Urban diabetes: The case of the metropolitan area of Rome

BACKGROUND: The world is rapidly urbanizing, causing alarming health problems to their citizens. The Cities Changing Diabetes program aims to address the social factors and cultural determinants that can increase type 2 diabetes (T2D) vulnerability among people living in cities. METHODS: Public data of Italian Institute for Statistics (ISTAT) and available scientific reports were reviewed and findings integrated. The prevalence of T2D in the 8 health districts of Rome was mapped and the correlation between prevalence and social and cultural determinants was assessed. RESULTS: The metropolitan area of Rome has 4.3 million inhabitants. People over 65 has increased by 136,000 units in the last decade, reaching 631,000 citizens in 2015. Elderly people living alone are 28.4%. The obesity prevalence is 9.3%, as compared to 8.2% in the year 2000. The prevalence of T2D is 6.6%, varying in the different 8 health districts between 5.9% and 7.3%. A linear correlation exists between the prevalence of diabetes in the districts, unemployment rate and use of private transportation rate (Pearson R 0.52 and 0.60, respectively), while an inverse correlation is present with aging index, school education level, and slow mobility rate (Person R -0.57, -0.52, and -0.52, respectively). CONCLUSIONS: Important socio-demographic changes have occurred in Rome during the last decades with a raise in the prevalence of obesity and diabetes. A wide variation exists in the prevalence of T2D among the districts of Rome, associated with social and cultural determinants. This study model can help rethinking diabetes in an urban setting

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

Urban-Planning Tactics and Strategies in New Decision-Making Process

The basis on which the main economic and social p institutions are situated, which until a few years ago we believed to be solid, began to waver dangerously, spreading in the public and scholars an atmosphere of uncertainty and concern that could hinder the seeking rigorous and convincing interpretations and therapies to deal with a particularly negative picture. According to Ulrich Beck, the systemic crisis triggered by the failure of Lehman Brothers Holdings Inc. definitively immersed us in a “global capitalism of uncertainty” such that the climate we are experiencing is characterized by a widespread awareness that unmistakable changes are about to arrive. Their direction, however, is still unknown. In this clearly problematic state, the disciplines that contribute most to the development of urban-planning practices are suffering even more evidently from a crisis of visibility and legitimateness due to which the role of planning tools is subject to rapid objection and substantial resizing. Over the years of feverish growth that pre- ceded the economic collapse in 2008, local administrators increasingly restricted planners’ field of initiative, limiting them to ensuring the feasibility of transformation initiatives that were promoted by private operators. And now that urban dynamics have experienced an almost unprecedented setback, the tasks assigned to planners will be drastically marginalized even more. A survey of the most important writings dedicated to the current socioeconomic crossroads encountered in many Western countries indicates that this planning crisis is situated within a more general decline in the social sciences. Furthermore, this dual setback represents an important reflection on the extraordinary difficulty encountered, especially in Europe, by the welfare system and the system of representative democracy. Therefore, the proposal for a new planning paradigm cannot help but direct, at least in part, a more general reconsideration of the conditions under which, even before the market and society, the governmental functions of the territory are exercised along an analytical path that finds a particularly meaningful intersection in the operation of decision- making processes. Faced with the intensive research programme illustrated in this volume, the reflection presented below offers a restricted contribution. Its utility resides not so much in the presentation of an original, mature theoretical/critical apparatus but in indicating a promising line of reasoning that aims to investigate the existing connection between new decision-making processes, the ways in which it is possible to favour public participation in territorial government, and, finally, the changes in the market economy and social context. The latter inevitably constitutes the background to and reference for innovations introduced as much in participatory processes as in the practice of urban planning. In particular, the first part aims to highlight the presence of the common roots of the economic crisis, society, and the settlement formations that have been produced in this first glimpse of the third millennium. The second part instead examines the conditions presiding over the identification of integrated solutions, i.e. those capable of favouring the search for a common way out of this particularly difficult situation. Finally, the third part derives the main consequences for a change in the planning tools that allow their effectiveness to ultimately unfold