Health tourism: an opportunity for sustainable development

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Dietary glycemic load and colorectal cancer risk

BACKGROUND

Insulin and insulin-like growth factors can stimulate proliferation of colorectal cells. High intake of refined carbohydrates and markers of insulin resistance are associated with colorectal cancer. To test the insulin/colon cancer hypothesis, we determined whether the dietary glycemic index and the glycemic load are associated with colorectal cancer risk.

DESIGN

A case-control study on colorectal cancer conducted in Italy. Cases included 1125 men and 828 women with histologically confirmed incident cancer of the colon or rectum. Controls were 2073 men and 2081 women hospitalized for acute conditions. We calculated average daily dietary glycemic index and glycemic load, and fiber intake from a validated food frequency questionnaire.

RESULTS

Direct associations with colorectal cancer risk emerged for glycemic index (odds ratio (OR) in highest vs. lowest quintile = 1.7; 95% confidence interval (CI): 1.4-2.0) and glycemic load (OR = 1.8; 95% CI: 1.5-2.2), after allowance for sociodemographic factors, physical activity, number of daily meals, and intakes of fiber, alcohol and energy. ORs were more elevated for cancer of the colon than rectum. Overweight and low intake of fiber from vegetables and fruit appeared to amplify the adverse consequences of high glycemic load.

CONCLUSIONS

The positive associations of glycemic index and load with colorectal cancer suggest a detrimental role of refined carbohydrates in the etiology of the disease.

Expression of wild-type and mutant human ornithine transcarbamylase genes in Chinese hamster ovary cells and lack of dominant negative effect of R141Q and R40H mutants

Chinese hamster ovary cultured cells were transformed to continuously express wild-type and two mutant ornithine transcarbamylase genes, R141Q and R40H. In addition, these cells were transfected to transiently express the same genes. The R141Q mutation abolishes the enzymatic activity, and the amount of "mature" protein present in transfected cells is equivalent to the wild type. The R40H mutation causes a reduction of enzymatic activity to approximately 26 to 35% of wild type concomitant with a significant reduction in the amount of protein present. Transfection with wild-type and mutant genes together in various proportions did not reveal dominant negative effects of the two mutations studied. This expression system can be used to examine the deleterious effect of private mutations or lack thereof in families with ornithine transcarbamylase deficiency as well as evaluate the potential dominant negative effects of gene delivery for treatment of ornithine transcarbamylase deficiency.