L’‘inconsueta ricostruzione’ di Copenaghen

This paper suggests that the City of Copenhagen’s experience as a case of “restoration of the city” is in some way different and original compared to what we think could be intended with this expression. In fact, in the Danish Capital, the municipal administrators and citizens regained the feeling of belonging to and loving the city not because of a ‘naive’ relationship with nature, but, on the contrary, because of a wider and smarter use of the best available technologies. In this sense, modernization is not an enemy of the environment but, on the contrary, it is a supporter because it uses the advantages of progress (i.e. better efficiency, reduced use of resources, etc.) in order to improve environmental protection. As a result, it is our opinion that Copenhagen represents a very interesting case of co-evolution between socio-economic development, technological progress and environmental protection which, through smart integration of area policies, are all heading in the same direction, namely sustainability.Il presente contributo propone l’esperienza della città di Copenaghen quale caso di “ricostruzione della città” per molti aspetti diverso e ‘innovativo’ rispetto a quanto ci sembra ci si potrebbe aspettare dall’utilizzo di tale espressione. Nella città danese, infatti, il recupero del sentimento di appartenenza alla, e amore per, la propria città da parte degli amministratori e dei cittadini è avvenuto non attraverso una ripresa quasi ‘naif’ del rapporto con la natura, ma, al contrario, grazie – fra l’altro – all’utilizzo esteso ed intelligente delle migliori tecnologie disponibili. La modernizzazione, in questo senso, non è ‘nemica’ dell’ambiente ma ne è alleata, in quanto impiega i vantaggi derivanti dal progresso (ad es. maggiore efficienza, minore impiego di risorse, ecc.) per garantire una migliore salvaguardia dell’ambiente. A nostro parere, quindi, a Copenaghen assistiamo a un interessantissimo caso di co-evoluzione tra sviluppo socioeconomico, progresso tecnologico e protezione dell’ambiente che, grazie a un’intelligente integrazione tra le politiche settoriali, risultano diretti lungo lo stesso percorso di crescita e sostenibilità

Climate-neutral and Smart Cities: a critical review through the lens of environmental justice

The political choices made by the European institutions in the last twenty years show how the conviction is increasingly rooted that the management of environmental problems and, more specifically, the fight against climate change can find a valid solution in technology and eco-innovations. This is evident starting from the last two growth strategies adopted (Europe 2020 and the European Green Deal), from the long series of measures implemented to put them into practice and from the main R&I funding programs, such as Horizon Europe. In this context, the problem of justice and inclusiveness of the various initiatives implemented is attracting growing attention. In fact, if the institutional documents assume that green and smart participated projects are also fair and inclusive, a growing body of literature based on empirical studies seems to refute this assumption. Within this framework, the present work analyses first the critical literature and then the three main preparatory documents for the Horizon Europe Mission Climate-neutral and Smart Cities, which selected 100 European cities to become climate-neutral by 2030. These have been studied through the lens of environmental justice, in order to assess the European Commission’s understanding of the existing and arising equity issues in the path toward climate neutrality. The research shows that, while the first two documents seemed informed by the idea that participation automatically translates into equality, the last guidelines show a deeper acknowledgement of the multidimensional nature of environmental justice. One that, beyond participation, also considers issues of distribution, rights, responsibilities and recognition. The present work should nevertheless be understood as a preparatory, analytical tool that will require the further definition and implementation of Climate City Contracts by the selected cities, in order to assess how the issue of environmental justice is effectively being considered in each specific context

Long-term analysis of the effects of COVID-19 in people with epilepsy: Results from a multicenter on-line survey across the pandemic waves

