La fragilit\ue0 e la vulnerabilit\ue0 in sanit\ue0. Sintesi dei risultati di un progetto di ricerca sul campo per identificare determinanti di fragilit\ue0 e vulnerabilit\ue0 sociale e suggerire approcci migliorativi in popolazioni a maggiore rischio.

Obiettivi. Identificare i determinanti di disuguaglianza nella domanda/offerta di salute, in particolare quelli dovuti a fattori di natura sociale, al fine di offrire un contributo concettuale, metodologico ma soprattutto empirico ai fornitori dell\u2019assistenza sanitaria della Regione Lombardia. Metodi. Sono stati coinvolti tutti i medici di medicina generale della ASL-Citt\ue0 di Milano. Lo studio prevedeva due fasi: una \u201cdescrittiva\u201d per quantificare la frequenza di vulnerabilit\ue0 e fragilit\ue0, e una seconda \u201canalitica\u201d, in un campione pi\uf9 selezionato di pazienti per individuare la mancata esecuzione di interventi di screening e riabilitazione (eventi sentinella). Risultati. I valori di fragilit\ue0 e vulnerabilit\ue0 (da 0 a 10) indicati dai medici per i 10.798 pazienti reclutati per la fase descrittiva erano rispettivamente di 3,7 e 3,1. Per la fase analitica dello studio sono stati reclutati 794 pazienti per un totale di 261 eventi sentinella, di cui il pi\uf9 frequente \ue8 stato la mancata esecuzione di riabilitazione post-infarto. Conclusioni. Questo studio, grazie alla buona partecipazione dei medici coinvolti, ha permesso di ottenere una stima di fragilit\ue0 e vulnerabilit\ue0 nella popolazione di assistiti dai medici di medicina generale di Milano e di studiare la prevalenza di alcuni eventi sentinella sul mancato accesso ai servizi del SSN forniti dalla Citt\ue0 di Milano

Dietary inclusion of a partially defatted black soldier fly (Hermetia illucens) larva meal in low fishmeal-based diets for rainbow trout (Oncorhynchus mykiss)

BACKGROUND: Recent investigations highlighted that Hermetia illucens (BSF) larva meal can be a valuable alternative protein source for aquafeed production. In this study, in substitution of fishmeal, we used increasing inclusion levels of a partially defatted BSF larva meal in low fishmeal-based diets for rainbow trout (Oncorhynchus mykiss Walbaum) and we evaluated the related implications in terms of growth performance, physical characteristics, proximate and fatty acid (FA) compositions of the fillets, gut and liver histology, and diet digestibility. In a 131-day trial, 576 fish (100.1\ub19.29g) were randomly allotted to 24 tanks (24 fish/tank, 4 replicates/treatment). Six experimental diets were produced to have partial replacement of fishmeal (0, 10%, 20%, 30%, 40% and 50%) by increasing levels of BSF meal (0% [BSF0], 3% [BSF3], 6% [BSF6], 9% [BSF9], 12% [BSF12] and 15% [BSF15] on as fed basis, respectively). RESULTS: No differences were observed among the treatments for all the considered growth performance parameters. The viscero and hepato-somatic indexes showed significant differences among the treatments, with the highest values observed in the BSF15 group. No differences were recorded in terms of fillet's physical characteristics, dry matter (DM), crude protein (CP) and ether extract (EE) contents. Total saturated and monounsaturated FA increased, while polyunsaturated FA (particularly n-3 FA) decreased while increasing the HI meal inclusion in the diet. Histopathology of liver and gut was not affected, whereas, in posterior gut, villi were higher in BSF6 and BSF9 compared to BSF3 fish. The apparent digestibility of DM, CP, EE and gross energy did not vary among the treatments. CONCLUSIONS: These results suggest that a partially defatted BSF meal could be included up to 15% in low fishmeal-based diets for rainbow trout with no adverse effects on growth performance, fillet's physical characteristics, gut and liver health, and diet digestibility. On the contrary, the fillet FA composition worsened while increasing the level of BSF meal in the diet

Effect of Insect Live Larvae as Environmental Enrichment on Poultry Gut Health: Gut Mucin Composition, Microbiota and Local Immune Response Evaluation

The aim of this study was to evaluate the effect of Hermetia illucens (HI) and Tenebrio molitor (TM) live larvae as environmental enrichment on the mucin composition, local immune response and microbiota of broilers. A total of 180 four-day-old male broiler chickens (Ross 308) were randomly allotted to three dietary treatments (six replicates/treatment; ten animals/replicate): (i) control (C); (ii) C+HI; (iii) C+TM. Live larvae were distributed based on 5% of the expected daily feed intake. At slaughter (39 days of age), samples of duodenum, jejunum and ileum (twelve animals/diet) were submitted to mucin histochemical evaluation. Expression of MUC-2 and cytokines was evaluated by rt-qPCR in jejunum. Mucin staining intensity was not influenced by diet (p > 0.05); however, this varied depending on the intestinal segment (p < 0.001). No significant differences were recorded for IL-4, IL-6 TNF-α, MUC-2 and INF-γ gene expression in jejunum, while IL-2 was lower in the TM group compared to HI and C (p = 0.044). Caecal microbiota showed higher abundance of Clostridium, Saccharibacteria and Victivallaceae in the HI group, while Collinsella was higher in the TM group. The results suggested that live insect larvae did not impair mucin composition or local immune response, and can slightly improve caecal microbiota by enhancing a minor fraction of short chain fatty acid-producing taxa

Nutritional effects of the dietary inclusion of partially defatted Hermetia illucens larva meal in Muscovy duck

Abstract Background The present work is aimed at evaluating the effect of different inclusion levels of a partially defatted black soldier fly (Hermetia illucens, L.; HI) larva meal for ducks. A total of 192 female 3-day-old Muscovy ducklings (Cairina moschata domestica, Canedins R71 L White, Grimaud Freres Selection, France) were divided into 4 groups, assigned 4 different dietary treatments (6 replicates/treatment and 8 birds/replicate) and reared from 3 to 50 days of age. HI larva meal was included at increasing levels (0, 3%, 6% and 9%, HI0, HI3, HI6 and HI9, respectively) in isonitrogenous and isoenergetic diets formulated for 3 feeding phases: starter (3–17 days of age), grower (18–38 days of age) and finisher (39–50 days of age). The growth performance and apparent total tract digestibility were evaluated during the trial using titanium dioxide as an inert marker (0.3% of inclusion). At 51 days of age, two birds per pen were slaughtered and histomorphological investigations were performed. Results The live weight and average daily gain showed a quadratic response to increasing HI meal in the grower period (minimum corresponding to the HI6 group). No effects of dietary inclusion levels were observed for the daily feed intake or feed conversion ratio. The apparent dry matter and organic matter digestibility were not affected by the dietary treatment. A linear decrease was observed for the crude protein apparent digestibility in the starter period (minimum for the HI9 groups). The ether extract apparent digestibility increased linearly during the grower and finisher periods (minimum for the HI0 group). The morphometric indices were not influenced by the dietary treatments. Conclusions The inclusion of up to 9% of HI partially defatted larva meal in the diet of ducks did not cause any effect on growth performance, as well as the apparent digestibility. Moreover, dietary HI inclusion preserved the physiological intestinal development