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Elena RIGHI
Professore Ordinario
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze Sede ex Sanità Pubblica
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Pubblicazioni
2024
- Climate change and infectious diseases: a general overview
[Abstract in Atti di Convegno]
Righi, E; Palandri, L.
abstract
It is well accepted that infectious diseases are climate-sensitive; however, the extent of human vulnerability is still poorly elucidated as numerous biological, ecological, environmental, and social factors act all together with complex interactions contributing to the spreading of infectious diseases and producing different effects in different social-economic and
geographical contexts. Climatic changes can affect the host and pathogens relationship in different ways both during extreme weather events and during everyday life. Climatic conditions are becoming more
suitable for travel-imported and local transmission of climate‑sensitive infectious diseases, including water or vector borne pathogens, such as dengue, chikungunya, West Nile virus, malaria, vibrio species. Different climatic hazards strengthen pathogens by enhancing suitability for reproduction, virulence, accelerating the life cycle, increasing seasons/length of likely exposure, enhancing pathogen-vector interactions. Further, climate change can diminish human capacity to cope with pathogens by affecting human immunocompetence to disease due
to altered body conditions, malnutrition, stress or traumas, unsafe living conditions or reduced access to medical care. Consequences can be especially serious in most vulnerable subgroups, such as pregnant women, children, elderly, people in poor health, specific workers.
Recently, a systematic review showed that worldwide 58% of infectious diseases have been at some point aggravated by climatic hazards and revealed more than 1,000 unique pathways by which climatic hazards, via different transmission types, can affect disease spread and human
health. Further research is, therefore, needed to better elucidate the major climate-related drivers in different social and territorial contexts to plan and implement effective local public health actions to prevent or mitigate the spread of climate-sensitive infectious diseases.
2024
- Climate change-related factors and west nile virus spread in italy: a systematic review
[Abstract in Atti di Convegno]
Granata, M; Tommasi, L; Verzelloni, P; Lorenzon, A; Paduano, S; Malavolti, M; Bargellini, A; Filippini, T; Righi, E; Vinceti, M
abstract
West Nile Virus (WNV) is a vector-transmitted pathogen affecting both humans and animals, whose presence has recently risen in Europe and particularly in Italy, concurrently with climate changes that favoured the diffusion of mosquitoes. Our review aims to assess such relation with
environmental and meteorological factors focusing on the WNV spread in the Italian territory.
Following PRISMA guidelines, we performed a literature search in online databases up to May 31, 2023 on four different databases: PubMed, Web of Science, Embase, Scopus. We used keywords and MeSH terms related to WNV and its vectors (C. pipiens and modestus). Following the PECOS criteria, we included observational studies examining vector dynamics and the WNV infection epidemiology in the Italian population and the possible association with environmental factors. The protocol registration on PROSPERO is in process.
Out of the 341 articles retrieved, 222 remained after duplicates exclusion and 44 papers were selected after screening of title and abstract by two blinded reviewers. After full-text screening,
31 studies (published between 2011 and 2023) were included. Climatic factors such as temperature, daylight hours and humidity seem to be strongly associated with the spread of WNV and its vectors, while rainfall showed less influence. Among environmental factors, soil characteristics and population dynamics (of both vector and host) were found to be the most predictive. By contrast, distance from specific areas (e.g. urban or protected areas) seems to have no influence.
These findings suggest that some climatic and environmental factors linked with climate change strongly affect the presence of WNV and its vectors. This issue can be considered a warning bell about the potential future increase in cases related to climate change, but offers helpful resources for predicting its spread and implement tailored public health interventions.
2024
- Conditioning factors in the spreading of Covid-19 – Does geography matter?
[Articolo su rivista]
Vandelli, Vittoria; Palandri, Lucia; Coratza, Paola; Rizzi, Cristiana; Ghinoi, Alessandro; Righi, Elena; Soldati, Mauro
abstract
There is evidence in literature that the spread of COVID-19 can be influenced by various geographic factors, including territorial features, climate, population density, socioeconomic conditions, and mobility. The objective of the paper is to provide an updated literature review on geographical studies analysing the factors which influenced COVID-19 spreading. This literature review took into account not only the geographical aspects but also the COVID-19-related outcomes (infections and deaths) allowing to discern the potential influencing role of the geographic factors per type of outcome.
A total of 112 scientific articles were selected, reviewed and categorized according to, subject area, aim, country/region of study, considered geographic and COVID-19 variables, spatial and temporal units of analysis, methodologies, and main findings.
Our literature review showed that territorial features may have played a role in determining the uneven geography of COVID-19; for instance, a certain agreement was found regarding the direct relationship between urbanization degree and COVID-19 infections. For what concerns climatic factors, temperature was the variable that correlated the best with COVID-19 infections. Together with climatic factors, socio-demographic ones were extensively taken into account. Most of the analysed studies agreed that population density and human mobility had a significant and direct relationship with COVID-19 infections and deaths. The analysis of the different approaches used to investigate the role of geographic factors in the spreading of the COVID-19 pandemic revealed that the significance/representativeness of the outputs is influenced by the scale considered due to the great spatial variability of geographic aspects. In fact, a more robust and significant association between geographic factors and COVID-19 was found by studies conducted at subnational or local scale rather than at country scale.
2024
- Effectiveness of the SARS-CoV-2 Vaccination in Preventing Severe Disease-Related Outcomes: A Population-Based Study in the Italian Province of Bolzano (South Tyrol)
[Articolo su rivista]
Lorenzon, Antonio; Palandri, Lucia; Uguzzoni, Francesco; Cristofor, Catalina Doina; Lozza, Filippo; Poluzzi, Riccardo; Rizzi, Cristiana; Bertoli, Pierpaolo; Zerzer, Florian; Righi, Elena
abstract
Objective: To investigate the effectiveness of SARS-CoV2 vaccination in preventing ordinary or intensive care unit (ICU) admissions and deaths among cases registered during a variant transitional pandemic phase in the geographically and culturally unique territory of the Province of Bolzano (South Tyrol), an Italian region with low vaccination coverage.
Methods: We collected data from 93,643 patients registered as positive for SARS-CoV-2 by health authorities during the winter of 2021–22. The data were analyzed retrospectively using descriptive statistics and multiple logistic regression.
Results: 925 patients were hospitalized (0.99%), 89 (0.10%) were in intensive care, and 194 (0.21%) died. Vaccinated patients had a significantly lower risk of being hospitalized: adjusted Odds Ratio (aOR): 0.39; 95% CI: 0.33–0.46, ICU admission: aOR: 0.16; 95% CI: 0.09–0.29 and death: aOR: 0.41; 95% CI: 0.29–0.58. Similar risk reductions were also observed in booster-vaccinated patients, independent of sex, age, and predominant variant. Furthermore, the median length of stay (LoS) in the ICU was significantly longer for unvaccinated individuals compared to vaccinated subjects (9 vs. 6 days; p < 0.003).
Conclusion: Primary series vaccination and ongoing campaign booster doses were effective in preventing all severe disease-related outcomes and in reducing ICU Length of Stay, even during a transitional pandemic phase and in a unique territorial context.
2024
- Greenness and diabetes: a systematic review and meta-analysis of observational studies
[Abstract in Atti di Convegno]
De Pasquale, L; Iamandii, I; Mullalli, A; Righi, E; Vinceti, M; Filippini, T
abstract
Since diabetes represents a serious Public Health problem and access to green spaces seems to influence some of its risk behaviors, we performed a systematic review to evaluate the association between greenness exposure and diabetes mellitus type 2 (TDM2), prediabetes and gestational diabetes. Following the PRISMA guidelines, we conducted an online literature search in PubMed, Embase and Web of Science databases by using terms related to «green space», «diabetes mellitus», «gestational diabetes» and «prediabetes». The identified studies were imported into the Rayyan web app where we performed a triple-blind screening of title, abstract and full-text, including only original studies with observational design that assessed the relation between exposure to greenness and diabetes incidence/mortality reporting effect measures (relative risk, hazard ration and odds ratio) with 95% confidence intervals (CI). Lastly, we performed a metaanalysis using both a restricted maximum likehood random effects model, comparing the highest versus lowest greenness categories or continuous increase of greenness, and a onestage dose-response using a 3-knots restricted cubic spline model with fixed percentiles (10th, 50th and 90th). We identified 212 potentially eligible articles, 34 of which were eventually included in the quantitative analyses. In the preliminary forest-plot analyses almost all studies reported a decreased TDM2 risk, regardless of the heterogeneity in the satellite-based methodologies to assess greenness. Furthermore, the dose-response curve showed a progressive reduction of the RR of TDM2 incidence, especially for exposure above 0.5 NDVI (risk ratio=0.93; 95% CI: 0.15, 5.67).
We observed a growing interest concerning the topic in recent years, and, considering the increasing disease burden, the identification of a protective role of greenness could help implement community preventive measures.
2024
- Investigating Eating Habits of Children Aged between 6 Months and 3 Years in the Provinces of Modena and Reggio Emilia: Is Our Kids’ Diet Sustainable for Their and the Planet’s Health?
[Articolo su rivista]
Palandri, L; Rocca, L; Scasserra, Mr; Vigezzi, Pg; Iughetti, L; Lucaccioni, L; Righi, E
abstract
A healthy and balanced diet is crucial for children’s well-being and aids in preventing diet-related illnesses. Furthermore, unhealthy dietary habits indirectly impact children’s health, as the food industry stands as one of the primary drivers of climate change. Evidence shows the
Mediterranean diet is sustainable for both children’s and the planet’s health. The aim of this crosssectional study was to evaluate the eating habits of children aged between 6 months and 3 years, in the province of Modena and Reggio Emilia, in Italy, along with their adherence to the guidelines
for a healthy diet, and examine the role of pediatricians in promoting knowledge about nutrition and sustainability. In our sample (218 children), most children exceeded the recommended meat and cheese intake, while consuming insufficient amounts of vegetables, fruit, and legumes. Vegetable and fruit consumption declined with the increase in age category while eating sweets, soft drinks, and processed food increased. Incorporating school meals’ data into this analysis, we observed a modification in dietary compliance, characterized by an increase in meat and cheese consumption, alongside improvements in the intake of vegetables, fruits, fish, eggs, and legumes. This study suggests that supporting an integrated approach that combines social and educational initiatives is crucial. Future research should prioritize fostering sustainable eating habits within communities to facilitate dietary habits’ transformation and encourage healthier lifestyles.
2024
- The key role of public health in renovating Italian biomedical doctoral programs
[Articolo su rivista]
Palandri, Lucia; Urbano, Teresa; Pezzuoli, Carla; Miselli, Francesca; Caraffi, Riccardo; Filippini, Tommaso; Bargellini, Annalisa; Righi, Elena; Mazzi, Davide; Vigezzi, Giacomo Pietro; Odone, Anna; Marmiroli, Sandra; Boriani, Giuseppe; Vinceti, Marco
abstract
Background: A key renovation of doctoral programs is currently ongoing in Italy. Public health and its competencies may play a pivotal role in high-level training to scientific research, including interdisciplinary and methodological abilities. Methods: As a case study, we used the ongoing renovation of the Clinical and Experimental Medicine doctoral program at the University of Modena and Reggio Emilia. We focused on how the program is designed to meet national requirements as well as students' needs, thus improving educational standards for scientific research in the biomedical field, and on the specific contribution of public health and epidemiology in such an effort. Results: The renovation process of doctoral programs in Italy, with specific reference to the biomedical field, focuses on epidemiologic-statistical methodology, ethics, language and communication skills, and open science from an interdisciplinary and international perspective. In the specific context of the doctoral program assessed in the study and from a broader perspective, public health appears to play a key role, taking advantage of most recent methodological advancements, and contributing to the renovation of the learning process and its systematic quality monitoring. Conclusions: From a comparative assessment of this case study and Italian legislation, the key role of public health has emerged in the renovation process of doctoral programs in the biomedical field.
2023
- COVID-19’s lessons learned from Primary Care and General Practice: enduring rafts against Pandemic Waves
[Abstract in Rivista]
Palandri, Lucia; Serafini, Alice; Ugolini, Giulia; Giansante, Chiara; Fornaciari, Davide; Ferrari, Alberto; Saletti, Marco; Scarpa, Marina; Padula, Maria; Riccomi, Silvia; Righi, Elena
abstract
Background: The Pandemic heavily hit northern Italy. Since most infections have
mild to moderate symptoms thus Primary Care(PC) had to quickly adapt and
reorganize to contribute to reducing hospital overload end ensure continuity of
care. Italian literature on COVID-19 outpatient management is scarce, and little
is known about overall management strategies. The study aims to describe the
overall reorganization in pharmacological and monitoring strategies adopted by
Italian general practitioners(GPs) to care for SARS-CoV-2 infected outpatients
during the pandemic’s first waves and to evaluate their effectiveness in COVID-19
hospitalisation.
Methods: This is a retrospective cohort study of SARS-CoV-2 infected adult
outpatients managed by their GPs from March 2020 to April 2021 in the
province of Modena(Italy). Using electronic medical records, we extracted
data on pharmacological and management strategies (home visits and remote
monitoring), patient characteristics, and hospitalizations. We stratified data
for disease severity and multiple logistic regression analysis was performed to
assess the probability of hospitalization.
Results: Of 5340 patients, 56%(83% with pneumonia) were actively monitored by
46 GPs and specifically created continuity-of-care-units. A significant reduction
in paracetamol, antibiotics and hydroxychloroquine prescriptions was observed
over time in concordance with newly released guidelines. FANS for moderate
patients(OR=0.50 95%CI:0.25-0.99), and steroids(OR=0.52 95%CI:0.32-0.84),
antibiotics(OR=0.42 95%CI:0.25-0.70) and heparin(OR=0.63 95%CI:0.38-1.04) for
severe-critical patients were effective in reducing the probability of hospitalisation,
yet none as much as GPs’ active monitoring(OR up to 0.32 95%CI:0.14-0.70) or
home visits(OR up to 0.42 95%CI:0.20-0.88).
Conclusion: Italian Primary Care showed to be resilient and prone to adapt
management and pharmacological strategies effective in reducing hospitalization
overload. Considering a new potential pandemic and given that the ending of
the current one is still proceeding at a slow pace, strengthening and investing in
territorial health systems is a key strategy for controlling hospital overload and its
consequences on patients health.
2023
- Crossing the border: Adherence to the Vaccination Campaing in multicultural provinces of South-Tyrol during COVID-19 Pandemic, a cross-sectional study
[Abstract in Rivista]
Uguzzoni, Francesco; Palandri, Lucia; Lorenzon, Antonio; Cristofor, Catalina; Lozza, Filippo; Poluzzi, Riccardo; Scasserra, Maria; Rizzi, Cristiana; Bertoli, Pierpaolo; Zerzer, Florian; Righi, Elena
abstract
Objectives and Background: “South-Tyrol” Alpine region in Italy is administered
as an “autonomous statute region”, bordering Austria. This geographically
heterogeneous environment is divided in 20 districts and is inhabited by a unique
multicultural population. Poor evidence exists on factors influencing adherence
to vaccination in peculiar contests, therefore
The aim of this study was to investigate the role played by geographical, cultural
and socio-demographical characteristics on COVID-19 vaccination adherence
during the first year of the Italian vaccination campaign.
Methods: We carried out an ecological study by analysing data collected from
each district of South-Tyrol: altitude, population density, linguistic belonging,
Austrian border proximity, cultural heritage, winter tourism, COVID-19 incidence,
complete primary vaccination cycle and booster dose. Data refer to February 2022,
one year after the beginning of the vaccination campaign. Spearman correlation,
Kruskal-Wallis and Mann-Whitney-U tests were performed to assess relationships
between variables.
Results: On February 2022 district percentages of vaccination adherence varied
widely ranging between 57.1% and 74.8%. Adherence to vaccination appears to
be negatively correlated to altitude (Rho=-0.626, p=0.003; Rho=-0.693, p<0.001,
respectively for primary vaccination and booster dose) and positively correlated
to population density (Rho=0.585, p=0.007; Rho=0.600, p=0.005). Furthermore,
primary vaccination appeared significantly lower in districts with a higher
prevalence of German speaking population (69.2% vs 74.7%, p<0.05) and in those
more isolated or with a prevalent German cultural heritage.
Conclusion: In analysing vaccination adherence, diversity in geographic,
demographic and cultural factors should be taken in great account, even when
the target population appears homogeneous from a clinical standpoint and
overall adherence to vaccination campaign is satisfying. To plan a more effective
and homogeneous vaccination campaing, specific public health interventions
more focused on cultural heritage and geomorphological peculiarities should be
considered and implemented for specific subpopulations and areas
2023
- Early life exposure to phthalates and risk assessment: are we doing enough?
