Health tourism: an opportunity for sustainable development

In February 2017, the “Programma Mattone Internazionale Salute” (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "AgeFriendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities

Copernicus Ocean State Report, issue 6

The 6th issue of the Copernicus OSR incorporates a large range of topics for the blue, white and green ocean for all European regional seas, and the global ocean over 1993–2020 with a special focus on 2020

Variations of taste perception and possible association with bmi in healthy subjects: a functional and genomic approach

Il senso del gusto è parte del sistema sensoriale ed è una fonte importante di input sensoriali: esso influenza l'appetibilità e il grado di accettazione di cibi o bevande. Esistono sei diversi gusti ad oggi noti, amaro, dolce, acido, salato, umami e gusto del grasso. Alcuni studi hanno stabilito una relazione tra variazione genetica, percezione del gusto e stato di salute: variazioni genetiche nei geni dei recettori del gusto inducono variazioni nella percezione del gusto. Tuttavia, la selezione del cibo dipende anche da altri fattori come lo stato nutrizionale, la fisiologia, l'ambiente e i fattori socioculturali. Le scelte del cibo e le abitudini alimentari possono influenzare lo stato di salute e il rischio di sviluppare malattie complesse. Il metodo più comunemente usato per studiare le patologie complesse è lo studio di associazione, che mira ad identificare, in una popolazione, una correlazione tra gli alleli di uno o più marcatori genetici, soprattutto i singoli nucleotidi polimorfici (SNP), e il fenotipo. L'obiettivo generale di questa tesi è quello di indagare come la percezione gustativa influenza l’ indice di massa corporea (BMI) e predispone a malattie complesse come l'obesità. Questa ricerca include 5100 partecipanti provenienti da tre diversi progetti all'interno del consorzio “Network Italiano Isolati Genetici” (INGI). I DNA genomici dei soggetti sono stati estratti da campioni di sangue e poi genotipizzati utilizzando “Illumina 370K high-throughput SNP array”, per un totale di circa 370.000 SNP per campione. Attraverso la consultazione del database bibliografico PubMed abbiamo selezionato tutti i geni recettori del gusto e i geni coinvolti nella cascata di trasduzione del segnale del gusto. Abbiamo eseguito una "analisi di associazione per geni candidati" assumendo il log10 del BMI come variabile dipendente e gli SNP di tutti i geni selezionati come regressori. Abbiamo utilizzato un modello genetico additivo e abbiamo assunto sesso ed età come covariate. Ogni popolazione è stata prima analizzata separatamente e poi risultati sono stati combinati mediante metaanalisi. Dopo l’analisi del fenotipo e del genotipo, 2827 soggetti sono stati analizzati complessivamente. La metaanalisi ha identificato alcuni polimorfismi associati con il BMI: 2 SNP appartengono al gene SCNN1B gene, un recettore del gusto salato, invece otto SNP appartengono al gene GNAT3, un gene che codifica una proteina-G gusto-selettiva implicata nella trasduzione del gusto dolce, amaro e umami, e 4 SNPs appartengono al gene PDE4B, una fosfodiesterasi AMPc-specifica per la trasduzione del segnale in generale. I risultati dei nostri studi suggeriscono che il meccanismo con cui le variazioni dei recettori del gusto possono influenzare il BMI, e quindi il rischio di sviluppare sovrappeso e obesità, è molto complesso e probabilmente strettamente correlato all’espressione e alla funzione dei recettori del gusto. I nostri risultati confermano che questi geni sono altamente polimorfici e che questi polimorfismi sono legati o alla proteina del recettore o alla proteina coinvolta nella cascata del segnale.The sense of the taste is part of the sensory system and is an important source of sensory input: it influences the palatability and the degree of acceptance of foods or drinks. There are six different tastes until now known, bitter, sweet, sour, salt, umami and fat taste. Some studies established a relationship between genetic variation, taste perception and health status: genetic variations in taste receptor genes induce variations in taste perception. However, food selection depends also on other factors like nutritional status, physiology, environment and sociocultural factors. Food choices and dietary habits may influence the health status and the risk of complex diseases. The method most commonly used for studying the complex disease is the association study, that aims to identify, in a population, a correlation between the alleles of one or more genetic markers, mostly the Single Nucleotide Polymorphisms (SNPs), and the phenotype. The general aim of this thesis is to investigate how taste perception affects body mass index (BMI) and predisposes to complex diseases such as obesity. This research includes 5100 participants from three different projects within “Italian Network on Genetic Isolate” (INGI) consortium. Genomic DNAs of subjects were extracted from blood samples and then were genotyped using Illumina 370k high-throughput SNP arrays, for a total of about 370.000 SNPs per samples. We selected all the taste receptors genes and the genes involved in the cascade of taste signal transduction through consultation of bibliographic database PubMed. We carry out a “candidate gene association analysis” assuming the log10 of BMI as the dependent variable and the SNPs of all selected genes as the regressors. We used an additive genetic model and gender and age as covariates. Each population was firstly separately analyzed and results were combined using meta-analysis. After phenotype and genotype analysis, 2827 subjects were analyzed overall. Meta-analyses identified some polymorphisms associated with the BMI: 2 SNPs belong to SCNN1B gene, which is a salty taste receptor, instead 8 SNPs belong to GNAT3 gene, a gene encoding a taste-selective G protein of transduction of sweet, bitter and umami taste, and 4 SNPs belong to PDE4B gene, which is a phosphodiesterase AMPc-specific for signal transduction in general. The outcomes of our studies suggest that the mechanism by which variations in taste receptors may influence the BMI, and therefore the risk of developing overweight and obesity, is very complex and probably closely related to expression and function of the taste receptors. Our results confirm that these genes are highly polymorphic and these polymorphisms are related to either protein receptor or protein involved in signaling cascade

