Epidemiologia & Prevenzione最新文献

Background: urban areas face growing challenges from climate change, especially in the form of extreme heat events that disproportionately affect vulnerable populations. Turin, a large city in Northern Italy, in past years has developed a policy framework integrating health equity into urban planning through the "Health in All Policies" approach.

Objectives: to assess climate-related health risks in Turin by identifying spatial patterns of social vulnerability associated with Urban Heat Islands (UHIs), with the goal of guiding targeted adaptation and mitigation strategies.

Design: cross-sectional ecological risk assessment using the IPCC framework, integrating data on hazard, exposure, and vulnerability.

Setting and participants: the analysis focused on the municipality of Turin (847,237 residents), with a specific emphasis on individuals aged over 65 years. The spatial unit of analysis was the census tract (N. 3,852).

Main outcome measures: an index of climate risk was developed for each census tract by aggregating normalized indicators for climatic hazard (UHI intensity), exposure (elderly population), and vulnerability (socioeconomic, demographic, health, and environmental indicators).

Results: the analysis revealed significant spatial disparities in climate risk across the city. Northern and peripheral neighbourhoods showed the highest levels of social vulnerability and climate risk, while green and less densely populated areas displayed lower risk. The approach enabled the identification of high-priority areas for urban health interventions.

Conclusions: the study demonstrates the feasibility and policy relevance of applying a structured climate health risk assessment framework at the urban level. The methodology supports evidence-based planning for climate adaptation, helping local authorities target actions to protect vulnerable populations and reduce health inequalities. The results contribute to ongoing efforts in Turin to integrate climate resilience into citywide health and social policy agendas.

Objectives: to quantify the impact of heat on mortality, in terms of heat attributable deaths in 6 Italian cities included in the CCM Climactions project (Turin, Genoa, Bologna, Rome, Bari, Palermo) and to estimate the potential health co-benefits by considering temperature reduction scenarios in urban areas proposed in the project case studies in terms of urban nature-based solutions measures and albedo variation of impervious surfaces.

Design: city-specific time series models and impact assessment.

Setting and participants: daily mortality counts and average temperature data in six Italian cities (Turin, Genoa, Bologna, Rome, Bari, Palermo) included in the CCM CLIMACTIONS project Main outcome measures: overall mortality. Non-linear distributed lag models were used to estimate risk and attributable deaths for increments between the 75th and the 99th percentiles of the mean temperature distribution (lag 0-3) over the period 2006-2015. To estimate the benefits of the intervention scenarios proposed in Climactions to reduce temperatures in urban areas, the deaths attributable to heat with and without this reduction were calculated and the difference between the two estimates corresponds to the potential change in the impact due to scenario measures introduced.

Results: the study reports a reduction in heat attributable deaths between 25% and 35% and between 40% and 60% in all cities, respectively, for the two scenarios of average temperature mitigation equal to 1.3°C and 2°C.

Conclusions: although only referring to simulation scenarios, the study provides further evidence of how urban nature-based solutions and the variation in the albedo of surfaces can be beneficial at an urban level both for the environment and populations health, supporting the implementation of climate change adaptation measures.

Objectives: to estimate the improvement of thermal comfort at a microclimatic level after using Nature-based Solutions (NBS) and albedo mitigation strategies in a square located in a densely built-up district of the city of Rome and subject to the phenomenon of Urban Heat Island.

Design: on the basis of the microclimatic simulation results of the current conditions of the area, obtained using the ENVI-met software, several microclimate cooling scenarios were developed and simulated; these scenarios included the integration of different layers of vegetation (herbaceous, shrubby, and arboreal) with different configurations and in different quantities and of different surfaces with high albedo index.

Setting and participants: the studio area is Piazza Mancini, located in the Flaminio district of Rome.

