Impact of the environment on the health: From theory to practice.

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Skin safety and health prevention: an overview of chemicals in cosmetic products.

INTRODUCTION: Cosmetic products contain a wide range of chemicals to which we are exposed every day. The aim of the study was to determine the presence of potential dangerous substances which can cause adverse health effects by examining product labels. MATERIALS AND METHODS: A total of 283 products were collected from various shops in Lecce (Italy) and divided into 3 categories: rinse-off, leave-on and make-up. The label of every product was examined and a list including fragrances, preservatives and other chemicals of concern was created. RESULTS: Fragrances were present in 52.3% of the examined products, mostly limonene (76.9%) and linalool (64.6%) but also citronellol (34.1%), geraniol (31.5%), coumarin (30%) and hexyl cinnamal (29.2%). Preservatives showed a rate of 60% and the most frequently identified were phenoxyethanol (48.7%), sodium benzoate (35.6%), potassium sorbate (22%), methylparaben (15.2%) and MI/MCI (9.9%). The other chemicals of concern were detected in 58% of products; included PEGs (62.3%), acrylate copolymer (34%), petrolatum (17.2%), polysorbates (14,8%), BHT (14.7%), ethylhextyl methoxycinnamate (13.6%), benzophenone-1 (3.7%), benzophenone-3 (4.9%), BHA (1.6%), cocamide DEA and toluene (1.2%). CONCLUSIONS: The use of many of these substances is allowed within certain limits, due to their toxicity at higher concentrations. Other important aspects should be considered as, for instance, the possibility of long-term effects. On the other hand, other substances may induce several acute adverse side-effects, i.e. contact dermatitis and allergic reactions. For these reasons, an enhancement of the criteria used for cosmetics formulation is required since many chemicals used singularly or combined are potentially unsafe.

Atherosclerosis is associated with a higher risk of hepatic steatosis in HIV-infected patients.

INTRODUCTION: Cardiovascular Diseases (CD) have emerged as a leading cause of morbidity and mortality in HIV population. Some studies have reported higher carotid Intima Media Thickness (c-IMT), a measure of subclinical atherosclerosis (AT), in this cohort of patients. METHODS: Here, we evaluate the role of Hepatic Steatosis (HS) as likely marker for AT in 128 HIV-infected patients without hepatitis C infection. c-IMT has been detected non-invasively by carotid ultrasonography to assess the progression of AT. HS has been evaluated using a process based on vibration-controlled transient elastography (Fibroscan) by a novel ultrasonic controlled attenuation parameter (CAP). The cut-off value for defining the presence of significant HS was CAP > 259 dBm-1. RESULTS: AT has been detected in 26 patients (20.3%), whereas steatosis of grade 2 (S2) in 31 (24.2%). The variables statistically related to AT were age, obesity, diabetes, hypertension and S2. In the multivariate analysis, AT was only associated (p < 0.001) with age and S2. The optimal cut-off value indicated by ROC curve for predicting AT was CAP > 250 dB/m-1. DISCUSSION: Our results highlight the presence of AT in HIVinfected persons and its association with fatty liver disease; therefore, HS assessment in HIV population results crucial to predict AT and CD.

Using the cytokinesis-block micronucleus cytome assay to evaluate chromosomal DNA damage in chronic renal patients undergoing bicarbonate haemodialysis and haemodiafiltration.

INTRODUCTION: Chronic Renal Failure (CRF) patients are considered to show genomic instability and are associated with a high risk of both cardiovascular diseases and cancer. We explored DNA damage due to two dialysis treatments in 20 patients undergoing bicarbonate haemodialysis (BD), 20 undergoing haemodiafiltration (HDF) and 40 healthy subjects. METHODS: The cytokinesis-block micronucleus (MN) assay was performed on peripheral blood lymphocytes to evaluate genetic damage. RESULTS: A higher frequency of MN in the dialysis groups compared with controls was found. The results do not show a relationship between genetic instability and the type, frequency and duration of haemodialysis. The average BD and HDF treatment time was respectively 3.8 ± 6.3 and 3.7 ± 3.9 yrs. CAT and scintigraphy was independently correlated with high levels of MN. CONCLUSIONS: Overall, the frequency of MN in CRF patients undergoing dialysis therapy was observed to be higher. Further studies need to be performed on a larger number of patients and for a longer period.

Are 6-8 year old Italian children moving away from the Mediterranean diet?

