Italian Island Research Articles

A survey of VKORC1 missense mutations in eleven Italian islands reveals widespread rodenticide resistance in house mice

To protect native wildlife, more than one hundred rodent eradications have been attempted in the Mediterranean islands by using anticoagulant rodenticides (ARs). Despite their high efficiency, resistance to ARs has been observed in many countries and it is mostly related to missense mutations (SNPs) in the VKORC1 gene. The presence of resistant individuals reduces the efficiency of rodent management, leading to an excessive use of ARs. Thus, the risk of poisoning in non-target species increases. In this study, the first survey of ARs resistance in the house mouse Mus domesticus covering multiple islands in the Mediterranean was performed. Tissue samples of eighty-two mice from eleven islands in Italy were analysed and eight missense SNPs were found. In addition to some well-known missense mutations, such as Tyr139Cys, six new missense SNPs for the house mouse were discovered, four of which were new even for any rodent species. Furthermore, the frequency of Tyr139Cys significantly increased in Ventotene Island after a four-year long rat eradication. This could be due to the selective pressure of ARs that allowed the mice carrying the mutation to survive. This study demonstrates once again the importance of assessing resistance to ARs before undertaking rodent eradications. Indeed, this would allow an informed decision of the most effective AR to use, maximizing the success rate of the eradications and minimizing secondary poisoning and other deleterious effects for non-target species and the environment.

Influence of Dietary Heritage in a Restricted Geographic Area and Role of Food Additives on Risk of Recurrent Kidney Stone.

Dietary factors may be implicated in the formation of kidney stones and should be closely monitored. To achieve this aim, patients are routinely assessed by means of generic dietary recall, a tool widely used by authors in a range of extensive patient populations to record food intake; the findings obtained, however, may be skewed due to dietary variations and underestimation of the effect of food additives. Fifty Frequent Kidney Stone Formers (FKSFs, mean age: 54.3 ± 13.9 years) with normal kidney function, absence of comorbidities, and reliable compliance were selected from a total of 68 patients' resident in Sardinia, an Italian island where genetic admixtures have been relatively rare for generations. The study, conducted from 1 January 2020 to 31 December 2023, was aimed at assessing nutritional values based on the meticulous recording of food quantities, quality, and potential modifications related to food preparation. Patients were selected during an initial clinical check-up and all efforts made to ensure they were capable of reliably recording all food and drinks consumed. A seven-day food diary was provided in which food and drink intake and their impact on 24 h urine output was recorded. The following parameters were measured in both foods and urine output: citrates, oxalates, calcium, phosphorous, uric acid, proteins and nitrogen compounds, magnesium, sulfates, potassium, carbohydrates, free fatty acids. Study outcomes established the presence of hypocitraturia, hyperoxaluria, hypercalciuria, and moderately high levels of nitrogen compounds. Univariate analysis followed by multivariate analysis for further confirmation were performed and the following observations made. Citrate intake correlated with citraturia but did not promote oxaluria; calcium intake promoted onset of sulfaturia, azoturia, and ammoniuria, whilst magnesium correlated with magnesiuria but not with oxaluria, calciuria, phosphaturia, and azoturia; sulfate intake elicited onset of azoturia but not kaliuresis; potassium intake promoted oxaluria and protein intake resulted in onset of ammoniuria and azoturia. (A) The chemical composition of urine based on dietary intake is hard to predict without taking into account the presence of dietary and urinary interferents; (B) the geographic isolation of patients studied underlines the importance of epigenetics in maintaining a traditional dietary heritage. (C) Moreover, the widespread use of food additives should consistently be taken into account to ensure a correct diagnosis of FKSF and set up a valid treatment plan.

