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Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze Sede ex Sanità Pubblica

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2022 - Investigation of Possible Factors Influencing the Neutralizing Anti-SARS-CoV-2 Antibody Titer after Six Months from the Second Vaccination Dose in a Sample of Italian Nursing Home Personnel [Articolo su rivista]
Modenese, Alberto; Paduano, Stefania; Bellucci, Rossana; Marchetti, Simona; Bruno, Fulvio; Grazioli, Pietro; Vivoli, Roberto; Gobba, Fabriziomaria; Bargellini, Annalisa

2022 - Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study [Articolo su rivista]
Ferri, Paola; Gambaretto, Carlo; Alberti, Sara; Parogni, Pierpaolo; Rovesti, Sergio; DI LORENZO, Rosaria; Sollami, Alfonso; Bargellini, Annalisa

Purpose: Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief therapy. Patients and Methods: A retrospective observational study was conducted in a sample including all adults treated by the professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019 to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27. Results: The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2±22 years (range 18–108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36±0.9 vs post m = 4.18±2.2, p<0.001; medical cars pre m = 7.25±1.7 vs post m = 3.50±2.6, p<0.001). Subsequently, pain was only reascertained in 24.3% of subjects. Conclusion: Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.

2022 - Risposta anticorpale neutralizzante anti-SARS-CoV-2 in operatori di una RSA del nord-Italia a 1 mese dalla vaccinazione e suo andamento a 6 mesi, e possibili fattori associati [Abstract in Atti di Convegno]
Modenese, Alberto; Paduano, Stefania; Bargellini, Annalisa; Bellucci, Rossana; Marchetti, Simona; Bruno, Fulvio; Grazioli, Pietro; Vivoli, Roberto; Gobba, Fabriziomaria

2022 - Seroprevalence Survey of Anti-SARS-CoV-2 Antibodies in a Population of Emilia-Romagna Region, Northern Italy [Articolo su rivista]
Paduano, Stefania; Galante, Pasquale; Berselli, Nausicaa; Ugolotti, Luca; Modenese, Alberto; Poggi, Alessandro; Malavolti, Marcella; Turchi, Sara; Marchesi, Isabella; Vivoli, Roberto; Perlini, Paola; Bellucci, Rossana; Gobba, Fabriziomaria; Vinceti, Marco; Filippini, Tommaso; Bargellini, Annalisa

taly was the first Western European country to be severely hit by the COVID-19 pandemic. Variations in seroprevalence rates were reported according to geographical and temporal differences of previous surveys, as well as depending on demographic and occupational factors. In this cross-sectional study, we evaluated the prevalence of anti-SARS-CoV-2 antibodies in a population of the Emilia-Romagna region in Northern Italy after the first wave in the period from 26 September 2020–26 March 2021. We included 5128 subjects who voluntarily underwent serological tests to determine anti-SARS-CoV-2 antibody positivity, including both self-referred individuals (24.2%) and workers adhering to company screening programs (76.8%). Overall, seroprevalence was 11.3%, higher in self-referred (13.8%) than employed-referred (10.5%) individuals. A slightly higher seroprevalence emerged in women compared to men (12.3% and 10.7%), as well as in the extreme age categories (18.6% for 60–69 years, 18.0% for ≥70 years, and 17.1% for <20 years compared to 7.6% for 20–39 years). Healthcare professionals showed the highest prevalence of seropositivity (22.9%), followed by workers in direct contact with customers, such as the communication, finance, and tourism sectors (15.7%). Overall subgroups seroprevalence increased compared to the first wave data but the trends agreed between the first and subsequent waves, except for an increase in the younger age group and in the sector in direct contact with customers. Among the occupational categories, our study confirms that healthcare workers and workers in the sports sector were at high risk of exposure to SARS-CoV-2.

2021 - Anti-SARS-CoV-2 antibodies frequency in non-Health Care Workers in a highly industrialized province of northern Italy [Relazione in Atti di Convegno]
Modenese, Alberto; Mazzoli, Tommaso; Berselli, Nausicaa; Ferrari, Davide; Bargellini, Annalisa; Borella, Paola; Filippini, Tommaso; Marchesi, Isabella; Paduano, Stefania; Vinceti, Marco; Gobba, Fabriziomaria

2021 - Assessing Undergraduates’ Perception of Risks Related to Body Art in Italy: The SUPeRBA Multicenter Cross-Sectional Study [Articolo su rivista]
Protano, C; Valeriani, F; Marotta, D; Bargellini, A; Bianco, A; Caggiano, G; Colucci, Me; Coniglio, Ma; Dallolio, L; De Giglio, O; Di Giuseppe, G; Laganà, P; Licata, F; Liguori, G; Marchesi, I; Marini, S; Montagna, Mt; Napoli, C; Orsi, Gb; Pasquarella, C; Pelullo, Cp; Romano Spica, V; Sacchetti, R; Tardivo, S; Veronesi, L; Vitali, M; Gallè, F

Abstract: Tattooing and piercing may lead to health complications. The present multicenter crosssectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0–11 for tattooing, 0–14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the

2021 - Association between outdoor traffic air pollutants and spread of SARS-CoV-2 pandemic in Modena, Northern Italy [Abstract in Rivista]
Filippini, Tommaso; Bigi, Alessandro; Teggi, Sergio; Bargellini, Annalisa; Vinceti, Marco

BACKGROUND AND AIM: Italy was the first European country severely affected by the SARS-CoV-2 pandemic, especially during the first wave in the North of the country. In particular, Modena is a city of Emilia-Romagna which is a region entirely included in the Po valley, one of European areas characterized by the heaviest air pollution levels due also to its orography. Previous studies yielded at a regional level suggested that higher air pollutant levels may increase both SARS-CoV-2 infection and mortality. METHODS: In this study, we further investigated the association between air pollutant exposure and spread of the SARS-CoV-2 using data collected from Modena municipality in the period February 2020-April 2021. We used traffic pollutant levels collected from an urban air quality monitoring station in the period January 2020-January 2021, including particulate matter (PM10), nitrogen oxides (NO2 and NOx), benzene, and black carbon (BC). We used a random-effects linear regression model within panel data analysis over the study period and we computed beta correlation coefficients (beta) with 95% confidence interval-CI between mean daily pollutant concentrations and SARS-CoV-2 daily positive cases diagnosed in Modena. RESULTS:We found a positive correlation between all traffic pollutants and SARS-CoV-2 cases, namely for PM10 beta was 1.23 (95%CI 1.00-1.46), lower for NOx (beta=0.66, 95%CI 0.56-0.75), and higher for NO2 (beta=1.95, 95%CI 1.59-2.31), benzene (beta=41.41, 95%CI 36.23-46.59), and BC (beta=5.95, 95%CI 1.19-10.72). CONCLUSIONS:Notwithstanding the limitations of use of aggregated data and potential the residual confounding, these findings seem to support the hypothesis that high levels of air pollution may favor the spread of SARS-CoV-2 infection, or alternatively that they reflect a higher mobility and number of social contacts that favor the spread of the infection. KEYWORDS: Air pollution, Traffic-related, Infectious diseases, Environmental epidemiology, Exposure assessment

2021 - COVID-19 in school settings: webinar aimed at both teachers and educators [Articolo su rivista]
Paduano, S; Marchesi, I; Frezza, G; Turchi, S; Bargellini, A

In the COVID-19 era, we designed the webinar "COVID-19: instructions for use" with the aim of providing clear and actionable information to school staff about the characteristics of the disease, the preventive measures to adopt and the path for early detection and control of COVID-19 in primary schools of Modena province.

2021 - Characteristics and risk factors of isolated and quarantined children and adolescents during the first wave of SARS-CoV-2 pandemic: A cross-sectional study in Modena, Northern Italy [Articolo su rivista]
Paduano, S.; Facchini, M. C.; Greco, A.; Borsari, L.; Mingrone, V. M.; Tancredi, S.; Fioretti, E.; Creola, G.; Iacuzio, L.; Casaletti, G.; Vinceti, M.; Bargellini, A.; Filippini, T.

Background and aim: In early 2020, SARS-CoV-2 was declared a pandemic by the WHO and Italy was one of the first and most severely affected country in Europe. Despite the global interest about COVID-19 pandemic, several aspects of this infection are still unclear, especially in pediatric population. This study aims to investigate the characteristics of the isolated or quarantined children and adolescents followed by the Public Health Department of the Italian province of Modena during the first wave of COVID-19. Methods: The study population included all non-adult subjects aged 0-18 years who underwent isolation or quarantine during the first wave of SARS-CoV-2 pandemic from February 24 to June 18, 2020 in Modena province, Northern Italy. Results: In Modena province, 1230 children and adolescents were isolated in case of SARS-CoV-2 infection (6.3%), or quarantined due to close contact with confirmed cases (88.7%) or travelling from a high-risk area (5.0%). Among 349 individuals who underwent swab testing, 294 (84.2%) reported close contact with an infected cohabiting relative and 158 (45.3%) were symptomatic. Among all tested subjects, 78 (22.4%) resulted positive, with a higher proportion of symptomatic subjects compared with the SARS-CoV-2-negative (78.2% vs. 35.8%). Fever was mostly present in SARS-CoV-2-positive children (48.7% vs. 12.6%). Both anosmia (58.3% vs. 41.7%) and dysgeusia (54.5% vs. 45.5%) had only slightly higher frequency in SARS-CoV-2-positive. Conclusions: These findings allow to expand the knowledge regarding characteristics of non-adult subjects isolated or quarantined during the first wave of SARS-CoV-2 pandemic. (

2021 - Frequency of anti-sars-cov-2 antibodies in various occupational sectors in an industrialized area of northern italy from may to october 2020 [Articolo su rivista]
Modenese, A.; Mazzoli, T.; Berselli, N.; Ferrari, D.; Bargellini, A.; Borella, P.; Filippini, T.; Marchesi, I.; Paduano, S.; Vinceti, M.; Gobba, F.

The results of a voluntary screening campaign for the presence of anti-SARS-CoV-2 serum antibodies are presented, performed on workers in the highly industrialized province of Modena in northern Italy in the period 18 May–5 October 2020. The employment activities of the subjects that tested positive for anti-SARS-CoV-2 IgM and/or IgG antibodies were determined and classified using the International Standard Industrial Classification of All Economic Activities (ISIC). The distribution across different sectors was compared to the proportion of workers employed in the same sectors in the province of Modena as a whole. Workers with anti-SARS-CoV-2 serum antibodies were mainly employed in manufacturing (60%), trade (12%), transportation (9%), scientific and technical activities (5%), and arts, entertainment and recreation activities (4.5%). Within the manufacturing sector, a cluster of workers with positive serological tests was observed in the meat processing sector, confirming recent data showing a possible increased risk of SARS-CoV-2 infection in these workers.

2021 - In vitro virucidal efficacy of a dry steam disinfection system against Human Coronavirus, Human Influenza Virus, and Echovirus [Articolo su rivista]
Marchesi, Isabella; Sala, Arianna; Frezza, Giuseppina; Paduano, Stefania; Turchi, Sara; Bargellini, Annalisa; Borella, Paola; Cermelli, Claudio

This in vitro study was aimed to assess the efficacy of dry steam in inactivating Human Coronavirus OC43 (HCoV-OC43) as surrogate of SARS-CoV-2, Human Influenza Virus A/H1N1/ WSN/33 and Echovirus 7 on stainless steel, polypropylene, and cotton. The virus models were chosen on the basis of their transmission route and environmental resistance. Tests were carried out under a laminar flow cabinet, where two panels of each material were contaminated with a viral suspension. The inocula were left to dry and then the virus on untreated panel (control) was collected by swabbing in order to determine the initial titer. The other panel was treated using a professional vacuum cleaner equipped with a dry steam generator. Dry steam is generated in a boiler where tap water is heated up to 155 °C at 5.5 bar pressure and then during the passage along the flexible hose the temperature decreases to a value between 100 C and 110 C at the output. The dry steam was applied for four sec with a window wiper on metal and plastic panels or a brush covered by a microfiber cap on cotton, simulating the steam application during routine cleaning. After the treatment, infectious virus possibly remained on the surface was collected following the same swabbing procedure applied for controls. HCoV-OC43 and Echovirus 7 were titrated by end-point method on HCT-8 line cells and Vero cells, respectively, while Human Influenza Virus was quantified by plaque reduction assay on MDCK cells. Dry steam resulted effective against the three viruses on all tested materials, achieving a mean Log10 reduction factor >=4 in viral titer of treated samples compared with controls according to UNI EN 14476:2019. Thus, dry steam may be proposed as an ease to use, effective, fast, and nontoxic alternative to chemicals for surface disinfection without damaging materials. Therefore, this device could be employed not only in healthcare facilities but also in occupational, domestic, and community settings, with advantages for environment and human health.

2021 - Neutralizing Anti-SARS-CoV-2 Antibody Titer and Reported Adverse Effects, in a Sample of Italian Nursing Home Personnel after Two Doses of the BNT162b2 Vaccine Administered Four Weeks Apart [Articolo su rivista]
Modenese, Alberto; Paduano, Stefania; Bargellini, Annalisa; Bellucci, Rossana; Marchetti, Simona; Bruno, Fulvio; Grazioli, Pietro; Vivoli, Roberto; Gobba, Fabriziomaria

Background: The immunization of healthcare workers (HCWs) plays a recognized key role in prevention in the COVID-19 pandemic: in Italy, the vaccination campaign began at the end of December 2020. A better knowledge of the on-field immune response in HCWs, of adverse effects and of the main factors involved is fundamental. Methods: We performed a study on workers at a nursing home in Northern Italy, vaccinated in January–February 2021 with two doses of the BNT162b2 vaccine four weeks apart, instead of the three weeks provided for in the original manufacturer protocol. One month after the second dose, the serological titer of IgG-neutralizing anti-RBD antibodies of the subunit S1 of the spike protein of SARS-CoV-2 was determined. The socio-demographic and clinical characteristics of the subjects and adverse effects of vaccination were collected by questionnaire. Results: In all of the workers, high antibody titer, ranging between 20 and 760 times the minimum protective level were observed. Titers were significantly higher in subjects with a previous COVID-19 diagnosis. Adverse effects after the vaccine were more frequent after the second dose, but no severe adverse effects were observed. Conclusions: The two doses of the BNT162b2 vaccine, even if administered four weeks apart, induced high titers of anti-SARS-CoV-2 neutralizing IgG in all the operators included in the study.

2021 - Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability [Articolo su rivista]
Campanini, Isabella; Bargellini, Annalisa; Mastrangelo, Stefano; Lombardi, Francesco; Tolomelli, Stefano; Lusuardi Mirco Merlo, Andrea

Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability

2021 - Seroprevalence of anti-SARS-CoV-2 antibodies after the first COVID-19 wave: a cross-sectional study in the province of Modena, city of a Northern Italy region [Abstract in Rivista]
Berselli, N; Filippini, T; Paduano, S; Malavolti, M; Modenese, A; Gobba, F; Borella, P; Marchesi, I; Vivoli, R; Perlini, P; Bellucci, R; Bargellini, A; Vinceti, M

2021 - Seroprevalence of anti-SARS-CoV-2 antibodies in the Northern Italy population before the COVID-19 second wave [Articolo su rivista]
Berselli, Nausicaa; Filippini, Tommaso; Paduano, Stefania; Malavolti, Marcella; Modenese, Alberto; Gobba, Fabriziomaria; Borella, Paola; Marchesi, Isabella; Vivoli, Roberto; Perlini, Paola; Bellucci, Rossana; Bargellini, Annalisa; Vinceti, Marco

The COVID-19 pandemic is due to SARS-CoV-2 coronavirus infections. It swept across the world in the spring of 2020, and so far it has caused a huge number of hospitalizations and deaths. In the present study, the authors investigated serum anti-SARS-CoV-2 antibody prevalence in the period of June 1-September 25, 2020, in 7561 subjects in Modena, Northern Italy.

2021 - Studio di fattori di rischio/protettivi associati alla risposta anticorpale anti-SARS-CoV-2 in un campione di lavoratori della provincia di Modena e province limitrofe [Abstract in Rivista]
Paduano, S; Modenese, A; Filippini, T; Berselli, N; Marchesi, I; Vinceti, M; Borella, P; Gobba, F; Bargellini, A

2021 - What about your body ornament? Experiences of tattoo and piercing among italian youths [Articolo su rivista]
Galle, F.; Valeriani, F.; Marotta, D.; De Giorgi, A.; Bargellini, A.; Bianco, A.; Colucci, M. E.; Coniglio, M. A.; Dallolio, L.; De Giglio, O.; Di Giuseppe, G.; Diella, G.; Lagana, P.; Licata, F.; Liguori, G.; Marchesi, I.; Marini, S.; Montagna, M. T.; Napoli, C.; Orsi, G. B.; Pasquarella, C.; Pelullo, C. P.; Ricciardi, L.; Spica, V. R.; Sacchetti, R.; Tardivo, S.; Veronesi, L.; Vitali, M.; Protano, C.

Background: tattooing and piercing are increasingly common, especially among youths. However, several health complications may be associated with these practices if basic hygiene rules are not respected. This multicenter study was aimed at exploring tattoo and piercing experiences reported by a large sample of Italian undergraduate students through a public health perspective. Methods: tattooed and/or pierced students attending 12 Italian universities were asked to complete a web-based questionnaire regarding their body art experience. Results: out of 1472 respondents, 833 (56.6%) were tattooed and 1009 (68.5%) were pierced. The greatest proportion of tattooed students (93.9%) got her/his first tattoo in a tattoo studio, while most of the pierced were serviced in a jewelry store (48.0%). The pierced ones were less informed on health issues related to the procedure (56.0% versus 77.8% of tattooed p < 0.001), and tattooists were reportedly more attentive to hygiene rules (instrument sterilization 91.5% versus 79.1% of piercers, p < 0.001; use of disposable gloves 98.2% versus 71% of piercers, p < 0.001). Conclusions: educational interventions for both professionals and communities are needed to improve the awareness and the control of health risks related to body art throughout the Italian territory.

2020 - Characterisation of Microbial Community Associated with Different Disinfection Treatments in Hospital hot Water Networks [Articolo su rivista]
Paduano, Stefania; Marchesi, Isabella; Casali, Maria Elisabetta; Valeriani, Federica; Frezza, Giuseppina; Vecchi, Elena; Sircana, Luca; Romano Spica, Vincenzo; Borella, Paola; Bargellini, Annalisa

Many disinfection treatments can be adopted for controlling opportunistic pathogens in hospital water networks in order to reduce infection risk for immunocompromised patients. Each method has limits and strengths and it could determine modifications on bacterial community. The aim of our investigation was to study under real-life conditions the microbial community associated with different chemical (monochloramine, hydrogen peroxide, chlorine dioxide) and non-chemical (hyperthermia) treatments, continuously applied since many years in four hot water networks of the same hospital. Municipal cold water, untreated secondary, and treated hot water were analysed for microbiome characterization by 16S amplicon sequencing. Cold waters had a common microbial profile at genera level. The hot water bacterial profiles differed according to treatment. Our results confirm the effectiveness of disinfection strategies in our hospital for controlling potential pathogens such as Legionella, as the investigated genera containing opportunistic pathogens were absent or had relative abundances ≤1%, except for non-tuberculous mycobacteria, Sphingomonas, Ochrobactrum and Brevundimonas. Monitoring the microbial complexity of healthcare water networks through 16S amplicon sequencing is an innovative and effective approach useful for Public Health purpose in order to verify possible modifications of microbiota associated with disinfection treatments.

2020 - Corrosion resistance of commonly used plumbing materials for water distribution systems exposed to disinfection treatments [Articolo su rivista]
Giovanardi, Roberto; Bononi, Massimiliano; Messori, Massimo; Bargellini, Annalisa; Paduano, Stefania; Borella, Paola; Marchesi, Isabella

In this study, the corrosion resistance of commonly used plumbing materials was evaluated when three disinfection treatments were applied in hot water distribution systems. In particular copper, brass, stainless steel and galvanised steel were tested in environments containing monochloramine, chlorine dioxide and hydrogen peroxide disinfectants under real field conditions for a long period of time (1 year), in order to evaluate the effect of free corrosion on the metal specimens; chlorinated polyvinylchloride (CPVC) was tested in the same environments in order to evaluate the degradation of the mechanical properties of plastic specimens. The results obtained enabled us to rank the metallic materials corrosion resistance against disinfectants in decreasing order, as follows: stainless steel, copper and copper-based alloys, galvanised steel. CPVC samples proved to be extremely stable in all of the disinfectants investigated, maintaining the same compression behaviour of the pipes aged with untreated water after 12 months of exposure

2020 - Dietary Estimated Intake of Trace Elements: Risk Assessment in an Italian Population [Articolo su rivista]
Filippini, T.; Tancredi, S.; Malagoli, C.; Malavolti, M.; Bargellini, A.; Vescovi, L.; Nicolini, F.; Vinceti, M.

Dietary intake to trace elements may represent the most relevant source of exposure for the general, non-occupationally population, but some of them have been rarely evaluated. We measured content of fifteen trace elements (antimony, barium, beryllium, boron, cobalt, lithium, molybdenum, nickel, silver, strontium, tellurium, thallium, titanium, uranium, and vanadium) in 908 food and beverage samples through inductively coupled plasma mass spectrometry. We estimated their dietary intake using a validated semi-quantitative food frequency questionnaire collected from a population of the Emilia-Romagna Region in Northern Italy. We compared our estimates with tolerable upper intake levels reported by international agencies and we assessed the non-carcinogenic risk through calculation of total hazard quotient for each trace element according to the US-EPA approach. Overall, estimates of their dietary intake were substantially similar to those reported from other countries, and they fell below the tolerable upper intake levels provided by international agencies. The total hazard quotient for each trace element was below 1. Our findings provide updated estimates of food levels and dietary intake of trace elements far frequently evaluated in a sample of Italian adult consumers. They also suggest that any non-carcinogenic risk associated with intake of investigated trace elements may be ruled out in our population.

2020 - Lactational exposure to phthalate monoesters among breastfed infants in Italy. [Abstract in Rivista]
Arletti, M; Maione, D; Fioretti, E; Panciroli, G; Predieri, G; Pinetti, D; Bargellini, A; Facchinetti, F; Fantuzzi, G; Righi, E

2020 - Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale [Articolo su rivista]
Bagnasco, A.; Zanini, M.; Catania, G.; Watson, R.; Hayter, M.; Dasso, N.; Dini, G.; Agodi, A.; Pasquarella, C.; Zotti, C. M.; Durando, P.; Sasso, L.; Barchitta, M.; Maugeri, A.; Favara, G.; San Lio, R. M.; Rossini, A.; Squeri, R.; Genovese, C.; D'Amato, S.; La Fauci, V.; Tardivo, S.; Moretti, F.; Carli, A.; Casini, B.; Baggiani, A.; Verani, M.; Rita Giuliani, A.; Fabiani, L.; D'Eugenio, S.; Boccia, G.; Santoro, E.; Battista Orsi, G.; Napoli, C.; Montesano, M.; Berdini, S.; Bertamino, E.; Perre, A.; Zerbetto, A.; D'Errico, M.; Ortolani, S.; Mercuri, M.; Traini, T.; Santarelli, A.; Fiorentini, R.; Benedetti, T.; Montagna, M.; Mascipinto, S.; Torre, I.; Pennino, F.; Schiavone, D.; Maria Iannicelli, A.; Tartaglia, E.; Veronesi, L.; Palandri, L.; Miguel Morgado, M. S.; Giudice, L.; Arrigoni, C.; Gentile, L.; Bascape, B.; Mura, I.; Sotgiu, G.; Barberis, I.; Maria Bersi, F.; Manca, A.; Massa, E.; Montecucco, A.; Rahmani, A.; Zacconi, S.; Ricco, M.; Magnavita, N.; Di Prinzio, R. R.; Torregrossa, M. V.; Calamusa, G.; Firenze, A.; Bargellini, A.; Ferri, P.; Righi, E.; Carraro, E.; Borraccino, A.; Traversi, D.; Ottino, M. C.; Baldovin, T.; Torre, S. D.; Sulaj, A.; Bianco, A.; Teti, V.; Novati, R.; Oriani, R.

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

2020 - Safety and effectiveness of monochloramine treatment for disinfecting hospital water networks [Articolo su rivista]
Marchesi, I.; Paduano, S.; Frezza, G.; Sircana, L.; Vecchi, E.; Zuccarello, P.; Conti, G. O.; Ferrante, M.; Borella, P.; Bargellini, A.

The formation of potentially carcinogenic N-nitrosamines, associated with monochloramine, requires further research due to the growing interest in using this biocide for the secondary disinfection of water in public and private buildings. The aim of our study was to evaluate the possible formation of N-nitrosamines and other toxic disinfection by-products (DBPs) in hospital hot water networks treated with monochloramine. The effectiveness of this biocide in controlling Legionella spp. contamination was also verified. For this purpose, four different monochloramine-treated networks, in terms of the duration of treatment and method of biocide injection, were investigated. Untreated hot water, municipal cold water and, limited to N-nitrosamines analysis, hot water treated with chlorine dioxide were analyzed for comparison. Legionella spp. contamination was successfully controlled without any formation of N-nitrosamines. No nitrification or formation of the regulated DBPs, such as chlorites and trihalomethanes, occurred in monochloramine-treated water networks. However, a stable formulation of hypochlorite, its frequent replacement with a fresh product, and the routine monitoring of free ammonia are recommended to ensure a proper disinfection. Our study confirms that monochloramine may be proposed as an effective and safe strategy for the continuous disinfection of building plumbing systems, preventing vulnerable individuals from being exposed to legionellae and dangerous DBPs.

2020 - The relevance of molecular genotyping to allocate cases in a suspected outbreak of Legionella pneumonia in patients with prolonged immunosuppressive therapy [Articolo su rivista]
Borella, Paola; Vecchi, Elena; Incerti, Federica; Marchesi, Isabella; Meacci, Marisa; Frezza, Giuseppina; Fregni Serpini, Giulia; Mansi, Antonella; Paduano, Stefania; Bargellini, Annalisa

Three cases of pneumonia by L. pneumophila serogroup 1 (Lp1) in immunosuppressed patients with repeated hospitalization were suspected as a healthcare-associated cluster. The environmental investigation did not reveal the presence of legionellae in the hospital patient's rooms. Water samples collected from the home of two patients were also negative for Legionella spp. In the absence of environmental strains potentially involved in the infections, we proceeded to genotype environmental Lp1 strains isolated in the hospital during the routine water sampling along the decade 2009-2019 and recovered after long term storage at -20 °C. These "historical" strains exhibited high grade of similarity and stability over time, regardless of disinfection systems. The different molecular profile showed among clinical and environmental strains excluded a nosocomial outbreak. The study suggests that the application of molecular typing may be a useful tool to discriminate hospital vs community-acquired cases, mostly for severely immunosuppressed patients in which the symptomatology could be insidious and the incubation period could be prolonged. Moreover, the genotyping allowed us to exclude that the cases were linked each other's.

2020 - [Development of a conceptual model for interpretation of monitoring indicators of childhood obesity prevention from the Italian National Prevention Plan] Sviluppo di un modello concettuale di riferimento per l’interpretazione degli indicatori di prevenzione dell’obesità infantile e nell'adolescenza nel Piano nazionale della prevenzione [Articolo su rivista]
Broccoli, Serena; Venturelli, Francesco; Bevere, Francesco; Braga, Mario; Cosentino, Mimma; Galeone, Daniela; Federici, Antonio; Marvulli, Mariagrazia; Vasselli, Stefania; Bellentani, Mariadonata; Bargellini, Annalisa; Perra, Alberto; Spinelli, Angela; Campostrini, Stefano; Porchia, Stefania; Cavallo, Franco; Faggiano, Fabrizio; Costa, Giuseppe; Giorgi Rossi, Paolo

BACKGROUND: the Italian National Prevention Plan (PNP) posed the standard to be achieved by Regions for the prevention of obesity in childhood and adolescence. The PNP also set up a monitoring system to assess the impact of implemented policies. OBJECTIVES: to develop a conceptual model to facilitate interpretation of variation in outcome indicators. METHODS: after a systematic review, the DPSEEA («Driving forces», «Pressures», «State», «Exposure», «Effect», «Actions!) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the framework were identified and indicators that allow measuring the changing of each of these factors were defined. RESULTS: the included «driving forces» were related to the profit-led food industry, to the nutrition environment at school, and to household-level factors. Among the «pressures», parenting behaviours, food provided by school canteens, sociocultural factors, social context, physical activity (PA), opportunities at school or after-school were included. In the State, the high consumption of processed food, the large quantities of high-calorie food easy available, the consumption of carbonated and sugar-sweetened beverages, the reduced social function of mealtimes in families, the early cessation of breastfeeding, the reduction of outdoors activity, active transportation, and PA at school for children were identified. The «exposure» factors were the reduced opportunities of doing PA and the over-consumption of calories that influence the «effect», described as the prevalence of children and adolescents affected by obesity. CONCLUSIONS: through the DPSEEA, a conceptual model was set up; it allows to place in the causal chain the «actions» and the mechanisms through which these actions should impact on the «exposure» (PA and over-consumption of calories), making the rationale of process and impact indicators explicit.

2020 - [The Health Examination Survey at regional level: the Emilia-Romagna Region (Northern Italy) example] [Articolo su rivista]
Salvia, Chiara; Donfrancesco, Chiara; Palmieri, Luigi; Lo Noce, Cinzia; Vanuzzo, Diego; Vinceti, Marco; Bargellini, Annalisa; Borella, Paola; Giampaoli, Simona

to assess time trend of lifestyles, cardiovascular risk factors, and prevalence of high-risk conditions in random samples of the general adult population residing in Emilia-Romagna, examined in two cross-sectional surveys conducted within the Epidemiological Cardiovascular Observatory (OEC 1998-2002) and the Epidemiological Cardiovascular Observatory/Health Examination Survey (OEC/HES 2008-2012).