Main outcome measures: the main outcome measures calculated from the simulations were the intensity of the Urban Heat Island (UHI) and the Universal Thermal Climate Index (UTCI) to estimate the perceived discomfort associated with heat and the potential improvement of such perceptions through the scenarios considered.

Results: the simulations based on data from 22.07.2021 showed a progressive reduction of UTCI and of the UHI in the three considered scenarios. From the first scenario, which provides for greening and replacement of the asphalt with a higher albedo, it goes to the second and third scenario, which included also changes in the structure of the square (scenario 2) and functional optimization by inserting a shading structure (scenario 3). Scenarios 2 and 3 show a decrease in UTCI of almost 7ºC and UHI of about 2ºC compared to the actual state.

Conclusions: the three presented scenarios show how it is possible to improve the conditions of the healthiness of space (reducing the UHI by about 1.5°C) and that it is possible to transform mitigation actions into opportunities for the regeneration and enhancement of urban public spaces.

Objectives: to estimate the microclimatic improvement due to the introduction of Nature-based Solutions (NbS) in a small square (about 1,500 m²) located in a densely built area of the city of Genoa (Liguria Region, Northern Italy), and subject to the Urban Heat Island phenomenon (UHI).

Design: through the microclimatic simulation results of the current state, obtained via the ENVI-met V 4.4.5 software, different microclimatic cooling scenarios were developed and simulated, introducing different vegetation layers (herbaceous, shrubby, arboreal), in increasing quantities per scenario, and clear surfaces. One of them was then selected for the implementation of the pilot project.

Setting and participants: the study was done on Piazza Metastasio in the Cornigliano neighbourhood (VI District) in Genoa, in an area delimited by Via Cornigliano (North), Polcevera mouth (South), railway station (West), and Fiumara commercial complex (East). This area was particularly critical due to population density, absence of significant green areas, and weather and climate conditions.

Main outcome measures: Evaluating the Universal Thermal Climate Index (UTCI) allowed to estimate the users' feelings of well-being/malaise inside the examined area, and the potential improvement of these perceptions through targeted greening scenarios.

Results: the simulations of the selected scenario for the pilot project (scenario with minimum greening and with the best microclimatic performance), carried out for one of the hottest days of the last 20 years, show a decrease in the air temperature lower by around 1.8°C, compared to the current state (t current state: 34.4°C, t scenario: 32.6°C). The UTCI shows a decrease of around 4.1°C, compared to the current state, in correspondence with the trees (t current state: 42.0°C, t scenario: 37.9°C).

Conclusions: the kind and the coverage ratio of the plant layers play a fundamental role on the microclimatic parameters with thermal comfort improvement (up to -1.8°C t air, up to -5.4°C UTCI), despite a reduction in the air flow (up to -0.3 m/s).

Background: green areas are often present in the space surrounding primary schools, where they are usually used as playing/recreation or sport areas. Regular maintenance of such areas may help reduce the risk of allergic reactions and asthma exacerbations in children.

Objectives: to evaluate the effects on the respiratory and allergic health of children in a primary school in the city of Palermo (Sicily Region, Southern Italy) following a maintenance intervention in the adjacent green area.

Design: non-randomized, controlled, longitudinal intervention study.

Setting and participants: all the children attending the third, fourth, and fifth grades (7-11 years) of the Orestano school institute (No. 211) were invited to participate in the study.

Main outcome measures: on 14.03.2022, the children completed a questionnaire on sociodemographic characteristics and the presence of symptoms/exposure to secondhand smoke in the last 7 days. On 21.03.2022, maintenance was carried out on the green area adjacent to the San Ciro building, but not the Conte Federico building. On 08.04.2022, the children filled out the questionnaire again. The pre-post variation in symptom prevalence was compared between the two buildings using logistic regression models with mixed effects, adjusted for sex, age, and exposure to secondhand smoke, with time-building interaction effects.