[Abstract in Rivista]
De Pasquale, Lisa; Lugli, Camilla; Palandri, Lucia; Barbieri, Riccardo; Passini, Erica; Facchinetti, Fabio; Iughetti, Lorenzo; Lucaccioni, Laura; Righi, Elena
abstract
Background and Objective: Phthalates, potential endocrine disruptors with
antiandrogenic effects, are widely used in several everyday products and are
ubiquitous pollutants. Since 1999 European Authorities enacted several
regulations to limit phthalate use and prevent exposure, mainly for more
susceptible populations such as infants. This study aims to evaluate the estimated
daily intake (EDI) of phthalates and to perform risk assessment evaluation in an
Italian pediatric cohort.
Methods: Between 2019 and 2020, 197 mother-child couples were enrolled in
a prospective cohort study at the University Hospital of Modena (Italy). Urine
samples were collected at birth, 3 and 6-months. 8 phthalates metabolites were
analyzed.
EDI was estimated and Risk quotients (RQ) were calculated using tolerable daily
intake levels, (RQ(TDI)) as determined by the European Food Safety Authority, and
the revised reference doses for anti-androgenicity RQ(RfD-AA), recently proposed.
Finally, combined Hazard Indexes (HI) were calculated to assess synergic effect
of different phthalates.
Results: Most EDI and RQ(TDI) were lower than the acceptable values. The highest
levels were found for Diethyl-phthalate (DEP), followed by Di-2-ethylhexyl-phthlate
(DEHP). Newborns showed the highest values, followed by 6-months infants.
Values exceeding the risk levels were observed for DEHP or di-n-butyl-phthalate
(DnBP) in 5.5% and 10% of the newborns, respectively for RQ(RfDAA) and HI.
Overall, HI higher values than threshold were observed at each follow-up visit.
Conclusion: Since the European Union has a strict regulation policy regarding the
most critical phthalates, these findings raise concern: exposure affecting children
in Modena is still spread and includes phthalates banned in childcare products,
such as DEHP and DnBP. Notably, few infants (especially newborns) exceeded
the risk threshold for antiandrogenic effects. Further, exposure patterns seem to
change over time during their first months of life. More extensive public health
measures need to be planned to efficiently protect the most sensitive subgroups,
including infants.
2023
- Early-life exposure to phthalates and minipuberty: is there any relationship?
[Abstract in Rivista]
Lucaccioni, L; Palandri, L; Trevisani, V; Righi, B; Calandra Bonaura, F; Predieri, B; Righi, E; Iughetti, L
abstract
2023
- Effectiveness of vaccination on hospitalisation related outcomes: a population-cased study in Northern Italy
[Abstract in Rivista]
Lorenzon, Antonio; Palandri, Lucia; Cristofor, Catalina; Lozza, Filippo; Uguzzoni, Francesco; Rizzi, Cristiana; Poluzzi, Riccardo; Scasserra, Maria; Bertoli, Pierpaolo; Zerzer, Florian; Righi, Elena
abstract
Background and objective: Although the efficacy of SARS-CoV-2 vaccines in
preventing severe disease – especially in older adults – is widely demonstrated,
there are not many studies conducted in the Alps with large sample sizes and during
Omicron variant period. Moreover, scarce literature analyses the hospitalisation
length of SARS-CoV-2 patients and its association with vaccination status. Aim
of this study is to investigate the associations between ordinary or intensive care
unit (ICU) hospitalisations and the vaccination status of SARS-CoV2 adult patients
resident in the Italian alpine province of Bolzano.
Methods: We collected anonymized data from 93643 patients who swabbed
positive for SARS-CoV-2 between November‘21 and February’22 – coinciding
with the arrival of the Omicron variant. Associations between vaccination status
and hospitalisation characteristics were assessed using bivariate statistics and
multiple logistic regression.
Results: Of 93643 positive patients, 925 were hospitalised (90% ordinary ward,
10% ICU).
Among over 65 (8% of the sample and 68% of hospitalisations), vaccinated patients
had a significantly lower risk of being admitted to ordinary wards compared to not
vaccinated: Odds Ratio(OR)=0.40(CI:0.35-0.48); to ICU: OR=0.26(CI:0.15-0.47)
and to die: OR=0.39(CI:0.29-0.52).
These risks were even lower for vaccinated with booster compared to
unvaccinated. Suggestively, also among vaccinated patients those with booster
showed decreased risk of hospitalisation: OR=0.54(CI:0.42-0.67); and death:
OR=0.39(CI:0.25-0.61).
Similar associations were found in age range 30-65.
Finally, average duration of ICU stay was significantly longer for unvaccinated
people compared to vaccinated (9-6 days; p<0.003), especially in over 65 (11-6
days; p<0.05).
Conclusion: Results suggest that vaccination played a protective role against
severe disease, even during Omicron variant period and especially in the most
at-risk age groups.
Additional/booster dose have granted a greater protection compared to the
primary cycle, supporting its administration policy.
The shorter ICU stay of vaccinated people suggests that vaccination could have
made recovery faster
2023
- Epidemiological update of human cases of Toscana Virus infections in the Emilia-Romagna region in the period 2010-2022
[Abstract in Rivista]
Azzalini, Daniela; Righi, Elena; Diegoli, Giuseppe; Matteo, Giulio; Mattivi, Andrea; Belloli, Gian; Mattei, Giovanna
abstract
Background and Objective: Toscana virus (TOSV) infection often occurs asymptomatically or with mild symptoms (asthenia, fever, headache) but it can also generate neurological clinical pictures (meningitis, encephalitis). This epidemiological update describes the trend of human confirmed cases of tosv in the period 2010-2022 in Emilia-Romagna region and the main characteristics of the population involved.
Methods: The elaborations refer to the notifications of infectious diseases, on the regional web-based system “Surveillance of Infectious Diseases” (SMI), provided by ministerial decree 15/12/90, based on the Arboviroses surveillance system (dgr 531/2022) of the 2022 Emilia-Romagna regional plan for the surveillance and
control of Arboviroses (PSCA).
Results: In the period 2010-2022, 568 confirmed cases of TOSV were notified. The trend of reports of TOSV infections was variable: a minimum number of cases in 2011 (15 cases) and two peaks in 2013 and 2022 (88 cases and 109 cases, respectively). During the period 2010-2021 we observed a peak of cases in August, in 2022 the peak was observed one month later. In all years, TOSV infection was
prevalent in males. In terms of incidence the most affected age group was 25-44 years followed by 45-64 years and over 65. Referring to 2022, we observed a wide overlap between the areas where more human TOSV infections were notified and
the areas where more sandflies were caught. During the period 2013-2022 TOSV infections manifested mainly with meningitis, except in 2018 when we recorded more cases of encephalitis.
Conclusions: TOSV infections represent an emerging public health concern. The aim of the PSCA and the Emilia-Romagna region surveillance system is to rapidly identify TOSV infections’ cases and to stimulate behaviors aimed at individual protection and prevention of the vector’s spread in order to correctly invest future
resources.
2023
- Home management of Covid-19 pneumonia in the early phases of the pandemic: analysis of real-life data of General Practitioners in the Province of Modena from the MAGMA study.
[Articolo su rivista]
Ugolini, Giulia; Serafini, Alice; Palandri, Lucia; Giansante, Chiara; Fornaciari, Davide; Marietta, Marco; Padula, Maria Stella; Stefani, Elisa; Righi, Elena; Riccomi, Silvia
abstract
Primary care management of Covid-19 pneumonia in the Province of Modena in the early phases of the pandemic: data integration from MAGMA study. Retrospective study on patients affected of Covid-19 and followed by General Practitioner from March 2020 to April 2021. 5340 patients were studied, 27% of them developed pneumoniae. Among these, most of them were managed entirely at home with an elevated intensity of care. Daily remote monitoring and home visits, together with a personalized pharmacological treatment, especially for the most severe forms, appeared to be the most effective interventions in reducing hospitalizations.
2023
- It's (not) rocket science! a quick guide to a successful scientific communication in public health
[Abstract in Rivista]
Palandri, Lucia; Filippini, Tommaso; Ferrari, Eleonora; Lugli, Camilla; Odone, Anna; Grignolio, Andrea; Righi, Elena; Vinceti, Marco
abstract
A Brief Outline Of The Overall Workshop: Our workshop is intended to act as an
overview of effective Public Health communication. We will examine various
contexts, beneficiaries, and actors in Preventive Medicine and Public Health
communication, stressing the importance of effective knowledge transfer in this
field.
* First sub-session “HOW TO: COMMUNICATE DATA TO HEALTH PROFESSIONALS”
(20 min):
* How to: Data Visualization - Lucia Palandri, MD, DrPH, PhDc
* How to: Digital Communication - Prof. Tommaso Filippini, MD, DrPH, PhD
- [HALF-TIME - 10 min]: DO’S AND DON’TS: INFOGRAPHICS FOR HEALTH
PROFESSIONALS VS GENERAL PUBLIC - Eleonora Ferrari, MD; Camilla Lugli, MD
* Second sub-session “COMMUNICATE HEALTH TO PEOPLE: SUCCESSFUL
EXAMPLES” (20 min):
* Leo and Giulia - Prof. Anna Odone, MD, MSc, MPH, PhD
* Vaccine Pills on TV - Prof. Andrea Grignolio, MA, PhD
* Q&A session (10 min)
Moderator: Prof. Elena Righi, PhD
Specific Aims/Objectives And Component Parts
As Public Health professionals and residents, COVID-19 pandemic had a significant
impact on our work, shedding light on a major issue: communication. As a matter
of fact, in the last few years, scientific communication has undoubtedly been
a challenge in two ways. On one hand, communication has been difficult even
among professionals due to the significant volume of data constantly gathered
and analyzed during the pandemic. On the other hand, we faced some difficulty
with the necessity to constantly interface with the population in an infodemic
setting.
Both challenges should be considered as important priorities in public health: the
lessons learnt from the pandemic (and beyond) should routinely and inextricably
guide us in carrying out our roles as PH specialists.
Hence, our necessity to delve into this topic and share what we have learnt with
coworkers. To this end, we chose to organize our workshop into two sections. A
first skill-building sub-session will be dedicated to the communication of scientific
information and data among health professionals and “insiders”. In the second
sub-session we would like to present a couple of examples of successful general
public scientific communication campaigns. We will merge the two sub-session
with a practical guide about do’s and don’ts in scientific posters and general public
infographic creation.
The Key Questions That The Workshop Will Address
- How to present scientific findings and relevant data to scientists and health
professionals? How to make data more comprehensible? - How to deliver a clear message and maintain public trust in science through
successful campaigns?”
2023
- Maternal phthalate exposure and dietary habits during pregnancy: what do we need to look for?
[Abstract in Rivista]
Scasserra, Maria; Maione, Domenico; Palandri, Lucia; De Pasquale, Lisa; Casalucci, Marta; Uguzzoni, Francesco; Lorenzon, Antonio; Facchinetti, Fabio; Iughetti, Lorenzo; Trevisani, Viola; Arletti, Maria; Lucaccioni, Laura; Righi, Elena
abstract
Background and Objectives: Phthalates are chemical products widely used as
plasticizers, potentially harmful, especially for their antiandrogenic effects in
specific populations, such as pregnant women and newborns. Ingestion is an
important exposure pathway, however specific exposure sources and drivers are
mainly unknown. The aim of this study was to evaluate the association between
dietary and cooking habits during pregnancy and phthalates exposure at delivery.
Methods: 197 women were recruited after delivery, in a single-center prospective
cohort study at Modena’s University Hospital (Italy), from January 2019 to October
2020. Exposure to 6 phthalates was assessed in urine samples and expressed as
µg/g of urinary creatinine. Pregnancy, dietary and cooking habits were recorded
by ad hoc questionnaire. Descriptive statistics and bivariate analyzes were
performed.
Results: Overall, exposure resulted widespread in women at delivery. In women
usually boiling food, urinary levels of Monobenzylphthalate (MBzP) (3.4±2 vs
4.7±3.3 μg/g) and Mono-2-ethylhexylphthalate (MEHP) (2.3±1.8 vs 5.2±15.2
μg/g) were significantly lower, whereas in women usually frying food, monon-butylphthalate (MnBP) appeared significantly higher (23.2±59.6 vs 9.8±11.5
μg/g). Low fruit consumption during pregnancy was associated with higher MnBP
concentrations compared to daily consumption (39.3±83.1 vs 10.6±11.5 μg/g).
Concentrations of monoethylphthalate (MEP) appeared higher in women who
consumed cheese, eggs and fish. Daily consumption of red meat, beef and pork
was associated with higher levels of di(2-ethylhexyl)phthalate (DEHP) metabolites.
Conclusion: No strong association among exposure and dietary habits was
observed, even though urinary levels of some phthalates resulted higher in women
frequently consuming fat food and lower when consuming fruits or choosing
healthier cooking methods. Surprisingly, no correlation appeared with packaged
foods and packaging material. Further studies are needed to better elucidate
ingestion exposure pathways with a greater focus on alternative sources of
contamination such as food production, processing and transportation to better
guide evidence-based policy making.
2023
- Parenting stress: socio-economic determinants before and during the covid-19 pandemic. results of an italian cross-sectional study
[Abstract in Rivista]
Fasano, Marco; Iughetti, Lorenzo; Palandri, Lucia; Pasquale, Lisa; Ferrari, Eleonora; Trevisani, Viola; Passini, Erica; Lucaccioni, Laura; Righi, Elena
abstract
Background and objective: Parenting can be a stressful experience and in the
context of a pandemic it can represent a challenge for many families. The aim
of this study was to investigate socio-demographic factors related to parenting
stress before and after the SARS-CoV-2 outbreak in Italian parents living in
Modena (Italy).
Methods: From September 2019 to May 2021, 80 parents of 6 months healthy
children were enrolled in a prospective cohort study at the local University
Hospital and filled in the Parenting Stress Index Short Form (PSI-SF), a validated
questionnaire measuring parenting stress, well-known in clinical practice for its
reliability and simplicity of use. PSI scores over the 90th percentile of the Italian
population distribution were considered indicative of a highly stressful condition.
The role played by different socio-demographic factors in increasing PSI score
was tested by chi-square test in the whole sample and by stratifying parents
according to the evaluation time (PRE-COVID and COVID period).
Results: Overall, 11% of parents reported high stress scores and prevalence was
higher during lockdown (15% vs 6%). In the COVID group, higher scores were
observed in younger mothers (17%), higher educated parents (16% and 23%
of mothers and fathers respectively), having only one child (18%) and living in
the urban environment (23%), regardless of infant’s gender. In the PRE-COVID
group higher stress scores were reported mainly by parents with more than one
child (10%), with male children (9%), and by mothers with lower education (8%). Nevertheless, differences were often not statistically significant.
Conclusion: Different socio-demographic factors appear to be related to higher
parenting stress and our results suggest that they could show inverse trends
in different conditions. Parenting stress in difficult circumstances must be
addressed carefully and promptly and specific public health interventions for
families with special needs must be planned and implemented.
2023
- Perinatal and postnatal exposure to phthalates and early neurodevelopment at 6 months in healthy infants born at term
[Articolo su rivista]
Lucaccioni, Laura; Palandri, Lucia; Passini, Erica; Trevisani, Viola; Calandra Buonaura, Filippo; Bertoncelli, Natascia; Talucci, Giovanna; Ferrari, Angela; Ferrari, Eleonora; Predieri, Barbara; Facchinetti, Fabio; Iughetti, Lorenzo; Righi, Elena
abstract
Background: Phthalates are non-persistent chemicals largely used as plasticizers and considered ubiquitous pollutants with endocrine disrupting activity. The exposure during sensible temporal windows as pregnancy and early childhood, may influence physiological neurodevelopment.
Aims and Scope: The aim of this study is to analyze the relationship between the urinary levels of phthalate metabolites in newborn and infants and the global development measured by the Griffiths Scales of Children Development (GSCD) at six months.
Methods: Longitudinal cohort study in healthy Italian term newborn and their mothers from birth to the first 6 months of life. Urine samples were collected at respectively 0 (T0), 3 (T3), 6 (T6) months, and around the delivery for mothers. Urine samples were analyzed for a total of 7 major phthalate metabolites of 5 of the most commonly used phthalates. At six months of age a global child development assessment using the third edition of the Griffith Scales of Child Development (GSCD III) was performed in 104 participants.
Results: In a total of 387 urine samples, the seven metabolites analyzed appeared widespread and were detected in most of the urine samples collected at any time of sampling (66-100%). At six months most of the Developmental Quotients (DQs) falls in average range, except for the subscale B, which presents a DQ median score of 87 (85-95). Adjusted linear regressions between DQs and urinary phthalate metabolite concentrations in mothers at T0 and in infants at T0, T3 and T6 identified several negative associations both for infants’ and mothers especially for DEHP and MBzP. Moreover, once stratified by children’s sex, negative associations were found in boys while positive in girls.
