Neuromedin U pathway in the control of obesity and other hypothalamus-regulated phenotypes

This is a candidate pathway study in European children and adults. Neuromedin U (NMU) is a hypothalamic neuropeptide that regulates metabolic phenotypes. Our preliminary analyses in European children suggested that NMU gene plays an important role in adiposity and bone health. This project aims at investigating the associations between hypothalamus-regulated phenotypes and NMU pathway genes, by: (i) investigating in children and confirming in adults possible associations between polymorphisms in NMU pathway genes and adiposity, insulin resistance, blood pressure and bone health; (ii) verifying gene-gene interaction effects; (iii) identifying specific rare loci or regions with aberrant methylation in the genes confirmed for associations. Two populations of children and adults will be used. A two-step approach will be set-up to identify and replicate associations, considering false discovery rate correction. The results will be useful to identify potential target for novel drugs and to recognize subjects at high risk for metabolic and bone diseases

Challenges and opportunities in establishing an Health Examination Survey

In Italy, the last 30 years witnessed the implementation of cross-sectional surveys providing baseline data on numerous risk factors collected from random samples of the adult general population. In order to support those groups who would like to implement an health examination survey (HES), according to the experience of  the CUORE Project surveys, the objective of this paper is to describe some information related to the organization of a survey (examination sites and sampling, selection of analytic laboratory, coordination and personnel involved, sample selection, recruitment and appointment scheduling, informative notice and informed consent, participation rate, non-participation bias, quality assurance, survey data, long term storage of the samples, internal quality control, external quality assessment, feedback to participants, error checking, correction and documentation of the data, transfer and storage of the data, statistical analyses and interpretation of results, dissemination of results), usually shortly described  in scientific papers but relevant when an HES is planned

Diagnostics of the tropical tropopause layer from in-situ observations and CCM data

A suite of diagnostics is applied to in-situ aircraft measurements and one Chemistry-Climate Model (CCM) data to characterize the vertical structure of the Tropical Tropopause Layer (TTL). The diagnostics are based on vertical tracer profiles and relative vertical tracer gradients, using tropopause-referenced coordinates, and tracer-tracer relationships in the tropical Upper Troposphere/Lower Stratosphere (UT/LS). Observations were obtained during four tropical campaigns performed from 1999 to 2006 with the research aircraft Geophysica and have been compared to the output of the ECHAM5/MESSy CCM. The model vertical resolution in the TTL (~500 m) allows for appropriate comparison with high-resolution aircraft observations and the diagnostics used highlight common TTL features between the model and the observational data. The analysis of the vertical profiles of water vapour, ozone, and nitrous oxide, in both the observations and the model, shows that concentration mixing ratios exhibit a strong gradient change across the tropical tropopause, due to the role of this latter as a transport barrier and that transition between the tropospheric and stratospheric regimes occurs within a finite layer. The use of relative vertical ozone and carbon monoxide gradients, in addition to the vertical profiles, helps to highlight the region where this transition occurs and allows to give an estimate of its thickness. The analysis of the CO-O3 and H2O-O3 scatter plots and of the Probability Distribution Function (PDF) of the H2O-O3 pair completes this picture as it allows to better distinguish tropospheric and stratospheric regimes that can be identified by their different chemical composition. The joint analysis and comparison of observed and modelled data allows to state that the model can represent the background TTL structure and its seasonal variability rather accurately. The model estimate of the thickness of the interface region between tropospheric and stratospheric regimes agrees well with average values inferred from observations. On the other hand, the measurements can be influenced by regional scale variability, local transport processes as well as deep convection, that can not be captured by the model

Diagnostics of the tropical tropopause layer from in-situ observations and CCM data

