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Background: In Italy, during the first epidemic wave of 2020, the peak of coronavirus disease 2019 (COVID-19) mortality was reached at the end of March. Afterward, a progressive reduction was observed until much lower figures were reached during the summer, resulting from the contained circulation of SARS-CoV-2. This study aimed to determine if and how the pathological patterns of the individuals deceased from COVID-19 changed during the phases of epidemic waves in terms of: (i) main cause of death, (ii) comorbidities, and (iii) complications related to death.Methods: Death certificates of persons who died and tested positive for SARS-CoV-2, provided by the National Surveillance system, were coded according to ICD rev10. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death.Results: The percentage of COVID-19 deaths varied over time. It decreased in the downward phase of the epidemic curve (76.6 vs. 88.7%). In February–April 2020, hypertensive heart disease was mentioned as a comorbidity in 18.5% of death certificates, followed by diabetes (15.9% of cases), ischemic heart disease (13.1%), and neoplasms (12.1%). In May–September, the most frequent comorbidity was neoplasms (17.3% of cases), followed by hypertensive heart disease (14.9%), diabetes (14.8%), and dementia/Alzheimer's disease (11.9%). The most mentioned complications in both periods were pneumonia and respiratory failure with a frequency far higher than any other condition (78.4% in February–April 2020 and 63.7% in May–September 2020).Discussion: The age of patients dying from COVID-19 and their disease burden increased in the May–September 2020 period. A more serious disease burden was observed in this period, with a significantly higher frequency of chronic pathologies. Our study suggests better control of the virus' lethality in the second phase of the epidemic, when the health system was less burdened. Moreover, COVID-19 care protocols had been created in hospitals, and knowledge about the diagnosis and treatment of COVID-19 had improved, potentially leading to more accurate diagnosis and better treatment. All these factors may have improved survival in patients with COVID-19 and led to a shift in mortality to older, more vulnerable, and complex patients.

Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Methods Patients aged 35–69 years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients’ data were compared with those from the general population. The 10-year CV risk was log-transformed, and multivariable linear regression was used to estimate mean ratios, adjusting for age, and education. Results Three hundred patients and 3,052 controls were included in the analysis. Among men, the 10-year CV risk score was very similar between patients with SMI and the general population (mean ratio [MR]: 1.02; 95%CI 0.77–1.37), whereas a 39% increase in 10-year CV risk was observed in women with SMI compared to the general population (MR: 1.39; 95%CI 1.16–1.66). Conclusions In our study, women with SMI were consistently more at risk than the general population counterpart, even at younger age.

We aimed to compare COVID-19-specific and all-cause mortality rates among natives and migrants in Italy and to investigate the clinical characteristics of individuals dying with COVID-19 by native/migrant status. The mortality rates and detailed clinical characteristics of natives and migrants dying with COVID-19 were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2,687) between February 21st and April 29th, 2020. The migrant or native status was assigned based on the individual's country of birth. The expected all-cause mortality among natives and migrants living in Italy was derived by the last available (2018) dataset provided by the Italian National Institute of Statistics. Overall, 68 individuals with a migration background were identified. The proportions of natives and migrants among the COVID-19-related deaths (97.5% and 2.5%, respectively) were similar to the relative all-cause mortality rates estimated in Italy in 2018 (97.4% and 2.6%, respectively). The clinical phenotype of migrants dying with COVID-19 was similar to that of natives except for the younger age at death. International migrants living in Italy do not have a mortality advantage for COVID-19 and are exposed to the risk of poor outcomes as their native counterparts.

Background The European Core Health Indicators (ECHI) list provides a 'snapshot' of European public health (including care). It is the result of consecutive EU-wide projects in response to a 1998 European Commission (EC) call to establish an indicator list as the core of the EU public health monitoring system. The current list contains 88 indicators, a large part of which have been implemented and used across the EU. Using ECHI to internationally compare public health aspects adds value to national health information. Currently, EC maintains a tool in which the indicators can be consulted. However, no formal governing entity exists. The aim of this study, under the Joint Action on Health Information (InfAct), is to explore the future of the policy guiding role of the ECHI list, the process of adapting and innovating the list and the role of current member state initiatives in this. Methods Relevant technical information, available via 'doc(umentation) sheets' dating from 2012, was subjected to an update process. Potential improvements in content (additions, deletions, and adjustments), overall balance and policy relevance were suggested by health information experts (via survey and expert meetings). This work will be expanded in the near future of InfAct. Results Peer-reviewed updates of the doc sheets included aligning with meta information from relevant data collecting bodies and reviving web links. A process to guide content changes to the list is in development, balancing sustainability and updates for public health policy. Online background ECHI information is disseminated via ECHI.eu. Conclusions Health information experts still consider the ECHI shortlist important for EU health policy, but it needs to be modernized and promoted. A formal structure is needed to ensure the highest value to EC and MS health policies. The future distributed research Infrastructure on population health (DIPoH) may host the shaping and governing the ECHI, in liaison with EC and MS.

Background The Institute for Health Sciences in Aragon developed a process-mining based algorithm deployed using a container solution to describe the Stroke Care Pathway reproducible in different Health Systems. Our aim is to apply the proposed solution to administrative data of an Italian region to explore interoperability in the case of the stroke care; the study is developed in the context of the Joint Action on Health Information 'InfAct' funded by the European Commission. Methods The target population included 1538055 residents in Marche Region who received National Health System (NHS) assistance in 2017. The collected information was sex, date of birth and death, residence from NHS Beneficiaries database; admission and discharge date/time, hospital code, admission type, discharge status, up to 6 diagnoses from Hospital Discharge database; admission date/time, urgent care facility code, discharge status, diagnosis from Emergency Care database. Patients without hospital/urgent care events were excluded from NHS Beneficiaries database. Care pathway traces and map with frequency information, timing across the pathway and timeline plots with time information were the outputs obtained. Results Data included 17752 patients, 10390 hospital, and 18329 urgent care events. Results were represented graphically, easy to read and spread: 500 episodes of stroke were detected, 66% of patients was hospitalised after emergency room (ER) admissions, 19% directly hospitalised and 10% discharged after ER admission. The most frequent access and exit points of the pathway were ER admission and hospital discharge. Conclusions The application of the stroke case to Italian data demonstrates feasibility and usefulness of interoperability in analysing health care administrative data for public health purposes. A European health information system is crucial to build capacity between researchers across Europe and improve health data on Health Monitoring and Health System Performance Assessment. Key messages Sharing a process-mining methodology deployed using a container solution is a useful strategy to describe care pathways and ensures results’ reliability across European Health Systems. Developing and testing tools to encourage interoperability between researchers across Europe is essential for public health policymaker in Europe.

Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target. Methods Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 Results In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions. Conclusions Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level. Key messages Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.

The European framework of health information (HI) consists - besides the supra-national framework - of national frameworks of health infrastructures. It is therefore essential to strengthening capacities to provide HI and carry out research in countries. Nowadays, one can experience lack of coordination, communication and cooperation between stakeholders in a country, leading to overlap or duplication of research and field-work. InfAct proposes a tool to overcome a majority of these difficulties by encouraging MSs to establish national nodes (NN) as a national focal point for DIPoH. A NN is a building block of DIPoH often coordinated by a national institution or governmental unit that functions as a NN and brings together relevant national stakeholders in an organised way. Researchers from public health institutes and research groups constitute the NN to share expertise and updated knowledge on HI with each other. Currently, there are some active NN in the EU, with differences in scope, scale and initial purpose, due to different organisation of HI systems in countries. Such heterogeneity can also be found in national eHealth strategies. Diverse organizational arrangements exist which has proven to influence collaborative activities. At the same time new needs are arising, such as to better bridge the digital HI between research and health care, so that our health care systems can faster contribute to integrated data driven insights. This also relates to the debate on the Health Data Space, which creation is stated in the mission letter to the new European Commissioner for Health. For example, the eHealth Network has been discussing policy documents targeted at national level policy with regard to the organization of National eHealth Networks. In this pitch presentation, an overview of different practices will be presented with proposals for future work in this area, including the role of NN in DIPoH and proposals for their sustainability. Panelists: H Van Oyen Epidemiology and Public Health, Sciensano, Brussels, Belgium Department of Public Health, Ghent University, Ghent, Belgium Contact: herman.vanoyen@sciensano.be S Montante Brussels Liaison Office, National Institute of Health of Italy (ISS), Brussels, Belgium Contact: sabrina.montante@iss.it E Bacry Health Data Hub, Santś publique France, Paris, France E Bernal-Delgado Health Services and Policy Research Group, Institute for Health Sciences in Aragon, Zaragoza, Spain Contact: ebernal.iacs@aragon.es C Sousa Pinto Advanced Analytics and Intelligence, Shared Services In Ministry Of Health, Lisbon, Portugal Contact: catiasousapinto@gmail.com

Background Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe. Methods 51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models. Results AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility. Conclusions While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education. Key messages Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.

Background Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population. Methods Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR Conclusions Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process. Key messages The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.

Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends a 25% relative reduction in the prevalence of raised blood pressure (RBP) by 2025. Prevalence of RBP and mean blood pressure in the Italian general adult population measured in the 2018 CUORE Project-Health Examination Survey are presented to investigate if Italy can reach this target. Methods Within the health examination survey conducted in 2018-2019, representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women) were examined in 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure was measured by automated oscillometric device using standardized procedures and methods; mean level of two measurements are here considered. RBP is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or being under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM. Results Preliminary analysis shows that prevalence of RBP is 43% (95% C.I. 40-47) in men and 32% (29-36) in women. Prevalence of persons with raised blood pressure and not receiving pharmacological treatment is 19% (15-22) in men and 9% (5-12) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern Regions. Mean value of systolic blood pressure is 131 mmHg (130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women. Conclusions Preliminary data underline that RBP is commonly observed in the Italian adult population. However, in comparison to data measured within the CUORE Project 10 years earlier, prevalence of RBP and mean blood pressure are declining, facilitating the meeting of WHO-NCDs target. Key messages Raised blood pressure is commonly observed in the Italian general adult population. If confirmed, in the last ten years prevalence of raised blood pressure and mean blood pressure are declining in the Italian general adult population.

Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) to cope with this critical issue. Investigation was conducted on 4798 Italian residents (49.7% women, aged 35&ndash, 79 years), participating in the CUORE Project Health Examination Survey 2008&ndash, 2012. The three MEHM questions&mdash, perceived health status, chronic morbidity and activity limitations&mdash, were examined also in association with living context, seasonality, marital status and level of education. A higher prevalence of health status negative perception was associated with older age (9% and 24% respectively in men and women aged 35&ndash, 44 years, 46% and 61% respectively in men and women aged 75&ndash, 79 years). In women, this negative perception was higher than in men in any age group, and reached 50% in the 65&ndash, 69 age group, 10 years earlier than in men. For both sexes, the level of education had a strong impact on this negative perception (odds ratio 2.32 and 2.72 in men and women respectively), while &ldquo, living alone&rdquo, played a greater impact in women than in men. MEHM activity limitations subscale was as much as 30% higher for questionnaires answered during the hottest months. This study identified potential predictors of perceived health status in adults aged 35&ndash, 79 years, which can be used to target interventions aimed at improving self-perceived health status.

During cultivation under nitrogen starvation, Yarrowia lipolytica produces a mixture of citric acid and isocitric acid whose ratio is mainly determined by the carbon source used. We report that mitochondrial succinate–fumarate carrier YlSfc1 controls isocitric acid efflux from mitochondria. YlSfc1 purified and reconstituted into liposomes transports succinate, fumarate, oxaloacetate, isocitrate and α-ketoglutarate. YlSFC1 overexpression determined the inversion of isocitric acid/citric acid ratio towards isocitric acid, resulting in 33.4 ± 1.9 g/L and 43.3 ± 2.8 g/L of ICA production in test-tube cultivation with glucose and glycerol, respectively. These titers represent a 4.0 and 6.3-fold increase compared to the wild type. YlSFC1 gene expression was repressed in the wild type strain grown in glucose-based medium compared to olive oil medium explaining the reason for the preferred citric acid production during Y. lipolytica growth on carbohydrates. Coexpression of YlSFC1 and adenosine monophosphate deaminase YlAMPD genes together with inactivation of citrate mitochondrial carrier YlYHM2 gene enhanced isocitric acid accumulation up to 41.4 ± 4.1 g/L with an isocitric acid/citric acid ratio of 14.3 in a small-scale cultivation with glucose as a carbon source. During large-scale cultivation with glucose pulse-feeding, the engineered strain produced 136.7 ± 2.5 g/L of ICA with a process selectivity of 88.1%, the highest reported titer and selectivity to date. These results represent the first reported isocitric acid secretion by Y. lipolytica as a main organic acid during cultivation on carbohydrate. Moreover, we demonstrate for the first time that the replacement of one mitochondrial transport system for another can be an efficient tool for switching product accumulation.

