DNA damage in workers exposed to pigment grade titanium dioxide (TiO2) and association with biomarkers of oxidative stress and inflammation

The present study was aimed at investigating DNA damage, micronuclei frequency and meta-nuclear alterations in buccal cells of workers involved in pigment-grade TiO2 production (15 exposed and 20 not-exposed). We also assessed associations of genotoxicity biomarkers with oxidative stress/inflammatory biomarkers in urine and exhaled breath condensate (EBC), as well as possible associations between biomarkers and reported respiratory symptoms. In spite of compliance with TiO2 Occupational Exposure Limits, results showed increased direct/oxidative DNA damage and micronuclei frequency in exposed workers. Genotoxicity parameters were associated with oxidative stress/inflammation biomarkers in urine and EBC, thus confirming that TiO2 exposure can affect the oxidative balance. Workers with higher genotoxic/oxidative stress biomarkers levels reported early respiratory symptoms suggesting that molecular alterations can be predictive of early health dysfunctions. These findings suggest the need to assess early health impairment in health surveillance programs and to address properly safety issues in workplaces where TiO2 is handled.

Occurrence of human pathogenic viruses in drinking water and in its sources: A review

Since many waterborne diseases are caused by human pathogenic viruses, virus monitoring of drinking water (DW) and DW sources is crucial for public health. Therefore, the aim of this review was to describe the occurrence of human pathogenic viruses in DW and DW sources; the occurrence of two viruses proposed as novel indicators of human faecal contamination (Pepper mild mottle virus and Tobacco mosaic virus) was also reported. This research was focused on articles that assessed viral occurrence using molecular methods in the surface water used for DW production (SW-D), groundwater used for DW production (GW-D), DW and bottled-DW (BW). A total of 1544 studies published in the last 10 years were analysed, and 79 were ultimately included. In considering the detection methods, filtration is the most common concentration technique, while quantitative polymerase chain reaction is the most common quantification technique. Regarding virus occurrence in SW-D, GW-D, and DW, high percentages of positive samples were reported for adenovirus, polyomavirus and Pepper mild mottle virus. Viral genomes were frequently detected in SW-D and rarely in GW-D, suggesting that GW-D may be a safe DW source. Viral genomes were also detected in DW, posing a possible threat to human health. The lowest percentages of positive samples were found in Europe, while the highest were found in Asia and South America. Only three articles assessed viral occurrence in BW. This review highlights the lack of method standardization and the need for legislation updates.

Occurrence of antibiotic-resistant bacteria and resistance genes in the urban water cycle

This study investigates the antibiotic resistance fate in the urban water cycle, evaluating the dynamics of antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) in three different full-scale wastewater treatment plants (WWTPs) and two drinking water treatment plants (DWTPs) located in the same geographical area (North-West of Italy). ARB (tetracycline-, ampicillin-, and sulfonamide-resistant bacteria) were quantified by plate counting and the abundances of selected ARGs (i.e., tetA, bla_TEM, and sulII) and intI1 gene were measured using quantitative real-time PCR (qPCR). Higher concentrations of ARB and ARGs were observed in the WWTPs with respect to the DWTPs identifying the WWTP as hotspot for the spread of antibiotic resistances. Although a significant reduction of ARB and ARGs was observed in WWTPs and DWTPs after the treatment, none of the detected ARB or ARGs was completely removed in drinking water. The stability of the antibiotic-resistant rates between inlet and outlet associated with the reduction of relative ARG abundances underlined that both the treatments (WWTs and DWTs) did not apply any selective pressure. The overall results highlighted the importance to investigate the antibiotic resistance dynamics in aquatic ecosystems involved in urban water cycle integrating the information obtained by culture-dependent method with the culture-independent one and the need to monitor the presence of ARB and ARGs mainly in drinking water that represents a potential route of transmission to human.

Lifestyle-Related Risk Factors of Orthorexia Can Differ among the Students of Distinct University Courses

Orthorexia nervosa (ON) is defined as the excessive attention on healthy eating, and studies especially focused on food quality ON prevalence in university students can be extremely variable. The objective of this study is to investigate whether there was a difference in ON risk between health-scientific, economic-humanistic, sport sciences and dietetics and nutrition students, and to evaluate if lifestyle-related ON risk factors (dieting, physical activity, drugs and supplements use) could have an impact in different ways in determining ON risk among students attending these four programs. Participants were recruited at the University of Pavia and received a two-section questionnaire including demographic and lifestyle information and the ORTO-15 questionnaire. A total of 671 students (54% F e 46% M) completed the questionnaire (median age 21.00 (IQR 20.00−23.00), median BMI 21.77 kg/m2 (IQR 20.06−23.66 kg/m2)). The 31.2% had ORTO-15 test scores < 35, and were considered at risk of having ON. No differences were found in ON risk among the students attending the four university courses. Dieting was confirmed as the major ON risk factor for health-scientific, economic-humanistic and sport sciences students. The type of sport practiced was an important determinant of ON risk only for the economic-humanistic course, while supplements use was statistically different between sport sciences students with or without ON. Our findings may suggest that lifestyle-related risk factors of orthorexia can differ among the students of distinct university courses, but these results need to be supported by further longitudinal and prospective studies.

Traits of orthorexia nervosa and muscle dysmorphia in Italian university students: a multicentre study

PURPOSE

This study aimed to evaluate the prevalence of traits of orthorexia nervosa (ON) and muscle dysmorphia (MD) in a group of undergraduates, investigate the associations between the risk of these conditions and the type of university course attended, the individual characteristics (gender, BMI, amount of physical activity, supplements and medicines use, dieting) and the risk of eating disorders (EDs).

METHODS

A self-reported questionnaire consisting of a socio-demographic section and three tests validated for the evaluation of a risk of ON (ORTO-15), MD (MDDI-ITA) and EDs (EAT-26) was completed by 918 students from three Italian universities.

