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Since the Second World War, Italy has experienced major demographic changes, including increasing survival, decreasing fertility and higher rates of immigration. These changes have silently and slowly led to important shifts in the structure and the territorial distribution of the population. Thus, like in many other European countries, population ageing and depopulation have become the most relevant demographic phenomena in Italy. In this paper, we studied the relationship between depopulation and ageing in Italian territories in the 1971-2019 period using the census data of the Italian municipalities and applying spatial techniques. We found that high levels of depopulation later result in high levels of population ageing, and that recent population ageing processes are also connected to ongoing depopulation processes, thereby creating a vicious circle. [ABSTRACT FROM AUTHOR]

While campaigns of vaccination against SARS-CoV-2 are underway across the world, communities face the challenge of a fair and effective distribution of a limited supply of doses. Current vaccine allocation strategies are based on criteria such as age or risk. In the light of strong spatial heterogeneities in disease history and transmission, we explore spatial allocation strategies as a complement to existing approaches. Given the practical constraints and complex epidemiological dynamics, designing effective vaccination strategies at a country scale is an intricate task. We propose a novel optimal control framework to derive the best possible vaccine allocation for given disease transmission projections and constraints on vaccine supply and distribution logistics. As a proof-of-concept, we couple our framework with an existing spatially explicit compartmental COVID-19 model tailored to the Italian geographic and epidemiological context. We optimize the vaccine allocation on scenarios of unfolding disease transmission across the 107 provinces of Italy, from January to April 2021. For each scenario, the optimal solution significantly outperforms alternative strategies that prioritize provinces based on incidence, population distribution, or prevalence of susceptibles. Our results suggest that the complex interplay between the mobility network and the spatial heterogeneities implies highly non-trivial prioritization strategies for effective vaccination campaigns. Our work demonstrates the potential of optimal control for complex and heterogeneous epidemiological landscapes at country, and possibly global, scales. Author summary: The development of vaccines has sparked high hopes towards the control of SARS-CoV-2 transmission without resorting to extensive community-wide restrictions. A fundamental unanswered question concerns the best possible allocation of a limited vaccine stock in space and time given a specific goal. We address this through an optimal control framework based on a reliable spatially explicit COVID-19 epidemiological model, where vaccine distribution is optimized under supply and deployment capacity constraints. This tool provides strategies for optimal allocations in different scenarios, yielding important improvements over considered alternatives. By accounting for the spatial heterogeneity and human mobility networks, the presented approach complements currently used allocation methods based on criteria such as age or risk. [ABSTRACT FROM AUTHOR]

Estimates of the real death toll of the COVID-19 pandemic have proven to be problematic in many countries, Italy being no exception. Mortality estimates at the local level are even more uncertain as they require stringent conditions, such as granularity and accuracy of the data at hand, which are rarely met. The "official" approach adopted by public institutions to estimate the "excess mortality" during the pandemic draws on a comparison between observed all-cause mortality data for 2020 and averages of mortality figures in the past years for the same period. In this paper, we apply the recently developed machine learning control method to build a more realistic counterfactual scenario of mortality in the absence of COVID-19. We demonstrate that supervised machine learning techniques outperform the official method by substantially improving the prediction accuracy of the local mortality in "ordinary" years, especially in small- and medium-sized municipalities. We then apply the best-performing algorithms to derive estimates of local excess mortality for the period between February and September 2020. Such estimates allow us to provide insights about the demographic evolution of the first wave of the pandemic throughout the country. To help improve diagnostic and monitoring efforts, our dataset is freely available to the research community. [ABSTRACT FROM AUTHOR]

To better understand the pattern of variation in biocomplexity of springs and first‐order streams, it is essential to explore how the characteristics of spring communities may vary from the spring source (eucrenal) to the first reach of the originating springbrook (hypocrenal). For these reasons, we assessed spatial and temporal variation of crenic assemblages and leaf‐litter breakdown along a 45‐m reach of a spring–springbrook system in Central Italy. We found that physicochemical and hydrological parameters of Vera Spring did not vary significantly along the 45‐m reach investigated. In contrast, total richness of assemblages was significantly higher at 20 and 45 m from the spring source, while abundances were more variable and did not show significant differences between seasons and among sites. The composition of assemblages did not show significant temporal trends in all sites investigated, while spatial differences along the eucrenal–hypocrenal ecotone were more prominent. The functional organization of assemblages was relatively stable in both space and time, and no spatial differences were observed in the rate of leaf‐litter breakdown, though the dry mass loss of poplar leaves was slightly higher at the most downstream site. We conclude that immediately after groundwater emergence, spring communities are less stable and more variable while they tend to be better organized at short distance downstream. Small and gradual spatial changes in the strength of competitive interactions and predation pressures may have a fundamental role in structuring spring communities more than variation in abiotic parameters and/or differences in quantity and quality of food resources. [ABSTRACT FROM AUTHOR]

