Densità di popolazione e SARS-CoV-2: uno studio epidemiologico di urban health

Despite SARS-CoV-2 transmission being a complex phenomenon, greater population density seems to be a risk factor. The aim of this study was to analyze through an epidemiologic urban health approach the relationship between population density and SARS-CoV-2 incidence using data which are comparable with regard to testing strategies. All 10,300 SARS-CoV-2 confirmed cases between October and December 2020 were included. We conducted separate analysis by gender standardizing and stratifying by age and month. In the Province Capital (p.d.=765 inhabitants/km2), standardized SARS-CoV-2 incidence rate was higher than the expected, both in men (SIR=1.17, 95%CI=1.12;1.22, p<0.0001) and women (SIR=1.20, 95%CI=1.15;1.25, p<0.0001). In municipalities with p.d. >200 inhabitants/km2, standardized SARS-CoV-2 incidence rate was similar to the expected (p>0.05). In municipalities with p.d. <200 inhabitants/km2, standardized SARS-CoV-2 incidence rate was lower than the expected, both in men (SIR=0.85, 95%CI=0.81;0.90, p<0.0001) and women (SIR=0.84, 95%CI=0.80;0.88, p<0.0001). Stratified analysis by months with likelihood ratio test showed heterogeneity of the p.d. effect in men and women (p<0.05). SARS-CoV-2 incidence rate seemed to be higher in most densely populated areas, both in men and women. Our results confirmed the great importance of restrictive measures as well as the importance of limiting the epidemic wave in the initial stages and could help guide pandemic management strategies according to urban context and population density.

The relationship between soil and household dust metals and the impact on olfaction in children

Background

Through this study we aimed to test the association between the exposure to metals measured in soil, outdoor and indoor dust and olfactory function among children living close to ferromanganese alloy plants. Moreover, we investigated how metal concentrations vary with the distance from the plants and the relationships among the different environmental media.

Methods

A total of 130 children between 6 and 13 years old were enrolled in the province of Brescia in Italy. The olfactory performance was assessed through the Sniffin' Sticks test. The concentration of 20 metals in dust and soil samples was determined through an X-ray fluorescence portable analyzer (p-XRF). Weighted Quantile Sum (WQS) regression was applied to test for the association between the multi-media environmental markers (MMEM) and olfactory function while restricted cubic splines were used to evaluate the relationship between metal concentrations and distance from the closest plant and deviation from the main wind direction.

Results

WQS regression showed a negative significant association between the MMEM and the Sniffin' Sticks score (beta=-0.028; 95%CI -0.047, -0.009) identifying As, Fe, Rb, Pd, K and Pb as the elements with the higher weights. Except Rb, all elements together with Mn (one of the main elements released by the plants), showed a decreasing trend for soil and outdoor dust concentration at increasing distance from the source or at increasing deviation from the main wind direction. A positive association between outdoor and indoor dust and between soil and outdoor dust was also observed.

Conclusions

This work highlights the risk of the exposure to metal mixtures on child olfactory function which is known to be associated with neurodegenerative diseases in older age. Moreover, this analysis can contribute in terms of public health policies assessing the risk of being exposed as a function of the distance from the plants and the deviation from the main wind direction.

Key messages

Metal mixture concentration in dust is associated with decreased smell identification ability. Indoor metal concentrations can be affected by external source of exposure.

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.

From epidemiology to public health decision making: analysis on IMD & vaccination strategy in Italy

Introduction

Invasive Meningococcal Disease (IMD) is one of the most severe vaccine-preventable disease, with high fatality rate and severe sequelae in up to 20% of survivors. MenB, MenC and MenACWY vaccines are available in Italy, but recommendations vary among Italian regions in terms of type of vaccines and targeted age groups. The aim of the study is to describe epidemiology of IMDs in order to provide the best vaccination strategy.

Methods

IMDs surveillance data in the period 2011-2017 from the Italian National Health Institute were explored. Excel was used to present trend analysis, stratifying by age and serogroups.

Results

In Italy, during the period 2011-2017, IMDs overall incidence increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 in 2017. Most cases after 2013 were caused by non-B serogroups (52%, 52%, 66%, 64%, 59% from 2013 to 2017). Although incidence is highest in 1 years old children, the number of cases is highest in the age range 25-64. The number of cases in this age-range had a steady increase after 2013 (36 cases in 2011, 79 in 2017), with serogroups C, W and Y present in more than 65% of cases in 25+ age ranges after 2012.