RESULTS

29.0% of participants demonstrated traits of ON and 5.0% of MD, without differences in prevalence in the three areas of study investigated (health-scientific, economic-humanistic, sport sciences); students of sport sciences exhibited a significantly higher score for MDDI-ITA (F = 6.493, p = 0.002). Participants with ON and MD traits were more on a diet (OR = 0.47, p ≤ 0.001 and OR = 0.428, p = 0.020, respectively) and showed a higher prevalence of EDs risk (OR = 3.55, p < 0.001 and OR = 10.23, p ≤ 0.001, respectively). The simultaneous presence of ON, MD, and EDs traits was seen in 5.4% of the students and the three test scores were correlated.

CONCLUSIONS

The prevalence of ON and MD traits was found similar to that reported in the literature on undergraduates. Some associations observed improvement in the knowledge about these conditions, especially the association of participants with ON and MD traits with dieting and EDs traits and the correlation of the three test scores suggests a connection among these potential conditions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Cryptosporidium oocysts: are they still a risk for human population? A case study in Italy

Over the past decade, several outbreaks of cryptosporidiosis have been reported in many EU countries in association with the consumption of contaminated drinking water, recreational waters, food consumption and contact with animals. The aim of this study was to evaluate the occurrence of Cryptosporidium oocysts in a drinking water treatment plant (DWTP) located in a rural area of northern Italy. Influent and effluent samples at the DWTP, together with tap water samples from a public fountain were collected for three years (2013-2016). All samples were analysed for the presence of Cryptosporidium spp. oocysts by the EPA Method 1623 based on immunomagnetic separation (IMS)/immunofluorescence assay (IFA), complemented by 4,6-diamidino-2-phenylindole (DAPI) staining. The detection has been implemented with a reverse transcriptase-PCR (RT-PCR) protocol to evaluate the oocyst viability. The results highlighted a high variability of oocyst concentrations in all samples (mean 4.3 - 5.8/100 L) and a high percentage variability of the DAPI-positive specimens (mean 48.2% - 40.3%). Conversely, RT-PCR did not reveal the presence of any viable C. parvum and C. hominis oocysts. A nested PCR targeting Cryptosporidium 18S ribosomal DNA was carried out in two water samples to deepen the understanding of the obtained results. This test revealed the presence of a particular Cryptosporidium genotype associated with wild animals in the river and in tap water. Although the recovered Cryptosporidium genotype is not a human pathogen, its presence demonstrates the existence of a potential pathogen Cryptosporidium spp. contamination risk. Moreover, these results underline the importance of considering unconventional (not bacterial) biological contaminations (protozoa) in water resources in rural areas, including those of developed countries.

Key messages

The supply source and the drinking water treatment plant examined represent a classic example of a system that requires continuous monitoring to guarantee population health. Cryptosporidium oocysts may still be a Public Health problem even in industrialized countries, especially in rural and mountain areas.

Role of different wastewater treatment plants in antibiotic resistance spreading

The global action plan on antimicrobial resistance reports the necessity to develop standards and guidance for the presence of antimicrobial agents in the environment, especially in wastewater, highlighting its possible role in the antibiotic resistance spreading. In addition, the New European One Health Action Plan against Antimicrobial Resistance underlines the need to support research into knowledge gaps on the release of resistant microorganisms into the environment and their dissemination. The aim of this study was to evaluate the presence of Antibiotic Resistance Bacteria (ARB) and Antibiotic Resistance Genes (ARG) in wastewater treatment plants (WWTPs). At this scope, untreated sewage and treated effluents of three different WWTPs (A, B and C) were sampled for one year. Sample dilutions were plated on R2Agar added/not-added with 4 different antibiotics (ampicillin 32mg/L; tetracycline 16 mg/L; chloramphenicol 32 mg/L; sulfamethoxazole 50,4 mg/L) to evaluate the percentage of antibiotic resistant bacteria and their WWTPs removal rate (%). DNA extraction on the filter used to concentrate the wastewater samples was performed to reveal the ARG presence; subsequently specific PCRs for ARG (blaTEM, tetA, sul II, sul III) were carried out. ARB were detected in all samples analysed. The highest antibiotic resistance percentage was revealed in the sewage (mean 21,7%±4,8) and effluent (mean 21,1%±3,0) of the three wastewater treatment plants for sulfamethoxazole. Moreover, sul II was the most present gene in the samples (81% of all samples, 89 % of sewages and 72% of effluents). The lower WWTPs removal was recovered in the plant B for the tetracycline (95, 7%). The results obtained underlines the need to monitor WWTP as critical hot spot for the antibiotic resistance spreading also considering the One Health approach. Furthermore, the results obtained could suggest interventions to reduce the spread of the antibiotic resistance in the integrated urban water cycle.

Key messages

The information obtained could provide usefulness information about the role of wastewater treatment plant in the antibiotic resistance spreading. The results could contribute to suggest the interventions targeted to reduce the antibiotic resistance phenomenon in the integrated urban water cycle.

Genotoxic damage in workers exposed to pigment-grade titanium dioxide (TiO2) during paint production

TiO2 is broadly used in a wide range of applications such as photocatalysis, pigments and additives. Despite the promising commercial opportunities, different studies have shown that TiO2 can induce oxidative stress, inflammatory and genotoxic effects. The European Union has classified certain titanium dioxide powders and powder mixtures containing TiO2 as a suspected carcinogen (Category 2) via inhalation. Considering that the information about the potential adverse health effects of TiO2 in occupational environment are still scarce and controversial, the purpose of the study was to investigate the genotoxic effects and oxidative stress in workers exposed to TiO2 during paint production.