BackgroundThe availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources.MethodWe performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI).ResultsThe use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research.ConclusionsOur results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.

Autism spectrum disorder (ASD) is a broad and heterogeneous group of neurological developmental disorders characterized by impaired social interaction and communication, restricted and repetitive behavioural patterns, and altered sensory processing. Currently, no reliable ASD molecular biomarkers are available. Since immune dysregulation has been supposed to be related with ASD onset and dyslipidaemia has been recognized as an early symptom of biological perturbation, lipid extracts from peripheral blood mononuclear cells (PBMCs), consisting primarily of lymphocytes (T cells, B cells, and NK cells) and monocytes, of 38 children with ASD and their non-autistic siblings were investigated by hydrophilic interaction liquid chromatography (HILIC) coupled with electrospray ionization and Fourier-transform mass spectrometry (ESI-FTMS). Performances of two freeware software for data extraction and processing were compared with acquired reliable data regardless of the used informatics. A reduction of variables from 1460 by the untargeted XCMS to 324 by the semi-untargeted Alex123 software was attained. All-ion fragmentation (AIF) MS scans along with Alex123 software were successfully applied to obtain information related to fatty acyl chain composition of six glycerophospholipid classes occurring in PBMC. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were explored to verify the occurrence of significant differences in the lipid pool composition of ASD children compared with 36 healthy siblings. After rigorous statistical validation, we conclude that phospholipids extracted from PBMC of children affected by ASD do not exhibit diagnostic biomarkers. Yet interindividual variability comes forth from this study as the dominant effect in keeping with the existing phenotypic and etiological heterogeneity among ASD individuals. Graphical abstract.

A homolog of the mitochondrial succinate/fumarate carrier from yeast (Sfc1p) has been found in the Arabidopsis genome, named AtSFC1. The AtSFC1 gene was expressed in Escherichia coli, and the gene product was purified and reconstituted in liposomes. Its transport properties and kinetic parameters demonstrated that AtSFC1 transports citrate, isocitrate and aconitate and, to a lesser extent, succinate and fumarate. This carrier catalyzes a fast counter-exchange transport as well as a low uniport of substrates, exhibits a higher transport affinity for tricarboxylates than dicarboxylates, and is inhibited by pyridoxal 5′-phosphate and other inhibitors of mitochondrial carriers to various degrees. Gene expression analysis indicated that the AtSFC1 transcript is mainly present in heterotrophic tissues, and fusion with a green-fluorescent protein localized AtSFC1 to the mitochondria. Furthermore, 35S-AtSFC1 antisense lines were generated and characterized at metabolic and physiological levels in different organs and at various developmental stages. Lower expression of AtSFC1 reduced seed germination and impaired radicle growth, a phenotype that was related to reduced respiration rate. These findings demonstrate that AtSFC1 might be involved in storage oil mobilization at the early stages of seedling growth and in nitrogen assimilation in root tissue by catalyzing citrate/isocitrate or citrate/succinate exchanges.

Introduction: Obesity is associated to an increased risk of hypertension, non-communicable diseases (NCDs), such as diabetes, coronary heart disease, stroke, and cancers, and conditions including obstructive sleep apnoea and osteoarthritis. Obesity is largely preventable and one of the WHO Global Action Plan for the Prevention of NCDs targets is to halt its rise. Hypothesis: Between 2000 and 2016, obesity trends showed a steady increase in all WHO regions and income groups. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project-health examination survey. Methods: Within the ongoing survey started in 2018, mean of BMI and prevalence of obesity (BMI>=30 kg/m 2 ) and overweight (252 ) were assessed in random samples of resident population, aged 35-74 years, stratified by age and sex (men 822 and women 869), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methodologies. A standardized questionnaire was used to collect data on education and physical inactivity. The survey is funded by the Italian Ministry of Health-CCM. Results: Mean values of BMI resulted 26.8 kg/m 2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m 2 (25.6-26.3) in women. Prevalence of obesity was 19.0% (16.3-21.7) in men and 21.7% (19.0-24.5) in women; prevalence of overweight was 44.5% (41.1-47.9) in men and 28.4% (25.4-31.4) in women. Obesity levels resulted significantly higher in persons with lower education (primary or high school) vs those with higher level of education: 25.6% (20.0-31.1) vs 16.0% (13.0-19.0) in men and 32.5% (27.0-37.9) vs 16.7% (13.6-19.7) in women. Prevalence of physical inactivity during leisure time was 31.9 % (28.7-35.1) in men and 41.4% (38.2-44.7) in women. Both in men and women the prevalence of obesity was significantly higher in the Southern regions, likewise physical inactivity. Conclusions: Preliminary data of the first 8 Regions (out of 10 to be examined in the on-going survey) underline that more than half of Italian adults are in excess of weight. In comparison to data measured within the CUORE Project 10 years earlier, a slight increasing of normal weight men seems to occur moving in the direction of the WHO-NCDs obesity target.