Several indices can predict the long-term fate of emerging infectious diseases and the effect of their containment measures, including a variety of reproduction numbers (e.g. R 0 ). Other indices evaluate the potential for transient increases of epidemics eventually doomed to disappearance, based on generalized reactivity analysis. They identify conditions for perturbations to a stable disease-free equilibrium ( R 0 < 1 ) to grow, possibly causing significant damage. Here, we introduce the epidemicity index e0, a threshold-type indicator: if e0 > 0, initial foci may cause infection peaks even if R 0 < 1 . Therefore, effective containment measures should achieve a negative epidemicity index. We use spatially explicit models to rank containment measures for projected evolutions of the ongoing pandemic in Italy. There, we show that, while the effective reproduction number was below one for a sizable timespan, epidemicity remained positive, allowing recurrent infection flare-ups well before the major epidemic rebounding observed in the fall. Several prognostic indices are available to predict the long-term fate of emerging infectious diseases and the effect of their containment measures, including a variety of reproduction numbers. Here, the authors introduce the epidemicity index, a complementary index to evaluate the potential for transient increases of SARS-Cov-2 epidemics. [ABSTRACT FROM AUTHOR]

Background: According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks' gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods: Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks' GA with birth weight ≤ 1500 g, 34–36 weeks' GA neonates with suspected intraamniotic infection and neonates ≥34 weeks' GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks' GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks' GA newborns (n = 95, group A), ≥ 37 weeks' GA newborns (n = 170, group B), and ≥ 34 weeks' GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar's test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results: 32/265 (12.1%) neonates ≥34 weeks' GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion: Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed. [ABSTRACT FROM AUTHOR]

Multi-source mudslides are common in the Daunia Apennines, i.e., the Apulian sector of the Southern Apennines of Italy, and play an important role in the historical evolution of the landscape, with significant impact on the social and economic activities of the area. They also represent the most relevant geological hazard along the front of the Apennine Chain and expose to a considerable risk the local population and infrastructures. The outer sector of the Daunia Apennines is part of the foreland thrust belt system, made up of fissured fine-grained materials, belonging to the Daunia tectonic unit formations. Concerning landslide typology, the most frequent slope movements are represented by flows and composite mudslides, the latter typically starting as slumps evolving from flows. This paper deals with the production of landslide activity maps of three case studies of composite mudslides from the front of the Daunia Apennines. The maps were produced integrating traditional interpretation of multi-year aerial photograph coverage and field surveys with the available digital elevation models to analyze surface morphology. Each landslide activity map corresponds to multi-temporal landslide inventories compiled for the last 15–20 years. This paper outlined that in the last 20 years the front of the Daunia Apennines underwent a significant reactivation of slope failure phenomena after years of quiescence, or of limited activity. The three case studies clearly confirm that: (i) the active portions of the mudslides are located inside or near preexisting slope failures, and (ii) the spatial distribution of instability phenomena is strictly dependent upon the presence of older, larger and dormant, phenomena. Landslide activity maps are an important tool for the evaluation of landslide susceptibility and hazard in the study area, and for quantitative geomorphological analyses it aimed at understanding the long-term geomorphological evolution of this portion of the Southern Apennines. Moreover, we argue that high-quality multi-temporal inventories could have positive effects on all derivative products and analyses, including erosion studies and landscape modeling, susceptibility and hazard assessments, and risk evaluations as well. [ABSTRACT FROM AUTHOR]

