore, through the use of a synthetic indicator of socioeconomic environmental exposure, the most vulnerable areas were identified. This indicator provides immediate and effective information to support policies to protect health and combat environmental and social risk factors in the area.
The course "Climactions-URBAN HEALTH", dedicated to all professions related to the national health service, aimed to raise awareness among healthcare professionals about the risks to human health associated with climate...The course "Climactions-URBAN HEALTH", dedicated to all professions related to the national health service, aimed to raise awareness among healthcare professionals about the risks to human health associated with climate change through an online tool. The course was created to promote training as a means of implementing adaptation and mitigation strategies for climate change. It is an online Continuing Medical Education (CME) course developed on the e-learning platform of the Italian National Health Institute (Istituto Superiore di Sanità - ISS). This course was directed and scientifically coordinated by the Ecosystem and Health Unit (ISS), in collaboration with the Department of Epidemiology of the Latium Region, and technically coordinated by the Training Office (ISS).The course attracted 25,000 participants, reaching the maximum limit available on the platform.The high number of participants who completed the course, their positive feedback on the course, the different professional categories to which they belong, and their diverse origins across the country serve as indicators of the effectiveness of distance learning, demonstrating it as a valid tool for promoting climate change adaptation and mitigation strategies for professionals within the Italian National Health Service and the Italian National Health System for Prevention.
OBJECTIVES: to estimate CO2 emissions for different commuting modes before, during, and after the COVID-19 lockdown, and define scenarios to assess their impact on the environment and health. DESIGN: cross-sectional stud...OBJECTIVES: to estimate CO2 emissions for different commuting modes before, during, and after the COVID-19 lockdown, and define scenarios to assess their impact on the environment and health. DESIGN: cross-sectional study using data retrieved from a survey. SETTING AND PARTICIPANTS: the study included anonymous participation from both researchers involved in the Climactions project and the general population; the questionnaire was made available through social media. Information was gathered on the transportation modes used to commute, the distance travelled and travel times before, during, and after the COVID-19 emergency, and proposals for actions/solutions to enhance sustainable commuting in urban areas. MAIN OUTCOME MEASURES: the amount of CO2 emissions due to different commuting modes during various stages of the pandemic was estimated based on vehicle-specific emission coefficients provided by the European Environmental Agency, taking into account the average number of passengers per vehicle. Sustainable commuting scenarios were also proposed, including active transportation (walking, cycling, etcetera). RESULTS: the online questionnaire was filled-in by 2,904 persons, predominantly women (62.3%) and residents in Northern Italy (44.6%). Over 80% of the respondents were aged over 40 (0.7% <25 years). On average, the distance travelled on a daily commute was 23.6 km (median: 13 km), with longer distances in the Southern Regions (average: 38.2 km, median: 20 km). The average per-capita CO2 emissions were 2 kg per day in the pre-pandemic situation. The reduction in commuting during lockdown periods led to a significant decrease in estimated CO2 emissions, with an average per capita reduction of about 100 grams per day. From September 2020, the increase in smart working among respondents still allowed for a reduction in estimated CO2 levels, despite an increase in emissions from private vehicle use (1.5 kg per capita per day). Considering sustainable scenarios, a 15-minute walk during the daily commute would lead to a reduction in estimated CO2 levels of up to 0.7 kg per capita per day. Regarding the statement that "improving air quality in cities and reducing greenhouse gas emissions are useful actions to combat climate change", 94% of respondents strongly agreed. CONCLUSIONS: in Italy, road transport accounts for approximately 25% of the total CO2 emissions. The lockdown provided a natural scenario for reducing emissions in urban areas, and the implementation of smart working was associated with a decrease in CO2 emissions due to reduced commuting. However, it is crucial to promote sustainable and active transportation modes for daily commuting such as walking and cycling, also considering the significant health co-benefits.
