Deindustrialisation, demographic decline, aging, economic crisis and social involution in a metropolitan area analysed by applying Socio-Economic and Health Deprivation Indices.

Aims - Genoa is a city hit by a strong economic, demographic and social involution. The changes in the demographic and socio-economic (SE) situation were analysed and the capacity of two Socio-Economic and Health Deprivation Indices (SEHDI) in describing the evolutions of the recent period were verified. Material and Methods – The data about the evolution of demographic and SE situation in Genoa came from publications of Statistics Offices of Genoa Municipality and Liguria Region and from published analyses of Bank of Italy. The two SEHDIs, referring to 2001 and 2011 population, were computed at census tract level by linear regression, factor and clusters analyses and had been already validated and published. Results – Wide transformations in aging and population composition by age groups and gender occurred in Genoa between 1951 and 2016. Internal (from other Italian regions) and external (from other countries) migrations concurred to change the profile of Genoese population. These changes followed the industrial history of city and its deindustrialization occurred since 2001. A progressive SE involution, worsened by the Italian and international crises, carried out the recent impoverishment of the city. Between 2001 and 2011 the population at medium-high deprivation increased and the SEHDIs 2001 and 2011 contributed to describe the population distribution by deprivation groups, either geographically, and by groups of citizenships (Italians and Foreigners). The first identified in 2001 some aspects of a well-off society regarding education, labour market and characteristics of the family and housing structure. The second depicted in 2011 an impoverished society in aging, lack of family support and of property of the main house, diminishing of educational level. Discussion - Genoa city demonstrated an its own specific decline. Starting from the deindustrialization, a worsening of welfare, independently from the national and international economic troubles, was evident. The aging and the changed equilibria among age groups testified the growing difficulties of society in keeping up with the deep social and economic changes. The results demonstrated that specific deprivation indices aid to better define the populations under analysis, because they identify the subpopulations that could have the maximum benefit from investments of resources targeted to the correction of inequalities

The local Socio-Economic Health Deprivation Index: methods and results

Introduction. A socio-economic (SE) deprivation index is a measure which aim is to provide an indication of a SE condition of hardship and disadvantage in the population. This study provided ten Socio-Economic and Health Deprivation Indices (SEHDI) calculated with a shared methodology. The peculiar construction method makes them suitable for investigating the relationships between SE inequalities and aspects of health and prevention in the population. Materials and methods. Data on the demographic and SE situation of the populations derived from the 2011 Census at Census Tract (CT) level (2001 for Rome municipality). For the construction of the SEHDIs only the variables statistically significant correlated with the SMRs of general mortality were subjected to a tolerance test of linearity in order to eliminate the collinear ones. On them, a PCA analysis was applied to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted in five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparison with the trends of the main synthetic SE indices of the 2011 Census (2001 for Rome municipality). A validation at the health level was made by comparison with the trends of some causes of death. Both comparisons were made by the ANOVA. Regarding the vaccination coverage, the data were collected from the general practitioners, using, as a proxy for coverage, the geo-referencing of medical offices at CT level, in order to estimate the percentage of vaccinated over-65 years on population of the same age. To evaluate the role of SE differences on vaccination coverage, the latter was compared though the deprivation groups, calculating the differences in coverage between groups applying ANOVA testing. Results. The ten considered areas were the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one a specific SEHDI was computed and the different variables part of each index stressed the peculiar aspects of the SE and health deprivation at area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%), and, a linear distribution of the main statistical SE indices and of the general mortality in each area, according with the scientific literature about the relationship among SE condition and health status of population. The analyses about the by-cause mortality distribution through the SEHDIs deprivation clusters were discussed in other articles, which developed the findings of the study in each area.Conclusion. The SEHDIs showed good ability in identifying the elements of SE inequalities that impact on the health conditions of populations, in describing the distribution of death causes sensitive to SE differences for which aspects of the social and family support structure are relevant, in describing the characteristics that underlie the differences in vaccine coverage through the different groups of deprivation. From a public health perspective these results are relevant, because they make it possible to direct the vaccination promotion actions on the basis of the characteristics that define the deprivation groups

Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis.

Aims - Genoa is a city hit by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population ten years apart. Material and Methods – Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population, while the second, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p<0.05) of differences in death distribution among groups. Results – The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). Discussion - Deprivation trends confirmed the literature about populations lapsing towards poverty. Ageing-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies is emerging, adequate to support in a targeted way a population in an alarming condition of socio-economic deterioration

Neuromuscular Junctions as Key Contributors and Therapeutic Targets in Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) is a recessive autosomal neuromuscular disease, representing the most common fatal paediatric pathology. Even though, classically and in a simplistic way, it is categorized as a motor neuron (MN) disease, there is an increasing general consensus that its pathogenesis is more complex than expected. In particular, neuromuscular junctions (NMJs) are affected by dramatic alterations, including immaturity, denervation and neurofilament accumulation, associated to impaired synaptic functions: these abnormalities may in turn have a detrimental effect on MN survival.Here we provide a description of NMJ development/maintenance/maturation in physiological and pathological (SMA) conditions, focusing on pivotal molecules and on the time-course of pathological events. Moreover, since NMJs could represent an important target to be exploited for counteracting the pathology progression, we also describe several therapeutic strategies that, directly or indirectly, aim at NMJs

Expression of muscle-specific MiRNA 206 in the progression of disease in a murine SMA model

Spinal muscular atrophy (SMA) is a severe neuromuscular disease, the most common in infancy, and the third one among young people under 18 years. The major pathological landmark of SMA is a selective degeneration of lower motor neurons, resulting in progressive skeletal muscle denervation, atrophy, and paralysis. Recently, it has been shown that specific or general changes in the activity of ribonucleoprotein containing micro RNAs (miRNAs) play a role in the development of SMA. Additionally miRNA-206 has been shown to be required for efficient regeneration of neuromuscular synapses after acute nerve injury in an ALS mouse model. Therefore, we correlated the morphology and the architecture of the neuromuscular junctions (NMJs) of quadriceps, a muscle affected in the early stage of the disease, with the expression levels of miRNA-206 in a mouse model of intermediate SMA (SMAII), one of the most frequently used experimental model. Our results showed a decrease in the percentage of type II fibers, an increase in atrophic muscle fibers and a remarkable accumulation of neurofilament (NF) in the pre-synaptic terminal of the NMJs in the quadriceps of SMAII mice. Furthermore, molecular investigation showed a direct link between miRNA-206-HDAC4-FGFBP1, and in particular, a strong up-regulation of this pathway in the late phase of the disease. We propose that miRNA-206 is activated as survival endogenous mechanism, although not sufficient to rescue the integrity of motor neurons. We speculate that early modulation of miRNA-206 expression might delay SMA neurodegenerative pathway and that miRNA-206 could be an innovative, still relatively unexplored, therapeutic target for SMA