Biomarkers of early effect (DNA damage and micronuclei) were evaluated in the buccal cells and salivary leucocytes of 30 workers (15 production workers and 15 controls). To collect information about personal details, occupational history, medication, smoking, diet, physical activity, a questionnaire was administered to all workers. Personal and area monitoring have been carried out to determine airborne inhalable and respirable fraction of TiO2; a NanoTracer was used to monitor the presence of ultrafine particles.

In spite of the low mass concentration and a mild percentage of nanoparticles, filter deposited TiO2 was in sub-micron size, thus accounting for its respirability. Preliminary results on salivary leucocytes show a slight higher DNA damage in the exposed workers as compared to the controls.

Whereas biomarker assessment is still in progress, these preliminary findings show that workers are exposed to low but measurable levels of TiO2 able to induce a mild genotoxic damage. A combined approach using both personal exposure assessment and biomonitoring can improve the risk assessment in occupational settings in which TiO2 is handled. Moreover, this also suggest to take precautionary measure during specific activities and operational phases thus decreasing the risks for worker.

Key messages

The results of the present study may promote effective risk management practices in occupational environments that uses TiO2. The results obtained suggest the introduction of activities and operational phases with lower risks for the worker.

Monitoring air pollution effects on children for supporting public health policies (MAPEC_LIFE study)

Background

Children are at high risk of suffering health consequences of air pollution and childhood exposure can increase the risk of developing chronic diseases in adulthood. The MAPEC_LIFE project, funded by EU Life+ Programme (LIFE12 ENV/IT/000614), aimed to evaluate the association between air pollution exposure and biomarkers of early effect in children and to propose guidance for implementing environmental policies.

Methods

The study was carried out on 6-8-year-old children. Micronucleus (MN) frequency was investigated in buccal cells of children and its association with air pollution exposure was assessed applying multiple Poisson regression mixed models, including socio-demographic and lifestyle factors as confounders. We also dichotomize air pollutants concentration according to the EU Ambient Air Quality Directives and WHO Air Quality Guidelines in all Poisson regression models to assess their risk predictive capacity.

Results

The project involved 1149 children providing buccal cells in winter and spring. 2139 biological samples were included in the analysis (1093 collected in winter, 1046 in spring). The analysis of the association between MN frequency and air quality parameters found positive associations for PM10, PM2.5, benzene, SO2 and ozone. Considering EU Directives, an association was found between MN frequency and PM10 exposure higher than the annual limit value, with an increase of the risk of 17.9% (95%CIs: 0.6-38.1%). Considering WHO Guidelines, the exposures to levels of PM10, benzene and BaP higher than the annual limits were associated with MN frequency, with a risk increase of 22.5%, 27.8% and 59.8% (95%CIs: 3.9-44.3%, 3.8-57.3%, 21.0-111.1%), respectively.

Conclusions

The analyses conducted showed an association between MN frequency in buccal cells of children and levels of some air pollutants, even at concentration below EU and WHO thresholds, which hence seemed to be insufficient for protecting children from this type of damage.

Key messages

Air pollution exposure induced chromosomal damage in buccal cells of children, even at concentration below the law limits. Early biological damage detected might be predictive of the occurrence of future harmful effects in humans, at a population level.

Cryptosporidium Oocyst Contamination in Drinking Water: A Case Study in Italy

The aim of this study was to evaluate the occurrence of Cryptosporidium oocysts in a drinking water treatment plant (DWTP) located in a rural area of northern Italy. Influent and effluent samples were collected at the DWTP over three years (2013-2016). In parallel, tap water samples from a public drinking fountain were collected as well. All samples were analyzed for the presence of Cryptosporidium spp. oocysts by a common method based on an immunomagnetic separation (IMS)/immunofluorescence assay (IFA), complemented by 4,6-diamidino-2-phenylindole (DAPI) staining. A reverse transcriptase-PCR (RT-PCR) protocol was added to evaluate oocyst viability. The results highlighted a high variability of oocyst concentrations across all samples (mean 4.3 ± 5.8/100 L) and a high variability in the percentage of DAPI-positive specimens (mean 48.2% ± 40.3%). Conversely, RT-PCR did not reveal the presence of viable C. parvum and C. hominis oocysts. A nested PCR targeting Cryptosporidium 18S ribosomal DNA, carried out in two water samples, confirmed the presence of a Cryptosporidium genotype associated with wild animals in the river and in tap water. The results obtained underline the vulnerability of the investigated surface water to Cryptosporidium spp. contamination. Although the recovered Cryptosporidium genotype is not a human pathogen, its presence demonstrates the existence of a potential pathogen Cryptosporidium spp. contamination risk. Moreover, these results underline the importance of also considering unconventional (not bacterial) biological contaminations (protozoa) in water resources in rural areas, including those of developed countries.

Mutagenic and genotoxic effects induced by PM0.5 of different Italian towns in human cells and bacteria: The MAPEC_LIFE study

Particulate matter (PM) is considered an atmospheric pollutant that mostly affects human health. The finest fractions of PM (PM_2.5 or less) play a major role in causing chronic diseases. The aim of this study was to investigate the genotoxic effects of PM_0.5 collected in five Italian towns using different bioassays. The role of chemical composition on the genotoxicity induced was also evaluated. The present study was included in the multicentre MAPEC_LIFE project, which aimed to evaluate the associations between air pollution exposure and early biological effects in Italian children. PM₁₀ samples were collected in 2 seasons (winter and spring) using a high-volume multistage cascade impactor. The results showed that PM_0.5 represents a very high proportion of PM₁₀ (range 10-63%). PM_0.5 organic extracts were chemically analysed (PAH_s, nitro-PAH_s) and tested by the comet assay (A549 and BEAS-2B cells), MN test (A549 cells) and Ames test on Salmonella strains (TA100, TA98, TA98NR and YG1021). The highest concentrations of PAHs and nitro-PAHs in PM_0.5 were observed in the Torino, Brescia and Pisa samples in winter. The Ames test showed low mutagenic activity. The highest net revertants/m³ were observed in the Torino and Brescia samples (winter), and the mutagenic effect was associated with PM_0.5 (p < 0.01), PAH and nitro-PAH (p < 0.05) concentrations. The YG1021 strain showed the highest sensitivity to PM_0.5 samples. No genotoxic effect of PM_0.5 extracts was observed using A549 cells except for some samples in winter (comet assay), while BEAS-2B cells showed light DNA damage in the Torino, Brescia and Pisa samples in winter, highlighting the higher sensitivity of BEAS-2B cells, which was consistent with the Ames test (p < 0.01). The results obtained showed that it is important to further investigate the finest fractions of PM, which represent a relevant percentage of PM₁₀, taking into account the chemical composition and the biological effects induced.