Objective: Psychological distress is common in cancer patients during the diagnostic phase. Research demonstrated that anxiety, depression and defense mechanisms may influence physical and psychological well-being in patients with malignant tumors. The present retrospective study investigated the associations between clinical and psychological characteristics of cancer patients waiting for the diagnosis, focusing on metastatic cancer (MC) and breast cancer (BC). Methods: Patients with a new diagnosis of cancer referring to a Clinical Oncology Unit in Central Italy were interviewed during the 2017 for psychological assessment. Double-blind information about anxiety, depression, sleep disorders, defense style, and cancer diagnosis were available for the 567 patients included in this study. T-test, chi-squared and regression analyses were performed to detect associations between psychological variables and the presence of metastasis (MC) in the whole sample and in the subgroup of breast cancer (BC) patients. Results: Female gender and younger age were associated with anxiety, depression, and maladaptive defense style. A significant positive relationship was found between presence of metastasis and symptoms of anxiety. Depression resulted significantly more frequent in BC, while there was a trend close to statistical significance in MC. Immature defense style was widely used by BC women, with a score close to statistical significance. Conclusions: This retrospective study provided empirical evidence of the relationship between psychological functioning and clinical characteristics of cancer. In line with previous research, our findings confirmed the peculiar psychological functioning of BC patients. Further investigations are needed to understand how the diagnosis of cancer may influence the individual psychological functioning and vice versa. [ABSTRACT FROM AUTHOR]

COVID‐19 has been declared a pandemic by the World Health Organization. As of April 1, 2020, Italy was the country with the second highest number of cases in the world. The spread of COVID‐19 has required a rapid reorganization of health service delivery in face of the pandemic. Breast cancer units have reprioritized their workload to guarantee the health of oncologic patients at the highest risk and regular screening activities. However, at the end of the pandemic emergency, many benign and reconstructive cases will return to our attention and their surgical treatment will be necessary as soon as possible. [ABSTRACT FROM AUTHOR]

The spread of coronavirus disease 2019 (COVID-19) in Italy prompted drastic measures for transmission containment. We examine the effects of these interventions, based on modeling of the unfolding epidemic. We test modeling options of the spatially explicit type, suggested by the wave of infections spreading from the initial foci to the rest of Italy. We estimate parameters of a metacommunity Susceptible–Exposed–Infected–Recovered (SEIR)- like transmission model that includes a network of 107 provinces connected by mobility at high resolution, and the critical contribution of presymptomatic and asymptomatic transmission. We estimate a generalized reproduction number (R0 = 3.60 [3.49 to 3.84]), the spectral radius of a suitable next-generation matrix that measures the potential spread in the absence of containment interventions. The model includes the implementation of progressive restrictions after the first case confirmed in Italy (February 21, 2020) and runs until March 25, 2020.We account for uncertainty in epidemiological reporting, and time dependence of human mobility matrices and awareness-dependent exposure probabilities. We draw scenarios of different containment measures and their impact. Results suggest that the sequence of restrictions posed to mobility and human-to-human interactions have reduced transmission by 45% (42 to 49%). Averted hospitalizations are measured by running scenarios obtained by selectively relaxing the imposed restrictions and total about 200,000 individuals (as of March 25, 2020). Although a number of assumptions need to be reexamined, like age structure in social mixing patterns and in the distribution of mobility, hospitalization, and fatality, we conclude that verifiable evidence exists to support the planning of emergency measures. [ABSTRACT FROM AUTHOR]

We present an example of integration of persistent scatterer interferometry (PSI) and in situ measurements over a landslide in the Bovino hilltop town, in Southern Italy. First, a wide-area analysis of PSI data, derived from legacy ERS and ENVISAT SAR image time series, highlighted the presence of ongoing surface displacements over the known limits of the Pianello landslide, located at the outskirts of the Bovino municipality, in the periods 1995-1999 and 2003-2008, respectively. This prompted local authorities to install borehole inclinometers on suitable locations. Ground data collected by these sensors during the following years were then compared and integrated with more recent PSI data from a series of Sentinel-1 images, acquired from March 2014 to October 2016. The integration allows sketching a consistent qualitative model of the landslide spatial and subsurface structure, leading to a coherent interpretation of remotely sensed and ground measurements. The results were possible thanks to the synergistic operation of local authorities and remote sensing specialists, and could represent an example for best practices in environmental management and protection at the regional scale. [ABSTRACT FROM AUTHOR]

In Italy, the recent wolf expansion process is the result of a series of historical, natural, ecological and conservation related factors that have characterized the Italian environmental context during the last few decades. The difficulties in broaching the environmental management of the wolf species have increased economic conflicts, mainly with livestock farmers. To facilitate and pacify the debate, an assessment of the risk of wolf attacks on livestock farms in Umbria’s municipalities needed to be carried out. For this assessment, AHPSort II, a new multi-criteria sorting method for a large number of alternatives, has been developed. This is used for sorting the alternatives into predefined, ordered risk categories. It requires far fewer comparisons than its predecessor, AHPSort. This sorting method can be applied to different environmental problems that have a large number of alternatives. In our case study, AHPSort II requires only 1.4% of the comparisons that would have been required by AHPSort. Combined with clustering, only 0.54% of the comparisons are required. The resulting map shows that a high number of municipalities are at risk, especially those near protected areas. [ABSTRACT FROM AUTHOR]

