The role of life cycle thinking-based methodologies in the development of waste management plans

The aim of this article is to examine how Life Cycle Thinking (LCT) contributes to the development of Waste Management Plans (WMPs). The case of Italy has been deeply investigated. The article first analyses whether and how the LCT methodologies were applied to the 21 regional WMPs; then, it draws indications for using LCT in the preparation of a WMP. Moreover, it outlines why the Life Cycle Assessment (LCA) methodology could be used as a powerful tool for regional planning in the waste field, analysing the indications for preparing a WMP that already exist at the European level and in the Italian National WM Programme. Results reveal that only four of the 21 regional WMPs include comprehensive and site-specific LCA studies. Building on these case study results, insights into the opportunities and benefits associated with incorporating LCT methodologies into WMP development and implementation are provided. This study underscores the critical importance of LCT and LCA in promoting sustainable waste management practices, ensuring compliance with European directives, and offering a foundation for more informed regional planning strategies

Sostenibilità sociale in agricoltura: la sicurezza sul lavoro

Nella pianificazione dello sviluppo sostenibile per l'agricoltura occorre considerare la multidimensionalità di questo concetto. Lo sviluppo rurale (ovvero il secondo pilastro della PAC) conferisce grande importanza alla dimensione sociale della sostenibilità, che considera, tra l'altro, le condizioni di lavoro ed in particolare la sicurezza e la salute dei lavoratori. Lo studio fornisce risultati concernenti fattori strutturali di rischio infortunistico nell'agricoltura italiana. Nella ricerca vengono identificati, mediante cluster analysis su indicatori provinciali, sistemi agricoli locali, che costituiscono la base per la costruzione di mappe di rischio in agricoltura per fini prevenzionali

Does twin gestation really have long-term maternal cardiac sequelae? Reply

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Cardioprotective role of zofenopril in patients with acute myocardial infarction: a pooled individual data analysis of four randomised, double-blind, controlled, prospective studies

Early administration of zofenopril following acute myocardial infarction (AMI) proved to be prognostically beneficial in the four individual randomised, double-blind, parallel-group, prospective SMILE (Survival of Myocardial Infarction Long-term Evaluation) studies. In the present analysis, we evaluated the cumulative efficacy of zofenopril by pooling individual data from the four SMILE studies

Cardioprotective role of zofenopril in hypertensive patients with acute myocardial infarction: a pooled individual data analysis of the SMILE studies

Purpose: The four SMILE studies demonstrated that early administration of zofenopril following acute myocardial infarction is prognostically beneficial compared to placebo or other angiotensin-converting enzyme (ACE) inhibitors. In the present retrospective pooled analysis of individual SMILE studies, we evaluated the efficacy of zofenopril on cardiovascular (CV) outcomes in 1880 hypertensive and 1662 normotensive patients. Materials and methods: Four hundred and forty-nine hypertensives and 486 normotensives were treated with placebo, 980 and 786 with zofenopril 30–60 mg daily, 252 and 259 with lisinopril 5–10 mg daily, 199 and 131 with ramipril 10 mg daily, for 6 to 48 weeks. Results: The 1-year risk of death or hospitalization for CV causes was significantly reduced with zofenopril and lisinopril vs. placebo in both hypertensive (HR: 0.65; 95%CI: 0.48–0.86; p = .003 and .60, .36–.99; p = .049, respectively) and normotensive patients (0.56, 0.42–0.75; p = .0001 and .51, .28–.90; p = .020), whereas this was not the case for ramipril (hypertensives: 1.02, 0.69–1.52; p = .918; normotensives: 0.91, 0.59–1.41; p = .670). Zofenopril significantly reduced the risk of CV outcomes vs. the other two ACE-inhibitors pooled together in hypertensive (0.76; 0.58–0.99; p = .045), but not in normotensive patients (0.77; 0.55–1.10; p = .150). Conclusions: In cardiac patients of the SMILE studies with arterial hypertension treatment with the ACE-inhibitor zofenopril was beneficial in reducing the 1-year risk of CV events as compared to placebo and ramipril. An efficacy similar to that of zofenopril was observed with lisinopril

Efficacy of zofenopril in combination with thiazide diuretics in patients with acute myocardial infarction: A pooled individual data analysis of four randomized, double-blind, controlled, prospective studies

