Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Phytoremediation and Environmental Risk Assessment: a new approach

Il lavoro di ricerca ha avuto come oggetto lo sviluppo di una metodologia di valutazione del rischio ambientale (VRA) applicata al fitorisanamento di suoli contaminati. Il metodo proposto ha lo scopo di agevolare la raccolta delle informazioni, necessarie alla VRA, in maniera standardizzata e permettere l'identificazione dei potenziali effetti connessi con un approccio caso per caso. La struttura di valutazione del rischio ambientale proposta, PhytERA, (Phytoremediation Environmental Risk Assessment), comprende un Modello Concettuale e un questionario elettronico guidato da un'applicazione, sviluppata ad hoc, in Microsoft Access. Lo sviluppo di PhytERA ha seguito due percorsi paralleli finalizzati alla raccolta di dati ed informazioni da utilizzare per la definizione dello specifico Modello Concettuale e da considerare nella redazione del questionario elettronico abbinato. La prima parte del lavoro ha previsto l'analisi della bibliografia esistente sull'argomento e la consultazione di gruppi di lavoro ed esperti internazionali che lavorano nel campo del fitorimedio. La parte di consultazione è stata portata avanti sia attraverso interviste di persona, sia con la partecipazione a convegni e seminari, sia mediante l'invio a gruppi di lavoro internazionali di un questionario di indagine sulle ricerche in atto. La seconda parte del lavoro di dottorato è stato programmato e finalizzato ad allo sviluppo del Modello Concettuale e del questionario elettronico abbinato. Il Modello Concettuale si basa sul presupposto che affinché si presenti un effetto ambientale è necessaria la presenza di 3 componenti e dalle loro interconnessioni: FONTE – FATTORI DI DIFFUSIONE -– RECETTORI; in assenza anche di una sola delle componenti il rischio non si verifica. La fonte di rischio è il processo di fitorisanamento; i fattori di diffusione sono legati alle caratteristiche botanico-agronomiche della pianta, alle caratteristiche morfo-climatiche del sito in cui avviene il fitorisanamento, al metodo colturale applicato, incluso l'utilizzo di ammendanti del suolo, e alla raccolta e immagazzinamento del materiale vegetale; i recettori possono essere uomini, animali e diversi componenti ambientali potenzialmente bersaglio del rischio. Il modello concettuale viene rappresentato graficamente come un diagramma di flusso. Per ogni singola casella del diagramma, sono state redatte le domande necessarie al processo di valutazione del rischio ambientale. Le informazioni sono state suddivise in modo da permettere la caratterizzazione dei soggetti di ogni casella e per comprendere se e quali, dei vari percorsi (fonte- fattore di diffusione-recettore) vengano attivati. Le domande redatte per una completa caratterizzazione del Modello Concettuale sono 289 e sono di tre tipi. Il primo richiede una risposta descrittiva e permette di caratterizzare l'oggetto di ogni casella del Modello Concettuale (il processo di fitorisanamento, il polline, il seme, etc.); il secondo tipo comprende domande multiple che in genere richiedono risposte del tipo si/no/non so e che permettono di aprire o meno una via di rischio specifica, alcune delle domande multiple elencano una breve lista di opzioni tra le quali l'utilizzatore può selezionarne una, ma non può inserire alcun testo. Il terzo tipo sono domande di controllo che permettono di considerare contemporaneamente le risposte fornite a due o più domande. L'applicazione sviluppata in Access permette di attivare automaticamente ogni potenziale percorso a seconda delle informazioni inserite e delle risposte date alle domande apri/chiudi. L'utilizzatore del questionario, valutatore o ricercatore, viene messo in grado, rispondendo alle domande, di seguire le singole vie di rischio iniziando dalla fonte, considerando i singoli fattori di diffusione, le relative vie di migrazione e recettori, arrivando ad identificare gli specifici effetti correlati alla via di rischio percorsa. In questo modo si otterrà una lista di effetti direttamente relazionabili al fattore di diffusione che li ha provocati e allo specifico recettore, e potrà, se richiesto, mettere in atto misure di gestione del rischio specifiche che vadano ad interrompere la via di rischio abbassando la probabilità che l'effetto identificato si realizzi. Una volta compilato il questionario sarà possibile stampare un rapporto contenente tutte le informazioni inserite e la lista dei potenziali effetti identificati. Un'attenta analisi delle informazioni raccolte nei rapporti mettono in grado l'utente di valutare l'esposizione e le possibili conseguenze legate ad ognuno degli effetti identificati e quindi la caratterizzazione dei rischi connessi. Inoltre, l'applicazione di PhytERA a un numero significativo e diversificato di casi studio e l'analisi e confronto dei risultati potrebbe portare alla messa a punto di strategie di gestione e piani di monitoraggio più efficaci anche in fase ex ante rilascio.The research work was focused on the development of a methodology for environmental risk assessment (ERA) applied to phytoremediation of contaminated soils. The proposed method has the purpose of facilitating the collection of information needed by the ERA, in a standardized way and of enabling the identification of potentially associated effects, with a case by case approach. The proposed structure for environmental risk assessment, PhytERA, (Phytoremediation Environmental Risk Assessment), includes a Conceptual Model and an electronic questionnaire driven by an application, developed ad hoc, in Microsoft Access. Development of PhytERA has followed two parallel paths aimed at collecting data and information to be used for the definition of the specific Conceptual Model and to be considered in preparing the associated electronic questionnaire. The first part of the work involved the analysis of the existing literature on the subject and consultation of working groups and international experts working in the field of phytoremediation. The consultation was carried out through personal interviews, through participation in conferences and seminars, and by sending to international working groups a questionnaire survey on the research currently taking place. The second part of the doctoral work was planned and aimed at the development of the Conceptual Model and of the associated electronic questionnaire. The Conceptual Model is based on the assumption that to produce an environmental effect, the presence of three components and their interconnections is required: SOURCE - FACTORS FOR DISSEMINATION - RECEPTORS; in the absence of even one of the components, the risk does not occur. The source of risk is the process of phytoremediation; the diffusion factors are related to the botanical-agronomic characteristics of the plant, to the morpho-climatic conditions of the site in which phytoremediation occurs, to the culture method applied, including the use of soil amendments, and to the collection and storage of plant material; receptors can be humans, animals and various environmental components, potential targets of the risk. The conceptual model is represented graphically as a flow chart. For each box of the diagram, I have prepared the necessary questions for the process of environmental risk assessment. The information has been divided so as to enable the characterization of the subjects of each box and to understand which, if any, of the various routes (source-diffusion factor-receptor) are activated. The questions prepared for a complete characterization of the Conceptual Model are 289 and they are of three types. The first type requires a descriptive answer and allows to characterize the object of each box of the Conceptual Model (the process of phytoremediation, pollen, seed, etc.); the second type includes multiple questions that typically require answers like yes / no / do not know and that allow or not to open a way of specific risk, some of the multiple questions provide a short list of options from which the user can select, but no text can be entered. The third type are control questions that allow to consider simultaneously the answers to two or more questions. The application developed in Access automatically activates each potential path depending on the entered information and answers to open / close questions. The user of the questionnaire, either responsible for the evaluation or researcher, is allowed, by answering questions, to follow individual routes starting at the source of risk, considering the individual factors of diffusion, the migration routes and receptors, arriving to identification of the specific effects related to the specific route. In this way it is possible to obtain a list of effects directly relatable to the diffusion factor that caused them and to the specific receptor, and it will be possible, if required, to implement specific measures of risk management to stop the risk path lowering the probability of occurrence of that effect. Once the questionnaire is completed, the user will be able to print a report containing all the information entered and the list of potential effects identified. A careful analysis of the information collected in the reports will allow the user to assess the exposure and the possible consequences related to each of the identified effects and thus characterize the risks. Moreover, the application of PhytERA to a significant number of diverse case studies and the analysis and comparison of the results could lead to the development of more effective management strategies and monitoring plans even ex ante to the release