Introduction: The WHO Global Action Plan for the Prevention of Non-Communicable Diseases (NCDs) recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Hypothesis: Agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. Within the NPP, initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators are implemented. In order to estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project. Methods: Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from random samples of persons aged 35-79 years, resident in all Italian 20 Regions. A new survey is ongoing (2018-2019) involving random samples of persons aged 35-74 years, resident in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the seven regions examined up to now in the ongoing survey and the age range of 35-74 years. Results: Within the 2018-2019 survey, mean level of sodium chloride per day in 673 men and 709 women was 161 mmol (95% confidence interval: 156-166 mmol) and 122 mmol (119-126 mmol) respectively, whereas in the 2008-2012 survey the corresponding mean levels in 642 men and 627 women was 183 mmol (95% confidence interval: 178-189 mmol) and 140 mmol (135-144 mmol), respectively. A sodium chloride intake level within the WHO recommended upper level of 85 mmol (or 5 grams of salt) per day was detected in 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019 vs 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012. Conclusions: These preliminary data show that the average habitual sodium intake in Italy is still largely higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives for reduction of sodium intake and its monitoring in the population.

Background: Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to the funds of the Italian Center for Diseases Control and Prevention-CCM of the Ministry of Health, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS. Objective: A pilot study was conducted to evaluate the feasibility of the M-PHOL international questionnaire HLS-EU using the Italian version of the short form (HLS-EU-Q16 items), during the CUORE Project-Health Examination Survey 2018-2019. Methods: One hundred people aged 35-74 years, resident in the South of Italy, were face-to-face interviewed following consecutive access to the HES. The 4 Likert-type responses were grouped in 2 classes: 0 (zero) for fairly difficult/very difficult and 1 for fairly easy/very easy. According to the HLS-EU-Q16 sum score (range: 0–16), three levels of HL were defined: ‘Inadequate’ (0–8), ‘Problematic’ (9–12), ‘Sufficient’ (13–16). HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Means and prevalence were age and gender standardised using the European standard population. Results: Ninety-eight persons completed the questionnaire (47 men, 51 women); HL mean score was 13.1 (SD=3.2) with no sex difference; prevalence of persons with ‘Inadequate’ HL was 11.2%, ‘Problematic’ 26.5%, ‘Sufficient’ 62.3%. For persons with the highest educational level (Tertiary) the highest prevalence was in the ‘Sufficient’ HL (20.5%); in the same HL category, only 3.4% was the prevalence of those with the lowest educational level (Primary). Hypertension was lower in the ‘Sufficient’ HL category (37.9% vs. 45.1% in the ‘Inadequate’ HL). Smoking habit decreased with increasing HL level (21.3%, 19.0%, 5.4% in the three HL categories, respectively). Conclusion: More than one third of interviewed adult population had ‘Inadequate’/’Problematic’ HL. Preliminary results from the Italian pilot of the HLS-EU-Q16 within the HES of the CUORE Project suggest that the survey is an important opportunity for the possibility of linking HL data with HES measured data. A national survey on HL will be implemented in the Italian general population in the framework of the M-POHL network.

Introduction: Hypertension is a major risk factor for coronary heart disease, chronic kidney disease, ischaemic and haemorrhagic stroke. The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) target by 2025 for hypertension is a 25% relative reduction in the prevalence of raised blood pressure. Hypothesis: Prevalence of raised blood pressure in adults has declined in high-income countries over the past few decades; the CUORE project surveys have shown this trend also in Italy from the 1980s to the 2010s. This preliminary analysis aims to assess mean level of blood pressure and prevalence of raised blood pressure in the Italian general adult population using the data collected within the CUORE Project-health examination survey. Methods: Within the ongoing survey, started in 2018, mean of blood pressure and prevalence of raised blood pressure are assessed in random samples of resident population, aged 35-74 years, stratified by age and sex (men 822 and women 869), from 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure is measured three times consecutively by automated oscillometric device using standardized procedures and methods. Mean level of first two measurements are here considered. Raised blood pressure is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM. Results: Preliminary analysis shows a mean value of systolic blood pressure of 131 mmHg (95% C.I.130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women. Prevalence of raised blood pressure is 43.3% (39.9-46.7) in men and 32.4% (29.2-35.5) in women. In men prevalence of persons with raised blood pressure and untreated is 18.5% (14.6-22.3) and 8.6% (5.4-11.7) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern regions. Conclusions: Preliminary data of first 8 Regions (out of 10 which should be examined) underline that raised blood pressure is widely present in the Italian adult population. In comparison to data measured within the CUORE Project 10 years earlier, a decrease of mean level of blood pressure and prevalence of raised blood pressure seems to occur facilitating the meeting of WHO-NCDs target.

Background: The Italian National Prevention Plan 2005-2008 included a 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE-Project risk score. GPs were encouraged to collect data on risk factors, perform a 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim: The aim of this study is to show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population, a first step to implement primary preventive actions at individual level. Methods: A training plan for GPs was launched by the Ministry of Health. Data were collected using the cuore.exe software, easily and freely downloadable by GPs from the CUORE-Project website (www.cuore.iss.it). The CRO provides a web-platform to analyze and compare data on 10-CR and risk factors at both regional and national level. In the subgroup of persons examined at least twice a year, variations in continuous risk factors mean levels and categorical risk factors prevalence between baseline and follow-up and their 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results: By October 2019, about 3,500 GPs downloaded cuore.exe ; about 300,000 CR assessments on about 140,000 persons were sent to CRO. CR mean was 3.1% in women, 8.5% in men; 28% of men and 64% of women were at lower risk (CR Conclusions: Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. The individual risk score is becoming a useful tool for GPs to assess their patients’ CR and promote primary prevention by focusing attention on the adoption of healthy lifestyles. These encouraging data can be used to support health policy decision processes.