Objectives. Patients with SSc have an increased risk of malignancy compared with the general population. Before now, no study has evaluated the risk of thyroid cancer (TC) in SSc patients. The aim of the study was to evaluate the prevalence of TC in SSc patients. Methods. We studied the prevalence of TC in 327 unselected SSc patients in comparison with two population-based, gender- and age-matched control groups (654 subjects from an iodine-deficient area and 654 subjects from an iodine-sufficient area). Thyroid status was assessed by measurement of circulating thyroid hormones and autoantibodies, thyroid ultrasonography and fine-needle aspiration cytology (when necessary). Results. Circulating thyroid-stimulating hormone, anti-thyroglobulin and anti-thyroperoxidase antibody levels, and the prevalence of hypothyroidism were significantly higher in SSc patients (P<0.01, for all). Six patients with papillary TC (PTC) were detected among SSc patients, whereas only one case was observed in each of controls 1 and 2 (P = 0.007, for both). In SSc all patients with TC had evidence of thyroid autoimmunity vs 40% of the other SSc patients (P = 0.001). Conclusion. These data suggest a high prevalence of papillary TC in SSc patients, in particular in the presence of thyroid autoimmunity; careful thyroid monitoring would be opportune during the follow-up of these patients. [ABSTRACT FROM AUTHOR]

The dynamic behavior of a rocky cliff under severe sea waves has been analyzed in the location of Polignano, facing on the Adriatic coast of Apulia, Southern Italy. In this area, the classical and, at the same time, complex problem of the stability of a cliff in calcareous rocks is burdened by the presence on the top of the cliff of the ancient town. To analyze the behavior of the cliff under the impulsive transfer of energy generated by the sea waves, two types of measures were carried out on the rocky mass: (1) ambient noise and (2) strong-motion records. The first type of measures, which may be executed in a short time with a high spatial density, has provided a recognition of the intrinsic and anisotropic dynamic behavior of the coastal cliff. The accelerometric records, carried out during heavy storms in December 2009 and January 2010, allowed to evaluate the energy transfer from waves to cliff, in terms of maximum values and temporal and directional distribution. To facilitate a correct interpretation of the measures, also a geomechanical characterization of the rocky mass has been carried out through the Rock Mass Rating system Bieniawski (The Geomechanics Classification in Rock Engineering Applications. Proceedings of the 4th ISRM Cong., Montreux, pp 51-58, ), Bieniawski (Engineering Rock Mass Classifications. Wiley, New York, p 251,) and the Markland's test (A useful technique for estimating the stability of rock slopes when the rigid wedge sliding type of failure is expected, pp 10,). The first allowed to classify the rocky masses in terms of quality, the second one to individuate the potential failure mechanisms of the cliff. [ABSTRACT FROM AUTHOR]

There is currently little empirical evidence regarding how patients’ attachment patterns manifest in individual psychotherapy. This study compared the in-session discourse of patients classified secure, dismissing, and preoccupied on the Adult Attachment Interview (AAI). Rather than focusing on content or form alone, this study analyzed how patients’ discourse elicits and maintains emotional proximity with the therapist. The AAI was administered to 56 patients prior to treatment and one session for each patient was rated with the Patient Attachment Coding System (PACS) by four independent raters, blind to patients’ AAI classification. Significant differences were found in the discourse of patients with different attachment patterns. Namely, secure and preoccupied patients showed more contact-seeking behavior than dismissing patients, who avoided emotional proximity more, while preoccupied patients resisted therapists’ help more than did secure and dismissing patients. These results suggest that the different attachment patterns may have distinctive manifestations in the psychotherapy process that can be tracked by external observers. [ABSTRACT FROM PUBLISHER]