Effectiveness of a neutral electrolysed oxidising water (NEOW) device in reducing Legionella pneumophila in a water distribution system: A comparison between culture, qPCR and PMA-qPCR detection methods

Disinfection of hot water systems is critical for reducing Legionnaires' disease in high-risk buildings. The use of neutral electrolysed oxidising water (NEOW) is a promising method for the control of microorganisms in hot water systems. However, full-scale evaluations of the efficacy of NEOW devices to control Legionella pneumophila are currently lacking. The aim of this study was to assess the effectiveness of a NEOW device in reducing L. pneumophila in a hotel water network. Water samples (n = 67) were collected from different sites of a hotel distribution system before and after the installation of the NEOW device at the 1st, 4th, 8th and 12th week. Detection of L. pneumophila was performed comparing culture, qPCR and PMA-qPCR methods. Total bacterial counts (22 °C and 37 °C), Pseudomonas spp. and physico-chemical parameters were also monitored. The NEOW treatment resulted in a reduction of the amount of L. pneumophila positive samples (-32%) and of the number of heavily contaminated points (>10⁴ CFU/L and >10³ CFU/L) (-100% and -96%, respectively). Treatment maintained L. pneumophila at low levels (<10² CFU/L), which do not require specific intervention measures. The effectiveness of the disinfection system was also confirmed by PMA-qPCR (p < 0.001). The use of PMA resulted in a signal decrease in almost all samples upon the disinfection treatment. The NEOW disinfection device appears to be a promising approach to reduce the colonisation of hot water systems by L. pneumophila; however, further investigations are needed to ascertain its efficiency over longer time periods.

Physical Activity, Lifestyle Factors and Oxidative Stress in Middle Age Healthy Subjects

Oxidative stress (OS) has been recognized to play a primary role in many acute and chronic diseases. Environmental and lifestyle factors, such as physical activity and dietary intake are involved in the oxidative balance, but their specific influence remains unclear. In order to contribute to a greater characterization of the oxidative status in relation to exercise training and to environmental and lifestyle factors, different biomarkers—pro-oxidant capacity (d-ROMs), anti-oxidant capacity (BAP), radical scavenging activity (DPPH) and DNA damage (8-OHdGuo)—were measured in biological samples of a group of healthy middle aged subjects. The evaluation of the investigated biomarkers highlighted a significant effect of exercise training on OS, measured as d-ROMs and 8OhdGuo, in subjects playing regular physical activity. An association of the OS status measured by DPPH and 8-OhdGuo with the condition of living in urban high traffic areas was also found. Otherwise dietary habits did not reveal any significant effect on OS levels by the investigated biomarkers. As a whole the results obtained in this investigation suggested that a correct lifestyle, with regular physical activity practice, contributes to control the OS status in middle age subjects.

Black and white teas as potential agents to combine with amphotericin B and protect red blood cells from amphotericin B-mediated toxicity

Abstract Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with black tea or white tea and protective of citotoxic effect. The present study shows that white and black teas have additive effects with amphotericin B against some species Candida. In addition, the combination of white and black tea with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that white and black tea is a potential agent to combine with amphotericin for antifungal efficacy and to reduce the amphotericin dose to lessen side effects.

Primary mediastinal large B-cell lymphoma: Outcome of a series of pediatric patients treated with high-dose methotrexate and cytarabine plus anti-CD20

Between 2007 and 2013, 13 children diagnosed with primary mediastinal large B-cell lymphoma (PMLBL) were treated according to a modified version of AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) LNH-97 protocol based on high-dose methotrexate, anthracyclines, and addition of anti-CD20. Ten patients achieved a continuous complete remission with front-line therapy. The overall 5-year survival was 91.7%, and event-free survival was 83.9%, with only one patient dying of progressive disease. Despite the few cases, these results demonstrate that this therapy, which includes anti-CD20, given in a multicenter setting, is feasible with acceptable toxicity in children with PMLBL.

Viability of Legionella pneumophila in Water Samples: A Comparison of Propidium Monoazide (PMA) Treatment on Membrane Filters and in Liquid

Legionella pneumophila is a ubiquitous microorganism widely distributed in aquatic environments and can cause Legionellosis in humans. A promising approach to detect viable cells in water samples involves the use of quantitative polymerase chain reaction (qPCR) in combination with photoactivatable DNA intercalator propidium monoazide (PMA). However, the PMA efficiency could be different depending on the experimental conditions used. The aim of this study was to compare two PMA exposure protocols: (A) directly on the membrane filter or (B) in liquid after filter washing. The overall PMA-induced qPCR means reductions in heat-killed L. pneumophila cells were 2.42 and 1.91 log units for exposure protocols A and B, respectively. A comparison between the results obtained reveals that filter exposure allows a higher PMA-qPCR signal reduction to be reached, mainly at low concentrations (p < 0.05). This confirms the potential use of this method to quantify L. pneumophila in water with low contamination.