The aim of this study is to evaluate whether nutrients intake in an Italian adult population receiving pharmacological treatment for hypertension, dyslipidemia, and diabetes are within the recommended values proposed by dietary guidelines. Cross-sectional data from the Cardiovascular Epidemiology Observatory/Health Examination Survey in 8462 individuals 35&ndash, 79 years were used. Food consumption was assessed with a self-administered semi-quantitative food frequency questionnaire. Dietary sodium and potassium intakes were measured in 24-hour urine collection. Recommendations from WHO were used for salt and potassium intakes, those from the Diabetes and Nutrition Study Group for diabetes, and those from the European Society of Cardiology for hypertension and dyslipidemia. Salt intake in urine collection of participants receiving treatment for hypertension was 11.1 &plusmn, 4.0 g/day for men and 8.6 &plusmn, 3.3 g/day for women, higher than recommended. In participants treated for dyslipidemia, mean saturated fat intake was 11.4% and 11.6% total Kcal in men and women respectively, higher than recommended, while cholesterol intake was higher only in men (365.9 &plusmn, 149.6 mg/day). In both men and women receiving treatment for diabetes, mean intake of saturated fats (12.3% and 12.2% of total Kcal), simple carbohydrates (17.5% and 19.8% of total Kcal) and cholesterol (411.0 &plusmn, 150.4 and 322.7 &plusmn, 111.1 mg/day) were above the recommendations, while fiber intake was below (19.5 &plusmn, 6.3 and 17.5 &plusmn, 6.2 mg/day). Overall, 70% to 80% of participants treated for these conditions received advice from family doctors on dietary management, however, nutrition is far from being optimal.

Background The availability of data generated from different sources is increasing with the possibility to link these data sources together. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and the artificial intelligence (AI) in routine public health activities, and to identify the related health outcome and intervention indicators and determinants of health for non-communicable diseases. Method We performed a survey across European countries to explore the current practices applied by national institutes of public health and health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or the AI). Results The use of data linkage and the AI at national institutes of public health and health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health and health information and statistics. Using linked data, 46 health outcome indicators related to seven health conditions, 34 indicators related to determinants and 23 to health interventions were estimated in routine. Complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to link different data sources in routine for public health surveillance and research. Conclusions Our results highlight that the majority of European countries have integrated data linkage in routine public health activities but a few use the AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development process. Building analytical capacity and awareness of the added value of data linkage in national institutes is necessary for improving the utilization of linked data in order to improve the monitoring of public health activities.

Oxidative stress is considered to be a key factor of the pathogenesis of Parkinson&rsquo, s disease, a multifactorial neurodegenerative disorder characterized by reduced dopaminergic neurons in the substantia nigra pars compacta and accumulated protein aggregates. Rotenone is a worldwide-used pesticide that induces the most common features of Parkinson&rsquo, s by direct inhibition of the mitochondrial complex I. Rotenone-induced Parkinson&rsquo, s models, as well as brain tissues from Parkinson&rsquo, s patients, are characterized by the presence of both lipid peroxidation and protein oxidation markers resulting from the increased level of free radical species. Oxidation introduces several modifications in protein structure, including carbonylation and nitrotyrosine formation, which severely compromise cell function. Due to the link existing between oxidative stress and Parkinson&rsquo, s disease, antioxidant molecules could represent possible therapeutic tools for this disease. In this study, we evaluated the effect of curcumin, a natural compound known for its antioxidant properties, in dopaminergic PC12 cells treated with rotenone, a cell model of Parkinsonism. Our results demonstrate that the treatment of PC12 cells with rotenone causes severe protein damage, with formation of both carbonylated and nitrotyrosine-derived proteins, whereas curcumin (10 &micro, M) co-exposure exerts protective effects by reducing the levels of oxidized proteins. Curcumin also promotes proteasome activation, abolishing the inhibitory effect exerted by rotenone on this degradative system.

Maps of dynamics can be beneficial for motion planning. Information about motion patterns in the environment can lead to finding flow-aware paths, allowing robots to align better to the expected mo ...

The task of building maps of dynamics is the key focus of this book, as well as how to use them for motion planning. In this chapter, we present a categorisation and overview of different types of ...

A key challenge in robotics is the efficient generation of optimal robot motion with safety guarantees in cluttered environments. Recently, deterministic optimal sampling-based motion planners have been shown to achieve good performance towards this end, in particular in terms of planning efficiency, final solution cost, quality guarantees as well as non-probabilistic completeness. Yet their application is still limited to relatively simple systems (i.e., linear, holonomic, Euclidean state spaces). In this work, we extend this technique to the class of symmetric and optimal driftless systems by presenting Dispertio, an offline dispersion optimization technique for computing sampling sets, aware of differential constraints, for sampling-based robot motion planning. We prove that the approach, when combined with PRM*, is deterministically complete and retains asymptotic optimality. Furthermore, in our experiments we show that the proposed deterministic sampling technique outperforms several baselines and alternative methods in terms of planning efficiency and solution cost.

The key idea of modelling flow of discrete objects is to capture the way they move through the environment. One method to capture the flow is to observe changes in occupancy caused by the motion of ...

The shared feature of the flow of discrete objects and continuous media is that they both can be represented as velocity vectors encapsulating direction and speed of motion. In this chapter, we pre ...

The oncogenic KRAS mutation has a critical role in the initiation of human pancreatic ductal adenocarcinoma (PDAC) since it rewires glutamine metabolism to increase reduced nicotinamide adenine dinucleotide phosphate (NADPH) production, balancing cellular redox homeostasis with macromolecular synthesis1,2. Mitochondrial glutamine-derived aspartate must be transported into the cytosol to generate metabolic precursors for NADPH production2. The mitochondrial transporter responsible for this aspartate efflux has remained elusive. Here, we show that mitochondrial uncoupling protein 2 (UCP2) catalyses this transport and promotes tumour growth. UCP2-silenced KRASmut cell lines display decreased glutaminolysis, lower NADPH/NADP+ and glutathione/glutathione disulfide ratios and higher reactive oxygen species levels compared to wild-type counterparts. UCP2 silencing reduces glutaminolysis also in KRASWT PDAC cells but does not affect their redox homeostasis or proliferation rates. In vitro and in vivo, UCP2 silencing strongly suppresses KRASmut PDAC cell growth. Collectively, these results demonstrate that UCP2 plays a vital role in PDAC, since its aspartate transport activity connects the mitochondrial and cytosolic reactions necessary for KRASmut rewired glutamine metabolism2, and thus it should be considered a key metabolic target for the treatment of this refractory tumour. UCP2 is shown in yeast and mammalian cells to transport aspartate out of mitochondria, thus enabling KRAS-mutated pancreatic ductal adenocarcinoma cells to perform glutaminolysis to support cancer growth.