Time and space co-ordinates of Hodgkin's lymphoma in Sardinia, Italy

BackgroundThe epidemiological investigation of Hodgkin's lymphoma (HL) among the genetically peculiar population of the Italian island of Sardinia might provide interesting etiological clues. MethodsWe used the database of 1974–2003 incident cases of hematological malignancies in Sardinia and Bayesian methods to explore the time trend and geographic spread of HL incidence by sex, and age whether ≤44 or ≥45 years. We also tested its association with several socio-economic and environmental risk factors. ResultsThe age- and sex-standardized (world population) incidence rate of HL was 2.6 per 100,000 (95% CI, 2.5–2.8). Over the study period, HL incidence increased linearly in both sexes and among those aged ≤44 years but not above that age. Cases clustered among young women in a central-western area covering four bordering administrative units (13 cases vs. 5.7 expected, P = 0.002). The posterior probability of excess HL cases aged ≤44 years was elevated only in a commune in the suburban area of the region's capital. Cases aged ≥45 years were uniformly spread over the region. Among the risk factors we explored, urban residence was associated with an elevated and goat farming with a decreased risk of HL occurrence. We did not observe a link with socio-economic deprivation, environmental exposures, or multiple sclerosis. The geographic spread of COVID-19 was also unrelated to past HL incidence. ConclusionsOur results prompt further in-depth investigation into the previously undetected cluster and the nature of the observed associations.

An expanded phylogeny of the genus Pseudamnicola (Gastropoda; Truncatelloidea; Hydrobiidae) across the Mediterranean Basin.

The genus Pseudamnicola Paulucci, 1878, is commonly found throughout the Mediterranean region. The genus displays considerable levels of endemism, accompanied by notable systematic and taxonomic ambiguity. However, the application of molecular data has proven highly effective in clarifying taxonomy and unveiling the diversity of cryptic species within the genus. Therefore, we employed all cytochrome c oxidase subunit I sequence data available and generated new ones from Greece to infer the phylogeny of the genus throughout its Mediterranean range and estimate the divergence times as well as the ancestral area of diversification. Our phylogenetic and time-estimate analyses demonstrate that with 36 to 38 extant Pseudamnicola species and genetic divergences across species ranging from 0.5% to 11.9% on average, the genus underwent relatively recent diversification during late Miocene (6.53 Ma), and the primary speciation events occurred during Plio-Pleistocene. The Italian Peninsula and Islands and the Ionian Drainages as defined by the Freshwater Ecoregions of the World are the ancestral regions of the genus following two different dispersal routes. Our study contributes to deepening our understanding of Pseudamnicola phylogeny by using data from throughout its range for the first time. This phylogeny provides evidence and confirms previous studies that relatively recent habitat isolation, followed by founder and dispersal events, has been one of the primary reasons for the evolution of the genus Pseudamnicola in the Mediterranean basin.

Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia

PurposeThe Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013–2022). MethodsPatients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013–December 2022) and prevalence (December 31, 2022) were calculated. ResultsA total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6–78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3–2.7) per million and 2.6 (1.9–3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7–2) per million and 1.8 (1.3–2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. ConclusionsThe epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.

Libyan deportees on the Italian island of Ustica: Remembering colonial deportations in the (peripheral) metropole

In 1911, the Italian liberal government launched the colonial occupation of what is now known as Libya, which was met with unexpected local resistance. The government resorted to mass deportations to the metropole to sedate the resistance, which continued for more than two decades under both the liberal and Fascist regimes. This chapter of Europe’s and Italy’s colonial history has been almost entirely removed from collective memory. The article explores the extent to which colonial deportations are remembered on the Sicilian Island of Ustica, which witnessed the deportation from Libya of more than 2000 people. Currently, the island is home to the only cemetery in Italy that is entirely dedicated to Libyan deportees. I argue that the visits of Libyan delegations, which took place from the late 1980s to 2010, succeeded in challenging colonial aphasia at the local level. Yet, as a result of Ustica’s peripheral position within the national space, the memory work developed through the encounter between local and Libyan actors remained marginal, despite its potential to redefine the Mediterranean as a symbolic space where colonial histories are articulated and remembered. Italy’s outsourcing of the memory work in relation to colonial deportations implies a missed opportunity to interrogate the postcolonial present and thus question persistent dynamics of power in Europe that exclude the constructed Other.

Why identification matters: an explorative study on six cases of family reunification

