Scientific evidence supporting the newly developed one-health labeling tool "Med-Index": an umbrella systematic review on health benefits of mediterranean diet principles and adherence in a planeterranean perspective.

BACKGROUND: Med-Index is a one-health front-of-pack (FOP) label, based on Mediterranean diet (MedDiet) principles, developed to summarize information about the nutritional properties and related-health benefits of any food as well as its sustainable production processes, and the associated food company's social responsibility parameters in a new "Planeterranean" perspective. Thus, Med-Index can be adopted in and by any European region and authority as well as worldwide; this is achieved by consumption and cooking of locally available and sourced foods that respect MedDiet principles, both in terms of healthy nutrition and sustainable production. The huge body of scientific evidence about the health benefits of the MedDiet model and principles requires a comprehensive framework to encompass the scientific reliability and robustness of this tool. A systematic review was carried out to examine the association between human health and adherence to MedDiet patterns upon which the "Med-Index" tool was subsequently developed. METHODS: MEDLINE and PubMed databases were searched for eligible publications from 1990 to April 2023. Systematic literature reviews, with or without meta-analysis, of clinical trials and observational studies were screened by two independent investigators for eligibility, data extraction, and quality assessment. English language and the time interval 1990-2023 were applied. A registry code CRD42023464807 was generated on PROSPERO and approved for this search protocol. The corrected covered area (CCA), calculated to quantify the degree of overlap between reviews, gave a slight overlap (CCA = 4%). RESULTS: A total of 84 systematic reviews out of 6681 screened records were selected. Eligible reviews included studies with predominantly observational designs (61/84, 72.6%%), of which 26/61 referenced studies of mixed observational and RCT designs, while 23/84 (27.4%) were RCT-only systematic reviews. Seventy-nine different entries were identified for health outcomes, clustered into 10 macro-categories, each reporting a statistically significant association with exposure to the MedDiet. Adherence to MedDiet was found to strongly benefit age-related chronic diseases (21.5%), neurological disorders (19%), and obesity-related metabolic features (12.65), followed by CVDs (11.4%), cancer (10.1%), diabetes (7.5%), liver health (6.3%), inflammation (5%), mortality (5%), and renal health (1.2%). The quality of the studies was moderate to high. CONCLUSION: In the context of a "Planeterranean" framework and perspective that can be adopted in any European region and worldwide, MedDiet represents a healthy and sustainable lifestyle model, able to prevent several diseases and reduce premature mortality. In addition, the availability of a FOP, such as Med-Index, might foster more conscious food choices among consumers, paying attention both to human and planetary health.

COVID-19 epidemic spread and green areas Italy and Spain between 2020 and 2021: An observational multi-country retrospective study.

Several studies have proposed that environmental factors influencing human wellbeing, such as chronic exposures to high levels of particulate matter, could indirectly or even directly affect also the severity of COVID-19 disease in case of infection by novel coronavirus SARS-COV2. This study has investigated the association between COVID-19 infections, hospitalizations or deaths and the extension of public green areas (km2 per 100,000 based on OECD data of 2014), an indicator that has been chosen as independent endpoint variable to test the research hypothesis in 10 Italian and 8 Spanish Provinces with more than 500.000 inhabitants, including capitals (Rome and Madrid) and bigger cities (Bologna, Catania, Florence, Genoa, Milan, Naples, Palermo, Turin and Venice for Italy; Barcelona, Valencia, Seville, Zaragoza, Malaga, Las Palmas and Bilbao for Spain). Two different methodologies have been applied: a bottom-up approach was applied to Spanish institutional data concerning contagions/hospitalizations/deaths and the extent of public green areas for each responder to an official questionnaire in the frame of a nationwide survey (with detailed data granularity per province) containing specific georeferenced information; a top-down approach was used for Italy, starting from the official figures of contagions/hospitalizations/deaths of each province and linking them to the OECD statistics about the extension of public green areas in the different areas. Linear and generalized models were used for statistical analyses including also PM2.5 in a multivariate approach (with annual average concentrations from official air quality monitoring stations) and were able to adjust for the different number inhabitants living in each province, in order to take into account the difference in contagion dynamics related to the different density of population. The results obtained for Spain are consistent with those observed for Italy, as for both countries, it has clearly emerged a statistically significant association between COVID-19 clinical features (contagions, hospitalizations, and deaths) and the extension of public green areas, as well as the annual average concentrations of PM2.5 (with this latter variable loosing statistical significance in some province). Therefore, the extension of public green areas and air pollution seem to have a high correlation with COVID-19 severity.

Autism Spectrum Disorder and Prenatal or Early Life Exposure to Pesticides: A Short Review.

