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Supplemental material, sj-doc-1-taj-10.1177_20406223211056722 for Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project by Sabrina Zora, Carlo Custodero, Yves-Marie Pers, Verushka Valsecchi, Alberto Cella, Alberto Ferri, Marta M. Pisano-Gonz��lez, Delia Pe��acoba Maestre, Raquel Vazquez Alvarez, Hein Raat, Graham Baker and Alberto Pilotto in Therapeutic Advances in Chronic Disease

Supplemental material, sj-doc-2-taj-10.1177_20406223211056722 for Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project by Sabrina Zora, Carlo Custodero, Yves-Marie Pers, Verushka Valsecchi, Alberto Cella, Alberto Ferri, Marta M. Pisano-Gonz��lez, Delia Pe��acoba Maestre, Raquel Vazquez Alvarez, Hein Raat, Graham Baker and Alberto Pilotto in Therapeutic Advances in Chronic Disease

IntroductionMore than 70% of world mortality is due to chronic conditions. Furthermore, it has been proven that social determinants have an enormous impact on both health-related behaviour and on the received attention from healthcare services. These determinants cause health inequalities. The objective of this study is to reduce the burden of chronic diseases in five European regions, hereby focusing on vulnerable populations, and to increase the sustainability of health systems by implementing a chronic disease self-management programme (CDSMP).Methods and analysis2000 people with chronic conditions or informal caregivers belonging to vulnerable populations, will be enrolled in the CDSMP in Spain, Italy, the UK, France and the Netherlands. Inclusion of patients will be based on geographical, socioeconomic and clinical stratification processes. The programme will be evaluated in terms of self-efficacy, quality of life and cost-effectiveness using a combination of validated questionnaires at baseline and 6 months from baseline.Ethics and disseminationThis study will follow the directives of the Helsinki Declaration and will adhere to the European Union General Data Protection Regulation. The project’s activities, progress and outcomes will be disseminated via promotional materials, the use of mass media, online activities, presentations at events and scientific publications.Trial registration numberISRCTN70517103; Pre-results.

The impact of past global climate change on local terrestrial ecosystems and their vegetation and soil organic matter (OM) pools is often non-linear and poorly constrained. To address this, we investigated the response of a temperate habitat influenced by global climate change in a key glacial refuge, Lake Ohrid (Albania, Macedonia). We applied independent geochemical and palynological proxies to a sedimentary archive from the lake over the penultimate glacial-interglacial transition (MIS 6–5) and the following interglacial (MIS 5e-c), targeting lake surface temperature as an indicator of regional climatic development and the supply of pollen and biomarkers from the vegetation and soil OM pools to determine local habitat response. Climate fluctuations strongly influenced the ecosystem, however, lake level controls the extent of terrace surfaces between the shoreline and mountain slopes and hence local vegetation, soil development and OM export to the lake sediments. There were two phases of transgressional soil erosion from terrace surfaces during lake-level rise in the MIS 6–5 transition that led to habitat loss for the locally dominant pine vegetation as the terraces drowned. Our observations confirm that catchment morphology plays a key role in providing refuges with low groundwater depth and stable soils during variable climate.