Lifestyles and socio-cultural factors among children aged 6-8 years from five Italian towns: the MAPEC_LIFE study cohort

BACKGROUND

Lifestyles profoundly determine the quality of an individual's health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6-8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors.

METHODS

A questionnaire composed of 148 questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities (Torino, Brescia, Pisa, Perugia and Lecce) to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics. The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors.

RESULTS

The final cohort was composed of 1,164 children (50.9 boys, 95.4% born in Italy). Frequency of some factors appeared different in terms of the survey season (physical activity in the open air, the ways of cooking certain foods) and among the various cities (parents' level of education and rate of employment, sport, traffic near the home, type of heating, exposure to passive smoking, ways of cooking certain foods). Exposure to passive smoking and cooking fumes, obesity, residence in areas with heavy traffic, frequency of outdoor play and consumption of barbecued and fried foods were higher among children living in families with low educational and/or occupational level while children doing sports and consuming toasted bread were more frequent in families with high socio-economic level.

CONCLUSIONS

The socio-economic level seems to affect the lifestyles of children enrolled in the study including those that could cause health effects. Many factors are linked to the geographical area and may depend on environmental, cultural and social aspects of the city of residence.

The role and working conditions of Movement Science students employed in sport and recreational facilities: An Italian multicenter study

BACKGROUND

In Italy, students from Movement Science (MS) Degree Courses often work in sport and recreational facilities before graduation.

OBJECTIVE

The employment conditions of Movement Science students working in sport/recreational facilities were investigated, and the management and structural features of the facilities were evaluated, including safety policies. Regional differences were also considered.

METHODS

Questionnaires were administered to undergraduate and graduate students (N = 4,217) in 17 Universities. Students' perceptions of the quality of the facilities where they had been employed was evaluated using multivariate analysis. A latent class model with covariates was used to evaluate how variables relating to participants, employment facilities or regions influence their opinions.

RESULTS

A high proportion of MS students were employed in sporting facilities (undergraduate level: 33% ; graduate level: 55%), in most cases without any formal employment contracts. Both the structural and hygienic features, as well as the professional knowledge of the staff, were considered good to excellent by the majority of participants (about 70%). Communication of the basic behavioral rules was considered adequate by 61-63% of undergraduate students and 71-75% of graduate students, while nearly half of the participants were dissatisfied with the staff safety training. Correlations between the perceived good structural/hygienic conditions, the presence of regulations and training programs for the staff were investigated. Differences regarding occupational level and safety training among different regions of Italy were also observed.

CONCLUSIONS

Italian students in Movement Science were easily employed in sport/recreational facilities, but frequently without a formal contract. This is a consequence of the lack of specific regulations in the field of recreational/leisure employment and could have negative implications, especially in terms of safety.

Socio-Economic and Environmental Factors Associated with Overweight and Obesity in Children Aged 6-8 Years Living in Five Italian Cities (the MAPEC_LIFE Cohort)

The prevalence of obesity among Italian children has reached such alarming levels as to require detailed studies of the causes of the phenomenon. A cross-sectional study was carried out in order to assess the weight status of 1164 Italian children aged 6–8 years (the Monitoring Air Pollution Effects on Children for Supporting Public Health Policy (MAPEC_LIFE) cohort) and to identify any associations between selected socio-economic and environmental factors and overweight/obesity. The data were obtained by means of a questionnaire given to parents, and any associations were examined by binomial logistic regression analyses. Overweight was found to be positively associated with male gender, parents of non-Italian origin, and parents who smoke, and negatively associated with the parents’ level of education and employment. In addition, the frequency of overweight varied in relation to the geographical area of residence, with a greater prevalence of overweight children in the cities of central-southern Italy. This study highlights the need to implement appropriate obesity prevention programs in Italy, which should include educational measures concerning lifestyle for parents from the earliest stages of their child’s life.

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.

Detection of pathogenic Campylobacter, E. coli O157:H7 and Salmonella spp. in wastewater by PCR assay

The aim of this study was the evaluation of the occurrence of pathogenic Campylobacter, Escherichia coli O157:H7, E. coli virulence genes and Salmonella spp. in different wastewater treatment plants (WWTPs) using a method based on an enrichment step and PCR. This method was sensitive enough to detect low levels (∼2 CFU100 ml(-1) of raw sewage) of all the investigated pathogens. In the WWTP samples, E. coli O157:H7 DNA and the eae gene were never found, but 33 % of influents and effluents exhibited amplicons corresponding to Shiga-like toxin I. Twenty-five percent of the influent and 8 % of the effluent exhibited the presence of Shiga-like toxin II. Campylobacter jejuni and C. coli DNA were identified in 50 and 25 % of the influents and in 8 and 25 % of the effluents, respectively. Salmonella spp. DNA was present in all the samples. Considering the results obtained, the method tested here offers a reliable and expeditious tool for evaluating the efficiency of the effluent treatment in order to mitigate contamination risk. Influent contamination by Salmonella spp. and Campylobacter spp. provides indirect information about their circulation; moreover, their presence in effluents underlines the role of WWTPs in the contamination of the receiving surface waters, which affects public health directly or indirectly.

Quercetin and rutin as potential agents antifungal against Cryptococcus spp

Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting as cryptococcosis the immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with quercetin or rutin and as a protective of citotoxic effect. The antifungal activity to amphotericin B, quercetin and rutin alone and in combination was determined in Candida sp and Cryptococcus neoformans strains. Cytotoxicity test on erythrocytes was performed by spectrophotometric absorbance of hemoglobin. The amphotericin B MIC was reduced when used in combination with quercetin or rutin to C. neoformans ATCC strain and reduced when combined with rutin to a clinical isolate of C. neoformans. In addition, the combination of quercetin with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that quercetin and rutin are potential agents to combine with amphotericin B in order to reduce the amphotericin dose to lessen side effects and improve antifungal efficacy.

