Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.

In Italy, data on shared-care programs for diabetes are lacking. We described the characteristics of type 2 diabetic population assisted in general practice and evaluated 3 years of follow-up outcomes and performance indicators in a shared-care program in Modena, Italy (1998-2001); only well-controlled diabetic patients were considered. Forty-nine percent of territorial GPs adhered to the project (257 out of 521) and 77% of them sent 6409 paired baseline and follow-up datasheets. Altogether, 97.8% patients had type 2 diabetes, mean age 68.6+/-11.7 years, disease duration 9.6+/-7.5 years, BMI 28.6+/-4.8 kg/m2, HbA(1c) 7.6%+/-1.6%, 16.1% of them were disabled. Among the non-disabled patients, 23.6% had optimal glycemic control (HbA(1c) < or =6.5%); at baseline the prevalence of micro- and macrovascular diabetic complications was: 8.2% microalbuminuria and 2.4% macroalbuminuria plus nephropathy, 11.0% nonproliferative and 3.0% preproliferative retinopathy, 7.0% neuropathy, 1.8% diabetic foot; 8.5% angina, 6.9% TIA or stroke, 6.3% infarction, 5.2% intermittent claudication, 4.1% heart failure. Among the disabled patients 27.9% had optimal glycemic control, but they had more diabetic complications. The performance indicators significantly improved over the 3-year study period: glycemic control indicators increased from 66%-75% to 83%-90% and micro- and macrovascular indicators from 59%-65% to 75%-81%. The outcome indicators also improved: mean HbA(1c) value changed from 7.6%+/-1.6% to 7.3%+/-1.3% and the percentage of people with HbA(1c)< or =6.5% significantly improved over time. Similar trends were observed in both disabled and non-disabled diabetic patients.

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We explore the determinants of state fragility in sub-Saharan Africa. Controlling for a wide range of economic, demographic, geographic and istitutional regressors, we find that institutions, and in particular the civil liberties index and the number of revolutions, are the main determinants of fragility, even taking into account their potential endogeneity. Economic factors such as income growth and investment display a non robust impact after controlling for omitted variables and reverse causality. Colonial variables reflecting the history of the region display a marginal impact on fragility once institutions are accounted for.

This article explores the empirical determinants of state fragility in sub-Saharan Africa over the 1992–2007 period. Our dataset includes those sub-Saharan countries for which we have information on the distribution by quintiles of the World Bank Country Policy and Institutional Assessment (CPIA) ratings. We evaluate the potential influence on fragility of a wide range of economic, institutional, and historical variables. Among economic factors, we consider per-capita GDP, both in levels and growth rates, investment, natural resources, and schooling. We also consider economic policy variables such as government expenditures, trade openness, and inflation. Demographic forces are accounted for through the fertility rate, life expectancy, and the youth bulge. Institutional factors are captured by measures of ethnic fractionalization, civil liberties, revolutions, and conflicts, as well as governance indicators. Moreover, we select historical variables that reflect the colonial experience of the region, namely the national identity of the colonizers and the political status during the colonial period. Finally, we account for geographic factors such as latitude, access to sea, and the presence of fragile neighbors. Our central findings is that institutions are the main determinants of fragility: even after controlling for reverse causality and omitted variable bias, the probability for a country to be fragile increases with restrictions of civil liberties and with the number of revolutions. Before controlling for endogeneity, economic factors such as per-capita GDP growth and investment show some explanatory power, but economic prosperity displays a contradictory net impact since growth reduces fragility while investment facilitates it. Moreover, instrumental variables estimates show that per-capita GDP growth is no longer a significant factor. Colonial variables display a marginal residual influence: after controlling for all other factors former colonies are actually associated with a lower probability of being fragile.