A suite of diagnostics is applied to in-situ aircraft measurements and one Chemistry-Climate Model (CCM) data to characterize the vertical structure of the Tropical Tropopause Layer (TTL). The diagnostics are based on the vertical tracers profiles, relative vertical tracers gradients, and tracer-tracer relationships in the tropical Upper Troposphere/Lower Stratosphere (UT/LS), using tropopause coordinates. Observations come from the four tropical campaigns performed from 1998 to 2006 with the research aircraft Geophysica and have been directly compared to the output of the ECHAM5/MESSy CCM. The model vertical resolution in the TTL allows for appropriate comparison with high-resolution aircraft observations and the diagnostics used highlight common TTL features between the model and the observational data. The analysis of the vertical profiles of water vapour, ozone, and nitrous oxide, in both the observations and the model, shows that concentration mixing ratios exhibit a strong gradient change across the tropical tropopause, due to the role of this latter as a transport barrier and that transition between the tropospheric and stratospheric regimes occurs within a finite layer. The use of relative vertical ozone gradients, in addition to the vertical profiles, helps to highlight the region where this transition occurs and allows to give an estimate of its thickness. The analysis of the CO-O3 and H2O-O3 scatter plots and of the Probability Distribution Function (PDF) of the H2O-O3 pair completes this picture as it allows to better distinguish tropospheric and stratospheric regimes that can be identified, first, by their differing chemical composition. The joint analysis and comparison of observed and modelled data allows us to evaluate the capability of the model in reproducing the observed vertical structure of the TTL and its variability, and also to assess whether observations from particular regions on a monthly timescale can be representative of the fine scale mean structure of the Tropical Tropopause Layer

Impact of deep convection in the tropical tropopause layer in West Africa: in-situ observations and mesoscale modelling

We present the analysis of the impact of convection on the composition of the tropical tropopause layer region (TTL) in West-Africa during the AMMA-SCOUT campaign. Geophysica M55 aircraft observations of water vapor, ozone, aerosol and CO2 show perturbed values at altitudes ranging from 14 km to 17 km (above the main convective outflow) and satellite data indicates that air detrainment is likely originated from convective cloud east of the flight. Simulations of the BOLAM mesoscale model, nudged with infrared radiance temperatures, are used to estimate the convective impact in the upper troposphere and to assess the fraction of air processed by convection. The analysis shows that BOLAM correctly reproduces the location and the vertical structure of convective outflow. Model-aided analysis indicates that in the outflow of a large convective system, deep convection can largely modify chemical composition and aerosol distribution up to the tropical tropopause. Model analysis also shows that, on average, deep convection occurring in the entire Sahelian transect (up to 2000 km E of the measurement area) has a non negligible role in determining TTL composition

AD HOC SURVEYS: HOW TO MEASURE AND REPORT QUALITY METHODS

Surveys need a clear report on adopted quality methods to support surveillance, research and to implement evidence-based health policies. Aim of this report is to provide a simple and practical tool to those interested in survey, like HIS or HES , suggesting the different aspects of the quality to be controlled. These are crucial to generate useful and reliable results that can help the monitoring of health policy in Europe. Starting from the wide literature available in the field, the various quality dimensions that should be documented in a quality report and support the published results are briefly presented. In this paper, the six dimensions of the quality are analysed, as well as the different steps necessary to implement a survey, with particular attention to the quality and taking account of the remarkable expertise in the field. Before starting the survey, as known, the planning of specific steps is required. Moreover, to improve quality, training and testing of personnel involved in the different sets (organization, data collection, data processing, and statistical analysis) are fundamental. The methods used and the results obtained need to be published

Geographic and socioeconomic variation of sodium and potassium intake in Italy : results from the MINISAL-GIRCSI programme

