La globalització i els seus efectes sobre la nostra relació amb el territori

La globalització ha normalitzat un model de vida allunyat de la dimensió local, fet que ha generat un desarrelament de la nostra identitat social de la realitat dels territoris. La promoció de nous espais del coneixement, juntament amb dinàmiques d’intel·ligència col·lectiva situada, fa emergir una inversió de tendència

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Macro meso micro: systemic territory framework from the perspective of social innovation

The place matters. We were born there, have been living and working there, entered there and exited from there. Places are an object of observation from the outside while we experience them from the inside. A place is the most ethnographic level of observation of relational territorialisation. However, do we really know how territories behave? Can we really observe in practise the notion of the Network Territory? How does the dynamic concept of a territory fit and juxtapose with that of a network? Some territories are putting all their efforts, thanks to the common work of public, private, and civil agents, into restructuring the post-crisis economic and social system. Nevertheless, can we observe and see what is occurring in these places and territories? How are we supposed to observe those big black boxes with input and output but with an unknown and hardly explainable process? How can we apply hermeneutics to the socially innovating processes in the networked territories at any scale? What tools should we use for this observation? What tools do we want and can we use to intervene? What effect do we ultimately want to have? All these elements may demand a systemic vision in the cybernetic multi-disciplinary sense that Social Innovation requires and that links with the two main currents of Social Innovation in a coherent way: we are referring to, on the one hand, the more academic approach, with a social justice dimension, aligned towards the Territory and Social Economy and, on the other hand, the more practitioner and policy-making approach, championed by the third-way labour school of thought of the Young Foundation, Nesta and Demos. Keywords: social innovation, territory, cities, regions, city-regions, processes, scales, methodology, framework, social transformation, democracy, identity, networks, land, action research, place, spac

The Role of TOMM40 in Cardiovascular Mortality and Conduction Disorders: An Observational Study

Abstract: Aims: TOMM40 single nucleotide polymorphism (SNP) rs2075650 consists of allelic variation c.275-31A > G and it has been linked to Alzheimer disease, apolipoprotein and cholesterol levels and other risk factors. However, data on its role in cardiovascular disorders are lacking. The first aim of the study is to evaluate mortality according to TOMM40 genotype in a cohort of selected patients affected by advanced atherosclerosis. Second aim was to investigate the relationship between Xg and AA alleles and the presence of conduction disorders and implantation of defibrillator (ICD) or pacemaker (PM) in our cohort. Materials and Methods: We enrolled 276 patients (mean age 70.16 ± 7.96 years) affected by hemodynamic significant carotid stenosis and/or ischemia of the lower limbs of II or III stadium Fontaine. We divided the population into two groups according to the genotype (Xg and AA carriers). We evaluated several electrocardiographic and echocardiographic parameters, including heart rate, rhythm, presence of right and left bundle branch block (LBBB and RBBB), PR interval, QRS duration and morphology, QTc interval, and left ventricular ejection fraction (LVEF). We clinically followed these patients for 82.53 ± 30.02 months and we evaluated the incidence of cardiovascular events, number of deaths and PM/ICD implantations. Results: We did not find a difference in total mortality between Xg and AA carriers (16.3 % vs. 19.4%; p = 0.62). However, we found a higher mortality for fatal cardiovascular events in Xg carriers (8.2% vs. 4.4%; HR = 4.53, 95% CI 1.179–17.367; p = 0.04) with respect to AA carriers. We noted a higher percentage of LBBB in Xg carriers (10.2% vs. 3.1%, p = 0.027), which was statistically significant. Presence of right bundle branch block (RBBB) was also higher in Xg (10.2% vs. 4.4%, p = 0.10), but without reaching statistically significant difference compared to AA patients. We did not observe significant differences in heart rate, presence of sinus rhythm, number of device implantations, PR and QTc intervals, QRS duration and LVEF between the two groups. At the time of enrolment, we observed a tendency for device implant in Xg carriers at a younger age compared to AA carriers (58.50 ± 0.71 y vs. 72.14 ± 11.11 y, p = 0.10). During the follow-up, we noted no statistical difference for new device implantations in Xg respect to AA carriers (8.2% vs. 3.5%; HR = 2.384, 95% CI 0.718–7.922; p = 0.156). The tendency to implant Xg at a younger age compared to AA patients was confirmed during follow-up, but without reaching a significant difference(69.50 ± 2.89 y vs. 75.63 ± 8.35 y, p = 0.074). Finally, we pointed out that Xg carriers underwent device implantation 7.27 ± 4.43 years before AA (65.83 ± 6.11 years vs. 73.10 ± 10.39 years) and that difference reached a statistically significant difference (p = 0.049) when we considered all patients, from enrollment to follow-up. Conclusions: In our study we observed that TOMM40 Xg patients affected by advanced atherosclerosis have a higher incidence of developing fatal cardiovascular events, higher incidence of LBBB and an earlier age of PM or ICD implantations, as compared to AA carriers. Further studies will be needed to evaluate the genomic contribution of TOMM40 SNPs to cardiovascular deaths and cardiac conduction diseases

Le ravitaillement en blé de Rome et des centres urbains des début de la République jusqu'au Haut Empire

Ce fut le grand exploit et la fierté des Empereurs romains que d’avoir fondé l’approvisionnement de Rome sur des bases nouvelles et plus sûres. Pour expliquer leur succès, il ne faut certes négliger ni l’acquisition d’importantes nouvelles sources d’approvisionnement (l’Egypte), ni l’amélioration des moyens de transport et de stockage, ainsi que des installations portuaires, ni les progrès de l’administration (le préfet de l’annone). Mais la concentration des armées aux frontières et leur relative indépendance économique constituent un autre élément d’explication. Tout au long du Principat, l'armée régulière, dans l’ensemble, resta éloignée de Rome. Les deux groupes de consommateurs les plus importants de l’Empire n’étaient pas en concurrence. Leurs systèmes d’approvisionnement étaient séparés et distincts ; chaque concentration importante de soldats, aux avant-postes de l’Empire, se trouvait au centre d’une économie administrative et militaire relativement autonome

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours. Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge

Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

Non