2019 - Aluminum and tin: Food contamination and dietary intake in an Italian population [Articolo su rivista]
Filippini, Tommaso; Tancredi, Stefano; Malagoli, Carlotta; Cilloni, Silvia; Malavolti, Marcella; Violi, Federica; Vescovi, Luciano; Bargellini, Annalisa; Vinceti, Marco

Aluminum and tin are ubiquitous in the environment. In normal biological systems, however, they are present only in trace amounts and have no recognized biological functions in humans. High exposure to these metals can result in adverse health effects such as neurodegenerative diseases. In non-occupationally exposed subjects, diet is the primary source of exposure. In this study, we aimed at estimating dietary aluminum and tin intake in an Italian adult population. We measured aluminum and tin concentrations through inductively-coupled plasma mass spectrometry in 908 food samples. We also estimated dietary intake of these two metals, by using a validated semi-quantitative food-frequency questionnaire administered to 719 subjects (319 men and 400 women) recruited from the general population of the Emilia Romagna region, Northern Italy. We found the highest aluminum levels in legumes, sweets, and cereals, while the highest tin levels were in sweets, meat and seafood. The estimated median daily dietary intake of aluminum was 4.1 mg/day (Interquartile range – IQR: 3.3–5.2), with a major contribution from beverages (28.6%), cereals (16.9%), and leafy vegetables (15.2%). As for tin, we estimated a median intake of 66.8 μg/day (IQR: 46.7–93.7), with a major contribution from vegetables (mainly tomatoes) (24.9%), fruit (15.5%), aged cheese (12.2%), and processed meat (10.4%). This study provides an updated estimate of the dietary intake of aluminum and tin in a Northern-Italy adult population, based on data from a validated food-frequency questionnaire. The intake determined for this population does not exceed the established thresholds of tolerable intake.

2019 - Blood pressure levels and hypertension prevalence in a high selenium environment: results from a cross-sectional study [Articolo su rivista]
Vinceti, M.; Chawla, R.; Filippini, T.; Dutt, C.; Cilloni, S.; Loomba, R.; Bargellini, A.; Orsini, N.; Dhillon, K. S.; Whelton, P.

Background and aims: Recent human and laboratory studies have suggested the possibility that selenium overexposure may increase blood pressure. We sought to ascertain whether adults living in a seleniferous area exhibit an association between selenium exposure and both blood pressure levels as well as prevalence of hypertension. Methods and results: We measured selenium levels in blood (serum), hair and nail samples obtained from 680 adult volunteers (267 men and 413 women), living in seven Punjabi villages in a seleniferous area and related them to health outcomes, including systolic and diastolic blood pressure and presence of hypertension. In a multivariable restricted cubic spline regression model, adjusted for age, sex and history of hypertension, we found a positive association between systolic blood pressure and both serum (P = 0.004) and hair (P = 0.058) selenium levels, but not with nail selenium content. Little association emerged between the three selenium biomarkers and diastolic blood pressure. Hypertension prevalence was positively associated with the three exposure indicators (P < 0.001). The associations we found were generally stronger in women than in men. Conclusions: Overall, these findings suggest that chronic overexposure to environmental selenium may increase blood pressure, though there were inconsistencies for this association according to the choice of exposure indicator, the study endpoint and the sex.

2019 - Dietary exposure estimates to fifteen trace elements in an adult population of Emilia Romagna region, Northern Italy [Abstract in Atti di Convegno]
Filippini, T; Tancredi, S; Malagoli, C; Malavolti, M; Vescovi, L; Bargellini, A; Vinceti, M

The health effects and the exposure levels of trace elements in humans are important public health topics. Assessing their dietary intake is fundamental to evaluate the long-term risks for public health and for food safety assessment. Since a priority of food safety regulatory agencies is to ensure the protection of consumers and to assess the health risks for the general population, to estimate the actual dietary intake of trace elements for comparison with the upper and lower tolerable levels is very important. In this study, we aimed to evaluate the dietary intake of several trace elements in an Italian community, namely of antimony, barium, beryllium, boron, cobalt, lithium, molybdenum, nickel, silver, strontium, tellurium, thallium, titanium, uranium, and vanadium. To do that, in 2016-2017 we collected a total of 908 food samples available in Italian markets and groceries from two Northern Italy provinces (Modena and Reggio Emilia), and we measured their trace element content through inductively-coupled plasma mass spectrometry. We also administered a validated semi-quantitative food frequency questionnaire to 708 residents (300 men and 48 women) in the Emilia-Romagna Region, to assess their dietary habits and eventually to estimate their dietary intake of the aforementioned trace elements. Overall, study results showed that in our population the dietary exposure levels to selected trace elements could be considered similar to that observed in other European and non-European populations. Though we cannot rule out the possibility that the dietary exposure estimates in the present study may not be representative of the population as a whole, our results provide a good and updated assessment of trace elements far frequently evaluated in a sample of Italian adult consumers from the Emilia Romagna region. Our findings finally suggest that our population should not be at risk of adverse health effects in relation to excess or deficiency of the investigated trace elements since the estimated dietary intake generally point out exposure levels within the safe range as far as indicated by recommendations of international agencies.

2019 - Difficoltà nella identificazione della fonte ambientale di Legionella: un esempio dalla pratica clinica di casi comunitari inizialmente classificati come nosocomiali [Abstract in Atti di Convegno]
Borella, P.; Vecchi, E.; Incerti, F.; Marchesi, I.; Cagarelli, R.; Pecorari, M.; Bargellini, A.; Frezza, G.; Barbieri, M.; Paduano, S.

Introduzione I casi di polmonite da Legionella sono in aumento in tutto il mondo in parte per la maggior capacità diagnostica, in parte per la molteplicità delle possibili fonti di contagio, con comparsa sempre più frequente di focolai epidemici, la cui origine è spesso difficile da identificare. In Germania, come in altre realtà europee, sono state sospettate come reservoirs le torri di raffreddamento, ma la connessione con i casi raramente è stata possibile. Per quanto riguarda casi singoli o clusters epidemici eventualmente contratti in strutture di ricovero e cura, l'associazione con la contaminazione ambientale viene effettuata sulla base del periodo di incubazione della malattia, anche se la complessità clinica dei pazienti rende talora difficile stabilire l'esordio dei sintomi. In questo studio, riportiamo alcuni casi di polmonite da Legionella diagnosticati nel Policlinico Universitario di Modena, inizialmente classificati come nosocomiali, ipotesi poi smentita da un approfondimento sulle caratteristiche molecolari dei ceppi clinici e ambientali. Materiali e Metodi Nel periodo aprile e maggio 2018, sono stati diagnosticati tramite ricerca dell’antigene urinario tre casi di polmonite da Legionella in pazienti immunodepressi con importanti co-morbilità, il cui ricovero era compatibile con il periodo di incubazione della malattia. Sono state condotte analisi colturali sui campioni idrici nei reparti e stanze in cui i pazienti avevano soggiornato e si è provveduto all’isolamento colturale del microorganismo su espettorato, con successiva analisi di tipizzazione molecolare con metodica RAPD-PCR e Sequence-Based Typing (SBT). I ceppi isolati dai pazienti sono stati confrontati con ceppi ambientali isolati e conservati al Policlinico. Le indagini disposte dalla Direzione Ospedaliera sono state condotte nei laboratori dell'Università e in parallelo dal Servizio di Igiene e Sanità Pubblica che ha anche disposto verifiche nelle abitazioni dei pazienti. Risultati L'esame colturale dell'escreato dei tre pazienti è risultato positivo per L. pneumophila (Lpn) sierogruppo (sg) 1. Dall’analisi di genotipizzazione, i ceppi isolati dai pazienti presentano profili SBT diversi (ST 18, ST2632, ST263 l) con basso grado di similarità. Le indagini ambientali condotte nell’ospedale e nelle abitazioni sono risultate tutte negative. L'analisi molecolare di dieci ceppi storicamente isolati nel Policlinico ha riscontrato in tutti Lpn ST1, con alto grado di similarità tra loro, ma dissimili dai ceppi clinici. Conclusioni I casi riportati evidenziano la difficoltà di definire come nosocomiali polmoniti da Legionella che insorgono in pazienti complessi, ricoverati a più riprese in ospedale. Lo studio delle caratteristiche molecolari dei ceppi clinici e ambientali ci ha permesso infatti di classificarli come casi singoli di origine comunitaria, diversi l'uno dall'altro e non inquadrabili come un cluster di origine nosocomiale. Nell'ospedale, tutte le fonti idriche sono risultate legionella-free, anche grazie ai sistemi di disinfezione adottati da tempo, e la mancata similarità tra i tre ceppi clinici e quelli isolati e conservati nella ceppoteca ospedaliera ha confermato che si trattava di microrganismi estranei alla struttura. Lo studio mette in evidenza la possibilità di slittamenti temporali nel periodo di incubazione della polmonite da Legionella, particolarmente in pazienti gravemente compromessi, e ciò rende problematica la ricerca delle fonti del contagio sia nelle polmoniti nosocomiali che in quelle comunitarie

2019 - Genotipizzazione molecolare di Legionella come strumento dirimente un sospetto cluster nosocomiale. J Prev Med Hyg. 2019 September; 60(3) S1: E303. [Abstract in Rivista]
Borella, P; Incerti, F; Marchesi, I; Bargellini, A; Paduano, S; Vecchi, E; Barbieri, M; Pecorari, M; Fregni Serpini, G; Grottola, A; Cagarelli, R

2019 - Occupational exposure to electromagnetic fields and prevention of possible adverse effects in workers: results of 20 years of research at the University of Modena and Reggio Emilia [Capitolo/Saggio]
Modenese, Alberto; Bargellini, Annalisa; Gobba, Fabriziomaria

The occupational risk related to electromagnetic fields (EMF) exposure in workplaces is one of the main research fields developed in the last 20 years by the Chair of Occupational Medicine and the Chair of Hygiene of the Public Health Section of the Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. During this period we have approached several topics in the field of exposure and prevention of EMF risk in occupational settings, including: - the occupational and environmental Extremely Low Frequency – Electromagnetic Fields (ELF-EMF) exposure and effects in different groups of workers; - the possible mechanisms of ELF-EMF effects in biological tissues; - the development of best practices to manage and prevent the EMF related occupational risk in workers according to the European Directives, with particular consideration for health surveillance of exposed workers; - the occupational risk and the health surveillance of Magnetic Resonance Imaging operators; - the epidemiology of proposed adverse long-term effects of occupational EMF exposure.

2019 - Selenium and selenium species in the etiology of Alzheimer's dementia: The potential for bias of the case-control study design [Articolo su rivista]
Vinceti, Marco; Michalke, Bernhard; Malagoli, Carlotta; Eichmüller, Marcel; Filippini, Tommaso; Tondelli, Manuela; Bargellini, Annalisa; Vinceti, Giulia; Zamboni, Giovanna; Chiari, Annalisa

Several human studies imply that the trace element selenium and its species may influence the onset of neurological disease, including Alzheimer's dementia (AD). Nevertheless, the literature is conflicting, with reported associations between exposure and risk in opposite direction, possibly due to biases in exposure assessment. After conducting a cohort study that detected an excess AD risk associated with higher levels of inorganic-hexavalent selenium in subjects with mild cognitive impairment (MCI), we investigated the relation between selenium and AD using a case-control study design. We determined cerebrospinal fluid levels of selenium species in 56 MCI participants already included in the cohort study, considered as referents, and in 33 patients with established AD. AD risk was inversely correlated with inorganic selenium species and with the organic form bound to selenoprotein P. Selenium bound to other organo-selenium species was positively correlated with AD risk, suggesting compensatory selenoprotein upregulation following increased oxidative stress. The finding of an increased AD risk associated with inorganic-hexavalent selenium from the cohort study was not replicated. This case-control study yielded entirely different results than those generated by a cohort study with a partially overlapping participant population, suggesting that case-control design does not allow to reliably assess the role of selenium exposure in AD etiology. This inability appears to be due to exposure misclassification, falsely indicating an etiologic role of selenium deficiency likely due to reverse causation, and involving most selenium species. The case-control design may instead lend insights into the pathologic process underlying disease progression.

2019 - Studio dell’impatto di diverse strategie di disinfezione sulla comunità microbica delle reti idriche ospedaliere tramite l’applicazione della genomica. [Abstract in Atti di Convegno]
Paduano, Stefania; Casali, Maria Elisabetta; Marchesi, I; Frezza, G.; Valeriani, F.; Romano-Spica, V.; Vecchi, E.; Borella, P.; Bargellini, Annalisa

Introduzione. La maggior parte delle strutture sanitarie applica al sistema idrico trattamenti di disinfezione in continuo al fine di ridurre il rischio infettivo. Tali trattamenti possono modificare la composizione della comunità batterica dei sistemi di distribuzione dell'acqua sia in termini di abbondanza che di varietà di genere. Le tecnologie NGS (Next Generation Sequencing) e gli strumenti bioinformatici utilizzati negli studi di metagenomica consentono di rilevare tutti i batteri coltivabili e non, appartenenti alla comunità microbica della rete idrica indagata, sequenziando segmenti del loro DNA. Scopo dello studio è valutare l’impatto di diversi trattamenti di disinfezione sulla comunità microbica presente nelle reti di distribuzione dell’acqua calda dell’Azienda Ospedaliero-Universitaria di Modena tramite queste tecnologie. Materiali e metodi. L’ospedale oggetto dello studio comprende un monoblocco principale e quattro palazzine separate provviste ciascuna della propria centrale idrica. Tutti gli edifici sono alimentati da acqua fredda clorata proveniente dall’acquedotto comunale. Sono stati raccolti campioni di acqua fredda in ingresso (in due sessioni di campionamento a distanza di un anno) e di acqua calda da ricircoli e punti distali di quattro reti idriche, di cui tre trattate con diversi biocidi (monocloramina, perossido di idrogeno e biossido di cloro) e una rete non trattata chimicamente. Ogni campione è stato analizzato per la caratterizzazione del microbioma tramite NGS. Risultati. Le acque fredde in ingresso presentavano profili microbici comuni, confermati nella loro similitudine anche a distanza di un anno dal primo campionamento. Nello specifico, Proteobacteria e Bacteroidetes rappresentavano i phyla predominanti e Burkholderia, Sediminibacterium, e Bradyrhizobium i generi prevalenti e comuni a tutte queste acque. Nelle reti idriche trattate predominavano alcuni generi resistenti a condizioni ambientali sfavorevoli quali Bradyrhizobium (rete trattata con perossido di idrogeno e biossido di cloro), Mycobacterium (perossido di idrogeno), Gallionella (monoclorammina) e Blastomonas (biossido di cloro). Generi termofili (Thermobaculum) predominavano invece nelle acque non trattate chimicamente che avevano una temperatura più elevata (>50°C) rispetto alle reti trattate tenute tra 40°C e 45°C per evitare la degradazione dei biocidi stessi. In tutti i campioni, Legionella spp e Pseudomonas spp risultavano inferiori all’1% sul totale dei generi identificati. Conclusioni. La caratterizzazione dei profili microbici delle reti idriche ospedaliere mediante l’analisi metagenomica rappresenta un approccio innovativo nella sua applicazione in Sanità Pubblica. Tutti i sistemi di disinfezione studiati sono risultati efficaci nel controllare la contaminazione da Legionella e Pseudomonas all’interno delle reti idriche ospedaliere. I nostri risultati suggeriscono un impatto diverso dei tre biocidi sui profili batterici delle acque calde, selezionando alcuni generi resistenti a stress ossidativi e limitatamente alla rete trattata con perossido di idrogeno patogeni opportunisti appartenenti al genere Mycobacterium. Ulteriori indagini sarebbero necessarie per monitorare nel tempo la stabilità della comunità microbica nelle reti idriche trattate.

2019 - The effect of Public Health/Pediatric Obesity interventions on socioeconomic inequalities in childhood obesity: A scoping review [Articolo su rivista]
Venturelli, Francesco; Ferrari, Francesca; Broccoli, Serena; Bonvicini, Laura; Mancuso, Pamela; Bargellini, Annalisa; Giorgi Rossi, Paolo

Childhood obesity has a strong social gradient. This scoping review aims to synthesize the evidence on the impact on inequalities of non-targeted interventions to reduce the prevalence of childhood and adolescent obesity in high-income countries. We updated a review by Hillier-Brown, searching up to 31 December 2017 on MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO, with no limitations on study design. Fifty-eight studies describing 51 interventions were included: 31 randomized clinical trials and 27 non-randomized trials, with sample sizes from 67 to 2,700,880 subjects. The majority were implemented in the school setting at a community level; the others were in health services or general population setting and targeting individuals or the system. Twenty-nine interventions proved to be effective overall; seven others had an effect only in a subgroup, while 15 proved not to be effective. All types of included interventions can increase inequalities. Moreover, some interventions had opposite effects based on the socioeconomic characteristics. Any kind of intervention can reduce equity. Consequences are difficult to predict based on intervention construct. Complex interventions acting on multiple targets, settings, and risk factors are more effective and have a lower risk of increasing inequalities.

2019 - Vantaggi e svantaggi di diversi biocidi nel controllo della contaminazione da Legionella in ospedale [Abstract in Atti di Convegno]
Marchesi, I.; Bargellini, A.; Paduano, S.; Frezza, G.; Mansi, A.; Giovanardi, R.; Vecchi, E.; Borella, Paola

Introduzione. Per il controllo della contaminazione idrica da Legionella, vengono proposti vari sistemi di disinfezione che richiedono una valutazione non solo dell’efficacia ma anche dei possibili effetti collaterali. Obiettivo dello studio è valutare l'efficacia nel lungo periodo di diversi trattamenti adottati in strutture sanitarie in termini di riduzione della contaminazione, presenza di legionelle vitali ma non coltivabili (VBNC), formazione di sottoprodotti tossici ed i possibili effetti corrosivi. Materiali e Metodi. Lo studio è stato condotto in strutture sanitarie del territorio modenese nelle quali sono attivi programmi di sorveglianza e controllo della legionellosi secondo le raccomandazioni delle linee guida regionali. Tali programmi prevedono l’adozione di sistemi di disinfezione in continuo (biossido di cloro, monoclorammina, perossido di idrogeno) ed il monitoraggio periodico della contaminazione degli impianti idrosanitari. Legionella spp. è stata quantificata tramite coltura (metodo ISO 11731:2017) ed identificata a livello di specie e sierogruppo. Per oltre 150 campioni, i risultati ottenuti con il metodo colturale sono stati confrontati con quelli ottenuti con la qPCR convenzionale ed il metodo EMA-qPCR che consente di rilevare l’eventuale presenza di legionelle VBNC. La concentrazione dei biocidi ed altri parametri chimico-fisici dell’acqua quali temperatura, pH, cloriti, clorati, ammonio, nitriti, nitrati, N-nitrosammine, e trialometani sono stati misurati con metodi standard. Per valutare l’eventuale effetto corrosivo dei biocidi, supporti di polivinilcloruro clorurato (PVC-C) contenenti provini di materiali utilizzati per le tubazioni/rubinetterie (rame, ottone, acciaio zincato e acciaio inossidabile) sono stati collegati al ricircolo di tre reti trattate in continuo con disinfettanti e di una non trattata. Dopo tre, sei e dodici mesi di esposizione, la corrosione dei provini metallici è stata valutata in termini di perdita di peso, mentre i supporti in PVC-C sono stati sottoposti a schiacciamento per valutarne la resistenza meccanica all’esposizione ad acqua trattata. Risultati. La monoclorammina ha dimostrato una maggiore efficacia nel controllo della contaminazione rispetto a biossido di cloro e perossido di idrogeno. Con i trattamenti a base di cloro, i punti positivi sono risultati contaminati da L. pneumophila sierogruppo 1, mentre col perossido erano prevalenti altre specie/sierogruppi. Nelle acque trattate con i biocidi allo studio non sono state rilevate legionelle VBNC. La formazione di cloriti e clorati è stata associata all’uso di biossido di cloro, mentre con la monoclorammina non sono stati osservati fenomeni di nitrificazione né formazione di nitrosammine. Tutti i biocidi hanno causato effetti corrosivi, anche se per i metalli testati la velocità di corrosione era entro 0,50 mm/anno, valore considerato soddisfacente per le reti idriche. Il PVC-C ha mantenuto inalterate le sue caratteristiche meccaniche anche in presenza dei disinfettanti. Conclusioni. La disinfezione chimica in continuo si conferma efficace nel ridurre ma non eradicare le legionelle dagli impianti evitando anche la presenza di cellule vitali ma non coltivabili potenzialmente infettive. Ogni metodo ha dei limiti in termini di aggressività, tossicità e selezione di ceppi, che devono essere attentamente valutati al momento della scelta del disinfettante da adottare.

2018 - Diet composition and serum levels of selenium species: A cross-sectional study [Articolo su rivista]
Filippini, Tommaso; Michalke, Bernhard; Wise, Lauren A.; Malagoli, Carlotta; Malavolti, Marcella; Vescovi, Luciano; Salvia, Chiara; Bargellini, Annalisa; Sieri, Sabina; Krogh, Vittorio; Ferrante, Margherita; Vinceti, Marco

Selenium is a trace element of both nutritional and toxicological interest, depending on its dose and chemical form. Diet is the primary source of exposure for most individuals. We sought to investigate the influence of food intake on serum levels of selenium species. Among fifty subjects randomly selected from a Northern Italian population, we assessed dietary habits using a validated semi-quantitative food frequency questionnaire. We also measured circulating levels of selenium species in serum using high pressure liquid chromatography associated with inductively-coupled plasma dynamic reaction cell mass spectrometer. Circulating levels of inorganic selenium, the most toxic selenium species, were positively associated with intake of fish, legumes and dry fruits, and inversely associated with intake of dairy products and mushrooms. Concerning the organic selenium species, selenoproteinP-bound selenium was inversely associated with intake of fish, fresh fruits, vegetables, and legumes, while selenocysteine-bound selenium positively associated with intake of fresh fruit, potato, legume and mushroom. In the present study, intakes of different foods were correlated with different types of selenium species. These results have important public health implications when assessing the nutritional and toxicological potential of diet composition with reference to selenium exposure.

2018 - Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study [Articolo su rivista]
Campanini, Isabella; Mastrangelo, Stefano; Bargellini, Annalisa; Bassoli, Agnese; Bosi, Gabriele; Lombardi, Francesco; Tolomelli, Stefano; Lusuardi, Mirco; Merlo, Andrea

BACKGROUND:Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS: A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS: One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS: The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment

2018 - Food contamination from the food packaging metals aluminum and tin: estimation of their dietary exposure in an Italian adult community. [Abstract in Atti di Convegno]
Filippini, T; Tancredi, Stefano; Malagoli, C; Cilloni, S; Malavolti, M; Violi, F; Vescovi, L; Bargellini, A; Vinceti, M.

2018 Scientific meeting Italian Association for the Study of Trace Elements in living Organisms – AISETOV. Ozzano Emilia, Bologna, October 12, 2018 (ISBN: 9788894309812)

2018 - Hospital Hygiene and Infection Prevention and Control in Italy: state of the art and perspectives [Articolo su rivista]
Brusaferro, S; Arnoldo, L; Finzi, G; Mura, I; Auxilia, F; Pasquarella, C; Agodi, ; A and the GISIO Group (Agodi, A; Arrigoni, C; Auxilia, F; Barchitta, M; Brusaferro, S; Calella, G; Casini, B; Cristina, Ml; D'Errico, M; Laurenti, P; Masia, Md; Montagna, Mt; Mura, I; Pasquarella, C; Olivieri, G; Orsi, A; Orsi, Gb; Pesapane, L; Ripabelli, G; Sodano, L; Squeri, R; Teti, V; Torregrossa, Mv; Torri, E; Zarrilli, R; Are, Bm; Brighenti, A; Mascipinto, S; Iannazzo, S; D'Ancona, Fp; Sessa, G; Motta, A; Appignanesi, R; Argiolas, F; Baldovin, T; Bargellini, A; Berdini, S; Boccia, G; Calagreti, G; Caldarulo, T; Campanella, F; Chiesa, R; Ciorba, V; Contrisciani, R; D'Alessandro, D; De Giglio, O; Fabiani, L; Fara, Gm; Giuliani, G; Laganà, P; Marani, A; Mattaliano, Ar; Molino, A; Montesano, M; Moretti, F; Moro, M; Moscato, U; Napoli, C; Nicolotti, N; Nobile, M; Novati, R; Palumbo, F; Piana, A; Privitera, G; Prospero, E; Quattrocchi, A; Righi, E; Romano Spica, V; Rossi, F; Rossini, A; Schieppati, S; Sotgiu, G; Tardivo, S; Torre, I; Valeriani, F; Veronesi, L; Zotti, C)

Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of “infection control and hospital hygiene” which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as “healthcare organisation hygiene” in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: “all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers”. Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.

2018 - Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study [Articolo su rivista]
Montagna, Mt; Mascipinto, S; Pousis, C.; Bianchi, Fp; Caggiano, G; Carpagnano, Lf; De Giglio, O; Barbuti, G; Auxilia, F; Destrebecq, A; Castaldi, S; Baldovin3, T; Bargellini, A; Righi, E; Boccia, G; Santoro, E; Casini, B; Baggiani, A; Novati, R; Oriani, R; Odone, A; Mezzoiuso, Ag; Orsi, Gb; Napoli, C; Pasquarella, C; Veronesi, L; Ripabelli, G.; Sammarco, Ml; Rossini, A; Squeri, R; Laganà, P; Antonuccio, Gm; Genovese, C; Tardivo, S; Torre, I; Alfano, R; Pennino, F; Torregrossa, Mv; Barchitta, M; Agodi., A

Background. The World Health Organization’s Action Framework for tuberculosis elimination in lowtuberculosis incidence countries includes the screening for active and latent tuberculosis in selected highrisk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. Methods. Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions’ students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. Results. Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions’ students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. Discussion. In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

2018 - Lactational Exposure to Phthalates: Preliminary Results from an Italian Cross-Sectional Study [Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Pinetti, Diego; Francesca, Faggioli; Scelsa, Francesca; Bargellini, Annalisa

Background: Human exposure to phthalates, endocrine disruptors ad reproductive toxicants, is ubiquitous because of their extensive use as plasticizers. Breast milk is the optimal source of nutrition for newborns, however, it can be a source of exposure to several environmental contaminants, Including phthalates. Up to date limited information exists on lactational exposure to phthalates and their metabolites in Italy: the aim of this study, therefore, was to determine the levels of 8 different phthalates diesters and monoesters in breast milk of women living in Modena, Italy, and to investigate the relationship with women's diet and other habits.Methods: 130 women (mean age: 33; range: 19 - 45 years) provided a sample of breast milk (30-40 days postpartum) and filled in a questionnaire on personal data and on potential sources exposure to phthalates. After solid extraction, samples were analysed by triple Quad LC/MS Mass Spectrometry.Results: Phthalate diesters, due to their metabolic degradation, resulted almost undetectable. Phthalate monoesters appeared more widespread. Among them, mono-isononylphthalate (MiNP) was detected in 125 breast samples (mean: 1.63 +2.71; range: 0.10 - 18.4 µg/l) and mono-ethylphthalate (MEP) in 106 samples (mean: 2.35 + 7.36; range: 0.04 - 69.0 µg/l). Their levels appeared higher in lactating women more frequently using cosmetics or consuming food and beverages preserved in plastic containers. Differences, however, were not statistically significant. Further, levels appeared well below the daily intake levels established by the European Food Safety Authority (EFSA).Conclusions: Although a number of phthalate monoesters were detected in maternal breast milk, their concentrations tended to be lower than those reported in other international studies and the values recommend by EFSA. Human milk represent a unique nourishment for infants in a crucial period of their life: its use should not be discouraged.

2018 - Microbial biodiversity of thermal water and mud in an Italian spa by metagenomics: a pilot study [Articolo su rivista]
Paduano, Stefania; Valeriani, Federica; Romano-Spica, Vincenzo; Bargellini, Annalisa; Borella, Paola; Marchesi, Isabella

In literature, the microbial diversity of hot spring waters has been the focus of extensive research, while there is a paucity of studies on thermal water distribution network of spa centres and as yet no studies have been carried out on the bacterial population of thermal muds. In this context, the aim of our study is to characterize the microbial community of sulphurous-bromine-iodine thermal water and mud within an Italian spa complex using Next Generation Sequencing (NGS) technologies. This is the first report of microbiome characterization along a water supply network from the spring to points of use within a spa. According to the 16S rRNA gene sequences analysis, our data highlight the presence of a typical microbial community, mainly composed of sulphur-cycling bacteria belonging to Desulfomonile, Thermodesulfovibrio, Geothermobacterium, Thermus, Thiofaba and Syntrophomonas genera. In addition, the characterization and evolution of the bacterial community in thermal muds during the maturation process is investigated for the first time. Interestingly, the microbiome of mature mud resulted dominated by bacteria capable of lipid biosynthesis, suggesting that these bacteria may play a role in the anti-rheumatic properties of thermal mud.

2018 - The efficacy of interprofessional simulation in improving collaborative attitude between nursing students and residents in medicine. A study protocol for a randomised controlled trial [Articolo su rivista]
Ferri, Paola; Rovesti, Sergio; Magnani, Daniela; Barbieri, Alberto; Bargellini, Annalisa; Mongelli, Francesca; Bonetti, Loris; Vestri, Annarita; Alunni Fegatelli, Danilo; DI LORENZO, Rosaria

Background: Effective collaboration among health professionals is an essential component to ensure quality of care. Many adverse events experienced by patients are attributed to misunderstanding or poor communication among members of the interprofessional team. Interprofessional simulation is a learning strategy used to improve collaboration and facilitate communication between medical and nursing students. Aim of the work: To determine the efficacy of educational program based on high-fidelity interprofessional simulation aimed at improving collaborative attitude. Method: For this purpose, a protocol for a planned single-center, non-blinded and Randomized Controlled Trial (RCT) was chosen. The present has been approved by the Ethics Committee of Area Vasta Emilia Nord (Italy) (n° 479/2018). All students attending the second and third year of nursing and all resident physicians in anesthesia, reanimation, intensive care and pain management of University of Modena and Reggio Emilia, will be recruited and randomly assigned to two groups. The Experimental Group (EG) will receive an educational intervention based on high-fidelity simulation and the Control Group (CG) will attend a traditional classroom lesson. Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Readiness for Interprofessional Learning Scale (RIPLS) will be administered before and after the educational program in both the EG and CG. Conclusion: Expected outcomes is that, at the end of the study, nursing students and resident physicians who participated in the interprofessional simulation show significantly higher levels of interprofessional collaboration compared to the CG, evaluated through the JSAPNC.