Aim: The aim of the study is to evaluate changes in opinions and behaviors of university students about sexual attitudes, use and effectiveness of contraceptive methods and sexually transmitted diseases (STDs). Subjects and methods: The study was carried out through three surveys in 1998, 2003 and 2008. A self-completion questionnaire, divided into three major sections, was administered. The groups were analyzed with the Chi-square test and the multiple logistic regression analysis; the significance level was set at p < 0.05. Results: Contraceptive methods were not used by 12.0, 12.5, and 16.2 % of the sample in 1998, in 2003 and 2008 respectively. The condom was the most common method used by responders, followed by the pill; both methods of birth control are also considered the most effective. In 2008, students demonstrated to have a good knowledge about STDs transmission through sexual intercourse and contraceptive use was higher among responders with multiple partners ( p = 0.028), lower in smokers ( p= 0.003) and female gender ( p = 0.001). Conclusion: The results highlight the necessity to activate programs on sex education, on the use of contraceptives and STD prevention. Peer education should also be considered. [ABSTRACT FROM AUTHOR]

The Fossa Bradanica in Basilicata (S Italy) is affected by almost 15% permanent Pleistocene and Holocene gullies. In the past decades climate versus land use management have dramatically increase both the soil loss rate and the muddy-flooding frequency. In this paper the impact of global change on soil production rates and erosion/deposition dynamics at medium-time scale (1949-2000) for two permanent gullies (Fosso Lavandaio and Fosso San Teodoro) has been studied. Pluviometric regime, land use changes and multi-temporal (1949, 1986 and 2000) subtraction method of digital elevation models have been conducted. From 1949 to 1986 the sediment production rate was estimated in 1,988.43 Mg ha year at Fosso Lavandaio and in 808.5 Mg ha year at Fosso San Teodoro, with deposition prevailing over erosion processes. From 1986 to 2000 the sediment production rate was estimated in 2,487.92 Mg ha year at Fosso Lavandaio and in 2,883.9 Mg ha year at Fosso San Teodoro, with higher values of net erosion. The data confirm that the increase in sedimentation would be due to human activities, in particular the levelling of gully heads for the production of cereals and orchards. Differently, the increase of the erosion processes depends on the recent changes of the pluviometric regime characterized by the extension of dry horizon and the concentration of high magnitude precipitation in macro-events of three to four consecutive days. [ABSTRACT FROM AUTHOR]

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The relationship between dry weight and body length for larvae of Plecoptera ( Leuctra spp., Isoperla grammatica, Nemoura cinerea) and Ephemeroptera ( Baetis spp., Habrophlebia fusca, Paraleptophlebia submarginata, Ecdyonurus helveticus, Rhithrogena semicolorata), collected from a carbonate stream in the Apennine (central Italy), is reported. The power equation f( x) = Ax B has been applied to fit the curves of dry weight vs. body size (length) in the ranges 0.03–13.00 mg and 2–14 mm, respectively; a total of 674 larvae were examined. The power model was in very good agreement with experimental data. Moreover, the error between measured and estimated weight was in the 4–20% range. The data on Isoperla grammatica, Leuctra spp., Rhithrogena semicolorata and Baetis spp. were compared to those in a previous study in a different geographical setting (south-western Germany’s Black Forest) obtaining similar results but with lower errors. We used and compared two methods: the weighted least-square method (WLS) and an analysis of covariance (ANCOVA). The values of the A and B coefficients obtained with the two methods were very similar (<6% discrepancy for either A or B). We found the best fits for all the examined Plecoptera (species, genus, and order level), while the results for Ephemeroptera were varied, with loose fits at the order level and also for Leptophlebiidae collectively considered. [ABSTRACT FROM AUTHOR]

Information on water mite assemblages from high elevation lentic biotopes is scant. A survey of 14 small Alpine lakes located between 1900 and 2400 m a.s.l. in Italy resulted in the discovery of 17 species of Hydrachnidia and a single species of freshwater Halacaridae. Arrenurus conicus and Lebertia tuberosa were the most widespread and abundant species; Lebertia sefvei, Lebertia rufipes, Oxus setosus, Panisus torrenticolus and Sperchon glandulosus were also widely distributed but relatively less abundant. Atractides fissus and Arrenurus conicus are recorded for the first time from Italy. In contrast to mid/low elevation lakes and ponds, water mite assemblages of alpine lakes are less diverse and are composed mainly of rheo- and crenobiontic taxa, most of which are cold-stenothermic. Typical standing water dwellers represented only a small fraction (23%) of the species sampled. A principal component analysis conducted on lake environmental variables resulted in a clear separation of the lakes mainly based on ionic contents, pH and temperature. Water mites seem to be less influenced by these factors than by temperature fluctuations and habitat stability and heterogeneity. We conclude with some considerations of the influence of abiotic and biotic factors on the altitudinal and latitudinal distribution pattern of water mites. [ABSTRACT FROM AUTHOR]