Conclusions: Phthalates exposure is widespread, especially for not regulated compounds. Urinary phthalate metabolites were found to be associated to GSCD III scores, showing inverse association with higher phthalate levels related to lower development scores. Our data suggested differences related to the child’s sex.
2023
- Present and future of Home Care by GPs in the Province of Modena (Italy): a descriptive study with a qualitative insert, the MAGMA Home Study.
[Abstract in Atti di Convegno]
Serafini, A; Borellini, E; Fornarciari, D; Ghirotto, L; Kurotschka, P; Palandri, L; Riccomi, S; Righi, E; Stefani, E; Ugolini, G; Feltri, G.
abstract
Background:
The increase in life expectancy, in disabilities and in the number of elderly living alone represent a challenge
for healthcare services and in particular for GPs as an increasing number of patients require Home Care (HC).
Rumors spread among the population claiming that “GPs no longer make house calls'' while Italian GPs’
perceive an increasing workload for HC. At present, we are not aware of any study performed in Italy
describing the HC activity of GPs and their perceptions about.
Research questions:
How is HC actually organized in the Province of Modena and how many home visits do GPs perform each
year, to which patients and with what outcomes?
What do physicians, nurses, patients and caregivers think about the HC service?
Method:
We'll conduct a retrospective descriptive study from the GP’s EMR-data through a SQL extraction in Modena
Province (Italy), led by GPs-investigators in collaboration with the Local Health Authority and the University
Department of Public Health. The variables will characterize both GPs and patients (socio-demographic data,
comorbidities and socio-economic status), the volume and type of HC delivered, and their outcomes. A
collection of qualitative data regarding experience and reflection of GPs, nurses, patients and caregivers will
be performed through Focus Groups. The inclusion in the retrospective descriptive study will be on a voluntary
basis, and all GPs will be asked to participate. Based on previous studies, we expect to include at least 10%
of GPs. For participating in the Focus Group, GPs, nurses, patients and caregivers will be randomly extracted
from the HC lists and asked to take part. The main outcomes will be the number and type of HC performed by
each GPs and hospitalizations, deaths and ED access rates. The descriptive data will be
2023
- SARS-CoV-2 incidence and hospitalisation in South Tyrol (Italy): a population-based ecological study
[Abstract in Rivista]
Cristofor, Cd; Lorenzon, A; Palandri, L; Uguzzoni, F; Lozza, F; Poluzzi, R; Rizzi, C; P, Bertoli; Zerzer, F; Righi, E
abstract
Literature associating SARS-CoV-2 spread to environmental
variables such as altitude, tourism, vaccination adherence and
demographics, is inconclusive and contrasting. This study
aimed at studying these relationships during the first unrestricted winter in South Tyrol, a multicultural Italian alpine
province.
Methods:
An ecological study was performed, based on the 20 districts of
the area. Data about incidence and hospitalization between
November ’21 and February ’22 was collected and associated to
geographical, demographic and health-related characteristics
via bivariate analyses.
Results:
Incidence (range: 15% - 22%) and hospitalization (range:
overall = 0.09% - 0.26%/ intensive care unit (ICU) = 0 -
0.06%) varied widely among districts. Incidence showed positive correlations with average altitude (Rho = 0.62,
p < 0.001), tourist amount (0.54, p < 0.04) and average family
size (0.66, p < 0.005); whereas negative ones with vaccination
coverage (-0.62, p < 0.04) and population density (-0.44,
p < 0.05). Similar trends were observed for ICU admissions.
Incidence was significantly higher in Ladin speaking districts
and lower in Italian ones, while ordinary wards admission
appeared lowest in Ladin districts and higher in the Italian
ones, as well as close to main cities and hospitals.
Conclusions:
Living in urban districts, geographically and linguistically
closer to the Health Authorities, may have played a protective
role against infection and severe disease, through an increased
adherence to public health preventive measures. The concomitant higher rate of admissions might be due to the easier
access to the structures. By contrast, infection spread was
higher in rural and sparsely populated districts, associated with
greater winter tourism and family sizes, but also characterized
by lower herd immunity and institutional closeness. More
attention should be paid to communities with special needs
(geographical and cultural) to ensure equitable means for
future pandemics.
2023
- The Territorial Operative Center: an innovative management for Assisted Hospital Discharges in the health district of Vignola, Modena, Italy
[Abstract in Rivista]
Barbieri, Riccardo; Casoni, Federica; Menabue, Valeria; Righi, Elena
abstract
Background: As part of the National Recovery and Resilience Plan (NRRP 2021), Mission 6 should provide for the creation of proximity networks, structures of intermediate care and telemedicine in order to improve territorial healthcare: these interventions, regulated by Ministerial Decree 77/2022, will lead to the strengthening and the implementation of Community Houses and Hospitals and
to the development of Territorial Operative Centers (COT).
Objective: COT is an organizational model that performs a function of coordination of taking care of the patient and connection between services and professionists involved in different settings. The role of the COT is to facilitate transition from the hospital to the territory and to reduce the risk of riadmission and improper use
of Emergency Department.
Methods: In the health district of Vignola, COT highlights the importance of building an outlined process for taking care of frail patients on assisted hospital discharges (AHD). The management of this process should consider the peculiarities of territory, which is large and heterogeneous, characterized by both flat areas with high population density and mountainous regions with low population density. COT will be placed inside Vignola’s new Community
House. An analysis of indicators related to the hospitalization of frail patients will be performed after the introduction of the COT, in order to evaluate its impact compared to the current model and to verify an improvement on AHD.
Results: COT’s functions on AHD would include:
* receive and decode reports from hospital;
* evaluate health needs through multidimensional assessment, identifying the most appropriate program for each patient;
* verify the start of the personalised program and monitore its progress over time.
Conclusions: The originality of this project is to evaluate the role of the COT in the improvement of frail patient’s journey. If the effectiveness were confirmed, this project should be standardize at the provincial level.
2023
- The effects of primary care monitoring strategies on COVID-19 related hospitalisation and mortality: a retrospective electronic medical records review in a northern Italian province, the MAGMA study
[Articolo su rivista]
Serafini, Alice; Palandri, Lucia; Kurotschka, Peter Konstantin; Giansante, Chiara; Sabattini, Maria Rita; Lavenia, Martina Alfina; Scarpa, Marina; Fornaciari, Davide; Morandi, Matteo; Bellelli, Francesco; Padula, Maria Stella; Righi, Elena; Ugolini, Giulia; Riccomi, Silvia
abstract
Background: Most symptomatic SARS-CoV-2 infections produce mild to moderate symptoms. Although most patients are managed in the outpatient setting, little is known about the effect of general practitioners' (GP) management strategies on the outcomes of COVID-19 outpatients in Italy. Objectives: Describe the management of Italian GPs of SARS-CoV-2 infected adult patients and explore whether GP active care and monitoring are associated with reducing hospitalisation and death. Methods: Retrospective observational study of SARS-CoV-2 infected adult outpatients managed by GPs in Modena (Italy) from March 2020 to April 2021. Information on management and monitoring strategies, patients' socio-demographic characteristics, comorbidities, and outcomes (hospitalisation and death due to COVID-19) were retrieved through an electronic medical record review and analysed descriptively and through multiple logistic regression. Results: Out of the 5340 patients from 46 GPs included in the study, 3014 (56%) received remote monitoring, and 840 (16%) had at least one home visit. More than 85% of severe or critical patients were actively monitored (73% daily) and 52% were visited at home. Changes over time in patients' therapeutic management were observed in concordance with the guidelines' release. Active daily remote monitoring and home visits were strongly associated with reduced hospitalisation rate (OR 0.52, 95% CI 0.33-0.80 and OR 0.50, 95% CI 0.33-0.78 respectively). Conclusion: GPs effectively managed an increasing number of outpatients during the first waves of the pandemic. Active monitoring and home visits were associated with reduced hospitalisation in COVID-19 outpatients.
2023
- The influence of geographical factors on COVID-19 outbreak: A literature review
[Abstract in Atti di Convegno]
Coratza, Paola; Ghinoi, Alessandro; Palandri, Lucia; Righi, Elena; Rizzi, Cristiana; Soldati, Mauro; Vandelli, Vittoria
abstract
A significant number of papers focusing on the relationships between COVID-19 diffusion and geographic factors is available in literature. The same applies to the use of geographic techniques (e.g., spatial tools and mapping) for the study of the pandemic. Although the literature on these topics is already abundant, a detailed and comprehensive review is still lacking.
In this context, the purpose of this paper is to fill the existing gap by presenting a literature review of geographical studies dealing with the COVID-19 pandemic. The review is aimed at: i) understanding the role of geographic/territorial determinants (e.g., geographic location of confirmed cases, climatic and environmental characteristics, urbanization) in the spread of COVID-19; ii) identifying common approaches, materials, and methods used in the study of the COVID-19 outbreak from a geographical perspective; iii) recognising possible research gaps to address future in-depth analyses.
To achieve these goals a literature review was made concerning the application of geographical approaches for the study of one or more geographical factors/variables, as well as socioeconomic factors in relation to the outbreak and diffusion of the COVID-19 pandemic. The main academic literature databases were inquired. More than 80 papers were reviewed and categorized according to different criteria, e.g., considered variables, investigated period, spatial and temporal resolution and applied methodologies.
This research is part of an interdisciplinary project (“DISCOV19”) funded by the University of Modena and Reggio Emilia and aiming at identifying the main vulnerability and risk factors related to COVID-19 outbreak and at formulating prevention and management schemes with a focus on the Province of Modena (Northern Italy). The investigation crosses different disciplines: i) public health epidemiology, investigating the contagion modalities and health and socio-demographic predisposing factors; ii) economic-statistical methodology, pointing out the structural characteristics of the networks that convey the contagion and the main social, technological and management vulnerabilities with respect to COVID-19 spread; iii) geography and geomorphology, for thematic mapping and spatial analysis of COVID-19 outbreak and understanding the role of environmental and physical-geographical factors on COVID-19 incidence. The review here presented fits into this context being one of the first outputs of the project implementation.
2023
- The shape of water - preliminary data from a cluster of patients infected by Mycobacterium saskatchewanense in Haemodialysis setting in Emilia-Romagna, Northern Italy
[Abstract in Rivista]
Ferrari, Eleonora; Vecchi, Elena; Mattei, Giovanna; Belloli, Gian; Diegoli, Giuseppe; Monte, Paola; Santoro, Antonio; Palma, Alessandra; Amadori, Nicola; Falcone, Patrizia; Patuelli, Melania; Palandri, Lucia; Vinceti, Marco; Righi, Elena
abstract
Background and Objective: Nontuberculous mycobacteria (NTM) are common environmental contaminants and, as opportunistic pathogens, they can colonize/infect immunocompromised patients. Our work Aims to report the main features of a cluster of haemodialysis patients infected by Mycobacterium saskatchewanense, and to describe the infection prevention and control (IPC) strategies implemented accordingly. Methods: We conducted a descriptive analysis of data coming from the infectious diseases data stream of the Emilia-Romagna Region. Spectrometric and DNA-sequencing analyses in ultrafiltered liquid were done in the regional reference laboratory, while blood cultures were performed in the local hospital laboratory. Results: Between 04/01/2022 and 18/07/2022, a cluster of 6 patients (3 males and 3 females, median age 63.5 years) with positive blood culture for Mycobacterium saskatchewanense was reported in two HUB hospitals of the Region Emilia-Romagna, Northern Italy. All patients underwent online haemodiafiltration before the symptom’s onset; water samples from the dialysis machines’ ultrafilters also tested positive. The key clinical features reported were varied, including weight loss, asthenia, gastrointestinal symptoms, cough, night sweats, recurrent fever of unknown origin. In addition, common Findings were cytopenia, increased blood levels of systemic inflammation markers, splenomegaly, osteo-medullary granulomas, and pulmonary pathologic imaging. Conclusions: The application of the best IPC strategies (clinical and environmental surveillance, switch to traditional haemodialysis and heat disinfection...) is currently supervised by a regional interdisciplinary team, and preliminary data indicate positive outcomes. As a precaution, considering the extreme fragility of haemodialysis patients, a constant epidemiological monitoring based on clinical and diagnostic criteria is still in place, and regular environmental sampling is being performed.
2023
- Validation of the collaborative outcomes study on health and functioning during infection times (COH-FIT) questionnaire for adults
[Articolo su rivista]
Solmi, Marco; Thompson, Trevor; Estradé, Andrés; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schloegelhofer, Monika; Aschauer, Elena; Schneeberger, Andres; Huber, Christian G; Hasler, Gregor; Conus, Philippe; Do Cuénod, Kim Q; von Känel, Roland; Arrondo, Gonzalo; Fusar-Poli, Paolo; Gorwood, Philip; Llorca, Pierre-Michel; Krebs, Marie-Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna-Żydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kamiński, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan-Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Manková, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer-Lindenberg, Andreas; Kahl, Kai G; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pal; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana V; Valvassori, Samira S; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu-Bernabeu, Alvaro; Cáceres, Antonia San José; Arango, Celso; Díaz-Caneja, Covadonga M; Hidalgo-Mazzei, Diego; Vieta, Eduard; Gonzalez-Peñas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A; Verdolini, Norma; Andrlíková, Eva; Janků, Karolina; Millan, Mark John; Honciuc, Mihaela; Moniuszko-Malinowska, Anna; Łoniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Łukasz; Marlicz, Maria; Sowa, Paweł; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Machado, Ana Inés; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching-Fang; Guu, Ta-Wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winkel, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi-Bahmani, Dena; Sheybani, Farshad; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errazuriz, Antonia; Crossley, Nicolas; Ristic, Dragana Ignjatovic; López-Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb-Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F; Daskalakis, Jeff; Yatham, Lakshmi N; Yang, Lin; Okasha, Tarek; Dahdouh, Aïcha; Gerdle, Björn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Jamei, Yasser Abu; Weiser, Mark; Correll, Christoph U
abstract
Background: The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score". Methods: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. Results: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex. Conclusions: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health.
2022
- A Knowledge, Attitude, and Perception Study on Flu and COVID-19 Vaccination during the COVID-19 Pandemic: Multicentric Italian Survey Insights
[Articolo su rivista]
Cristina, Genovese; Claudio, Costantino; Anna, Odone; Giuseppe, Trimarchi; Fauci Vincenza, La; Francesco, Mazzitelli; Smeralda, D'Amato; Raffaele, Squeri; Covid-Risk Perception Group (Alessandra Casuccio, The; Pia Fantini, Maria; Azara, Antonio; Castaldi, Silvana; Righi, Elena; Bianco, Aida; Cosentino, Sofia; Mistretta, Antonio; Gabutti, Giovanni; Prato, Rosa; Icardi, Giancarlo; Fabiani, Leila; Siliquini, Roberta; Bonaccorsi, Guglielmo; Torre, Ida; Pavia, Maria; Villari, Paolo; Messina, Gabriele; Majori, Silvia; Restivo, Vincenzo; Gori, Davide; Deiana, Giovanna; Palandri, Lucia; Panciroli, Giovanni; Licata, Francesca; Marranzano, Marina; Stefanati, Armando; Fortunato, Francesca; Martinelli, Domenico; Panatto, Donatella; Amicizia, Daniela; Moretti, Annalucia; Di Risio, Damiana; Voglino, Gianluca; Bert, Fabrizio; Lorini, Chiara; Pennino, Francesca; Di Giuseppe, Gabriella; Andrea, ; Marzuillo, Carolina; Rivieri, Cesare; Nante, Nicola; Tardivo, Stefano; Moretti, Francesca; Ragusa, Rosalia; Signorelli), Carlo
abstract
In January 2020, Chinese health authorities identified a novel coronavirus strain never before isolated in humans. It quickly spread across the world, and was eventually declared a pandemic, leading to about 310 million confirmed cases and to 5,497,113 deaths (data as of 11 January 2022). Influenza viruses affect millions of people during cold seasons, with high impacts, in terms of mortality and morbidity. Patients with comorbidities are at a higher risk of acquiring severe problems due to COVID-19 and the flu-infections that could impact their underlying clinical conditions. In the present study, knowledge, attitudes, and opinions of the general population regarding COVID-19 and influenza immunization were evaluated. A multicenter, web-based, cross-sectional study was conducted between 10 February and 12 July 2020, during the first wave of SARS-CoV-2 infections among the general population in Italy. A sample of 4116 questionnaires was collected at the end of the study period. Overall, 17.5% of respondents stated that it was unlikely that they would accept a future COVID-19 vaccine (n = 720). Reasons behind vaccine refusal/indecision were mainly a lack of trust in the vaccine (41.1%), the fear of side effects (23.4%), or a lack of perception of susceptibility to the disease (17.1%). More than 50% (53.8%; n = 2214) of the sample participants were willing to receive flu vaccinations in the forthcoming vaccination campaign, but only 28.2% of cases had received it at least once in the previous five seasons. A higher knowledge score about SARS-CoV-2/COVID-19 and at least one flu vaccination during previous influenza seasons were significantly associated with the intention to be vaccinated against COVID-19 and influenza. The continuous study of factors, determining vaccination acceptance and hesitancy, is fundamental in the current context, in regard to improve vaccination confidence and adherence rates against vaccine preventable diseases.
