Relationship between Environmental Conditions and Utilisation of Community-Based Mental Health Care: A Comparative Study before and during the COVID-19 Pandemic in Italy.

(1) Background: Lower socioeconomic status increases psychiatric service use, exacerbated during the COVID-19 pandemic by environmental stressors like air pollution and limited green spaces. This study aims to assess the influence of sociodemographic and environmental factors on mental health service utilisation. (2) Methods: This retrospective study uses an administrative database focusing on community mental health services in Northeast Italy. Spatial and temporal analyses were used to address space-time dependencies. (3) Results: Findings showed that sociodemographic factors like living in rented apartments and lower education levels predicted higher mental health service use. Environmental factors, such as elevated NO2 levels and, before the pandemic, lower solar radiation and tree cover, correlated with increased service utilisation. COVID-19 reduced most of the pre-existing differences associated with these factors across census blocks with a different composition of sociodemographic and environmental factors. (4) Conclusions: These findings contribute to a better understanding of the impact of the environment on public mental health.

A right to health-based approach to dental caries: towards a comprehensive control strategy.

BACKGROUND: Health is a matter of human rights and dental caries is the most common non-communicable disease (NCD) globally. Consequently, dental caries is a matter of human rights and its control, particularly prevention, must be a priority. Although largely preventable, this is too often neglected, both in the literature of human rights- and health law, and in dental research. The right to oral health has recently been acknowledged by the World Health Organization (WHO), but it is insufficiently clear what this right entails. SUMMARY: This article introduces a right to health-based narrative in the context of dental caries. The right to health is stipulated in human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC). States that are Parties to these treaties, which are virtually all States globally, are mandated to ensure the enjoyment of individuals' right to the highest attainable standard of health, including oral health. KEY MESSAGES: Dental caries is a matter of human rights. States have binding obligations to address dental caries: they require the regulation of the healthcare system, i.e. the traditional focus on operative care, but also put the regulation of other risk factors on an equal footing, such as the regulation of the living environment and access to fluoride. A right to health-based approach to dental caries thus offers a comprehensive approach to dental caries control, particularly prevention.

Consumer Interaction with Sustainability Labelling on Food Products: A Narrative Literature Review.

Sustainability labelling on food products can help consumers make informed purchasing decisions and support the urgent transition to sustainable food systems. While there is a relatively robust body of evidence on health and nutrition labelling, less is known about the effectiveness of sustainability labelling in facilitating sustainable food choices. This paper investigates the impact of sustainability labelling on consumer understanding, attitudes, and behaviour to support a more nuanced, detailed, and holistic understanding of the evidence. Using a narrative literature review methodology, the paper assesses studies covering environmental, social, and/or animal welfare aspects of sustainability labelling on food products. We found that consumer understanding of sustainability information is often limited, which could hinder behaviour change. While sustainability labelling can influence consumer attitudes and purchasing behaviours, evidence from real consumer settings tends to show small effect sizes. Consumers are generally willing to pay more for sustainability-labelled products, and organic labelling often leads to the highest reported willingness to pay. The review emphasises the importance of trust, suggesting a preference for labelling backed by governments or public authorities. Sustainability labelling that uses intuitively understandable cues has an increased impact, with visual aids such as traffic light colours showing promise. We conclude that further research is needed in real-world settings, using representative populations and exploring the influence of demographic factors, values, and attitudes.

Reply to Hodac, N.; Wittekind, A. Comment on "Moz-Christofoletti, M.A.; Wollgast, J. Sugars, Salt, Saturated Fat and Fibre Purchased through Packaged Food and Soft Drinks in Europe 2015-2018: Are We Making Progress? Nutrients 2021, 13, 2416".

We acknowledge the points raised by Hodac and Wittekind [...].

High Levels of Nutrients of Concern in Baby Foods Available in Europe That Contain Sugar-Contributing Ingredients or Are Ultra-Processed.