Musique et processus identitaire : les églises nationale de Rome (16e - début 17e siècle)

This themed session relates to a research project devoted to analysis of the musical model of the national churches in Rome, jointly funded by the European Union (Marie Curie Programme) and the University of Liège. This research aims to contribute towards the study of music in the national churches in Rome during the 16th and 17th centuries by examining the fundamental issue of cultural exchanges between these institutions and the nations they represented in the pontifical city. Michela Berti and Emilie Corswarem will present an overview of the results obtained by the project to date, focussing on one of its main aspects: analysis of how the liturgical and paraliturgical traditions, as an expression of ‘nationhood’, may constitute one of the axes around which communities strengthened their identity in a foreign country. In the second part of the session, Galliano Ciliberti and Esteban Hernandez, collaborators on the project, will focus on concrete examples relating to the churches of S. Luigi dei Francesi and S. Giacomo degli Spagnoli. Galiano Ciliberti: From a liturgical perspective, the French national church in Rome, S. Luigi dei Francesi, held a particular position among the chapels of the 17th century in Rome. The discovery of three signed volumes by Vincezo Ugolini, dating from the years of his magisterium at S. Luigi (1616-1620 and 1631-1638) opens up new avenues for research. The repertoires contained in these books of vespers for the feast of the titular Saint of the national churches, do not follow the Roman liturgical Rite but the earlier Parisian Rite. Some pieces (such as the Prière du Roy and the Salvuum fac) anticipate the liturgical practice established by Louis XIV at Versailles. Esteban Hernández Castelló: As numerous publications have already shown, the national churches played an active role in Rome. The increasing 'Spanish' presence and its rise in power and influence in the Urbs in the 16th century was visible in many ways and undoubtedly justify, at least in part, its ambition to establish traditions which were particular to Spanish churches in the town, and which, in some cases, sought to 'contaminate' Roman traditions. The first exhaustive catalogue of the musical archives of Santa Maria in Monserrato degli Spagnoli (as well as some items belonging to San Giacomo) has revealed - among other things - a musical manuscript, which shows entirely Spanish customs and habits being exported to Rome. In particular, this is true for the subject of this communication: polyphonic song of the Passion for the Dominica in Ramis.Le modèle musical des églises nationales à Rome à l’époque baroque (BeIPD-COFUND-IPD APPEL 2013

Derivation and Validation of a Clinical Score for Predicting Postoperative Atrial Fibrillation in Noncardiac Elective Surgery (the HART Score)

Postoperative atrial fibrillation (POAF) represents the most frequent cardiac arrhythmia in the surgical setting. It affects almost 3% of all patients over 45 years old who underwent noncardiovascular surgery and is associated with a higher risk of stroke, heart failure, myocardial infarction, and cardiac arrest. The study aimed to assess independent predictors of POAF and derive and validate a score for risk prediction in clinical practice. This was a retrospective cohort study including all consecutive candidates to all types of noncardiac elective surgery attending a cardiological preoperative assessment from 2016 to 2019. Exclusion criteria were a previous diagnosis of AF and the cancelation of the planned surgery. A total of 2,048 patients were enrolled (1350 men, aged 72 ± 12 years). A total of 44 patients experienced POAF (2.1%) - median 3 days (first to third quartile 2 to 4 days). Age (odds ratio [OR] 1.03 for each year, 95% confidence interval [CI] 1.01 to 1.07), hypertension (OR 3.43, 95% CI 1.22 to 9.63), thyroid dysfunction (OR 2.47, 95% CI 1.22 to 5.01), and intermediate or high-risk surgery (OR 18.28, 95% CI 2.51 to 33.09) resulted as independent predictors of POAF (all p <0.05). The Hypertension, Age, surgery Risk, and Thyroid dysfunction score (OR 2.59 for each point, 95% CI 1.79 to 3.75, p <0.001) was then created based on those 4 items. A cut-off score ≥6 had a 70% sensitivity and a 72% specificity in detecting POAF (area under the curve 0.76). Bootstrapping for internal validation confirmed the overall results (area under the curve 0.72). In conclusion, POAF complicates around 2% of all noncardiac surgery. A 4-item risk score, such as the Hypertension, Age, surgery Risk, and Thyroid dysfunction score, could be effective in implementing POAF screening and improving management

