Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

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

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

L'articolo 35 della legge finanziaria 2002. Prime note sui nuovi principi in tema di regolazione dei servizi pubblici locali

Il tema dei servizi pubblici locali alla luce delle novità legislative introdotte dall'articolo 35 della legge finanziaria 200

Il finanziamento degli investimenti per le infrastrutture idriche

Il finanziamento degli investimenti per le infrastrutture idriche nazionali è il frutto dell’interazione di una molteplicità di fonti da cui dipende l’innovazione del sistema infrastrutturale, principalmente riconducibili alla tariffa del Servizio Idrico Integrato e al finanziamento pubblico europeo e nazionale. Il pesante deficit infrastrutturale e la lentezza dello sviluppo degli investimenti, uniti all’esigenza di incrementare in maniera significativa la quantità di opere e interventi sul territorio nazionale, richiedono un’azione mirata e che faccia ricorso a più leve e misure di sostegno al Servizio Idrico, in particolare attraverso: la revisione del quadro normativo e di regolazione; il ricorso ad interventi infrastrutturali contraddistinti da un partenariato pubblico - privato; la defiscalizzazione; l’emissione di titoli obbligazionari di durata medio-lunga e, infine, una complessiva semplificazione delle procedure.The financing of investments for water infrastructure is the result of the interaction of a variety of sources, primarily attributable to the Water Service Integrated Tariff and the European and national public funding, to which the innovation of the infrastructure system as a whole. The heavy infrastructure deficit and the slow pace in the development of investments, joined the need to increase significantly the amount of works and interventions on the national territory, require targeted action and make use multiple levers and support measures to the Water Service, in particular through: the review of the regulatory framework and regulation; the use of infrastructure work marked by a public-private partnership; tax relief; the issuance of bonds of medium-long term

The relaunch of privatizations in italy amid public debt reduction and gdp growth

Between 2012 and 2016, while the financial crisis was unfolding its effects in Italy and globally, several divestments of Italian State-owned companies were carried out, leading observers to believe that a new season of privatizations — similar to the one carried out in the 1990s — had finally been launched. However, after the initial considerable divestments announcing the completion of privatization of large public companies, the momentum faded away due to the strong Italian political instability combined with an international trend oriented to nationalism. The sizeable privatizations launched in 2014-2016, which led to important results in terms of revenue and attraction of investments (including international ones), produced lights and shadows, mainly due to the lack of a long-term roadmap. In this context, the only constant feature of any privatization strategy in Italy appears to be the feeble and fluctuating trend that — today just like yesterday — prevents the country from fully exploiting the potentialimplicit in the divestment of large State-owned companies

Centrale del latte public company

21 maggio 1995 - Articolo in cui si affronta la tematica delle public compan

Le reti e i mercati regolati

Le reti e i mercati regolati sono quelli nei quali è presente una infrastruttura che eroga servizi a disposizione dei cittadini e dei consumatori su cui vigila una Autorità amministrativa indipendent

I golden powers tra legislazione e applicazione concreta

Il d.l. 15 marzo 2012, n. 21 ha rappresentato uno dei più importanti sforzi che il legislatore italiano ha compiuto negli ultimi anni per cercare di definire una strategia di salvaguardia degli assetti proprietari delle società che operano in quei settori reputati strategici e d’interesse nazionale da possibili scalate ostili. Con il recentissimo d.l. 16 ottobre 2017, n.148, il Governo ha inteso rafforzare l’ambito di applicazione dei poteri speciali anche nei settori c.d. ad alta intensità tecnologica (di futura determinazione regolamentare) mettendoli in relazione al neointrodotto binomio “sicurezza – ordine pubblico”. Peraltro, sull’onda lunga del caso relativo alle partecipazioni detenute da Vivendi SA in Telecom S.p.A. e in sostanziale contestualità con le novità legislative descritte, il Presidente del Consiglio dei Ministri ha, con propri decreti del 16 ottobre e 2 novembre del 2017, esercitato in concreto i poteri speciali che sono riconosciuti all’Esecutivo nell’ambito di TIM e società, anche indirettamente, controllate tramite l’imposizione di prescrizioni e condizioni.The d.l. March 15, 2012, no. 21 was one of the most important efforts the Italian legislator has done in recent years in trying to define a strategy for safeguarding the ownership of companies operating in those areas of strategic and national interest from possible hostile escalators. With the recent d.l. 16 October 2017, no. 148, the Government intended to strengthen the scope of special powers also in the c.d. areas of high technological intensity (of future regulatory determination) by putting them in relation to the newcomer binomial "security - public order". Moreover, on the long wave of the case concerning the holdings held by Vivendi SA in Telecom S.p.A. and in substantial context with the legislative novelties described, the President of the Council of Ministers, with its decrees of 16 October and 2 November 2017, specifically exercised the special powers that are recognized by the Executive in the TIM and company, also indirectly, controlled by the imposition of prescriptions and conditions