Conclusions

IMD is a rare but severe vaccine-preventable disease. The key role of public health is to monitor disease serogroups, trends and outbreaks and strengthen methodological evidence-based tools for decision-making processes, public health policies, planning of healthcare services and intervention measures, including immunization. The increase in incidence shown in the period 2011-2017 in Italy, although probably due to better surveillance, highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population. Based on our analysis we believe that anti-meningococcal vaccination plan in Italy should include the highest number of preventable serogroups and be aimed to the whole population through a multicohort strategy, including boosters in children and in adults.

Key messages

Anti-meningococcal vaccination plan in Italy should include all the preventable serogroups and be aimed to the whole population with a multicohort strategy including boosters in children and in adults. The increase in incidence of IMD in the period 2011-2017 in Italy highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population.

Family life stress, maternal depression and child behavioral health in industrialized Italian cities

Although family life stress adversely impacts child health, few tools measure its relationship to child outcomes in the setting of maternal variables. This study validates the Italian version of Crisis in Family Systems-Revised (CRISYS-R) and characterizes relationships between family life stress, maternal depression and child behavior in two Italian cities.

This cross-sectional study was nested in current research on health impacts of neurotoxic environmental exposures in children. 101 mother-child pairs (child age=9.91±2.17yrs; 53% female) and children's teachers were enrolled in Taranto (south Italy) and Brescia (north Italy). Mothers performed the Italian CRISYS-R and PHQ9; teachers completed Child Behavior Checklist (CBCL/6-18). Spearman's rank correlation coefficients showed associations of family CRISYS-R, maternal PHQ9 and child CBCL/6-18. Wilcoxon Rank-Sum test compared groups of continuous variables.

Mothers with depressive symptoms (PHQ9≥5) reported higher ongoing stress and proportion of negative stressors on CRISYS-R than non-depressed mothers (p < 0.05). Children of depressed mothers performed worse in all CBCL/6-18 domains: Internalizing Problems, Externalizing Problems and Total Problems (p < 0.01). Specifically, children of depressed mothers scored higher on subscales of Anxious-Depressed (p < 0.05), Withdrawn-Depressed (p < 0.01), Rule-Breaking (p < 0.01) and Aggressive Behavior (p < 0.05). Maternal depressive symptoms correlated with ongoing stress (rs = 0.27; p < 0.01), child Internalizing Problems (rs = 0.34; p < 0.001), Externalizing Problems (rs = 0.28; p < 0.01) and Total Problems (rs = 0.35; p < 0.001).

This study describes links among maternal depression, family life stress, and child behavioral health. It is first to validate Italian CRISYS-R and to explore these factors conjointly in Italian contexts with known neurotoxic exposures. Findings support considering maternal depression and family life stress in child behavioral and environmental health research and policy.

Key messages

Family life stress, maternal depressive symptoms, and preadolescent behavioral health were highly interrelated in two industrialized Italian cities. The Italian version of CRISYS-R is a useful instrument for assessing and understanding family life stress, a crucial yet under-explored contributor to child behavioral health outcomes.

Distribution of Manganese-Substituted Magnetites in Dusts from Taranto, Italy

Elevated exposure to manganese (Mn) in environmental dusts and airborne particulates, particular from ferromanganese alloy steel production and metal working, is associated with a number of negative health outcomes, including Parkinsonism and other nervous system diseases. Manganese contamination and exposure from industrial sources is difficult to identify or quantify, as manganese is naturally abundant in the environment, and means to distinctly identify or fingerprint Mn arising from different industrial and environmental sources are limited. Here, the chemical and mineralogical properties of Mn in dusts from an active steel production facility in Taranto, Italy, were compared with those of indoor and outdoor deposited dust samples and surface soils collected in a series of schools in the nearby town. X-ray absorption spectroscopy revealed distinct chemical forms of Mn in industrial sources from those in typical background soils. Manganese ore from the facility contained abundant Mn(III, IV) oxides, while Mn-substituted magnetites were the most abundant mineral phase in dusts found in areas of the plant where metal was produced or combustion occurred. All school dusts were primarily composed of Mn-substituted magnetites, while most of the soils contained abundant manganese(IV) oxides. Source apportionment of Mn in regional dust and soil samples was estimated using linear combination fitting with representative industrial source materials. Manganese in dusts from the Taranto area community adjacent to the plant was derived primarily from industrially-sourced dusts produced during high temperature coke or steel production rather than re-suspended local soils or ore source material. Soils contained smaller proportion of industrially-derived Mn and are distinct from dusts, indicating that soil is a minor contributor of dust Mn in this area.