Introducing children to healthy and diverse complementary foods, either prepared at home or produced commercially, helps to establish taste preferences and good eating habits later in life. Assessing the nutrient profile of foods available commercially is key to informing consumers and policy makers. We used commercial data to provide an overview of the energy and nutrient content of 7 categories of foods intended for infants and young children that were launched or re-launched across 27 European countries from March 2017 to March 2021 (n = 3427). We also assessed the presence of sugars as added ingredients, and the foods' level of processing, using the NOVA classification system. In total, 38.5% of the products contained at least one sugar-contributing ingredient; about 10% of products listed an added sugar, almost » of the products listed a free sugar and finally about 20% of the products listed fruit and vegetable purees and powders as an ingredient. Half of the products had a 'no added sugars' positioning statement; among these, almost 35% had free sugars, fruit and vegetable purees and powders as added ingredients. With regard to processing classification, 46.3% of the products were minimally processed, 24.5% were processed and 29.2% ultra-processed. About half of all products had a 'no artificial ingredient' positioning statement; however, among these, 31.4% were ultra-processed. Our analysis showed that, within each food category, products with sugars as an added ingredient had a less desirable nutrient profile compared to those that did not have sugar-contributing ingredients. The results for level of processing were similar; in most food categories, ultra-processed foods had higher energy, fat, saturated fat, sugars and sodium content, and lower fibre content, compared to the minimally processed and processed ones.

Sugars, Salt, Saturated Fat and Fibre Purchased through Packaged Food and Soft Drinks in Europe 2015-2018: Are We Making Progress?

The availability, purchase and consumption of foods high in fat, sugars and salt and low in fibre are linked to the high health and economic burden of noncommunicable diseases, including cancer, in Europe. Therefore, assessing the quality of the food offer is key as feedback to decision makers, as well as to identify good practices and areas of the food supply still requiring urgent action. We combined detailed market share and sales data with nutrition composition data to evaluate the nutritional quality of 14 packaged food and soft drinks categories sold across 22 European countries over the 2015-2018 period. Our analysis shows great variability of the nutritional composition within and among packaged food and soft drinks categories across European countries. Our estimates of the market-share weighted mean, a measure that integrates possible changes in nutrient content with the amount of a product sold to consumers, as well as daily per capita nutrient sale estimates, suggest a small but statistically significant progress in certain food categories only. Overall, the amounts of sugars, saturated fat, salt and fibre being sold to European citizens through these products is not improving to an extent to meet public health objectives.

Healthy low nitrogen footprint diets.

Shifting towards more plant-based diets can reduce the environmental burden of the food system including its impact on the nitrogen cycle. However, such changes need to be compatible with healthy nutrition. To discuss the health aspects of plant-based dietary patterns, this literature review analyses vegetarian and vegan diets and concludes that well-planned, balanced vegetarian diets are nutritious and healthy. Food-based dietary guidelines (FBDGs) that include environmental aspects and practical advice to individuals and society are needed as crucial instruments to further promote public health within the planetary boundaries. FBDGs need to be better exploited to serve as a basis to policies that promote diets supporting the UN sustainable development goals.

The ineligibility of food products from across the EU for marketing to children according to two EU-level nutrient profile models.

BACKGROUND: A variety of nutrient profiling models have been developed to restrict food marketing to children. Previous assessments have shown substantial differences in terms of model strictness and agreement, but EU-wide data on how leading products in the various national markets perform against these health-minded nutrition criteria are unavailable. OBJECTIVE: To evaluate the nutritional composition of the pre-packaged food offer in selected categories sold at scale in the EU using criteria of two nutrient profile models intended to restrict food marketing to children. METHODS: The nutrient profile models of the private-sector EU Pledge and of the World Health Organization's Regional Office for Europe were applied to a commercial database with sales and nutritional information of 2691 pre-packaged products from five product categories (breakfast cereals, ready meals, processed meat, processed seafood, and yoghurts) and 20 EU countries. This study describes the criteria not met, the product ineligibility rates, and the distances to the various criteria thresholds. FINDINGS: Between 48% (EU Pledge) and 68% (WHO Europe) of the 2691 products analysed were found to be ineligible for marketing to children. The criteria thresholds most often not met were those for total sugars (in breakfast cereals, yoghurts), salt (in processed meat, processed seafood, ready meals), and fibre (in breakfast cereals). Total and saturated fat criteria also played a substantial role in rendering yoghurt products ineligible, and the energy criterion did so for ready meals. INTERPRETATION: A large number of food products selling at scale in the EU do not meet the criteria of two EU-level nutrient profile models intended to restrict food marketing to children. Given the considerable market share of many such products, they are likely to be consumed widely and in some cases regularly, including by children, even without being marketed to them. Nutrient profile models could serve as benchmarking tools for monitoring and evaluating food product reformulation efforts.