Background: Autism spectrum disorder (ASD) diagnoses have rapidly increased globally. Both environmental and genetic factors appear to contribute to the development of ASD. Several studies have shown a potential association between prenatal or postnatal pesticide exposure and the risk of developing ASD. Methods: We reviewed the available literature concerning the relationship between early life exposure to pesticides used in agriculture, such as organochlorines, organophosphates and pyrethroids, and ASD onset in childhood. We searched on Medline and Scopus for cohort or case-control studies published in English from 1977 to 2020. Results: A total of seven articles were selected for the review. We found a remarkable association between the maternal exposure to pyrethroid, as well as the exposure to organophosphate during pregnancy or in the first years of childhood, and the risk of ASD onset. This association was found to be less evident with organochlorine pesticides. Pregnancy seems to be the time when pesticide exposure appears to have the greatest impact on the onset of ASD in children. Conclusions: Among the different environmental pollutants, pesticides should be considered as emerging risk factors for ASD. The potential association identified between the exposure to pesticides and ASD needs to be implemented and confirmed by further epidemiological studies based on individual assessment both in outdoor and indoor conditions, including multiple confounding factors, and using statistical models that take into account single and multiple pesticide residues.

CO2 concentration monitoring inside educational buildings as a strategic tool to reduce the risk of Sars-CoV-2 airborne transmission.

In order to avoid SARS-CoV-2 transmission inside educational buildings and promote the safe reopening of schools, the Italian Government, in line with the other European countries and in accordance with the WHO recommendations, adopted a contingency plan including actions able to guarantee adequate air ventilation in classrooms. Therefore, in this pilot study, a surveillance activity based on the real-time monitoring of CO2 levels as a proxy of SARS-CoV-2 transmission risk, was conducted inside 9 schools (11 classrooms) located in Apulia Region (South of Italy) during the reopening of schools after the lockdown due to COVID-19 pandemic. More specifically, monitoring activities and data treatment were conducted to evaluate the initial scenario inside the classrooms (first stage of evaluation) and the potential improvements obtained by applying a detailed operating protocol of air ventilation based on specific actions and the simultaneous real time visualization of CO2 levels by non-dispersive infrared (NDIR) sensors (second stage of evaluation). Although, during the first evaluation stage, air ventilation through the opening of windows and doors was guaranteed, 6 (54%) classrooms showed mean values of CO2 higher than 1000 ppm and all classrooms exceeded the recommended CO2 concentration limit value of 700 ppm. The development and implementation of tailored ventilation protocol including the real time visualization of CO2 levels allowed to depict better scenariosAn overall improvement of CO2 levels was indeed registered for all classrooms where teachers were compliant and helpful in the management of the air ventilation strategy. Therefore, this study reports the first evidence-based measures demonstrating that, with the exception of few environments affected by structural limits, the real-time visualization and monitoring of CO2 concentrations allowes effective air exchanges to be implemented and contributes to prevent SARS-CoV-2 transmission. Moreover, on the basis of the monitoring outcomes and in order to ensure adequate air ventilation in educational buildings, a 4 level-risk classification including specific corrective actions for each level was provided.

The impact of atmospheric pollution on outdoor cultural heritage: an analytic methodology for the characterization of the carbonaceous fraction in black crusts present on stone surfaces.

COVID-19 has reduced tourism in both museums and historical sites with negative economic effect. The wellbeing and good preservation of monuments is a key factor to encourage again tourism. Historical monuments exposed to outdoor pollution are subjected to well known degradation phenomenon including the formation on their surface of black crusts (BCs) causing blackening and deterioration of the monuments and, as a consequence, a worst fruition by the visitors. The aim of this research is the development and validation of a novel method to characterize and quantify the various components present in the black crusts. SO2 together with the carbonaceous fraction (i.e. OC, organic carbon, and EC, elemental carbon) represent the main atmospheric pollutants involved in the process of BCs formation which consists in the partial transformation of the carbonate substrate into gypsum where black particles are embedded. A new methodology based on the use of TGA/DSC (Thermogravimetric Analysis/Differential scanning calorimetry) and CHN (Carbon, Hydrogen, Nitrogen) analysis was set up allowing to determine organic carbon and elemental carbon together with other components such as gypsum. Four standard mixtures simulating BCs composition were prepared and analysed by the set-up methodology. The new procedure was subsequently applied to study real BCs samples taken from monuments and historical buildings placed in cities heavily affected by atmospheric pollution and by PCA (principal component analysis) their main features, from the point of view of carbonaceous fraction, were highlighted.

School as ideal setting to promote health and wellbeing among young people.