Paleoecology can provide valuable insights into the ecology of species that complement observation and experiment-based assessments of climate impact dynamics. New paleoecological records (e.g., pollen, macrofossils) from the Italian Peninsula suggest a much wider climatic niche of the important European tree species Abies alba (silver fir) than observed in its present spatial range. To explore this discrepancy between current and past distribution of the species, we analyzed climatic data (temperature, precipitation, frost, humidity, sunshine) and vegetation-independent paleoclimatic reconstructions (e.g., lake levels, chironomids) and use global coupled carbon-cycle climate (NCAR CSM1.4) and dynamic vegetation (LandClim) modeling. The combined evidence suggests that during the mid-Holocene (6000 years ago), prior to humanization of vegetation, A. alba formed forests under conditions that exceeded the modern (1961-1990) upper temperature limit of the species by 5-7°C (July means). Annual precipitation during this natural period was comparable to today (>700-800 mm), with drier summers and wetter winters. In the meso-Mediterranean to sub-Mediterranean forests A. alba co-occurred with thermophilous taxa such as Quercus ilex, Q. pubescens, Olea europaea, Phillyrea, Arbutus, Cistus, Tilia, Ulmus, Acer, Hedera helix, Ilex aquifolium, Taxus, and Vitis. Results from the last interglacial (ca. 130 000-115 000 BP), when human impact was negligible, corroborate the Holocene evidence. Thermophilous Mediterranean A. alba stands became extinct during the last 5000 years when land-use pressure and specifically excessive anthropogenic fire and browsing disturbance increased. Our results imply that the ecology of this key European tree species is not yet well understood. On the basis of the reconstructed realized climatic niche of the species, we anticipate that the future geographic range of A. alba may not contract regardless of migration success, even if climate should become significantly warmer than today with summer temperatures increasing by up to 5-7°C, as long as precipitation does not fall below 700-800 mm/yr, and anthropogenic disturbance (e.g., fire, browsing) does not become excessive. Our finding contradicts recent studies that projected range contractions under global-warming scenarios, but did not factor how millennia of human impacts reduced the realized climatic niche of A. alba.

The Eurasian (née European) Modern Pollen Database (EMPD) was established in 2013 to provide a public database of high-quality modern pollen surface samples to help support studies of past climate, land cover, and land use using fossil pollen. The EMPD is part of, and complementary to, the European Pollen Database (EPD) which contains data on fossil pollen found in Late Quaternary sedimentary archives throughout the Eurasian region. The EPD is in turn part of the rapidly growing Neotoma database, which is now the primary home for global palaeoecological data. This paper describes version 2 of the EMPD in which the number of samples held in the database has been increased by 60 % from 4826 to 8134. Much of the improvement in data coverage has come from northern Asia, and the database has consequently been renamed the Eurasian Modern Pollen Database to reflect this geographical enlargement. The EMPD can be viewed online using a dedicated map-based viewer at https://empd2.github.io and downloaded in a variety of file formats at https://doi.pangaea.de/10.1594/PANGAEA.909130 (Chevalier et al., 2019).

The impact of past global climate change on local terrestrial ecosystems and their vegetation and soil organic matter (OM) pools is often non-linear and poorly constrained. To address this, we investigated the response of a temperate habitat influenced by global climate change in a key glacial refuge, Lake Ohrid (Albania, Macedonia). We applied independent geochemical and palynological proxies to a sedimentary archive from the lake over the penultimate glacial-interglacial transition (MIS 6–5) and the following interglacial (MIS 5e-c), targeting lake surface temperature as an indicator of regional climatic development and the supply of pollen and biomarkers from the vegetation and soil OM pools to determine local habitat response. Climate fluctuations strongly influenced the ecosystem, however, lake level controls the extent of terrace surfaces between the shoreline and mountain slopes and hence local vegetation, soil development and OM export to the lake sediments. There were two phases of transgressional soil erosion from terrace surfaces during lake-level rise in the MIS 6–5 transition that led to habitat loss for the locally dominant pine vegetation as the terraces drowned. Our observations confirm that catchment morphology plays a key role in providing refuges with low groundwater depth and stable soils during variable climate.

We analysed sediments from Crveni Potok (Tara Mountains, Serbia), a key site in the Dinaric Alps because it is located within the restricted distribution range of the endemic conifer Picea omorika (Serbian spruce), and thereby bears a unique potential in revealing its Holocene history. We used a set of proxies (pollen, plant-macrofossils, charcoal) to reconstruct the long-term vegetation and fire histories at different spatial scales. The comprehensive snapshot provided by the reconstructions fill an important gap of European long-term vegetation and fire histories in the overall data-coverage poor region of the Dinaric Alps. The reconstructions unfolded an unusual late-Holocene persistence of high forest cover that contrasts with the large majority of European landscape-scale forest-cover records, which show massive anthropogenic openings in the past two millennia. We also found evidence for good post-fire recovery of the currently threatened endemic P. omorika populations. This leads us to suggest that prescribed-burning programmes may be beneficial to reduce the vulnerability of the species, and for ecological restoration and conservation purposes of the declining and endangered populations.