Public health economic evaluation of different European Union-level policy options aimed at reducing population dietary trans fat intake.

BACKGROUND: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. OBJECTIVE: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or self-regulatory measures). DESIGN: We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods. RESULTS: The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option. CONCLUSIONS: The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy.

Assessing herbal products with health claims.

Herbs, herbal extracts, or phytochemicals are broadly used as foods, drugs, and as traditional medicines. These are well regulated in Europe, with thorough controls on both safety and efficacy or validity of health claims. However, the distinction between medicines and foods with health claims is not always clear. In addition, there are several cases of herbal products that claim benefits that are not scientifically demonstrated. This review details the European Union (EU) legislative framework that regulates the approval and marketing of herbal products bearing health claims as well as the scientific evidence that is needed to support such claims. To illustrate the latter, we focus on phytoecdysteroid (PE)-containing preparations, generally sold to sportsmen and bodybuilders. We review the limited published scientific evidence that supports claims for these products in humans. In addition, we model the in silico binding between different PEs and human nuclear receptors and discuss the implications of these putative bindings in terms of the mechanism of action of this family of compounds. We call for additional research to validate the safety and health-promoting properties of PEs and other herbal compounds, for the benefit of all consumers.

Polycyclic aromatic hydrocarbons (PAHs) in the Mediterranean Sea: atmospheric occurrence, deposition and decoupling with settling fluxes in the water column.

∑(30)PAH gas phase concentrations (13-86 and 22-40 ng m(-3) in the Mediterranean and Black Seas, respectively) dominated the atmospheric levels due to the high contribution of phenanthrene, dibenzothiophene and their alkylated derivates. The high variability of PAH atmospheric concentrations in the different sub-basins is due to several factors (i.e. air-mass trajectory, proximity to sources and losses by deposition). The ∑(30)PAH atmospheric deposition (dominated by low MW PAH net air-water diffusive fluxes) is estimated to be ~3100 ton y(-1) (Mediterranean) and ~500 ton y(-1) (Black Sea). Net volatilization for certain PAHs was estimated. Deposition fluxes (1-2 orders of magnitude higher than reported PAH settling fluxes in the water column) confirm an important depletion/sink of water column PAH in the photic zone, especially for low MW PAHs. Degradation processes in the water column may be responsible for this decoupling. Conversely, high MW PAHs dry deposition fluxes are similar to their settling fluxes.

Persistent organic pollutants in Mediterranean seawater and processes affecting their accumulation in plankton.

The Mediterranean and Black Seas are unique marine environments subject to important anthropogenic pressures due to riverine and atmospheric inputs of organic pollutants. Here, we report the results obtained during two east-west sampling cruises in June 2006 and May 2007 from Barcelona to Istanbul and Alexandria, respectively, where water and plankton samples were collected simultaneously. Both matrixes were analyzed for hexaclorochyclohexanes (HCHs), hexachlorobenzene (HCB), and 41 polychlorinated biphenyl (PCB) congeners. The comparison of the measured HCB and HCHs concentrations with previously reported dissolved phase concentrations suggests a temporal decline in their concentrations since the 1990s. On the contrary, PCB seawater concentrations did not exhibit such a decline, but show a significant spatial variability in dissolved concentrations with lower levels in the open Western and South Eastern Mediterranean, and higher concentrations in the Black, Marmara, and Aegean Seas and Sicilian Strait. PCB and OCPs (organochlorine pesticides) concentrations in plankton were higher at lower plankton biomass, but the intensity of this trend depended on the compound hydrophobicity (K(OW)). For the more persistent PCBs and HCB, the observed dependence of POP concentrations in plankton versus biomass can be explained by interactions between air-water exchange, particle settling, and/or bioaccumulation processes, whereas degradation processes occurring in the photic zone drive the trends shown by the more labile HCHs. The results presented here provide clear evidence of the important physical and biogeochemical controls on POP occurrence in the marine environment.

Novel and established intestinal cell line models - An indispensable tool in food science and nutrition.