Hospital effluents management: Chemical, physical, microbiological risks and legislation in different countries

Hospital wastewater (HWW) can contain hazardous substances, such as pharmaceutical residues, chemical hazardous substances, pathogens and radioisotopes. Due to these substances, hospital wastewater can represent a chemical, biological and physical risk for public and environmental health. In particular, several studies demonstrate that the main effects of these substances can't be neutralised by wastewater treatment plants (WWTPs). These substances can be found in a wide range of concentrations due to the size of a hospital, the bed density, number of inpatients and outpatients, the number and the type of wards, the number and types of services, the country and the season. Some hazardous substances produced in hospital facilities have a regulatory status and are treated like waste and are disposed of accordingly (i.e., dental amalgam and medications). Legislation is quite homogeneous for these substances in all industrial countries. Problems that have emerged in the last decade concern substances and microorganisms that don't have a regulatory status, such as antibiotic residues, drugs and specific pathogens. At a global level, guidelines exist for treatment methods for these effluents, but legislation in all major industrial countries don't contain limitations on these parameters. Therefore, a monitoring system is necessary for these effluents as well as for substances and pathogens, as these elements can represent a risk to the environment and public health.

Inflammation response and cytotoxic effects in human THP-1 cells of size-fractionated PM10 extracts in a polluted urban site

To contribute to a greater characterization of the airborne particulate matter's toxicity, size-fractionated PM10 was sampled during different seasons in a polluted urban site in Torino, a northern Italian city. Three main size fractions (PM10 - 3 μm; PM3 - 0.95 μm; PM < 0.95 μm) extracts (organic and aqueous) were assayed with THP-1 cells to evaluate their effects on cell proliferation, LDH activity, TNFα, IL-8 and CYP1A1 expression. The mean PM10 concentrations were statistically different in summer and in winter and the finest fraction PM<0.95 was always higher than the others. Size-fractionated PM10 extracts, sampled in an urban traffic meteorological-chemical station produced size-related toxicological effects in relation to season and particles extraction. The PM summer extracts induced a significant release of LDH compared to winter and produced a size-related effect, with higher values measured with PM10-3. Exposure to size-fractionated PM10 extracts did not induce significant expression of TNFα. IL-8 expression was influenced by exposure to size-fractionated PM10 extracts and statistically significant differences were found between kind of extracts for both seasons. The mean fold increases in CYP1A1 expression were statistically different in summer and in winter; winter fraction extracts produced a size-related effect, in particular for organic samples with higher values measured with PM<0.95 extracts. Our results confirm that the only measure of PM can be misleading for the assessment of air quality moreover we support efforts toward identifying potential effect-based tools (e.g. in vitro test) that could be used in the context of the different monitoring programs.

Feasibility and reliability of a questionnaire for evaluation of the exposure to indoor and outdoor air pollutants, diet and physical activity in 6-8-year-old children

INTRODUCTION

The MAPEC-Life project aims to study the biological effects of early exposure to air pollutants on the oral mucosa cells of school-age children in five Italian cities. A questionnaire was created to evaluate the association between outdoor and indoor airborne pollutants, lifestyle, diet and biomarker effects. The feasibility and reliability of the questionnaire were evaluated.

METHODS

A questionnaire was drawn up to be filled in by the parents of 6-8-year-old children. It consisted of 148 questions on the children's health, physical activity, environmental exposures and the frequency of food consumption at the main meals. First we conducted a questionnaire feasibility study involving 53 volunteer parents. We then performed a reliability study by administering the questionnaire to a further 156 parents and again one month later (test/retest method). The correlations between answers at the first and second administration of the questionnaire were evaluated using the Kappa statistic and Spearman's coefficient.

RESULTS

After verifying the feasibility of the questionnaire, we conducted a reliability analysis on 132 completed questionnaires. The percentage of agreement between the first and the second responses given was over 70%, all K values being greater than 0.6. The analysis of calories and macronutrients also showed good agreement.

CONCLUSIONS

The questionnaire drawn up for the study proved to be sufficiently reliable for gathering information about the factors of interest in our study of the relationship between air pollution and early biological effects in children.

Microbial-chemical indicator for anaerobic digester performance assessment in full-scale wastewater treatment plants for biogas production

Anaerobic digestion was introduced into wastewater treatment plants several years ago, but anaerobic digestion performance has not yet been achieved. The variability of the microbial community in digesters is poorly understood, and despite the crucial role of anaerobic digestion reactors, the microbial equilibrium that yields the best performance in these reactors has only recently been hypothesised. In this study, two full-scale continuous anaerobic reactors, placed in Torino's main wastewater treatment plant in northern Italy, were followed to develop a summary indicator for measuring anaerobic digestion performance. A total of 100 sludge samples were collected. The samples were characterised chemically and physically, and microbial groups were quantified by qRT-PCR. A chemical biological performance index strictly correlated to specific biogas production (rho=0.739, p<0.01) is proposed. This approach will produce new management tools for anaerobic digestion in wastewater treatment plants.