Key messages

Manganese speciation gives useful information in investigating Mn toxicology to humans in urban areas. Manganese-substituted magnetites may represent the target compound useful to distinguish toxic and non-toxic Mn-containing elements.

Assessment of coverage and analysis of the determinants of adherence to influenza vaccination in the general practitioners of Taranto

BACKGROUND

In Italy, the general practitioner (GP) is the operations manager of the campaigns regarding influenza immunization. He/she identifies people eligible for vaccination among the clients, invites them actively and administers the vaccine. The GPs are directly in contact with the target population that should be vaccinated and their opinion about the flu vaccine may ultimately influence the decision of the patient to accept or not the vaccination. This study aims to assess levels of immunization for influenza vaccination among GPs and factors influencing their adherence to the vaccinations recommended for GPs in the province of Taranto (Apulia region, Southern Italy).

METHODS

We conducted a cross-sectional study among 471 general practitioners working in the province of Taranto during the February-March period of 2016. We emailed all GPs a self-administered web-based standardized questionnaire. The questionnaire analyzed the self-reported flu vaccination coverage, knowledge, perception and positions of the GPs with regard to the forecasted vaccinations of the in-risk categories among their patients.

RESULTS

A total of 229 (48.6%) GPs participated in the survey. In the 2015/2016 influenza season, the vaccination coverage among the interviewed GPs was 76.4% (n = 175). A patient number ≥ 900 increased the likelihood to have been vaccinated in the 2015/2016 season (OR = 3.3; P < 0.01). Overall only 79.9% prefers to use the adjuvated vaccines on patients > 64 and the 58% of GPs who chose not to get vaccinated considers influenza as a non-risk pathology for a healthy subject.

CONCLUSIONS

The coverage achieved among the Taranto's ASL GPs during the 2015/16 season reaches the minimum threshold set by the Minister, but they could implement their knowledge and their participation in relation to the anti-influenza vaccine in order to discard all the wrong or clearly unfounded common beliefs. The best strategy in order to optimize the governance system seems to be the empowerment of primary care physicians, to be fulfilled through actions shared with the Public Healthcare Services based on training, communication and projects supporting vaccine coverage.

Universal proposal strategies of anti-HPV vaccination for adolescents: comparative analysis between school-based and clinic immunization programs

INTRODUCTION

A promising approach to increase teenager's adherence to immunization against HPV is the administration of vaccinations within the school facilities. The Local Health Unit of Taranto experienced two different vaccine strategy proposals in the twelve-year-olds: the first one was the usual active call strategy in the outpatient clinic, while the second one provided the involvement of the schools in the area. The aim of the study is to evaluate the results of the proposed vaccination strategies in both sexes and in towns of different sizes in order to identify an effective path for achieving vaccine coverage improvement.

METHODS

To estimate the number of anti-HPV vaccine doses administered in adolescents of the 2003 cohort, we used the computerized vaccination system data of the Apulia Region. Then, once analyzed, the data for anti-HPV vaccine were broken down by gender, vaccine strategy and size of the town of residence. Analyses performed by using STATA SE 14.

RESULTS

The multiple logistic regression points out that, females (OR = 3.2; p < 0.01), living in small towns (OR = 1.3; p < 0.01) and school vaccination strategy (OR = 2; p < 0.01) increase the likelihood of completing the anti-HPV vaccine cycle in adolescents. The comparative assessment of anti-HPV coverage strategies, suggests that school vaccination has resulted in significantly better outcomes than outpatient clinic one, for all the groups considered (overall 72.3% vs 55.6%).

CONCLUSIONS

The involvement of school institutes can define a winning organizational model to get a wider adolescent's adherence to immunization programs, especially in bigger towns. The school vaccination strategy could improve anti-HPV vaccine adherence also in males, who perceives a lower HPV-related diseases risk than females.