BACKGROUND: The Mediterranean diet (MD) is considered one of the healthiest dietary models, as it decreases the risk of chronic diseases and may modulate the organism's early response to environmental pollution. In recent decades, Mediterranean countries have been replacing their traditional diet with other less healthy eating habits, especially among children and teenagers. OBJECTIVE: The aim of this study was to evaluate the MD and the level of adherence to it in 6-8 year old Italian children, in relation to residence, lifestyle, and social and family contexts. METHODS: A questionnaire was administered to the children's parents in two seasons in 5 Italian towns. The diet section contained 116 questions investigating the frequency of consumption of different types of food. The Italian Mediterranean Index (IMI) was calculated according to the intake of 6 typical Mediterranean and 4 non-Mediterranean foods. On the basis of IMI score, MD adherence was classified as low (≤ 3 IMI score), medium (4-5) and high (≥ 6). Total energy load and diet composition in micro- and macronutrients were calculated from consumption frequency. RESULTS: Diet analysis was computed on 1164 subjects with two complete questionnaires. Body mass index, calculated for each subject, showed that 28.9% of the children were overweight, the figure varying slightly with area of residence. Our findings showed that 59.0% of the children had a low score for MD adherence. CONCLUSIONS: The results of this study showed that most Italian children did not follow the MD and socio-economic characteristics appeared not to be associated with type of diet.

Monitoring air pollution effects on children for supporting public health policy: the protocol of the prospective cohort MAPEC study.

INTRODUCTION: Genotoxic biomarkers have been studied largely in adult population, but few studies so far have investigated them in children exposed to air pollution. Children are a high-risk group as regards the health effects of air pollution and some studies suggest that early exposure during childhood can play an important role in the development of chronic diseases in adulthood. The objective of the project is to evaluate the associations between the concentration of urban air pollutants and biomarkers of early biological effect in children, and to propose a model for estimating the global risk of early biological effects due to air pollutants and other factors in children. METHODS AND ANALYSIS: Two biomarkers of early biological effects, DNA damage by the comet assay and the micronuclei (MN) test, will be investigated in oral mucosa cells of 6-8-year-old children. Concurrently, some toxic airborne pollutants (polycyclic aromatic hydrocarbon (PAH) and nitro-PAH) and in vitro air mutagenicity and toxicity in ultra-fine air particulates (PM0.5) will be evaluated. Furthermore, demographic and socioeconomic variables, other sources of exposures to air pollutants and lifestyle variables will be assessed by a structured questionnaire. The associations between sociodemographic, environmental and other exposure variables and biomarkers of early biological effect using univariate and multivariate models will be analysed. A tentative model for calculating the global absolute risk of having early biological effects caused by air pollution and other variables will be proposed. ETHICS AND DISSEMINATION: The project has been approved by the Ethics Committees of the local Health Authorities. The results will be communicated to local Public Health Agencies, for supporting educational programmes and health policy strategies. LIFE+2012 Environment Policy and Governance. LIFE12 ENV/IT/000614.

Identification of HEV in symptom-free migrants and environmental samples in Italy.

Hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The occurrence of HEV genotypes in samples of faeces from asymptomatic migrants arriving on the coasts of South Italy and environmental samples was investigated. Analyses of sequences were used to compare human and environmental genotypes. A total of 40 stool specimens, 12 samples of untreated urban sewage, 12 samples of treated urban sewage and 12 samples of surface water were analysed. Viruses were concentrated from water samples by the tangential flow ultrafiltration technique. The presence of HEV RNA was detected by nested RT-PCR. Viral isolates were sequenced and phylogenetically characterized. Two (5%) of the 40 faecal samples tested were found to be positive for HEV RNA (G1 and G3 genotypes). The virus was detected in 25% (3/12) of the untreated sewage samples and 25% (3/12) of the surface water samples: all isolates belonged to G3 genotype. None of the treated sewage samples were found to be HEV RNA positive. The virus was detected in the faeces of two asymptomatic subjects, suggesting a potential role for symptom-free HEV carriers as a human reservoir. G3 HEV strains were detected in the untreated sewage, as observed in similar studies conducted in other European countries but differing from another study conducted in Italy recently. Moreover, our results show the first case of HEV isolated from fresh surface waters.

Sequence analysis of human rotavirus strains: comparison of clinical isolates from Northern and Southern Italy.

