Neighbourhood property value and type 2 diabetes mellitus in the Maastricht study: A multilevel study

Objective Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. Research design and methods Using cross-sectional data from the Maastricht Study (2010\u20132013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40\u201375 years), 494 (24%) were diagnosed with T2DM. Results Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%\u201316%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58\u20133.58), independently of individual SES. Conclusions Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM

Le disuguaglianze socioeconomiche individuali e territoriali nel Diabete Mellito di Tipo 2 nella città di Milano: uno studio multilivello

This article investigates the presence of a territorial heterogeneity and of a contextual effect in Type 2 Diabetes Mellitus in the City of Milan. Type 2 Diabetes Mellitus is a growing health problem worldwide, whose onset is largely determined by an unhealthy lifestyle, as defined by an unbalanced diet and poor physical activity. Being such habits and behaviours more rooted in the most socially, economically, and culturally disadvantaged people, a clear social gradient is visible, with the disease mostly occurring in subjects of lower socioeconomic status. The onset is also determined by the characteristics of the urban environment of residence, such as green spaces, walkability, the food environment, and the availability of services and amenities. To date, there is no empirical evidence concerning the Milanese case. This study aims at shedding light on the phenomenon investigated by integrating administrative healthcare data from the Health Protection Agency of the Metropolitan City of Milan with data from the most recent population census. Multilevel regression models show higher risk of onset in the most disadvantaged areas, regardless the socioeconomic and demographic profile of their inhabitants. This highlights the needs to conceive territorial policies in order to tackle the spread of the disease and its related inequalities

EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water

This Opinion of the EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) deals with the setting of dietary reference values for water for specific age groups. Adequate Intakes (AI) have been defined derived from a combination of observed intakes in population groups with desirable osmolarity values of urine and desirable water volumes per energy unit consumed. The reference values for total water intake include water from drinking water, beverages of all kind, and from food moisture and only apply to conditions of moderate environmental temperature and moderate physical activity levels (PAL 1.6). AIs for infants in the first half of the first year of life are estimated to be 100-190 mL/kg per day. For infants 6-12 months of age a total water intake of 800-1000 mL/day is considered adequate. For the second year of life an adequate total water intake of 1100-1200 mL/day is defined by interpolation, as intake data are not available. AIs of water for children are estimated to be 1300 mL/day for boys and girls 2-3 years of age; 1600 mL/day for boys and girls 4-8 years of age; 2100 mL/day for boys 9-13 years of age; 1900 mL/day for girls 9-13 years of age. Adolescents of 14 years and older are considered as adults with respect to adequate water intake. Available data for adults permit the definition of AIs as 2.0 L/day (P 95 3.1 L) for females and 2.5 L/day (P95 4.0 L) for males. The same AIs as for adults are defined for the elderly. For pregnant women the same water intake as in non-pregnant women plus an increase in proportion to the increase in energy intake (300 mL/day) is proposed. For lactating women adequate water intakes of about 700 mL/day above the AIs of non-lactating women of the same age are derive

Numerical simulation of barge impact on a continuous girder bridge and bridge damage detection

Vessel collisions on bridge piers have been frequently reported. As many bridges are vital in transportation networks and serve as lifelines, bridge damage might leads to catastrophic consequences to life and economy. Therefore it is of great importance to protect bridge structures, especially bridge piers, against vessel impacts. Many researches have been conducted to predict vessel impact loads on bridge piers, and to design bridge piers or additional protective structures to resist such impact loads. Studies on assessing the bridge conditions after a vessel impact are, however, very limited. Current practice basically uses visual inspections, which not only requires very experienced engineers to perform the inspection in order to obtain creditable assessment, but also is often very difficult to inspect the underwater pier conditions. Therefore it is necessary to develop methods to give efficient, quantitative and reliable assessment of bridge conditions under ambient conditions after a vessel impact. This study explores the feasibility of using vibration measurements to quickly detect bridge conditions after a vessel impact.The study consists of three parts. First, a detailed numerical model of an example bridge structure is developed to calculate the vibrations under ambient hydrodynamic force. Then the model is used to simulate vessel impact on bridge pier and predict the pier damage. The vibration response analysis of the damaged bridge model is performed again in the third step to simulate vibration responses of the damaged bridge under ambient conditions. Using the vibration data obtained before and after vessel impact, the bridge vibration parameters such as vibration frequencies and mode shapes are extracted by using the frequency domain decomposition method. The bridge condition will then be identified through the changes in bridge vibration parameters and compared with the damage observed in the impact simulation. It is found that this method is capable of estimating bridge damage condition after barge impact accident

Describing the epidemic trends of covid-19 in the area covered by agency for health protection of the metropolitan area of Milan = Descrizione dell’andamento dell’epidemia di covid-19 nell’ats di Milano