BACKGROUND: public health aims to promote a health-centred approach in all policies, even in adaptation and mitigation policies for climate change. OBJECTIVES: to provide a critical summary on legislations, policies and...BACKGROUND: public health aims to promote a health-centred approach in all policies, even in adaptation and mitigation policies for climate change. OBJECTIVES: to provide a critical summary on legislations, policies and case studies at international, national and local level and to assess the implementation of the "health lens", in support of researchers and workers on environment and health. DESIGN: document review on legislations, policies and case studies, focusing on mitigation of urban health island and sustainable mobility. METHODS: a policy and legislation review was carried out from institutional websites at European and local level. Sustainable urban mobility plans (SUMP) and energy and climate action plans (SECAP) were retrieved for the cities included in the Climactions project (Genoa, Turin, Bologna, Rome, Bari, Palermo) from local authorities' websites. Best practices of urban heat island mitigation and sustainable mobility were searched from European platforms (Climate adapt, Urban mobility observatory -- ELTIS, EIT Urban Mobility) to obtain a critical picture of adaptation and mitigation options in cities. RESULTS: the review shows a large number of legislations, plans, and programmes on adaptation and mitigation both at European and Italian level with a gap between planned and actually implemented actions also due to the lack of dedicated economic resources. There is also an inequal level of implementation among Italian regions, with some criticalities, for example, in the citizen participatory process within the strategic environmental assessment of SUMPs, SECAPs, and adaptation plans. At the local level, in the last decade, several best practices of urban heat island mitigation and sustainable mobility were experienced in different sectors including new urban green space infrastructures, albedo enhancement measures, car-pooling apps, incentives to active mobility, temporary streets liberation, and a combination of measures within adaptation plans such as London Climate Action Plan and Barcelona Superblock programme. Only few measures were health centred embedding public health into urban planning (e.g., the London plan based on the 'healthy streets' approach) suggesting health benefits for the population. CONCLUSIONS: the recent increase in regulations and policies at European and national level is not paralleled by real progresses in climate actions, despite the constant growth of annual emissions. Therefore, there is the need to accelerate the fossil fuel emission mitigation while promoting adaptation to be ready to counteract actual and future climate related risks. Health workers such as paediatricians, family doctors, epidemiologists can advocate the transition and support the citizens and youth engagement in climate-related decision making.
The respiratory syncytial virus causes numerous respiratory infections in children, with particularly severe manifestations during the first months of life, especially in premature infants or those with pre-existing clin...The respiratory syncytial virus causes numerous respiratory infections in children, with particularly severe manifestations during the first months of life, especially in premature infants or those with pre-existing clinical conditions.In Italy, the introduction of nirsevimab, a monoclonal antibody that is more practical and potentially usable in a broader population compared to the previous palivizumab, has highlighted several critical issues in the management of the prevention system. Initially, the manufacturer proposed the drug under category C, making it fully paid by patients. Subsequently, the company began direct negotiations with regional authorities, which independently planned the administration of the drug at no cost to patients, adopting differing and inconsistent approaches to preventive immunoprophylaxis programmes.Difficulties worsened when a statement from the Italian Ministry of Health clarified that regions undergoing financial recovery plans could not guarantee the administration of nirsevimab, as the treatment was excluded from the essential levels of care. The public and media uproar surrounding this exclusion prompted institutions to find a rapid solution. A national agreement was reached, allocating funds for an immunization campaign covering approximately 75% of newborns, corresponding to the availability guaranteed by the manufacturer. Additionally, a solidarity distribution mechanism was introduced, allowing up to 20% of doses to be shared among regions to protect the most vulnerable individuals.Despite the campaign started with the onset of the epidemic season, challenges persist in organizing procurement processes and managing immunoprophylaxis operations, resulting in significant disparities in implementation across regions.The nirsevimab case underscores the urgency of a nationally coordinated and shared strategy among central institutions, regional authorities, and other stakeholders to ensure equity and effectiveness in prevention policies, especially in light of upcoming regional autonomies.
BACKGROUND: although there is an overabundance of terms that over time have connoted the phenomenon usually defined as Alcoholism, or Alcohol Dependence, this has been universally considered a unitary disease by experts,...BACKGROUND: although there is an overabundance of terms that over time have connoted the phenomenon usually defined as Alcoholism, or Alcohol Dependence, this has been universally considered a unitary disease by experts, the media and lay people. OBJECTIVES: to investigate whether there is a variety of configurations of alcohol dependence and alcohol abuse corresponding to different countries. DESIGN: secondary analysis of a dataset from a European project conducted in 2013-2014. The analysis was carried out mainly based on both artificial intelligence and statistical tools: Self Organizing Map (SOM) Neural Network, Multidimensional Scaling Population Algorithm (MSPA), and K-Means clustering algorithm. SETTING AND PARTICIPANTS: 1,767 participants in a European project treated in specialist alcohol dependence units in 9 countries/regions of Europe. MAIN OUTCOME MEASURES: patients were interviewed to ascertain their correspondence to the 11 DSM-4 symptoms used for the diagnosis of 'alcohol dependence' and 'alcohol abuse', following up on a previous study that used traditional statistical methodology. RESULTS: results confirm that the symptoms of 'alcohol dependence' and 'alcohol abuse' identified by the DSM-4 are distributed according to distinct European geographical macroareas: Central-Northern and Southern, with an intermediate macroarea. These could partly correspond to different typologies of drinking cultures in the different macroareas. CONCLUSIONS: alcoholism does not appear to be a unitary disease, but varies according to different cultures and social contexts, and should be treated appropriately.