The Official Control beyond the Official Control. How To Plan And Schedule Controls Starting From Risk Assessment Along The Agro-Food Supply Chain

Every year the Italian Ministry of Health, on the basis of regional data, draws up the "Report on Official Controls" to be submitted to the Parliament. The report contains abundant data, diagrams and charts and illustrates the number and type of official controls (OC) performed by the pertinent Bodies (Ministry of Health, Regional and Local Health Authorities) over the previous year on Food Business Operators (FBO), in accordance with the EC Regulation 882/2004. The trend - which has consolidated over the years - relates to the multiplicity of OC and shows a decrease of such controls compared to an increase in "non-conformities". OC frequency is established by the Regional Authorities on the basis of the categorisation of both a "generic risk" for companies calculated taking into account the probability of occurrence of a "non-conformity", and a "specific" risk, assessed on the basis of the results of the OC actually performed on a given "Operatore del Settore Alimentare" (Food Sector Operator, in Italian: OSA). Thus, categorisation (i.e. the probability of occurrence of non-conformities) is the main driver of the OC scheduling and planning process. We have been asking ourselves whether the current OC planning/scheduling method is still suitable for ensuring food safety in the face of internalisation of the food supply chain. As a matter of fact, food safety is now becoming increasingly variable due to the globalization of consumption where "farm to fork", rather than "border to fork", food safety must be ensured. On the basis of these considerations, a different OC planning /scheduling method is being proposed based on the assessment of risks and the estimation of the occurrence of the same along the agro-food chain.

[Managing the difficult balance between employment needs and public health in large industrial sites]

Environmental pressures affecting Taranto area led institutional commitment to the local Health (LHA) and Environment Agency, which have helped to provide data in support of epidemiological and health impacts evidence.This is relevant in view of the issues related to the public health which led the Apulia Region to enact measures for environmental monitoring of dioxins (Regional Law 44/2008) and protection of food safety (Regional Council Deliberation 1442/2009). The LHA investigated three lines of development: monitoring of food matrices, studies of human biomonitoring and the establishment of local Cancer Registry. Same time to the actions of the Taranto Judiciary, Apulia Region has enacted the RL 24/12, integrating the legislative gap present into the Environmental Authorization procedures, which will allow the Health Damage Assessment, through the correlation between environmental monitoring data, biomonitoring and Cancer Registry. The next step will see the LHA involved in managing effective and feasible prevention initiatives. The Special Health and Environment Plan objective is to monitor the Taranto population health status, to screen the health determinants, to estimate the toxicologically relevant indicators of possible contamination and, if possible, to modify the correlations between risk factors, body burden, and specific diseases.

[Increasing immunization coverage in adults and elderly by creating structural relationships with general practitioners]

In order to reach vaccination coverage in adults, the elderly and in high risk subjects, a tight network of collaboration between preventive medicine specialists and general practitioners must be created in the same way that they must be created with pediatricians. In fact, this strategy has brought about very high coverage rates in childhood vaccinations. The solution to propose once again would thus be to develop partnerships between the protagonists of the network (community health district, department of prevention, general practitioners, primary care physicians) so that synergies may be created which permit the realisation of common and specific training programs.

[Nutrition prevention intervention for cancers: "Med-Food Anticancer Program"]

Several studies recommend the Mediterranean diet and daily physical activity to prevent cancer development. These recommendations, however must be transformed into public health structured programmes, so that they assume operational effectiveness. The aim of the diet and lifestyle intervention called Med-Food Anticancer Program (MFAP) is to promote the Mediterranean diet and physical activity in the adult population. In particular; the target for participants in the intervention is the increased consumption of legumes, fish, whole grain bread and cereals, fruits and vegetables, and the decreased consumption of meat, cheese and foods of animal origin. At the same time, it is recommended to make at least ten thousand steps a day. Two studies have shown the effectiveness of MFAP.

Meditations on the Italian population of low interest to the vaccination campaign against the pandemic from H1N1v. The point of view of the region

In this article we developed a technical reflection on the organization of the National Pandemic Influenza A H1N1 variant plan, implemented in the Italian Region and in specific in the Local Health Agency Taranto. The audit has raised some critical issues that led to the limited success of the vaccination campaign. Among the critics it was really difficult to find quickly and easily those healthy individuals at risk for disease. Therefore it raises the need to prepare a special population register as an essential preliminary step necessary for the active call of the target population in anticipation of a possible pandemic wave. In this vein, the Prevention Department of Taranto has developed a recording database system that has been experienced during the influenza vaccination campaign for the 2010-2011 season.

Malignant cancer mortality in Province of Taranto (Italy). Geographic analysis in an area of high environmental risk

BACKGROUND

A geographic analysis of the causes of death is an important tool for assessing the effectiveness of Public Health initiatives. The aim of this study is to analyse the causes of death between 2000 and 2004, to discover any excess mortality from cancer in Province of Taranto, an area at high environmental risk.

