Creating a Tourism Destination through Local Heritage: The Stakeholders’ Priorities in the Canavese Area (Northwest Italy)

A specific region, characterized by a significant natural and cultural heritage, is not necessarily a tourist destination. However, it can become so if there is active participation of local stakeholders oriented towards local development. In this context, this study focuses on a specific area, the Canavese (northwest Italy), which needs to find new regional development alternatives to the industrial sector. In particular, the research focused on the level of integration of local stakeholders and on their ability to identify common guidelines for tourist enhancement of the region. From an operational point of view, a survey of public and private stakeholders was carried out through a mixed-method approach divided into three stages: a questionnaire developed by a group of experts and individual interviews carried out by the Delphi method, presentation of the results, and identification of local priorities by the nominal group technique. Findings show the opportunity to act on specific elements to enhance local tourism offerings: outdoor nature and landscape, culture, and food and wine. Moreover, the stakeholders underlined the need for coordination among the parties involved to strengthen the local system. This activity should be supported by a single third party capable of managing the various phases of local development

Improving the Landscape and Tourism in Marginal Areas: The Case of Land Consolidation Associations in the North-West of Italy

Land fragmentation is a factor that limits the development of the agricultural and forestry sector, as well as the ability of operators to reach a profitable economic dimension. This phenomenon also influences the creation of activities and incomes in a negative way in marginal areas. In this context, land consolidation associations (LCA) can be a useful tool in reducing this limitation and promoting better management of the territory by improving the link between the landscape and tourism. This study aims to make a comparison between the different LCAs operating in the north-west of Italy, with a specific focus on differences and similarities amongst LCAs, highlighting each orientation towards the management of the landscape with the purpose of improving tourism development. The research used a survey method; a questionnaire was designed, and a semi-structured interview was conducted with each LCA president. Findings show that land management by LCAs allows the preservation and/or improvement of the landscape and supports the development of agricultural activities such as animal breeding. This kind of landscape-based land management increases the attractiveness of the territory in terms of tourism, stimulating the nature-oriented tourism tools. Therefore, on the one hand, the Piedmontese model supports the landscape and also allows economic and social goals to be reached by tourism solutions, and on the other hand it stimulates the improvement of the environment and the creation of chests of biodiversity

Foodservice in a UNESCO Site: The restaurateurs' perception on communication and promotion tools

The foodservice sector plays an important economical role in the “Langa del Barolo”, in Northwest Italy. It is now on the UNESCO (the United Nations Educational, Scientific and Cultural Organization) World Heritage List and is in first place in Italy in the Vineyard Landscape field, along with the Roero and Monferrato territories. The tourists who visit this area are constantly increasing and its inscription in UNESCO World Heritage List seems to have increased its international appeal even more. This study aimed at obtaining feedback from the “Langa del Barolo” restaurateurs as to their perception of the communication and promotion tools implemented to enhance the territory. A semi-structured interview, that adopted a questionnaire based on the PAPI technique, was used to survey all the 78 restaurateurs in this area. This technique was chosen to stimulate the individual propensity of the restaurant owner to share information freely. It was observed that the UNESCO status provides new stimuli for the restaurateurs when carrying out their activities, increases tourist’s interest in the “Langa del Barolo” and disseminates the local brands at an international level. Other tools, such as TripAdvisor, word-of-mouth, Slow Food and gastronomic guides, were also presented and discussed with the participants. The feedback and results demonstrate that having a UNESCO status improves and enhances the territory, making it an extremely useful promotion tool

Relation Between Soluble Adhesion Molecules and Insulin Sensitivity in Type 2 Diabetic Individuals

OBJECTIVE—The purpose of this study was to explore the relation between insulin resistance and plasma levels of soluble adhesion molecules and to examine the effects of acute hyperinsulinemia on these molecules in type 2 diabetic individuals. RESEARCH DESIGN AND METHODS—Intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, and E- and P-selectin plasma concentrations were measured in 36 nonobese type 2 diabetic patients without cardiovascular disease and in 7 healthy subjects. Insulin sensitivity was assessed by a 4-h euglycemic (∼5 mmol/l)-hyperinsulinemic (∼300 pmol/l) clamp performed in combination with [3H]3-d-glucose infusion. RESULTS—Diabetic subjects were insulin resistant but did not show plasma concentrations of adhesion molecules that were significantly higher than control subjects. In diabetic subjects, plasma ICAM-1 and E-selectin were negatively correlated with total glucose disposal during the insulin clamp (r = −0.432, P < 0.01; and r = −0.375, P < 0.05, respectively), whereas plasma VCAM-1 and P-selectin were not. Plasma ICAM-1 as well as E- and P-selectin were positively correlated with BMI, total body fat (TBF), and waist girth (P < 0.05–0.001). In multiple regression analyses, the relation of plasma ICAM-1 and E-selectin with insulin sensitivity was lost after adjustment for potential confounders, including HbA1c, blood pressure, and/or LDL cholesterol. In these analyses, BMI was the only independent predictor of plasma ICAM-1 (R2 = 0.244, P < 0.002), whereas TBF was the only independent predictor of plasma E-selectin (R2 = 0.202, P = 0.01). The 4-h insulin infusion during the glucose clamp did not significantly change plasma levels of adhesion molecules. CONCLUSIONS—Overall adiposity, rather than insulin resistance, may be a determinant of plasma levels of ICAM-1 and E-selectin in type 2 diabetic individuals. In these patients, acute hyperinsulinemia does not exert any significant effect on plasma adhesion molecules. These findings support the possibility that adipose tissue releases one or more factors that may adversely affect endothelial function on one hand and insulin sensitivity on the other