This review presents the applications of intestinal cell models of human and pig origin in food and nutritional sciences and highlights their potential as in vitro platforms for preclinical research. Intestinal cell models are used in studies of bioavailability, adsorption and transport in nutritional or toxicological settings, allergic effects of food components, as well as probiotics and/or host-pathogen gut interactions. In addition, this review discusses the advantages of using specialized and functional cell models over generic cancer-derived cell lines.

A bioaccumulation model for herbicides in Ulva rigida and Tapes philippinarum in Sacca di Goro lagoon (Northern Adriatic).

A bioaccumulation model to predict concentrations of s-triazine herbicides in the macroalgae Ulva rigida and in clams Tapes philippinarum has been implemented, calibrated and validated. The model uses input data from a 3D biogeochemical model that provides biomasses in the different compartments, i.e. phytoplankton, zooplankton and bacteria; and from a 3D fate model that provides the herbicides concentrations in the water column as well as in the sediments. Simulated data were compared with experimental data collected during a set of sampling campaigns carried out in 2004 and 2005 in the Sacca di Goro lagoon (Northern Adriatic). The model predicts correctly the concentrations of herbicides measured in Ulva rigida and reproduces with good agreement the values of concentration of herbicides found in clams. Furthermore, the simulated spatial and temporal dynamics in the biota compartment, following those of the water and sediments, are also in agreement with the experimental data. This integrated approach combining biogeochemical, fate and bioaccumulation models provide an overall assessment of the importance of the different environmental compartments and it can also support the testing of different management strategies to improve ecosystem state and functioning. Further research is necessary to elucidate the role and importance of the metabolism of these compounds by clams.

Needs for reliable analytical methods for monitoring chemical pollutants in surface water under the European Water Framework Directive.

The state of the art in monitoring chemical pollutants to assess water quality status according to Water Framework Directive (WFD) and the challenges associated with it have been reviewed. The article includes information on environmental quality standards (EQSs) proposed to protect the aquatic environment and humans against hazardous substances and the resulting monitoring requirements. Furthermore, minimum performance criteria for analytical methods and quality assurance issues have been discussed. The result of a survey of existing standard methods with a focus on European (EN) and international standards (ISO) for the analysis of chemical pollutants in water is reported and the applicability of those methods for the purpose of compliance checking with EQSs is examined. Approximately 75% of the 41 hazardous substances for which Europe-wide EQSs have been proposed can be reliably monitored in water with acceptable uncertainty when applying existing standardised methods. Monitoring in water encounters difficulties for some substances, e.g., short-chain chlorinated paraffins (SCCPs), polybrominated diphenyl ethers (PBDEs), tributyltin compounds, certain organochlorine pesticides and six-ring PAHs, mainly due to a lack of validated, sufficiently sensitive methods that are applicable in routine laboratory conditions. As WFD requires monitoring of unfiltered samples for organic contaminants more attention needs to be paid to the distribution of chemical pollutants between suspended particulate matter and the liquid phase. Methods allowing complete extraction of organic contaminants from whole water samples are required. From a quality assurance point of view, there is a need to organise interlaboratory comparisons specifically designed to the requirements of WFD (concentrations around EQSs, representative water samples) as well as field trials to compare sampling methodologies. Additional analytical challenges may arise when Member States have identified their river basin specific pollutants and after revision of the list of priority substances.

Analysis of perfluorooctanoate (PFOA) and other perfluorinated compounds (PFCs) in the River Po watershed in N-Italy.

C7-C11 perfluorinated carboxylates (PFACs) and perfluorooctansulfonate (PFOS) were analysed in selected stretches of the River Po and its major tributaries. Analyses were performed by solid-phase extraction (SPE) with Oasis HLB cartridges and methanol elution followed by LC-MS-MS detection using 13C-labelled internal standards. High concentration levels ( approximately 1.3 microg l(-1)) of perfluorooctanoate (PFOA) were detected in the Tánaro River close to the city Alessandria. After this tributary, levels between 60 and 337 ng l(-1) were measured in the Po River on several occasions. The PFOA concentration close to the river mouth in Ferrara was between 60 and 174 ng l(-1). Using the river discharge flow data in m3 s(-1) at this point (average approximately 920 m3 s(-1) for the year 2006), a mass load of approximately 0.3 kg PFOA per hour or approximately 2.6 tons per year discharged in the Adriatic Sea has been calculated. PFOS concentration levels in the Po River at Ferrara were approximately 10 ng l(-1).