Lecce is a city located in the southern part of the Apulia region (south Italy). Its subsoil is rich in the remains of superimposed ancient settlements from the Messapian period (7th–3rd century BC) to the Roman, Medieval, Renaissance, and Baroque periods. Lecce Cathedral is one of the most important buildings in the town. It was built in the 12th century and transformed in the 16th and 17th centuries. Ground-penetrating radar (GPR) surveys were carried out in the cathedral and its crypt with the aim to evidence both probably buried structures related to the known crypt and other features such as tombs. The GPR investigations allow us to locate many features under the floor of the church. Some of them are unknown and could belong to the previous building of the Romanesque period. Furthermore, most of the identified structures are related to tombs and underground rooms (ossuaries). Under the crypt floor, six tombs of the 19th and 20th centuries and other ancient structures were documented. [ABSTRACT FROM AUTHOR]

The pressing need to restart socioeconomic activities locked-down to control the spread of SARS-CoV-2 in Italy must be coupled with effective methodologies to selectively relax containment measures. Here we employ a spatially explicit model, properly attentive to the role of inapparent infections, capable of: estimating the expected unfolding of the outbreak under continuous lockdown (baseline trajectory); assessing deviations from the baseline, should lockdown relaxations result in increased disease transmission; calculating the isolation effort required to prevent a resurgence of the outbreak. A 40% increase in effective transmission would yield a rebound of infections. A control effort capable of isolating daily ~5.5% of the exposed and highly infectious individuals proves necessary to maintain the epidemic curve onto the decreasing baseline trajectory. We finally provide an ex-post assessment based on the epidemiological data that became available after the initial analysis and estimate the actual disease transmission that occurred after weakening the lockdown. Releasing COVID-19 lockdown measures risks increases in transmission. Here, the authors estimate the increase in transmission rate for different regions in Italy and estimate that isolation of 5.5% exposed and highly infectious individuals would be needed to compensate for a 40% increase in transmission. [ABSTRACT FROM AUTHOR]

• Depopulation rate in Italy was analysed comparatively over three decades (1981–2011). • Depopulation is strictly associated with time-invariant territorial characteristics. • Spatial heterogeneity in depopulation rates increased over time. • Analysis of depopulation trends confirms the importance of cumulative demographic effects. • Results inform local development policies in areas exposed to depopulation risk. Population decline is a major issue impacting environmental sustainability, economic growth and social well-being. Although earlier studies evaluated demographic factors, social forces and economic aspects associated with population decline in Europe, the role of territorial factors was less considered when investigating the spatial linkages between rural depopulation and the local context. As demographic patterns are the result of past dynamics depending on place-specific factors, this study hypothesizes that (time-invariant) territorial characteristics (altitude, geographical area, proximity to the sea, and urban hierarchy) are important drivers of the spatial variability in depopulation rates on a local scale. To verify this assumption, changes over time (1981–2011) in resident populations of Italian municipalities were investigated and a regression model aimed at identifying the relevant factors shaping the population decline in Italy was run separately for three decades (1981–1991, 1991–2001, 2001–2011) with depopulation rate as the dependent variable. Model estimation was based on a system of simultaneous equations where the dependent variable at time t is an explanatory variable of the model at a subsequent time (t + 1). Results show that basic territorial factors – and especially altitude - impacted significantly on local-scale depopulation rates. North-south differences in population decline emerged more clearly in the last decade. Municipalities with a declining population at a given time were more likely to experience depopulation also in the subsequent decade. These findings highlight the relevant role of territorial factors in shaping depopulation across Italy and the importance of a spatially explicit analysis of demographic dynamics for local development research and policy. [ABSTRACT FROM AUTHOR]

The city of Taranto in the south of Italy is one of the areas declared as "at high risk of environmental crisis" by the Italian government because it represents one of the most complex industrial sites in Europe, located near urban areas of high population density. The rich ecosystem of the Mar Piccolo basin, located at north of Taranto, started exhibiting unconfutable signs of environmental pollution, confirmed by the high concentrations of organic and inorganic contaminants. Among the different aspects involved in the environmental studies aiming at the basin remediation, this paper focuses on submarine sediments and reports some results of the geotechnical laboratory investigations which made also use of non-standard equipment and revised procedures for data interpretation in order to take account of the sediments' contamination and heterogeneities. The geotechnical laboratory tests show that, despite the Mar Piccolo recent Holocene sediments having similar origin and composition to those of the Sub-Apennine clay basic formation, their behavioral facets appear to be altered by the presence of contaminants of both natural and anthropogenic origin. Results of washing tests are also presented as a first attempt to quantify the effects of chemo-mechanical coupling processes on the plasticity properties of the shallow sediments. [ABSTRACT FROM AUTHOR]