2022
- A review of European and international phthalates regulation: focus on daily use products
[Abstract in Rivista]
Monti, M; Fasano, M; Palandri, L; Righi, E
abstract
Background: Phthalates are known endocrine disruptors used in a wide range of industrial and household products. With globalization and interdependency of the supply chain, the control of toxic substances in daily use products has become more challenging. Many countries have implemented laws and policies to limit their use, although these regulations are neither unified nor seem adequate, as studies suggest that more vulnerable populations (children, pregnant women) are exposed to phthalates that should be restricted.
Methods: For seven of the most used phthalates - bis(2-Ethylhexyl) phthalate (DEHP), Butylbenzyl phthalate (BBP), Dibutyl phthalate (DBP), Diisobutyl phthalate (DIBP), diisononyl
phthalate (DINP), diisodecyl phthalate (DIDP), Di-n-octyl
phthalate (DNOP) - we performed an online research on institutional sites and dedicated Agencies of the three largest
world economies (European Union (EU), United States of America (USA), China) to analyze their uses and bans, focusing on Food Contacts Materials (FCM), cosmetics, toys and childcare articles.
Results: In the EU area DEHP, BBP, DBP and DIBP are not allowed in toys and childcare articles above 0,1% by weight. All the seven phthalates are also severely restricted in FCM, and mostly banned as cosmetic components. In the USA, there is no
formal prohibition to their use in cosmetics but phthalates are
mostly limited in FCM. In China, the limit for DBP, BBP, DEHP, DNOP, DINP, DIDP in plastic toys is 0,1% of the material composition; regarding cosmetics DEHP, BBP and DBP are prohibited.
Conclusions: We found substantial differences in the international legislation. Though there is essential agreement on toys and childcare articles legislation, there are many discrepancies about FCM and cosmetics. Further research is needed to compare the regulation with data about concentrations of these ubiquitous elements, to underline the real exposure and risk in different populations and to improve knowledge and safety on this matter.
2022
- Alimentazione complementare nella prima infanzia e aderenza alle raccomandazioni: uno studio cross-sectional nella provincia di Modena
[Abstract in Rivista]
Casalucci, Ma; Palandri, L; De Pasquale, L; Fasano, M; Ferrari, A; Rizzi, C; Trevisani, V; Passini, E; Lucaccioni, L; Righi, E
abstract
Introduzione
I modelli nutrizionali delle prime fasi della vita possono condizionare la salute futura dell’individuo, influenzando il rischio di sviluppare malattie croniche. Tuttavia, le numerose
indicazioni sull’Alimentazione Complementare (AC) non risultano univoche ed evidence based e questo si traduce spesso in comportamenti eterogenei. Lo scopo dello studio è quello di descrivere l’AC di un gruppo di bambini modenesi nelle primissime fasi dello svezzamento e la loro aderenza alle raccomandazioni italiane ed europee.
Materiali e metodi
Nel triennio 2019-2021 le abitudini alimentari di 75 bambini
(età media 6,2 ± 0,6 mesi) sono state investigate tramite un
questionario compilato dalle mamme su base volontaria dopo rilascio di consenso informato.
rilascio di consenso informato. I dati raccolti sono stati sintetizzati tramite statistiche descrittive.
Risultati
Oltre il 93% e il 96% dei bambini consuma giornalmente rispettivamente frutta e verdura e il 44% ha introdotto questi
alimenti da più di un mese. Il 78% assume cereali, il 42% quotidianamente.
Il 67% ha già iniziato a consumare carne mentre
i legumi compaiono nella dieta solamente nel 51.4% del
campione, spesso saltuariamente. Anche il consumo di pesce
risulta limitato: il 72% dei bambini non lo mangia o lo assume
raramente. Solamente 6 bambini (8%) mangiano uova. Relativamente ai derivati del latte, yogurt e formaggi sono assunti rispettivamente dal 51% e 47% del campione. Il 63% prosegue con l’allattamento materno. Infine, 8 bambini bevono camomilla mentre nessun bambino assume tè.
Conclusioni
Complessivamente, nonostante sia all’inizio percorso alimentare, il campione presenta un’AC varia e sembra aderire alla dieta mediterranea,
raccomandata per adulti e bambini a partire dall’inizio
dello svezzamento. Si nota tuttavia ancora una certa prudenza nell’introduzione di alcuni cibi non supportata dalle LG più recenti.
Riguardo al ferro, ad esempio, le attuali LG europee raccomandano l’assunzione sia di carne che di legumi, ma il consumo di questi ultimi appare limitato. Non tutto il campione segue, inoltre, le raccomandazioni di non assumere fino ai 3 anni thè e camomilla perché tannino e altre sostanze riducono la biodisponibilità di ferro. Gli alimenti tradizionalmente considerati allergizzanti appaiono poco diffusi, nonostante l’indicazione di introdurli in tempi successivi sia ormai ampiamente superata. Interventi di Sanità pubblica mirati a fornire alla famiglia indicazioni sulla corretta alimentazione, varia e rispettosa dei contesti socioculturali, sempre aggiornate e in accordo con corretti modelli nutrizionali per la prima infanzia, potrebbero rappresentare un valido sostegno per pediatri e famiglie in una fase così delicata della crescita del bambino.
2022
- Applicazione del Containment and Health Index ad una realtà locale: valutazione timeline delle restrizioni adottate nella provincia di Modena durante la pandemia SARS-COV-2 nel periodo febbraio 2020 – agosto 2021
[Abstract in Rivista]
Rizzi, C; Palandri, L; Iseppi, R; Lugli, C; Ferrari, A; De Pasquale, L; Casalucci, Ma; Fasano, M; Righi, E
abstract
Introduzione
Durante la pandemia da SARS-CoV-2 si è resa necessaria l’applicazione di interventi restrittivi non farmacologici al fine di ridurre la circolazione virale. Le autorità italiane hanno più
volte introdotto o sospeso interventi diretti alla popolazione
generale, determinando cambiamenti radicali nella quotidianità per oltre due anni. Quantificare il grado di restrizione nell’analisi dell’efficacia delle suddette misure è ancora argomento di discussione.
Questo studio ha l’obiettivo di valutare l‘applicabilità del Containment and Health Index (CHI), score internazionalmente validato, al complesso della normativa emanata nella provincia di Modena, al fine poi di confrontare le restrizioni locali con quelle attuate a livello nazionale e internazionale.
Materiali e metodi
La normativa nazionale e locale emessa tra Febbraio 2020 e
Agosto 2021 è stata valutata per calcolare CHI, score compreso tra 0 (nessuna restrizione) e 100 (massime restrizioni).
Questo indice corrisponde alla media dei valori assegnati a 8
diverse categorie restrittive sociali (chiusura scuole; chiusura
luoghi di lavoro e adozione di lavoro da remoto; cancellazione eventi pubblici; divieto assembramenti; riduzione trasporti pubblici; ordinanze “stay at home”; riduzione movimenti nazionali ed internazionali) e 6 categorie riguardanti interventi di Sanità pubblica (adozione di campagne informative; utilizzo test diagnostici; tracciamento contatti; utilizzo mascherine; politica vaccinale; protezione soggetti fragili).
Risultati
L’analisi di 135 norme ha portato al calcolo di 62 diversi CHIscore locali. Le principali criticità emerse nella costruzione
del CHI locale riguardano il riscontro di restrizioni differenti
che andavano a ricadere in un’unica categoria interpretativa
del CHI. Gli score calcolati sul territorio italiano e provinciale
hanno andamenti simili, minimo 62,5 (luglio 2021) e
massimo 85,42 (Aprile 2020) con media superiore a 75/100
in tutto l’arco temporale considerato. Questi valori sono risultati più elevati rispetto ai valori medi europei (compresi tra 40-60/100), che hanno raggiunto i livelli di restrizione italiani solo per periodi brevi. In Italia e localmente le restrizioni più persistenti sono risultate: adozione del lavoro da remoto, divieto di assembramenti e distanziamento sociale e utilizzo di mascherine.
Conclusioni
Le principali restrizioni emanate nella provincia di Modena
consistono in interventi indirizzati prevalentemente al singolo
individuo, utili a contrastare sia la diffusione del virus SARSCoV-2 che di altre infezioni respiratorie.
Nonostante alcune criticità, CHI-score appare un valido strumento nella quantificazione delle restrizioni locali, il cui utilizzo nella salute pubblica può rappresentare una valida risorsa per studiare l’impatto dei diversi interventi restrittivi sulla diffusione di patogeni infettivi al fine di selezionare le politiche sanitarie di maggior efficacia.
2022
- Assistenza territoriale extraospedaliera dei pazienti COVID-19: quali sono state le scelte farmacologiche adottate dai medici di medicina generale della provincia di Modena nel corso della prima ondata della pandemia e di quelle successive
[Abstract in Rivista]
Ferrari, A; Palandri, L; Serafini, A; Ugolini, G; Bellelli, F; Morandi, M; Fornaciari, D; Giansante, C; Sabattini, Mr; Lavenia, Ma; Scarpa, M; Padula, Ms; Riccomi, S; Righi, E
abstract
Introduzione
La fase iniziale della pandemia SARS-CoV-2 è stata caratterizzata da una forte incertezza e mancanza di linee guida ufficiali, soprattutto riguardo la gestione farmacologica extraospedaliera dei pazienti COVID-19. L’obiettivo di questo
studio è descrivere le strategie terapeutiche dei medici
di medicina generale (MMG) e le loro variazioni nel corso
delle diverse ondate o in base alla gravità della patologia.
Materiali e metodi
È stato condotto uno studio retrospettivo che ha valutato una coorte di adulti positivi a SARS-CoV-2 (diagnosticato tramite tampone molecolare) gestiti in ambito territoriale dai MMG della provincia di Modena, da marzo 2020 ad aprile 2021.
Hanno aderito allo studio, su base volontaria, 46 MMG (10%
dei MMG della provincia di Modena). I dati clinici e quelli
relativi alla prescrizione farmaceutica sono stati estratti dalle
cartelle cliniche informatizzate.
Risultati
Sono stati analizzati un totale di 5340 pazienti affetti da
SARS-CoV-2: 3883 (73%) asintomatici o con sintomi lievi
e 1457 (27%) colpiti dalle forme più severe della patologia.
1413 pazienti (27%) non hanno ricevuto trattamenti farmacologici (94% di questi asintomatici/paucisintomatici).
Paracetamolo è stato complessivamente il farmaco più prescritto (47%), seguito da FANS (29%), antibiotici (28%), eparina (16%), steroidi (13%), ossigeno (4%) e idrossiclorochina (0,9%).
Tra la prima ondata e quelle successive è emerso un aumento della prescrizione di FANS (22% vs 30%, p < 0,01)
e una riduzione della prescrizione di paracetamolo (60% vs
46%, p < 0,001) di idrossiclorochina (11% vs 0,2%, p<0,001)
e antibiotici (41% vs 27%, p < 0,001). Specificatamente tra
le ondate si è ridotta la prescrizione di macrolidi (25% vs
15%, p < 0,001) e fluorochinoloni (4% vs 2%, p < 0,001) ed
è aumentato l’utilizzo di betalattamici (1% vs 15%, p < 0,05).
Stratificando le prescrizioni in base alla gravità dei sintomi
emerge che antibiotici, cortisone, eparina e ossigeno vengono prescritti più frequentemente nei pazienti con forme severe e il loro utilizzo in questi pazienti aumenta significativamente dalla prima ondata a quelle successive.
Conclusioni
Le scelte farmacologiche compiute dai MMG della provincia
di Modena sono cambiate in modo significativo tra la prima
ondata e quelle successive anche in seguito alla diffusione
delle prime linee guida ufficiali sulla corretta gestione territoriale dell’infezione da SARS-CoV-2. Questo evidenzia come la medicina territoriale sia recettiva e capace di adattare rapidamente le proprie risposte alla pandemia in modo corretto e coerente con le evidenze man mano disponibili e sottolinea l’importanza di interventi di supporto da parte della direzione delle Cure Primarie da svolgere sempre più in collaborazione con i MMG.
2022
- COVID-19 Pandemic: opinions and behavior of Italian general population during the first epidemic phase
[Articolo su rivista]
Genovese, C; La Fauci, V; Di Pietro, A; Trimarchi, G; Odone, A; Casuccio, A; Costantino, C; Restivo, V; Fantini, M; Gori, D; Azara, A; Deiana, G; Castaldi, S; Righi, E; Palandri, L; Panciroli, G; Bianco, A; Licata, F; Cosentino, S; Mistretta, A; Marranzano, M; Ragusa, R; Gabutti, G; Stefanati, A; Prato, R; Fortunato, F; Martinelli, D; Icardi, G; Panatto, D; Amicizia, D; Fabiani, L; Moretti, A; Di Risio, D; Siliquini, R; Voglino, G; Bert, F; Lorini, C; Bonaccorsi, G; Torre, I; Pennino, F; Pavia, M; Di Giuseppe, G; Paolantonio, A; Villari, P; Marzuillo, C; Messina, G; Rivieri, C; Nante, N; Majori, S; Tardivo, S; Moretti, F; D’Amato, S; Mazzitelli, F; Giunta, I; Lo Giudice, D; Pantò, G; Signorelli, C; Squeri, R.
abstract
Background and aim: On January 9, 2020, the World Health Organization (WHO) declared that Chinese health authorities had identified a new coronavirus strain never before isolated in humans, the 2019-nCoV later redefined SARS-CoV-2, that still today represent a public health problem. The present survey started on 10 February 2020 with the aim of a) assessing the risk perception in healthcare workers and young students, following the evolution of attitudes, perception and knowledge over time, b) provide useful information to the general population during survey.
Results: A study sample consisting of 4116 Italian individuals of both sexes was enrolled. High levels of risk perception, low perception of self-efficacy and low levels of knowledge scores (24.55 ± 5.76 SD) were obtained indicating the need for continuous population monitoring as well as further communication strategies carried out at institution levels.
Conclusion: The results of the present study could help public health authorities in carrying out informative campaigns for general population and could be an important tool in evaluating public knowledge and misperceptions during the management of the COVID-19.
2022
- COVID-19 pneumonia in the outpatient setting in Italy: a population-based observational study'
[Abstract in Atti di Convegno]
Serafini, A; Ugolini, G; Palandri, L; Kurotschka, Pk; Scarpa, M; Padula, Ms; Fornaciari, D; Lavenia, M; Morandi, M; Bellelli, F; Sabattini, Mr; Giansante, C; Righi, E; Riccomi, S.
abstract
Background: While around 80% of symptomatic SARS-CoV-2 infections are characterised by mild to moderate respiratory symptoms, two out of ten patients develop severe disease, with pneumonia being the most common clinical outcome. Little is known about the prevalence and the patient management of SARS-CoV-2 related
pneumonia in Italian general practices.
Research questions: To describe the clinical features of outpatients with SARS-CoV-2 related pneumonia and the management strategies of Italian general practitioners (GPs) in the province of Modena (Italy).
Method: Retrospective study of SARS-CoV-2 infected adult outpatients managed by their GPs from March to May
2020 to April 2021. Data on GPs’ monitoring and treatment strategies, patients’ clinical and sociodemographic
characteristics, hospitalisation and death were extracted from the GP’s electronic medical
records and were analysed using descriptive and bivariate statistics.
Results: 5340 patients from 46 GP practices were included in the analyses and among these 1457 (27%) developed
pneumoniae with (12%) or without (15%) respiratory failure. Among these, 940 (66 %) were managed entirely
in the outpatient setting by GPs. 59% of patients received paracetamol, 33 % NSAID, 59% antibiotics, 37%
corticosteroids, 47% LMWH, 14% oxygen and 3% hydroxychloroquine; significant differences were observed
in prescription patterns between the first and subsequent waves. 921 (63%) patients with pneumonia received
active monitoring while 611 (42%) were visited at home; this percentage remained stable despite the
exponential increase in the overall number of cases and the resulting GPs’ workload. 114 (8%) patients with
pneumonia died, mostly (96%) with critical disease and 27 (24%) of deaths occurred in the outpatient setting.
Conclusions: The study quantifies the important contribution of Primary Care to the management of COVID-19 outpatients with pneumonia in Italy and describes the variation of therapeutic and management strategies between the first and subsequent waves.