During the last 6 months, the world has been unsettled by the diffusion of a virus that has peculiar properties, causing alarm not only for the direct pathologic effect of the virus on affected individuals, but, mostly, for its only partially clarified ways of propagation [[1, 2]]. The medical, social, and economic impact of the new disease is extraordinary and also deeply touches our ethical and moral values. The public confidence in science is perturbed because the medical response is dominated by uncertainty, and the requests to science for a fast remedy are left unmet

BackgroundWe investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological ‘wear and tear’, resulting from adaptation to chronic stress.MethodsIn a cross-sectional analysis, 27 019 men and 26 738 women aged 35–74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components.ResultsLess-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women.ConclusionsIn men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.

Background: Waist circumference (WC) and hip circumference (HC) are both strongly associated with risk of death, however their joint association has rarely been investigated. This study aimed to assess the combined influence of WC and HC, as well as a range of other obesity measures, with the risk of all-cause and cardiovascular disease (CVD) death. Methods: This study uses participant data from 30 cohorts of the MORGAM Project conducted in 11 countries; 90,487 males and females aged 30-74 years, predominantly Caucasian, with no history of CVD, recruited in 1986-2010, and followed-up for up to 24 years. Hazard ratios were estimated using sex specific Cox models stratified by cohort with age as the time scale. Models included baseline categorical obesity measures, age, total and HDL cholesterol, systolic blood pressure, antihypertensive drugs, smoking and diabetes. Findings: 9105 all-cause deaths were recorded during a median follow up of 10 years. Hazard ratios for all-cause death presented J- or U-shaped associations with most obesity measures. When WC and HC were included in the same model, in both men and women, for all hip sizes, having a smaller waist was found to be strongly associated with lower risk of death, except for males with the smallest hip size. In addition, among those with smaller waists, hip size was strongly negatively associated with risk of death, with around 20% more people identified as being at increased risk compared to WC alone. Interpretation: A more complex relationship between HC, WC and risk of death is revealed when both measures are considered simultaneously. This is particularly true for individuals with smaller waists, where having larger hips was protective. Considering both WC and HC in the clinical setting could help to best identify those at increased risk of death. Funding Statement: The MORGAM Project received funding from Medical Research Council London grant G0601463 (80983) and European Union FP7 project BiomarCaRE (HEALTH-F2-2011-278913). The activities of the MORGAM Data Centre have been sustained also by recent funding from European Union FP 7 project CHANCES (HEALTH-F3-2010-242244). AJC, HR and LO were supported by Deakin University. AJC is the recipient of an Australian Research Council Discovery Early Career Researcher Awards (project number DE160100141). SS was supported by the Swedish Heart-Lung Foundation, the County Council of Vasterbotten (ALF, VLL-548791), and Umea University. Declaration of Interests: No conflicts of interest exist in relation to this work. Ethics Approval Statement: Each MORGAM participating centre was responsible for ethical approval and patient consent, according to local rules at the time of study enrollment.

Background Health information systems both at the national and international level play a key role in ensuring that timely and reliable evidence is used for operational and strategic decision making inside and outside the health sector. The availability of data generated from different sources is increasing with the possibility to link these data sources together. However, more efficient data generation processes are required to use data collected for different purposes initially, as well as advanced statistical techniques to generate comparable and timely health information. The main objective is to explore the innovative use of health information for better public health policy across the Member States. Methods As part of InfAct, we have conducted as survey among EU-MS to describe the innovative use of data sources. We are collecting inspiring examples on the innovative use of health information based on national or European data networks involved with health policy-making at national, regional or local level. We are further developing generic methods to estimate health indicators using machine learning techniques and mathematical modelling. Results These approaches will generate a roadmap on the innovative use of health information across Member States, enlarge the existing list of health indicators estimated from linked data and/or advanced statistical techniques, inform on the implications of these indicators in health policy with inspiring examples from Member States, and provide methodological guidelines for using linked data and advanced statistics to estimate health indicators, and composite outcome measures. Conclusions This work will highlight the gaps in the innovative use of data sources, and improve the comparability of health indicators and the capacity of EU-Member states to apply innovation for increased relevance and timeliness of health information for public health policy-making.

Issue Health literacy (HL) is recognized as a determinant, mediator or moderator of health and of use and results of health care services Inadequate HL is associated with patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. Description of the problem Few previous studies suggested that inadequate HL is a prevailing problem in Italy. As compared with the European Countries, Italy has peculiar characteristics of socio-demographic determinants of HL levels, which constitute a challenge for policy making. In so far HL has not been considered as a strategic priority for the Italian National Health Service. The Italian National Institute of Health and Ministry of Health are promoting a national program on HL by adhering to the WHO action network on measuring population and organizational health literacy (M-POHL). Main aim of the program is to propose policies that could enable all citizens to share the benefits of improved HL. A national population survey, coordinated at European level, has been planned in each participating country in 2019. Preliminary results We are setting up the survey using the questionnaire with 47 specific questions about HL and 32 about lifestyles and demographic characteristics. Updated results of this survey will be analysed in order to define a strategic line for the implementation of actions for the improvement of HL in the next National Prevention Plan. Furthermore, the national survey will be scheduled and repeated to monitor results. Lesson State Policies can be implemented at individual, community, organization or system level. Italy is at the beginning of its experience in this field. A national steering committee of experts has also been appointed to support HL policy initiatives. The comparison with existing policies in other countries within the M-POHL action will be another asset to develop HL policies and related activities to benefit citizens, patients and communities.

Background Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project. Methods Mean of BMI and prevalence of obesity (BMI > =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee. Results In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively. Conclusions Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025. Key messages Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.

Issue The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Description of the problem According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls. Results The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months. Lessons In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025. Key messages In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.

Background Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to Ministry of Health funds, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS. Objective: The HLS-EU-Q16 questionnaire was administered to a sample of adult population during the Health Examination Survey-HES of the CUORE Project started in 2018, to verify and evaluate the feasibility of the HL survey. Methods One hundred people aged 35-74 years, resident in Reggio Calabria (South of Italy), were interviewed (face-to-face) following consecutive access to the HES. According to the HLS-EU-Q16 sum score, three levels of HL were defined: inadequate, problematic, and sufficient. HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Results HL mean score of 98 completed questionnaires (47 men, 51 women) was 13.0 (SD = 3.5), with no sex difference; prevalence of persons with inadequate HL was 11.2%, problematic 26.5%, sufficient 62.3%. Sufficient HL level presents the highest prevalence (72%) of high educational level. Smoking habit decreases as HL level increases. Conclusions The HLS-EU-Q16 questionnaire represents a standardised tool applicable in the general population. Preliminary results from the Italian pilot of the HLS-EU-Q16 suggest that the survey is feasible within the HES of the CUORE Project, with the opportunity to link HL data with HES measured data. More than one third of interviewed adult population have inadequate/problematic HL.