METHODS

Mortality data from cancer were selected from the Puglia Regional Nominative Causes of Death Registry. Crude and standardized rates and Standardized Mortality Ratios (SMR) were calculated for the five Provinces of the Puglia Region, their capital cities and in four concentric rings around the industrial area located in Province of Taranto.

RESULTS

. Even if the highest death rate for all tumours resulted in the Province of Lecce (24.9 x 10,000), in the cities of Lecce and Bari (29 x 10,000), the distribution of the SMRs in Province of Taranto showed an excess of mortality (+10%) in the ring next to industrial area. For lung cancer the highest rate was reported in city of Taranto (6 x 10,000) and the highest risk (+24%) in the ring next to industrial area. Moreover, in this area 9 (70%) of the 13 considered malignant tumours types presented an excess of mortality.

CONCLUSION

The results uphold the data reported in the published literature. It is fundamental to intensify research into other risk factors (exposure at work and aberrant lifestyles). Moreover, there is an increasing need for a Regional Cancer Register.

Application of a scorable neurological examination to near-term infants: longitudinal data

The aim of this study was to follow the evolution of neurological findings in a cohort of near-term infants born between 35 and 37 weeks. A total of 448 infants born between 35 and 36.9 weeks gestational age with normal cranial ultrasonograms or only minor abnormalities, were studied using the Hammersmith Infant Neurological Examination, at 6, 9 and 12 months (corrected for prematurity). Our results showed that while some items such as cranial nerve and movements showed minimal changes over time, other items mainly related to "tone", "posture" and "reflexes" showed progressive maturation. There was no significant difference between the infants born at 35 and 36 weeks gestation. When compared to term infants assessed at the same age intervals, our cohort showed a wider variability of scores. Mean and 10 (th) percentile for global scores were lower than those reported for term infants suggesting that when assessing infants born at 35 and 36 weeks the optimality scores used for infants born full-term should not be used as normative data. Our results, providing longitudinal data in near-term infants without brain lesions, can be used as a reference in both clinical and research setting to monitor early neurological signs in those children.

Large outbreak of viral gastroenteritis caused by contaminated drinking water in Apulia, Italy, May-October 2006

At the end of July 2006, an unusually high number of patients with acute diarrhoea were reported by the accident and emergency departments in Taranto, Apulia. Subsequently, a field investigation was conducted jointly by the Apulia Regional Epidemiological Observatory and the Regional Reference Laboratory in Bari, and the Epidemiological Department of Taranto Local Health Unit.

[Evaluation of the role of occupational and environmental exposure to inorganic arsenic in the urinary excretion of the metal: preliminary data]

INTRODUCTION

Urinary inorganic arsenic is an expression of occupational exposure to the metal, provided that there is no history of ingestion of foods containing high concentrations of inorganic and/or organic arsenic. The present study was conducted to assess the contribution of professional and environmental exposure to inorganic arsenic on urinary excretion of the metal.

MATERIALS AND METHODS

We examined 195 workers at a steelfoundry in Taranto, exposed to very low concentrations of inorganic arsenic and two control groups consisting of 105 subjects resident near the factory and 144 subjects resident approximately 20 Km away. All participants were administered a questionnaire enquiring about general characteristics, lifestyle, occupational and extra occupational exposure to arsenic. Urinary arsenic was determined by atomic-absorption spectrophotometry.

RESULTS

Exposed and non exposed subjects were similar as regards general characteristics and lifestyle. The environmental concentration of arsenic for the foundryworkers was invariably lower than 0.1 microg/m3. Urinary excretion of arsenic was higher in the subjects in all three groups, examined singly and together, if they had eaten crustaceans and/or shellfish in the three days before urine collection. There was a significant positive correlation with the consumption of shellfish and a significant negative correlation with the number of days since the last crustacean/shellfish meal. Multiple regression analysis showed a dependence of urinary elimination of arsenic on the days since the last crustacean/shellfish meal.

DISCUSSION

The absence of occupational exposure to arsenic allowed us to attribute the higher urinary elimination of arsenic to ingestion of crustaceans and/or shellfish in the three days before collection of the urine, both in subjects exposed to inorganic arsenic and in the two groups belonging to the general population. Our results support the hypothesis that inorganic arsenic, determined by atomic-absorption spectrophotometry, may derive from the catabolism of organic arsenic compounds contained in crustaceans and/or shellfish included in the diet.