Purpose: The worldwide pandemic caused by SARS-CoV-2 virus posed many challenges to the scientific and medical communities, including the protection and management of fragile populations. People with epilepsy (PWE) are a heterogenous group of subjects, with different treatment regimens and severity of symptoms. During the National lockdown, in Italy many patients with chronic conditions lost their regular follow-up program. The aim of this study was to investigate the impact of COVID-19 on their health status, from the start of the pandemic (March 2020) to July 2021 and one year later. Methods: We proposed an online questionnaire to subjects followed up at different epilepsy centers located in Milano, Monza & Lodi, three of Lombardy, Northern Italy, the most affected areas by the pandemic. Survey evaluated age, sex, characteristics of patients, type of epilepsy and therapies, COVID-19 diagnosis, vaccines, sleep quality, and anxiety status. Results: Among 178 analyzed surveys, 37 individuals reported symptoms of COVID-19 in closed contacts, including 9 with molecular diagnosis and 16 PWE performing the nasopharyngeal swab with 3 positive cases. One year later, 35 individuals reported at least one symptom overlapping with those typical of COVID-19, 8 received COVID-19 diagnosis, among which 6 were positive for SARS-CoV-2 infection. According to the sleep quality scale assessment, most PWE (52.3%) had poor sleep quality. Assessing anxiety status, 32 (38.1%) had a pathological score. Conclusion: In this multicenter study, we observed that PWE do not appear to be at a higher risk of severe COVID-19. It will be fundamental monitoring this group to assess possible differences in long-COVID-19 and/or neuro-COVID-19 prevalence. On the other hand, our survey confirmed the impact of the pandemic on anxiety and quality of sleep in PWE. Thus, it is important to promptly recognize and treat psychological distress in PWE, because it could be a risk factor in seizure aggravation and quality-of-life deterioration. Telemedicine appears to be a useful tool to support patients with chronic diseases, such as epilepsy

Diabetes-Related Autoantibodies in Children With Acute Lymphoblastic Leukemia

[No abstract available

Mixed connective tissue disease : state of the art on clinical practice guidelines

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Mixed connective tissue disease (MCTD) is a complex overlap disease with features of different autoimmune connective tissue diseases (CTDs) namely systemic sclerosis, poly/dermatomyositis and systemic lupus erythematous in patients with antibodies targeting the U1 small nuclear ribonucleoprotein particle. In this narrative review, we summarise the results of a systematic literature research which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines (CPGs) or recommendations. Since no specific CPGs on MCTD were found, other CPGs developed for other CTDs were taken into consideration in order to discuss what can be applied to MCTD even if designed for other diseases. Three major objectives were proposed for the future development of CPGs: MCTD diagnosis (diagnostic criteria), MCTD initial and follow-up evaluations, MCTD treatment. Early diagnosis, epidemiological data, assessment of burden of disease and QOL aspects are among the unmet needs identified by patients.This publication was funded by the European Union’s Health Programme (2014-2020)info:eu-repo/semantics/publishedVersio

Menopause in systemic sclerosis: the impact on clinical presentation in a multicenter cross-sectional analysis from the National Registry of the Italian Society for Rheumatology (SPRING-SIR)

Abstract Background: Hormonal changes in menopause might interact with the presentation of underlying autoimmune diseases, such as systemic sclerosis (SSc). Objectives: Our study aimed to evaluate the association of (1) current menopausal status, (2) early menopause, and (3) disease onset during fertile or post-menopausal age on SSc clinical phenotype in a large SSc cohort from the Italian Systemic sclerosis Progression INvestiGation (SPRING-SIR) registry. Design: Female SSc patients from the SPRING-SIR registry, fulfilling the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2013 classification criteria, with data on SSc disease onset, menopausal status, and menopausal age, were eligible. SSc onset was categorized as pre-menopausal if SSc onset happened >1year before menopause or as post-menopausal onset if it occurred >1year after menopause. An early menopause was defined by a menopausal age <45years. Methods: Descriptive statistics and regression models were built to test the association between current menopausal status, pre-menopausal disease onset, and early menopause with SSc-related features. Results: At baseline, 1157/1538 (75%) patients were in menopause, 632 (50.4%) had a premenopausal SSc onset, and 130 (14.4%) reported an early menopause. Post-menopausal patients had more frequent limited cutaneous SSc, anti-centromere antibody positivity, interstitial lung disease, and gastrointestinal manifestations. Pre-menopausal onset case