Background Identification of high risk individuals is one of the main goals of the primary prevention of cardiovascular disease (CVD) and constitutes the basis for implementing actions aiming at reducing modifiable risk factors at individual level through changing life styles or drug interventions. The most appropriate method for identifying high risk individuals is the absolute risk assessment, a probability indicator of incidence, predictable on the basis of risk factors levels. Objectives The CUORE project score of the National Institute of Health-ISS is adopted in Italy; since 2007 ISS has implemented a national training course for General Practitioners-GPs with the aim of supporting and facilitating the use of CVD risk assessment in clinical practice as a preventive action in the general population. Results The training course is based on five sequential packages linked to educational credits: packages 1-2 facilitate the adoption of standardised methodologies for the assessment of CVD risk score; in package 3 patients are invited by GPs to assess the risk score; packages 4-5 evaluate and discuss data collected with GPs and stakeholders. A cascade training was implemented: ISS personnel provided training to local GPs who in turn provided the same training to other GPs. Two manuals for the training course were published. Since 2007 about 4,300 GPs were trained; about 320,000 10-year CVD risk assessments were performed in 260,000 men and women aged 35-69 years. Feedback was provided to all GPs participating to the 4th-5th packages of the training courses. Conclusions Implementation of the training course for the use of CVD risk assessment in the population represents a primary preventive action according to the recommendation of the EU Guideline on CVD prevention. The collected data may play an important role in the identification of strengths and weaknesses of preventive actions and represents the first step to improve good clinical practices standards.

Background Data collection methods, metadata-reporting standards and usage of data for health monitoring (HM) and health system performance assessment (HSPA) are not uniform in Europe. Moreover, the evidence produced by research are not always available, comparable or usable for research purposes and policy making. The aim is to summarize health data collection methods, quality assessment, availability and accessibility procedures covering different data sources for HM and HSPA across EU countries. Methods The study is conducted through a multidimensional approach, which includes: i) a review of institutional websites (OECD, Eurostat, WHO-Europe); ii) a review of EU research networks; and iii) a multi-national survey addressing epidemiologists, health data managers and researchers that have played leading roles in EU projects. Currently, the survey instrument is being piloted. A qualitative data analysis to describe and compare the identified data sources for HM and HSPA will be performed. Results As part of the work within the Joint Action ‘Information for Action’ (InfAct), the study will generate knowledge on standardized health data collections and related metadata, used methods and procedures for HM and HSPA in EU. It will also facilitate the identification of national or sub-national health data collected through standardized procedures but not included in international databases or research networks. Conclusions The lack of infrastructures for health data sharing in EU limits data usage and comparability within and between countries. This study, as part of InfAct, will facilitate the assessment of health inequalities across EU countries in terms of quality, availability, accessibility and comparability of health data and information. It will also facilitate sharing and dissemination of standardized and comparable health data collections, which are essential for research and evidence-based policy-making.

In Saccharomyces cerevisiae the export of 2-oxoglutarate from the mitochondria, catalyzed by Yhm2p, Odc1p and Odc2p or by at least one of these transporters, has recently been shown to be essential for glutamate biosynthesis in glucose-supplemented minimal synthetic (SM) medium without glutamate, because the triple mutant yhm2∆odc1∆odc2∆ displays a growth defect under these conditions. Surprisingly, in this study it was found that yhm2∆odc1∆odc2∆ cells grow like wild-type (WT) cells in the same medium supplemented with non-fermentable carbon sources. Direct transport assays of 2-oxoglutarate/2-oxoglutarate homoexchange activity in mitochondria from WT and yhm2∆odc1∆odc2∆ cells (solubilized and reconstituted into liposomes) showed that the mitochondrial extract from yhm2∆odc1∆odc2∆ was completely inactive at variance with that from WT cells, showing that S. cerevisiae mitochondria do not contain additional proteins capable of catalyzing 2-oxoglutarate transport efficiently besides Yhm2p, Odc1p and Odc2p. Furthermore, quantitative real-time PCR experiments showed that in both WT and yhm2∆odc1∆odc2∆ cells the expression of GDH1 is low on lactate and high on glucose and, vice versa, the expression of GDH3 is high on lactate and low on glucose. These results may be interpreted to indicate that in S. cerevisiae, grown in glucose-supplemented SM medium, glutamate is synthesized by Gdh1p in the cytosol, whereas in lactate-supplemented SM medium glutamate is synthesized by Gdh3p in the mitochondria; therefore, the pathway of ammonia assimilation under fermentative conditions requires export of 2-oxoglutarate from the mitochondria, whereas the alternative pathway under respiratory conditions does not.

International audience; The Arabidopsis thaliana genome contains 58 members of the solute carrier family SLC25, also called the mitochondrial carrier family, many of which have been shown to transport specific metabolites, nucleotides, and cofactors across the mitochondrial membrane. Here, two Arabidopsis members of this family, AtUCP1 and AtUCP2, which were previously thought to be uncoupling proteins and hence named UCP1/PUMP1 and UCP2/PUMP2, respectively, are assigned with a novel function. They were expressed in bacteria, purified, and reconstituted in phospholipid vesicles. Their transport properties demonstrate that they transport amino acids (aspartate, glutamate, cysteine sulfinate, and cysteate), dicarboxylates (malate, oxaloacetate, and 2-oxoglutarate), phosphate, sulfate, and thiosulfate. Transport was saturable and inhibited by mercurials and other mitochondrial carrier inhibitors to various degrees. AtUCP1 and AtUCP2 catalyzed a fast counterexchange transport as well as a low uniport of substrates, with transport rates of AtUCP1 being much higher than those of AtUCP2 in both cases. The aspartate/glutamate heteroexchange mediated by AtUCP1 and AtUCP2 is electroneutral, in contrast to that mediated by the mammalian mitochondrial aspartate glutamate carrier. Furthermore, both carriers were found to be targeted to mitochondria. Metabolite profiling of single and double knockouts shows changes in organic acid and amino acid levels. Notably, AtUCP1 and AtUCP2 are the first reported mitochondrial carriers in Arabidopsis to transport aspartate and glutamate. It is proposed that the primary function of AtUCP1 and AtUCP2 is to catalyze an aspartate(out)/glutamate(in) exchange across the mitochondrial membrane and thereby contribute to the export of reducing equivalents from the mitochondria in photorespiration.