BACKGROUND: promoting physical activity and reducing sedentary behaviour are public health priorities aimed at ensuring health and well-being at all stages of life. Physical activity should be encouraged from early child...BACKGROUND: promoting physical activity and reducing sedentary behaviour are public health priorities aimed at ensuring health and well-being at all stages of life. Physical activity should be encouraged from early childhood, with play being a key component, including interactive 'floor-based' activities in safe spaces. The introduction of colourful markings in playgrounds and public spaces (such as 'playground markings') may offer a cost-effective and feasible way to promote physical activity, also providing structured opportunities for teachers to support motor skill development. OBJECTIVES: to provide evidence of the benefits of playground markings interventions in schools on increasing physical activity levels and enhancing the physical and psychological well-being in pre-school and school-aged children. DESIGN: a systematic literature search was conducted in Cochrane Library, MedLine, Embase, PsycInfo, and Epistemonikos databases up to 13.02.2024. The primary focus was to identify systematic reviews (SRs) or, in their absence, randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs). Study quality was assessed using validated tools according to study design, and meta-analyses were conducted where feasible. The GRADE approach was used to evaluate the certainty of evidence and results were presented in Summary of Findings (SoF) tables. Studies not included in the meta-analyses due to data unavailability or heterogeneity in outcome measures or interventions were narratively reported. SETTING AND PARTICIPANTS: students aged 3 to 10 years attending preschool and primary school. MAIN OUTCOME MEASURES: increased physical activity (including light, moderate vigorous and reduction of sedentary lifestyle); reduced obesity, overweight, Body Mass Index; well-being (quality of life, psychological aspect); cognitive level; school performance. RESULTS: a total of 557 records were screened and 35 potentially eligible full-text assessed publications. The review included 14 publications corresponding to 11 studies: 6 RCTs and 5 NRCTs. No systematic reviews were included. Meta-analyses were conducted using data from 2 RCTs, examining outcomes related to reduced sedentary behaviour and increased light, moderate, and vigorous physical activity. No statistically significant differences between comparison groups. The certainty of evidence was very low for all outcomes. Four of the 9 studies that were not included in the meta-analysis were RCT studies and 5 non-randomized studies reported heterogeneous results with respect to the physical activity outcome with some outcomes showing an effect in favour of the intervention while others reported no effect. CONCLUSIONS: multi-coloured playground markings consist of a low-cost approach to promote physical activity in children. However, the results reported by the few available studies in both pre-school and school-age children are inconclusive.
BACKGROUND: twenty years after the last review of the European Union (EU) pharmaceutical legislation, the pharmaceutical sector has significantly changed and become more globalised. Unmet medical needs and unequal access...BACKGROUND: twenty years after the last review of the European Union (EU) pharmaceutical legislation, the pharmaceutical sector has significantly changed and become more globalised. Unmet medical needs and unequal access to innovative treatments persist. In addition, there is a growing awareness of the need for developing new antibiotics and a rational use of existing ones. In this context, in 2020 the European Commission proposed a new pharmaceutical strategy for Europe aiming to ensure equitable access to effective and safe medicines while strengthening the competitiveness of the sector globally. In line with this strategy, the Commission itself proposed a comprehensive reform of the pharmaceutical legislation in 2023, which was later amended by the European Parliament. OBJECTIVES: to analyse some of the main proposals for changes to the current regulatory framework and discuss their impact on European pharmaceutical policies and public health. DESIGN: analysis of the current regulatory context on medicines and comparison with the main proposals of the European Commission and Parliament. RESULTS: among the most significant reform proposals are: 1. the changes to data and market protection with the creation of a system of incentives to support innovation, promoting the development of safe and effective medicines and their access to patients, and making the EU attractive to the pharmaceutical companies; 2. the set of measures to incentivise the development of new antimicrobials and control antimicrobial resistance; 3. the measures aimed at increasing the transparency of the European Medicines Agency. CONCLUSIONS: this critical and independent analysis of the current draft reform of the pharmaceutical legislation shows important novelties that could deeply transform the current European regulatory framework of the pharmaceutical sector, highlighting some critical issues regarding the significance and effectiveness of some proposals. Once the entire legislative process has been completed, it will be possible to witness the implementation of the reform in its final version, which will require an assessment of its real impact.