2022
- Casi di infezione/colonizzazione da Candida auris in Emilia- Romagna. A case series study
[Abstract in Rivista]
Ferrari, E; Vecchi, E; Mattei, G; Diegoli, G; Gagliotti, C; Ricchizzi, E; Moro, Ml; Righi, E.
abstract
Il fenomeno dell’antimicrobico-resistenza è un’emergenza di Sanità Pubblica a livello globale. In particolare,
l’European Centre for Disease Prevention and Control
(ECDC) e il Ministero della Salute hanno rinnovato l’allerta in
merito alla diffusione di Candida auris, un fungo multiresistente
che trova facile diffusione nelle strutture sanitarie e può
determinare gravi infezioni in pazienti fragili o portatori di devices, con un elevato tasso di mortalità. La finalità del presente
lavoro è descrivere i casi registrati in Emilia-Romagna, ponendo
l’accento sulle misure di infection prevention and control
e antimicrobial stewardship implementate.
2022
- Casi di infezione/colonizzazione da Candida auris in Emilia- Romagna: un aggiornamento del quadro epidemiologico.
[Abstract in Rivista]
Ferrari, E; Vecchi, E; Mattei, G; Diegoli, G; Gagliotti, C; Ricchizzi, E; Moro, Ml; Palandri, L; Righi, E
abstract
Introduzione
L’antimicrobico-resistenza è un’emergenza di Sanità Pubblica a livello globale. In particolare, l’European Centre for Disease Prevention and Control (ECDC) e il Ministero della Salute hanno rinnovato l’allerta in merito a Candida auris, un fungo multiresistente che può facilmente circolare nelle strutture sanitarie, determinando gravi infezioni in pazienti fragili o portatori di device. La finalità dell’abstract è descrivere i casi registrati in Emilia-Romagna, mettendo in luce le misure di prevenzione del rischio infettivo e le politiche di antimicrobial stewardship implementate.
Materiali e metodi
A dicembre 2021 la Regione Emilia-Romagna ha avviato un
aggiornamento della situazione epidemiologica relativa ai casi di infezione/colonizzazione da Candida auris registrati dal 2018 al 2021 (casi importati e autoctoni). La scheda di censimento indagava: numero di casi, substrato e data del primo isolamento, capacità diagnostiche dei laboratori aziendali, misure di prevenzione e controllo del rischio infettivo.
Risultati
Nel periodo 2018-2021 i casi di infezione/colonizzazione da
Candida auris registrati in Regione sono stati 15, con un’incidenza annuale variabile da 0 (2018) a 0,23 (2021) casi per 10000 ricoveri (0 casi nel 2018 e 2019, 23 casi nel 2020, 1312 casi nel 2021).
L’età media dei pazienti alla diagnosi era di 61,3 anni (66,7%
erano maschi, 43,3% femmine). Oltre la metà di loro era ricoverata in Terapia Intensiva. I casi positivi sono stati riscontrati solo in due strutture (in una erano tutti importati dalla Liguria).
Le infezioni (candidemie) sono state 3, mentre le colonizzazioni identificate su altri substrati sono state: 5 6 su lavaggi bronco-alveolari, 2 3 su urina, 4 su tamponi cutanei, 1 su catetere venoso centrale.
In Regione, oltre il 90% delle Aziende applica precauzioni da
contatto e disinfezione terminale in caso di positività a Candida auris; l’82% possiede un laboratorio interno in grado di identificare il micete.
Conclusioni
Nonostante l’incidenza ancora molto bassa, Candida auris si
configura come patogeno emergente anche in Emilia-Romagna.
Coerentemente con la letteratura, i principali fattori di rischio sembrano essere durata e intensità delle cure: i casi riscontrati si trovavano in lungodegenza o in Terapia Intensiva, dove verosimilmente è anche più attivo lo screening per Candida auris.
Ulteriori studi potranno chiarire la reale prevalenza di tale
germe e i principali fattori di rischio implicati: per favorire la
precoce individuazione del patogeno e l’applicazione delle necessarie precauzioni igienistiche, la Regione, oltre a semplificare il sistema di notifica, ha diffuso nelle Aziende indicazioni di infection prevention and control, antimicrobial stewardship e materiale informativo (fact sheet).
2022
- Early-life exposure to phthalates among infants in Italy: characterization and time trends
[Abstract in Atti di Convegno]
Righi, E; Palandri, L; Ferrari, A; Barbieri, R; Lugli, C; Trevisani, V; Passini, E; Facchinetti, F; Lucaccioni, L
abstract
BACKGROUND AND AIM: Human exposure to phthalates, endocrine disruptors, and reproductive toxicants, is ubiquitous. Urine is the matrix of choice for biomonitoring and in utero exposure is well documented. Evidence of early life exposure to phthalates is scarce. The aim of this study is to assess phthalate exposure and its changes over time in a cohort of healthy infants in the province of Modena, Italy.
METHODS: In this prospective birth-cohort study, we assessed phthalate exposure(8 metabolites of 6 phthalates)in urine samples collected from mothers just after delivery and in infants at birth, 3 and 6 months using phthalate-free bags. Mother-infant pairs were enrolled in a university hospital in Modena(Italy) between January 2019 and May 2020. After solid-phase extraction, samples were analyzed by triple Quad LC/MS Mass
Spectrometry.
RESULTS: 188 mother-infant pairs were enrolled. MEP was always detectable and showed the highest levels, increasing over time. MMP and DEHP metabolites showed as well an increasing trend, however, they were detected at lower levels, while MnBP and MBzP showed intermediate concentrations and decreasing trends over time.
Significant associations between mother-infant pairs at birth were found only for a few metabolites(MMP, MEP, and MnBP). Infant levels at 3 and 6 months appeared more related, suggesting a continuative exposure to these chemicals inside the indoor environment.
CONCLUSIONS: Phthalate exposure appears wide and extended over time. Infants were exposed to several phthalates, including those more toxic and strictly regulated in infant toys, personal care products and food contact materials in the European Union. Their unregulated use in other consumers’products, building and
decorating materials or home furniture may explain the potential exposure of at-risk groups, such as infants or pregnant women. To effectively protect the most vulnerable subjects, public health preventive and regulatory actions should address this specific issue as well.
2022
- Early-life exposure to phthalates in a population of infants from the north of Italy: characterization and time trends
[Abstract in Rivista]
Lucaccioni, L; Righi, E; Trevisani, V; Passini, E; Palandri, L; Bruzzi, P; Predieri, B; Iughetti, L
abstract
Phthalates are ubiquitous environmental contaminants and endocrine-disrupting chemicals (EDCs). Nowadays, they are considered reproductive toxicants and in-utero exposure is well documented, although evidence of early life exposure is
scarce, and needs to be described. Aim of this study is to assess
phthalate exposure and its changes over the first months of life in a cohort of healthy full term infants and their mothers from a
restricted area of the north of Italy.
2022
- Esposizione a ftalati e accrescimento corporeo in bambini della Provincia di Modena: dati preliminari di uno studio di coorte prospettico.
[Abstract in Atti di Convegno]
Lugli, C; Barbieri, R; Lucaccioni, L; Arletti, M; Trevisani, V; Palandri, L; Righi, E
abstract
Gli ftalati sono composti ampiamente usati a livello industriale nella produzione di materie plastiche, prodotti per l’igiene personale e alcuni tipi di farmaci. L’esposizione prenatale a questi composti è ampiamente documentata e, data la loro potenziale attività di interferenti endocrini, indagini epidemiologiche suggeriscono un suo possibile ruolo sull’accrescimento corporeo dei neonati. Al contrario, il ruolo esercitato dall’esposizione peri e postnatale a ftalati sull’accrescimento dei bambini durante i primi mesi di vita è stato, fino ad ora, scarsamente valutato. L’obiettivo di questo studio è quello di valutare il potenziale effetto interferente dell’esposizione peri e postnatale a ftalati sull’accrescimento corporeo e le distanze anogenitali (AGD) misurate durante i primi 6 mesi di vita in una coorte di neonati sani e nati a termine nella provincia di Modena.
Presso il reparto di Ostetricia del Policlinico di Modena da Gennaio 2019 ad Ottobre 2020 sono state reclutate, previo rilascio del consenso informato, 187 coppie mamma-bimbo. L’esposizione peri e postnatale a ftalati è stata valutata dosando 8 metaboliti dei 6 ftalati di più ampio utilizzo in urine raccolte subito dopo il parto (madri e neonati) e a 3 e 6 mesi di vita dei bambini, nei quali contemporaneamente sono stati misurati principali parametri auxologici di accrescimento corporeo e le AGD.
Ad esclusione di MiNP, tutti i composti ricercati sono risultati ampiamente diffusi nelle urine raccolte nei diversi periodi di tempo. L’elaborazione preliminare dei dati evidenzia l’esistenza di correlazioni significative tra diversi parametri di accrescimento misurati nei bambini e diversi ftalati, in particolare con i livelli di MMP e MEP rilevati nelle urine delle mamme e dei bambini. Tali correlazioni si confermano anche nei mesi di vita successivi suggerendo un potenziale effetto prolungato nel tempo di questi composti sui parametri di accrescimento corporeo e AGD.
L’esposizione a ftalati appare molto diffusa nei neonati della provincia di Modena anche se a livelli ridotti rispetto a studi precedenti. Le preliminari associazioni evidenziate tra ftalati, accrescimento corporeo e AGD suggeriscono che anche l’esposizione peri e postnatale possano avere un effetto interferente sullo sviluppo somatico e sessuale dei bambini durante i primi mesi di vita. Risulta dunque importante pianificare strategie di promozione della salute della popolazione femminile in età fertile al fine di ridurre l’esposizione a queste sostanze non solo in gravidanza ma anche nelle prime e più vulnerabili fasi di crescita dei bambini.
2022
- Esposizione peri e postnatale a ftalati in una coorte di neonati della provincia di Modena: valutazioni preliminari.
[Abstract in Atti di Convegno]
Barbieri, R; Lugli, C; Ferrari, A; Lucaccioni, L; Passini, E; Palandri, L; Righi, E
abstract
Gli ftalati, composti utilizzati come plasticizzanti in molti prodotti di uso quotidiano, possono, nell’organismo umano, agire da interferenti endocrini alterando la funzionalità ormonale e causando effetti avversi sulla salute umana.
Le urine sono la matrice biologica più utilizzata per quantificare l’esposizione a ftalati in diversi momenti della vita; tuttavia, dati relativi all’esposizione nei primi mesi di vita dei bambini sono molto limitati. L’obiettivo dello studio è quindi quello di valutare l’esposizione a ftalati in un campione di neonati della Provincia di Modena e di
analizzarne la variabilità temporale attraverso campionamenti ripetuti nei primi 6 mesi di vita.
Da gennaio 2019 ad ottobre 2020 sono state arruolate 186 coppie madre-bambino ricoverate presso il reparto di Ostetricia del Policlinico di Modena. L’esposizione peri e postnatale a ftalati è stata valutata dosando 8 metaboliti dei 6 ftalati di più ampio utilizzo in urine raccolte subito dopo il parto (madri e neonati) e a 3 e 6 mesi di vita dei
bambini.
Ad esclusione di MiNP, tutti gli ftalati ricercati sono risultati ampiamente diffusi nelle urine raccolte nei diversi periodi di tempo. Alla nascita alcune correlazioni significative sono state osservate tra le concentrazioni di ftalati osservate nelle urine delle mamme e dei bambini; tuttavia, le concentrazioni dei singoli metaboliti tendono a differire e alcuni composti mostrano livelli più elevati nelle mamme e altri nei neonati. Anche i trend temporali sono apparsi differenti per i diversi composti: i livelli di MMP, MEP, MEHHP e MEOHP evidenziano infatti trend in crescita,
mentre i valori di MnBP e MBzP nello stesso arco temporale risultano ridotti.
L’esposizione a ftalati appare ancora molto diffusa nei neonati della provincia di Modena. La concentrazione degli ftalati nelle urine di mamme e bambini risulta diversa a seconda del metabolita analizzato e del momento di raccolta, evidenziando differenze espositive importanti tra mamme e bambini. Anche i trend temporali differenziati per metabolita indicano l’esistenza di fonti di esposizione differenziate che devono essere investigate con ulteriore attenzione. Queste informazioni saranno utili per pianificare efficaci strategie di promozione della salute indirizzate alle neomamme allo scopo di ridurre l’esposizione a queste sostanze in un periodo della vita dei loro
bambini particolarmente delicato e sensibile alle alterazioni indotte da potenziali interferenti endocrini.
2022
- Exposure to phthalates, potential endocrine disruptors, in an infant cohort in Modena, Italy
[Abstract in Rivista]
Lugli, C; Palandri, L; Ferrari, A; Barbieri, R; Trevisani, V; Passini, E; Lucaccioni, L; Facchinetti, F; Righi, E
abstract
Phthalates are pollutants ubiquitous in the environment. Human exposure to phthalates and their endocrine disrupting effects have been widely studied. Therefore, the European Union forbids phthalates in toys, cosmetic and kitchenware manufacturing. However, phthalate metabolites can still be found in human biological matrices. The purpose of this study is to investigate phthalate exposure over time in a group of Italian healthy newborns. In a prospective cohort study, we enlisted 187 women who gave birth in the University Hospital of Modena, Italy, between January 2019 and May 2020. Urine samples from women after delivery and from their infants at birth, 3 and 6 months were collected and 8 metabolites of 6 phthalates were analysed. Descriptive statistics were calculated and preliminary correlation coefficients tests were performed. Monoethylphthalate (MEP) was always detectable in urine samples. MEP, monomethylphthalate and diethylhexylphthalate
metabolites showed an increasing trend over time, while monobutylphthalate and monobenzylphthalate showed decreasing levels over time. Associations between levels of phthalates metabolites in mother and infant pairs at birth were
found for a few metabolites, while metabolites in infant samples at 3 and 6 months appeared often significantly associated. Infants’ phthalate exposure in Modena is still high and prolonged over time, even to those more toxic and strictly regulated. As phthalates presence in indoor environment can be a risk factor especially for the most fragile groups of population, such as children, public Health campaigns addressing childbearing age women should stress about the risk posed by these substances and how to avoid their exposure. Moreover, regulatory actions and a stricter legislation should be considered.
2022
- Financial loss and depressive symptoms in university students during the first wave of the COVID-19 pandemic: comparison between 23 countries
[Articolo su rivista]
Tancredi, S; Burton-Jeangros, C; Ruegg, R; Righi, E; Kagstrom, A; Quesnel Vallee, A; Chiolero, A; Bracke, P; Buffel, V; Van de Velde, S; Cullati, S
abstract
Objectives: To assess the association between students’ financial loss and depressive symptoms during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and whether this association varied by countries having different levels of lockdown
measures.
Methods: This cross-sectional survey, conducted in spring 2020, included 91,871 students from 23 countries. Depressive symptoms were measured using the shortened Center for Epidemiological Studies Depression Scale and information on lockdowns retrieved from the COVID-19 government response tracker. The association between financial loss and depressive symptoms was investigated
estimating prevalence ratios (PR) with multilevel Poisson models.
Results: Some 13% of students suffered financial loss during the lockdown and 52% had a relatively high depression score, with large between-countries differences. Minimally and
maximally adjusted models showed a 35% (PR = 1.35, 95% Confidence Interval (CI) = 1.29–1.42) and 31% (PR = 1.31, 95% CI = 1.26–1.37) higher prevalence of depressive symptoms in students who lost economic resources compared to students with stable
economic resources. No substantial differences in the association were found across countries.
Conclusion: Depressive symptoms were more frequent among students who suffered financial loss during the pandemic. Policy makers should consider this issue in the implementation of COVID-19 mitigating measures
2022
- Ftalati e salute umana: analisi della regolamentazione europea ed internazionale.
[Abstract in Atti di Convegno]
Monti, M; Palandri, L; Ferrari, E; Azzalini, D; Lugli, C; Barbieri, R; Panciroli, G; Righi, E
abstract
Gli ftalati, noti interferenti endocrini con potenziali ripercussioni sulla salute umana, sono sostanze ampiamente utilizzate in materiali plastici a contatto con alimenti, cosmetici, articoli per l’infanzia, vestiario, imballaggi, materiali elettrici e dispositivi medico-farmaceutici. L’esposizione umana è molto diffusa e può avvenire per ingestione, inalazione o contatto con mucose o pelle. In un contesto economico sempre più globalizzato, in cui l’accesso a materiali plastici provenienti da filiere produttive sparse in più nazioni è molto frequente, diviene necessario conoscere la diffusione degli ftalati e i criteri legislativi che ne regolano la produzione e il commercio a livello internazionale.
Per valutare lo stato dell’arte delle normative nazionali ed internazionali vigenti, abbiamo condotto una ricerca su siti sia istituzionali (come Unione Europea, USA, Cina) che delle Agenzie deputate (come EFSA, ECHA, FDA, EPA).