Background: Nowadays, young people face several health challenges. As children and teenagers spend most of their time in the classroom, schools may have the opportunity to positively influence students' quality of life, playing a crucial role in fostering their health. The aim of this review was to analyze evidence that demonstrated why school is the ideal setting for thepromotion of young generations' wellbeing. Methods: We have reviewed the available literature about health promotion in school setting, searching for articles and books published from 1977 to 2020. A total of 74 articles and 17books were selected and assessed. Results: The promotion of students' wellbeing could reduce the prevalence of measurable unhealthy outcomes and improve their academic achievements. At least 80% of all cases of heart diseases, strokes, type 2 diabetes and one third of all cancers can be prevented through health education. In this perspective, primary prevention and health promotion should start as early as possible, finding in the school the ideal setting of action. Effective school-based preventive approaches should raise students' motivation towards a personal interiorization of health knowledge and develop in young people a critical thinking about harmful consequences of the most common risky behaviours. Educators should receive adequate training concerning health topics and become expert in the most innovative approaches to effectively engage students in adopting healthy lifestyles. Conclusion: As primary educational institution, school should integrate students' health promotion in its ordinary teaching and learning practices in the perspective of "better health through better schools".

Indoor air quality at school and students' performance: Recommendations of the UNESCO Chair on Health Education and Sustainable Development & the Italian Society of Environmental Medicine (SIMA).

The issue of indoor air quality (IAQ) concerns 64 million students across Europe, but it is still a neglected topic, although it impacts both their health and learning outcomes. Classroommicroclimate is the first key factor determining a healthy or unhealthy school environment, and it is influenced by ventilation, temperature and humidity rate. Classrooms are usually crowded, overheated and poorly ventilated, thus resulting in possible increases of carbon dioxide (CO2), that can cause several problems when its concentrations exceed the value of 0.15 percentage volume of CO2 (1500 ppm) or even at lower levels (1000 ppm). CO2 can also arise from outside the school, being widely produced by the combustion of fossils or road traffic. Anthropogenic activities are responsible for the emission of nitrogen dioxide (NO2) and polycyclic aromatic hydrocarbons(PAH) too, which represent other possible external contaminants potentially impairing IAQ. Furtherdangerous exposures for students' health are those related to natural emission of gas Radon, which typically accumulates in poorly ventilated classrooms, and volatile organic compounds (VOCs, released by building materials, paints, furnishings, detergents), while chemicals substances (i.e.cyanoacrylate, lead, cadmium, nickel) might be contained in school materials. Finally, particulate matter (PM2.5 and PM10) originating from road traffic, domestic heating or industrial activities represent additional possible contaminants impacting schools' air quality. Poor IAQ might result in mild adverse events (i.e. headaches, nausea etc.) or cause respiratory problems. More frequently, IAQ affects students' attention and their school performances, as widely documented by many studies. Standardized tests administered to pupils exposed to poor IAQ (to assess reading and mathematical abilities) systematically result in worse outcomes compared to students staying in healthy classroom environments. In this paper, we present recommendations of UNESCO Chair on Health Education and Sustainable Development and Italian Society of Environmental Medicine(SIMA) to ensure an optimal IAQ at school, including some post-COVID-19 issues.

Children's literature to promote students' global development and wellbeing.

Background: Tales were transmitted from one generation to another, enriching young people with values, beliefs, imagination and creativity. Children's literature still plays a crucial part in education as it provides knowledge and entertainment, representing a typical example of "edutainment". In this paper, we carried out a review to examine pedagogic, didactic and psychological/therapeutic dimensions of children's literature, with the aim of highlighting its role in promoting students' holistic development and wellbeing. Methods: We have searched for original articles (from 1960s to 2019), by using the following keywords: "fairytales" or "fairy tales" or "folktales" or "fables" AND "education" or"development" or "learning" or "teaching" or "school" or "curriculum" or "classroom" AND "children" or "child" or "kids" or "childhood" AND "health" or "wellbeing". Results: We found 17 studies concerning pedagogic aspect of children literature, while 21 and17 studies were selected for didactic and therapeutic dimensions, respectively. From a pedagogic point of view, tales convey basic values useful for children lives. In a didactic perspective, properly chosen storybooks represent a valuable resource for school activities, improving students' language skills and building up a friendly/respectful classroom environment. Children stories are also used by health professionals for therapeutic purposes (bibliotherapy) to prevent unhealthy habits and addictions, or address psychosomatic disorders. Finally, storybooks and web-based/digital stories can be an effective vehicle for health contents, to encourage the adoption of healthy lifestyles among schoolchildren. Conclusion: Children's literature and storytelling could be helpful in promoting students' global development and wellbeing, when included in school curricular activities.

Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records.

OBJECTIVES: As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population. METHODS: We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820-821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433-434), and TIA (code 435) between 2001-2005. Cost analyses were based on diagnosis-related groups. RESULTS: The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005). CONCLUSION: The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.