Objectives To assess geographic and socioeconomic gradients in sodium and potassium intake in Italy. Setting Cross-sectional survey in Italy. Participants 3857 men and women, aged 39–79 years, randomly sampled in 20 regions (as part of a National cardiovascular survey of 8714 men and women). Primary outcome measures Participants’ dietary sodium and potassium intakes were measured by 24 h urinary sodium and potassium excretions. 2 indicators measured socioeconomic status: education and occupation. Bayesian geoadditive models were used to assess spatial and socioeconomic patterns of sodium and potassium intakes accounting for sociodemographic, anthropometric and behavioural confounders. Results There was a significant north-south pattern of sodium excretion in Italy. Participants living in southern Italy (eg, Calabria, Basilicata and Puglia >180 mmol/24 h) had a significantly higher sodium excretion than elsewhere (eg, Val d'Aosta and Trentino-Alto Adige <140 mmol/24 h; p<0.001). There was a linear association between occupation and sodium excretion (p<0.001). When compared with occupation I (top managerial), occupations III and IV had a 6.5% higher sodium excretion (coefficients: 0.054 (90% credible levels 0.014, 0.093) and 0.064 (0.024, 0.104), respectively). A similar relationship was found between educational attainment and sodium excretion (p<0.0001). When compared with those with a university degree, participants with primary and junior school education had a 5.9% higher urinary sodium (coefficients: 0.074 (0.031, 0.116) and 0.038 (0.001, 0.075), respectively). The socioeconomic gradient explained the spatial variation. Potassium excretion was higher in central regions and in some southern regions. Those in occupation V (low-skill workers) showed a 3% lower potassium excretion compared with those in occupation I. However, the socioeconomic gradient only partially explained the spatial variation. Conclusions Salt intake in Italy is significantly higher in less advantaged social groups. This gradient is independent of confounders and explains the geographical variation

Acute myocardial infarction and stroke registries. The Italian experience

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, data available on CVD incidence and prevalence is generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS recommendations; it also took into account the experience acquired by Italy in the MONICA project since the mid-1980s and continued with the coordination of the EUROCISS The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of acute myocardial infarction (AMI) in Mediterranean countries according to EUROCISS recommendations” in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry

Acute myocardial infarction and stroke registries. The italian experience

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, available data on CVD incidence and prevalence are generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction (AMI) and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS Project recommendations; it also took into account the experience acquired by Italy in the WHO-MONICA project since the mid-1980s and continued with the coordination of the EUROCISS Project. The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of AMI in Mediterranean countries according to EUROCISS recommendations”, in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry

Prevalence and cardiovascular risk profile of chronic kidney disease in Italy: Results of the 2008-12 National Health Examination Survey

Background National surveys in countries outside Europe have reported a high prevalence (11-13%) of chronic kidney disease (CKD). Studies in Europe have provided a variable prevalence likely due to differences in study design, including age and extent of geographic areas, equation used to evaluate estimated glomerular filtration rate (eGFR) and CKD stages examined. Methods The 2008-12 National Health Examination Survey in Italy randomly extracted samples from the general population aged 35-79 years, stratified by age and gender, from the resident list of each Italian region (440 persons/1.5 million of residents). We estimated the prevalence of CKD by means of urinary albumin: creatinine ratio and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). Cardiovascular (CV) risk profile was also evaluated. Results Three thousand eight hundred and forty-eight men and 3704 women were examined. In the whole population, mean age was 57 ± 12 and 56 ± 12 years in men and women, respectively; hypertension was prevalent in men and women, respectively (56 and 43%) and the same held true for overweight (48 and 33%), obesity (26 and 27%), diabetes (14 and 9%) and smoking (21 and 18%), whereas CV disease was less frequent (9 and 6%). Overall, the prevalence of CKD (95% confidence interval) was 7.05% (6.48-7.65). Early stages constituted 59% of the CKD population [Stage G1-2 A2-3: 4.16% (3.71-4.61) and Stage G3-5: 2.89% (2.51-3.26)]. At multivariate regression analysis, age, obesity, hypertension, diabetes, CV disease and smoking were all independent correlates of CKD. Conclusions CKD has a relatively lower prevalence in Italy, in particular for advanced stages, when compared with similar national surveys outside Europe. This occurs despite older age and unfavourable CV risk profile of the whole population