2018 - Trace Elements in Human Milk from Italian Lactating Women: Comparison with Infant Formulas [Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Ferrari, Angela; Marchesi, Isabella; Pescarolo, Letizia; Casali, Maria Elisabetta; Venturelli, Francesco; Bargellini, Annalisa

Background: Human milk is the best source of nutrition for the newborns, and exclusive breastfeeding is recommended by WHO up to 6 months of age. It contains all the nutrients and essential trace elements necessary to ensure correct functioning of the organism. Infant formulas, the most common substitutes for human milk, usually contain nutrient levels modeled to have a composition similar to human milk. However, few recent data on nutrient levels in breast milk and infant formula are available from women living in Italy. The aim of this study was to determine the levels of five essential (Fe, Zn, Cu, Mn, Se) and four non-essential/toxic elements (Ni, Cr, Cd, Pb) in infant formulas and breast milk of women living in Modena, Italy and to compare them with recommended values. Methods: 130 samples of human milk (mature milk: 30-40 days postpartum) and a representative sample of infant formulas (0-6 months) sold in Italy were analyzed by ICP-MS in triplicate after microwave digestion. Results: Breast milk showed adequate levels of essential trace elements, despite the inter-individual variability observed, which was not influenced by women' characteristics and dietary habits. Non-essential/toxic elements content was well below the maximum tolerable limits set by the European Food Safety Authority (EFSA). In infant formulas as well, essential element levels were within the European recommended values, however, Fe and Mn levels, were significantly higher than in breast milk. Conclusions: The levels of essential micronutrients in lactating women living in Modena are suitable for the proper development of infants and no risk for excessive toxic elements intake was detected. Infant formulas show high fortification with Fe and Mn. Considering the growing evidence of cognitive development effects due to an excessive Mn intake, a deeper discussion on infants' Mn requirement is needed. According to our findings, breastfeeding should be still encouraged and recommended.

2018 - Trace elements in starter infant formula: dietary intake and safety assessment [Articolo su rivista]
Bargellini, Annalisa; Venturelli, Francesco; Casali, Elisabetta; Ferrari, Angela; Marchesi, Isabella; Borella, Paola

The aim of this study was to investigate the concentrations of five essential (Fe, Mn, Zn, Cu and Se) and four non-essential/toxic elements (Cr, Cd, Ni and Pb) in 35 different starter infant formulas (0-6 months) sold in Italy. In addition, a safety assessment of these trace elements was carried out, by comparing the estimated daily intake (EDI) with the adequate intake (AI) and the provisional tolerable daily intake (PTDI), with a view to provide information on the metal distribution patterns and health risk to infants arising from the consumption of these products. The concentrations were determined by using inductively coupled plasma mass spectrometry after microwave digestion. The concentrations expressed in geometric mean ± geometric standard deviation of Fe (6.17 ± 1.61 mg/L), Zn (6.21 ± 1.31 mg/L), Cu (416.4 ± 1.21 μg/L), Mn (121.5 ± 1.85 μg/L) and Se (13.27 ± 1.67 μg/L) were within legal limits. In spite of this, the mean EDIs of Fe (4.81 mg/day) and Mn (94.75 μg/day) were many times higher than the recommended AI, especially for Mn. Chromium, Ni, Cd and Pb concentrations were not detectable in 11, 37, 57 and 66% of the samples, respectively. Considering the overall sample, the GM ± GSD of these elements were 4.80 ± 5.35 μg/L for Cr, 1.02 ± 11.65 μg/L for Ni, 0.21 ± 14.83 μg/L for Cd and 0.14 ± 17.13 μg/L for Pb. The mean EDIs were far below the respective PTDI. When the safety assessment was based on the 75° percentile level of each elements, all EDIs remained well below the PTDI, with the exception of Cd, whose EDI approached (74.7%), albeit remaining below the PTDI. In conclusion, our results and the increased awareness on the potential risks of excessive Mn and Fe for infants support that an urgent scientific-based definition of the appropriated levels of fortification in formulas is required. Moreover, regular monitoring of all the stages of production of infant formulas is essential in order to limit toxic metal contamination.

2017 - Carico assistenziale e bisogni del caregiver della persona in fase avanzata di malattia oncologica nella provincia di Reggio Emilia. Ricp- La rivista italiana di cure palliative 2017;vol.2-Estate 2017. [Articolo su rivista]
Bargellini, Annalisa; Pedroni, Cristina; Marzi, Anna; Ghizzi, Nuccia: Saffioti; Venturelli, Francesco; Sforacchi, Federica; Mastrangelo, Stefano; Coriani, Sandra

The present study aims to describe characteristics and needs of informal caregivers of patients with advanced cancer phase, in the province of Reggio Emilia. The sample was recruited in three of the six Day Hospital and in both the hospice of the area. Data were collected using the anonymous standardized questionnaire of Corli et al (2005). The questionnaire covered socio-demographic characteristics of both the caregiver and patient, caregiving characteristics, the relationship with the health care service and the economic burden for each family. Caregiver profile did not change compared to previous investigations. The results suggest that to be a caregiver of non self-sufficient patients, a caregiving period longer than two years and to be a caregiver without any care support from other family members, are characteristics associated with caregiving burden outcomes, that should be considered when developing targeted supporting interventions. A multidisciplinary approach seems to be the best way to provide a complete health care assistance and to give an appropriate answer to caregiver and patients needs.

2017 - Comparison of breast milk and infant formulas in essential and toxic elements content [Abstract in Atti di Convegno]
Bargellini, A; Marchesi, I; Fantuzzi, G; Righi, E; Pescarolo, Letizia; Ferrari, A; Paduano, Stefania; Borella, P

Background and aim: Human milk is considered to be the best source of nutrition for the newborn infants, and exclusive breastfeeding is recommended by WHO up to 6 months of age. It contains all the nutrients and essential trace elements necessary to ensure correct functioning of the organism. Sometimes, breast milk may be a potential source of undesirable (toxic) elements as their content reflects the level of environmental pollution and mother’s diet. In developed countries, the most common substitutes for human milk are commercially available infant formulas. Nutrient levels in formulas are generally modeled on the composition of human milk with the aim to make them similar. Relatively few recent data on breast milk which can be used as background data for setting adequate daily intakes for infants, are available from women living in Italy. The aim of this study was to determine the levels of five essential (Fe, Zn, Cu, Mn, Se, Cr) and four non-essential/toxic elements (Ni, Cr, Cd, Pb) in breast milk of women living in Modena, Italy; to compare them with recommended values; to investigate the relationship with diet and mother characteristics; to compare them with infant formulas. Methods: 130 samples of human milk (mature milk: 30-40 days postpartum) and a representative sample of infant formulas (0–6 months) sold in Italy were analyzed by ICP-MS in triplicate after microwave digestion. Results: Mature breast milk contains adequate levels of essential trace elements, despite the inter-individual variability not influenced by the women characteristics, demographic parameters and dietary habits. Non-essential/toxic elements content was well below the maximum tolerable limits set by EFSA. Regarding infant formulas, higher amounts of Fe and Mn were observed in comparison to breast milk. Conclusions: This study highlights that the levels of essential micronutrient in lactating women living in Modena are suitable for the proper development of infants and no risk for excessive toxic elements intake was detected. Comparison with infant formulas shows that high fortification with Fe and Mn requires more attention by researcher and international authorities. According to our findings, breastfeeding should be still encouraged and recommended.

2017 - Corrosive effect on various pipe materials following different treatments for Legionella spp control in hospital water systems [Abstract in Atti di Convegno]
Marchesi, I; Paduano, S; Giovanardi, R; Bonomi, Marco; Sircana, L; Vecchi, E; Bargellini, A; Borella, P.

The aim of this study is to verify the long term corrosive effect of three disinfection procedures on different commonly used plumbing materials, in hospital water networks

Scelsa, F; Righi, E; Fantuzzi, G; Predieri, G; Bargellini, A; Borella, P; Aggazzotti, G

INTRODUZIONE: Gli ftalati, diesteri dell’acido ftalico, appartenenti alla categoria degli endocrine disruptors, sono un problema emergente per quanto riguarda l’allattamento, a causa della loro presenza, talvolta in concentrazioni elevate, nel latte materno evidenziata in alcuni recenti studi. Si tratta di sostanze di sintesi ampiamente utilizzate per la produzione di oggetti plastici, imballaggi, prodotti biomedicali e per la cura e l’igiene personale. I livelli che raggiungono nel latte sono influenzati dalle abitudini e dall’ambiente di vita della donna. Lo scopo dello studio è di determinare le concentrazioni di ftalati nel latte materno di puerpere residenti a Modena e Provincia e di evidenziare potenziali differenze nei loro livelli in relazione alle diverse fonti di esposizione, alle abitudini e alle caratteristiche delle donne stesse. MATERIALI E METODI: A 130 puerpere (età media: 33, range: 19-45 anni), arruolate su base volontaria, è stato chiesto di fornire un campione di latte (20 ml) a 30-40 giorni dal parto e di rispondere ad un questionario sulle principali caratteristiche demografiche e sulle possibili fonti espositive ai contaminanti indagati. Il latte raccolto, previa estrazione dispersiva in fase solida (d-SPE), è stato analizzato in cromatografia liquida ad alte prestazioni con rivelatore a spettrometria di massa tandem - triplo quadrupolo (HPLC/MS/MS). RISULTATI: Il composto più diffuso è risultato il mono-iso-nonilftalato (MiNP) ritrovato in 125 campioni (media: 1,63±2,71 range 0,10-18,4 μg/l), seguito dal mono-etilftalato (MEP) rilevato in 106 campioni (media: 2,35±7,36 range 0,04-69,00 μg/l). Le concentrazioni rilevate sono apparse più elevate nei latti delle donne che fanno maggior uso di cosmetici e che hanno consumato alimenti e bevande confezionati in plastica durante l’allattamento. Le differenze tuttavia non sono apparse statisticamente significative. Gli ftalati diesteri, come conseguenza della loro trasformazione metabolica in monoesteri, sono risultati quasi totalmente assenti. CONCLUSIONI: Non è stato evidenziato, nel nostro territorio, un problema rilevante di salute legato all’assunzione di ftalati con l’allattamento al seno

Pescarolo, L.; Fantuzzi, G.; Righi, E.; Ferrari, A.; Marchesi, I.; Borella, P.; Bargellini, A.

INTRODUZIONE: L’allattamento al seno rappresenta la miglior fonte di nutrimento per i neonati di tutto il mondo tanto che l’OMS ne raccomanda l’esclusività fino al 6° mese di vita del bambino. Il latte umano fornisce tutte le sostanze nutritive, tra cui elementi essenziali in traccia, necessarie al corretto funzionamento dell’organismo del neonato. Tuttavia, può anche essere una potenziale fonte di elementi tossici, pericolosi per la salute del neonato, ed il loro contenuto può riflettere sia il livello di inquinamento ambientale che la dieta della madre. Scopo dello studio è quello di determinare nel latte materno di un campione rappresentativo di donne sane residenti a Modena e Provincia le concentrazioni di 5 microelementi essenziali come Fe, Zn, Cu, Mn, Se, di 2 elementi non essenziali come Ni e Cr e di due elementi tossici di grande rilevanza per il bambino come Pb e Cd, al fine di ottenere dati aggiornati ed aumentare le conoscenze riguardanti l’esposizione neonatale a tali elementi attraverso l’allattamento. MATERIALI E METODI: I campioni di latte materno sono stati raccolti tra il 30esimo e il 40esimo giorno post partum e le concentrazioni degli elementi in traccia sono state determinate attraverso ICP-MS, previa digestione con microonde. Sono state raccolte informazioni sulle abitudini alimentari materne e sui parametri socio-demografici. RISULTATI: 130 campioni di latte sono stati analizzati. Nonostante l’ampia variabilità inter-individuale, le concentrazioni medie di elementi in traccia essenziali risultano in linea con i valori raccomandati e il contenuto di elementi non essenziali/ tossici è ampiamente al di sotto dei limiti massimi tollerabili (PTDI) stabiliti dall’EFSA e dagli altri organi competenti. Le differenze osservate con altri studi possono essere attribuite al momento di raccolta del campione, a fattori ambientali o a differenze nella valutazione analitica. CONCLUSIONI: Possiamo confermare che i latti analizzati in questo studio contengono i livelli di micronutrienti essenziali adatti al corretto sviluppo del neonato e che l’allattamento al seno costituisce un metodo sicuro per l’alimentazione del neonato.

2017 - EMA-qPCR: a rapid technique for managing the risk of Legionella spp in waters subjected to disinfection treatments [Abstract in Atti di Convegno]
Mansi, A; Marchesi, I; Amori, I; Marcelloni, Am; Proietto, Ar; Bargellini, A; Paduano, S; Borella, P.

The aim of this study is to evaluate the advantages of this method in evaluating the presence of Legionella spp in water compared with both culture and qPCR

2017 - Effectiveness of monochloramine at different dosage in reducing Legionella water contamination avoiding formation of potentially toxic by-products [Abstract in Atti di Convegno]
Paduano, S; Marchesi, I; Vecchi, E; Saini, N; Bolognesi, A; Borella, P; Sircana, L; Bargellini, A.

This study evaluates the efficac of monchloramine in reducing Legionella pneumophila contamination without formation of toxic by-products

2017 - Health risk assessment of environmental selenium: Emerging evidence and challenges (Review) [Articolo su rivista]
Vinceti, Marco; Filippini, Tommaso; Cilloni, Silvia; Bargellini, Annalisa; Vergoni, Anna Valeria; Tsatsakis, A; Ferrante, M.

New data have been accumulated in the scientific literature in recent years which allow a more adequate risk assessment of selenium with reference to human health. This new evidence comes from environmental studies, carried out in populations characterized by abnormally high or low selenium intakes, and from high-quality and large randomized controlled trials with selenium recently carried out in the US and in other countries. These trials have consistently shown no beneficial effect on cancer and cardiovascular risk, and have yielded indications of unexpected toxic effects of selenium exposure. Overall, these studies indicate that the minimal amount of environmental selenium which is source of risk to human health is much lower than anticipated on the basis of older studies, since toxic effects were shown at levels of intake as low as around 260 µg/day for organic selenium and around 16 µg/day for inorganic selenium. Conversely, populations with average selenium intake of less than 13-19 µg/day appear to be at risk of a severe cardiomyopathy, Keshan disease. Overall, there is the need to reconsider the selenium standards for dietary intake, drinking water, outdoor and indoor air levels, taking into account the recently discovered adverse health effects of low-dose selenium overexposure, and carefully assessing the significance of selenium-induced proteomic changes.

2017 - La prevalenza dell’abuso di alcol tra i lavoratori in Italia [Articolo su rivista]
Venturelli, Francesco; Poscia, Andrea; Carrozzi, Giuliano; Sampaolo, Letizia; Bargellini, Annalisa; Ricciardi, Walter; Magnavita, Nicola

«Prevalence of alcohol abuse among workers in Italy». Background: Unhealthy alcohol consumption among workers increases the risk of job-related injuries and reduces productivity. Therefore, preventing workplace alcohol abuse is a public health priority. Objectives: This study is based upon data collected by PASSI and aims to outline the prevalence and socio-demographic characteristics of alcohol consumption among workers in Italy. Methods: PASSI is a nationwide surveillance system that examines health-related behaviours and the degree of knowledge and adherence to the preventive interventions offered by the Italian National Health Service. Between 2010 and 2013, 101,002 telephone interviews were collected from a sample of residents aged 18-69, randomly selected from local health unit lists. Results: 45.3% of those interviewed declared to be abstemious, while 16.5% reported an unhealthy alcohol drinking, with a higher prevalence among workers than non-workers (18.0% vs 14.2%, p<0.001). Binge drinking was the most common kind of risky drinking (8.7%), followed by alcohol consumption before meals (7.3%) and heavy consumption (4.0%). Among workers, unhealthy alcohol consumption was significantly related (p<0.001) to discontinuous work (OR 1.34), male gender (OR 2.34), younger age (18-34 vs 50-69 years old, OR 2.38) and serious economic problems (OR 1.26). It was also associated with Italian citizenship (OR 1.33) and residency in the northern (OR 2.17) and central (OR 1.29) regions. Conclusions: PASSI provides reliable and updated data to develop and assess interventions in workplace health promotion.

2017 - Lead, cadmium and mercury in cerebrospinal fluid and risk of amyotrophic lateral sclerosis: A case-control study [Articolo su rivista]
Vinceti, Marco; Filippini, Tommaso; Mandrioli, Jessica; Violi, Federica; Bargellini, Annalisa; Weuve, Jennifer; Fini, Nicola; Grill, Peter; Michalke, Bernhard

Exposure to neurotoxic chemicals such as pesticides, selenium, and heavy metals have been suggested toplay a role in the etiology of amyotrophic lateral sclerosis (ALS). We assessed exposure to lead, cadmium,and mercury in 38 ALS patients (16 men and 22 females) and 38 hospital-admitted controls by using theircerebrospinal fluid (CSF) content as biomarker. We determined CSF heavy metal levels with inductivelycoupled plasma sector field mass spectrometry, according to a methodology specifically developed forthis biological matrix. ALS patients had higher median values for Pb (155 vs. 132 ng/L) but lower levelsfor Cd (36 vs. 72 ng/L) and Hg (196 vs. 217 ng/L). In the highest tertile of exposure, ALS odds ratio was1.39 (95% CI 0.48–4.25) for Pb, 0.29 (0.08–1.04) for Cd and 3.03 (0.52–17.55) for Hg; however, no dose-response relation emerged. Results were substantially confirmed after conducting various sensitivityanalyses, and after stratification for age and sex. Though interpretation of these results is limited by thestatistical imprecision of the estimates, and by the possibility that CSF heavy metal content may notreflect long-term antecedent exposure, they do not lend support to a role of the heavy metals cadmium,lead and mercury in ALS etiology.

2017 - Toenail selenium as an indicator of environmental exposure: A cross-sectional study. [Articolo su rivista]
Filippini, Tommaso; Ferrari, Angela; Michalke, B; Grill, P; Vescovi, L; Salvia, Chiara; Malagoli, Carlotta; Malavolti, Marcella; Sieri, S; Krogh, V; Bargellini, Annalisa; Martino, Antonio; Ferrante, M; Vinceti, Marco

The relation between toxicity and essentiality of selenium (Se) is of growing interest in human health, as the effects may widely differ depending of its different chemical species and the exposure levels. Toenail Se has been proposed as a reliable biomarker of long-term Se exposure, but few studies investigated the correlation between its toenail content and environmental determinants (i.e., dietary food intake). We aimed to determine the relation of toenail Se levels with serum Se species as well as food items. We recruited a random sample of Modena (Northern Italy) municipal residents, from whom we collected detailed personal information, dietary habits, toenail specimen for Se determination and a blood sample for serum Se speciation analysis. Toenail Se mean value was 0.96 µg/g (range, 0.47‑1.60), with slightly higher levels in females, in non-obese subjects and in Se supplements users, while it was lower in current smokers. Toenail Se positively correlated with organic Se forms, mainly selenoprotein P and selenocysteine, and inversely with the inorganic forms (selenite and selenate). Toenail Se was not associated with meat, cereals and dairy products consumption, positively correlated with fruit and slightly with vegetable intake, and negatively with fish and seafood consumption. Finally, no clear association emerged with estimated air Se exposure.

2017 - Trace element concentrations in breast milk [Abstract in Rivista]
Borella, Paola; Fantuzzi, Guglielmina; Righi, Elena; Marchesi, Isabella; Ferrari, Angela; Paduano, Stefania; Bargellini, Annalisa

Breast milk is the best source of nutrition for the newborn infant, and exclusive breast feeding is recommended by WHO up to 6 months of age. Human milk provides all the nutrients including essential trace elements, Conversely, human milk can also be a potential source of undesirable (toxic) elements which are dangerous for a baby, and their content reflects the level of environmental pollution and the mother’s diet. The aim of this study is to provide updated information on concentrations of a wide range of essential, non-essential and toxic elements in human milk collected from a significant group of healthy lactating women living in Modena, Italy, together with information on dietary habits. Samples were collected between day 30 and 40 after childbirth, and the trace element concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) after microwave digestion. Preliminary results show that concentrations in human milk of some essential trace elements like Fe, Zn, Cu, Se and Mn are in line with reference standard (WHO 1989). No detectable levels of Pb were found, whereas concentrations of Cd were detected in more than one third of mother’s milk samples, although none in amounts that could represent a health hazard.

2017 - Trace element concentrations in breast milk. Journal of Trace Elements in Medicine and Biology 41S (2017) 1–88. [Abstract in Rivista]
Borella, P; Fantuzzi, G; Righi, E; Marchesi, I; Ferrari, A; Paduano, S; Bargellini, A

2017 - [A pilot study on pain assessment among elderly with severe dementia<BR>in residential aged care facilities of Reggio Emilia district] [Articolo su rivista]
Bargellini, Annalisa; Mastrangelo, Stefano; Cervi, Monica; Bagnasco, Michele; Reghizzi, Jlenia; Coriani, Sandra

Introduction. Despite the availability of pain assessment tools and best practice recommendations for the assessment and management of pain in people with severe dementia, pain in residential aged care facilities is still undetected or misinterpreted. Objective. To assess pain prevalence and analgesic load medication in people with severe cognitive impairment admitted to residential aged care facilities of Reggio Emilia (Italy) province. Methods. A pilot cross-sectional study was conducted on 84 elderly patients affected by severe dementia and resident in aged care facilities. Pain was assessed with the PAINAD observational scale, both at rest and during routine procedures: positioning in bed, from bed to standing position, from bed to chair or during the medication of a pressure sore (under challenge). Results. 33.4% of patients had pain at rest, mainly mild, and 86.9 % under challenge. During routine interventions, in 64 patients (76.2%) pain increased compared to at rest condition (for 39, 2/3, moderate-severe); although 46 of them were prescribed as-required analgesic medication, none had received the drug. Also patients with analgesics on regular basis experienced more pain during routine procedures. Conclusions. Many patients experienced pain during routine procedures. The regular use of pain assessment tools and adequate training of all healthcare professionals are essential requirements for an effective pain control

Bargellini, Annalisa; Venturelli, Francesco; Casali, Maria Elisabetta; Ferrari, Angela; Reghizzi, J; Fagioli, F; Pedrazzi, Marcello; Borella, Paola

Human milk represents the most suitable pattern of nutrients to meet the physiological requirements of the young infant and exclusive breast feeding is recommended up to 6 months of age. When breast feeding is not possible, infant formulas are often used as substitutes for human milk, hence, an accurate knowledge of their composition, also in term of trace elements, is essential to understand if the nutrient requirements of the infant fed with formulas are adequate. Essential trace elements play a relevant role in growth and development. Although they are required only in small amounts, the intake may not always be adequate, and their amount in formula composition has received insufficient attention. Moreover, infant formula and human milk may hold toxic elements as a result of environment pollution or food processing. The main objective of this study is to compare the total concentrations of Fe, Zn, Cu, Mn, Se, Cr, Ni, Cd and Pb in a representative sample of infant starting (0-6 months) formulas consumed in Italy (n=35) with just as many breast milk samples of healthy lactating women from Modena (Italy) and collected on 30 day postpartum. The element concentrations were determined by ICP-MS after microwave digestion. The levels of essential elements in infant formulas were within min/max of recommended values established by the European directives. Concentrations of Pb and Cd were detected in some infant formulas, although none in amounts that could represent a health hazard for the consumer. As expected Cu, Fe, Zn and Mn are significantly higher in all investigated formulas compared to breast milk, due to fortification associated with their poor absorption from artificial products. Growing evidence of negative effects on cognitive development from excessive Mn intake suggests a reconsideration on the real need to fortify commercial human-milk substitutes to high concentrations, in order to ensure infant health

2016 - Control of Legionella contamination and risk of corrosion in hospital water networks following various disinfection procedures [Articolo su rivista]
Marchesi, Isabella; Ferranti, Greta; Mansi, Antonella; Marcelloni, Anna M; Proietto, Anna R; Saini, Navneet; Borella, Paola; Bargellini, Annalisa

Physical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study is to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and not culturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine and hydrogen peroxide. The temperature levels and the biocide concentrations that proved to obtain reliable results were analysed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for six months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide and hyperthermia. A different selection of Legionella spp was observed, as networks treated with chlorine-based disinfectants were mainly contaminated by L. pneumophila serogroup 1, hyperthermia was associated with the serogroups 2-14 and hydrogen peroxide mainly with non-pneumophila species. NC cells were only detected in heat-treated waters, also when the temperature was approximately 60°C. The corrosion rate of the coupons was within a satisfactory limit for water networks, but the morphology changed. We confirm that chemical disinfection controls Legionella colonization more effectively than hyperthermia. Monochloramine was the most effective treatment, while hydrogen peroxide could be a promising alternative to chlorine-based disinfectants due to its ability to select for other less virulent or non-pathogenic species.

2016 - Hospital-acquired Legionella infections: an update on the procedures for controlling environmental contamination [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Marchegiano, Patrizia; Vecchi, Elena; Marchesi, Isabella

The waterborne healthcare-associated infections are mainly sustained by Legionella and Pseudomonas spp. Various water factors and plumbing characteristics, and the interaction with other water microorganisms are considered to be predictive of Legionella contamination. It is therefore mandatory to organize plans of surveillance, prevention and control in order to avoid disease appearance in immunosuppressed patients, with higher risk of death. Guidelines for the prevention of Legionnaires' disease have been published, benefiting those who face this problem, but definitive standardized solutions do not exist yet. Here we describe fifteen years of activity, during which our study group gathered interesting data on the control of Legionella contamination. Water disinfection is not generally sufficient to control the risk of infection, but a complex water safety plan should be developed, including system maintenance, training of staff and implementation of a clinical surveillance system aimed at early detection of cases. Concerning the control measures, we evaluated the effectiveness of different treatments suggested to reduce Legionella spp contamination, comparing our results with the current literature data. The performance ranking was highest for the filter, followed by boilers at high temperature, monochloramine and, at a lower level, chlorine dioxide; the effectiveness of hyperchlorination was limited, and thermal shock was even more ineffective.

2016 - Legionella: la paura dell'acqua calda [Capitolo/Saggio]
Borella, Paola; Paduano, Stefania; Saini, Navneet; Bargellini, Annalisa; Marchesi, Isabella

Questo volume che vede la collaborazione di molti studiosi affronta da diversi punti di vista un tema che è sempre stato di grande interesse per l'igiene e la sanità pubblica. Parlare di acqua significa affrontare un tema multiforme con aspetti che non riguardano esclusivamente la sicurezza e la prevenzione delle malattie ma comprende anche aspetti di promozione della salute, di tutela dell'ambient, di gestione economica del ciclo idrico integrato. Nello specifico in questo capitolo viene affrontato il problema Legionella.

2016 - Livelli di piombo, cadmio e mercurio nel liquido cerebrospinale e rischio di sclerosi laterale amiotrofica: uno studio caso-controllo. [Abstract in Atti di Convegno]
Filippini, Tommaso; Violi, Federica; Mandrioli, Jessica; Bargellini, Annalisa; Weuve, J; Fini, N; Grill, P; Michalke, B; Vinceti, Marco


2016 - The epidemiology of selenium and human health. [Capitolo/Saggio]
Vinceti, M; Burlingame, B; Filippini, T; Naska, A; Bargellini, A; Borella, P.


2015 - Lifestyle and food habits changes after migration: a focus on immigrant women in Modena (Italy) [Articolo su rivista]
Casali, Maria Elisabetta; Borsari, Lucia; Marchesi, Isabella; Borella, Paola; Bargellini, Annalisa

Background: This study aimed to explore post-migration lifestyle and weight changes in a sample of migrant women recruited in Modena, Italy. Taking into account the importance of the perceived personal susceptibility in improving prevention and treatment seeking behaviors, we further investigated women’s self-recognition of overweight/obesity. We also examined the changes in self-perceived quality of life after the arrival in Modena. Methods: A cross-sectional study was conducted among 97 female migrants visiting a family counseling in Modena. Socio-demographic information, post-migration changes in lifestyle, dietary habits and selfperceived quality of life were obtained by administering an anonymous questionnaire, created ad hoc with expert consultation and previously tested in a pilot study. Thereafter blood pressure, height and weight were measured. Results: More than half of the sample met criteria for overweight/obesity and 58% reported a weight increase after the arrival in Italy. The increased risk of weight gain after migration was significantly associated with women age, lower education level, African ethnicity and post-migration increased consumption of cheese and snacks/sweets. After applying a conditional multiple logistic regression, ethnicity, age and increased post-migration cheese consumption remained the main predictors of weight gain. More than half of subjects with BMI ≥25 Kg/m2 were not aware of their own overweight or obesity. Such weight underestimation was more common in African migrants than in other ethnicities. Findings about the perceived quality of life showed an overall improved economic situation, although more than half of women revealed deterioration in their social relationships after migration. Conclusions: Our results are important to identify the gaps in the current migrant populations’ health promotion in Modena and suggest that strategies to support female migrants to reinforce good dietary patterns may be the key in preventing unhealthy weight gain. Indeed, understanding immigrant women’s culture, beliefs and traditions of their country of origin, as well as food acculturation, is essential to improve the efficiency of these interventions.

2015 - Pain assessment in elderly patients affected by severe dementia [Abstract in Rivista]
Monica, Cervi; Stefano, Mastrangelo; Sergio, Cecchella; Michele, Bagnasco; Marcello, Gangale; Francesca, Reggiani; Roberta, Boiardi; Bargellini, Annalisa

Introduction Although dementia and chronic pain are frequent in old age, there aren't sufficient data about the pain prevalence in elderly dementia patients. It appears that the percentage of dementia patients with at least one chronic complaint diminishes as the cognitive deficit increases. The cause of this clear underestimation comes from the impaired verbal expression of such patients, as "self-reporting" is the gold standard for pain assessment. This means that healthcare workers are responsible to identifying when a patient feels pain. Purpose/Methods An epidemiological cross sectional study among elderly patients affected by severe dementia (CDR 3-4-5) and resident in Reggio Emilia care homes, was conducted with the aim of: -assessing pain prevalence using the PAINAD observational scale, while the patients are at rest or carrying out potentially painful activities; -evaluating the percentage of patients on antalgic treatment during the assessment; -raising the awareness of doctors and nurses; -estimate the level of health workers' knowledge of pain management for elderly dementia patients. Results The results of this study showed a significant increase in the amount of pain felt by patients while performing potentially painful activities. Of the patients assessed, a considerable number were not on any antalgic treatment at the time of the assessment. More than 20% had received pain treatment with generic, non-pain specific indications, while performing the activities.