BACKGROUND: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.METHODS: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies.FINDINGS: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.INTERPRETATION: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.

Background there is concern about the increased risk for SARS-CoV-2 infection, COVID-19 severe outcomes and disparity of care among patients with a psychiatric disorder (PD). Based on the Italian COVID-19 death surveillance, which collects data from all the hospitals throughout the country, we aimed to describe clinical features and care pathway of patients dying with COVID-19 and a preceding diagnosis of a PD. Methods in this cross-sectional study, the characteristics of a representative sample of patients, who have died with COVID-19 in Italian hospitals between February 21st and August 3rd 2020, were drawn from medical charts, described and analysed by multinomial logistic regression according to the recorded psychiatric diagnosis: no PD, severe PD (SPD) (i.e. schizophrenia and other psychotic disorders, bipolar and related disorders), common mental disorder (CMD) (i.e. depression without psychotic features, anxiety disorders). Findings the 4020 COVID-19 deaths included in the study took place in 365 hospitals across Italy. Out of the 4020 deceased patients, 84 (2•1%) had a previous SPD, 177 (4.4%) a CMD. The mean age at death was 78.0 (95%CI 77.6–78.3) years among patients without a PD, 71.8 (95%CI 69.3–72.0) among those with an SPD, 79.5 (95%CI 78.0–81.1) in individuals with a CMD. 2253 (61.2%) patients without a PD, 62 (73.8%) with an SPD, and 136 (78.2%) with a CMD were diagnosed with three or more non-psychiatric comorbidities. When we adjusted for clinically relevant variables, including hospital of death, we found that SPD patients died at a younger age than those without a PD (adjusted OR per 1 year increment 0.96; 95% CI 0.94–0.98). Women were significantly more represented among CMD patients compared to patients without previous psychiatric history (aOR 1.56; 95% CI 1.05–2.32). Hospital admission from long-term care facilities (LTCFs) was strongly associated with having an SPD (aOR 9.02; 95% CI 4.99–16.3) or a CMD (aOR 2.09; 95% CI 1.19–3.66). Comorbidity burden, fever, admission to intensive care and time from symptoms' onset to nasopharyngeal swab did not result significantly associated with an SPD or with a CMD in comparison to those without any PD. Interpretation even where equal treatment is in place, the vulnerability of patients with a PD may reduce their chance of recovering from COVID-19. The promotion of personalised therapeutic projects aimed at including people with PD in the community rather than in non-psychiatric LTCFs should be prioritised.

The ATP-Mg/phosphate carriers (APCs) modulate the intramitochondrial adenine nucleotide pool size. In this study the concentration-dependent effects of Mg2+ and other divalent cations (Me2+) on the transport of [3H]ATP in liposomes reconstituted with purified human and Arabidopsis APCs (hAPCs and AtAPCs, respectively, including some lacking their N-terminal domains) have been investigated. The transport of Me2+ mediated by these proteins was also measured. In the presence of a low external concentration of [3H]ATP (12 μM) and increasing concentrations of Me2+, Mg2+ stimulated the activity (measured as initial transport rate of [3H]ATP) of hAPCs and decreased that of AtAPCs; Fe2+ and Zn2+ stimulated markedly hAPCs and moderately AtAPCs; Ca2+ and Mn2+ markedly AtAPCs and moderately hAPCs; and Cu2+ decreased the activity of both hAPCs and AtAPCs. All the Me2+-dependent effects correlated well with the amount of ATP-Me complex present. The transport of [14C]AMP, which has a much lower ability of complexation than ATP, was not affected by the presence of the Me2+ tested, except Cu2+. Furthermore, the transport of [3H]ATP catalyzed by the ATP/ADP carrier, which is known to transport only free ATP and ADP, was inhibited by all the Me2+ tested in an inverse relationship with the formation of the ATP-Me complex. Finally, direct measurements of Mg2+, Mn2+, Fe2+, Zn2+ and Cu2+ showed that they are cotransported with ATP by both hAPCs and AtAPCs. It is likely that in vivo APCs transport free ATP and ATP-Mg complex to different degrees, and probably trace amounts of other Me2+ in complex with ATP.

To describe longitudinal relationships of metabolic syndrome (MetS) to cognitive decline and functional disability in a sample of older non-institutionalized men.data from 1991 to 2000 of the Italian cohorts of the Finland, Italy, the Netherlands, Elderly (FINE) study, were used. Global cognitive function and functional disability, defined as limitations in mobility, basic (ADLs) and instrumental activities of daily living (IADLs) were screened in 1991 and 2000. MetS was defined according to the NCEP ATP-III criteria.The study sample consisted of 195 men, baseline age 76.1±3.1years. Baseline MetS was prospectively associated with greater 10-year cognitive and functional decline in ADLs and IADLs. After multiple adjustment including age, education, marital status, ApoE ε4 allele, cerebrovascular disease and initial cognitive and depressive status, MetS predicted cognitive decline (B=-1.684, 95%CI=-2.202 to -1.167, p0.001) and risk of IADLs (OR=1.09, 95% CI=1.01-1.20, p=0.048) and ADLs disability (OR=1.35, 95%CI=1.12-1.62, p0.001). Interestingly, such associations were not attributable to individual altered components of MetS nor to their sum. Incident disability in ADLs and IADLs were not explained by parallel decline in cognitive function.MetS as an entity was associated with accelerated cognitive and functional decline in a population-based sample of very old men.