[Impact of cerebral palsy in patients discharged from neonatal intensive care units]

AIM

The aim of this study was to assess the impact and the peculiarities of cerebral palsy (CP) in children discharged from our neonatal intensive care unit (NICU) from January 1998 to April 2004.

METHODS

A total of 2 303 children were discharged from our NICU during this period and 1 912 were followed up for 1 year through neurological examination (traditional, Brazelton, general movements) and cranial ultrasound (US); high-risk newborns were evaluated with brain magnetic resonance imaging (MRI) too.

RESULTS

In 65 children (3.4% of the follow-up group) were diagnosed CP, and classified as follows: 21 (32%) diplegia, 19 (29%) quadriplegia, 20 (31%) hemiplegia, 4 (6%) double hemiplegia, 1 (2%) dyskinetic form. In diplegia and quadriplegia prevailed low birth weight infants (less than or equal to 2,500 g) and preterm infants, while in hemiplegia prevailed normal birthweight infants (greater than 2,500 g) and infants at term. The main MRI findings were: in diplegia 82% periventricular white matter lesions; in quadriplegia 94% periventricular and/or subcortical white matter lesions; in hemiplegia 95% bilateral periventricular or subcortical white matter lesions, predominating on contralateral cerebral hemisphere; in double hemiplegia 100% periventricular and/or subcortical white matter lesions, 100% enlargement of subarachnoid spaces; in dyskinetic form 100% basal ganglia lesions.

CONCLUSIONS

The impact of CP in children discharged from our NICU, in agreement with the literature, is higher than in the total population of newborns, thus it is very important to evaluate carefully high-risk newborns during hospitalization and follow-up, through neurological examination and radiologic imaging (US, MRI), for an accurate and early treatment.

[Carriers of Neisseria meningitidis among teen-agers in Apulia (Italy)]

An investigation about N. meningitidis carriers was carried out in Apulia (Italy) among teen-agers. 85 healthy carriers were identified (1.4%): the 81.2% of isolates resulted polyagglutinable, 3.5% autoagglutinable and 1.2% were not classifiable with antisera. The other strains belonged to serogroup B (9.4%), W135 (2.3%), Y (1.2%) and 29E (1.2%). Some Authors report that non-groupable strains are usually isolated from healthy carriers pharynx. The most recent molecular methods permit to subdivide these bacteria in serotype and serosubtype by membrane protein antigens, too. So, today the only identification as serogroup is not able to study N. meningitidis epidemiology.

[Exposure to PAHs, urinary 1-pyrenol and DNA adducts in samples from a population living at different distances from a steel plant]

This study aims at measuring association between environmental exposure to PAHs and internal or biologically effective dose biomarkers among 212 individuals living at different distance from the industrial area of Taranto, Italy. Environmental PAH exposure was determined by area monitoring. PAH levels was measured by HPLC UV/FL. Urinary 1-hydroxypyrene levels were measured by HPLC/Fluorescence. The levels of DNA adducts were determined by 32P. post-labelling. A questionnaire was administered to gather personal data, residence, occupational history, alcohol, tobacco smoke, and diet, to control for other sources of exposure to PAH. Blood and urinary samples, drawn from the subjects studied were collected and analysed. A multivariate regression model was used to investigate the influence of several confounding factors. Housing was placed within 1 km from smokestacks in Taranto and Statte, whereas they were more far away in Locorotondo and in Alberobello. The prevalence of current smokers was 31.6%.

Induction of ovulation in thalassemic patients

The authors studied 19 thalassemic patients: 14 patients with secondary amenorrhea (group A), 5 patients with primary amenorrhea (group B) and 1 patient with anovulation (group C). All the patients underwent three cycles of induction of ovulation with FSH. The level of 17 beta-estradiol and the diameter of follicles were evaluated every three days. Normal gonadal function was maintained in three patients with positive response at Step 1 of the treatment.

Osteopenia in female beta-thalassemic patients

Sixty-four women with thalassemia major aged 13-28 years were studied. 49 patients had primary amenorrhea and 15 had secondary amenorrhea. Bone density of the spine was performed using lunar DPX. The Z score was used to evaluate the degree of osteopenia. In 82% of the patients a Z score less than -2 was found. BMD correlated negatively with the duration of amenorrhea and age of thalassemic patients.