2015 - Selenium in humans: which is the safe range of intake? [Abstract in Atti di Convegno]
Vinceti, Marco; Filippini, Tommaso; Violi, Federica; Malavolti, Marcella; Malagoli, Carlotta; Bargellini, Annalisa; Borella, Paola

Selenium in humans: which is the safe range of intake?

2015 - TRACE ELEMENTS IN INFANT MILK [Abstract in Atti di Convegno]
Bargellini, Annalisa; Elisabetta, Casali; Ferrari, Angela; Venturelli, Francesco; Borella, Paola

Introduction: When breast feeding is not possible, infant formulas are often used as substitutes for human milk and play an indispensable role in infant nutrition. These substitutes are specially manufactured and fortified with micronutrients such as vitamin, trace and mineral elements, essential to satisfy the nutritional requirements of infant. Although trace elements play an important role in infants’ growth and development, their amount in formula composition has received very little attention, since recent research on such food has focused mainly on protein and energy content. We aimed to determine the levels of various essential (Fe, Zn, Cu, Mn, Se, Cr) and toxic (Cd, Pb) elements in a representative sample of infant starting (0-6 months) formulas consumed in Italy, in order to increase the knowledge on infant exposure to trace elements and to compare the results with standard recommended values. Formula milk concentrations of the investigated elements were also compared with those obtained in a sample of mother’s milk. Materials and methods: The mineral content of the commercially available milk-based infant formulas consumed in Italy together with 5 human milk samples were investigated. We included starting infant cow’s milk, powder and liquid formulas and we excluded products not officially on sale in Italy. Dry powder milk samples were reconstituted according to the manufacturer's instructions, using distilled water to avoid any external contamination. The levels of elements were determined by ICP-MS after microwave digestion. For the precision and accuracy of the method, a standard reference material (BCR 063R: whole milk powder) was analyzed. Results: The levels of essential elements were within min/max of recommended values established by European directives. Fe, Zn and Mn were significantly higher in all investigated formulas than in breast milk. Particularly, concentrations of Mn from formula varied from 15 up to 40 times the concentration of breast milk. Concentrations of Pb and Cd were detected in some infant formulas, although none in amounts that could represent a health hazard for the consumer, while they were not detected in human milk. Conclusion: The results of this study highlight two important aspects: the presence in infants formulas, although at low levels, of toxic elements such as lead and cadmium, which in our opinion should be absent in food products, and the excessive fortification of essential elements such as Fe, Zn, Mn in infant formulas in comparison to breast milk. Growing evidence of negative effects on cognitive development from excessive Fe and Mn intake suggests, in line with other researchers, a deep consideration on the real need to fortify commercial human-milk substitutes to such high concentrations, since infants are characterized by higher absorption and less effective excretion of dietary elements compared to adults

2014 - Etiology, source and prevention of waterborne healthcare-associated infections: a review. [Articolo su rivista]
Ferranti, Greta; Marchesi, Isabella; Favale, Marcella; Borella, Paola; Bargellini, Annalisa

The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAI) published from 1990 to 2012. The revision focuses on the aquatic bacteria and describes both outbreaks and single cases in relation to patients characteristics, settings, and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 of them describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot water distribution systems were the primary source of Legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. Intensive care unit was the most frequently involved setting but patient characteristics are the main risk factor, independently of the ward. As the microbes water contamination is difficult to be avoided and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients to avoid tap water exposure, also for their personal hygiene, and to regularly use sterile water for rinsing/cleaning devices

2014 - Hand Hygiene Knowledge, Hand Contamination and Practice of Italian Nursing and Medical Students [Articolo su rivista]
Bargellini, Annalisa; Ferranti, Greta; Santangelo, Maddalena; Venturelli, Francesco; Borella, Paola; Marchesi, Isabella

Background: Our objective was to measure hand bacterial contamination in a group of Italian nursing and medical students attending clinical wards for practical training, in order to verify the reliability of the information on hand hygiene (HH) adherence obtained by a self-reporting questionnaire. This questionnaire was administered with the aim of exploring the effectiveness of basic education. Methods: In this cross-sectional study, an anonymous questionnaire designed to investigate HH knowledge and practices was administered to a convenience sample of 100 nursing and 100 medical students. Data collected was combined with hand bacterial contamination measured both at the point of entry and exit from the ward. Results: HH practices and knowledge were significantly higher in nursing compared to medical students. The most effective procedure in reducing bacterial contamination was the alternate use of hand washing and hand rubbing compared to only one practice and the absence of hand hygiene (geom. mean: 180.3, 410.2 and 907.4 CFU/hand respectively, p<0.001). Hand contamination was significantly higher in students who declared to have hardly ever/never implemented HH teaching during clinical practice compared to those who stated to have done it frequently/always (geom. mean: 716 vs 277.1 CFU/hand, p<0.02). ConclusionS: Our investigation adds something new to the topic of HH that is the measure of bacterial hand contamination to verify the reliability of the information obtained by questionnaire. The findings, pointing out some critical aspects in HH teaching among healthcare students, highlight that solid knowledge results in correct behaviour, and consequently in a reduction of hand contamination.

2014 - I fattori comportamentali tra i lavoratori in Emilia-Romagna secondo la sorveglianza PASSI [Abstract in Atti di Convegno]
Venturelli, F; Carrozzi, G; Balestra, F; Sampaolo, L; Bolognesi, L; Bertozzi, N; Filippini, T; Ferrari, D; Bernardini, M; Giannini, A; Bargellini, A; Finarelli, C

INTRODUZIONE: In Italia, la promozione della salute sui luoghi di lavoro sta evolvendo, orientata dal D.lgs. 81/2008 e in linea con iniziative internazionali come il Workplace Health Promotion (WHP). Accanto a scuole e luoghi di cura, anche il posto di lavoro è ormai identificato come setting opportunistico per svolgere attività di prevenzione, non solo mirata a fattori di rischio occupazionali o alla cultura della sicurezza, ma anche come educazione a stili di vita salutari. L’obiettivo è descrivere i differenziali dei principali fattori di rischio comportamentali in relazione alla condizione lavorativa, alla mansione e al settore d’impiego per indirizzare la promozione della salute nei luoghi di lavoro. MATERIALI E METODI: Sono state analizzate 9977 interviste PASSI di persone di 18-69 anni, raccolte nel triennio 2010-12 in Emilia-Romagna, regione aderente al modulo opzionale sulla sicurezza sul lavoro. PASSI è una sorveglianza nazionale sui fattori comportamentali di salute realizzata mediante interviste telefoniche effettuate da operatori dei Dipartimenti di prevenzione delle ASL italiane. L’analisi mette in relazione alcuni comportamenti con le principali variabili socio-demografiche (classe d’età, sesso, livello d’istruzione, difficoltà economiche, cittadinanza) e quelle riguardanti mansione svolta e settore d’impiego. I fattori indagati sono: abitudine tabagica, consumo di alcol, indice di massa corporea e attività fisica svolta. RISULTATI: Il 29.3% degli intervistati ha dichiarato di essere fumatore. L’abitudine tabagica è maggiore negli uomini (32.9%), nella fascia d’età 18-34 anni (34.0%), nelle persone con bassa scolarità (32.9%) e con molte difficoltà economiche percepite (42.2%). Emergono differenze per condizione lavorativa: fuma il 31.3% (IC95% 30.1-32.5) di chi lavora in modo continuativo, il 37.2% (IC95% 32.7-42.0) di chi lavora in modo non continuativo e il 23.6% (IC95% 22.0-25.3) di chi non lavora. Il dato è disomogeneo anche per settori d’impiego, dal 18.5% del settore scolastico al 39.5% dell’industria del legno e della carta, e per mansione svolta, dal 14.6% nelle forze dell’ordine al 39.8% negli operai. Il fumo è più frequente tra chi svolge una mansione manuale (38.4% IC95% 36.2-40.7). Secondo i criteri PASSI, il 21.4% degli intervistati è definito consumatore di alcol a maggior rischio per la salute. Tale dato è maggiore negli uomini (27.9%), tra 18-34 anni (34.2%) e in persone con alto grado d’istruzione (23.1%). La prevalenza per condizione lavorativa è del 21,3% (IC95% 20.3-22.4) tra chi lavora in modo continuativo, 27.3% (IC95% 23.3-31.8) tra chi in modo discontinuo e del 20.7% (IC95% 19.1-22.3) in chi non lavora. Tra i lavoratori è più diffuso il consumo definito binge drinking (12.0% IC95% 11.2-12.8). I settori meno interessati sono la pubblica amministrazione e la sanità (14.8%), mentre nei trasporti si raggiunge il 28%. Il 42.9% degli intervistati risulta in eccesso ponderale: il 31.7% in sovrappeso e l’11.2% obeso. Gli uomini (53.1%), la fascia d’età 50-69 anni (58.1%), le persone a bassa scolarità (53.1%) e coloro che percepiscono difficoltà economiche (46.5%) sono le categorie più coinvolte. Tra chi lavora in modo continuativo la prevalenza è del 41.4% (IC95% 40.1-42.7), tra chi lavora saltuariamente è del 39.0% (IC95% 34.5-43.7) e 46.7% (IC95% 44.8-48.6) tra chi non lavora. Tra settori, l’eccesso ponderale è meno rappresentato in quello scolastico (30.2%) e molto diffuso nell’agricolo (55.1%). Tra le mansioni, è più frequente in chi lavora manualmente (47.4%) e le percentuali vanno dal 28.0% degli insegnanti al 55.9% delle forze dell’ordine. Secondo i criteri PASSI, il 21.5% degli intervistati è sedentario, il 41,7% parzialmente attivo e il 36,8% attivo. La sedentarietà è più diffusa tra le donne (22.4%), nella fascia d’età 50-69 anni (25.5%), in persone con basso livello d’istruzione (

2014 - Valutazione dei rischi di malattia da agenti biologici, fisici e chimici nell'era della globalizzazione: dati epidemiologici e strategie di prevenzione [Relazione in Atti di Convegno]
Borella, Paola; Ferranti, Greta; Aggazzotti, Gabriella; Marchesi, Isabella; Bargellini, Annalisa

In questa pubblicazione vengono riportati alcuni dei più attuali contaminanti chimico-fisici e infettivi che attraverso la catena alimentare possono rappresentare un rischio per la salute umana

2013 - A culture-proven case of community-acquired Legionella pneumonia apparently classified as nosocomial: diagnostic and public health implications [Articolo su rivista]
Bargellini, Annalisa; Marchesi, Isabella; P., Marchegiano; Richeldi, Luca; R., Cagarelli; Ferranti, Greta; Borella, Paola

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the Oncology ward were negative, notably the patient’s room and the oxygen bubbler, and the revision of the history-case induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires’ disease has major clinical, legal and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2-10 days incubation period

F., Baldoni; C., Gualanduzzi; A. C., Finarelli; Bargellini, Annalisa; Borella, Paola; R., Cagarelli; Santangelo, Maddalena

OBIETTIVI: La polmonite da Legionella spp è associata alla presenza di diversi fattori di rischio, in particolare malattie cronico degenerative, fumo di sigaretta, assunzione di alcool e droghe, e in generale con fenomeni di immunodepressione. I dati ufficiali delle notifiche riportano tuttavia una percentuale di circa il 50% di persone che ammalano in assenza di co-morbilità. Scopo dello studio è revisionare le schede di sorveglianza per la legionellosi per verificare se la mancata segnalazione di fattori di rischio sia un fenomeno reale o legato a carenze nella compilazione della scheda e/o a errata diagnosi. METO DI: Lo studio, condotto con metodologia casocontrollo, prevede di revisionare le schede di sorveglianza per la legionellosi pervenute alla Regione Emilia Romagna nel triennio 2009-2011. La prima fase riguarda una attenta rilettura delle schede per estrapolare quelle in cui non vengono segnalati fattori di rischio noti in grado di spiegare la malattia (“casi”). Successivamente ad ogni caso viene associato un paziente con polmonite da Legionella portatore di fattori di rischio noti estratto casualmente dall’intera lista (“controllo”). RISULTATI: Lo studio è in corso e si concluderà nel mese di settembre. Da una prima indagine è emerso che oltre il 20% delle schede raccolte negli anni presi in considerazione riguardano soggetti apparentemente privi di fattori associabili all’insorgenza della malattia. Il medico di famiglia ed i sanitari che hanno avuto in cura il paziente nel periodo della polmonite vengono contattati per completare la scheda. Particolare attenzione viene data alle indagini laboratoristiche svolte per stabilire l’origine della polmonite (antigene urinario, metodo colturale, sierologia ecc.) oltre all’indagine anamnestica successiva alla polmonite per comprendere se siano comparsi sintomi di malattie cronico-degenerative non riscontrabili al momento dell’evento. CONCLUSIONI: I risultati di questa indagine possono rivestire particolare interesse per la mancanza di informazioni scientifiche sulle caratteristiche dei soggetti malati di legionellosi, ma apparentemente privi di fattori di rischio associati ad infezioni da opportunisti. In particolare, lo studio intende distinguere se al momento dell’esordio non fossero presenti malattie immunodepressive comparse solo dopo l’evento oppure se sia opportuno consigliare maggiore attenzione nella compilazione delle schede e nella attribuzione al germe legionella della polmonite in relazione al tipo di indagine laboratoristica utilizzata.

2013 - Erratum: Protozoa and human macrophages infection by Legionella pneumophila environmental strains belonging to different serogroups (Archives of Microbiology DOI: 10.1007/s00203-012-0851-9) [Articolo su rivista]
Messi, P.; Bargellini, A.; Anacarso, I.; Marchesi, I.; Niederhausern, S. D.; Bondi, M.

A., Mansi; I., Amori; Marchesi, Isabella; A. M., Marcelloni; A. R., Proietto; Ferranti, Greta; Bargellini, Annalisa; V., Magini; F., Valeriani; Borella, Paola

Quantitative real-time-PCR (q-PCR) is largely used to evaluate different pathogens in both environmental and clinical samples, including Legionella spp Advantages on traditional culture include the high sensitivity, accuracy and rapid evaluation of germ contamination. The main disadvantage is that this method does not distinguish dead/viable cells, a relevant aspect in case of continuous disinfection like in swimming pools. This study presents a new quantitative PCR method using ethidium monoazide (EMA) to detect only viable cells. The comparison with conventional culture can further inform on culturable and VBNC (viable but not culturable) Legionella spp. To develop the new test, experiments have been conducted with L. pneumophila ATCC 33152. We compared EMA addition at different concentrations on both viable cells during exponential growth period and dead cells. After DNA extraction, q-PCR reaction was made using LightMix kit Legionella spp with amplification of the fragment 386 bp of 16S gene. Water samples from swimming pools and hot water distribution systems treated with both chlorine and other disinfection procedures have been collected for analysis by EMA-qPCR. All samples have been also analysed with conventional culture (ISO-11731) to isolate Legionella spp. EMA in the range 100-6 μM was able to completely inhibit DNA amplification in samples containing dead legionellae at concentration of 3x105 UFC/L. In contrast, EMA at concentrations of 6 μM did not reduce the q-PCR results on viable Legionella. However, higher EMA levels were associated with partial inhibition of DNA amplification on viable cells due to dye toxicity. The analyses on real water samples are still in course. Our results confirm that the Ema-qPCR can represent a new procedure able to distinguish dead and viable legionellae. We underline the need for a balance between EMA toxicity and efficacy, depending on Legionella spp concentration. The results of this method on water samples collected from both swimming pools and hot water distribution systems will be useful to compare EMA-qPCR and culture in evaluating differences in dead/viable/culturable germ cells according to various disinfection procedures.

2013 - Legionella e Pseudomonas spp, i maggiori determinanti di infezioni di origine idrica in ospedale: differenze nella contaminazione e nella risposta ai sistemi di disinfezione [Articolo su rivista]
Borella, Paola; Marchesi, Isabella; P., Marchegiano; Ferranti, Greta; Santangelo, Maddalena; A., Campagna; Bargellini, Annalisa

In this study, long-term surveillance of Legionella and Pseudomonas spp contamination in water systems of a big hospital and effi cacy of disinfection treatments are reported. In the period 2008-2011, 550 hot water samples from technical rooms and showers/taps of hospital wards were collected for Legionella and Pseudomonas spp isolation by cultural methods. In the hospital, several measures to control water contamination, including shock treatments and continuous systems (chlorine dioxide, monochloramine, boiler) have been employed. Legionella spp was detected in 38.9% of the samples, and the more effective methods in reducing contamination were in order boiler, monochloramine and chlorine dioxide. Pseudomonas spp was isolated in 25.4% of the samples, mainly at peripheral sites; the number of positive sites were reduced effi ciently by boiler, while the other methods did not signifi cantly modify the contamination. Different associations between the two studied bacteria and some water parameters, such as total bacterial count, pH and metals, were observed. Our study points out that Legionella and Pseudomonas spp differ for contamination mode and for response to disinfection systems. The prevalent contamination of pseudomonas at point-of-use suggests that, besides disinfection, the constant maintenance and replacement of faucets and showers is mandatory to control this germ.

2013 - Legionellosis risk in swimming pool and SPA [Abstract in Rivista]
Ferranti, Greta; Bargellini, Annalisa; Marchesi, Isabella; A., Mansi; Borella, Paola

Spas used for either therapeutic or recreational aims are considered at risk for legionellosis occurrence. Thermal water is normally used at temperature between 30 and 40°C, ideal for Legionella growth, with a potential risk for users. Inhalation of colonized aerosol has been associated with sporadic cases or clusters of both Legionnaires’ disease and Pontiac fever, particularly involving immune depressed subjects. Italian and European guidelines have been issued to prevent and control this risk. At the spring, thermal water can contain small concentrations of legionellae, but within the distribution lines the amplification of these bacteria is promoted by stagnancy and incrustation, a frequent phenomenon also associated with the high mineral content of these waters. In addition, the detachment of dead cells, body lotions/creams residuals and skin debris in swimming pools favorites the bacteria multiplication. The devices/treatments more involved in transmission risk are inhalation therapies, frequently utilized by persons with chronic disease, showers and whirlpools, largely used also in the wellness centers. We revised the studies on Legionella spp presence in hot springs and related structures. The majority of published reports documented the germ contamination both at the source and along the distribution lines up to the point of use with increasing concentrations. Particular water characteristics such as high levels of sulfur and/or carbonate seem to be unfavorable to legionellae colonization but further studies are needed to deep this aspect. Contamination risk is less relevant for swimming pools due to high chlorine content, unless an insufficient disinfection plan is applied. From eighty years, about 50 studies have been published documenting cases of Legionnaires’ disease associated with spas. The majority of them occurred in Japan, where also a large outbreak is described with more than 300 persons involved. In almost all cases, L. pneumophila was the responsible germ and during the environmental inquire Legionella spp was found in many points of the spas: in spring water, in the distribution system, in the tank, in devices for nasal irrigation and aerosol therapy as well as in the whirlpool bath and swimming pool. To study the infection risk, the antibodies against Legionella have been evaluated in workers and patients attending the spa; the antibodies presence was found in a decreasing proportion from therapists to administration personnel. In conclusion, we underline the need for an accurate surveillance and control of Legionella spp and other waterborne germs in spas and other structures where inhalation of aerosolized water is expected.

2013 - Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-products (DBPs) formation in hospital water networks. [Articolo su rivista]
Marchesi, Isabella; Ferranti, Greta; Bargellini, Annalisa; Marchegiano, Patrizia; Predieri, Guerrino; Stout, Je; Borella, Paola

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pretreatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l−1 and chlorine dioxide between 0.50 and 0.70 mg l−1 were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution systems

2013 - Protozoa and human macrophages infection by Legionella pneumophila environmental strains belonging to different serogroups [Articolo su rivista]
Messi, Patrizia; Bargellini, Annalisa; Anacarso, Immacolata; Marchesi, Isabella; De Niederhausern, Simona; Bondi, Moreno

Three Legionella pneumophila strains isolated from municipal hot tap water during a multicentric Italian survey and belonging to serogroups 1, 6, 9 and the reference strain Philadelphia-1 were studied to determine the intracellular replication capability and the cytopathogenicity in human monocyte cell line U937 and in an Acanthamoeba polyphaga strain. Our results show that both serogroups 1 and Philadelphia-1 were able to multiply into macrophages inducing cytopathogenicity, while serogroup 6 and ever more serogroup 9 were less efficient in leading to death of the infected macrophages. Both serogroups 1 and 6 displayed a quite good capability of intracellular replication in A. polyphaga, although serogroup 1 was less cytopathogenic than serogroup 6. Serogroup 9, like Philadelphia-1 strain, showed a reduced efficiency of infection and replication and a low cytopathogenicity towards the protozoan. Our study suggests that bacterial pathogenesis is linked to the difference in the virulence expression of L. pneumophila serogroups in both hosts, as demonstrated by the fact that only L. pneumophila serogroup 1 shows the contextual expression of the two virulence traits. Serogroup 6 proves to be a good candidate as pathogen since it shows a good capacity for intracellular replication in protozoan.

2013 - Rilevazione ed analisi delle modalità dell'emocoltura nel paziente pediatrico [Abstract in Rivista]
Rosalba, Cavaleri; Bargellini, Annalisa; Fabiola, Cerullo; Ferri, Paola

BACKGROUND L’emocoltura, rappresenta l’esame fondamentale per una diagnosi clinica tempestiva, di batteriemia permettendo l’identificazione dell’agente eziologico e l’instaurazione precoce di una efficace terapia antimicrobica. Il prelievo ematico per emocoltura viene prevalentemente eseguito dal personale infermieristico. È responsabilità di quest’ultimo professionista eseguire la tecnica del prelievo secondo standard evidence based, in quanto l’errata esecuzione può comportare emocolture false-positive. Pertanto durante la raccolta del campione è importante rispettare la procedura corretta per non contaminare la coltura e di conseguenza alterare l’esito dell’esame, determinando incertezze diagnostiche e aumenti della spesa sanitaria a causa di trattamenti inutili, esecuzione di costosi test di verifica e allungamento della durata della degenza del bambino. OBIETTIVO L’obiettivo principale dell’indagine è rilevare la modalità di esecuzione della tecnica dell’emocoltura in uso tra gli infermieri in diverse strutture ospedaliere dell’Emilia Romagna e identificare eventuali aree critiche. MATERIALI e METODI Studio trasversale multicentrico tramite indagine conoscitiva con l’utilizzo di un questionario di tipo strutturato costituito da 21 domande chiuse a risposta multipla, gentilmente concesso dagli autori di uno studio condotto sulla popolazione adulta ospedalizzata presso l’Azienda Ospedali Riuniti di Bergamo. Il questionario è stato integrato con domande di carattere generale per raccogliere alcune informazioni sia sul livello di esperienza soggettiva in ambito pediatrico che sulla prassi indagata e sulle caratteristiche anagrafiche e formative dei partecipanti allo studio. Campione: tutta la popolazione infermieristica in servizio c/o le aree pediatriche. Durata dello studio aprile/giugno 2011. RISULTATI Gli infermieri coinvolti sono stati 342, hanno risposto 71operatori (61,4%). Dalle risposte emerge che: differenti sono le fonti di conoscenza specifiche della procedura mentre è chiaro il concetto dell’importanza del lavaggio delle mani prima di procedere a tecniche invasive. Circa la metà degli operatori intervistati utilizza un corretto antisettico cutaneo prediligendo il povidone iodio al 10% (45,5%) rispetto alla clorexidina gluconato 0,5% in soluzione alcolica (10,6%). Solamente il 5.8% dichiara di aspettare l’asciugatura del disinfettante prima della venipuntura. Il 44.3 % dichiara di disinfettare il tappo in gomma prima di raccordare il flacone al vacutainer contro il 55.7%. La quantità di sangue raccolto nel flacone pediatrico risulta variabile: il 60.0% si attiene a quanto indicato dalla procedura aziendale e dalle indicazioni della ditta fornitrice. Una percentuale troppo alta degli operatori 51,4% dichiara di prelevare 1 solo set per paziente contrariamente alle indicazioni riportate in letteratura. Il 44.3% dichiara di utilizzare il set pediatrico e solo l’1,4% utilizza 2 set. Anche l'intervallo dichiarato tra un prelievo e l'altro è molto variabile il 57,1% afferma di non attendere tra un set e l’altro. Nel caso di una sospetta batteriemia a partenza da CVC, circa la metà del campione (il 46.2%) esegue l'emocoltura sia da CVC che da vena periferica contemporaneamente. Il 98,5% effettua l’emocoltura nel paziente in terapia con antibiotici 30 minuti prima della successiva somministrazione. CONCLUSIONI Dall’analisi dei dati si evince grande variabilità comportamentale nell’esecuzione della prassi dell’emocoltura. Emerge poca adesione alla letteratura di riferimento. Gli aspetti maggiormente critici sono legati a fattori tecnici quali la scelta del materiale, la modalità del prelievo e il volume di sangue e a fattori clinici quali il numero e la successione temporale dei prelievi. Tali aspetti influiscono sulla possibilità di interpretare correttamente il risultato dell’esame con conseguenti ricadute sia s

2013 - Selenium and human health: bridging together epidemiological and laboratory evidence. [Abstract in Atti di Convegno]
Vinceti, Marco; Bargellini, Annalisa; Malagoli, Carlotta; Borella, Paola


2012 - Conoscenze sulla tubercolosi e percezione del rischio tra i giovani universitari, Modena-2011 [Articolo su rivista]
Morandi, Matteo; Favale, Marcella; Borsari, Lucia; Carluccio, Eugenia; Bisaccia, Eufemia; Arcolin, Elisa; Baldoni, Filippo; Bargellini, Annalisa; Borella, Paola; Bergomi, Margherita; Aggazzotti, Gabriella

In November 2011, a cross-sectional study was carried out among 824 first-year university students from medical andnon-medical school sectors about knowledge on infection and tuberculosis characteristics, risk factors and prevention. Medicalsector students were founded with higher general knowledge level (OR 1.61, IC 95%: 1.43-1.79), but both groups showed littleknowledge of risk factors and low level of risk perception. Radio and television were indicated as main source of information.

2012 - Control of Legionella contamination in a hospital water distribution system by monochloramine [Articolo su rivista]
Marchesi, Isabella; S., Cencetti; P., Marchegiano; Frezza, Giuseppina; Borella, Paola; Bargellini, Annalisa

Background: We report the results of 1-year application of monochloramine to control Legionella pneumophila contamination in a hospital hot water distribution system. Methods: In the main building of the hospital, a device continuously distributing monochloramine was installed. Legionella pneumophila and Pseudomonas spp contamination was followed in comparison with 2 other water networks in the same building using chlorine dioxide. Results: Monochloramine significantly reduced the number of contaminated sites compared with baseline (from 97.0% to 13.3%, respectively), chlorine dioxide device I (from 100% to 56.7%, respectively), and device II (from 100% to 60.8%, respectively). No positive sample exceeded 104 colony-forming units/L versus 59.4% at baseline. Conclusion: Monochloramine could represent a good alternative to chlorine dioxide in controlling legionellae contamination in public and private buildings.

2012 - Hand hygiene in nursing and medical students during training: a study on knowledge, practices and impact on bacterial contamination. [Abstract in Rivista]
Bargellini, Annalisa; Marchesi, Isabella; Ferranti, Greta; Favale, Marcella; Borella, Paola

Aim. To collect information about knowledge, behavior and hand hygiene (HH) practices in Italian nursing and medical students combining data with hand bacterial contamination before and after a morning training. Methods. A questionnaire designed to investigate knowledge on HH and its practical realization was administered to a casual sample of 100 nursing and 100 medical students attending our University. Data collected were associated with hand contamination measured at the entrance and exit of the turn of training. Results. All nursing students performed HH during training and the frequency was significantly higher compared to medical students, 39% of which declared not to have done it. At the end of training, hand contamination were significantly reduced in both groups, but more pronounced in nursing students. Scores on the HH knowledge were significantly related to HH practices and self-reported HH compliance and were significantly higher for nursing students. Students were also asked to give their opinion on HH knowledge acquired during the course and a significant increase of adequacy as the medical students progressed through their course was found. Discussion. Since the first year of their course, nursing students receive adequate knowledge and consequently apply HH practices during training activities, data confirmed by total bacterial count. Medical students get HH knowledge later and less attention is devoted to these practices also in relation to the reduced occasions of patient contact during their training. This suggested us to anticipate the Hygiene and Public Health teaching before the start of the training activity.

2012 - Igiene delle mani in studenti di Infermieristica e Medicina durante i tirocini: studio pilota su conoscenze, comportamenti e impatto sulla contaminazione batterica [Articolo su rivista]
Bargellini, Annalisa; Borella, Paola; Ferri, Paola; Ferranti, Greta; Marchesi, Isabella

Introduction. Despite exhaustive guidelines on hand hygiene (HH), compliance in health care professionals is reported to be low. In order to improve adherence with HH, interventions on students’ education should be effective. Aim. To describe the knowledge, behavior and hand hygiene (HH) practices in nursing and medical students. The results of the pilot study are presented. Methods. A questionnaire designed to investigate knowledge on HH and its practical implementation was administered to a sample of 50 nursing and 50 medical students. Data collected were associated with hand contamination measured at the beginning and at the end of the training shift. Results. All nursing students performed HH with a significantly higher frequency compared to medical students. At the end of training, total bacterial counts were significantly reduced in both groups, but more in nursing students. Total bacterial count increased in absence of hygienic practices and the most effective procedure was the alternate use of conventional hand washing and alcohol-based hands rubs. The knowledge of both groups was adequate, although some differences were observed. Conclusions. At the beginning of their course, nursing students are educated to correct practices that implement during practical training. Medical students receive information on HH later in their education and pay less attention to these aspects, also due to the limited number of physical contacts with patients. Thus, the contents on HH should be anticipated before the start of the training activity.

