[Radon risk in healthcare facilities: environmental monitoring and effective dose]. / Il rischio radon in ambienti sanitari: monitoraggio ambientale e dose efficace.

BACKGROUND: Radon, the second cause of lung cancer after smoking (WHO- IARC), is a natural, radioactive gas, which originates from the soil and pollutes indoor air, especially in closed or underground spaces. OBJECTIVES: The purpose of this study was to determine the concentration of radon gas, its effective dose, and the measurement of microclimatic degrees C; U.R. % and air velocity in non-academic intensive care units of public hospitals in the Naples area. METHODS: The annual average concentrations of radon gas were detected with EIC type ionization electret chambers, type LLT with exposure over four 3-month periods. RESULTS: The concentrations varied for all health facilities between 186 and 1191 Bq/m3. Overall, the effective dose of exposure to radon gas of 3mSv/a recommended by Italian legislation was never exceeded. CONCLUSIONS: The concentration of radon gas showed a decreasing trend starting from the areas below ground level to those on higher floors; such concentrations were also influenced by natural and artificial ventilation of the rooms, building materials used for walls, and by the state of maintenance and improvements of the building (insulation of floors and walls). The data obtained confirmed the increased concentration of radionuclides in the yellow tuff of volcanic origin in the Campania Region and the resulting rate of release of radon gas, whereas the reinforced concrete structure (a hospital located on the hillside), which had the lowest values, proved to provide good insulation against penetration and accumulation of radon gas.

Occurrence of polychlorobiphenyls in buffalo mozzarella cheese from Campania (Italy).

Buffalo milk and mozzarella cheese produced in the Caserta and Salerno areas in Campania region have been investigated on the presence and the levels of polychlorobiphenyls (PCBs). Seven congeners, six non dioxin-like (NDL-PCBs nos. 28, 52, 101, 138, 153 and 180) and one dioxin-like (DL-PCB n. 118), were detected. PCBs were found at detectable levels in the 83% of the buffalo milk and in the 100% of the mozzarella cheese samples from Caserta; in those from Salerno the prevalence of contamination was 77% for milk and 73% for mozzarellas, respectively. The NDL-PCB content of mozzarellas collected in Caserta was significantly higher than that found in those from Salerno. The more diffuse congeners were PCB 28, 138 and 153 both in milk and in mozzarella cheese; PCB 118 contributed to the total PCB content for the 7% in milk and 2-3% in mozzarella cheese. On the basis of the Italian annual average consumption the contribution of mozzarella to the daily dietary intake of NDL-PCB can vary between 0.41 and 21.33 ng kg(-1) bw, median value of 3.66 ng kg(-1) bw. The levels of contamination in milk and dairies analyzed are similar or quite lower than those found in other European countries.

Appropriateness of admission and hospitalization days in a specialist hospital.

The assessment of hospital utilization is an important tool in the management of Hospital Health Care. The Authors examined the extent and the reasons of inappropriate hospital admission and stay in patients admitted to the Monaldi Hospital, Naples, Italy. Five hundred and thirty three medical records, were analysed. The survey was carried out in the period May-October 1999, using the italian version of the Appropriateness Evaluation Protocol (AEP) method. Of the admissions days, 15.8% were considered inappropriate; the most frequent cause of inappropriateness was waiting period for diagnostic test. The highest percentage of inappropriateness was found for females, for less serious pathologies and in the summer months. Compared to the admissions, the proportion of inappropriateness of the index days was higher (35.5%); the most frequent cause of an inappropriate day of stay was the persistence of mild symptoms which according to the attending physician justified prolonging the stay, while the same variables found for inappropriate admission (female sex, less serious pathologies and summer months) were related to inappropriateness of stay. This survey has allowed us to offer some useful suggestions with a view to making some of the activities of the "Monaldi Hospital" more efficient.

Evaluation of benzene exposure in children living in Campania (Italy) by urinary trans,trans-muconic acid assay.

The urinary benzene metabolite trans,trans-muconic acid (MA) was determined in 144 children living in Campania (Italy): 92 from Naples (1,300,000 inhabitants), designated as an urban source, and compared to 52 from Pollica (300 inhabitants), considered a rural, background exposure for benzene. The children participating in the study were tested by an anonymous questionnaire about the possible sources of exposure to benzene. Quantifiable levels of MA were found in 63% of the urine samples analyzed. Setting the value of nondetectable urinary samples at 7 microg/L MA, a value that is one-half of the instrument detection limit of 14 microg/L, the mean urinary concentration levels were 98.7+/-81.0 microg/L and 48.4+/-71.7 microg/L in Naples and Pollica, respectively; adjustment of these values to creatinine clearance resulted in MA levels of 141.2+/-145.4 microg/L in Naples and 109.8+/-133.2 microg/L in Pollica. Passive smoke exposure did not significantly affect urinary MA levels, but proximity of the home to traffic increased urine MA content. Data show that MA can be utilized as a biomarker for exposure; however, a clear-cut association to benzene requires personal monitoring and control of dietary sorbic acid.

Alkyltins in farmed fish and shellfish.