The article presents a study on the quality of diabetes care indicators in a large, representative multiregional population-based cohort of people living in Italy. The study found that 42 percent of the patients examined did not have their hemoglobin A1c measured for over a year. The study also found that a very low proportion of patients in whom microalbuminuria was tested in spite of its role as a strong predictor of cardiovascular diseases and dialysis.

Fertility is a key process shaping long-term population dynamics. Distinctive fertility trends have characterized demographic transitions, exhibiting sequential periods of spatial convergence and divergence. This descriptive study investigates the spatiotemporal evolution of Total Fertility Rate (TFR) and Crude Birth Rate (CBR) at different geographical scales in Italy between 2002 and 2018. Descriptive statistics of the TFR and CBR values across geographical scales were computed and the associated maps were prepared for the most detailed spatial levels available; specifically, down to the municipality level. Spatial analysis at the provincial and municipality level was based on both global and local Moran's indexes. Southern Italy, a mostly disadvantaged region, was characterized by relatively stable fertility patterns; fertility then decreased following an opposite trend with respect to economic conditions. The reverse relationship was observed in Northern Italy. As such, economic expansion and recession impacted fertility more intensively in Northern Italy. • The study represents an attempt to study fertility across space and time in Italy using a multi scale spatial approach. • The study covers a period of economic expansion (2002–2009) and recession (2010–2018). • Results show the existence of important local spatial heterogeneities in terms of fertility trends and dynamics. • The results suggest that fertility trends are in some way associated with economic downturns. • North-South divide is an important issue in terms of spatio temporal variability of fertility trends and dynamics. [ABSTRACT FROM AUTHOR]

In order to evaluate the prevalence of gestational diabetes mellitus (GDM) and the presence of risk factors for GDM, we conducted a retrospective study of a cohort of Italian women. In addition, we compared universal versus selective screening to validate the ADA''s recommendations in our population. From June 1st, 1995 to December 31st, 2001, universal screening for GDM was performed in 3950 women. The glucose challenge test (GCT) was positive (GCT+) in 1389 cases (35.2%). The 1-h glucose level after GCT enabled us to diagnose GDM directly in 24 pregnant women. Oral glucose tolerance test (OGTT) was performed in 1221 GCT+ women (144 cases with GGT+ dropped out) and GDM was diagnosed in 284 (23.2%) of them. OGTT was also performed in 391 randomly chosen, women from the GCT negative (GCT−) group. In this last group 25 (6.3%) women had GDM. Thus, the total number of subjects with GDM was 333 out of 3806 with a prevalence of 8.74% in the entire cohort. Assuming that the rate of GDM observed in the random sample of GCT− women is applicable to the whole group of 2561 GCT− women, then 161 GCT− patients could also have GDM. This will further increase the estimated prevalence for the whole cohort up to 12.3% (i.e. 469 out of 3806 pregnant women). There were 236 (5.6%) women with a low risk for GDM (normal weight, age less than 25 years and without a family history of diabetes). In this group we found 34 cases and five cases with positive screening test and GDM, respectively. Thus, if we excluded low risk women from the screening test, as suggested by ADA recommendations, only five women with GDM would have been missed. However, about 95% of our population were at medium or high risk for GDM and, therefore, would have been screened. The rate of GDM was significantly higher in women with a positive history of diabetes, increasing age, previous pregnancies, pre-pregnancy overweight and short stature. After logistic regression analysis, GDM diagnosis was significantly correlated with age (P<0.0001), pre-pregnancy BMI (P<0.0001), weight gain (P<0.0001) and family history of diabetes (P<0.01). [Copyright &y& Elsevier]

• A multidisciplinary petrographic and geotechnical study for soft rocks is proposed. • Apulian carbonate soft rocks are classified in six Dunham-based petrographic classes. • Apulian carbonate soft rocks show weak resistance and high deformability. • Statistical analyses show many links between petrography and geotechnical parameters. • Petrographic features influence the physical and mechanical behavior of soft rocks. [ABSTRACT FROM AUTHOR]