The escalating phenomenon of migration, accompanied by a disturbing surge in associated tragedies, has persistently violated internationally protected human rights. Absence of physical evidence, namely the presence of adequately identified corpses, may impede the full enjoyment of human rights and—in some cases—the course of justice as it obstructs the initiation of legal proceedings against individuals implicated in causing such catastrophes. It also presents administrative obstacles, as death certificates are indispensable in legitimizing statuses like orphanhood and widowhood. Family reunification, particularly for orphans, plays a significant role for those attempting to reconnect with their relatives all over the world. Likewise, for mothers, the acknowledgment of their marital status or widowhood can be a pathway to regain their marginalized right to social life. To elucidate this issue, we analyzed six representative cases from the tragic October 3, 2013, shipwreck near the Italian island of Lampedusa, where 366 individuals were retrieved dead from the sea. These cases underscore the practical challenges involved, highlighting the compelling need for continued efforts to ensure that this burdensome problem transcends from being a mere ethical, moral, and legal discourse. Although considerable progresses, these cases also reveal that substantial work still lies ahead. There is a pressing need for improved mechanisms to certify kinship ties, which are often the limiting factor in many reunifications, and can hinder the granting of custody to children. The severity and far-reaching implications of this problem necessitate thoughtful attention and action, especially considering the ongoing escalation in migration and related fatalities.

An extremely rare serovar of Salmonella enterica (Yopougon) discovered in a Western Whip Snake (Hierophis viridiflavus) from Montecristo Island, Italy: case report and review

Reptiles, including snakes, can be asymptomatically infected with multiple pathogen microorganisms, including Salmonella spp., which is considered an important concern for public and animal health. Small and uninhabited isles are quite ecologically different from mainland and represent interesting fields of study, to discover unexpected biological and microbiological aspects of their wild inhabitants. This work reports the presence of the very rare Salmonella enterica serovar Yopougon, isolated in a carcass of a native wild snake (Hierophis viridiflavus) from an Italian uninhabited island of Mediterranean Sea, Montecristo. To our knowledge, S. enterica serovar Yopougon was previously isolated only once 34 years earlier in Ivory Coast, from a human fecal sample. In the present study, we present the genomic characterization of the new isolate, the phylogenetic comparison with the previously isolated S. enterica serovar Yopougon strain of human origin and with other sequences available in public databases. In addition, an extensive review of available data in the literature and from our case history is provided. Our finding represents an example of the ability of some pathogens to travel for very long distances within their hosts and then to infect others, even from different taxa.

Italian Factive islands are not ‘that weak’

Long-distance dependencies are a major property of human language, deriving from the successive application of movement operations across sentences. Nevertheless, this possibility seems to be restricted by the presence of barriers, which ‘trap’ constituents in more or less 'resistant' syntactic islands. Given this scenario, this paper paper investigates a specific type of island, namely factive complements, which are traditionally considered ‘weak’ islands. The main goal is thus to verify the status of factive islands in Italian, based on original experimental data. Moreover, since island effects have been generally tested against wh-extractions, a secondary goal of the present study is to verify whether other types of A’-movement, such as Focus fronting, can be restricted by island effects as well. The results obtained from two experimental tests, carried out with the collaboration of a total of 310 informants, provide evidence that Italian factive islands seem to lie somewhere between strong and weak islands, qualifying as a sort of ‘intermediate’ island. Indeed, direct objects appear to be less constrained than subjects, indirect objects and adjuncts. Furthermore, the extraction of a Focus constituent from a factive complement lowers the acceptability of the sentence, thus indicating that (factive) islands are indeed sensible to Focus fronting.

An island in the sun material. Legacies of colonialism in sardinia between the nation-building process and (a lack of) decolonization

As European colonialism has had an impact both on the territories and populations that have undergone European occupation, and on Europe itself, decolonization must also be investigated by taking into consideration the so-called “motherland” as well, to verify whether, and in what way, Europeans have come to terms with that past. Studying the presences and the permanencies in the public space which shows signs of the colonial past offers an essential perspective from which to answer these questions. At the same time, conducting this analysis on a local scale allows us to investigate the meanings of these presences and legacies in depth. From this perspective, the essay investigates the case of Sardinia, an Italian island in the Mediterranean that occupies a peripheral position in the Italian state. It aims to understand, on the one hand, the role colonialism played in the island’s “nationalization”. On the other hand, the island has faced its colonial past from the fall of the Italian empire until now. The essay first retraces the position of Sardinia and Sardinians within the colonial project, then analyses the presence of different types of colonial signs (toponymy, commemorative plaques, commercial activities) in the public space. It identifies them not just in space but also in time, historicizing their presence and, therefore, their meaning. The study demonstrates that the island was crossed by an intense process of “colonization”, which ran parallel to the process of urbanization and modernization; at the same time, it has not only not questioned those signs, but in several cases they were presented again, demonstrating the absence not only of material decolonization but also, above all, of cultural decolonization.