Angina in 2022: Current Perspectives

Angina is the main symptom of ischemic heart disease; mirroring a mismatch between oxygen supply and demand. Epicardial coronary stenoses are only responsible for nearly half of the patients presenting with angina; whereas in several cases; symptoms may underlie coronary vasomotor disorders; such as microvascular dysfunction or epicardial spasm. Various medications have been proven to improve the prognosis and quality of life; representing the treatment of choice in stable angina and leaving revascularization only in particular coronary anatomies or poorly controlled symptoms despite optimal medical therapy. Antianginal medications aim to reduce the oxygen supply-demand mismatch and are generally effective in improving symptoms; quality of life; effort tolerance and time to ischemia onset and may improve prognosis in selected populations. Since antianginal medications have different mechanisms of action and side effects; their use should be tailored according to patient history and potential drug-drug interactions. Angina with non-obstructed coronary arteries patients should be phenotyped with invasive assessment and treated accordingly. Patients with refractory angina represent a higher-risk population in which some therapeutic options are available to reduce symptoms and improve quality of life; but robust data from large randomized controlled trials are still lacking

Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis

: Atrial flutter (AFL) is a macro-reentrant arrhythmia characterized, in a 12 lead ECG, by the continuous oscillation of the isoelectric line in at least one lead. In the typical form of AFL, the oscillation is most obvious in the inferior leads, due to a macro-reentrant circuit localized in the right atrium, with the cavo-tricuspid isthmus as a critical zone.: This circuit can be activated in a counterclockwise or clockwise direction generating in II, III, and aVF leads, respectively, a slow descending/fast ascending F wave pattern (common form of typical AFL) or a balanced ascending/descending waveform (uncommon form of typical AFL). Atypical AFLs (scar-related) do not include the CTI in the circuit and show an extremely variable circuit location and ECG morphology

Heart rate variability is reduced in underweight and overweight healthy adult women

Heart rate variability (HRV) is altered in obese subjects, but whether this is true also in underweight (UW) subjects is still under debate. We investigated the HRV profile in a sample of healthy adult women and its association with adiposity. Five-minute resting state electrocardiographic activity was recorded in 69 subjects grouped according to their body mass index, [23 normal weight (NW), 23 overweight/obese (OW) and 23 UW). Body fat mass (FM) was measured by bio-impedance. Frequency- and time-domain analyses were performed. Compared to NW, UW and OW subjects showed a significant decrease in HRV indices, as revealed by spectral analysis. No differences were observed between UW and OW subjects. A second-order polynomial regression unveiled an inverted U-shaped relationship between FM extent and HRV indices. A decrease of HRV indices was associated with changes in FM extent, proving that in UW and OW subjects, the adaptive flexibility of autonomic cardiac function was reduced. These findings provide important clues to guide future studies addressed to determine how changes in adiposity and autonomic cardiac function may contribute to health risk

Functional Assessment of Corticospinal System Excitability in Karate Athletes

OBJECTIVES:To investigate the involvement of the primary motor cortex (M1) in the coordination performance of karate athletes through transcranial magnetic stimulation (TMS). METHODS:Thirteen right-handed male karate athletes (25.0±5.0 years) and 13 matched non-athlete controls (26.7±6.2 years) were enrolled. A single-pulse TMS was applied using a figure-eight coil stimulator. Resting motor threshold (rMT) was determined. Surface electromyography was recorded from the first dorsal interosseous muscle. Motor evoked potential (MEP) latencies and amplitudes at rMT, 110%, and 120% of rMT were considered. Functional assessment of the coordination performance was assessed by in-phase (IP) and anti-phase (AP) homolateral hand and foot coordination tasks performed at 80, 120, and 180 bpm. RESULTS:Compared to controls, athletes showed lower rMT (p<0.01), shorter MEP latency (p<0.01) and higher MEP amplitude (p<0.01), with a significant correlation (r = 0.50, p<0.01) between rMT and MEP latency. Coordination decreased with increasing velocity, and better IP performances emerged compared to AP ones (p<0.001). In general, a high correlation between rMT and coordination tasks was found for both IP and AP conditions. CONCLUSION:With respect to controls, karate athletes present a higher corticospinal excitability indicating the presence of an activity-dependent alteration in the balance and interactions between inhibitory and facilitatory circuits determining the final output from the M1. Furthermore, the high correlation between corticospinal excitability and coordination performance could support sport-specific neurophysiological arrangements

Correction: Functional assessment of corticospinal system excitability in karate athletes

[This corrects the article DOI: 10.1371/journal.pone.0155998.]