Long-term cognitive sequelae in a case of Wernicke’s encephalopathy after allogeneic stem cell transplantation

We describe the case of a non-alcoholic patient with chronic myeloid leukemia who developed iatrogenic Wernicke’s encephalopathy (WE) following stem cell transplantation. Four years after the WE acute event, the patient’s cognitive profile was mainly characterized by moderate memory impairment, and functional and daily-living difficulties. Our report sustains the hypothesis that a iatrogenic form of WE may produce long-term cognitive sequelae even when thiamine therapy is administered in the acute phase until the resolution of the neurological signs

UN MODELLO OPERATIVO PER LA VALUTAZIONE DEL RISCHIO AMBIENTALE APPLICATA AI SITI ITALIANI DI IMPORTANZA COMUNITARIA: IDENTIFICAZIONE DEI POTENZIALI EFFETTI SUL SUOLO

The fast development of agro-biotechnologies asks for a harmonized approach in risk analysis of GMOs releases. An Italian experts group has elaborated an operating model for the environmental risk assessment (OMERA) based on the assumption that the occurring of a risk is related to the presence of four components: source, diffusion factors, dispersal routes, receptors. This model has been further developed to become a Decision Supporting System based on Fuzzy logic (FDSS) to assessors and notifiers. It is a web based Questionnaire that conducts the user through a decision tree from the source to the receptors and leads to the identification and assessment of the risks. The FDSS has been tested on case studies, simulating, as source, herbicide tolerant oilseed rape and insect resistant maize. The resulting identified potential effects on soil are changes to structure and microbial diversity.Le développement rapide des agro-biotechnologies demande une approche harmonisée en matière d'analyse des risques des GMO. Un groupe d'experts italien a élaboré un modèle opérationnel pour l'évaluation des risques pour l'environnement (OMERA), basé sur l'hypothèse que le survenant d'un risque est lié à la présence de quatre éléments: la source, les facteurs de diffusion, les voies de dispersion, les récepteurs. Ce modèle a été développé pour devenir une véritable système d'information décisionnel sur la base de la logique fuzzy (SIDF). Un questionnaire Web mène l'utilisateur à travers un arbre de décision à partir de la source aux récepteurs et conduit à l'identification et l'évaluation des risques. Le SID a été testé en simulant, en tant que source, colza tolérant à un herbicide et maïs résistant aux insectes. Pour le sol, les effets potentiels identifiés sont les changements à la biodiversité et aux pratiques agricoles.Il rapido sviluppo delle agrobiotecnologie richiede un approccio armonizzato nell’analisi del rischio dei rilasci di OGM. Un gruppo di esperti italiani ha elaborato un modello operativo per la valutazione dei rischi ambientali (OMERA), basato sul presupposto che l’insorgere di un rischio è legato alla presenza di quattro componenti: fonte, fattori di diffusione, vie di migrazione, recettori.. Questo modello è stato ulteriormente sviluppato fino a diventare Sistema di Supporto alle Decisioni basato sulla logica fuzzy (FDSS) per valutatori del rischio e notificanti. Un questionario web-based conduce l'utente attraverso un albero decisionale dalla sorgente ai ricettori e ha porta alla individuazione e valutazione dei rischi. . Il DSS è stato testato su casi-studio usando come fonti colza tollerante agli erbicidi e mais resistente agli insetti. I potenziali effetti identificati per il suolo sono i cambiamenti nella struttura e nella diversità della comunità microbica