Migrants’ deaths at Europe’s southern border: Cultural psychological dimensions of memory and mourning in Lampedusa

This paper explores undocumented migrants’ deaths, known as border-deaths, in the Mediterranean Sea by adopting liminality theory to memory and border concepts. Bordering, securitizing, externalizing, and militarizing policies have transformed the Mediterranean into the southern border of Europe. Consequently, the Sea has become a submerged cemetery where thousands of people have lost their lives. Particularly, the Italian Island of Lampedusa has become a geopolitical fiat boundary where conflicting securitarian/humanitarian symbolic frameworks compete. The death of migrants has been an ongoing historical issue, resulting a permanent state of liminality. Using empirical data collected through semi-structured interviews and participant observations in Lampedusa, this study aims to understand the cultural psychological dimension of memory from the experiential standpoint of Lampedusans citizens and community. The findings reveal three themes: the primacy of experience, the relational diffidence, and the memorialization/mourning practices act as subjective and collective forms of resistance subverting external oppressing narratives. Moreover, they also serve to differentiate mourners from spectators and to preserve the material functioning of the Lampedusan community by replicating the symbolic order holding it together. Finally, implications for a semiotic-cultural psychological and liminality theory of memory and border studies are discussed.

Genomic epidemiology of the main SARS-CoV-2 variants in Italy between summer 2020 and winter 2021.

Since the beginning of the pandemic, SARS-CoV-2 has shown a great genomic variability, resulting in the continuous emergence of new variants that has made their global monitoring and study a priority. This work aimed to study the genomic heterogeneity, the temporal origin, the rate of viral evolution and the population dynamics of the main circulating variants (20E.EU1, Alpha and Delta) in Italy, in August 2020-January 2022 period. For phylogenetic analyses, three datasets were set up, each for a different main lineage/variant circulating in Italy in that time including other Italian and International sequences of the same lineage/variant, available in GISAID sampled in the same times. The international dataset showed 26 (23% Italians, 23% singleton, 54% mixed), 40 (60% mixed, 37.5% Italians, 1 singleton) and 42 (85.7% mixed, 9.5% singleton, 4.8% Italians) clusters with at least one Italian sequence, in 20E.EU1 clade, Alpha and Delta variants, respectively. The estimation of tMRCAs in the Italian clusters (including >70% of genomes from Italy) showed that in all the lineage/variant, the earliest clusters were the largest in size and the most persistent in time and frequently mixed. Isolates from the major Italian Islands tended to segregate in clusters more frequently than those from other part of Italy. The study of infection dynamics showed a positive correlation between the trend in the effective number of infections estimated by BSP model and the Re curves estimated by birth-death skyline plot. The present work highlighted different evolutionary dynamics of studied lineages with high concordance between epidemiological parameters estimation and phylodynamic trends suggesting that the mechanism of replacement of the SARS-CoV-2 variants must be related to a complex of factors involving the transmissibility, as well as the implementation of control measures, and the level of cross-immunization within the population.

Lampedusa Island hotspot is a crucial migrant health checkpoint. Is enough attention being paid?

Abstract Background The migrant reception system in Italy operates on two levels: first and second reception centers. The first reception is carried out in collective centers -called hotspots- where newly arrived migrants are identified. Approximately, ¾ of the landings take place on Lampedusa, a small Italian island 113 km away from the Tunisian coast, that has its own hotspot. Here migrants should receive the first medical care and the first health screening and identification. The aim of this study is to understand the quality of healthcare provided at the Lampedusa hotspot. Methods A survey was conducted in April 2023 on all the 80 doctors and nurses who worked in the Lampedusa hotspot clinic between 2020 and 2022. In the first part, questions concerning their work in hotspot, experience, training before starting the task, and the actual needs of the migrant population were asked. In the second part, the focus was on available medical tools and screening for infectious diseases. Results Thirty-nine (46%) of the healthcare professionals responded to the survey, with half of them in their first work experience. Less than 40% had previously worked in a migrant assistance context. 93% of them started the job without a training course. 80% of respondents have never had access to protocols or guidelines and 80% believe that the structure is unsuitable for screening infectious diseases. Four out of 10 migrants seek treatment and ⅔ of the respondents state that there was no health screening. Conclusions These results highlight the need for health screening and treatment implementation, to prevent the spreading of infectious diseases, the development of antibiotic resistance, and the good management of economic resources. The migrant reception system in Lampedusa is highly present in the political and journalistic debate, but not as much in the scientific, as the latest publication dates back to 2015. Key messages • Lampedusa hotspot is an essential checkpoint for infectious disease and migrants’ health screening. • Migrants’ health at arrival is a public health issue that must be better tackled by the scientific community.