Smimmo A, Monda E, De Rosa B
… +27 more, Fordellone M, De Stasio C, Fusco A, Marzullo F, Caiazza M, Mazzella M, Rega S, Esposito S, Russo F, Diana V, Iasevoli C, Boccia MC, Bassolino S, Pagliafora A, Fiorentino G, Iervolino A, Galdo M, Trama U, Buono P, Postiglione A, Di Gennaro M, Mazzucato M, Facchin P, Morgillo B, Russo MG, Chiodini P, Limongelli G
OBJECTIVES: to provide the epidemiological framework of those affected by rare diseases resident in the Campania Region (Southern Italy), using the data entered in the Campania Region Rare Disease Registry, acquiring inf...OBJECTIVES: to provide the epidemiological framework of those affected by rare diseases resident in the Campania Region (Southern Italy), using the data entered in the Campania Region Rare Disease Registry, acquiring information potentially useful for regional planning. DESIGN: observational retrospective cohort study on patients with rare diseases included in the Regione Campania Rare Disease Registry from 01.01.2022 to 31.12.2022. SETTING AND PARTICIPANTS: population included in the Rare Disease Registry and resident in the Campania Region as at 31.12.2022. MAIN OUTCOME MEASURES: using the data entered in the Regione Campania Rare Disease Registry, the cumulative incidence (I) of patients with rare diseases resident in Campania was calculated, stratified by age group and rare disease group with the respective 95% confidence intervals (IC95%). Standardised cumulative provincial incidences were also calculated. These are reported using a multiplication factor of 100,000. RESULTS: the incidence of patients with rare diseases in the Campania Region is 50.0 (IC95% 49.4-50.6) per 100,000 inhabitants in the year 2022. Furthermore, the rare disease groups with the highest incidence per 100,000 inhabitants are diseases of the central and peripheral nervous system (I: 8.32 per 100,000 inhabitants) and congenital malformations, chromosomopathies and genetic syndromes (I: 8.52 per 100,000 inhabitants). Moreover, the age groups in which the incidence is highest are in the paediatric age group. CONCLUSIONS: an epidemiological framework of the Campania Region on rare diseases such as this one for the year 2022 is fundamental for national and regional planning in order to improve the care and quality of life of people affected by rare diseases, who often feel neglected by society. Sharing this type of information also draws attention to the need for faster diagnosis and the specialisation of new centres.
Tunesi S, Cavaliero d'Oro L, Dalle Carbonare S
… +9 more, Fanetti AC, Gambino ML, Maifredi G, Villa M, Zucchi A, Leoni O, Cereda D, Russo AG, Gruppo di lavoro Portale Profili di Salute
BACKGROUND: Lombardy Region (RL) is organized into 8 Health Protection Agencies (ATS) and 86 Districts, which are responsible for organizing and coordinating territorial health care for reference population ranging betwe...BACKGROUND: Lombardy Region (RL) is organized into 8 Health Protection Agencies (ATS) and 86 Districts, which are responsible for organizing and coordinating territorial health care for reference population ranging between 80,000 and 120,000 inhabitants. RL has implemented the Health Profiles Portal, an advanced system that integrates health care, socio-health, and social data to provide a clear and comparable view of the population's needs at different territorial levels. To develop the portal, it was necessary to construct denominators that would ensure the accuracy and comparability of the healthcare indicators. OBJECTIVES: to compare three different methods for constructing population denominators: two based on Regional Registries (NAR) and one on the Italian National Institute of Statistics (Istat) data. METHODS: the first denominator (NAR_portale) used for the portal was constructed from all monthly extractions of NAR in 2023 collected by the ATSs; the second denominator (NAR_202401) was based on the assisted population as of January 2024, including those who died in 2023; the third denominator (ISTAT_202401) was based on Istat population data as of 01.01.2024. Comparisons, expressed as percentage variations (VP) relative to NAR_portale, were carried out at both the ATS and District levels, with separate analyses by gender, age, nationality, and residence in nursing homes (RSA). Results: overall, NAR_portale identified a population of 10,111,769 residents, NAR_202401 recorded 10,106,191 subjects (VP 0.05%), and ISTAT_202401 recoded 10,012,054 (VP 0.99%). Greater variability was observed at the ATS level, whereas districts within the same ATS exhibited more homogeneous trends. The largest VPs were observed in the extreme age groups (0-1 and 85+ years), among foreign citizens, and among RSA residents. CONCLUSIONS: the differences between denominators highlight the complexity of constructing reference populations for health monitoring. NAR_portale provides greater dynamism and completeness, but efforts are needed to standardise and ensure comparability with other sources. In the future, the integration of different data sources and the use of advanced methodologies could improve monitoring quality and support more effective healthcare planning.