2012 - Water contamination [Capitolo/Saggio]
Borella, Paola; Marchesi, Isabella; A., Mansi; Favale, Marcella; Bargellini, Annalisa

In this current book, the authors have called attention to the issue of hospital infection control. They focus on basic learning and clinical guidelines in the ongoing effort for optimal control. The information provided will be helpful in reducing the burden of health-care associated infections.

2011 - Comparison of procedures for controlling hot waterLegionella pneumophila contamination in health structuresP. Borella, I. Marchesi, P. Marchegiano, A. Bargellini, G. Ferranti,S. Cencetti [Abstract in Rivista]
Borella, Paola; Marchesi, Isabella; P., Marchegiano; Bargellini, Annalisa; G., Ferranti; S., Cencetti

In a big hospital of northern Italy colonized by L. pneumophila, the effectiveness of various procedures in controlling contamination and preventing case onset was evaluated. Application of superheating showed the lest capability in reducing Legionella and is not suitable for large buildings as flushing with water >60°C at each outlet cannot reliably be maintained. In emerging situations, shock hyperchlorination is preferable as a more effective germ reduction method although requires higher manpower and pipes corrosion cannot be excluded. Point-of-care filters achieve the goal of 100% negative samples, and are adopted where transplant, oncological and other high risk patients are hospitalized. Also electric boilers installed on cold water line in high risk patient rooms guarantee absence of contamination, provided that temperature is maintained above 58°C. Continuoustreatment with chlorine dioxide is highly efficient in reducing germ concentration, but does not eradicate Legionella from the system, and at least 0.3 ppm at outlets are requested for the goal of L. pneumophila concentration below 100 cfu/L. More satisfactoryresults were obtained by injecting monochloramine, as control of contamination was evident just within the first month of application. Monochloramine level associated with germ below the detection limit approximate 3 ppm, but 2 ppm were sufficient for reducing legionellae below 100 cfu/L. Application of different procedures according to patient risk appear to be the best strategy and no cases of nosocomial Legionnaires’ disease were detected in the hospital during the observation period.

2011 - Ecological behaviour of three serogroups of Legionella pneumophila within a model plumbing system [Articolo su rivista]
Messi, Patrizia; Anacarso, Immacolata; Bargellini, Annalisa; Bondi, Moreno; Marchesi, Isabella; DE NIEDERHAUSERN, Simona; Borella, Paola

Three Legionella pneumophila strains isolated from water samples and belonging to serogroups (sgs) 1, 6, and 9 were analysed for their capability to colonise an experimental model simulating a domestic hot water distribution system. Ecological factors that could influence the persistence of sgs as intracellular life within protozoan hosts and bacterial interference by the production of antagonistic compounds were also studied. L. pneumophila viable counts incremented both in the planktonic and in the sessile phases. Serogroup 6 had a marked prevalence during the whole experiment and exhibited the highest host infection efficiency. Serogroup 1 was significantly less represented, but showed the highest capability to reproduce inside the protozoan hosts. Serogroup 9 was poorly isolated and less adapted to the intracellular life. Among 14 bacteria continuously isolated in the system, five (35.7%) produced antagonistic substances against legionella, with differences according to the bacterial strain and L. pneumophila serogroups.

2011 - Effectiveness of different methods to control legionella in the water supply: ten-year experience in an Italian university hospital. [Articolo su rivista]
Marchesi, Isabella; Marchegiano, P; Bargellini, Annalisa; Cencetti, S; Frezza, Giuseppina; Miselli, M; Borella, Paola

We report our ten-year experience of hyperchlorination, thermal shock, chlorine dioxide, monochloramine, boilers and point-of-use filters for controlling legionella contamination in a hospital hot water distribution system. Shock disinfections were associated with a return to pre-treatment contamination levels within one or two months. We found that chlorine dioxide successfully maintained levels at <100cfu/L, whilst preliminary experiments gave satisfactory results with monochloramine. No contamination was observed applying point-of-use filters and electric boilers at temperatures of >58°C and no cases of nosocomial legionellosis were detected in the ten-year observation period. Our performance ranking in reducing legionella contamination was filter, boiler, chlorine dioxide, hyperchlorination and thermal shock. Chlorine dioxide was the least expensive procedure followed by thermal shock, hyperchlorination, boiler and filter. We suggest adopting chlorine dioxide and electric boilers in parallel.

2011 - Hand hygiene in students of medical school during training activities: knowledge, behaviour and prevalence of bacterial contamination. [Abstract in Rivista]
Borella, Paola; Marchesi, Isabella; Bargellini, Annalisa; Ferri, Paola; Aggazzotti, Gabriella; S., Cencetti

The aim of the study was to evaluate knowledge, attitude and on-field practices concerning hand hygiene of undergraduate students attending the university hospital of Modena. The prevalence of bacterial contamination of their hands at entry to ward and at exit was also evaluated. Swab samples were analysed for total bacteria count at 37°C, Staphylococcus aureus, Pseudomonas aeruginosa and enterococci. At the end of the morning activity, participant students filled a questionnaire on personal data, activities, opportunities, opinion and compliance of hand hygiene. Higher total counts were measured at entrance compared to exit in both medical and nursing students, but the last group exhibited a stronger reduction due to higher compliance with hand-hygiene practices. Alcohol gel was the preferred procedure, and showed also a higher efficacy in reducing hand contamination. Contacts with stethoscopes and case history were those associated with higher levels of total bacterial counts as no hand hygiene followed those activities. No pathogen was recovered with the exception of two samples colonised by Staphylococcus aureus. Knowledge on hand hygiene was in general good, but should be implemented for students becoming doctors.

2011 - L'infermiere della pediatria e l'errore terapeutico: studio multicentrico sul territorio modenese [Abstract in Rivista]
R., Cavaleri; Bargellini, Annalisa; Rovesti, Sergio; F., Cerullo; Ferri, Paola

Tra il 15 maggio e il 15 giugno 2010 abbiamo condotto uno studio trasversale sulla popolazione infermieristica che prestava servizio nei reparti di Pediatria della provincia modenese per stimare, sulla base del ricordo degli infermieri, l’esperienza di errore terapeutico durante l’intera carriera lavorativa in ambito pediatrico. Hanno risposto al questionario 85 infermieri su 104 totali pari al 81,7% con una età media di 38,9±7,7 anni (range, 24-62). Solo due appartenevano al genere maschile (2,3%). Il titolo di studio prevalente era il diploma regionale (60,0%), seguito dalla Laurea in Infermieristica (26,0%) e dal Diploma Universitario (7,0%). La media degli anni di servizio prestati in ambito pediatrico era di 13,1± 8,3 anni (range, 1-37).Una percentuale molto elevata di infermieri (90,6%) dichiara di aver assistito durante la propria carriera lavorativa ad errori di terapia. Nel processo di gestione del farmaco è nella fase di somministrazione che si verifica il maggior numero di errori, tra i quali spicca l’errato dosaggio. Il 33,3% degli eventi avversi descritti dettagliatamente dal campione riguardava un’errata dose e tra questi il 18,2% un “ten-fold error” (somministrazione di una dose dieci volte superiore). Il farmaco maggiormente coinvolto risulta l’insulina, dato sovrapponibile alla letteratura di riferimento. Gli orari più a rischio di errore risultavano essere quelli della somministrazione della terapia, che coincidevano anche con quelli dell’ingresso dei visitatori, della fine del turno infermieristico e della preparazione alla visita medica.I nostri dati possono fornire validi spunti per interventi correttivi e di prevenzione del rischio clinico in ambito pediatrico, in particolare, la progettazione di eventi formativi mirati, il miglioramento della precisione nelle prescrizioni farmacologiche e soprattutto la creazione di un contesto organizzativo e strutturale che consenta all’infermiere di operare in sicurezza.

2011 - Parameters predictive of Legionella contamination in hot water systems: association with trace elements and heterotrophic plate counts [Articolo su rivista]
Bargellini, Annalisa; Marchesi, Isabella; Righi, Elena; Ferrari, Angela; S., Cencetti; Borella, Paola; Rovesti, Sergio

The contamination of hot water samples with Legionella spp. was studied in relation to temperature, total hardness, trace element concentrations (iron, zinc, manganese, and copper) and heterotrophic plate counts (HPC) at both 22 and 37 °C. Factor analysis and receiver operating characteristic (ROC) curves were used to establish the cut-off of water parameters as predictors for Legionella contamination. Legionella spp. were isolated in 194 out of 408 samples (47.5%), with L. pneumophila being the most common (92.8%). After multiple logistic regression analysis, the risk for legionellae colonisation was positively associated with Mn levels >6 µg l-1, HPC at 22 °C >27 CFU l-1, and negatively with temperature >55 °C and Cu levels >50 µg l-1. Multiple regression analysis revealed that Legionella spp. counts were positively associated with Mn, HPC at 37 °C and Zn and negatively associated with temperature. Only 1 out of the 97 samples (1%) having a Mn concentration, an HPC at 22 °C and an HPC at 37 °C below the respective median values exhibited a Legionella spp. concentration exceeding 104 CFU l-1 vs. 41 out of the 89 samples (46.1%) with the three parameters above the medians. Our results show a qualitative and quantitative relationship between Legionella spp., the Mn concentration and heterotrophic plate counts in hot water samples from different buildings, suggesting that these parameters should be included in a water safety plan. The role of manganese in biofilm formation and its possible involvement in the mechanisms favouring Legionella survival and growth in water niches should be investigated further.

2011 - Pratiche di igiene delle mani in studenti di medicina e infermieristica: conoscenze, adesione ed impatto sulla contaminazione batterica [Abstract in Rivista]
Bargellini, Annalisa; Marchesi, Isabella; Favale, Marcella; G., Ferranti; Ferri, Paola; Borella, Paola

Scopo dello studio è quello di valutare conoscenze, atteggiamenti e pratica sul campo inerenti l’igiene delle mani fra gli studenti di medicina e gli allievi infermieri che svolgono attività di tirocinio presso l’ospedale universitario di Modena. I dati raccolti sono stati associati al livello di contaminazione batterica delle loro mani misurata all’entrata e all’uscita dal reparto. A tal scopo sono stati valutati: carica batterica totale a 37°C, Staphylococcus aureus, Pseudomonas aeruginosa ed enterobatteri. A fine attività, gli studenti coinvolti nello studio hanno compilato un questionario su dati personali, attività, opinioni e compliance al lavaggio delle mani. È stata rilevata una carica batterica totale più elevata all’ingresso rispetto all’uscita dal reparto, sia tra gli studenti di medicina che tra gli allievi infermieri, ma in quest’ultimo gruppo si è osservata una riduzione più rilevante associata ad una maggiore frequenza nella pratica del lavaggio delle mani comeconseguenza di più numerose opportunità. La modalità preferita era l’utilizzo dell’alcool gel messo a disposizione in tutto l’ospedale, e questa modalità si è dimostrata più efficace dell’acqua e sapone nel ridurre la contaminazione delle mani, anche se la più bassa carica batterica totale si registrava tra coloro che avevano utilizzato entrambi i metodi, eventualmente associati all’uso dei guanti. Alcune pratiche come il contatto con il fonendoscopio e le cartelle cliniche erano associate ad un incremento della contaminazione perché queste azioni non erano seguite dal lavaggio delle mani. Non sono stati rilevati batteri patogeni ad eccezione di due campioni colonizzati da Staphylococcus aureus. Le conoscenze sull’igiene delle mani e la corretta applicazione da parte dei tirocinanti può considerarsi buona anche se occorrerebbe una maggiore attenzione verso talepratica all’ingresso nel reparto.

2011 - Sorveglianza e monitoraggio delle cadute nei pazienti ricoverati: l’esperienza della Azienda USL di Reggio Emilia [Abstract in Rivista]
S., Mastrangelo; Bargellini, Annalisa; M. Cervi, M.

Secondo l’OMS “le cadute e i danni ad esse correlati sono una problematica prioritaria per i sistemi sanitari e sociali in Europa e nel mondo, soprattutto tenendo conto del rapido accrescersi dell’aspettativa di vita”. Un’indagine retrospettiva, relativa al 2003-2006 ha rilevato un’incidenza di cadute nei pazienti ricoverati nei 5 ospedali dell’Azienda USL di Reggio Emilia, pari allo 0,56-0,66% su tutti i ricoveri, evidenziando una probabile sottostima del fenomeno (Italia: 0,86-4%; dati internazionali: 2-17% in base a tipologia di struttura e tipo di paziente). OBIETTIVI: uno specifico progetto aziendale elaborato da un gruppo di lavoro multidisciplinare mirava a: migliorare la sorveglianza ed il monitoraggio delle cadute nei pazienti ricoverati nel setting ospedaliero dell’Azienda USL di Reggio Emilia; definire le dimensioni del fenomeno nel proprio contesto; fornire elementi conoscitivi agli operatori per attuare efficaci azioni di prevenzione.MATERIALI E METODI: a partire dall’anno 2007 il progetto ha previsto: numerosi corsi di formazione, rivolti a medici, infermieri e OSS, con l’obiettivo di sensibilizzare i professionisti al tema delle cadute, acquisire competenze in merito alla valutazione del rischio, alla raccolta dati e segnalazione dell’evento; -la realizzazione di una specifica scheda di segnalazione; -la creazione/implementazione di uno specifico database informatizzato, alimentato direttamente dalle unità operative ospedaliere;-la elaborazione di una specifica istruzione operativa per l’utilizzo deglistrumenti disponibili. RISULTATI: i dati relativi alle cadute avvenute nei 5 ospedali aziendali nel periodo 2007-2010, mostrano un notevole e costante incremento del fenomeno, da 128 eventi (2007) a 256 (2010) con tassi di caduta che passano dallo 0,73/1000 giornate di degenza (2007) al 1,53 (2010). Considerando che sostanzialmente non si sono rilevate differenze nelle caratteristiche demografiche e cliniche dei pazienti ospedalizzati, come emerge dall’analisi dei dati estrapolati dai DRG, così come nei trattamenti e nei servizi offerti dagli ospedali stessi, tale incremento sembrerebbe essere imputabile ad un reale miglioramento del sistema di segnalazionedel fenomeno. CONCLUSIONI: un approccio multifattoriale (formazione, sensibilizzazione, elaborazione di specifici strumenti) al tema critico delle cadute dei pazienti in ospedale, si è rilevato efficace ed in grado di contribuire ad ottenere una stima quantitativa del fenomeno caduta nel setting ospedaliero dell’Azienda USL di Reggio Emilia. L’utilizzo del database informatizzato attiverà poi un processo a sé stante finalizzatoall’analisi dei rischi e alla prevenzione delle cadute.

2010 - Elementi in traccia e carica batterica totale come parametri predittivi della contaminazione e crescita di Legionella spp. nell’acqua calda sanitaria. [Abstract in Rivista]
Bargellini, Annalisa; Marchesi, Isabella; Rovesti, Sergio; Frezza, Giuseppina; R., Masironi; Borella, Paola

Obiettivi. Stabilire la relazione tra parametri chimico-fisici e batteriologici dell’acqua e contaminazione da Legionella spp in campioni di acqua calda prelevati da abitazioni, alberghi e strutture sanitarie. Metodi. Fe, Mn, Cu, Zn, Mg and Ca sono stati analizzati in spettroscopia di assorbimento atomico in 408 campioni prelevati prima di ogni trattamento di disinfezione. Temperatura e durezza sono stati misurati con metodi standard. Per la determinazione di Legionella spp e cariche batteriche totali (CBT) a 37°C e 22°C sono stati utilizzati specifici metodi colturali. Risultati. Legionella è stata isolata da 194 campioni (47,5%) con una carica media di 4.500 ufc/l. I campioni di acqua positivi per Legionella spp mostravano livelli di Fe, Mn, Zn, CBT a 22°C e 37°C significativamente più elevati rispetto ai campioni negativi. La concentrazione di Legionella correlava positivamente con Mn, Fe, Zn e CBT, negativamente con temperatura e durezza dell’acqua. Applicando la regressione lineare multivariata, rimanevano come variabili predittive il Mn, la CBT a 37°C, lo Zn e la temperatura. Applicando invece la regressione logistica multipla, il Mn e la CBT a 22°C risultavano i principali parametri di rischio della presenza di Legionella spp, seguiti da temperatura e rame come fattori di protezione. Conclusioni. In questo studio abbiamo dimostrato che alcuni parametri chimico-fisici e batteriologici dell’acqua sono utili a predire la contaminazione da Legionella spp nell’acqua calda sanitaria. Particolare importanza riveste la misurazione dei livelli di Mn e le cariche batteriche totali, in grado di influire sia sul numero di campioni positivi che sulla concentrazione di legionelle, presumibilmente perché sono indicatori della crescita del biofilm. Si è inoltre confermato che la contaminazione da Legionella si riduce quando la temperatura dell’acqua supera i 55°C.

2010 - Errori di terapia: come gli infermieri della realtà pediatrica modenese percepiscono il problema [Abstract in Rivista]
R., Cavaleri; Bargellini, Annalisa; F., Cerullo; Ferri, Paola

Gli errori terapeutici rappresentano una delle principali cause di eventi avversi in ambito ospedaliero. Garantire la sicurezza dei pazienti è uno dei principali impegni della professione infermieristica e riveste un’assoluta priorità, in particolar modo quando i pazienti sono neonati o bambini. In Italia, il grado di consapevolezza ed interesse che gli infermieri hanno rispetto al tema degli errori in terapia, quali siano per loro i principali fattori di rischio e quali le strategie per prevenirli, sono poco conosciuti. Per tale motivo abbiamo voluto replicare uno studio condotto in alcune TIN della Toscana per indagare tale fenomeno nella realtà pediatrica ospedalizzata di un territorio dell’Emilia Romagna. E’ stato condotto uno studio trasversale sulla popolazione infermieristica di tutte le UO di Pediatria della provincia di Modena mediante la somministrazione di un questionario anonimo predisposto ad hoc e gentilmente concesso dal gruppo di ricerca dell’Ospedale Pediatrico Meyer di Firenze. Hanno risposto al questionario 85 infermieri (81,7%). Analogamente alla realtà toscana il concetto di rischio clinico evoca nel 48,9% la prevenzione degli errori ma per quasi un 18,7% ansia e paura di sbagliare. Più del 90% dei professionisti modenesi ritiene il problema degli errori in terapia rilevante o molto rilevante e come i colleghi toscani il 68,5% riporta di non aver fatto mai fatto almeno un’esperienza di audit. Il 90,6% afferma di aver assistito ad errori di terapia. La fase di somministrazione del farmaco risulta la più problematica (39,4%). Solo nel 4,9% dei casi l’evento è stato tenuto nascosto ai medici. I principali fattori di rischio individuati sono di tipo organizzativo (elevati carichi di lavoro, turni stressanti e scarso personale) ed umano (stanchezza, distrazione e stress). Le azioni preventive suggerite sono principalmente rivolte alla limitazione delle interruzioni e del disturbo durante la gestione della terapia, all’aumento del personale e ad una maggiore chiarezza nelle prescrizioni terapeutiche. I dati emersi, in gran parte sovrapponibili a quelli della realtà toscana, evidenziano la sensibilità degli infermieri rispetto alla problematica e la loro capacità di individuare i punti critici nella gestione della terapia fornendo al tempo stesso preziosi suggerimenti volti a limitarli. Tali considerazioni potranno costituire validi spunti per interventi correttivi e di prevenzione del rischio clinico in ambito pediatrico.

2010 - Influence of mineral content on Legionella and bacteria contamination in hot water distribution system [Abstract in Rivista]
Marchesi, Isabella; Bargellini, Annalisa; A., Mansi; Borella, Paola

Many minerals largely present in waters are involved in microbial growth, being essential like iron and zinc, or having toxic properties such as copper and manganese. Particular attention has been recently devoted to Legionella spp., an intracellular opportunistic pathogen ubiquitously present in the aquatic environment. L. pneumophila is responsible for severe pneumonia which occurs world-wide in susceptible persons inhaling aerosolised contaminated water. Interestingly, this bacterium is iron-dependent and requires iron superoxide dismutase for viability. In addition, recent studies documented a zinc-metalloprotease, the first identified type II effector necessary for optimal Legionella intracellular infection of amoebae. Copper interacts with hydroperoxide radicals and with the cell membranes, thus it is used as a biocide for controlling water microbial contamination. Lastly, manganese is regarded both as an essential and a toxic component of drinking water, but little is known on its role in bacteria surviving, including legionellae. The aim of this study was to establish the relationship between mineral content of a representative number of hot water samples and microbial contamination with specific reference to Legionella and Pseudomonas spp.

2010 - Inter-laboratory validation of a rapid assay for detection and quantification of Legionella spp. in water samples [Articolo su rivista]
Bargellini, Annalisa; Marchesi, Isabella; E., Leoni; A., Mansi; S., Cristino; A. M., Marcelloni; Borella, Paola

Aims: To compare the standard culture method with a new, rapid test (Scan-VIT-Legionella) using fluorescently labelled gene probes for the detection and enumeration of Legionella spp. The new technique was validated through experiments conducted on both artificially and naturally contaminated water and through an inter-laboratory comparison.Methods and Results: All samples were processed by the ScanVIT test according to the manufacturer’s instructions and by a culture method (ISO 11731). ScanVIT detected significantly more positive samples, although concentrations were similar and a strong positive correlation between the two methods was observed (r = 0,888, P &lt; 0,001). The new test was more accurate in identifying the co-presence of Legionella pneumophila and Leg. non-pneumophila. ScanVIT showed a slightly higher Legionella recovery from water samples artificially contaminated with Leg. pneumophila alone or together with Pseudomonas aeruginosa. Lastly, the inter-laboratory comparison revealed that the ScanVIT test exhibits a lower variability than the traditional culture test (mean coefficient of variation 8,7 vs 16,1%).Conclusions: The results confirmed that the ScanVIT largely overlaps the reference method and offers advantages in terms of sensitivity, quantitative reliability and reduced assay time.Significance and Impact of the Study: The proposed method may represent a useful validated alternative to traditional culture for the rapid detection and quantification of Legionella spp. in water.

2010 - Possible protective role of trace elements in human cancer: a review of recent epidemiological studies [Abstract in Rivista]
Borella, Paola; Bargellini, Annalisa; Marchesi, Isabella; R., Masironi

The interest in the role of trace elements in cancer is increasing, particularly for those with a possible protective action, such as selenium and zinc. Despite the vast amount of epidemiological studies already conducted, there is a need for further investigations to better understand what compounds, at what levels and with which mechanism trace elements are involved in the protection of a specific cancer or groups of cancer. From our studies, we observed that cancer type and patient characteristics can substantially affect plasma concentrations of trace element status. A better evaluation of the body burden of trace elements should include analysis of other indicators such as hair, cells or tissue specimens, which tends to reflect long-term exposure th these elements.

Messi, Patrizia; Anacarso, Immacolata; Bargellini, Annalisa; Marchesi, Isabella; Frezza, Giuseppina; Bondi, Moreno; Borella, Paola

Obiettivi specifici. Data la difficoltà di controllare la contaminazione da Legionella spp in sistemi idrici di grandi edifici, abbiamo ritenuto interessante valutare l’efficacia della monoclorammina, da tempo utilizzata negli USA per la disinfezione dell’acqua condottata, sulla persistenza del germe sia in forma planctonica che sessile in un impianto idrico ospedaliero contaminato da L. pneumophila.Materiali e metodi. Da marzo 2009 è stato installato un impianto a dosaggio controllato (4 mg/l) e continuo di monoclorammina sul sistema di distribuzione dell’acqua calda sanitaria di un edificio ospedaliero. A intervalli di tempo prestabiliti, sia prima che dopo l’installazione dell’impianto, sono stati effettuati prelievi di acqua e biofilm sui quali valutare la contaminazione da Legionella, la carica batterica totale e la presenza di amebe, utilizzando metodiche standardizzate.Risultati. I prelievi effettuati prima dell’utilizzo della monoclorammina hanno evidenziato una forte contaminazione dell’acqua (da 4,5 x 102 a 2,7 x 104 UFC/L secondo i punti di prelievo) con presenza di L. pneumophila sierogruppi 9, 6 e 1. Al termine della prima settimana di trattamento si è ottenuto un miglioramento solo parziale, con il 50% dei punti divenuti negativi; dopo un mese tutti i punti di prelievo, eccetto uno, si sono negativizzati e questo andamento si è confermato successivamente al terzo mese. Per quanto riguarda la carica batterica totale del biofilm, l’andamento è risultato analogo, con una diminuzione da 33.5 a 9,2 UFC/cm2 dopo un mese di trattamento; al termine del terzo mese i valori sono rimasti pressoché costanti (11,8 UFC/cm2). All’interno del biofilm, la concentrazione di legionelle è solo lievemente calata, passando da 4,2 x 102 prima del trattamento a 3,6 x 10 UFC/cm2 dopo tre mesi. La concentrazione di amebe nell’impianto idrico non ha subito variazioni, mantenendosi tra 1 e 10 cellule/ml in circolo e tra 10 e 100 cellule/ml nel biofilm, per tutta la durata della sperimentazione.Conclusioni. Il metodo proposto è risultato efficace nel mantenere sotto controllo la contaminazione da Legionella planctonica nel sistema. Pur essendo la monoclorammina attiva nel ridurre la carica microbica del biofilm, inclusa Legionella, la persistenza di amebe sia nel torrente idrico che nel biofilm sembra comunque favorire la sopravvivenza del patogeno anche in presenza del disinfettante. Sono in corso studi per comparare questo sistema di disinfezione con il biossido di cloro e stabilire se la monoclorammina è più efficace nel ridurre la formazione del biofilm e il rischio di corrosione delle tubature.

2009 - Effects of dietary micro-algae, other lipid sources, inorganic selenium and iodine on yolk n-3 fatty acid composition, selenium content and quality of eggs in laying hens. [Articolo su rivista]
L., Rizzi; D., Bochicchio; Bargellini, Annalisa; M., Simioli; P., Parazza

BACKGROUND: This aim of this study was to investigate the effects of supplementing laying hen diets with different n-3 fattyacid sources (linseed oil, fish oil and microalgae) on egg quality and fatty acid profile. The addition of inorganic selenium (Se)and iodine (I) and their effects on egg characteristics and Se concentrationwere also evaluated.RESULTS: A significantly lower egg weight was found in the control group and in groups fed a diet containing fish oil or a dietcontaining microalgae plus Se and I. Yolks from all supplemented diet groups exhibited a significant reduction in n-6 fattyacid content compared with the control group. The docosahexaenoic acid (DHA) content of yolks was higher (P < 0.01) in allsupplemented diet groups. Selenium supplementation increased the Se concentration (P < 0.001) in eggs.CONCLUSION: The results of this study provide evidence that an improvement in egg weight and in the DHA content ofyolks can be achieved by feeding hens a microalgae-rich diet, which avoids the unpleasant flavours associated with fish oilsupplementation. Dietary inorganic Se, especially in combination with I, can enhance the concentration of Se in eggs.

2009 - Extremely low frequency-magnetic fields (ELF-EMF) occupational exposure and natural killer activity in peripheral blood lymphocytes [Articolo su rivista]
Gobba, Fabriziomaria; Bargellini, Annalisa; M., Scaringi; Bravo, Giulia; Borella, Paola

Extremely Low Frequency-Magnetic Fields (ELF-MF) are possible carcinogens to humans and some data suggest that they can act as promoters or progressors. Since NK cells play a major role in the control of cancer development, an adverse effect on ELF-MF on NK function has been hypothesized. We examined NK activity in 52 workers exposed to different levels of ELF-MF in various activities. Individual exposure was monitored during 3 complete work-shifts using personal dosimeters. Environmental exposure was also monitored. ELF-MF levels in the workers were expressed as Time-Weighted Average (TWA) values. NK activity was measured in peripheral blood lymphocytes (PBL). In the whole group the median occupational TWA was 0.21 microT. According to the TWA levels, workers were classified as low exposed (26 subjects, TWA < or =0.2 microT) and higher exposed workers (26 subjects; TWA >0.2 microT). In higher exposed workers, we observed a trend to reduce NK activity compared to low exposed, but the difference was not significant. Then we selected a subgroup of highest exposed workers (12 subjects; TWA >1 microT); no difference was observed between low and highest exposed subjects in the main personal variables. Considering both E:T ratios from 12:1 to 50:1 and Lytic Units, a significant reduction in NK activity was observed in the highest exposed workers compared to the low exposed. Multivariate analysis showed a significant negative correlation between exposure and LU, while no correlation was evidenced with other personal characteristics. ELF-MF are considered possible carcinogens, and existing data suggest that they can act as promoters. Due to the role of NK activity in host defence against cancer, the results obtained in this study in workers exposed to ELF-MF levels exceeding 1 microT are in agreement with this hypothesis, and support the need for further investigation in this field.

2009 - Natural killer cell activity decreases in workers occupationally exposed to extremely low frequency magnetic fields exceeding 1 microT. [Articolo su rivista]
Gobba, Fabriziomaria; Bargellini, Annalisa; Bravo, Giulia; M., Scaringi; L., Cauteruccio; Borella, Paola

In a preliminary study a reduction in Natural Killer (NK) cell activity in peripheral blood lymphocytes (PBL) was observed in a group of workers exposed to levels of Extremely Low Frequency- Magnetic Fields (ELF-MF) exceeding 1 microT. This study was performed to confirm the results. In 121 workers engaged in various occupational activities, individual ELF-MF exposure was monitored for 2 work shifts. Exposure levels were calculated as Time-Weighted Average (TWA). Subjects were classified as Low exposure (TWA ≤ 0.2 μT) Medium exposure (TWA 0.21-0.99 microT), or Higher exposure (TWA > 1 μT). In higher exposure workers NK activity proved significantly reduced compared to low exposure,(p<0.01). In medium exposure a reduction was also observed, but the difference was not significant. Multivariate analysis also confirmed the relation between exposure and NK activity. It has been suggested that ELF might affect tumour progression by inducing changes in the immune system: due to the role played by NK activity in host defence against cancer, the interference with the NK cell activity observed in this study is in agreement with this hypothesis. Furthermore, an increased risk for some neurodegenerative disorders has been reported in some epidemiological studies in ELF-MF-exposed workers: changes in NK function were also described in these diseases. Our results, showing the effect on NK activity of exposure exceeding 1 microT, suggest a possible mechanism for ELF-MF effects. This could open new horizons regarding the adverse long-term effects of these fields.