The surveillance and monitoring of rotavirus (RV)-related diseases, preferably through the establishment of sentinel surveillance sites, are essential for assessing the need for vaccination and the projected results of the vaccine in terms of reducing the burden of disease. The objective of the present study was to compare RV strains isolated in Northern (Ferrara) and Southern (Galatina-LE) Italy. During 2007-2008, 115 RV-positive stool samples were collected from children with diarrhea admitted to the hospitals of Ferrara and Galatina. The specimens were genotyped for VP7 (G-type) and VP4 (P-type) gene by reverse transcription (RT) and multiplex polymerase chain reaction (PCR). A subset of 21 RV strains was randomly selected and characterized by sequence analysis of the VP7 genes. In total, seven G/P combinations (G1P[8], G2P[4], G4P[8], G9P[8], G2P[8], G1P[9], and G2P[10]) were identified. Phylogenetic comparison of the VP7 encoding gene of selected strains showed that there was similarity among RV strains circulating in Northern and Southern Italy. The observation of nucleotide sequence diversity contributes to a better understanding of RV spreading and helps to characterize the various antigenic shifts that could have an impact on vaccine effectiveness.

Widespread microbiological groundwater contamination in the South-eastern Salento (Puglia-Italy).

In the Salento peninsula (Puglia Region, South-East Italy), underground waters are a fundamental resource for the population because they constitute the principal reservoir for drinking water and irrigation. They are, however, affected by overexploitation. The risk factors in the Salento arise mainly from anthropic activities, especially tourism and agriculture (leaking wells, sewage and inadequate waste disposal procedures). The Southern Salento is recognized to be at high risk of pathologies characterised by oral-faecal transmission. From 2001 to 2009 the incidence of typhoid fever in the Salento was 12.11/100,000 inhabitants as against 2.91 in Italy. Enteritis caused by rotaviruses is an important cause of hospitalization of paediatric-aged children in the Salento, with high social costs. An effective monitoring system for the conservation and management of water bodies and the protection of public health is therefore fundamental. The present study sought to determine the microbiological and chemical-physical quality of groundwater in the Salento and to analyse the factors associated with contamination. The results indicated widespread pollution from salt and microbial contamination. Contamination from faecal microorganisms posed a significant risk of human infection in 100% of samples. Furthermore, the water was unsuitable even for irrigation in a high percentage of cases (31.8%), which is of considerable significance given that agriculture is one of the most important economic activities in the area under study. The high salt concentration was probably due to excessive extraction of water for intensive irrigation, especially in summer. Under these circumstances, some of mitigation activity is necessary. Furthermore, it would be advisable to decrease the pollution load from anthropic activities in the territory and to reduce water consumption in order to conserve groundwater resources especially.

Microbial and nutritional aspects on the production of live feeds in a fish farming industry.

Aquaculture is an enterprise in constant development, in particular relating to its effect on the environment and also the quality of its products. It represents a valid alternative to traditional fishing, facing the increasing demand for fish products. To guarantee to the consumer a product of high nutritional, organoleptic and hygienic quality, it is fundamental to monitor every phase of the fish farming industry, isolating the potential risk points. For this reason there has been a rapid evolution of productive technique, particularly in the technology, artificial reproduction and feed sectors. The aim of this research has been the monitoring of the evolution of certain microbial and nutritional quality indexes (total microbial counts and lipid analysis on suspensions of Rotifers and Artemia, used as live feed) in the larval phase of the productive cycle of the farm raised fish, in an intensive system. The study has shown an increment in the total microbial counts in the fish farming industry within the production of Rotifers and Artemia, more evident in the suspensions of Rotifers. In addition the study has demonstrated that the maintenance phase, in the enrichment protocol, can reduce the EPA and DHA content. The results confirm the importance of microbial and nutritional control of the live feeds before they get supplied to fish larvae.

Spatial distribution of fungal microflora in the sediment of a brackish lake (Lake Alimini Grande, Italy) used for fish production and bathing.

A study of the distribution of fungal microflora was conducted on the sediment of Lake Alimini Grande in order to contribute to the evaluation of the ecosystem characteristics that can effect the process of decomposition. The isolation and identification of fungal species and ergosterol analysis were performed on sediment samples taken from 33 monitoring stations in autumn and winter. Altogether, 24 strains belonging to 8 genera were isolated. Trichoderma spp (41.6%) and Aspergillus spp (20.8%) were the dominant genera: in particular, Trichoderma was present near the Traugnano marsh, whereas Aspergillus was isolated in the area of connection to the sea.