Background: We conducted a prospective study of the clinical outcomes and health-related quality of life after implantation of the CorCap support device (Acorn Cardiovascular Inc, St Paul, MN) for dilated cardiomyopathy., Methods: The criteria adopted for CorCap implantation were dilated cardiomyopathy (left ventricular [LV] end-diastolic diameter≥60 mm, LV ejection fraction≤0.30 and >0.10), and New York Heart Association functional class II or III despite maximal medical therapy. Echocardiographic follow-up and evaluation with the Short Form-36 questionnaire were performed., Results: Included were 39 patients: 5 in New York Heart Association class II and 32 in class III. At 13.3±2.5 months of follow-up, a statistically significant improvement was evident in mean LV volume (LV end-systolic volume from 202±94 to 138±72 ml. p=0.005) and systolic function (LV ejection fraction from 0.26±0.05 to 0.36±0.05, p<0.001). The mean LV sphericity index was significantly increased at the end of the follow-up (p=0.009). Ischemic etiology, diabetes, advanced age, and LV ejection fraction of less than 0.15 predicted lesser reversal of the LV alterations. Operative mortality was 5.1%. Cumulative follow-up mortality was 10.2%. The average Physical Health domain scores (Physical Functioning, Role Physical, General Health) were improved. Average Mental Health domain scores were also increased., Conclusions: The cardiac support device obtains reverse remodelling of the LV and is useful to improve the quality of life of patients with dilated cardiomyopathy and New York Heart Association class III symptoms of heart failure. The integration of different and complementary strategies (cardiac support device and resynchronization therapy) may represent the key to success for more complex patients, although further studies are required., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Stroke is characterized by well-defined clinical major subtypes, but there are few studies on incidence rates, aetiologies and outcomes in population-based setting. We assessed the age/sex incidence of the major stroke subtypes in a region of Southern Italy., Methods: We established a multisource, prospective population-based register in Puglia, Southern Italy to identify all residents with a first-ever stroke between 1 January 2001 and 31 December 2002., Results: One hundred and twenty-seven first-ever strokes were diagnosed, and stroke subtype was defined in 119 cases. The incidence rates per 100 000 adjusted to the European population (AEP) were 112 for cerebral infarction (CI), 30 for intracerebral haemorrhage (IH), four for subarachnoid haemorrhage (SH) and nine for undetermined stroke (US). The incidence rates for CI, IH and US approximately doubled with each decade of life and were higher in men. AEP incidence rates for CI in the age groups 45-84 were lower compared to other studies, whilst the corresponding rates for IH were higher., Conclusions: This population had a lower incidence of CI compared to other population-based studies from Northern Europe and the United States. Furthermore, with the projected increase in the segment of the very old in the general population, our data indicate that both CI and IH will dramatically increase in the near future.

Background and Purpose: Although a lower incidence of stroke has been observed in the Mediterranean area compared to other European countries, this is based on only a few studies. We sought to determine the incidence and 28-day case-fatality of stroke through a population-based stroke register in a rural area in Southern Italy, characterized by a stroke unit in the referral hospital., Methods: We established a multisource prospective population-based register in a well defined geographic area of 38 735 inhabitants in Puglia, Southern Italy. We identified all subjects in the study area with a first-ever stroke between January 1, 2001 and December 31, 2002., Results: We identified 127 first-ever strokes (77 males, 50 females) during the two-year study period. Hospitalization was 95%: 92 cases (72.4%) were cerebral infarction, 24 (18.9%) intracerebral hemorrhage, 3 (2.4%) subarachnoid hemorrhage, and 8 (6.3%) were unclassifiable strokes. The overall crude annual incidence was 1.6 per 1000 (95%CI: 1.4 to 1.9), 2.0 for males (95% CI:1.6 to 2.5), and 1.3 for females (95% CI:0.9 to 1.6). The incidence rates standardized to the 2001 European and world populations were respectively 1.5 (2.0 for males and 1.3 for females) and 0.8 (0.9 for males and 0.6 for females). Incidence rates progressively increased with age in both sexes, reaching their peak at 85 years or more (21.4/1000 overall, 35.0 for men and 13.4 for women). The 28-day case-fatality was 18.1%., Conclusions: Our study supports previous findings of lower incidence of stroke in the Mediterranean area, whereas the case-fatality in our study was lower than in previous studies from Italy. Further studies are needed to determine the role of prompt referral and stroke units on prognosis in population-based setting.