2009 - Validazione di un metodo innovativo per la determinazione quali-quantitativa di Legionella spp. in campioni idrici [Abstract in Rivista]
Bargellini, Annalisa; Marchesi, Isabella; S., Cristino; A., Marcelloni; A., Chiominto; Frezza, Giuseppina; A., Mansi; E., Leoni; Borella, Paola

Obiettivi specifici. Validare un metodo innovativo basato sulla tecnologia di ibridazione in situ fluorescente per la determinazione quali-quantitativa di Legionella spp. in campioni idrici, attraverso uno studio multicentrico di confronto tra diversi laboratori.Materiali e metodi. Il metodo proposto (ScanVIT, Biocontrol Systems) è stato applicato su campioni di acqua prelevati in diverse strutture e campioni contaminati artificialmente con L. pneumophila in presenza/assenza di P. aeruginosa e confrontato con metodo colturale classico (ISO 11731:98). Lo ScanVIT prevede la concentrazione del campione mediante filtrazione su membrana che dopo decontaminazione viene seminata su terreno selettivo e dopo 72 h trattata con sonde geniche a DNA. Queste sonde sono marcate con fluorocromi e si legano specificamente alle sequenze bersaglio site sull’RNA 16S di Legionella, permettendo di identificare e contare le cellule vitali mediante un microscopio a fluorescenza; le microcolonie di Legionella spp. appaiono verdi e quelle di L. pneumophila rosse.Risultati. Il 63,7% dei campioni esaminati è risultato positivo con metodo ScanVIT rispetto al 56,6% con metodo colturale e in 7,9% dei positivi capace di rilevare la co-presenza di L. pneumophila e non pneumophila. Il metodo ScanVIT ha permesso inoltre di rilevare concentrazioni di legionella superiori con una differenza statisticamente significativa. L’analisi della regressione ha evidenziato l’esistenza di una forte correlazione positiva tra i due metodi (r=0,888, p<0,001). In campioni contaminati artificialmente si è confermata la maggior efficienza del metodo ScanVit sulla tecnica colturale sia in termini qualitativi (94,4% di positivi vs 83,3%) che quantitativi. Inoltre, in presenza di P. aeruginosa, la tecnica standard senza decontaminazione riduce al 50% l’isolamento di legionelle. Falsi negativi sono stati trovati alle basse concentrazioni: <60 CFU/L per ScanVIT e <600 CFU/L per tecnica standard.Conclusioni. Il test innovativo proposto offre vantaggi di tipo qualitativo e quantitativo rispetto alla tecnica tradizionale. È in grado di evidenziare un maggior numero di positività anche sui bassi livelli e in presenza di fattori interferenti come la co-colonizzazione con P. aeruginosa. Inoltre è capace di individuare più accuratamente la co-presenza di L. pneumophila e non pneumophila. Operativamente, si effettua con maggior rapidità e sicurezza per l’operatore, anche se sono emersi alcuni problemi di tipo tecnico facilmente risolti nei nostri laboratori. Il confronto tra laboratori dotati di elevata esperienza ha evidenziato una maggior sovrapposizione dei dati ottenuti con lo ScanVIT rispetto al metodo colturale.

2008 - Distribuzione e attività biologica del selenio in pazienti affette da tumore alla mammella [Abstract in Rivista]
Bargellini, Annalisa; Piccinini, Lino; Marchesi, Isabella; Cauteruccio, Laura; Frezza, Giuseppina; R., Masironi; Borella, Paola

L’obiettivo del presente studio è stato quello di indagare sul ruolo del selenio nella insorgenza/evoluzione della patologia tumorale. Nella maggior parte degli studi epidemiologici, l’associazione tra Se e tumori è stata indagata misurandone la concentrazione totale nel plasma/siero, mentre una miglior comprensione dell’attività del Se può derivare dallo studio della sua distribuzione nelle diverse selenoproteine funzionalmente attive e nella modalità di accumulo nei tessuti neoplastici.Nell’ambito di uno studio caso-controllo su pazienti affette da tumore mammario, è stato pertanto misurato nel siero il Se totale e quello legato alla glutatione-perossidasi (GSH-Px), alla selenoproteina-P e all’albumina. Si è proceduto a misurare il Se in un prelievo bioptico dalla mammella, includendo sia un campione di tessuto neoplastico che di tessuto sano. Le tre principali proteine sono state separate tramite cromatografia di affinità e le analisi del Se sono state effettuate con metodo fluorimetrico.Dai nostri risultati, la concentrazione di Se totale nel siero è risultato solo lievemente inferiore nei casi rispetto ai controlli, ma nelle pazienti si riduceva significativamente il Se legato all’albumina. In termini di distribuzione percentuale, è stato evidenziato nelle pazienti un significativo “shift” del Se dalla frazione albuminica, che svolge una probabile funzione di deposito, verso la selenoproteina-P, di cui è nota la funzione di trasporto, e in misura inferiore verso la GSH-Px. L’analisi dei campioni bioptici ha evidenziato un maggior accumulo di Se nel tessuto malato rispetto al sano. Pur essendo questi risultati preliminari, è possibile ipotizzare che in presenza di patologia tumorale l’attivazione funzionale del Se, elemento noto per la sua attività antiossidante, venga stimolata per contrastare la crescita delle cellule neoplastiche. Il calo del Se plasmatico, evidenziato in molti studi epidemiologici, potrebbe essere interpretato come una conseguenza del suo richiamo dal torrente circolatorio verso i tessuti tumorali.

2008 - Esposizione occupazionale a campi magnetici a frequenza estremamente bassa (ELF-MF) e attività natural killer in linfociti di sangue periferico [Relazione in Atti di Convegno]
Gobba, Fabriziomaria; Borella, Paola; Bargellini, Annalisa; M., Scaringi; Bravo, Giulia; Giacobazzi, Pierluigi

I campi magnetici a frequenza estremamente bassa (ELF-MF) costituiscono un rischio di grande interesse nell’ambito della Medicina del Lavoro data la loro presenza praticamente ubiquitaria e per la loro classificazione tra i possibili cancerogeni per l’uomo (Gruppo 2B, IARC). In particolare, gli ELF-MF non sembrano causare effetti genotossici diretti, ma alcuni dati suggeriscono una possibile azione sulla promozione e/o sulla progressione. In accordo con questa possibilità sarebbero i risultati di alcuni studi che hanno osservato effetti a carico del sistema immunitario in seguito ad esposizioni occupazionali croniche ELF-MF. In particolare è stato riportato un effetto avverso sull’attività citotossica dei linfociti Natural Killer (NK); i risultati sono, però, finora limitati e poco conclusivi. Su questa base ci siamo proposti di esaminare gli effetti della esposizione occupazionale a campo magnetico ELF a carico dell’attività citotossica delle cellule NK nei linfociti di sangue periferico.E’ stato studiato un campione di 109 lavoratori addetti a diverse mansioni in vari comparti lavorativi. L’esposizione personale a campi magnetici ELF è stata valutata mediante dosimetria personale protratta per due turni lavorativi completi. I valori sono stati espressi come Time-Weighted Average (TWA) calcolati come media delle misurazioni nel periodo campionato.L’attività citotossica delle cellule NK è stata valutata nei linfociti di sangue periferico con un metodo basato sulla lisi di cellule target (T), costituite da cellule eritroleucemiche (Erythroleukaemic cell line K562) a differenti concentrazioni di cellule NK attivate (Effector cells -E-), e viene espressa sia come % di lisi a differenti rapporti tra NK e cellule target (E:T ratio: 100:1, 50:1, 25:1, 12:1, 6:1) ,che come numero di Unità Litiche (UL) per 107 linfociti. L’esposizione personale mediana nell’intero gruppo è risultata pari a 0,17 µT con 5° e 95° percentile rispettivamente 0,03 e 2,85 µT.Il campione è stato suddiviso in tre sottogruppi di esposizione: bassa esposizione (56 lavoratori; TWA 0,2 µT), esposizione intermedia (30 lavoratori; 0,2 <TWA < 1 µT), esposizione più elevato (23 lavoratori; TWA 1 µT).Nessuna differenza significativa è stata osservata nei rispettivi gruppi per le variabili demografiche e personali di rilievo (sesso, età, BMI, attitudine al fumo).Tra il gruppo a bassa esposizione ed il gruppo ad esposizione intermedia (0,2 <TWA < 1 µT) è stata osservata una significativa riduzione del numero di U.L. (57,43 vs 40,55; p =0,02). Ponendo invece a confronto il gruppo di soggetti a bassa esposizione (≤ 0,2 µT) con quelli ad esposizione più elevata (> 1 µT), non solo la riduzione delle U.L. viene confermata, ma emerge anche una significativa riduzione degli E:T ratio per tutte la concentrazioni testate.Questi risultati sono in accordo con un nostro studio preliminare, e confermano una possibile interferenza di un’esposizione cronica a livelli di ELF-MF superiori a 1 µT sull’attività funzionale delle cellule NK. Sebbene non sia possibile trarre delle conclusioni in ambito clinico, i risultati di questa osservazione sono coerenti con l’ipotesi di un possibile ruolo degli ELF-MF sulla promozione e/o progressione, mediante un effetto avverso sulla difesa immunitaria.

2008 - Gestione e controllo del rischio legionella nelle strutture sanitarie [Abstract in Rivista]
Marchesi, Isabella; P., Marchegiano; Bargellini, Annalisa; Frezza, Giuseppina; Cauteruccio, Laura; Borella, Paola; D., Cavani; S., Cencetti

Il problema Legionella è particolarmente rilevante nelle strutture sanitarie per la frequente contaminazione degli impianti idrici e la presenza di pazienti ad elevato rischio di malattia, per cui le Direzioni Sanitarie devono attivare interventi mirati per prevenire la contaminazione, anche in assenza di casi. Accanto alle periodiche attività di manutenzione/pulizia degli impianti, le Linee Guida nazionali propongono diversi metodi di bonifica la cui efficacia nel medio e lungo periodo è tuttora da dimostrare. Su questa base, è stato condotto il nostro studio che mette a confronto i principali sistemi di disinfezione applicati nel corso di un decennio in un grande ospedale contaminato da Legionella. I trattamenti shock di iperclorazione e ipertermia, sia da soli che in combinazione, danno buoni risultati solo nel brevissimo periodo perché già dopo un mese si ha la ripresa della colonizzazione e dopo 6 mesi si raggiungono livelli simili o superiori a quelli iniziali. I trattamenti con biossido di cloro in continuo hanno portato in 6 mesi ad una progressiva riduzione della contaminazione senza giungere però alla completa eradicazione del germe, ed hanno evidenziato la necessità di un costante controllo del dosaggio del cloro per evitare ricolonizzazioni. Nelle stanze di degenza che ospitano pazienti più a rischio sono stati installati piccoli boiler a temperatura di oltre 55° C che garantiscono l’assenza di Legionella ai rubinetti e/o docce, con limitato impatto economico. Inoltre due palazzine costruite negli anni ‘90 sono tuttora esenti da contaminazione, molto presumibilmente per l’adozione di criteri costruttivi moderni e di elevata qualità. In conclusione, il nostro studio conferma la difficoltà ad eradicare Legionella dagli impianti idrici e sottolinea che diversi fattori quali tipo di pazienti, caratteristiche strutturali ed impiantistiche, oltre al tipo ed entità della contaminazione, devono essere attentamente valutati per decidere anche in termini costo-efficacia quale trattamento applicare.

2008 - La malattia dei legionari nei viaggiatori: epidemiologia, fattori di rischio e prevenzione [Abstract in Rivista]
Borella, Paola; A., Borrello; Torcasio, Francesca; Bargellini, Annalisa; Marchesi, Isabella; G., Bucherini; Cauteruccio, Laura; Frezza, Giuseppina; L., Salizzato

La capacità di Legionella spp di sopravvivere nell’ambiente idrico come parassita intracellulare di protozoi e di associarsi ai biofilm spiega la scarsa efficacia dei biocidi e le difficoltà ad eradicare il germe dagli edifici pubblici e privati. Per questo motivo, per l’attenzione al problema e per il miglioramento delle capacità diagnostiche, la Malattia dei Legionari aumenta di anno in anno sia in Italia che in Europa e circa il 20% dei casi sono associati ai viaggi. Italia, Spagna e Francia sono i paesi più frequentemente visitati dai casi che insorgono in turisti e viaggiatori. L’Italia è quindi un paese particolarmente a rischio e questo può derivare dalla elevata frequenza ed entità di contaminazione delle nostre strutture turistico-alberghiere. Dal 2003, a seguito di un cluster epidemico, è stato condotto uno studio in una area costiera caratterizzata da strutture a prevalente apertura stagionale per verificare i fattori di rischio che si associano alla persistenza della contaminazione da Legionella e alla comparsa di casi tra gli ospiti, nonostante l’applicazione delle Linee Guida. I principali fattori associati alla comparsa di casi negli alberghi sono risultati la presenza di L. pneumophila sierogruppo 1, la contaminazione a livelli >10.000 CFU/L, e la percentuale dei siti contaminati all’interno della struttura (>60%). E’ emerso inoltre che le attività di manutenzione, pulizia e disinfezione per essere efficaci devono essere attuate dopo una attenta analisi del rischio che tenga in considerazione tutti gli aspetti degli impianti, compresa la modalità distributiva dell’acqua fredda. In sostanza, per limitare la legionellosi nei viaggiatori, è importante che i Dipartimenti di Prevenzione svolgano un ruolo di informazione e supporto per i gestori delle strutture turistico-alberghiere, al fine di favorire la corretta applicazione di protocolli di prevenzione, adeguatamente selezionati anche in termini costo-efficacia in funzione delle caratteristiche delle singole strutture.

2008 - Prevalence of anti-legionella antibodies among Italian hospital workers [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Marchesi, Isabella; Rovesti, Sergio; G., Stancanelli; S., Scaltriti; M., Moro; M. T., Montagna; D., Tatò; C., Napoli; M., Triassi; S., Montegrosso; F., Pennino; C. M., Zotti; S., Ditommaso; M., Giacomuzzi

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P<0.001), whereas in Naples both groups exhibited high antibody frequency (48.8 vs 44.0%) and had a higher proportion of antibodies to legionella serogroups 1-6. Dental workers had a higher seroprevalence than office staff in Bari, but not in Turin, where daily disinfecting procedures had been adopted to avoid contamination of dental unit water. No association was found between the presence of antibodies and the presence of risk factors for legionellosis, nor with the occurrence of pneumonia and/or flu-like symptoms. In conclusion, the presence of legionella antibodies may be associated with occupational exposure in the hospital environment, but there was no evidence of any association with disease.

2008 - Selenium interactions with essential and toxic elements in egg yolk from commercial and fortified eggs [Articolo su rivista]
Bargellini, Annalisa; Marchesi, Isabella; L., Rizzi; Cauteruccio, Laura; R., Masironi; M., Simioli; Borella, Paola

The main objective of this work was to evaluate the interaction between selenium concentration in both commercial and Se-enriched eggs and other essential/toxic elements (Ca, Mg, Fe, Zn, Pb, and Cd), taking into account a possible synergic action of iodine. Commercial eggs were purchased from several sale points or directly from the producers (farmyard eggs). Fortified eggs were obtained by supplementing chickenfeed for 6 weeks with Se as sodium selenite (1.0 microg/g Se) or Se plus iodine (1.0 microg/g Se+3.7 microg/g I). Se in experimental egg yolks significantly increased over the basic value by 39% in the Se group and 61% in the Se+I group, suggesting that I addition may enhance Se absorption. Levels of Se in commercial yolks were identical in free-range, barn or battery eggs, but significantly lower in farmyard and higher in organic eggs where the Se content approximated that found in Se fortified eggs. A significant reduction in Cd was observed in Se+I treated yolks compared to both control and Se alone diet, thus suggesting a high sensitivity of Cd to the detoxifying effect of Se combined with I. Furthermore, Se+I supplementation was associated with a significant Zn reduction, a finding which needs clarification to avoid attempts to maximize one component affecting the levels of other essential elements.

2007 - Prevalenza di Malattia dei Legionari e studio caso-controllo sui fattori di rischio: risultati dello studio Multicentrico italiano [Abstract in Rivista]
Borella, Paola; E., Leoni; M. T., Montagna; V., Romano Spica; G., Stancanelli; M., Triassi; Marchesi, Isabella; Cauteruccio, Laura; Bargellini, Annalisa

Obiettivi. Gli scopi dello studio erano individuare le polmoniti da Legionella tra i pazienti ricoverati per stabilire la prevalenza di malattia su base nazionale e indagare sui fattori di rischio ambientali, personali e immunitari associati con la comparsa di malattia. Metodi. In sei grandi ospedali, è stata condotta per 4 anni una sorveglianza attiva per individuare i casi tra i pazienti con polmonite. Il protocollo prevedeva la sistematica raccolta delle urine per la ricerca dell’antigene di L. pneumophila, delle secrezioni respiratorie e del siero come test di conferma. Come controlli sono stati inclusi soggetti sani e pazienti affetti da altre forme di polmonite. Sono stati raccolti dati sulle caratteristiche personali e sono state effettuate analisi biochimico-cliniche e di alcuni parametri immunitari. Risultati. In totale. sono stati individuati 189 casi comunitari su 6032 polmoniti (3,2%), 174 erano comunitari e 15 nosocomiali. Dallo studio caso-controllo sono emersi alcuni fattori di rischio quali il titolo di studio, il fumo passivo ed attivo, il soggiorno fuori casa e, tra le malattie concomitanti, la presenza di tumori, HIV e diabete. La malattia dei legionari è accompagnata da una significativo calo degli eritrociti, oltre ad alterazioni nel colesterolo, GPT, ferro e rame. Tra i parametri immunitari era significativa la diminuzione dei linfociti, delle cellule helper ed NK, quest’ultima particolarmente evidente nei soggetti <50anni senza patologie concomitanti. Conclusioni. La prevalenza della malattia tra le polmoniti ricoverate riflette quanto riportato da altre indagini. Dallo studio caso-controllo sono stati confermati alcuni fattori di rischio noti, mentre altri che notoriamente accompagnano i processi flogistici suggeriscono che la malattia si manifesta con una maggiore gravità rispetto ad altre polmoniti. Infine il calo delle cellule NK sembra spiegare perché anche soggetti giovani apparentemente sani ma esposti al fumo contraggono la Malattia dei Legionari.

2007 - Risk factors for particulate and microbial contamination of air in operating theatres. [Articolo su rivista]
Scaltriti, Stefania; S., Cencetti; Rovesti, Sergio; Marchesi, Isabella; Bargellini, Annalisa; Borella, Paola

This study was designed to standardize dust collection in recently built operating theatres equipped with a continuous monitoring system. The objectives were to establish the relationship between microbiological and dust contamination, and then to compare those parameters with the main indicators of surgical activity in order to better define risk factors affecting air quality. The air quality during 23 surgical operations was studied in three conventionally ventilated operating theatres. Microbiological air counts were taken using both passive and active sampling methods. Air dust particles, > or =0.5 and > or =5 microm in size, were measured using a light-scattering particle analyser. The overall dust load was mainly (98%) composed of fine particulate matter, most probably due to its longer suspension time before settlement. These particles positively correlated with operation length, but not with surgical technique, suggesting that fine particles may be a good tracer of operation complexity. In contrast, the surgical technique was the main predictor for the concentration of particles > or =5 microm, with a higher risk from general conventional surgery compared with scope surgery. The frequency of door-opening, taken as an index of staff and visitor movement, was the main negative predictor of over-threshold values of both fine and larger dust particles but, conversely, was a positive predictor of raised bacterial counts.

Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; Rivasi, Marianna; Guerrieri, Elisa; Messi, Patrizia; Borella, Paola

Obiettivo. Scopo dello studio era di verificare la capacità di sopravvivenza e crescita, in forma libera e nel biofilm, di ceppi di Legionella pneumophila appartenenti a diversi sierogruppi (sgs) in un sistema sperimentale che simula un impianto distribuzione di acqua calda.Materiali e metodi. Il modello da noi allestito è paragonabile a quello di un condominio di medie dimensioni, dove l’acqua a 40°C circola mediante una pompa. Dopo la stabilizzazione del sistema, sono stati inoculati 107 ufc/L ciascuno dei sgs 1, 6 e 9. I prelievi dell’acqua e del biofilm formato su un tubo posto all’interno della vasca sono stati effettuati settimanalmente per 3 mesi.Risultati. Dopo una settimana dall’inoculo, si è osservata una netta prevalenza del sg 6, pari al 70% sugli altri due ceppi. Tale trend si è confermato nel tempo e dopo sette settimane il sg 6 rappresentava il 93% degli isolati, contro un 7% del sg 1 e un valore prossimo allo 0% per il sg 9. Successivamente, l’andamento si è modificato, con un progressivo aumento del sg 1 che a 90 giorni rappresentava il 47% degli isolati contro il 41% del sg 6 e il 12% del sg 9. Andamenti del tutto analoghi sono stati osservati anche nei campioni di biofilm.Conclusioni. I risultati confermano che a parità di inoculo, ceppi appartenenti a diversi sierogruppi della specie L. pneumophila si diversificano sia nella formazione del biofilm che nella esistenza in forma planktonica. Tra i ceppi saggiati, l’adattabilità maggiore era del sg 6, seguita dai sgs 1 e 9. Va inoltre osservato che la percentuale del sg 1 (dal 7% al 47% delle legionelle isolate) sembra rispecchiare quella ritrovata in condizioni reali, sia nelle abitazioni che negli alberghi, a conferma della validità del nostro modello sperimentale per indagare sui meccanismi di crescita ambientale di Legionella spp.

Bargellini, Annalisa; Cauteruccio, Laura; Marchesi, Isabella; Borella, Paola

Obiettivo. Comprendere i meccanismi di virulenza di Legionella pneumophila nei confronti dell’ospite attraverso lo studio delle interazioni tra Legionella e macrofagi umani.Materiali e metodi. Per lo studio sono stati testati ceppi di Legionella pneumophila appartenenti al sierogruppo 1, ceppo altamente virulento responsabile di un caso clinico, e ai sierogruppi 6 e 9, confrontati con il ceppo di riferimento Philadelphia 1 (ATCC 33152) e saggiati su cellule macrofagiche umane in linea continua (U937). Sono state studiate l’attività citotossica, misurata come sopravvivenza fino a 72 ore dei macrofagi dopo contatto con Legionella a diverse concentrazioni (MOI); l’attività citopatogena, valutata come vitalità macrofagica dopo l’esposizione a Legionella per 2 ore; la crescita/sopravvivenza di Legionella nelle cellule ospiti e infine la produzione di citochine.Risultati. Nei tests di citotossicità la sopravvivenza dei macrofagi si modificava solo dopo 48 ore e alla MOI 1:1 dopo 72 ore il sierogruppo 1 si associava ad una significativa minore sopravvivenza delle U937 (35% vs 65%-76% degli altri sierogruppi) (p<0.05). Un comportamento analogo si è evidenziato per l’attività citopatogena alla MOI 10:1. I dati di crescita intramacrofagica suggerivano una maggior capacità del sierogruppo 1 ad entrare nel macrofago: dopo 2 ore le legionelle erano da 2 a 4 volte più concentrate rispetto agli altri ceppi. Il sierogruppo 9 invece manifestava una crescita più elevata solo dopo 48 ore.Discussione. I dati preliminari dello studio sembrano confermare che ceppi appartenenti a diversi sierogruppi di Legionella pneumophila possono avere caratteristiche di virulenza differenti, in grado di spiegare una diversa capacità di dare malattia. In particolare, il sierogruppo 1 manifestava una più rapida crescita intracellulare e una maggiore attività citotossica e citopatogena. Il sierogruppo 9 invece, più raramente coinvolto nella comparsa di malattia, pur crescendo attivamente nelle cellule macrofagiche, non era in grado di causarne la distruzione.

2007 - Sorveglianza clinica attiva per la ricerca di polmoniti da Legionella. Risultati e considerazioni per le strutture sanitarie. [Articolo su rivista]
Marchesi, Isabella; Bargellini, Annalisa; S., Cencetti; P., Marchegiano; Cauteruccio, Laura; Casolari, Chiara; Borella, Paola

In an university hospital of about 900 beds, a clinical surveillance was activated to detect cases of Legionnaires' disease in patients affected by community and/or nosocomial-acquired pneumonia. In the hospital Legionella spp was detected in the hot water distribution system and various disinfecting and control procedures were adopted to reduce contamination. Contemporary, the clinical surveillance began with the systematic detection of Legionella urinary antigen among recovered pneumonia, seroconversion as confirmation test and the collection of respiratory secretions or other biological materials to isolate the microorganism in patients positive to the urinary antigen. From September 2003 to May 2005, 486 pneumonia were followed, 98 of which considered of nosocomial origin. In total, 15 cases of community-acquired Legionnaires' disease were detected by the urinary test, whereas no cases of nosocomial origin were found. The characteristics of the detected cases are described in comparison with the other pneumonia and the surveillance cost was evaluated. The systematic clinical surveillance for Legionella infections is feasible with limit costs, allows to detect community-acquired cases otherwise unknown and to ascertain the absence/presence of nosocomial-acquired pneumonia, irrespective of the environment contamination.

Bargellini, Annalisa; Scaringi, Meri; Bravo, Giulia; Cauteruccio, Laura; Marchesi, Isabella; Gobba, Fabriziomaria

I campi magnetici a frequenza estremamente bassa (ELF) costituiscono un rischio ambientale di grande attualità ed interesse nell’ambito della Sanità Pubblica, data la loro presenza praticamente ubiquitaria negli ambienti di vita e di lavoro. Studi in vitro e sperimentali suggeriscono che gli ELF possano causare effetti avversi sulla funzione immune, ma i dati sono contraddittori. In uno studio pilota condotto su lavoratori professionalmente esposti a vari livelli di ELF, abbiamo evidenziato una possibile interferenza dell’esposizione a tali campi sull’attività funzionale delle cellule natural killer (NK). Scopo di questo lavoro è di approfondire questo aspetto, allargando lo studio ad un gruppo numericamente più consistente (circa 100) di lavoratori addetti a varie mansioni in diversi comparti lavorativi (aziende di servizi, metalmeccanico, ceramico, tessile ed alimentare). Mediante l’utilizzo di dosimetri personali, in ogni soggetto è stata misurata per due turni lavorativi successivi l’esposizione ad ELF, espressa in microTesla (T) e calcolata come media ponderata nel tempo (Time Weighted Average –TWA-). In base ai risultati il campione è stato suddiviso in tre gruppi di esposizione: bassa, intermedia, elevata. Da un campione di sangue periferico sono stati separati i linfociti per la misura dell’attività citolitica delle cellule NK tramite metodo non radioattivo (Borella et al, JIM 1995). L’indagine è tuttora in corso, ma la elaborazione dei dati di un primo gruppo di soggetti è indicativa di una riduzione dell’attività NK nei lavoratori ad esposizione più elevata rispetto al gruppo meno esposto. Questo risultato è in accordo con i dati preliminari e l’interferenza sulla funzionalità delle cellule NK suggerisce che gli ELF possano svolgere un ruolo di co-promozione nello sviluppo di tumori, tramite una riduzione delle difese immunitarie.

2006 - L'epidemiologia della Legionellosi [Relazione in Atti di Convegno]
Borella, Paola; Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; Rovesti, Sergio; Aggazzotti, Gabriella

La legionellosi è considerata una malattia emergente perchè è in forte aumento sia in Italia che nel resto dell' Europa. Le ragioni sono molteplici: maggiore attenzione alla diagnosi da parte dei medici, anche grazie ai nuovi test rapidi che permettono di identificare il caso precocemente, moltiplicazione delle occasioni espositive per intensificazione dei viaggi, tendenza a centralizzare la gestione e produzione di acqua potabile, utilizzo di tecnologie che producono aereosolizzazione dell'acqua. Inoltre, aumentano le persone a rischio di ammalare perchè portatori di fattori predisponenti il passaggio da infezione a malattia. Attualmente si segnalano in Italia circa 600 casi l'anno, un numero certamente sottostimato rispetto al reale perchè una sorveglianza attiva da noi condotta in pochi ospedali ha permesso di identificare 34 casi in soli 6 mesi e di stabilire che legionella è responsabile di circa il 4% delle polmoniti ricoverate.

Borella, Paola; A. M., Borrello; G., Bucherini; Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; L., Salizzato

ObiettiviIl problema della legionellosi nei viaggiatori è di particolare interesse per la presenza di numerose strutture turistiche contaminate da Legionella. L’Italia risulta essere il secondo paese europeo per numero di casi nei viaggiatori, con una inevitabile ricaduta negativa sul turismo, tanto che nel 2005 sono state emanate dall’ISS linee guida intese a favorire l’adozione di sistemi di prevenzione da parte dei gestori di strutture turistico-recettive e termali. L’indagine qui riportata si riferisce alla comparsa di numerosi casi nella riviera romagnola ed ai successivi interventi mirati a contenere il fenomeno. Materiali e metodi. Nell’estate del 2003, sono pervenute al Dipartimento di Sanità Pubblica 10 notifiche di Malattia dei Legionari in persone che avevano soggiornato in alberghi della zona. Il Dipartimento ha immediatamente attuato un sistema di sorveglianza sulle strutture interessate, verificando la contaminazione del sistema idrico e l’adozione di opportune misure di bonifica ambientale. Al fine di prevenire la ricomparsa di casi, sono state attuati incontri di informazione/formazione con i gestori ed è stata resa obbligatoria, tramite ordinanza del Sindaco, la istituzione del registro della manutenzione idro-potabile per tutte le strutture alberghiere. Negli anni successivi è stato attuato un monitoraggio per verificare, a campione e sulle strutture interessate dai casi, se gli alberghi avevano adottato i protocolli di manutenzione e se risultavano ancora contaminati da Legionella. Risultati. Si è assistito nel tempo ad una progressivo adeguamento degli alberghi alle misure di prevenzione, con una radicale riduzione del numero di casi ed un progressivo aumento di strutture esenti da contaminazione.Discussione. Il nostro studio documenta che le misure per il controllo della legionellosi sono efficaci soprattutto se accompagnate da una attenta sorveglianza da parte degli igienisti del territorio, il cui ruolo nella informazione, gestione e controllo del rischio appare indispensabile sia nel momento della comparsa di casi che nel lungo periodo.

Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; Borella, Paola

Nell’ambito dello studio multicentrico sulle legionellosi in Italia, è stata avviata una ricerca sui meccanismi di interazione tra Legionella pneumophila ed ospite, al fine di individuare quali caratteristiche del germe consentono di indurre o meno l’infezione e la progressione verso la malattia.I dati epidemiologici raccolti in cinque anni di attività suggeriscono la netta prevalenza del sierogruppo 1 come agente responsabile dei casi, nonostante che questo rappresenti una minoranza degli isolati ambientali, mentre altri sierogruppi, più frequenti nell’ambiente, raramente si associano alla malattia. La nostra ipotesi di lavoro è che all’interno della specie pneumophila i diversi sierogruppi possano avere caratteristiche di virulenza diverse, tali da spiegare la differenza nella capacità di dare infezione/malattia.Nella fase iniziale del nostro studio vengono utilizzati modelli sperimentali di crescita/sopravvivenza di Legionella in macrofagi umani in linea continua per verificar la capacità citotossica del germe e l’interferenza con l’immunocompetenza del macrofago. L’aspetto innovativo della nostra ricerca riguarda il confronto tra ceppi di L. pneumophila a diversa virulenza e differente distribuzione clinico/ambientale.I risultati preliminari dei test di citotossicità condotti con legionelle e macrofagi in rapporto pari a 10:1 per un periodo di incubazione di 24 ore dimostrano che L. pneumophila sierogruppo 1 è in grado di uccidere una percentuale di macrofagi significativamente più elevata di altri sierogruppi di provenienza ambientale.Sono tuttora in corso gli esperimenti per valutare eventuali differenze nella replicazione intramacrofagica di diversi ceppi L. pneumophila assumendo come ceppo di riferimento L. pneumophila Philadelphia 1.

2006 - La valutazione di un questionario sull’esposizione personale a fattori ambientali: sottoprodotti della disinfezione nelle acque potabili ed effetti sulla salute. [Articolo su rivista]
Righi, Elena; Fantuzzi, Guglielmina; Bargellini, Annalisa; L., Casolari; Aggazzotti, Gabriella

Epidemiological studies to evaluate the association between environmental exposure to risk factors and negative health effects often use population level aggregated data to measure exposure, but do not consider personal characteristics that may affect the degree of exposure at the individual level. The aim of this study was to evaluate the validity and reproducibility of a questionnaire specifically designed to measure individual oral, inhalation and transdermal exposure to disinfection byproducts in drinking water. Reproducibility of the questionnaire was evaluated by administering the questionnaire twice, in different time periods, to the same subjects. On the other hand, validity was tested by comparing responses to the questions with information contained in diaries filled out by the subjects daily over a period of one week (gold standard). Questionnaire reproducibilty and validity were both found to be very good, as shown by high Spearman's correlaton coefficients, Intraclass correlation coefficients (ICC), kappa concordance coefficient, sensibility and specificity. The use of a questionnaire such as the one evaluated in this study may be a valuable aid when conducting epidemiological studies to assess individual environmental exposure to risk factors found in drinking water and to explain the effect of such factors on human health.

2006 - Prevalence of Legionnaires’ disease and Investigation on Risk Factors: Results on an Italian Multicentric Study. [Relazione in Atti di Convegno]
Borella, Paola; S., Boccia; E., Leoni; F., Zanetti; Marchesi, Isabella; Bargellini, Annalisa; M. T., Montagna; D., Tato'; S., Montegrosso; F., Pennino; V., ROMANO SPICA; G., Stancanelli; Scaltriti, Stefania

We here present the preliminary results of a large multicentric study carried out in Italy to detect Legionnairs' disease among patients with pneumonia. The general objective was to better evaluate the prevalence of disease within various Italian regions in order to confirm the existing data on the disease frequency and to eventually verify differences related to the disease.

2006 - Relationship between trace elements and cardiovascular disease [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Rovesti, Sergio; Marchesi, Isabella; Vivoli, Gianfranco; R., Masironi

Some trace elements have been studied for their alleged protective effects on cardivascular function (Cr, Mn, Se, Zn and Cu), others instead for their possible negative effects (Al, As, Cd, Fe, Hg, Pb and Cu- the latter being considered both protective and harmful). The results of recent epidemiological studies highlight the role of the most controversial elements: Fe, Se, Cr, Cd, Pb, Zn and Cu on cardiovascular disease (CVD).

2006 - Rischio infettivo associato all'acqua potabile. Parte I: Analisi del problema [Articolo su rivista]
Marchesi, Isabella; Bargellini, Annalisa; Guerrieri, Elisa; Cauteruccio, Laura; Aggazzotti, Gabriella; Borella, Paola

Negli ultimi anni il riscontro di un aumento del numero di epidemie correlate all'utilizzo dell'acqua potabile ha portato a una maggiore attenzione alle problematiche connesse alla presenza di microrganismi patogeni nelle risorse idriche. Tra gli agenti batterici responsabili vi è anche Legionella.

2006 - Rischio infettivo associato all'acqua potabile. Parte II: il problema legionellosi. [Articolo su rivista]
Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; P., Marchegiano; Borella, Paola

La diffusa presenza di Legionella nelle strutture pubbliche e private italiane e il rischio di malattia connesso è un problema emergente nell'ambito della Sanità Pubblica che richiede una speciale attenzione, anche perchè è possibile prevenirlo, ma solo attraverso la stretta collaborazione tra le diverse figure professionali coinvolte

2006 - Studio multicentrico italiano sulla Legionellosi. Contaminazione ambientale da Legionella spp in strutture pubbliche e private [Relazione in Atti di Convegno]
Borella, Paola; E., Leoni; M. T., Montagna; V., Romano Spica; G., Stancanelli; M., Triassi; Marchesi, Isabella; Bargellini, Annalisa; Cauteruccio, Laura; R., Sacchetti; F., Zanetti; D., Tatò; C., Napoli; Scaltriti, Stefania; S., Montegrosso; F., Pennino; S., Boccia

Nel 2001 è stato avviato uno studio multicentrico a livello nazionale sulla Malattia dei legionari per approfondire le conoscenze su alcuni degli aspetti critici e tuttora poco conosciuti del rischio Legionellosi, con specifico riferimento alla realtà italiana. Questo studio, coordinato dall'Università degli Studi di Modena e Reggio Emilia vede la partecipazione di altre Università italiane dislocate lungo tutta la penisola, in modo da evidenziare eventuali differenze territoriali nella contaminazione ambientale e nell'infezione, nelle fonti di esposizione, nelle situazioni di rischio particolare. Vengono riportati i risultati più salienti, in quattro anni di attività del Gruppo Multicentrico Italiano di studio sulle Legionellosi, delle indagini ambientali ed in particolare la ricerca di legionella nell'acqua calda sanitaria di abitazioni ed alberghi, effettuata per stabilire la frequenza della contaminazione nelle diverse realtà geografiche e per individuare i fattori di rischio ad essa associati.

2005 - A critical evaluation of the role of trace elements in human cancer [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Piccinini, Lino; Vinceti, Marco; R., Masironi; Vivoli, Gianfranco

The interest in the role of trace elements in cancer is increasing, particularly for those with a possible protective action, such as Se and Zn. Despite the vast amount of investigations already conducted, there is a need for further epidemiological studies to better understand what compounds, at what levels, and with which mechanism trace elements are involved in protection against a specific cancer type or groups of cancer. Critical aspects remain the search for the most appropriate biological indicators of body burden, the variability in biological activity according to chemical form and the current state of knowledge of the mechanisms of action which could be mediated by interference of the neuroendocrine and/or immune system. On the basis of our experience on the relationship between trace elements and cancer disease, we discuss the critical aspects of the problem and try to define guidelines for future research.

2005 - A multicenter study comparing different commercial tests for detection of Legionella urinary antigen [Abstract in Rivista]
M. T., Montagna; D., Tatò; G., Spilotros; G., Barbuti; Borella, Paola; S., Stampi; G., Stancanelli; M., Triassi; C. M., Zotti; C., Casolari; Bargellini, Annalisa; E., Leoni; Scaltriti, Stefania; S., Montegrosso; S., Ditommaso

The detection of the specific Legionella Urinary Antigen (LUA) is actually the most used method to diagnose legionellosis, but some different tests are commercially available at the moment in Italy. The Italian Working Group on Legionella Infections carried out an investigations to compare the reproducibility of three commercial tests for LUA detection versus the Biotest Legionella Urinary Antigen EIA , which is declared to have the highest sensitivity and specificity, as well as the ability to recognize all species of Legionella.

2005 - Cell culture isolation of a transmissible cytotoxicity from a human sample of cerebrospinal fluid [Articolo su rivista]
Portolani, Marinella; Beretti, Francesca; Cermelli, Claudio; Am, Bartoletti; P., Pietrosemoli; Bargellini, Annalisa; DE POL, Anto; Rossini, Gian Paolo

We investigated a transmissible cytotoxicity isolated in VERO cell cultures from a sample of cerebrospinal fluid (CSF) drawn from a woman with ischemic brain injury. Amorphous aggregates formed by subunities of similar to 11nm of diameter were detected in ultracentrifugates from partially purified cytotoxic cell preparations in the absence of virion-like particles which might justify the trasmissibility of this cytotoxic activity. Results of chemico-physical studies provided indications on the presence in the CSF of two protease-resistant acidic glycoproteins of about 39 and 27 kDa, respectively. The conformational change of a proteinic molecule may associate with particular properties such as tendency to aggregation, resistance to proteolysis, cytotoxicity. Considering that these same properties are shared by proteins present in the CSF sample under study, a hypothesis to pursue is that the CSF inoculum we isolated contained misfolded proteins formed in vivo following the ischemic injury of brain tissue. As far as the in vitro transmissibility of the cytotoxic activity, this could take place following the reproduction of the alterations of those proteins, independently of the original cause(s) which have fostered their formation in vivo.

2005 - Esposizione a Legionella spp in ambiente clinico e odontoiatrico: risultati di uno studio multicentrico [Abstract in Rivista]
Borella, Paola; Bargellini, Annalisa; Mazzini, Elisa; Calcagnile, Gian Luigi; D., Tatò; S., Di Tommaso; S., Montegrosso; E., Leoni; M., Moro; M. A., Coniglio

Nell'ambito di uno studio multicentrico sulle infezioni da Legionella in Italia, è stata condotta un'indagine conoscitiva sulla contaminazione nei sistemi idrici di alcuni grandi ospedali e sull'efficacia di alcuni sistemi di disinfezione. Per verificare se esiste per il personale un rischio di infezione/malattia, è stato effettuato uno studio sulla prevalenza di anticorpi anti-legionella nel personale delle strutture sanitarie esaminate.

Marchesi, Isabella; Bargellini, Annalisa; G., Stancanelli; Scaltriti, Stefania; M., Moro; S., Pignato; M. A., Coniglio; G., Giammanco; G., Ribera d’Alcalà; F., Pennino; Borella, Paola

Obiettivi. Nell’ambito di uno studio multicentrico sulla legionellosi in Italia, questa indagine intende studiare il rischio espositivo nei soggetti HIV positivi, valutando sia la prevalenza di anticorpi anti-Legionella sia l’incidenza della malattia.Metodi. Sono stati reclutati 154 soggetti sieropositivi per HIV e 207 controlli, ugualmente distribuiti tra Nord e Sud Italia. A ciascun soggetto è stato prelevato un campione di sangue per la ricerca degli anticorpi specifici (metodo IFA) ed è stato somministrato un questionario per indagare i fattori di rischio personali ed ambientali associati ad un maggior rischio espositivo. Quattro casi di legionellosi sono stati individuati mediante ricerca dell’antigene di Legionella nell’urina (metodo EIA) e sieroconversione.Risultati. La positività per Legionella è risultata del 12,3 % negli HIV contro il 26,1 % dei controlli (p<0,001), con titoli anticorpali significativamente più bassi negli HIV rispetto ai controlli. Inoltre, è stata riscontrata una differenza nel tipo di anticorpi in relazione all’area geografica, con una maggiore frequenza di anticorpi anti L. pneumophila sierogruppi 1-6 e non pneumophila al Sud rispetto al Nord, sia negli HIV (46,2 % vs 0%) che nei controlli (15,2% vs 0% e 39,4% vs 9,5%). Non sono emerse correlazioni significative con i fattori di rischio e/o sintomi associabili con la legionellosi. I soggetti HIV positivi che hanno contratto la legionellosi presentavano un età media inferiore a quella dei casi comunitari reclutati, titoli anticorpali più bassi, una sintomatologia extrapolmonare più frequente e livelli significativamente inferiori di cellule natural killer.Conclusioni. I soggetti HIV positivi presentano sieropositività per Legionella con una frequenza inferiore ai controlli, a parità di fattori di rischio espositivi e personali. Questo potrebbe indicare una minore difesa all’infezione, che spiega anche la frequente comparsa della malattia segnalata negli ultimi anni tra i soggetti HIV positivi.

2005 - Is there a professional risk of Legionnaires’ disease? Results of a multicentric serological study. [Abstract in Rivista]
Borella, Paola; Mazzini, Elisa; Bargellini, Annalisa; M. T., Montagna; D., Tatò; C., Napoli; S., Pignato; G., Giammanco; M. A., Coniglio; G., Stancanelli; Scaltriti, Stefania; L., Lopalco; C. M., Zotti; M., Giacomuzzi; M., Gentile; M., Triassi; G., Ribera D’Alcalà; F., Pennino

Despite Legionella spp. frequently contaminate water distribution systems of private and public buildings, the risk of infection/disease among workers is scarcely known. A multicentric survey was carried out to evaluate the seroprevalence of Legionella antibodies in different exposure risk groups accurately studying the related risk factors. Pneumonia events in the last 5 years and flu-like symptoms in the last year were also recorded.

2005 - Legionella contamination in hot water of Italian hotels [Articolo su rivista]
Borella, Paola; M. T., Montagna; S., Stampi; G., Stancanelli; V., Romano Spica; M., Triassi; Marchesi, Isabella; Bargellini, Annalisa; D., Tatò; C., Napoli; F., Zanetti; E., Leoni; M., Moro; Scaltriti, Stefania; G., Ribera D'Alcalà; R., Santarpia; S., Boccia

A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of >= 10(3) CFU liter(-1), and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup I was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

2005 - Rapporti tra elementi in traccia, ansietà e parametri immunitari in pazienti affetti da tumore [Abstract in Rivista]
Piccinini, Lino; Bargellini, Annalisa; M., De Palma; Marchesi, Isabella; Borella, Paola

Obiettivi. Nell’ambito di una serie di studi avviati da tempo, abbiamo cercato di approfondire i rapporti tra elementi in traccia, parametri immunitari e tumori, tenendo in considerazione alcuni tratti di personalità quali l’ansietà, in grado di modulare sia la risposta immunitaria che la malattia neoplastica.Materiali e Metodi. In questo studio caso-controllo abbiamo esaminato 30 pazienti affetti dai più comuni tipi di neoplasia, reclutati al momento della diagnosi e prima di iniziare gli eventuali trattamenti chemio e radioterapici, e 30 soggetti sani di controllo. Se, Zn e Cu sono stati misurati nel plasma insieme all’enzima glutatione perossidasi (GSH-Px) e alla perossidazione lipidica. Zn e GSH-Px sono stati misurati anche negli eritrociti. Sono stati indagati alcuni parametri dell’assetto immunitario di base. Si è proceduto inoltre alla somministrazione e compilazione dello State-Trait Anxiety Inventory (STAI-Y1 eY2) per la misurazione del grado di ansietà.Risultati. Per quanto riguarda gli elementi in traccia, i pazienti avevano un elevato livello di Zn negli eritrociti rispetto ai controlli e, solo nei maschi, di Cu plasmatico, mentre la perossidazione lipidica era diminuita. I soggetti affetti da tumore erano più ansiosi e mostravano alcune modificazioni nell’assetto immunitario di base, in particolare un incremento significativo nella % delle cellule natural killer (NK) rispetto ai controlli sani. Solo nei pazienti è stata riscontrata una significativa correlazione positiva tra GSH-Px e ansietà di tratto e tra Cu plasmatico e ansietà di stato.Conclusioni. Nel nostro campione non sono emerse carenze nei livelli plasmatici degli elementi in traccia, probabilmente a causa del numero limitato di soggetti finora reclutati e della presenza di diversi tipi di tumore. L’aumento delle cellule NK nei pazienti fa ipotizzare l’attivazione di un meccanismo di difesa immunitaria per contrastare la progressione della malattia dal momento che queste cellule sono deputate alla sorveglianza nei confronti degli agenti infettivi e delle cellule a sviluppo tumorale. Particolarmente interessante anche perché finora poco indagato e per questo degno di ulteriori indagini il riscontro di un rapporto associativo tra gli elementi in traccia e un tratto di personalità quale l’ansia.

Bargellini, Annalisa; Marchesi, Isabella; L., Rizzi; Borella, Paola

Obiettivi. Il selenio, micronutriente essenziale per l’uomo, sembra svolgere un ruolo protettivo nei confronti dell’insorgenza di malattie cronico-degenerative, in particolare del cancro, grazie alla sua attività antiossidante. La sorgente naturale di selenio è rappresentata dalla dieta e la sua concentrazione nei cibi dipende dalle caratteristiche geobotaniche dell’area di provenienza degli alimenti. Nell’ambito di uno studio sull’arricchimento delle uova con acidi grassi 3 e microelementi essenziali (Se e I), il nostro obiettivo era quello di verificare se la supplementazione con Se potesse realmente arricchire l’uovo con questo elemento contribuendo ad un miglioramento della qualità nutrizionale dell’uovo. Per confronto sono state esaminate uova presenti normalmente sul mercato.Metodi. La prova è stata condotta su sette gruppi di galline ovaiole, alimentate con un mangime di base solo o addizionato con I o Se o con entrambi i sali. Le uova commerciali sono state acquistate tenendo conto dei diversi sistemi di allevamento delle ovaiole.Risultati. Il Se si accumula prevalentemente nel tuorlo delle uova sia commerciali (1,040,28 g/g) che trattate (da 1,600,21 a 1,980,16 g/g, secondo il trattamento). La supplementazione con Se e ancora di più quella con Se + I si associava ad una riduzione del contenuto di Cd , in misura inferiore di Pb, e favoriva l’accumulo di acidi grassi 3. Tuttavia si è osservato una tendenza al calo di Zn nei prodotti supplementati.Discussione. La dieta con alga supplementata con Se+I è quella che sembra offrire il maggior numero di vantaggi sia qualitativi che nutrizionali. Con questa dieta si ottiene il maggiore accumulo di Se e di omega 3, e il minore assorbimento di metalli tossici come Pb e Cd nel tuorlo delle uova biofortificate. Nessuna differenza è emersa nelle uova commerciali in relazione al tipo di allevamento.

2005 - The role of selenium and iodine in controlling some egg minerals [Articolo su rivista]
L., Rizzi; Bargellini, Annalisa; Borella, Paola; A., Mordenti

Il ruolo del selenio e dello iodio nel controllo di alcuni minerali nell’uovo. Una prova è stata condotta su sette gruppi di galline ovaiole, alimentate con un mangime di controllo (C) o contenente: olio di lino (L), olio di pesce (F), olio ricco di DHA derivante dalla micro-alga Schizochytrium sp in presenza o meno (A) di 5ppm di ioduro di potassio (AI) o di selenito di sodio (ASe) oppure di entrambi i sali (AISe). I contenuti di selenio e di zinco e di altri minerali sono stati valutati nei tuorli delle uova. A fine prova la concentrazione di selenio era aumentata in modo significativo (P&lt;0,001), mentre quella dello zinco si era ridotta (P&lt;0,05) nei tuorli dei gruppi ASe e AISe. I valori di Ca, Mn, Fe, Cu, Cd e Pb non differirono tra i tuorli dei vari gruppi, a parte il cadmio, la cui concentrazione si era ridotta nel gruppo AISe, attestando una influenza di iodio e selenio sulla deposizione di questo metallo.

2004 - Confronto tra diverse metodiche utilizzate per l’identificazione dell’antigene urinario di Legionella [Abstract in Rivista]
M. T., Montagna; D., Tatò; G., Spilotros; Borella, Paola; E., Leoni; G., Stancanelli; M., Triassi; C. M., Zotti; Marchesi, Isabella; Bargellini, Annalisa; C., Lazzari; M., Aporti; S., Scaltriti; R., Ieri; G., Ribera D’Alcalà; S., Montegrosso; S., Ditommaso; M., Gentile

Scopo del presente studio è mettere a confronto 4 kits commerciali per la ricerca dell’Ag urinario.Complessivamente, sono stati esaminati 84 campioni di urine di pazienti con polmonite (42 positivi per Ag urinario e, per controllo, 42 negativi) provenienti dalle U.U.O.O. di Bari, Bologna, Milano, Modena, Napoli e Torino.

Marchesi, Isabella; M., Attino; P., Marchegiano; G., Mantovani; Basili, Consuelo; Bargellini, Annalisa; G., Pieroni; Borella, Paola

Obiettivo. Studiare la diffusione ambientale di Legionella spp nel sistema di distribuzione dell’acqua calda sanitaria di un grande ospedale e verificare l’efficacia nel breve e medio periodo dei trattamenti di iperclorazione.

2004 - Indagine multicentrica sui fattori di rischio correlati alla presenza di Legionella spp nell’acqua di strutture pubbliche e private. [Abstract in Rivista]
Borella, Paola; M. T., Montagna; S., Stampi; G., Stancanelli; V., Romano Spica; M., Triassi; Bargellini, Annalisa; Marchesi, Isabella; D., Tatò; G., Spilotros; G., De Luca; R., Sacchetti; C., Ossi; P., Nizzero; P., Laurenti; U., Moscato; G., Ribera D'alcalà; S., Montegrosso

Obiettivi. Nell’ambito dello studio multicentrico italiano sulle legionellosi, è stata condotta una indagine per stabilire la diffusione di Legionella spp nei sistemi idrici di case, alberghi ed ospedali, identificando altresì i fattori di rischio associati alla colonizzazione.Discussione. La colonizzazione dei sistemi idrici è risultata molto frequente nelle abitazioni, soprattutto se dotate di sistemi centralizzati, ed assume proporzioni rilevanti in alberghi ed ospedali. Va tuttavia sottolineato che L.pneumophila sg1, responsabile della maggior parte delle polmoniti, colonizza raramente le abitazioni, ma è spesso presente negli alberghi, suggerendo la necessità di interventi prioritari di prevenzione nelle strutture turistico-alberghiere.

2004 - Relación entre micronutrientes y enfermedades cardiovasculares: pruebas epidemiológicas [Capitolo/Saggio]
Borella, Paola; Bargellini, Annalisa; Rovesti, Sergio; Basili, Consuelo; Mazzini, Elisa

En esta revision presentamos los resultados de los estudios epidemiologicos recientes sobre la function del hierro y el selenio en las enfermedades cardiovasculares (ECV). Ademas, se tratarà la relacion entre los oligoelementos toxicos/esenciales y la hipertension humana.

2004 - Sieropositività per Legionella spp in gruppi di popolazione a diverso rischio espositivo [Abstract in Rivista]
Borella, Paola; Mazzini, Elisa; Bargellini, Annalisa; M. T., Montagna; D., Tatò; C., Napoli; S., Pignato; G., Giammanco; M. A., Coniglio; G., Stancanelli; Scaltriti, Stefania; L., Lopalco; C. M., Zotti; M., Giacomuzzi; M., Gentile

Obiettivo. Nonostante la frequente presenza di Legionella nei sistemi idrici degli ambienti di vita e di lavoro, il rischio di infezione e/o malattia negli esposti è poco conosciuto. E’ stata pertanto condotta una indagine sulla prevalenza di anticorpi anti-Legionella nei dipendenti di ospedali contaminati e nei soggetti HIV-sieropositivi.Metodi.: Sono stati arruolati oltre 500 soggetti, suddivisi in base alle categorie di rischio: dipendenti degli ospedali (medici, infermieri, ecc.), personale di unità odontoiatriche, idraulici, soggetti HIV-positivi e come controlli donatori di sangue e impiegati delle strutture esaminate. La presenza di anticorpi nel siero è stata valutata tramite test IFA, assumendo 1:128 come cut-off per la positività. In tutti i gruppi sono state raccolte informazioni sui fattori di rischio per l’esposizione, utilizzando un questionario standardizzato.Risultati. La prevalenza di anticorpi anti-Legionella era significativamente più elevata nei dipendenti dell’ospedale (33,8 vs 10,0%, p<0,001) e nel personale odontoiatrico (31,8 vs 9,1%, p<0,01) rispetto ai controlli. Non è stata invece trovata differenza negli idraulici (9,8 vs 17,6%) e nei soggetti HIV-positivi. La positività riguardava prevalentemente L.pneumophila sierogruppi 7-14 e il titolo prevalente era 1:256. L’analisi dei fattori di rischio effettuata tra i lavoratori ospedalieri non ha evidenziato alcuna associazione significativa, tranne che per l’utilizzo di docce nei luoghi di lavoro. Nessun dipendente ha contratto la malattia negli ultimi 5 anni.Discussione. La frequenza di sieropositività è particolarmente elevata nel personale ospedaliero e nei lavoratori dell’odontoiatria, mentre gli HIV-positivi e gli idraulici hanno livelli di anticorpi paragonabili alle popolazioni di controllo. E’ da sottolineare come anche in queste ultime la sieropositività non sia trascurabile (dal 9,1% al 17,6%). Nel personale ospedaliero, la più elevata frequenza di anticorpi anti-L.pneumophila 7-14 coincideva con la maggior diffusione di questi sierogruppi nell’ambiente, suggerendo che la positività sia espressione di esposizione più che di malattia in atto o pregressa.

2003 - Cytotoxic activities of natural killer (NK) lymphocytes in workers exposed to various levels of extremely low frequency magnetic field [Articolo su rivista]
Gobba, F.; Bargellini, A.; Roccatto, L.; Giacobazzi, P.; Borella, P.

2003 - Diffusione ambientale di Legionella spp e frequenza di legionellosi in pazienti affetti da polmonite: primi risultati di uno studio multicentrico italiano [Articolo su rivista]
Borella, Paola; M. T., Montagna; V., ROMANO SPICA; S., Stampi; G., Stancanelli; M., TRIASSI M; Bargellini, Annalisa; Giacobazzi, Pierluigi; Vercilli, Francesco; Scaltriti, Stefania; Marchesi, Isabella; C., Napoli; D., Tato'; G., Spilotros; N., Paglionico; G., Quaranta; M., Branca; M., Tumbarello; P., Laurenti; U., Moscato; E., Capoluongo; G., DE LUCA; P. P., Legnani; E., Leoni; R., Sacchetti; F., Zanetti; M., Moro; C., Ossi; L., Lopalco; R., Santarpia; V., Conturso; G., RIBERA D'ALCALA'; S., Montegrosso

A multicentric Italian investigation on legionnaires' disease is in course to clarify host factors as well as pathogen associated characteristics involved in the infection/disease. The main goal of the research plan is to account for some critical aspects concerning identification and prevention of legionellosis. To improve knowledge on factors associated with Legionella spp colonisation in hot waters, to detect cases and to characterize risk factors in subjects which develop pneumonia are specific objectives of the research programme. Preliminary results show that hot waters of houses and hotels are frequently contaminated (22.6% and 54.6%, respectively), mainly by L. pneumophila. Microbial concentrations were low in domestic waters (<1.000 ufc/l), but higher in samples from the hotels (geom. mean 1.85 x 10(3) ufc/l). Warming system, age of the plant, type of building were risk factors significantly associated with Legionella spp positivity. The active surveillance on patients affected by pneumonia with search for Legionella urinary antigen allowed the identification of 34 cases, 3 of which of nosocomial origin, corresponding to 4.2% of the screened pneumonia. After informed consent, 26 subjects were recruited for a case-control-study to clarify risk factors for the disease.

2003 - Esposizione a sottoprodotti della disinfezione delle acque potabili ed effetti sul neonato: studio caso controllo presso l’azienda ospedaliera Policlinico di Modena [Articolo su rivista]
Righi, Elena; Fantuzzi, Guglielmina; M., Montanari; Bargellini, Annalisa; Predieri, Guerrino; Aggazzotti, Gabriella

Gli autori riportano i risultati di uno studio epidemiologico di tipo caso- controllo volto a valutare le potenziali associazioni tra esposizione durante la gravidanza ad acque potabili contenenti sottoprodotti della disinfezione ed effetti sul neonato, quali basso peso alla nascita e nascita pretermine.

2003 - Relationship between mineral content of domestic hot water and microbial contamination [Relazione in Atti di Convegno]
Borella, Paola; M. T., Montagna; V., ROMANO SPICA; S., Stampi; G., Stancanelli; M., Triassi; Marchesi, Isabella; Bargellini, Annalisa; Neglia, Rachele Giovanna; N., Paglionico; G., Spilotros; U., Moscato; G., Casati; P. P., Legnani; R., Sacchetti; C., Ossi; M., Moro; G., Ribera

The relationship between Legionella and Pseudomonas spp contamination and mineral content of domestic hot waters was investigated in a cross-sectional Italian survey. Pseudomonas spp contamination was associated with elevated Ca, but lower Fe and free chlorine content in the water. Waters with Cu concentrations > 50 microg/L prevented Legionella spp colonisation (OR = 0.14, 95% CI = 0.02-1.13), whereas the risk of legionellae occurrence increased in waters with Mn levels > 3 microg/L (OR = 2.37, 95% CI = 1.06-5.30). Furthermore, Mn was positively associated with the risk of colonisation by eterotrophic bacteria growing at either 22 and 36 degrees C. Legionella species and serogroups were differently distributed according to Cu and Mn concentrations, suggesting that Legionella strains may have a different sensibility/resistance to trace elements. A specific action of Cu as decontamination factor is suggested and the consideration of Mn as a risk indicator for bacterial colonisation and biofilm presence is proposed.