OBIETTIVI: descrivere l’andamento temporale e spaziale dell’epidemia di COVID-19 nel territorio dell’ATS di Milano nel periodo febbraio-maggio 2020. DISEGNO: studio descrittivo dei casi di COVID-19 SETTING E PARTECIPANTI: un sistema informativo dedicato ha permesso di registrare i casi di COVID-19, con positività del tampone nasofaringeo residenti nel territorio dell’ATS-MI. Sono inclusi i casi con data di insorgenza dei sintomi compresa tra febbraio e maggio 2020. I dati sono stati analizzati in base agli intervalli di tempo caratterizzati dalle diverse misure di conteni- mento dell’epidemia intraprese a livello regionale e nazionale. PRINCIPALI MISURE DI OUTCOME: percentuale di letali- tà tra i casi con tampone positivo, tasso di incidenza e indice di riproduzione del COVID-19 nei diversi periodi epidemici e suddivisioni territoriali dell’ATS-MI. RISULTATI: sono stati registrati 27.017 casi COVID-19 posi- tivi al tampone. I maschi sono il 45% e l’età media è di 65 anni. L’incidenza sul territorio dell’ATS-MI è stata di 776 per 100.000 abitanti. I deceduti sono 4.660, il tasso grezzo di le- talità del 17,3%, superiore nei maschi (21,2%) rispetto alle femmine (14,0%). Il numero di riproduzione dei casi nel tem- po è massimo nei periodi iniziali dell’epidemia (3,0) e poi de- cresce successivamente. Si rileva la presenza di diverse inten- sità di contagio nel territorio dell’ATS-MI con il territorio del Lodigiano maggiormente colpito rispetto al resto dell’ATS-MI. CONCLUSIONI: le stime di incidenza e mortalità sono supe- riori a quanto riportato per il territorio italiano. Sul territorio dell’ATS-MI vengono evidenziati diversi pattern di andamen- to dell’epidemia.OBJECTIVES: to describe the epidemic trends of COVID-19 over time and by area in the territory covered by Milan’s Agen- cy for Health Protection (ATS-MI) from February to May 2020. DESIGN: descriptive study of COVID-19 cases. SETTING AND PARTICIPANTS: a new information system was developed to record COVID-19 cases with positive na- sopharyngeal swab. Patients resident in the area covered by ATS-MI with symptom onset between February and May 2020 were selected. Different epidemic periods were consid- ered based on the timeline of the various regional and na- tional containment measures. MAIN OUTCOME MEASURES: case fatality ratios, inci- dence rates, and reproduction number by epidemic period and sub-area of ATS-MI. RESULTS: a total of 27,017 swab-positive COVID-19 cases were included. Mean age was 65 years and males were 45%. Incidence in the ATS-MI area was 776 per 100,000 popula- tion. The number of deaths was 4,660, the crude case fatali- ty ratio was 17.3%, higher in males (21.2%) than in females (14.0%). The estimated reproduction number registered its peak (3.0) in the early stages of the epidemic and subse- quently decreased. Territorial differences were observed in the epidemic spread, with a higher incidence in the Lodi area. CONCLUSIONS: estimated incidence and case fatality ratios were higher than national estimates for Italy. Each ATS-MI area had different epidemic spread patterns

Cholesterol and Lipoprotein Dynamics in a Hibernating Mammal

Hibernating mammals cease feeding during the winter and rely primarily on stored lipids to fuel alternating periods of torpor and arousal. How hibernators manage large fluxes of lipids and sterols over the annual hibernation cycle is poorly understood. The aim of this study was to investigate lipid and cholesterol transport and storage in ground squirrels studied in spring, summer, and several hibernation states. Cholesterol levels in total plasma, HDL and LDL particles were elevated in hibernators compared with spring or summer squirrels. Hibernation increased plasma apolipoprotein A-I expression and HDL particle size. Expression of cholesterol 7 alpha-hydroxylase was 13-fold lower in hibernators than in active season squirrels. Plasma triglycerides were reduced by fasting in spring but not summer squirrels. In hibernators plasma β-hydroxybutyrate was elevated during torpor whereas triglycerides were low relative to normothermic states. We conclude that the switch to a lipid-based metabolism during winter, coupled with reduced capacity to excrete cholesterol creates a closed system in which efficient use of lipoproteins is essential for survival

Disuguaglianze di accesso alle cure e all’assistenza nelle regioni italiane prima e dopo la crisi

Le disuguaglianze di accesso ai servizi di cura e assistenza sono considerate un determinante importante dell’eterogeneità della salute di una popolazione. In questo lavoro viene preso in esame il cambiamento nelle disuguaglianze di accesso ai servizi sanitari a livello regionale avvenuto in seguito alla crisi economica del 2008. Gli studi sulle disuguaglianze di salute mostrano un inasprimento della disparità in alcune regioni tra il 2005 e il 2013, il nostro scopo qui è investigare se esso viene confermato anche nelle disuguaglianze di assistenza. Impiegando dati campionari Istat rispetto ad alcuni indicatori di assistenza, in particolare l’accesso a visite generiche, visite specialistiche, Pap test e ricoveri, osserviamo che – fatta eccezione per l’ultimo indicatore – si riscontra un peggioramento nell’accesso per i soggetti meno istruiti in alcune regioni del Sud del Paese, in particolare Campania e Sicilia.Inequalities in access to health services are known to be an important determinant of heterogeneity in health conditions among a population. Here, we examine the change in the access to health services between the Italian regions as a consequence of the economic crisis of 2008. The literature on health inequalities shows a widening of health disparities at the regional level between 2005 and 2013. This work is aimed at assessing if a broadening of inequality is present also in relation to access to care. Relying on survey data from the Italian National Institute of Statistics concerning some healthcare indicators, we find that for three out of four of them a worsening in the access to services for the less educated in some southern regions of the country is present, in particular Campania and Sicily