Glycaemic Control in People with Type 2 Diabetes Mellitus Switching from Basal Insulin to Insulin Glargine 300 U/ml (Gla-300): Results from the REALI Pooled Database

INTRODUCTION: Using pooled data from the REALI European database, we evaluated the impact of previous basal insulin (BI) type on real-life effectiveness and safety of switching to insulin glargine 300 U/ml (Gla-300) in people with suboptimally controlled type 2 diabetes. METHODS: Patient-level data were pooled from 11 prospective, open-label, 24-week studies. Participants were classified according to the type of prior BI. Of the 4463 participants, 1282 (28.7%) were pre-treated with neutral protamine Hagedorn (NPH) insulin and 2899 (65.0%) with BI analogues (BIAs), and 282 (6.3%) had undetermined prior BI. RESULTS: There were no meaningful differences in baseline characteristics between subgroups, except for a higher prevalence of diabetic neuropathy in the NPH subgroup (21.6% versus 7.8% with BIAs). Mean ± standard deviation haemoglobin A1c (HbA1c) decreased from 8.73 ± 1.15% and 8.35 ± 0.95% at baseline to 7.71 ± 1.09% and 7.82 ± 1.06% at week 24 in the NPH and BIA subgroups, respectively. Least squares (LS) mean change in HbA1c was - 0.85% (95% confidence interval - 0.94 to - 0.77) in NPH subgroup and - 0.70% (- 0.77 to - 0.64) in BIA subgroup, with a LS mean absolute difference between subgroups of 0.16 (0.06-0.26; p = 0.002). Gla-300 mean daily dose was slightly increased at week 24 by 0.07 U/kg/day (approximately 6 U/day) in both subgroups. Incidences of symptomatic and severe hypoglycaemia were low, without body weight change. CONCLUSIONS: Irrespective of previous BI therapy (NPH insulin or BIAs), switching to Gla-300 improved glycaemic control without weight gain and with low symptomatic and severe hypoglycaemia incidences. However, a slightly greater glucose-lowering effectiveness was observed in people pre-treated with NPH insulin

Association of free-living physical activity measures with metabolic phenotypes in type 2 diabetes at the time of diagnosis. The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS)

Objective: Lifestyle is considered a major determinant of risk of type 2 diabetes (T2D). We investigated whether daily physical activity (DPA) is associated with beta-cell function (BF) and/or insulin sensitivity (IS) in patients with T2D at the time of diagnosis. Methods: In 41 subjects enrolled in the Verona Newly-Diagnosed Type 2 Diabetes Study we assessed: (1) IS, by euglycaemic insulin clamp; (2) BF, estimated by prolonged-OGTT minimal modeling and expressed as derivative and proportional control; (3) DPA and energy expenditure (EE), assessed over 48-hours monitoring by a validated wearable armband system. Results: Study participants (median[IQR]; age: 62 [53-67] years, BMI: 30.8 [26.5-34.3] Kg c5m-2, HbA1c: 6.7 [6.3-7.3]%; 49.7 [45.4-56.3] mmol/mol) were moderately active (footsteps/day: 7,773 [5,748-10,927]; DPA 653MET: 70 [38-125] min/day), but none of them exercised above 6 metabolic equivalents (MET). EE, expressed as EETOT (total daily-EE) and EE 653MET (EE due to DPA 653MET) were 2,398 [2,226-2,801] and 364 [238-617] Kcal/day, respectively. IS (M-clamp 630 [371-878] \u3bcmol/min/m2) was positively associated with DPA and EE, independent of age, sex and BMI (p<0.05). Among the DPA and EE parameters assessed, DPA 653MET and EETOT were independent predictors of IS in multivariable regression analyses, adjusted for age, sex, BMI (R2=16%, R2=19%, respectively; p<0.01). None of model-derived components of BF was significantly associated with DPA or accompanying EE. Conclusions Our study highlighted moderate levels of DPA and total EE as potential determinants of IS, but not BF, in T2D at the time of diagnosis. Intervention studies are needed to conclusively elucidate the effect of DPA on these features

A Novel Insulin/Glucose Model after a Mixed-Meal Test in Patients with Type 1 Diabetes on Insulin Pump Therapy

Current closed-loop insulin delivery methods stem from sophisticated models of the glucose-insulin (G/I) system, mostly based on complex studies employing glucose tracer technology. We tested the performance of a new minimal model (GLUKINSLOOP 2.0) of the G/I system to characterize the glucose and insulin dynamics during multiple mixed meal tests (MMT) of different sizes in patients with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion, CSII). The GLUKINSLOOP 2.0 identified the G/I system, provided a close fit of the G/I time-courses and showed acceptable reproducibility of the G/I system parameters in repeated studies of identical and double-sized MMTs. This model can provide a fairly good and reproducible description of the G/I system in T1D patients on CSII, and it may be applied to create a bank of "virtual" patients. Our results might be relevant at improving the architecture of upcoming closed-loop CSII systems