Green job bio-aerosol exposure during anaerobic digestion for biomass energetic valorisation

The continued expansion of the green economy increases the risk profile for green occupational jobs. One of the broadest green sectors in terms of growth is the anaerobic digestion of biomasses. In recent years, this development has also interested Italian regions. The management of biomass includes biological risk and the risk of particulate and endotoxin exposure. In the present study, we evaluated airborne exposure for anaerobic digestion workers at two real-scale plants. Digested biomass has different origins, ranging from cattle sludge and manure to poultry manure to agricultural harvesting or processing residues, particularly from maize and fruits. Two sampling points were chosen: at the first, the input biomasses were stored, and the hopper was loaded; at the second, the digested sludge exited the digester. The microbiological parameters, assessed using an active sampler and cultural method, were the total bacteria counts (at 22, 37, and 55°C), yeasts, fungi, Pseudomonaceae, Clostridia spp., Enterobacteriaceae and Actinomycetes. Moreover, at the same sampling points, we evaluated six PM10 fraction levels (10.0-7.2, 7.2-3.0, 3.0-1.5, 1.5-0.95, 0.95-0.49, and <0.49µm) and the endotoxin content of each fraction. In this investigation, the microbe contamination of the air varied from low to high levels, while the PM10 and endotoxin levels were limited, reaching rural environmental levels (61.40µg/m(3) and 18.88EU/m(3), respectively). However, contamination and occupational risk must be evaluated individually for each plant because numerous variables influence the risk magnitude, particularly digested sludge treatments, such as input biomass nature, storage, movement conditions, building configuration and technological processes.

PM10 in a background urban site: chemical characteristics and biological effects

PM10 was sampled in a background urban site in Torino, a northern Italian city. PM10 extracts were tested with THP-1 and A-549 cells to evaluate their effects on cell proliferation, LDH activity, TNFα, IL8 and CYP1A1 expression, and genotoxic damage induction (Comet assay). Through Principal Component Analysis (PCA), it was observed that (1) the aqueous extracts induced the inhibition of cell proliferation in the warm season that clustered together to total ions, (2) organic extracts determined a winter cell viability reduction and (3) there was a genotoxic effect associated with PAH and metal concentrations. The analysed low PAH levels were unable to induce significant CYP1A1 expression. The results obtained confirmed that PM composition and seasonality play an important role in particle-induced toxicity. The presence of PM10-induced biological effects at a low polluted site suggested that a reduction of PM10 mass did not seem to be sufficient to reduce its toxicity.

Focal nodular hyperplasia of the liver: an emerging complication of hematopoietic SCT in children

Hepatic focal nodular hyperplasia (FNH) is a nonmalignant condition rarely affecting children previously treated for cancer, especially those who received hematopoietic SCT (HSCT). Some aspects of its pathogenesis still remain unclear and a strong association with specific risk factors has not yet been identified. We report here a single institution's case series of 17 patients who underwent HSCT and were diagnosed with FNH, analyzing retrospectively their clinical features and the radiological appearance of their hepatic lesions. We aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) and to explore the role of transient elastography (FibroScan) to evaluate the degree of hepatic fibrosis in FNH patients. Our analysis showed an association of FNH with age at transplant ⩽12 years (hazard ratio (HR) 9.10); chronic GVHD (HR 2.99); hormone-replacement therapy (HR 4.02) and abdominal radiotherapy (HR 4.37). MRI proved to be a more accurate diagnostic tool compared with US. Nine out of 12 patients who underwent FibroScan showed hepatic fibrosis. Our study points out that FNH is an emerging complication of HSCT, which requires a lifelong surveillance to follow its course in cancer patients.

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.

Inactivation of Escherichia coli and Staphylococcus aureus by pulsed electric fields increases with higher bacterial population and with agitation of liquid medium

Inactivation of Escherichia coli, E. coli O157:H7, and Staphylococcus aureus in liquid media by pulsed electric fields (PEF) was conducted at varying bacterial populations with and without sample agitation. A laboratory-scale PEF batch unit with a rectangular electric pulse was used, operating under the following conditions: 25 kV/cm (E. coli, E. coli O157:H7) and 30 kV/cm (S. aureus) electric field strengths, 1-μs pulse width, 1-Hz pulse repetition rate, and 20 to 350 pulses for all samples. Not surprisingly, bacterial inactivation (for all three strains) increased with increasing pulse number, achieving the highest reduction at 350 pulses. Log CFU per milliliter microbial inactivation increased commensurately with increasing bacterial population (P < 0.05) but only when samples were treated with more than 200 pulses. For example, when E. coli was treated with 200 pulses at 10(5) CFU/ml, inactivation was only 3.0 Log versus 4.8 Log at the 10(10) inoculation level. When E. coli O157:H7 was treated with 200 pulses at 10(5) CFU/ml, inactivation was only 2.5 Log versus 4.6 Log at the 10(10) inoculation level. When S. aureus was treated with 200 pulses at 10(6) CFU/ml, inactivation was only 2.6 Log versus 4.8 Log at the 10(10) inoculation level. Inactivation of populations was also found to be statistically greater (P < 0.05) when liquid samples were agitated, in comparison to nonagitated samples. Because PEF inactivation activity is influenced by bacterial population and sample agitation, future studies should carefully consider these factors in experimental designs and/or scaled-up industry application.

Staphylococcal poisoning foodborne outbreak: epidemiological investigation and strain genotyping

In June 2011, an outbreak of Staphylococcus aureus enterotoxin food poisoning gastroenteritis occurred in Turin, Italy, following a catered dinner party at a private home. Within a few hours, 26 of the 47 guests experienced gastrointestinal illness, and 9 were hospitalized. A retrospective cohort study using a standardized questionnaire was carried out, and the risk ratios for each food item were calculated. The analysis indicated consumption of seafood salad as the most probable cause of the outbreak (risk ratio = 11.72; 95 % confidence interval, 1.75 to 78.54). Biological samples were collected from four of the hospitalized guests (stool and vomit), nasal mucosa swabs from three food handlers employed with the caterer, and available food residuals. All stool and vomit samples tested positive for enterotoxigenic S. aureus. As residues of the seafood salad were no longer available for sampling, suspected contamination could not be verified. However, no other food was found contaminated by S. aureus or its enterotoxins. All isolates from the biological samples were characterized at the genomic level by means of two multiplex PCR protocols to determine the presence of genes encoding staphylococcal enterotoxins, pulsed-field gel electrophoresis and staphylococcal protein A gene (spa) typing to describe their genetic profiles. All the isolates presented genes encoding SEA and SEI; the pulsed-field gel electrophoresis genetic profiles revealed the same pulsotype in the microorganism isolated from the hospitalized guests as in one of the isolates from a food handler's nasal mucosa, and the spa typing analysis reported two closely related spa types (t701 and t267), implicating the food handler as the most likely outbreak source.