Lizards on the borders: source and patterns of colonization of an opportunistic reptile, Podarcis siculus, on the remote island of Pantelleria (Italy) depicted by mtDNA phylogeography and dorsal pattern

Understanding patterns and modalities of species’ colonization in insular ecosystems is a major goal of biogeography and may be key to decision makers, in terms of e.g., management and conservation. In this paper, we assess source and patterns of colonization of an opportunistic reptile, Podarcis siculus, on the remote island of Pantelleria (Italy), following a multidisciplinary approach combining molecular phylogeography and dorsal pattern analyses. We analyzed the mitochondrial gene cytochrome b (cytb) from 13 lizards and we assessed the frequency of the dorsal pattern phenotypes observing 188 basking lizards from eight localities throughout the island. The parsimony network revealed that haplotypes from Pantelleria belong to a haplogroup characteristic of western Sicily with the most common haplotype from Pantelleria being also found in three Sicilian localities. Unlike other Italian island populations, the dorsal pattern is highly conserved on Pantelleria, as a high percent of the observed individuals show the pattern also found in the hypothesized source area in western Sicily. In conclusion, our results are compatible with an allochthonous origin of the P. siculus population of Pantelleria Island. Thus, the species would need no population monitoring programme for its conservation on the island.

ISOradioLAb: an educational project on environmental radioactivity for Italian minor islands—the case study of Lampedusa and Linosa

ISOradioLAb is an educational project for schools of the Italian minor islands promoted by the Italian National Institute of Nuclear Physics. It aims to increase the population awareness of natural radioactivity by involving the students of the high schools in the measurement of indoor radon activity concentration in their schools and in some representative buildings. Within this project, questionnaires about risk perception and radon knowledge are also dispensed. With this approach students learn-by-doing and share their knowledge with friends and relatives. In this paper, we present the activities performed during the first year of the project, focused on the case study of the minor island of Lampedusa and Linosa, Agrigento (Italy). Questionnaires and radon measurements (using CR-39 and Electret) results are reported.

Assessment of Energy, Mobility, Waste, and Water Management on Italian Small Islands

Small islands are recognized for their vulnerability to climate change. In this context, mitigation and adaptation policies are needed, but the ecological transition must be based on data. This study aims to assess the level of sustainability reached by 26 of the inhabited Italian small islands; it collects and analyzes the data and initiatives on the energy, mobility, waste, and water sectors and discusses the islands’ steps toward sustainability. The findings show that 18 of the 26 islands are not interconnected with the national grid and that the renewable sources cover less than 5% of the energy demand on 25 of the 26 islands. The number per capita of private vehicles reaches 90 cars per 100 inhabitants on three islands. The average of the separate collection of waste on the islands is 52%, which is far from the minimum recommended threshold of 65%. Pipelines or tankers on 17 of the 26 islands guarantee the water supply, and desalination plants are still not the rule, while the presence of wastewater treatment has been detected on 12 islands, and it often provides only partial treatment. An ambitious multi-stakeholder sustainability plan for each island should be developed to overcome the typical barriers of the island and to increase the building capacity in order to use economic incentives for that goal.

Morphometric versus genetic variation in the Eurasian Reed Warbler Acrocephalus scirpaceus in Italy

ABSTRACT Capsule The Eurasian Reed Warbler Acrocephalus scirpaceus from breeding sites in Italy has little genetic variability in the mitochondrial cytochrome b gene but shows morphological variation suggesting isolation of some populations. Aims To investigate the morphometric and genetic trait variation of Eurasian Reed Warbler populations at a large temporal and spatial scale. Methods We analysed morphometric traits and the mitochondrial cytochrome b (cyt b) gene of samples collected over 25 years, from populations at seven sites across the Italian peninsula and islands. Results While we found no genetic differences, we detected significantly smaller body sizes in individuals breeding in Sicily and Sardinia compared to those from mainland Italy. There were also significant body size differences between two Sicilian populations: one larger breeding on the southern coast and the other smaller at an inner highland site. Conclusion The morphometric data, together with the site fidelity of individuals, are consistent with there being isolation of some populations. Specifically, our results are consistent with an example of polyphenism, morphological plasticity, in the populations of the main Italian islands, Sicily and Sardinia.