L’attuale quadro normativo appare complesso e non lineare, costituito da plurime regolamentazioni, spesso frammentate tra diversi enti regolatori e agenzie (ambiente, salute, alimentazione, prodotti chimici ecc.). L’Unione Europea e gli Stati Uniti d’America, seppur con differenze organizzative, hanno emanato numerose leggi per proibire
o limitare l’utilizzo degli ftalati più pericolosi per la salute umana - tra cui DBP, BBP, DEHP, DINP e DIDP - in diversi materiali, come giocattoli, oggetti per la puericultura, contenitori per alimenti, cosmetici, dispositivi medici e farmaceutici. In Cina, alcuni ftalati vengono elencati come inquinanti maggiori, e vengono normati nei prodotti tessili per la puericultura o nei materiali a contatto con alimenti. In altre nazioni, tuttavia, si hanno legislazioni meno strutturate, spesso limitate ad alcuni composti o settori, come quello alimentare o dell’infanzia.
La globalizzazione dei commerci e l’interdipendenza nelle catene produttive di oggetti di largo consumo hanno portato ad un flusso sempre maggiore di articoli che potrebbero presentare pericoli per la salute umana a causa di legislazioni non uniformi. Molte normative, anche dove vigenti, mettono poi a dura prova gli enti di controllo, in quanto vi sono numerose eccezioni ed esenzioni in un contesto legislativo non sempre integrato. Di rilievo anche la questione del commercio al dettaglio gestito dai singoli acquirenti (e-commerce), difficilmente controllabile e sempre più in espansione, che necessiterà quindi di un monitoraggio specifico e adeguato.
2022
- Inactive footsteps. Monitoring behavioral risk factors in the post-pandemic era: weight gain, inactivity and active mobility in Emilia-Romagna
[Abstract in Rivista]
Palandri, L; Carrozzi, G; Sampaolo, L; Grieco, A; Zambasi, E; Giordano, R; Bisceglia, I; Musti, Ma; Conti, C; Ranieri, C; Bertozzi, N; Guidi, S; Cania, A.; Righi, Elena
abstract
Background
Restrictive measures due the COVID-19 pandemic and their
psychological impact changed human behavior.
The aim of the study was to describe the trend in weight gain and sedentary lifestyle among adults (18-69 years) before and after the pandemic outbreak in the Emilia-Romagna region.
Methods
We analysed data from the Italian-behavioral-risk-factor-surveillance-system (PASSI) from 2008-2021 on excessive
weight, sedentary lifestyle prior and after the pandemic outbreak, stratifying the population by sex, age, educational and socio-economic characteristics. Furthermore, preliminary data on active mobility from 2018-2021 was analysed.
Results
Data from 42122 interviews were collected between 2008-
2021 (3085 in 2019, 927 in 2020, 1834 in 2021).
Prevalence of overweight showed an increasing trend in the
pandemic period (28,7%, IC 95% [27,1-30,4] in 2019 vs
30,9% [27,8-34,3] in 2020 vs 31,2% [29,0-33,5] in 2021),
which broke the declining trend observed over the last decade, with a higher variation among ages 35 to 49. People with lower economic status showed high levels both in 2020 and 2021.
Prevalence of obesity showed a slight reduction in 2020, which returned to pre-pandemic values in 2021 (12,2% [11,0-13,5] in 2019 vs 9,7% [7,8-11,9] in 2020 vs 11,3% [9,8-12,9] in 2021). No differences were observed when stratifying by age and sex.
As for sedentary lifestyle, there was a foreseeable increase in
2020 with a sudden decrease in 2021 (16,3% [15,0-17,7%] in
2019 vs 16,8% [14,4-19,5] in 2020 vs 14,8% [13,1-16,7] in
2021) which is in line with the decreasing trend observed in
over the last decade. In 2020, women and people with a lower economic status were affected the most.
Finally, data on active mobility showed a decrease in 2020
both for cycling (19,1% [17,7-20,6] in 2019 vs 15,4% [12,9-
18,3] in 2020) and walking (45,7% [43,9-47,6] in 2019 vs
42,3% [39,1-46,1] in 2020) to go to work in. In 2021 the trend increases towards pre-pandemic levels for cycling (18,1% [16,2-20,1]) but not for walking (37,4% [35,1-39,8]) which continues decreasing.
Conclusions
The pandemic outbreak had a negative effect on behavioral
risk factors specifically regarding excessive weight gain, sedentary lifestyles, the latter having a higher impact on women and people with lower economic status. Data on sedentary lifestyle and active mobility in 2020 is compatible with national lockdown and smart working. As for the 2021 gap between cycling and walking, among other reasons, it may be justified by the quota related to public transportations and the grown fear of using it.
Targeted public health interventions are needed to encourage active lifestyles.
2022
- Introduzione di un nuovo percorso diagnostico dell’infezione da SARS-CoV-2: l’auto-testing in Regione Emilia-Romagna
[Abstract in Rivista]
Lugli, C; Azzalini, D; Matteo, G; Frasca, G; Giampà, V; Palandri, L; Righi, E; Mattivi, A; Massimiliani, E; Belloli, Gl; Diegoli, G; Mattei, G
abstract
Introduzione
Tra dicembre 2021 e gennaio 2022, in tutto il territorio italiano, si è assistito alla quarta ondata della pandemia COVID-19.
In analogia con il quadro epidemiologico nazionale, la regione Emilia-Romagna (RER) ha registrato, nella settimana
tra il 10/01 e il 16/01, 119.940 nuovi casi (incidenza 2.689
casi/100.000 abitanti), superando la capacità diagnostica di
SARS-CoV-2 del Servizio Sanitario Regionale (SSR) disponibile
fino a quel momento. La RER, per fronteggiare l’aumento
critico della domanda di testing, ha deliberato il documento
“Procedura per l’auto-testing di rilevazione del coronavirus e
trasmissione dell’esito”. Lo scopo del presente lavoro è quello
di riportare i dati sull’adesione a tale procedura.
Materiali e metodi
La Delibera di Giunta Regionale n. 33 del 17/01/2022 prevede
la registrazione dell’esito del tampone su Fascicolo Sanitario
Elettronico (FSE) permettendo al cittadino di avviare e chiudere in maniera autonoma e agevole il proprio isolamento in un momento di massima incidenza delle infezioni. La procedura, per garantire il riconoscimento autenticato dell’identità e impedire utilizzi impropri volti all’ottenimento o prolungamento del Green Pass, è stata resa disponibile ai soli cittadini con assistenza sanitaria in RER, muniti di SPID, asintomatici e vaccinati con
dose booster. I test riconosciuti per questa procedura sono test antigenici rapidi nasali per auto-testing marcati CE.
Risultati
Nel periodo 17/01/2022-05/06/2022 in tutta la RER sono state registrate 655.397 persone positive e di queste l’11% ha utilizzato la procedura di auto-testing. Nello stesso periodo sono stati registrati su FSE con auto-testing un totale di 154.299 tamponi, di cui il 50,2% positivi. La fascia di età nella quale si è avuta la maggior adesione è quella 25-44 (62,5 tamponi/1.000 abitanti) seguita dai 15-24 enni. Delle 8 AUSL della RER, l’adesione più elevata è stata registrata in quella di Bologna (28,7 tamponi/1.000 abitanti). La settimana con il maggior numero di caricamenti su FSE è stata quella 18/04-24/04/2022, mentre il numero maggiore di caricamenti di tamponi positivi sul totale è stato registrato nella settimana 30/05-05/06/2022.
Conclusioni
La procedura di auto-testing con registrazione dell’esito su
FSE è stata accolta favorevolmente dalla popolazione e l’adesione a questa procedura risulta in crescita, favorita dalla
semplificazione del processo diagnostico e dal termine della
convenzione tra farmacie e SSR. La DGR 33 del 2022 ha permesso, in un periodo di elevato sovraccarico dei servizi sanitari, un fondamentale alleggerimento, mettendo a disposizione dei cittadini emiliano-romagnoli un percorso diagnostico in grado di garantire un’efficace e rapida presa in carico.
2022
- Istituzione di un ambulatorio a valenza regionale per quesiti complessi inerenti le vaccinazioni: modello organizzativo e attività del VAX-CONSILIUM dell’Emilia-Romagna
[Abstract in Rivista]
Giampà, V; Lugli, C; Azzalini, D; Cintori, C; Matteo, G; Belloli, Gl; Diegoli, G; Mattei, G; Viale, Pl; Attard, L; Marconi, L; Righi, E; Bargellini, A
abstract
Introduzione
La L. n. 119/2017, relativa a introduzione e ampliamento
dell’obbligo vaccinale in ambito pediatrico, ha comportato un rilevante impegno per gli operatori della Sanità pubblica, specialmente nel processo decisionale relativo ai quesiti vaccinali complessi non considerati da linee guida nazionali o internazionali.
Tale necessità si è manifestata anche per le vaccinazioni rivolte a soggetti maggiorenni, in particolar modo durante la campagna vaccinale anti-COVID-19. La Regione Emilia-Romagna, con l’obiettivo prioritario di massimizzare la tutela dei pazienti, ha istituito con DGR n. 1902/2017 un servizio di counselling di terzo livello con équipe medica ad elevata specializzazione, a cui l’operatore di Sanità pubblica può rivolgersi relativamente a casi a maggiore complessità. Vengono qui presentate le modalità operative di accesso al servizio e i dati di attività del Vaxconsilium (Vax-C) dalla sua istituzione (2018).
Materiali e metodi
Il centro di coordinamento fa capo alla U.O. Malattie Infettive dell’Azienda Ospedaliero-Universitaria di Bologna - IRCCS e offre un servizio ambulatoriale gratuito di consulenza con un team medico multi-specialistico esperto in ambito vaccinale, in rete con medici di assistenza primaria e delle U.O. ospedaliere (1° livello) e i servizi vaccinali aziendali di competenza territoriale (2° livello). L’operatore dei servizi vaccinali, allertato con richiesta dal 1° livello e previa acquisizione del consenso informato del paziente, sottomette il caso al Vax-C inviando una relazione clinica e la documentazione sanitaria del paziente in modalità telematica protetta standardizzata (file con password tramite casella PEC). I coordinatori del Vax-C,
dopo una valutazione multidisciplinare basata sulle evidenze, forniscono al richiedente un report conclusivo sull’analisi del rapporto rischio/beneficio del caso in esame indicando l’eventuale raccomandazione/controindicazione alla vaccinazione.
Risultati
Dal 2018 a Giugno 2022 sono state prese in carico 325 richieste su un totale di 366; 41 sono state annullate dal richiedente o rigettate per documentazione insufficiente. Il 27% dei quesiti riguardava minorenni (età media 8 anni), il restante 73% soggetti maggiorenni (età media 49 anni). Tra queste, 249 consulenze erano relative ai vaccini anti-COVID-19. Solo in 13 casi è stata riscontrata una controindicazione assoluta (2 per vaccini anti-COVID-19), mentre in 54 casi è stata raccomandata un’altra tipologia di vaccino.
Conclusioni
L’attività del Vax-C ha permesso di dirimere le criticità dei
casi più complessi e ha rappresentato un valido aiuto nell'attività del medico vaccinatore, perseguendo la tutela della salute del paziente. Questo modello rappresenta un unicum in Italia e può essere esportato in realtà che manifestino necessità di supporto decisionale di elevato livello nel percorso vaccinale.
2022
- L’andamento epidemiologico della tubercolosi nella regione Emilia-Romagna: dati dal report regionale 1999-2020
[Abstract in Rivista]
Azzalini, D; Lugli, C; Matteo, G; Perilli, C; Mattivi, A; Massimiliani, E; Frasca, G; Gualanduzzi, C; Giampà, V; Righi, E; Belloli, Gl; Diegoli, G; Mattei, G
abstract
Introduzione
La tubercolosi (Tb) rappresenta una delle dieci principali cause
di morte nel mondo. L’Italia è un Paese a bassa endemia con
incidenza inferiore a 10 casi/100.000 abitanti. Questo lavoro
espone i dati più significativi dell’aggiornamento epidemiologico
sulla sorveglianza della Tb nella regione Emilia-Romagna
(RER).
Materiali e metodi
L’aggiornamento epidemiologico 2020 analizza i casi di Tb
notificati secondo i DM 15/12/1990 e 29/07/1998, rilevati dal
sistema di sorveglianza previsto dalla Circolare Regionale n. 9
del 26/04/2005 riguardanti residenti e domiciliati in RER nel
periodo 1999-2020 con focus negli anni 2016-2020.
Risultati
Analogamente ai dati nazionali, la RER ha registrato una diminuzione del tasso di incidenza (11,6 casi/100.000 abitanti
nel 2012 vs 7,3 nel 2020) ad eccezione del 2017 in cui si è
verificato un lieve aumento (9,3 casi/100.000 abitanti). Il calo
ha riguardato anche l’incidenza delle forme polmonari (4,8
casi/100.000 abitanti nel 2020). L’età media dei casi è calata
(53,9 anni nel 1999 vs 42,2 nel 2020) con rapporto maschi/
femmine di 1,5:1 nel periodo 2016-2020. La prevalenza è
maggiore nei nati all’estero (27,9% nel 1999 vs 69,6% nel
2020). La mediana del ritardo diagnostico è superiore nei nati
in Italia rispetto ai nati all’estero (45 gg vs 39 gg); in questi
ultimi il ritardo diagnostico è maggiore in chi viveva in Italia
da più di tre anni rispetto a chi vi risiedeva da meno tempo (40
gg vs 36 gg). Nel 2014 si è osservata una lieve flessione della
percentuale di esiti favorevoli di fine trattamento; tuttavia, per
la coorte dei casi 2019 è emerso il risultato migliore dal 2016
(68,5%) nonostante l’anno di sorveglianza coincidesse con il
primo anno di pandemia. Nel periodo 2016-2020, nell’8% dei
nuovi casi per i quali era disponibile il saggio di sensibilità ai
farmaci anti-Tb di prima linea, è stata rilevata almeno una resistenza farmacologica e nell’1,7% sono stati individuati ceppi
MDR.
Conclusioni
Il calo dell’incidenza di Tb e delle forme polmonari rappresenta
un successo delle politiche di prevenzione e controllo della
rete territoriale e dai Dipartimenti di Sanità Pubblica della
RER. Rimane necessario prestare attenzione alla popolazione
italiana e straniera più giovane per ridurre ritardo diagnostico e
potenziale diffusione ai contatti, migliorare follow-up ed esito
di malattia. La creazione di percorsi formativi destinati agli
operatori sanitari, prevista dal Piano Regionale della Prevenzione
2021-2025, si propone di potenziare comunicazione e
counseling rivolti alla popolazione straniera e favorire accessibilità ai servizi sanitari e adesione terapeutica.
2022
- L’impatto della pandemia sui comportamenti a rischio in emilia-romagna: focus su fumo e assunzione inappropriata di alcol
[Abstract in Rivista]
De Pasquale, L; Palandri, L.; Carrozzi, G.; Grieco, A; Sampaolo, L; Prazzoli, R; Ottone, M; Perlangeli, V; De Lisio, S; Venturi, B; Ferioli, S; Santoro, V; Vitali, P; Morri, M; Righi, E
abstract
Introduzione
Le misure restrittive dovute alla pandemia da SARS-CoV-2 e
il loro forte impatto psicologico possono avere indotto modifiche sulla diffusione dei comportamenti delle persone e degli stili di vita potenzialmente pericolosi per la salute. L’obiettivo dello studio è di descrivere l’impatto della pandemia sulle abitudini tabagiche e il consumo di alcol in Emilia-Romagna nella popolazione adulta di età compresa tra 18 e 69 anni.
Materiali e metodi
Sono stati analizzati dati dalla sorveglianza PASSI, raccolti in
Emilia-Romagna dal 2008 al 2021, su consumo di alcol a maggior rischio (binge drinking o consumo fuori pasto) e fumo di sigaretta prima e dopo l’avvento della pandemia. Informazioni su genere, età, istruzione e difficoltà economiche percepite sono stati raccolti e usati per stratificare i dati.
Risultati
Dall’inizio della Sorveglianza PASSI, in Emilia-Romagna
sono state raccolte 42122 interviste, di cui 1834 nel 2021, 927
nel 2020 e 3085 nel 2019.
La percentuale di consumatori di alcol a maggior rischio,
nel 2020, ha registrato un aumento rispetto alla tendenza già
ascendente dello scorso decennio per poi assestarsi su valori
inferiori a quelli precedenti la pandemia (24,3% [22,7-25,9]
nel 2019 vs 25,3% [22,2-28,6] nel 2020 vs 21,9% [19,9-24,0]
nel 2021). Nel 2020 le fasce maggiormente interessate sono
state le donne (18,4% nel 2019 vs 23,0% nel 2020) e i 50-
69enni (14,8% nel 2019 vs 20,2% nel 2020).
