Aim of the study was to estimate the prevalence and incidence of rheumatoid arthritis (RA) from an administrative cohort consisting of 2,268,514 males and 2,446,769 females, aged ≥ 18 years, from 32 Italian Health Districts. The diagnosis of RA was certified by a qualified specialist and confirmed by ≥3 prescriptions of "specific drugs" (corticosteroids, DMARDs or "biological" agents) during 2011. Patients on "specific drugs" qualified as "active RA"; those who never had more than 4 prescriptions in the past were classified as "unlikely RA," and those previously on chronic treatment but who discontinued therapy for >1 year were classified as "remission RA." The patients with a diagnosis of RA were 22,801 (0.48 %) with a prevalence of "active RA," "remission RA" and "confirmed RA" (Active + Remission RA) of 0.32, 0.09 and 0.41 % (95 % CI 0.38-0.44), respectively. The classification criteria tested in a fifth of the study population by direct analysis yielded >90 % accuracy and precision. The yearly incidence of "active RA" per 100,000 subjects was 48 (95 % CI 40-57) and 20 (95 % CI 10-30) for women and men, respectively. The peak for both prevalence and incidence was around the eighth decade of life. The female/male ratios for both prevalence and incidence were ca. 2.6 before the fifth decade of life, but approached unity in the ninth decade of life. The overall prevalence and incidence of RA in a large sample of the Italian population is only marginally lower than that reported from a similar administrative database of Sweden. With advancing age, the female/male ratio declines to about one.

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BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

The International Fusion Materials Irradiation Facility (IFMIF), presently in its Engineering Validation and Engineering Desi gn Activities (EVEDA) phase under the frame of the Broader Approach Agreement between Europe and Japan, accomplished in summer 2013, on schedule, its EDA phase with the release of the engineering design report of the IFMIF plant, which is here described. Many improvements of the design from former phases are implemented, particularly a reduction of beam losses and operational costs thanks to the superconducting accelerator concept, the re-location of the quench tank outside the 1 2 × test cell (TC) with a reduction of tritium inventory and a simplification on its replacement in case of failure, the separation of the irradiation modules from the shielding block gaining irradiation flexibility and enhancement of the remote handling equipment reliability and cost reduction, and the water cooling of the liner and biological shielding of the TC, enhancing the efficiency and economy of the related sub-systems. In addition, the maintenance strategy has been modified to allow a shorter yearly stop of the irradiation operations and a more careful management of the irradiated samples. The design of the IFMIF plant is intimately linked with the EVA phase carried out since the entry into force of IFMIF/EVEDA in June 2007. These last activities and their on-going accomplishment have been thoroughly described elsewhere (Knaster J et al [19]), which, combined with the present paper, allows a clear understanding of the maturity of the European-Japanese international efforts. This released IFMIF Intermediate Engineering Design Report (IIEDR), which could be complemented if required concurrently with the outcome of the on-going EVA, will allow decision making on its construction and/or serve as the basis for the definition of the next step, aligned with the evolving needs of our fusion community.