First-line diagnostic tests to intercept primary heart involvement in systemic sclerosis: Clinical associations from the SPRING-SIR registry

Introduction: Primary heart involvement (pHI) is an overlooked and poorly characterised complication of systemic sclerosis (SSc), associated with the risk of heart failure, arrhythmia and death. Despite consensus definition by the World Scleroderma Foundation/Heart Failure Association (WSF/HFA), diagnostic criteria and risk factors remain poorly elucidated. Methods: Out of 1922 patients in the Italian national SPRING registry, we excluded those with potentially confounding conditions according to WSF/HFA, and those with incomplete ECG or echocardiographic assessment, resulting in 600 subjects with clearly defined parameters to intercept SSc-pHI. Cross-sectional and longitudinal analyses were performed to identify factors associated with pHI. Results: ECG and/or echocardiographic signs of SSc-pHI were identified in 25% of patients at enrollment and were associated with older age (OR 1.04; 95% CI 1.02–1.06), diffuse cutaneous SSc (OR 1.85; 95% CI 1.05–3.26) and intestinal symptoms (OR 1.79; 95% CI 1.03–3.08). Diastolic dysfunction (62%) and conduction disturbances (34%) were the most frequent phenotypes, while diffuse hypokinesia with reduced ejection fraction was the least common (3%). During follow-up, new-onset signs of pHI were observed in an additional 25% of patients, particularly in those with skeletal muscle involvement (HR 2.83; 95% CI 1.01–7.73). Conclusions: pHI is a severe complication potentially affecting one-quarter of patients with SSc. Early detection is crucial, particularly in those with diffuse skin fibrosis, muscular involvement and intestinal manifestations

Prevalence and clinical relevance of digital ulcers in systemic sclerosis patients from the real-life: the experience of the SPRING Registry of the Italian Society for Rheumatology

ntroduction: Digital ulcers (DU) are one of the most frequent manifestations in systemic sclerosis (SSc). The presence of DU seems to be a sentinel sign of internal organ involvement and is related to a poor prognosis of the disease. The aim of this study was to evaluate the prevalence and the relationship of DU with clinical manifestations/variants in a large SSc cohort from the SPRING registry. Methods: SSc patients fulfilling the ACR/EULAR 2013 classification criteria without missing data on digital ulcers were enrolled in a cross-sectional study. Logistic regression models were built to test the association between the presence of DU and SSc-related features. Results: Among 1873 eligible SSc patients, the presence of DU was significantly associated with gastrointestinal involvement (OR 1.88, 2.04 and 1.74; p < 0.001) and serum ATA positivity (OR 2.15; p < 0.001), as well as with telangiectasias, sclerodactyly, digital pitting scar, and calcinosis (OR 1.40, p = 0.005; OR 3.43, p < 0.001, OR 9.12, p < 0.001 and OR 2.77, p < 0.001; respectively). In the multivariable regression models, even after adjustment for covariates, ATA positivity (OR 1.76, p = 0.039), puffy fingers (OR 2.82, p < 0.001), and a higher revEUSTAR-AI (OR 6.63, p < 0.001) emerged as risk factors for the presence of DU. Moreover, a low presence of DU was recorded in SSc patients with a history of previous immunosuppressive treatments (OR 0.53, p = 0.032). Conclusion: In our Italian SSc cohort, DUs were significantly associated with the presence of puffy fingers, high revEUSTR-AI, and ATA seropositivity. Noteworthy, immunosuppressive treatments were associated with a low rate of DU, suggesting that they might contribute to the prevention of these harmful manifestations. Key Points • Digital ulcers were significantly associated with the presence of puffy fingers, high disease activity, and anti-Scl70 seropositivity. • Immunosuppressive treatments were associated with a low rate of digital ulcers, suggesting that they might contribute to the prevention of these harmful manifestations. Keywords: Digital ulcers; Immunosuppressive therapy; Systemic sclerosis; Vascular disease