A study to update dibutyltin (DBT) and tributyltin (TBT) residues in farmed fish and shellfish (Mytilus edulis) was carried out 4 years after the adopting of the restricting regulation of the antifouling uses of organotins in Italy. DBT and TBT were simultaneously extracted from farmed fish and shellfish (M. edulis) and from free living specimens, used as control, purchased from retail stores or fishermen in the province of Naples (Italy), and detected using a capillary gas chromatograph equipped with a flame photometric detector (GC-FPD). Dosable amounts of DBT were found in the 10% of the farmed fish analyzed, ranging from 1 to 26 micrograms kg-1 wet wt (mean 10 micrograms kg-1) and in the 23% of the free living fish at an average level of 2 micrograms kg-1 wet wt (range 1-4 micrograms kg-1 wet wt). TBT was detected in 85% of the farmed fish, in concentrations varying from 2 to 260 micrograms kg-1 wet wt (mean 28 micrograms kg-1 wet wt) and in 46% of the free living specimens (mean 39 micrograms kg-1 wet wt; range 1-93 micrograms kg-1). All the mussel samples analyzed were polluted by both DBT and TBT. In the farmed mussels the average amounts of DBT and TBT were, respectively, 4 and 2 micrograms kg-1 wet wt; in the free living they were 4 and 5 micrograms kg-1 wet wt, respectively. The results indicate that the DBT and TBT contamination is as highly diffuse in farmed as in free living fish and mussels on sale in retail markets in Naples province even if the levels of the contamination are meanly quite low.

Routine preoperative investigation. Results of a multicenter survey in Italy. Collaborator Group.

We conducted a study to acquire information on the current behavior of a sample of Italian surgeons and anesthesiologists about prescribing, interpreting, and using routine preoperative investigations. Consultants in surgery and anesthesiology in 60 hospitals in northern, central, and southern Italy were interviewed. Prescription of these procedures by doctors were driven more by personal experience than by updated scientific knowledge. This practice often led to ineffective and inefficient clinical practice, with healthy patients undergoing useless, time-consuming, costly, and sometimes harmful procedures.

Modification of lipid composition of erythrocyte membranes in chronic alcoholism.

The lipid composition and microviscosity of erythrocyte membranes have been studied in chronic alcoholics with macrocytosis and minimal liver dysfunction. The findings have been compared with those obtained in subjects with macrocytosis not related to ethanol abuse. In all instances, macrocytosis was accompanied by an increased microviscosity of erythrocyte membranes, together with an increase of the cholesterol/phospholipid and of saturated/unsaturated fatty acids ratio. Both microviscosity and saturated/unsaturated ratio were significantly higher in alcoholics compared to subjects with macrocytosis not related to ethanol abuse. These findings confirm that altered lipid composition and fluidity of erythrocyte membrane may be observed in chronic alcoholics with minimal liver dysfunction, possibly due to the "stabilising" properties of ethanol - among a number of drugs- on biological membranes.

The effect of famotidine, a new H2 receptor antagonist, on antipyrine clearance in healthy volunteers.

The salivary clearance of Antipyrine (15 mg/kg p.o.) has been measured in nine healthy volunteers (5 males, 4 females) before and after 7 days treatment with Famotidine (40 mg/day at bedtime). Samples of saliva were collected twenty four hours after each dose of Antipyrine. The post-treatment sample was taken 12 hours after the last dose of Famotidine. The clearance of Antipyrine was measured by Gas-Liquid Chromatography using the simplified formula proposed by Dossing et al. (1982). After treatment with Famotidine, a slight but significant (p less than 0.01) increase of Antipyrine clearance was observed in eight out of the nine subjects, suggesting some interference of Famotidine with Antipyrine metabolism.

Childhood enteritis: a community study.

The population aged 0-12 years living in the area of an Italian Local Health Unit (about 8,800 children) was studied for one year in order to estimate the overall incidence rate of enteritis and the incidence rates of diarrheas from bacterial agents. All children complaining of acute diarrhea and seen by the pediatric practices of the study area were recorded by date, age, and sex; the microbiological study of stools was performed for a sample of patients. All hospitalized cases of childhood enteritis occurring in the same period in the study population were studied too. Campylobacter jejuni and Salmonella were cultured from 5 out of 71 examined out-patients (7.0%), with a projected annual consultation rate of 2.1 per 1000 population aged 0-12 years. Yersinia enterocolitica was cultured from 2 out-patients (2.8%), while no cases from Shigella and enterotoxigenic Escherichia coli were observed in this group. Data concerning hospitalized cases confirmed this pattern of results. Bacterial enteritis is an important public health problem in the study area and its occurrence is possibly related to animal reservoirs of infection, with particular regard to poultry and pets.

[Incidence and origin of Clostridium difficile in neonatology]. / Incidenza e origine di Clostridium difficile in neonatologia.

The epidemiology of Clostridium difficile was studied prospectively in 101 newborn infants by screening of fecal samples collected in the first or second day of life and in the fourth or fifth one. A vaginal swab and a stool specimen were collected from mothers before delivery. Environmental cultures were obtained from selected sites in the ward, while colonization of intestinal tract and contamination of the hands were evaluated in the personnel. C. difficile was isolated from the feces of 13 infants (13%); colonization rate was higher in infants delivered by cesarean section, but the difference was not significant. Intestinal carriage was demonstrated in two mothers (2%); the baby of one colonized mother was positive for C. difficile. All vaginal swabs were negative. Fecal samples of 2 nurses (18%) were positive; none of the environmental cultures yielded C. difficile. It was concluded that the mothers are not the sources of their infants' organisms and that the contamination of the environmental surfaces is the most likely explanation for the spread of C. difficile in the hospital setting.