Financial Analysis of a Desalination–Wastewater Recycle Plant Powered by a DC-DC Photovoltaic-Batteries System on the Aeolian Islands, Italy

The scarcity of drinking water is an increasingly pressing issue in many regions of the world, even in areas up till now considered developed. Climate change deprives many populations of the amount of water necessary for human consumption and traditional crops. Therefore, finding new water sources and making their usage more efficient and able to adapt to new environmental conditions without worsening the situation with further pollution is becoming mandatory. In the case study considered here, set on the Italian island of Vulcano in the Central Mediterranean, we propose the economic analysis and financial sustainability of plants for the desalination and recycled wastewater, powered by a DC-DC photovoltaic tracker system with silicon crystal panels sustained by a daily pack of lithium batteries. We present an estimation of the necessary budget, and propose a mix of traditional and innovative financial instruments to construct and analyse the economic trends of the installations over 30 years, considering the specific area price levels, salaries and interest rates. Finally, through the net present value index, we evaluate the financial sustainability of the entire operation, namely, identifying the circumstances when funding and building these plants in areas as remote as the one considered here is cost-effective.

Environmental Sustainability and Territorial Competitiveness: A Comparison between Italian Provinces

The emergence of globalisation and the removal of obstacles between markets have heightened rivalry between territorial areas. To have a competitive advantage, the regions have to be unique. As one of the tactics used to boost their reputation on a territorial level, territories are progressively adopting environmental policies for sustainable and shared prosperity. Indeed, effective management of urban growth depends heavily on sustainable development. In this regard, the literature occasionally refers to the “green branding” of cities, a strategy that makes use of environmental aspects to boost the allure of metropolitan environments. There is currently little consensus in the literature on the measuring of environmental performance, and no statistical study has been done to confirm the efficacy of these measures in terms of territorial competitiveness. Therefore, it is important to determine whether there is a relationship between a territory’s level of sustainability and competitiveness in Italy. According to the statistical analysis of the Italian provinces, the Northeast, Northwest, Centre, and Islands are the four geographical regions with the highest average scores. This unquestionably indicates a basic comprehension and supports the notion that there is a relationship between the two variables. However, it also serves as a warning about how geographical disparities in Italy represent a major issue affecting the most diverse sectors. In addition, the COVID-19 pandemic problem has drastically altered consumer demands and goals, leading consumers to seek out more sustainable travel and cities that are designed with citizens’ requirements in mind. It will therefore become more and more important to research how public and private administrators, as well as policy makers, react to these changes.

Declining trends of premature mortality from ischemic heart disease and regional differences in Italy from 2011 to 2017

AimsData regarding the premature mortality (<65 years of age) due to ischemic heart disease (IHD) in Italy are scant. We sought to analyze the incidence of premature death due to IHD in Italy and its time trend between years 2011 and 2017. Methods and resultsWe used the free publicly available EUROSTAT death certificate database to examine premature age-adjusted IHD mortality rates (per 100.000) and relative average annual percentage change (AAPC) in Italy from 2011 to 2017 using ICD-codes I20-I25. Over the study period, the proportional IHD-related mortality rates decline from 8.09% to 7.1% in the entire population (p for trend 0.012), showing a significant reduction in women (from 4.06% to 3.40%, p for trend: 0.02) but not in men (from 10.3% to 9.3%, p for trend 0.062). The age-adjusted IHD mortality rate decreased with an AAPC of −4.1 per year [(95% CI, −5.1 to −3.0), p < 0.001], resulting more pronounced in women [AAPC: −4.4 per year (95% CI: −6.4 to −2.3,), p = 0.001)] than in men [AAPC: −3.7 per year (95% CI: −5.4 to −2.0, p = 0.003)]. Age-adjusted IHD premature death rates above the 90th percentile were distributed in Italian southern regions and islands of Italy while premature death rates below the 10th percentile were clustered in the western and northeastern regions of the country. ConclusionsIn Italy, premature IHD-related mortality remains an important contributor to overall mortality. Age-adjusted mortality declined in the last decade, especially in the northern regions and among women. Moreover, a marked region-level variations were observed.