Nel 2020, la prevalenza di fumatori ha mostrato un aumento
dei valori percentuali che ha interrotto il trend in diminuzione
che si osservava da più di un decennio, registrando però nel
2021 una diminuzione tendente ai valori prepandemici (25,0% [23,4-26,6] nel 2019 vs 29,0% [25,8-32,5] nel 2020 vs 24,1% [22,1-26,3]). Le fasce maggiormente impattate sono state le donne, i 50-69enni, persone con difficoltà economiche o bassa istruzione che hanno registrato gli incrementi maggiori nel 2020, senza recupero nel 2021 per donne e persone con difficoltà economiche.
Conclusioni
La pandemia ha avuto un effetto negativo su diversi fattori di
rischio comportamentali. In particolare si osserva un importante incremento della percentuale di fumatori e in parte dei consumatori di alcol ad alto rischio. Si osservano inoltre evidenti differenze di genere, a sfavore delle donne, e differenze per condizione socioeconomica, a sfavore di persone con bassa istruzione o con difficoltà economiche percepite. Inoltre le fasce di popolazione maggiormente impattate sembrano anche avere recuperi più lenti. Queste informazioni risultano estremamente utili nell’orientare le azioni previste dal Piano Regionale della Prevenzione.
2022
- Maternal dietary adherence during pregnancy to recommendations: a cross-sectional study in Modena
[Abstract in Rivista]
De Pasquale, L; Palandri, L; Casalucci, Ma; Azzalini, D; Lucaccioni, L; Passini, E; Facchinetti, F; Righi, E
abstract
Background: Unbalanced nutrients intake and incorrect weight gain can lead to immediate and future adverse health consequences for
both mother and child. The Italian Society of Gynaecology and
Obstetrics (SIGO), has drawn up a series of nutritional
recommendations with the aim of promoting a correct food
intake for future mothers. The purpose of our study was to
assess adherence to good dietary indications during pregnancy
and to evaluate if voluptuary habits could play a role.
Methods: This cross-sectional study investigated dietary habits during the last trimester of pregnancy. We evaluated the adherence to dietary SIGO recommendations of a sample of pregnant
women representative of physiologic full-term pregnancies
(n = 572, mean age 33.4 5.2) living in Modena (Italy),
recruited between 2016 and 2020. Maternal diet during
pregnancy was assessed by a self-administered questionnaire
fill in at the hospital after childbirth, evaluating lifestyle habits
and usual food intake. Descriptive statistics and bivariate
associations (Chi-square tests) were performed.
Results: More than 50% of women did not comply with SIGO dietary recommendations. Overall, adherence was very low, ranging
between 8.4% (sweets) and 38.8% (seafood), for all food
categories, excluding coffee and tea (89%), alcohol (76.2%),
red wine (99.1%) and seasoning (olive oil 93.4%). Preliminary
results suggest that several factors and behaviours, including
BMI before pregnancy, age, smoking habits, education, are
associated with levels of adherence to different food categories.
Conclusions: Poor adherence to a proper dietary regimen during pregnancy is a missed opportunity for prevention and demonstrates the importance of promoting public health interventions to improve dietary recommendations adherence. Several initiatives, such as courses, information campaigns, use of social media and counselling can be useful for a nutrition education in pregnancy, raising awareness of the related benefits for both mother and child.
2022
- Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)
[Articolo su rivista]
Solmi, M.; Estrade, A.; Thompson, T.; Agorastos, A.; Radua, J.; Cortese, S.; Dragioti, E.; Leisch, F.; Vancampfort, D.; Thygesen, L. C.; Aschauer, H.; Schloegelhofer, M.; Akimova, E.; Schneeberger, A.; Huber, C. G.; Hasler, G.; Conus, P.; Cuenod, K. Q. D.; von Kanel, R.; Arrondo, G.; Fusar-Poli, P.; Gorwood, P.; Llorca, P. -M.; Krebs, M. -O.; Scanferla, E.; Kishimoto, T.; Rabbani, G.; Skonieczna-Zydecka, K.; Brambilla, P.; Favaro, A.; Takamiya, A.; Zoccante, L.; Colizzi, M.; Bourgin, J.; Kaminski, K.; Moghadasin, M.; Seedat, S.; Matthews, E.; Wells, J.; Vassilopoulou, E.; Gadelha, A.; Su, K. -P.; Kwon, J. S.; Kim, M.; Lee, T. Y.; Papsuev, O.; Mankova, D.; Boscutti, A.; Gerunda, C.; Saccon, D.; Righi, E.; Monaco, F.; Croatto, G.; Cereda, G.; Demurtas, J.; Brondino, N.; Veronese, N.; Enrico, P.; Politi, P.; Ciappolino, V.; Pfennig, A.; Bechdolf, A.; Meyer-Lindenberg, A.; Kahl, K. G.; Domschke, K.; Bauer, M.; Koutsouleris, N.; Winter, S.; Borgwardt, S.; Bitter, I.; Balazs, J.; Czobor, P.; Unoka, Z.; Mavridis, D.; Tsamakis, K.; Bozikas, V. P.; Tunvirachaisakul, C.; Maes, M.; Rungnirundorn, T.; Supasitthumrong, T.; Haque, A.; Brunoni, A. R.; Costardi, C. G.; Schuch, F. B.; Polanczyk, G.; Luiz, J. M.; Fonseca, L.; Aparicio, L. V.; Valvassori, S. S.; Nordentoft, M.; Vendsborg, P.; Hoffmann, S. H.; Sehli, J.; Sartorius, N.; Heuss, S.; Guinart, D.; Hamilton, J.; Kane, J.; Rubio, J.; Sand, M.; Koyanagi, A.; Solanes, A.; Andreu-Bernabeu, A.; Caceres, A. S. J.; Arango, C.; Diaz-Caneja, C. M.; Hidalgo-Mazzei, D.; Vieta, E.; Gonzalez-Penas, J.; Fortea, L.; Parellada, M.; Fullana, M. A.; Verdolini, N.; Farkova, E.; Janku, K.; Millan, M.; Honciuc, M.; Moniuszko-Malinowska, A.; Loniewski, I.; Samochowiec, J.; Kiszkiel, L.; Marlicz, M.; Sowa, P.; Marlicz, W.; Spies, G.; Stubbs, B.; Firth, J.; Sullivan, S.; Darcin, A. E.; Aksu, H.; Dilbaz, N.; Noyan, O.; Kitazawa, M.; Kurokawa, S.; Tazawa, Y.; Anselmi, A.; Cracco, C.; Machado, A. I.; Estrade, N.; De Leo, D.; Curtis, J.; Berk, M.; Ward, P.; Teasdale, S.; Rosenbaum, S.; Marx, W.; Horodnic, A. V.; Oprea, L.; Alexinschi, O.; Ifteni, P.; Turliuc, S.; Ciuhodaru, T.; Bolos, A.; Matei, V.; Nieman, D. H.; Sommer, I.; van Os, J.; van Amelsvoort, T.; Sun, C. -F.; Guu, T. -W.; Jiao, C.; Zhang, J.; Fan, J.; Zou, L.; Yu, X.; Chi, X.; de Timary, P.; van Winke, R.; Ng, B.; Pena, E.; Arellano, R.; Roman, R.; Sanchez, T.; Movina, L.; Morgado, P.; Brissos, S.; Aizberg, O.; Mosina, A.; Krinitski, D.; Mugisha, J.; Sadeghi-Bahmani, D.; Sadeghi, M.; Hadi, S.; Brand, S.; Errazuriz, A.; Crossley, N.; Ristic, D. I.; Lopez-Jaramillo, C.; Efthymiou, D.; Kuttichira, P.; Kallivayalil, R. A.; Javed, A.; Afridi, M. I.; James, B.; Seb-Akahomen, O. J.; Fiedorowicz, J.; Carvalho, A. F.; Daskalakis, J.; Yatham, L. N.; Yang, L.; Okasha, T.; Dahdouh, A.; Gerdle, B.; Tiihonen, J.; Shin, J. I.; Lee, J.; Mhalla, A.; Gaha, L.; Brahim, T.; Altynbekov, K.; Negay, N.; Nurmagambetova, S.; Jamei, Y. A.; Weiser, M.; Correll, C. U.
abstract
Background: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT – www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6–18 months plus 24–36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14–17 years), and children (age 6–13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. Results: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. Limitations: Cross-sectional and anonymous design. Conclusions: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents’ and families’, mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.
2022
- Primary care management strategies and COVID-19 related hospitalization: a population- based study
[Abstract in Rivista]
Palandri, L; Ferrari, A; Serafini, A; Riccomi, S; Ugolini, G; Kurotschka, Pp; Bellelli, F; Morandi, M; Padula, Ms; Righi, E
abstract
Background: Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the
need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most
symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary
care. In Italy, literature on COVID-19 outpatients management
by general practitioners (GPs) is scarce. This study explores the
effect of GP active care and monitoring on COVID-19-related
hospitalization in patients in the province of Modena (Italy) and
investigates the possible determinants of GP’s management.
Methods: This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote
monitoring), patients’ socio-demographic characteristics, and
hospitalization were extracted from the GP’s electronic
medical records and were analyzed using descriptive statistics
and multiple logistic regression.
Results: 46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home.
Remote monitoring and home visits were both associated with
a reduction of the probability of hospitalization rate of
approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80
and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of
determinants showed that GPs’ patient load, setting, age, and
sex were significantly associated with management strategies.
Conclusions: Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed
2022
- Self-triage tools during covid-19 outbreak: the CovidGuide app experience
[Abstract in Atti di Convegno]
Demurtas, J; Righi, E; Meer, A
abstract
Background: During the first phases of the pandemic many apps were launched to tackle the surge of covid-19, among those the CovidGuide app. The app is a conversational agent (CA) with a neural network artificial intelligence
(AI) supporting users in defining the right time to treat and point of care for their healthcare problem. To be
safe and effective, the advice of the app should be followed by the user. This can help reduce health systems
overloading.
Research questions: Can a self-triage app give safe and effective advice to patients in case of covid19-like symptoms?
Can self-triage tools impact on primary care professionals' (notably GPs') burden?
Method: CovidGuide database containing consultations results from inception to April 19 2022 was analyzed and the
main descriptive statistical analyses were performed
Results: On a total number of 374.179 consultations, the most frequent advice given was the indication to see the
doctor today (38% of the consultations). 62% patients were females, 75% in the age range 14-49 years, main
symptoms reported were viral syndrome not otherwise specified and throat symptoms complaints. 75.692
patients, 20% of cases, received indication for self-monitoring with safety net (ie indications on what to do in
case of symptoms’ worsening).
Conclusions: Data retrieved so far depict the core features of the users of this app: women in age range 14-49 were the most represented category of CovidGuide users. Further exploration of factors influencing intention to comply
with the app’s advice, already ongoing, may help understand what brings people to use this kind of app and
eventually follow the given advice.
Moreover, the huge number of consultations ending with the indications for self-monitoring may be
investigated to understand whether it is possible to use these tools to decrease PCPs’ burden.
2022
- Symptom clusters helping the assessment of SARS-COV-2-infected children: Amiens cohort versus European data
[Articolo su rivista]
Tchidjou, Hyppolite K; Palandri, Lucia; Righi, Elena; Monti, Marco; Ricard, Jannick; Pouplin, Suzanne; Tourneux, Pierre; Klein, Celine
abstract
Since December 2019, the novel coronavirus (SARS-CoV-2) pandemic, caused >240 million cases and >5 million deaths. Given the current wider dissemination of pediatric cases, it is important to address questions regarding the clinical picture in children or if there are clinical patterns that may help us identify in an early stage what can be the prognosis and help clinicians with patient management. The study aimed to investigate in a French monocentric cohort and other European cohorts the presence of symptom clusterization and its possible connection to illness categories to help medical first-line screening and orientation in the pediatric emergency department (ED).
2022
- The Kids Are Alright (?). Infants’ Development and COVID-19 Pandemic: A Cross-Sectional Study
[Articolo su rivista]
Ferrari, Eleonora; Palandri, Lucia; Lucaccioni, Laura; Talucci, Giovanna; Passini, Erica; Trevisani, Viola; Righi, Elena
abstract
Objectives: The study aimed to assess and compare the global development in six-month-old infants before and during the pandemic restrictive social distancing measures.
Methods: This cross-sectional nested study involved infants assessed through the Griffiths Scales of Child Development (GSCD) between September 2019 and April 2021. Infants were classified in a pre-COVID or a COVID group, considering the evaluation date and the restrictive measures in place. GSCD subscales and General Development Scores (GDS) were calculated and compared.
Results: One hundred and four healthy term-born infants were evaluated. GDS in the COVID group (n:70; median: 94; IQR: 90–100) appeared significantly lower than in the pre-COVID group (n:34; median: 98; IQR: 97–103; p < 0.001). Language and personal-social-emotional subareas scores appeared the most affected. A decreasing trend of GDS along with the severity of restriction was observed.
Conclusion: A reduction in infant development scores was observed during pandemic social distancing. Further studies are needed to systematize these findings and to address effective public health policies for infants and families during long-term forced isolation periods.
2022
- The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic
[Articolo su rivista]
Solmi, Marco; Estradé, Andrés; Thompson, Trevor; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schloegelhofer, Monika; Akimova, Elena; Schneeberger, Andres; Huber, Christian G.; Hasler, Gregor; Conus, Philippe; Cuénod, Kim Q. Do; von Känel, Roland; Arrondo, Gonzalo; Fusar-Poli, Paolo; Gorwood, Philip; Llorca, Pierre-Michel; Krebs, Marie-Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna-Żydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kamiński, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan-Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Manková, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer-Lindenberg, Andreas; Kahl, Kai G.; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pal; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P.; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R.; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana V.; Valvassori, Samira S.; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu-Bernabeu, Alvaro; Cáceres, Antonia San José; Arango, Celso; Díaz-Caneja, Covadonga M.; Hidalgo-Mazzei, Diego; Vieta, Eduard; Gonzalez-Peñas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A.; Verdolini, Norma; Fárková, Eva; Janků, Karolina; Millan, Mark; Honciuc, Mihaela; Moniuszko-Malinowska, Anna; Łoniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Łukasz; Marlicz, Maria; Sowa, Paweł; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Machado, Ana Inés; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H.; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching-Fang; Guu, Ta-wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winke, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi-Bahmani, Dena; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errazuriz, Antonia; Crossley, Nicolas; Ristic, Dragana Ignjatovic; López-Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb-Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F.; Daskalakis, Jeff; Yatham, Lakshmi N.; Yang, Lin; Okasha, Tarek; Dahdouh, Aïcha; Gerdle, Björn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Jamei, Yasser Abu; Weiser, Mark; Correll, Christoph U.
abstract
Background: High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID- 19 pandemic are needed. Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/ vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/ functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others. Results: . Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive. Limitations: Cross-sectional survey, preponderance of non-representative participants. Conclusions: . Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/stra-tegies during this/future pandemics.
2022
- Use of urinary gonadotropins for the evaluation of the minipubertal profile in term newborns and infants within the first six months of age
[Abstract in Rivista]
Lucaccioni, L; Trevisani, V; Passini, E; Palandri, L; Bruzzi, P; Predieri, B; Righi, E; Iughetti, L
abstract
The activation of the hypothalamus-pituitarygonadal
(HPG) axis during the first months both in males(M) and
females(F) is named as minipuberty. Urinary gonadotropins
(uGn) represent an unexpensive and non-invasive method of
assessing pubertal development and they have recently been used also for studying minipuberty.
Aims of this study are: 1) to describe the urinary hormonal pattern
(uLH, uFSH, testosterone – uT, oestradiol-uE) during minipuberty
in a group of healthy full-term infants. 2) to identify the relationship between urinary hormone levels and environmental
factors, anthropometric measurements, anogenital distances
(AGD).
2022
- Valutazione dell’impatto della pandemia sullo stress genitoriale nella provincia di Modena: primi risultati di uno studio cross-sectional
[Abstract in Rivista]
Fasano, M; Palandri, L; Casalucci, Ma; De Pasquale, L; Barbieri, R; Ferrari, E; Ferrari, A; Rizzi, C; Talucci, G; Lucaccioni, L; Righi, E
abstract
Introduzione
Le restrizioni sociali dovute alla pandemia hanno avuto un impatto sul benessere psicologico delle famiglie, soprattutto in presenza di bambini molto piccoli.
Lo scopo di questo studio è di valutare lo stress genitoriale prima e durante la pandemia come misurato dal Parenting Stress Index-Short Form (PSI-SF), questionario validato e standardizzato per genitori di bambini tra 1 mese e 12 anni.