[Evaluation of the bactericidal activity of a disinfectant containing sodium hypochlorite (Amiclor)]. / Valutazione dell'attività battericida di un disinfettante a base di ipoclorito di sodio (Amiclor).

We evaluated the stability and the bactericidal activity of a disinfectant containing sodium hypochlorite (Amiclor), which associates the buffer effect of the system sodium carbonate/sodium tetraborate to the stabilizing action of sodium chloride. The stability was determined evaluating the trend of the active chlorine title in various conservation conditions and comparing it with a product having only sodium chloride as stabilizing component. The bactericidal activity, instead, was evaluated by suspension and surface tests against Escherichia coli (ATCC 10536) and in relation to several variables, as product concentration, contact time, presence of interfering substances and water hardness. From the obtained data it is possible to affirm that Amiclor owns a greater stability as regards the traditional products stabilized only with sodium chloride. The activity tests have pointed out that the practical conditions affect the choice of the combination "product concentration/contact time" necessary to obtain an effective bactericidal activity. The activity of Amiclor is conditioned by the presence of proteins in the mixture or on the surface of reaction. This influence is not very clear in clean conditions while it considerably increases in dirty conditions. A decrease of bactericidal activity was observed when the product was diluted in hard water, mainly for contact times of 5 minutes or low product concentrations.

[Chemical-physical and microbiological survey in groundwater of Salento]. / Indagine chimico-fisica e microbiologica nelle acque della falda acquifera del Salento.

In order to know better the groundwater quality of Salento, chemical-physical and microbiological investigations were carried out on waters collected from 31 wells chosen after a preliminary study about the hydrogeologic features of the region. The analysis, conducted once in a month within the span of a year, pointed out a widespread contamination of faecal origin, which limits the employment (drinkable, irriguous) of groundwater because of possible health implications. The results of the chemical-physical analyses show how the groundwater of Salento is "contaminated" by sea water getting into the continent and which in some areas, also owing to excessive drawings, deteriorates its quality and compromises its irriguous use.

[Preliminary surveys about the use of "Mytilus galloprovincialis" as an accumulation matrix of bacteria in coastal waters]. / Valutazioni preliminari sull'utilizzo di Mytilus galloprovincialis (Lam.) come matrice di accumulo di batteri presenti in acque marino-costiere.

A biomonitoring study using "Mytilus galloprovincialis" mussels was carried out, to estimate their possible employment as "natural indicators" of coastal bacterial pollution. The research was conducted from September 2001 to May 2002, twice in a month, near two coastal zones of Salento. We analysed both natural and cultivated mussels. The latter were placed in cages, after checking their starting level of microbiological pollution. The bacteriological analyses conducted simultaneously on mussels and their ambient water, were directed to the search of: total and faecal coliforms, faecal streptococci, Escherichia coli, Salmonella spp., Staphylococcus aureus and yeasts. In this preliminary study the mussels proved to be "sensitive indicators of faecal pollution", since they had an accumulation of the faecal indicators even if the water was not contaminated. Nevertheless a lower frequency in finding yeasts in the mussels (53.8%) in comparison with water (74.3%), the irregular presence of Salmonella spp. in water (3.75%) and its absence in bivalves, show the need of further studies, also through "in vitro" tests, in order to verify absorption/elimination kinetics of microorganisms.

[Microbiological monitoring of beach water: old and new parameters]. / Il controllo microbiologico delle acque di balneazione: parametri "vecchi" e "nuovi".

The survival of fecal coliforms, fecal streptococci, Salmonella enteritidis and Staphylococcus aureus in sea water (35@1000 salinity) in the dark and at room temperature was evaluated. Staphylococcus aureus has been regarded for a long time as the new parameter to add to the classic ones in order to define the quality and suitability to recreational use. At the sperimental condition considered the survival of fecal coliforms, fecal streptococci, Salmonella enteritidis, and Staphylococcus aureus resulted equal to 48 h, 88 h, 56 h, and 96 h respectively. Fecal coliforms resulted the most sensitive bacteria to osmotic shock while Staphylococcus aureus the most adaptable species. Our results seem to indicate the opportunity of reconsidering the microbiological parameters used for the control of beach water.