2003 - Trace elements, anxiety and immune parameters in patients affected by cancer [Relazione in Atti di Convegno]
Bargellini, Annalisa; Piccinini, Lino; M., De Palma; Giacobazzi, Pierluigi; S., Scaltriti; M., Mariano; R., Roncaglia; Borella, Paola

The aim of this case-control study was to investigate the relationship between trace elements, immune parameters, and human cancer, taking into account some personality traits, such as anxiety, implicated in the modulation of both immune responses and pathology. Thirty patients affected by the most frequent cancer types were recruited at the onset of disease together with 30 healthy controls. Se, Zn and Cu were measured in plasma together with glutathione peroxidase (GSH-Px) activity, and lipid peroxidation (thiobarbituric acid-reactive substances--TBARS). Furthermore, Zn and GSH-Px activity were measured in red blood cells. A complete blood profile with the main lymphocytes subsets was obtained and the State-Trait Anxiety Inventory was applied to evaluate anxiety. The only differences found between trace element levels in cases and controls were significantly higher erythrocyte Zn in cancer patients and higher plasma Cu levels in male patients. In addition, subjects affected by cancer exhibited a significant reduction in TBARS levels, were more anxious, had lower total B cells percentage and T helper/T suppressor ratio, and had a higher percentage of natural killer cells. Interestingly, in patients only, GSH-Px in plasma was positively related to trait anxiety scores (p < 0.02) and Cu to state anxiety scores (p < 0.05). In conclusion, we could not confirm the existence of trace element deficiency in relation to cancer and no links between trace element levels and lymphocyte subsets were documented. However, interesting associations between state anxiety and Cu, and between trait anxiety and GSH-Px were observed thus deserving further investigations.

2002 - Epidemiologia degli infortuni nei minori con particolare riguardo all’infortunistica lavorativa: indagine nella città di Modena nel periodo gennaio-giugno 2000. [Abstract in Rivista]
Gatti, G; Fantuzzi, Guglielmina; Righi, Elena; Bargellini, Annalisa; Marcheselli, R; Aggazzotti, Gabriella


2002 - Fattori di rischio per la legionellosi: parametri immunologici e rapporto con alcuni elementi in traccia. [Abstract in Rivista]
Scaltriti, S; Marchesi, Isabella; Stancanelli, G; Giacobazzi, P; Righi, Elena; Bargellini, Annalisa; Borella, Paola


2002 - Il burnout nel personale sanitario: riflessioni sui fattori predisponenti e sui meccanismi di difesa alla luce dei rapporti con il sistema immunitario [Articolo su rivista]
Bargellini, Annalisa; Scaltriti, Stefania; Borella, Paola

Il burnout è una sindrome d’esaurimento fisico e mentale che si osserva dopo un lungo periodo di lavoro in situazioni di stress nelle professioni a stretto contatto con altre persone, in particolar modo nel personale sanitario. Sia le caratteristiche individuali che l’organizzazione e la tipologia del lavoro si associano al burnout e, più recentemente, in uno studio sui medici abbiamo osservato che anche alcuni tratti della personalità quali l’ansietà giocano un ruolo aggiuntivo nella comparsa della sindrome. Per verificare se l’esaurimento fisico dei medici allo studio potesse influire sullo stato di salute abbiamo indagato la loro situazione immunitaria. Contrariamente alle attese non è stato evidenziata un’immunosoppressione legata al sentirsi stanchi e distaccati emotivamente dal paziente ma un aumento selettivo d’alcune sottopopolazioni linfocitarie in rapporto alla realizzazione personale. Alla luce di questi dati riteniamo che il senso di gratificazione derivante dal proprio lavoro permette di contrastare il sovraccarico lavorativo e mantenere un buon livello di salute.

2002 - Natural killer activity in workers exposed to various levels of Extremely Low Frequency-Electromagnetic Fields (ELF-EMF) [Abstract in Rivista]
Gobba, Fabriziomaria; Borella, Paola; L., Roccatto; Giacobazzi, Pierluigi; Bargellini, Annalisa

Data on the effects of Extremely Low Frequency (ELF) Magnetic Fields (MF) on immune system in humans are conflicting. The aim of this study was to evaluate the NK cytotoxic activity in peripheral lymphocytes of a group of workers exposed to different levels of ELF-MF.

2002 - Valutazione del carico di stress negli operatori del soccorso: studio preliminare. [Abstract in Rivista]
Giacobazzi, P; Bargellini, Annalisa; Cacciari, Cristina; Righi, Elena; Borella, Paola


2001 - Effects of chronic exposure to anaesthetic gases on some immune parameters [Articolo su rivista]
Bargellini, Annalisa; Rovesti, Sergio; Barbieri, Alberto; R., Vivoli; R., Roncaglia; Righi, Elena; Borella, Paola

A cross-sectional survey was carried out to evaluate the relation between occupational exposure to low levels of anaesthetic gases (nitrous oxide and isoflurane) and immune parameters. Fifty-one anaesthetists were recruited among different Services of Anaesthesiology and Reanimation. The control group consisted of non-exposed physicians, similar for gender, age, and job grade. Total number of lymphocytes, lymphocyte subpopulations and the natural killer (NK) cytotoxic activity were measured. Information on personal and professional characteristics and on short- and long-term exposure was collected. Percentages of T cells (CD3) decreased significantly in anaesthetists compared to controls, whereas numbers of NK cells (CD16(+)CD3(-)) increased. After correction for confounders, short-term (last 2 weeks) exposure was associated with a decrease in percentages of total T and T helper (CD4) cells. Furthermore, T helper percentages were significantly reduced with increasing individual exposure score evaluated on the basis of working days and levels of anaesthetic gases in operating rooms. A significant X-ray-associated increase of numbers and percentages of NK cells was lastly observed. Despite limited present exposure to anaesthetic gases, a specific derangement in lymphocyte subpopulations, with T lymphocytes more affected than B, has been observed.

2001 - Valutazione nelle sale operatorie dei rischi da agenti anestetici volatili attraverso l'interferenza con l'attività funzionale delle cellule linfocitarie [Capitolo/Saggio]
Borella, Paola; Bargellini, Annalisa

Obiettivo dello studio è valutare l'interferenza dell'esposizione a gas anestetici con l'attività funzionale di cellule linfocitarie ed in particolare dei linfociti NK, il che avrebbe conseguenze rilevanti sui meccanismi di difesa contro le infezioni e la crescita di cellule tumorali. Verrà contemporaneamente valutato il numero totale di cellule linfocitarie circolanti, numero e percentuale delle cellule B, T, T helper, T suppressor, NK.

2000 - La legionellosi come problema emergente di Sanità Pubblica: aspetti di sorveglianza, diagnosi e controllo ambientale alla luce di recenti esperienze ospedaliere [Articolo su rivista]
Bargellini, Annalisa; F., Vercilli; Fantuzzi, Guglielmina; Borella, Paola; G., Stancanelli; C., Curti; R., Mazzucconi; A., Lazzarin; I., Manghi; L., Sircana; M., Pinotti; L., Rizzo

La malattia dei legionari è un problema ubiquitario, che interessa non solo il personale medico ospedaliero ma anche i medici operanti sul territorio, considerato che la maggior parte dei casi ha un'origine comunitaria, anche se i casi nosocomiali destano maggiore preoccupazione per la gravità.In questo studio vengono riportate le esperienze di due ospedali del Nord Italia sulla identificazione e sul controllo della legionellosi.

2000 - Prevenzione e controllo dell'infezione da Legionella in ambiente ospedaliero [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; S., Pergolizzi; Aggazzotti, Gabriella; C., Curti; P., Nizzero; G., Stancanelli; R., Vaiani; G., Gesu; R., Mazzuconi

An outbreak of nosocomial legionnaires' disease in a hospital of Northern Italy is described, together with the epidemiological survey and the control measures adopted. Two patients developed Legionella pneumophila (serogroup 1) pneumonia, one (immunodepressed) died. The Task Group organised by the Health Service excluded other previous nosocomial infections, and made controls on patients and personnel of at risk units (all negative). An intensive programme of environmental sampling and educational activities on personnel have been carried out. The environmental surveillance revealed that the centralised hot water distribution system of the hospital was colonised with Legionella. Shock heating and hyperchlorination of water were applied, which reduced the number of contaminated sites short term, but recolonisation took place two months later. We underline the difficulties encountered to control Legionella by active surveillance of water quality; once the system is contamined, Legionella eradication may be difficult and expensive, and cases of hospital-acquired legionnaieres' disease are likely to occur.

2000 - Relation between immune variables and burnout in a sample of physicians [Articolo su rivista]
Bargellini, Annalisa; Barbieri, Alberto; Rovesti, Sergio; R., Vivoli; R., Roncaglia; Borella, Paola

OBJECTIVES: To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables. METHODS: Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures. RESULTS: With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables. CONCLUSIONS: In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.

1999 - Aspetti epidemiologici del burnout in un campione di medici anestesisti. [Articolo su rivista]
Bargellini, Annalisa; Barbieri, Alberto; Rovesti, Sergio; Vivoli, R.; Borella, Paola

E’ stata condotta un’indagine trasversale su un gruppo di anestesisti, e per confronto su un gruppo di medici di sanità pubblica, per verificare se lo stress occupazionale misurato con il Maslach Burnout Inventory correla con alcune variabili personali e con la tipologia dell’attività lavorativa. I risultati indicano l’esistenza di un profilo di rischio secondo il quale non essere coniugati, essere di sesso femminile ed espletare mansioni superiori si associa ad un maggior livello di esaurimento emotivo, mentre la depersonalizzazione è correlata alle mansioni e alla tipologia del servizio in cui si opera. Va inoltre sottolineato che elevati livelli di ansietà correlano positivamente con l’esaurimento emotivo e negativamente con la realizzazione personale.

1999 - Emotional stability, anxiety, and natural killer activity under examination stress. [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Rovesti, Sergio; M., Pinelli; R., Vivoli; V., Solfrini; Vivoli, Gianfranco

This study was performed to evaluate the relation between a stable personality trait, a mood state and immune response to an examination stress. A self-reported measure of emotional stability (BFQ-ES scale) was obtained in a sample (n = 39) randomly selected from 277 cadets; this personality trait was also investigated by completing a neuroticism scale (Eysenck personality inventory) and a trait-anxiety scale (STAI). Natural killer (NK) cell activity was measured at baseline, long before the examination time and the examination day. The state-anxiety scale evaluated the response to the stressful stimulus. Taking subjects all together, the academic task did not result in significant modification over baseline in NK cell activity. Subjects were then divided into three groups based on emotional stability and state-anxiety scores: high emotional stability/low anxiety, medium, and low emotional stability/high anxiety. Examination stress induced significant increases in NK cell activity in the high emotional stability/low anxiety group, no effect in the medium group, and significant decreases in the low emotional stability/high anxiety group. The repeated-measure ANOVA revealed a significant interaction of group x period (baseline vs. examination) for both lytic units and percent cytolysis. The results did not change after introducing coffee and smoking habits as covariates. Our findings suggest that the state-anxiety acts in concert with a stable personality trait to modulate NK response in healthy subjects exposed to a psychological naturalistic stress. The relation between anxiety and poor immune control has been already described, whereas the ability of emotional stability to associate with an immunoenhancement has not yet reported. The peculiarity of our population, a very homogeneous and healthy group for life style and habits, can have highlighted the role of emotional stability, and may account for the difference with other studies.

1999 - Micro e macroelementi essenziali nella dieta di diversi gruppi residenti in comunità [Articolo su rivista]
Bargellini, Annalisa; E., Caselgrandi; I., Voglioso; Borella, Paola

In questo studio abbiamo analizzato pasti pronti per il consumo per verificare il contenuto di alcuni elementi essenziali nella dieta di diversi gruppi residenti in comunità (struttura militare, residenza per anziani, ospedale).

1999 - Surveillance of legionellosis within a hospital in northern Italy: May 1998 to September 1999 [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; S., Pergolizzi; Aggazzotti, Gabriella; C., Curti; P., Nizzero; G., Stancanelli; R., Vaiani; G., Gesu; R., Mazzuconi

In May 1998, a single case of nosocomial legionellosis was discovered in a 1000 bed hospital in Milan, which included departments serving immunocompromised and severely ill patients (transplant recipients, AIDS cases, patients receiving corticosteroids, etc.). This infection provided an opportunity to undertake a long term epidemiological and environmental survey. After 15 months of active surveillance, we have generated some suggestions for management of legionnaires’ disease acquired both in hospital and in the community.

1998 - Indagine sui livelli ematici e tissutali di Se, Zn e Cu in pazienti con patologia neoplastica. [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Zanelli, F; Franchini, M; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro


1998 - Plasma, hair and tissue levels of trace elements in lung cancer [Relazione in Atti di Convegno]
Piccinini, Lino; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; V., Arigliano; Davalli, Pierpaola

The purpose of this study was to investigate the relationship between plasma, hair and tissue levels of Se, Zn and Cu, and cancer.

1998 - Selenium determination in biological matrices [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; Caselgrandi, Eva; A., Menditto; M., Patriarca; A., Taylor; Vivoli, Gianfranco

In this study, we discuss some relevant aspects concerning the determination of selenium in biological materials with special reference to fluorometry and hydride generation atomic absorption spectroscopy (HG-AAS) techniques. The two methods may be applied without modifications to the analysis of Se in a wide spectrum of specimen types, and we describe their reliability in serum and hair analyses. Thirty-six independent control serum samples, the concentrations of which were unknown to the analyst, were analyzed in duplicate using both techniques in the Italian External Quality Assessment Scheme (EQAS). Accuracy was assessed by comparing Se values with those previously assigned by the organizers of the scheme using graphite furnace atomic absorption spectrometry (GF-AAS), which is the most frequently used technique for selenium determination in serum among the participants in the Italian EQAS. The results confirmed that fluorometry has a higher degree of accuracy than HG-AAS: the mean differences between observed and expected values were 1.5 mu g/liter (95% confidence interval, -1.06 to 3.97) for fluorometry and -1.1 mu g/liter (95% confidence interval, -5.05 to 2.76) for Hg-AAS. We also report some results obtained for the determination of Se in hair. Since a critical step in hair preparation is the pretreatment for removal of external contamination, we compared six different washing procedures. In general, Se is pearly leached from hair, but the efficiency of removal differed with the substance used, ranging from 0 to 13% of the original content. A nonionic detergent like Triton X-100 offers the advantage of safe working conditions and a substantial reduction in costs compared with organic solvents. Lastly, in a consistent group (n = 131) of women, Se in hair was found to be strongly reduced by the use of dye (389.9 ng/g vs 498.7 ng/g, P < 0.001). We recommend recording information on cosmetic treatments when hair is collected to evaluate Se reference values in epidemiological studies.

1998 - Selenium interaction with human cell functions [Relazione in Atti di Convegno]
Borella, Paola; Bargellini, Annalisa; V., Solfrini

We undertook a series of in vitro studies to evaluate the effects of different doses and compounds of selenium on functional activities of human lymphocytes. The NK cell activity and the proliferation and antibody release by cultured lymphocytes were studied. Our studies suggest that an excess of Se may have a detrimental effect on certain immunological parameters. In addition, Se bioavailability more than absolute levels should be considered to better understand the Se role on immune system

1998 - Selenium, Zinc and Copper il lung cancer: modifications in fluids and tissues [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; Arigliano, V; Davalli, P.


1998 - Valutazione del rischio di danno neuropsicologico per esposizione al piombo nell'infanzia [Articolo su rivista]
Borella, Paola; N., Sturloni; Rovesti, Sergio; R., Vivoli; Bargellini, Annalisa; Vivoli, Gianfranco

Potential neurotoxicity of lead in children has been explored in many recent epidemiological studies carried out all over the world. Within a multicentric European study, an investigation was carried out also in Italy on children living in an industrial area and characterised by a non steady-state exposure condition with higher exposure at the early stages of life. This peculiar feature allowed to observe interesting associations between neurobehavioural functions and the levels of Pb measured in teeth, but not in blood. Indeed, Pb in teeth was associated with the results of psychometric tests which evaluate the discriminant ability and the attention. Other associations, like those found between the intelligence quotient (IQ) scores and Pb in teeth disappeared after correction for the socioeconomical status of parents. In general, in children exposed to environmental Pb, more consistent associations were found with visual-motor integration and attention than with IQ measurements. In agreement with literature data from other countries, we suggest that the relevance of neurotoxic effects of Pb is limited, at least at the current exposure levels, but also that a threshold Pb level associated with no effect cannot be identified

Borella, Paola; Bargellini, Annalisa; Caselgrandi, Eva; Piccinini, Lino

Selenium, zinc and copper were measured in plasma, hair and tissue of patients affected by either breast or lung cancer and their controls. A decrease in plasma Se and Zn in women affected by breast cancer was observed, whereas plasma Cu was increased in lung cancer. No significant modification was found in hair trace element levels adjusted for the main confounders, in particular for hair treatment which altered Se content. The examined elements were highly concentrated in cancerous vs normal tissue, but results changed according to the unit used to express results. The usefulness and significance of these biomarkers of trace element status are discussed in the light of the most recent literature data.

1997 - Personalità, stress psicologico e attività natural killer: studio preliminare [Articolo su rivista]
Borella, Paola; BERNINI CARRI, E; Bargellini, Annalisa; Micaletti, E; Vivoli, R; Rovesti, Sergio

In questo studio preliminare vengono riportati i risultati di una indagine effettuata su giovani adulti per valutare se una situazione di stress psicologico, quale un esame di profitto, si accompagna ad alterazioni nella funzionalità del sistema immunitario, in particolare nella attività citolitica delle cellule natural killer (NK). Circa 300 cadetti del primo anno di corso della Accademia Militare di Modena sono stati sottoposti a una valutazione psicometrica per quantificare i tratti d’ansia della personalità e, su questa base, sono stati selezionati due gruppi di soggetti collocati agli estremi delle scale di valutazione. L’attività delle cellule NK è stata misurata, utilizzando una nuova metodica messa a punto nei nostri laboratori, prima dell’esame e, per confronto, in una giornata “tipo” all’inizio dell’anno accademico. L’attività NK è risultata inferiore negli allievi con un elevato punteggio di ansia di tratto, rispetto a quelli con un basso punteggio, e in occasione dell’esame rispetto alla giornata di controllo. Inoltre l’attività NK correlava con il punteggio di un questionario somministrato prima dell’esame, tendente a valutare l’ansia legata a questo evento stressante. È infine emersa una interessante relazione tra ansietà, risposta immunitaria e caratteristiche antropometriche, in quanto l’indice di massa corporea degli allievi correlava positivamente con l’attività NK e negativamente con il punteggio dell’ansia di stato.

1997 - Selenium status in the body of proliferative activity of malignant cells [Articolo su rivista]
Piccinini, Lino; Borella, Paola; Bargellini, Annalisa


1997 - Selenium, Zinc and Copper levels in blood, hair and tissue of patients affected by lung and breast cancer [Abstract in Atti di Convegno]
Bargellini, Annalisa; Borella, Paola; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I; Caselgrandi, E; Piccinini, L.


1997 - Studio caso-controllo dei tassi di Selenio (Se) nel sangue e nei tessuti di soggetti sani o affetti da tumore [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Malavolta, L; Longo, L; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro


1997 - Trace element content of normal and cancerous lung and breast tissue [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I.


1996 - A case-control study on selenium, zinc, and copper in plasma and hair of subjects affected by breast and lung cancer [Articolo su rivista]
Piccinini, Lino; Borella, Paola; Bargellini, Annalisa; C., Incerti Medici; A., Zoboli

The purpose of our study was to investigate the relationship between plasma and hair levels of Se, Zn, and Cu, and cancer. We selected a total of 66 patients affected by either breast (38) or lung (28) cancer. They entered into the study at the onset of disease, and before any chemical or radiotherapy. Controls were randomly selected among healthy people and were matched for sex, age, smoking habits, and residence. In the group of breast cancer, a significant decrease in hair Se was found compared to controls (p < 0.01), whereas plasma Se was only slightly decreased. No difference between cases and controls was detected in both hair and plasma levels of Zn and Cu. Subjects who developed lung cancer were significantly lower in hair Zn (p < 0.05) and Cu (p < 0.01) than controls, whereas there was no difference with regard to Se. In addition, plasma Cu of these patients was increased as compared to controls.

1996 - Chemical form of selenium greatly affects metal uptake and responses by cultured human lymphocytes [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; C., Incerti Medici

In this work, possible interference with functional activities of human lymphocytes after in vitro treatment with selenium was examined. Sodium selenite and selenomethionine compounds were tested in parallel, and their capability to inhibit or to increase the antibody production by lymphocytes was investigated. Furthermore, after incubation for 7 d, total cell-associated Se was measured by a fluorimetric method. The in vitro doses of Se employed in this study mainly reflect those measured in blood of individuals with different Se intake. Low doses of Se (0.5-2.0 mu M) added either as sodium selenite or selenomethionine did not alter the secretion of antibodies. When Se was added at higher levels, instead, an inhibitory effect was found using selenite, whereas a progressive increase in immunoglobulin production was observed after exposure to selenomethionine. Ln both cases, modifications were detected at 5 mu M (395 mu g Se/L), and were significant at 10 mu M (789 mu g Se/L). A different trend between the two chemical forms was also observed with regard to Se uptake by cells. Interestingly, both Se uptake and cell sensitivity were influenced by the density of the cells in culture. Our data suggest that the biological effects of Se in mammalian systems are strongly influenced by its chemical form, and caution should be exerted to avoid toxic effects of selenium.

1996 - Quality control in hair analysis: a systematic study on washing procedures for trace element determinations. [Articolo su rivista]
Borella, Paola; Rovesti, Sergio; Caselgrandi, Eva; Bargellini, Annalisa

Trace element analysis of human hair is widely used to provide an indicator of body burden, but there is a major problem associated with preparation. The washing procedure adopted before analysis represents still a critical point which deserves particular attention. This study aimed at comparing the efficiency of the most commonly used washing methods to identify the procedure which allows for satisfactory removal of external contamination alone. As results depend strongly on the element, toxic (Cd and Pb), essential trace (Cr, Cu, Se and Zn) and major (Ca, K and Mg) elements were tested. The comparison was carried out with six different methods which include use of ionic and non-ionic detergents, organic solvents, chelating agents and sonication. Removal efficiency varied according to the element and pretreatment, the highest being observed for EDTA and the lowest for sonication. Unsatisfactory results were found using an acetone/methanol mixture for the potential contamination caused by it. Organic solvents showed the highest removal efficiency for K and toxic elements, and seemed to be effective in removing a limited but significant fraction of element incorporated in the lipid matter of hair. The ionic detergent Na lauryl sulphate, instead, was more effective for essential elements, but also triggered a higher analytic variability. As detergents appear to remove only external contamination, a non-ionic detergent such as Triton X-100 is proposed as a reliable alternative to the acetone method recommended by IAEA. Practical advantages are safe working conditions, rapidity of application and reduction in costs.

1996 - Use of flameless atomic absorption spectroscopy in immune cytolysis for non radioactive determination of killer cell activity [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; S., Salvioli; Cossarizza, Andrea

We describe here a novel method to evaluate natural killer (NK) cytolytic activity by use of nameless atomic absorption spectroscopy (GF-AAS). This technique may be adopted for use in laboratories equipped with electrothermal atomic absorption spectrometers. Nonradioactive Cr as Na2CrO4 was used to label target cells (K562), and cell lysis was evaluated by measuring Cr released after 4 h of incubation with the effecters. We selected 520 mu g/L as the optimal dose for labeling targets, between 12 and 20 h as the optimal incubation time, and 10(4) cells as the optimal target size. Advantages of this method include: (a) exclusion of radioactive tracer, with no risk for workers; (b) limited costs; (c) high sensitivity and reproducibility; (d) possibility to store samples; and (e) better control of Cr used for labeling cells due to well-determined, fixed Cr concentrations in the range of nontoxic and linear cellular uptake. Comparison with data obtained by conventional Cr-51 labeling of targets killed by the same effecters was excellent, yielding comparable results and corroborating the method.

A., Bettinelli; M. G., Bianchetti; Borella, Paola; E., Volpini; M. G., Metta; E., Basilico; A., Selicorni; Bargellini, Annalisa; M. R., Grassi

To better clarify the genetic inheritance of primary tubular hypomagnesemia-hypokalemia with hypocalciuria, or Gitelman's syndrome (GS), we studied eight families (10 patients aged 11 to 22 years; 16 parents; 9 siblings) in which at least one offspring had GS (plasma magnesium < 0.65 mmol/liter; plasma potassium < 3.6 mmol/liter; high magnesium and potassium fractional excretions; molar urinary calcium/creatinine < 0.10). Two families each had two offspring of different sex with GS, who all had tetanic episodes and/or marked weakness during childhood or adolescence, whereas in three other families two mothers and three offspring presented GS and one father and two other offspring had hypomagnesemia and hypocalciuria but normal plasma potassium. The mean plasma magnesium and potassium levels of the patients of the first two families were significantly lower (P < 0.05) than those of the other three families. Intralymphocytic but not intraerythrocytic magnesium and potassium were significantly lower (P < 0.05) in patients compared to controls. We hypothesize that there are two different types of genetic transmission of GS, one autosomal recessive and one autosomal dominant with high phenotypic variability. It seems that this genetic heterogeneity is associated with a different clinical expression with frequent tetanic episodes and lower plasma potassium and magnesium levels in the autosomal recessive form.

Borella, Paola; Bargellini, Annalisa; Salvioli, S; INCERTI MEDICI, C; Cossarizza, Andrea

A novel method to measure target cell cytolysis based on the use of 'cold', non-radioactive chromium and on the determination of metal release by graphite furnace atomic absorption spectroscopy (FAAS) is proposed. Natural killer (NK) assays were performed by labelling target cells with chromium as Na2CrO4, and results were compared with those obtained by conventional overnight labelling with Cr-51 of targets killed by the same effecters. The cytotoxic capacity of peripheral blood lymphocytes from healthy subjects was evaluated, and NK activity measured with both methods showed a good agreement at each of the tested effector to target cell ratios (between 100:1 and 1:1), with a high and significant coefficient of correlation (r = 0.931, p < 0.0001). The selection of the appropriate Cr concentrations for labelling target cells took into account both the sensitivity of our instrumentation and the possible toxic effects of the metal. A study of the effects of Cr on the cell line (K562) which is usually employed as a target in NK tests showed that Cr could have a detrimental effect on cellular function, with significant numbers of cells with depolarised mitochondria and reduced DNA synthesis after 24 h incubation using Cr levels higher than 15 mu mol/l (780 mu g/l). The method proposed here has a number of advantages, including the use of a non-radioactive tracer, limited costs, high sensitivity and reproducibility, and the possibility of storing samples. In addition, the technique uses a fixed Cr concentration which is known to be non toxic.

1994 - Effects of Mg pyrrolidone carboxylate treatment in Gitelman's syndrome [Relazione in Atti di Convegno]
A., Bettinelli; Borella, Paola; M. G., Metta; E., Basilico; E., Volpini; C., Santeramo; Bargellini, Annalisa

The results of this study seem to indicate the use of magnesium pyrrolidone carboxylate in the treatment of Gitelman' syndrome

1994 - Magnesium supplementation in adults with marginal deficiency: response in blood indices, urine and saliva [Articolo su rivista]
Borella, Paola; Bargellini, Annalisa; G., Ambrosini

Magnesium in plasma, erythrocyte, urine and saliva was measured before intervention, and at weekly intervals during two 28-d cycles of Mg supplementation in a group of 10 adults with marginal Mg deficiency (mean daily intake = 3.58 mg/kg). A group of untreated subjects with higher Mg intake (4.51 mg/kg) served as control. Urinary Mg excretion was correlated with Mg intake, and increased significantly by treatment. No difference was ascertained in plasma, except in subjects with the lowest Mg intake. Mg in erythrocytes was 10% lower in the deficient group, and reached values close to controls after 2 weeks of supplementation. Modifications in salivary Mg were also detected. The significance and usefulness of each index for clinical purpose are discussed.

1994 - Recommendations about the use of leucocytes to assess magnesium status [Relazione in Atti di Convegno]
Borella, Paola; Facchinetti, Fabio; E., Rocchi; R., Lorini; Bargellini, Annalisa

The results of this study suggest that leucocytes are suitable for detecting magnesium deficiency, although modifications in magnesium content may differ according to the population studied.

1993 - Correlazioni tra magnesio intra cellulare e variazioni pressorie circadiane in gravidanza [Relazione in Atti di Convegno]
Facchinetti, Fabio; F., Pianazzi; Borella, Paola; S., De Martis; Bargellini, Annalisa; A. R., Genazzani

In questo studio preliminare abbiamo voluto verificare le possibili correlazioni tra omeostasi del Mg e variazioni circadiane della pressione arteriosa. Sono state studiate, alla 20a settimana di gestazione, 8 gravide che presentavano fattori di rischio per lo sviluppo di PIH

Borella, Paola; Bargellini, Annalisa

We have studied the effects of lead, cadmium and hexavalent chromium in cultured human lymphocytes. Both the proliferative response and the generation of antibodies were evaluated, and the metal accumulation in the cells was measured. Lead added in the range of human exposure caused a significant enhancement in Ig production, which was related to the Pb concentration in the cells. An inhibitory effect on blastogenesis, was detected at Cd doses found in occupationally exposed subjects. Chromium induced reductions in both blastogenesis and Ig production in relation to its capability to enter the cells.

1993 - Is magnesium content in erythrocytes suitable for evaluating cation retention after oral physiological supplementation in marginally magnesium-deficient subjects? [Articolo su rivista]
Borella, Paola; G., Ambrosini; M., Concari; Bargellini, Annalisa

In this study, the effects of oral magnesium supplementation were evaluated on plasma, erythrocyte, and urinary cation levels. The study was carried out with an open, cross-over and randomized design. Healthy subjects received two sachets per day of magnesium (366 mg Mg2+/d) for two 28 d cycles, separated by a 3-week washout interval. Magnesium concentrations were measured before the supplementation and at weekly intervals during the treatment. Urinary excretion of Mg was significantly increased during supplementation, with no differences among the weeks examined. Only small increases in plasma magnesium occurred, and values returned to the prestudy levels before the end of supplementation. The increase in erythrocyte magnesium, however, was statistically significant; this trend suggests the existence of a saturable mechanisms, which prevents any possible magnesium overload during oral supplementation. We conclude that erythrocytes might be considered a suitable index for evaluating the bioavailability of magnesium salts in marginally magnesium-deficient subjects