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Abstract Background Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. Methods The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20–84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater. Results During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107–109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. Conclusions For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.

ABSTRACTChina has recorded impressive economic achievements driving the structural transformation of its society. However, this transformation is marked by rising inequality, environmental pollution and stark provincial disparities. In 2015, the launching of the Agenda 2030 provided a common ground at the international level conceptualizing the United Nations’ Sustainable Development Goals (SDGs). This paper analyses the provincial performances towards the Agenda 2030 in the period 2015–19 by introducing the integrated sustainable development index cluster; convergence and econometric analyses are then used to explore synergies and trade-offs among SDGs. The empirical results capture the dynamics of sustainable development of China’s provinces and provide a clearer understanding of how policies may influence different the SDGs’ achievements, exploring the relationship between environmental versus different aspects of development. These results are used to draw policy recommendations that highlight the importance of identifying the appropriate mix of strategies to promote integrated sustainable development.

Background As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. Objective This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector. Results We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.

Abstract Objective To discuss the results of the KETASER01 trial and the reasons for its failure, particularly in view of future studies. Methods KETASER01 is a multicenter, randomized, controlled, open‐label, sequentially designed, non‐profit Italian study that aimed to assess the efficacy of ketamine compared with conventional anesthetics in the treatment of refractory convulsive status epilepticus (RCSE) in children. Results During the 5‐year recruitment phase, a total of 76 RCSEs treated with third‐line therapy were observed in five of the 10 participating Centers; only 10 individuals (five for each study arm; five females, mean age 6.5 ± 6.3 years) were enrolled in the KETASER01 study. Two of the five patients (40%) in the experimental arm were successfully treated with ketamine and two of the five (40%) children in the control arm, where successfully treated with thiopental. In the remaining six (60%) enrolled patients, RCSE was not controlled by the randomized anesthetic(s). Significance The KETASER01 study was prematurely halted due to low eligibility of patients and no successful recruitment. No conclusions can be drawn regarding the objectives of the study. Here, we discuss the KETASER01 results and critically analyze the reasons for its failure in view of future trials.

Scientists and practitioners implementing citizen science projects, in which the involvement of citizens is key, often need ideas and tools that help in reaching citizens, engaging them in the project and maximizing their contributions. In this paper, we describe the creation of an open toolkit, a web-based portal citizensciencetoolkit.eu1 designed in the framework of the CitieS-Health project for the development and promotion of citizen science (CS) projects. The main focus is on projects linking urban environmental exposures and health, but it has applicability to other settings. The toolkit comprises the steps and phases during the implementation of CS activities in environmental epidemiology. A total of 28 tools are currently included, of which most were co-designed and tested within CitiesS-Health, as well as some resulting from external projects. For each tool, in addition to the details of its purpose and the specific challenges it poses, downloadable support content is available. To help facilitate inspiration and the adoption of tools provided, an illustrative step-by-step demonstration and description of its use in a CS project in a real-life setting is included, focusing on recommendations derived from the user experience. The portal is designed as a live inventory of tools, enabling interested CS practitioners not only to replicate, but also to continuously update and enrich it is content. To this end, the long-term objective of the portal is to act as a hub of resources that would enable the active inclusion of citizens in all the phases of the participatory research projects.

Introduction: Mechanisms underlying cardiac arrhythmias are typically driven by abnormalities in cardiac conduction and/or heterogeneities in repolarization time (RT) across the heart. While conduction slowing can be caused by either electrophysiological defects or physical blockade in cardiac tissue, RT heterogeneities are mainly related to action potential (AP) prolongation or abbreviation in specific areas of the heart. Importantly, the size of the area with altered RT and the difference between the short RT and long RT (RT gradient) have been identified as critical determinators of arrhythmogenicity. However, current experimental methods for manipulating RT gradient rely on the use of ion channel inhibitors, which lack spatial and temporal specificity and are commonly only partially reversible. Therefore, the conditions facilitating sustained arrhythmia upon the presence of RT heterogeneities and/or defects in cardiac conduction remain to be elucidated.Methods: We here employ an approach based on optogenetic stimulation in a low-intensity fashion (sub-threshold illumination), to selectively manipulate cardiac electrical activity in defined areas of the heart.Results: As previously described, subthreshold illumination is a robust tool able to prolong action potentials (AP), decrease upstroke velocity as well as slow cardiac conduction, in a fully reversible manner. By applying a patterned sub-threshold illumination in intact mouse hearts constitutively expressing the light-gated ion channel channelrhodopsin-2 (ChR2), we optically manipulate RT gradients and cardiac conduction across the heart in a spatially selective manner. Moreover, in a proof-of-concept assessment we found that in the presence of patterned sub-threshold illumination, mouse hearts were more susceptible to arrhythmias. Hence, this optogenetic-based approach may be able to mimic conduction slowing and RT heterogeneities present in pathophysiological conditions.

In the last three decades, inclusive disability legislation has led to an increasing number of students with disabilities entering higher education. However, barriers to the full participation of students remain. This article presents evidence from studies conducted in two Italian universities. Drawing on the Capability Approach, the goal is to analyse the experiences of students with disabilities and to assess their capabilities in academic life. Participatory research methods were adopted using structured focus group discussion techniques. Fifty students with different types of disability participated in the study. Two major findings emerged from the data: (a) the essential value, in the experience of the students, of being able to use educational spaces, move around off campus and socialise with others; and (b) the tendency of capability achievements to vary according to context and type of disability, especially for students with visual disabilities, who experience relatively lower levels of mobility and respect.