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

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

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

INTRODUCTION

Cardiovascular Diseases (CD) have emerged as a leading cause of morbidity and mortality in HIV population. Some studies have reported higher carotid Intima Media Thickness (c-IMT), a measure of subclinical atherosclerosis (AT), in this cohort of patients.

METHODS

Here, we evaluate the role of Hepatic Steatosis (HS) as likely marker for AT in 128 HIV-infected patients without hepatitis C infection. c-IMT has been detected non-invasively by carotid ultrasonography to assess the progression of AT. HS has been evaluated using a process based on vibration-controlled transient elastography (Fibroscan) by a novel ultrasonic controlled attenuation parameter (CAP). The cut-off value for defining the presence of significant HS was CAP > 259 dBm^-1.

RESULTS

AT has been detected in 26 patients (20.3%), whereas steatosis of grade 2 (S2) in 31 (24.2%). The variables statistically related to AT were age, obesity, diabetes, hypertension and S2. In the multivariate analysis, AT was only associated (p < 0.001) with age and S2. The optimal cut-off value indicated by ROC curve for predicting AT was CAP > 250 dB/m^-1.

DISCUSSION

Our results highlight the presence of AT in HIVinfected persons and its association with fatty liver disease; therefore, HS assessment in HIV population results crucial to predict AT and CD.

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

BACKGROUND

The Mediterranean diet (MD) is considered one of the healthiest dietary models, as it decreases the risk of chronic diseases and may modulate the organism's early response to environmental pollution. In recent decades, Mediterranean countries have been replacing their traditional diet with other less healthy eating habits, especially among children and teenagers.

OBJECTIVE

The aim of this study was to evaluate the MD and the level of adherence to it in 6-8 year old Italian children, in relation to residence, lifestyle, and social and family contexts.

METHODS

A questionnaire was administered to the children's parents in two seasons in 5 Italian towns. The diet section contained 116 questions investigating the frequency of consumption of different types of food. The Italian Mediterranean Index (IMI) was calculated according to the intake of 6 typical Mediterranean and 4 non-Mediterranean foods. On the basis of IMI score, MD adherence was classified as low (≤ 3 IMI score), medium (4-5) and high (≥ 6). Total energy load and diet composition in micro- and macronutrients were calculated from consumption frequency.

RESULTS

Diet analysis was computed on 1164 subjects with two complete questionnaires. Body mass index, calculated for each subject, showed that 28.9% of the children were overweight, the figure varying slightly with area of residence. Our findings showed that 59.0% of the children had a low score for MD adherence.

CONCLUSIONS

The results of this study showed that most Italian children did not follow the MD and socio-economic characteristics appeared not to be associated with type of diet.

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

INTRODUCTION

Genotoxic biomarkers have been studied largely in adult population, but few studies so far have investigated them in children exposed to air pollution. Children are a high-risk group as regards the health effects of air pollution and some studies suggest that early exposure during childhood can play an important role in the development of chronic diseases in adulthood. The objective of the project is to evaluate the associations between the concentration of urban air pollutants and biomarkers of early biological effect in children, and to propose a model for estimating the global risk of early biological effects due to air pollutants and other factors in children.

METHODS AND ANALYSIS

Two biomarkers of early biological effects, DNA damage by the comet assay and the micronuclei (MN) test, will be investigated in oral mucosa cells of 6-8-year-old children. Concurrently, some toxic airborne pollutants (polycyclic aromatic hydrocarbon (PAH) and nitro-PAH) and in vitro air mutagenicity and toxicity in ultra-fine air particulates (PM0.5) will be evaluated. Furthermore, demographic and socioeconomic variables, other sources of exposures to air pollutants and lifestyle variables will be assessed by a structured questionnaire. The associations between sociodemographic, environmental and other exposure variables and biomarkers of early biological effect using univariate and multivariate models will be analysed. A tentative model for calculating the global absolute risk of having early biological effects caused by air pollution and other variables will be proposed.

ETHICS AND DISSEMINATION

The project has been approved by the Ethics Committees of the local Health Authorities. The results will be communicated to local Public Health Agencies, for supporting educational programmes and health policy strategies. LIFE+2012 Environment Policy and Governance. LIFE12 ENV/IT/000614.

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

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

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

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

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

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

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

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

[Evaluation of the bactericidal activity of a disinfectant containing sodium hypochlorite (Amiclor)]

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

[Preliminary surveys about the use of "Mytilus galloprovincialis" as an accumulation matrix of bacteria in coastal waters]

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

[Chemical-physical and microbiological survey in groundwater of Salento]

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

[Microbiological monitoring of beach water: old and new parameters]

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