Background: In the Survival of Myocardial Infarction Long-Term Evaluation (SMILE) studies, early administration of zofenopril after acute myocardial infarction (AMI) was prognostically beneficial as compared to placebo and other angiotensin-converting enzyme inhibitors (ACEIs), such as lisinopril and ramipril. Here, we investigated whether zofenopril efficacy could be affected by a concomitant use of thiazide diuretics (TDs). Methods: This was a post hoc analysis of pooled individual patient data from the SMILE studies. Patients treated with other diuretics than TDs were excluded. The primary study endpoint was the 1-year combined occurrence of death or hospitalization for CV causes, with or without TD. Results: Among 2,995 patients, 263 (8.8%) were treated with a combination including a TD (TD+), whereas 2,732 (91.2%) were not treated with any diuretic (TD-). Proportions of subjects who were treated with TD were equally distributed (p=0.774) within the placebo, zofenopril, and other ACEIs groups. The 1-year risk of major cardiovascular events was similar in TD+ (18.3%) and TD-(16.8%) patients (hazard ratio [HR] 1.04; 95% CI 0.74\u20131.45; p=0.838). After stratifying per concomitant treatment and TD, the 1-year risk of CV events was significantly lower with zofenopril than with placebo (HR 0.70; 95% CI 0.55\u20130.88; p=0.002) and other ACEIs (HR 0.58; 95% CI 0.46\u20130.74; p=0.0001). Treatment with ACEIs and TD as concomitant therapy was associated with a larger blood pressure (BP) reduction (p=0.0001 for systolic BP and p=0.045 for diastolic BP). Conclusion: In post AMI patients, zofenopril maintained its positive impact on prognosis compared to placebo or other ACEIs, regardless concomitant TD administration. In this setting, TD shows advantages in managing the most difficult hypertensive patients

Inequalities in enrollment of women and racial minorities in trials testing uric acid lowering drugs

Aims: We investigated sex and racial inequalities in clinical trials testing serum uric acid (SUA) lowering drugs and analyzed the temporal trends of participation among the pre-specified demographic groups. Data were collected from publications of clinical trials testing SUA-lowering drugs. Linear regression analysis was performed to assess the relation between drug approval year and proportion of women and minorities enrolled in clinical studies. Data synthesis: The mean percentage enrollment of women in clinical trials significantly decreased over the time (r = -0.43, P-value = 0.02). Moreover, there was a statistically significant difference in mean percentage enrollment of women among trials testing different SUA-lowering drugs, with the highest representation in rasburicase (71.1%) and the lowest representation of women in dotinurad (0.8%). Over the time, also the mean percentage enrollment of racial minorities decreased, passing from 8.7% to 2.2% in a 10-year period. Women were proportionally underrepresented compared with their share of the population with asymptomatic hyperuricemia, overall (participation-to-prevalence ratio (PPR) = 0.34), in trials testing xanthine oxiase inhibitors (PPR = 0.38) and uricosurics (PPR = 0.29), and in trials with febuxostat, allopurinol, pegloticase, halofenate/arhalofenate, verinurad, lesinurad and dotinurad. Women were proportionally underreppresented also compared with their share of the population with gout, overall (PPR = 0.69) and in trials testing XOIs (PPR = 0.69), uricosurics (PPR = 0.68), and all SUA-lowering drugs excepted for rasburicase, pegloticase and topiroxostat. Conclusions: Our analysis shows that women and racial and ethnical minorities are underrepresented in controlled clinical trials testing SUA-lowering drugs, with similar pattern across drug classes

Management of a Multicomorbid Patient with Heart Failure

The optimal use of sacubitril/valsartan in clinical practice needs further investigation, in particular for patients with multiple comorbidities, as such patients are usually poorly represented in clinical trials. To this end, well-documented case reports may add further evidence to the bulk of "field practice" experience on sacubitril/valsartan. We report here the case of a patient with heart failure with reduced ejection refraction with multiple comorbidities treated with sacubitril/valsartan. Overall, sacubitril/valsartan led to a prompt (within a few months) improvement in LVEF (+15%, from 38 to 53%), without any noticeable adverse events. This therapy also allowed the patient to discontinue furosemide

Análise do gerenciamento de resíduos sólidos e proposição de melhorias: estudo de caso em uma marcenaria de Cariacica, ES

Resumo: O presente trabalho investiga o gerenciamento de resíduos sólidos em uma empresa moveleira sediada no município de Cariacica, ES. Primeiro, foram obtidas informações acerca do setor moveleiro da região, por meio de material bibliográfico, junto à Associação de Indústrias e Produtos de Insumos do Setor Mobiliário de Cariacica (AMOVEL), à Secretaria Municipal de Desenvolvimento Econômico e Turismo (SEDETUR) da Prefeitura de Cariacica e ao Sindicato das Indústrias de Madeira e Atividades Correlatas em Geral da Região Centro Sul do Estado do Espírito Santo (SINDMADEIRA/ES). Em seguida, elaborou-se um questionário para coleta de informações. Depois, escolheu-se uma marcenaria para a análise em questão. Feito isso, por meio de visitas técnicas e entrevistas com o coordenador de produção da empresa, coletaram-se informações sobre o processo produtivo de móveis, com foco na utilização da matéria-prima e insumos, geração de resíduos sólidos, presença de técnicas de Produção mais Limpa, Licença Ambiental e Sistema de Gestão Ambiental. Ao final, constatou-se que, mesmo a empresa possuindo várias técnicas de Produção mais Limpa, há uma elevada quantidade de resíduos sólidos gerados ao longo da cadeia produtiva e que o percentual de perda de matéria-prima é superior a 20%, acima dos 10% estimados inicialmente. Com vistas nisso, alternativas com base no conceito de Produção mais Limpa foram propostas, para melhor aproveitamento e destinação dos resíduos sólidos gerados