Photocatalytic bacterial inactivation by TiO2-coated surfaces

The aim of this study was the evaluation of the photoactivated antibacterial activity of titanium dioxide (TiO2)-coated surfaces. Bacterial inactivation was evaluated using TiO2-coated Petri dishes. The experimental conditions optimized with Petri dishes were used to test the antibacterial effect of TiO2-coated ceramic tiles. The best antibacterial effect with Petri dishes was observed at 180, 60, 30 and 20 min of exposure for Escherichia coli, Staphylococcus aureus, Pseudomonas putida and Listeria innocua, respectively. The ceramic tiles demonstrated a photoactivated bactericidal effect at the same exposure time. In general, no differences were observed between the antibacterial effect obtained with Petri dishes and tiles. However, the photochemical activity of Petri dishes was greater than the activity of the tiles.Results obtained indicates that the TiO2-coated surfaces showed a photoactivated bactericidal effect with all bacteria tested highlighting that the titania could be used in the ceramic and building industry for the production of coated surfaces to be placed in microbiologically sensitive environments, such as the hospital and food industry.

Immune response to acetaldehyde-human serum albumin adduct among healthy subjects related to alcohol intake

Acetaldehyde (AA) is the main metabolic product in ethanol metabolism, although it can also derive from sources of airborne pollution. As a typical aldehyde, AA is able to react with a variety of molecular targets, including DNA and protein. This property justifies the hypothesis of a immune reaction against this kind of adduct, to be studied by a seroprevalence screening approach. In this study, the correlation between drinking habits and the amount of circulating AA-human serum albumin adduct (AA-HSA) was evaluated in a group of healthy subjects, non alcohol-addicted. Daily ethanol intake (grams) was inferred for each subject using the information collected through a questionnaire, and AA-HSA antibodies (AA-HSA ab) analyses were performed using the Displacement Assay on whole blood samples. The findings showed a correlation between ethanol intake and immune response to molecular adduct. These results underscore the evaluation of AA-HSA ab amount as a suitable molecular marker for alcohol intake that can be applied in future investigations on a large scale for prevention screening.

Exploring variables associated with rehabilitation length of stay in brain injuries patients

BACKGROUND

The impact of outcome measure as early variables on rehabilitation length of stay (LOS) in traumatic brain injury (TBI) patients remains poorly investigated.

AIM

To investigate: 1) the association between LOS and motor and functional outcomes; 2) the predictive factors of LOS in TBI patients admitted to a rehabilitation center.

DESIGN

Retrospective study.

SETTING

Inpatient TBI Rehabilitation Centre.

POPULATIONS

241 TBI patients (190 males and 51 females, mean age 43.61±19.4 years, initial Glasgow Coma Scale of 6.96±3.39).

METHODS

We recorded demographic characteristics (age, sex, setting and LOS in the acute phase, rehabilitation LOS) and outcome measures (Glasgow Outcome Scale, Disability Rating Scale, Levels of Cognitive Functioning, Functional Independence Measure).

RESULTS

Average rehabilitation LOS was 58.82±58 days; 191 (79%) subjects were discharged from the rehabilitation center within 90 days. Rehabilitation LOS was significantly correlated with acute-care LOS (P=0.001) and Glasgow Coma Scale, but not with patients' age (P=0.250) or sex (P= 0.348). Rehabilitation LOS was significantly correlated with functional and cognitive admission outcome scores but not with gains during rehabilitation. Rehabilitation LOS was significantly less in the group of patients that returned back home respect to others. Regression analysis also illustrated that longer acute-care LOS was independently associated with significantly increased rehabilitation LOS (P<0.001).

CONCLUSION

Our retrospective study suggests that rehabilitation LOS in TBI patients is correlated with timing of and score at admission to the rehabilitation setting rather than with gains in functional outcome.

CLINICAL REHABILITATION IMPACT

This result may help to optimize inpatient service utilization, especially in term of LOS.

The Locomotory Index in diplegic and hemiplegic children: the effects of age and speed on the energy cost of walking

BACKGROUND

The energy cost of locomotion (C) is a useful tool for quantifying the level of walking disability in the clinical evaluation of patients with cerebral palsy (CP). In addition to clinical condition, also age and velocity (v) can influence C, a fact that is often overlooked.

AIM

To show: i) that C differs in the clinical subtypes of CP (hemiplegia or diplegia) and ii) that C should be measured at comparable speeds in CP patients and controls (of the same age).

DESIGN

Controlled study.

SETTING

Pediatric Rehabilitation Unit of "E. Medea" Scientific Institute (Conegliano, TV); Exercise Physiology Lab of University of Verona.

POPULATION

Forty-three CP children (32 diplegic: Dg; 11 hemiplegic: Hg) and 20 healthy children (Cg) with an age range of 4-14 years.

METHODS

C was measured as the ratio of net oxygen uptake to walking speed (at v from 1 to 6 km·h(-1)). The Locomotory index (LI) was calculated as the ratio of C in Dg/Hg and Cg (of the same age) at the same speed.

RESULTS

C decreases with increasing speed in all groups but evolves differently in Hg and Dg: in the former C decreases by increasing age, becoming similar to that of Cg at 12-14 years; in the latter C does not change as a function of age being always larger than in Cg.

CONCLUSION AND CLINICAL REHABILITATION IMPACT

Our data highlight the reduction in C with increasing speed and suggest a better prognosis of locomotion for Hg compared to Dg.