Results: the study was completed by 132 children (50% San Ciro). Statistically significant increases in the prevalence of nasal and general symptoms were observed in San Ciro, while also ocular and respiratory symptoms increased in Conte Federico. Exposure to secondhand smoke was associated with a greater risk of skin (OR: 2.38), nasal (OR: 2.1), respiratory (OR: 5.47), and general (OR: 3.07) symptoms. The pre-post increase in the prevalence of ocular and respiratory symptoms was significantly greater in the Conte Federico building.

Conclusions: these preliminary results show that regular green area maintenance, with weed removal and pruning scheduling, can help reduce respiratory and allergy symptoms in primary school children.

Objectives: to provide the epidemiological framework of those affected by rare diseases resident in the Campania Region (Southern Italy), using the data entered in the Campania Region Rare Disease Registry, acquiring information potentially useful for regional planning.

Design: observational retrospective cohort study on patients with rare diseases included in the Regione Campania Rare Disease Registry from 01.01.2022 to 31.12.2022.

Setting and participants: population included in the Rare Disease Registry and resident in the Campania Region as at 31.12.2022.

Main outcome measures: using the data entered in the Regione Campania Rare Disease Registry, the cumulative incidence (I) of patients with rare diseases resident in Campania was calculated, stratified by age group and rare disease group with the respective 95% confidence intervals (IC95%). Standardised cumulative provincial incidences were also calculated. These are reported using a multiplication factor of 100,000.

Results: the incidence of patients with rare diseases in the Campania Region is 50.0 (IC95% 49.4-50.6) per 100,000 inhabitants in the year 2022. Furthermore, the rare disease groups with the highest incidence per 100,000 inhabitants are diseases of the central and peripheral nervous system (I: 8.32 per 100,000 inhabitants) and congenital malformations, chromosomopathies and genetic syndromes (I: 8.52 per 100,000 inhabitants). Moreover, the age groups in which the incidence is highest are in the paediatric age group.

Conclusions: an epidemiological framework of the Campania Region on rare diseases such as this one for the year 2022 is fundamental for national and regional planning in order to improve the care and quality of life of people affected by rare diseases, who often feel neglected by society. Sharing this type of information also draws attention to the need for faster diagnosis and the specialisation of new centres.

Objectives: to develop tools to identify the most appropriate and/or prioritized sets of patients with stable chronic conditions who are eligible for management by territorial services, to be included in a dedicated care pathway within Community Health Centers (CdC), as outlined in Italian Ministerial Decree 77/2022.

Design: retrospective observational study.

Setting and participants: subjects residing in the territory of the Health Protection Agency of Milan (ATS Milano) in the year 2023.

Main outcome measures: prevalence of hospitalizations, visits to the Emergency Room (ER) and patients receiving polytherapy, defined by specific criteria, to select chronic condition and cohort with potential territorial management. Duration of the disease and visits to the general practitioner (GP) clinic for the chronic population eligible for care in Community Houses provided for by the Italian Ministerial Decree No. 77 (DM77).

Results: starting from a population of 3.5 million inhabitants in the ATS Milano, 35% suffer from at least one chronic condition. The most represented pathologies are arterial hypertension (254,232 cases) and hypercholesterolemia (156,314 cases). Applying selection criteria on hospital discharge, access in emergency room, and therapy, 16 chronic pathologies of interest for territorial assistance were identified. The 15% of patients had the disease for less than 1 year while the 36,2% for over 10 years. Over 60,000 patients (10,2%) included in the cohort with potential territorial management did not even make one visit to the GP clinic during 2023.

Conclusions: through this model, approximately 600,000 subjects were identified as eligible for territorial care, based on the integration between the GP and the Community House, to be managed preferably within a Territorial Operations Center. This work represents a proposal for the application of a model to the information system available in a structure of the Italian National Health System for the planning of the care of the population affected by chronic diseases, as indicated by the DM77. The possibility of validating and developing similar approaches at a national level could represent a significant step towards better management of chronic conditions.