Occurrence of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) in Lake Maggiore (Italy and Switzerland).

Samples of air (gas and particulate phases), bulk deposition, aquatic settling material and sediments were collected in Lake Maggiore (LM) in order to determine their content of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs). Air (gas and particulate phases) concentrations were 0.5 pg m(-3), 80 pg m(-3), 13 pg m(-3) and 106 pg m(-3) for SigmaPCDD/Fs, SigmaPCBs, Sigma dioxin-like PCBs (DL-PCBs) and SigmaPBDEs, respectively. Deposition fluxes ranged from 0.7 ng m(-2) d(-1) for SigmaPCDD/Fs to 32 ng m(-2) d(-1) for SigmaPCBs. Aquatic settling material presented concentrations of 0.4 ng g(-1) dry weight (dw) for SigmaPCDD/Fs, 13 ng g(-1) dw for SigmaPCB, 3.4 ng g(-1) dw for SigmaDL-PCBs and 5.7 ng g(-1) dw for SigmaPBDEs. Mean sediment concentrations were 0.4 ng g(-1) dw for SigmaPCDD/Fs, 11 ng g(-1) dw for SigmaPCB, 3 ng g(-1) dw for SigmaDL-PCBs and 5.1 ng g(-1) dw for SigmaPBDEs. Similar PCDD/F and DL-PCB congener patterns in all the environmental compartments of LM point to an important, if not dominant, contribution of atmospheric deposition as source of these pollutants into LM. In contrast, PBDE congener distribution was not similar in the different environmental compartments. BDE 47 dominated air and settling material, while BDE 209 was the predominant congener in the bulk atmospheric deposition. Moreover, sediments showed two distinct PBDE congener profiles. Lower PBDE concentrated sediments were dominated by congeners 47 and 99, while BDE 209 dominated in higher PBDE concentrated samples. This suggests the influence of local sources as well as atmospheric input of PBDEs into LM.

Polar herbicides, pharmaceutical products, perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and nonylphenol and its carboxylates and ethoxylates in surface and tap waters around Lake Maggiore in Northern Italy.

A survey of contamination of surface and drinking waters around Lake Maggiore in Northern Italy with polar anthropogenic environmental pollutants has been conducted. The target analytes were polar herbicides, pharmaceuticals (including antibiotics), steroid estrogens, perfluorooctanesulfonate (PFOS), perfluoroalkyl carboxylates (including perfluorooctanoate PFOA), nonylphenol and its carboxylates and ethoxylates (NPEO surfactants), and triclosan, a bactericide used in personal-care products. Analysis of water samples was performed by solid-phase extraction (SPE) then liquid chromatography-triple-quadrupole (tandem) mass spectrometry (LC-MS-MS). By extraction of 1-L water samples and concentration of the extract to 100 microL, method detection limits (MDLs) as low as 0.05-0.1 ng L(-1) were achieved for most compounds. Lake-water samples from seven different locations in the Southern part of Lake Maggiore and eleven samples from different tributary rivers and creeks were investigated. Rain water was also analyzed to investigate atmospheric input of the contaminants. Compounds regularly detected at very low concentrations in the lake water included: caffeine (max. concentration 124 ng L(-1)), the herbicides terbutylazine (7 ng L(-1)), atrazine (5 ng L(-1)), simazine (16 ng L(-1)), diuron (11 ng L(-1)), and atrazine-desethyl (11 ng L(-1)), the pharmaceuticals carbamazepine (9 ng L(-1)), sulfamethoxazole (10 ng L(-1)), gemfibrozil (1.7 ng L(-1)), and benzafibrate (1.2 ng L(-1)), the surfactant metabolite nonylphenol (15 ng L(-1)), its carboxylates (NPE(1)C 120 ng L(-1), NPE(2)C 7 ng L(-1), NPE(3)C 15 ng L(-1)) and ethoxylates (NPE( n )Os, n = 3-17; 300 ng L(-1)), perfluorinated surfactants (PFOS 9 ng L(-1), PFOA 3 ng L(-1)), and estrone (0.4 ng L(-1)). Levels of these compounds in drinking water produced from Lake Maggiore were almost identical with those found in the lake itself, revealing the poor performance of sand filtration and chlorination applied by the local waterworks.