Materiali e metodi
Tra settembre 2019 e maggio 2021, 80 genitori di bambini di
circa 6 mesi nati sani al Policlinico di Modena hanno compilato il questionario PSI-SF. Nel PSI-SF, il punteggio di Stress Totale (TS) viene determinato sommando i punteggi delle tre sottoscale: “Distress genitoriale” (PD, distress percepito dal genitore nell’esercitare il proprio ruolo), “Interazione genitore-bambino disfunzionale” (P-CDI, che riflette la qualità del rapporto percepito genitore-figlio), e “Bambino difficile” (DC, che descrive quanto un genitore ritenga il proprio figlio di difficile gestione). Un’ulteriore scala indipendente, “Risposta difensiva” (DIF), misura la tendenza del genitore a fornire una rappresentazione di sé più favorevole. Il campione è stato stratificato in pre-COVID e COVID a seconda che la valutazione abbia avuto luogo prima o dopo l’introduzione del lockdown nella provincia di Modena (04/03/2020).
Risultati
I punteggi mediani (IQR) di TS registrati nel periodo pre-COVID e COVID risultano simili e rispettivamente pari a 64(25) e 63,50(27). Tuttavia, il 6% dei soggetti nel gruppo pre-COVID presenta punteggi di TS sopra range di normalità contro il 15% del gruppo COVID, dei quali il 71% raggiunge punteggi indicativi di livelli di stress clinicamente significativo.
Un lieve aumento dei punteggi mediani delle sottoscale P-CDI e DC nel gruppo COVID vs pre-COVID e una lieve riduzione dei punteggi nella sottoscala PD sono stati osservati. Tuttavia, nella sottoscala PD si osserva un aumento di valori sopra range di normalità dal 11,8% nei pre-COVID al 19,6% nei COVID. Infine, nel periodo COVID si osserva una riduzione della percentuale di DIF eccessiva (6,5%) rispetto al pre-COVID (20,6%).
Conclusioni
I risultati dello studio suggeriscono un possibile impatto della
pandemia sullo stress genitoriale che sembra influenzare principalmente la percezione di inadeguatezza che il genitore ha di sé e sembra determinare una maggiore presa di coscienza della difficoltà del ruolo genitoriale.
Ulteriori studi mirati a monitorare la salute mentale delle fasce più fragili, come neogenitori, nei periodi di particolare stress per le famiglie come la pandemia COVID-19, sono necessari per identificare le più efficaci strategie di supporto alle famiglie da mettere in atto.
2022
- Valutazione dell’incremento ponderale e delle abitudini alimentari in gravidanza in una coorte di donne della Provincia di Modena alla luce delle raccomandazioni della Società Italiana di Ginecologia e Ostetricia (SIGO)
[Abstract in Atti di Convegno]
Azzalini, D; Palandri, L; Ferrari, E; Monti, M; Lucaccioni, L; Trevisani, V; Maione, D; Righi, E
abstract
Durante la gravidanza un aumento ponderale inadeguato e un’alimentazione carente in frutta e verdura possono rappresentare una potenziale causa di esiti materno-fetali sfavorevoli. La Società Italiana di Ginecologia e Ostetricia (SIGO) ha definito degli intervalli di incremento ponderale in gravidanza sulla base del Body Mass Index (BMI)
pregravidico e ha raccomandato di assumere almeno 5 porzioni di frutta e verdura al giorno.
Da gennaio 2019 a ottobre 2020, 177 puerpere hanno compilato, presso il reparto di Ostetricia dell’Azienda Ospedaliero-Universitaria di Modena, un questionario mirato alla valutazione di stile di vita, abitudini alimentari durante la gravidanza e anamnesi fisiologico-ostetrica dal quale sono state estrapolate informazioni relative a BMI pregravidico, incremento ponderale registrato in gravidanza e numero di porzioni di frutta e verdura assunte al giorno.
L’incremento ponderale gravidico è stato esaminato per valutare se fosse conforme o meno alle raccomandazioni SIGO. Nel campione stratificato in base al BMI e all’incremento ponderale in gravidanza, è stato valutato il numero di porzioni di frutta e verdura assunte al giorno.
Il 67.8% delle donne presentava un BMI pregravidico indicativo di normopeso. Tuttavia dai dati è emerso come, in alcune categorie, l’incremento ponderale non sia stato in linea con le raccomandazioni SIGO. In particolare, nelle donne con BMI pregravidico indicativo di sottopeso (8.5%) l’incremento ponderale è stato inferiore al raccomandato (<12.5 kg) mentre nelle donne con BMI indicativo di sovrappeso (15.3%) e di obesità (8.5%) è stato eccessivo rispetto alle raccomandazioni (>11.4 e >9.1 kg, rispettivamente). Considerando l’assunzione quotidiana di frutta e verdura, essa è risultata inferiore alle 3 porzioni al giorno nella quasi totalità delle donne, indipendentemente dal BMI pregravidico e dall’entità dell’incremento ponderale registrato in gravidanza.
L’entità dell’incremento ponderale in gravidanza dovrebbe essere oggetto di maggiori attenzioni da parte dei professionisti della salute materno-fetale, in particolare nelle donne il cui BMI pregravidico è indice di sottopeso, di sovrappeso o di obesità, ovvero in quelle categorie caratterizzate da un incremento ponderale non in linea con le
raccomandazioni SIGO. Dai dati emerge inoltre come si rendano necessari interventi mirati alla promozione della salute attraverso una maggiore assunzione di frutta e verdura da parte delle donne durante la gravidanza, in modo che questo particolare periodo possa costituire un’opportunità per il miglioramento del proprio stile di vita.
2022
- “A casa tutto bene?” Valutazione dell’impatto delle restrizioni sociali sul quoziente di sviluppo neuro-cognitivo di una coorte di bambini e considerazioni post-pandemiche.
[Abstract in Atti di Convegno]
Ferrari, E; Palandri, L; Lucaccioni, L; Passini, E; Monti, M; Azzalini, D; Righi, E
abstract
L’avvento del virus SARS-CoV-2 ha modificato la quotidianità delle famiglie ed è cruciale indagare il potenziale impatto delle restrizioni sociali legate al contenimento della pandemia sulla crescita dei bambini. La finalità dello studio è quindi quella di descrivere il livello di sviluppo raggiunto all’età di 6 mesi da una coorte di bambini sani
residenti nella provincia di Modena, visitati in parte prima e in parte dopo lo scoppio della pandemia, attraverso le scale Griffiths III, uno strumento validato per la valutazione del profilo evolutivo di neonati e bambini fino ai 6 anni.
Si tratta di uno studio trasversale condotto su una coorte di bambini sani arruolati presso il Policlinico di Modena, nell’ambito di un più ampio studio di coorte prospettico.
I punteggi ottenuti mediante le scale Griffiths III, che analizzano 5 aree evolutive chiave (basi dell’apprendimento, linguaggio e comunicazione, coordinazione oculo-manuale, abilità personali-sociali-emotive, abilità grosso-motorie) sono stati stratificati in due periodi di tempo (pre e post-COVID) in base alla data di valutazione (pre o post il
29/2/2020).
104 bambini sani nati a termine con età mediana di 6 mesi (IQR 6-7) sono stati inclusi nello studio; 34 soggetti sono stati valutati prima del 29/02/2020, 70 dopo il 1/03/2020.
Il valore medio del quoziente di sviluppo (QS) globale è risultato pari a 95,56 (DS ±7,99) e presenta differenze significative nei bambini esaminati nei due periodi considerati (99,7 vs 93,4).
I QS nei domini dello sviluppo motorio e delle basi dell’apprendimento sono risultati nella maggioranza dei bambini sopra la media o nella media dei punteggi nazionali indicativi di sviluppo regolare e non hanno presentato differenze importanti nei due periodi di tempo considerati. Al contrario, i QS nelle scale relative alle abilità sociali
appaiono in una percentuale importante di bambini sotto la media dei punteggi nazionali e risultano particolarmente ridotti nel gruppo post-COVID, nel quale il QS medio è di circa 10 punti inferiore rispetto a quello del gruppo pre-COVID.
Le abilità sociali dei bambini di 6 mesi valutati in questo studio sembrano essere fortemente impattate dai periodi di isolamento domestico imposti dalla pandemia. È opportuno valutare se tale tendenza si confermi nel tempo e se sia effettivamente legata alle restrizioni dettate dall’emergenza sanitaria in corso, allo scopo di identificare eventuali interventi correttivi sulla popolazione esaminata e di progettare futuri interventi mirati a prevenire difficoltà di sviluppo neuro-cognitivo in neonati legate alla pandemia.
2021
- A machine learning approach to predict healthcare-associated infections at intensive care unit admission: findings from the SPIN-UTI project
[Articolo su rivista]
Martina, Barchitta; Andrea, Maugeri; Giuliana, Favara; Paolo Marco, Riela; Giovanni, Gallo; Ida, Mura; Antonella, Agodi; behalf of the SPIN-UTI network Paola Murgia, On; Dolores, Maria; Masia, ; Brusaferro, Silvio; Celotto, Daniele; Arnoldo, Luca; Bissolo, Emanuela; Rigo, Alberto; Tardivo, Stefano; Moretti, Francesca; Carli, Alberto; Pascu, Diana; Tessari, Lorella; Olga Bernasconi, Mara; Brusaferro, Marco; Pappalardo, Federico; Auxilia, Francesco; Fenaroli, Salesia; Pasquarella, Cesira; Sicoli, Ennio; Teresa Montagna, Maria; Egitto, Giovanni; Squeri, Raffaele; Tribastoni, Salvatore; Pulvirenti, Alessandro; Catalano, Sebastiano; Battaglia, Pietro; Bellocch, Patrizia; Castiglione, Igiacomo; Rita Mattaliano, Anna; Astuto, Marinella; Giuseppa LaCamera, Marinella; Maria Longhitano, Anna; Scrofani, Giorgio; Concetta Monea, Maria; Milazzo, Marina; Giarratano, Antonino; Calamusa, Giuseppe; Valeriatorregrossa, Maria; Di Benedetto, Antonino; MariaGisella Rizzo, Giuseppa; Manta, Giuseppe; Tetamo, Romano; Mancuso, Rosa; Maria Mella, Laura; Dei, Ignazio; Pandiani Antonino Cannistrà, Irene; Piotti, Paola; Girardis, Massimo; Righi, Elena; Barbieri, Alberto; Crollari, Patricia; Borracino, Albino; Coniglio, Salvatore; Palermo, Rosaria; Pintaudi, Sergio; Distefano, Daniela; Romeo, Antonina; Sticca, Giovanna; Minerva, Massimo; Fabiani, Leila; Gentile, Alessandra; Stefanini, Paolo; Mario D'Errico, Marcello; Donati, Abele; Deremigis, Santa; Venturoni, Federica; Antoci, Manuela; Pagliarulo, Riccardo; Bianco, Aida; Pavia, Maria; Pasculli, Marcello; Vittori, Cesare; Battista Orsi, Giovanni; Arrigoni, Cristina; Patrizia Olori, Maria; Antonelli, Massimo; Laurenti, Patrizia; Ingala, Franco; Conte, Carmela; Russo, Salvatore; Condorelli, Laura; Farruggia, Patrizia; Maria Luisa, Cristina; Galassi, Italia
abstract
BACKGROUND: Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care unit (ICU) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions.AIM: To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAIs risk prediction in ICUs, using both traditional statistical and machine learning approaches.METHODS: We used data of 7827 patients from the "Italian Nosocomial Infections Surveillance in Intensive Care Units" project. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, antibiotic therapy in 48 hours before ICU admission.FINDINGS: The performance of SAPS II for predicting the risk of HAIs provides a ROC (Receiver Operating Characteristics) curve with an AUC (Area Under the Curve) of 0.612 (p<0.001) and an accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, we found an accuracy of the SVM classifier of 88% and an AUC of 0.90 (p<0.001) for the test set. In line, the predictive ability was lower when considering the same SVM model but removing the SAPS II variable (accuracy= 78% and AUC= 0.66).CONCLUSIONS: Our study suggested the SVM model as a tool to early predict patients at higher risk of HAI at ICU admission.
2021
- COVIDGuide una app per il triage e l'autovalutazione della COVID-19.
[Articolo su rivista]
Demurtas, J; Tonelli, R; Celotto, S; Veronese, N; Lagolio, E; Rossi, F; Clini, E; Righi, E; Meer, A.
abstract
Introduzione- La pandemia senza precedenti da COVID-19 ha mostrato le debolezze dei sistemi sanitari e aperto nuovi spazi ad e-health e telemedicina. La letteratura recente afferma che i chatbot, se progettati e implementati in modo efficace, potrebbero essere strumenti utili per condividere rapidamente informazioni, promuovere comportamenti sani e aiutare a ridurre il peso psicologico dell'isolamento.Lo scopo di questo progetto è sviluppare e testare un sistema di supporto decisionale computerizzato (SSDC) in web-app sicuro e affidabile e valutarne l’utilizzo, fruibilità e gli esiti decisionali in termini di output.
Metodi- Un team multidisciplinare è stato reclutato per pianificare e progettare, sulla base del SSDC medico SMASS, gli scenari della web-app COVID-Guide, un sistema di self-triage per i pazienti con sospetta COVID-19.
Sono stati analizzati i dati di output del periodo Maggio-Settembre 2020 provenienti dalla Germania.
Risultati- Nel periodo preso in esame il totale delle consultazioni in Germania è stato di 96012.
3415 (3,56%) consultazioni indicavano la necessità di una valutazione immediata, tramite l'attivazione del servizio di emergenza (chiamare un'ambulanza) - 1942, pari al 2,02% - o consigliando al paziente di recarsi in ospedale – 1743, pari al 1,54%.
Conclusioni- I dati di utilizzo sembrano mostrare una buona fruibilità e un numero consistente di consultazioni effettuate.
2021
- Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network
[Articolo su rivista]
Barchitta, M.; Maugeri, A.; Favara, G.; Riela, P. M.; La Mastra, C.; La Rosa, M. C.; Magnano San Lio, R.; Gallo, G.; Mura, I.; Agodi, A.; Salesia, F.; Ennio, S.; Montagna, M. T.; Squeri, R.; Di Bartolo, R. M.; Salvatore, T.; Mattaliano, A. R.; Bellocchi, P.; Castiglione, G.; Astuto, M.; Longhitano, A. M.; Monea, M. C.; Scrofani, G.; Di Benedetto, A.; Carmela, R. M.; Manta, G.; Tetamo, R.; Dei, I.; Pandiani, I.; Antonino, C.; Piotti, P.; Girardis, M.; Righi, E.; Pierangelo, S.; Arnoldo, L.; Brusaferro, S.; Coniglio, S.; Albino, B.; Pintaudi, S.; Minerva, M.; Milazzo, M.; Bissolo, E.; Rigo, A.; Fabiani, L.; Marinangeli, F.; Stefanini, P.; D'Errico, M. M.; Donati, A.; Tardivo, S.; Moretti, F.; Carli, A.; Pagliarulo, R.; Bianco, A.; Pavia, M.; Pasculli, M.; Vittori, C.; Orsi, G. B.; Arrigoni, C.; Laurenti, P.; Ingala, F.; Farruggia, P.
abstract
Background: Although preventive strategies have been proposed against catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate. Aim: To distinguish patients according to their characteristics at ICU admission, and to identify clusters of patients at higher risk for CAUTIs. Methods: A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project. Findings: Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the community. Cluster 2 comprised patients who were more likely to come from other wards/hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P<0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P=0.033). Conclusion: To the authors' knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies.
2021
- Disaster risk reduction and interdisciplinary education and training
[Articolo su rivista]
Righi, Elena; Lauriola, Paolo; Ghinoi, Alessandro; Giovannetti, Enrico; Soldati, Mauro
abstract
Natural and technological disasters and health emergencies are increasingly causing human and economic losses and disruptions. Disaster risk reduction can be effectively achieved only through a comprehensive approach aimed at connecting and integrating all the actors involved in forecasting, preventing, managing and mitigating disaster risk and its consequences. Furthermore, disaster risks can certainly be minimized by transferring to the relevant institutions and the general public valid and reliable knowledge on the nature, causes and effects of such disasters. A virtuous and effective approach to this matter is shown by the innovative Academic Upgrading Course on Territorial, Environmental and Health Emergencies (EmTASK) offered by the University of Modena and Reggio Emilia (Italy), which has proved to be a powerful tool for sharing experiences and raising attention and awareness on disaster risk reduction needs within both the workforce involved in disaster management and the general public. Before introducing the EmTASK Course, this paper provides an overview of the environmental, socio-economic and health issues related to the main natural and technological disasters recently occurred in Italy, focusing also on epidemics including the ongoing COVID-19 pandemic. Special attention is paid to the region Emilia-Romagna (northern Italy) that was hit by severe disasters in the last decade, caused by earthquakes, floods and landslides. The experience achieved in emergency and disaster management by local, regional and national institutions clearly shows that interdisciplinary policies and interventions, moving beyond traditional public health and emergency responses and activities, are needed to prevent or minimize the effects of disasters. New and innovative approaches, such as the EmTASK education and training initiative, should be pursued and enhanced, since they facilitate the integration of knowledge and experience achieved during past emergencies, and definitely raise preparedness to better cope with risks and related emergencies at different scales and levels.
2021
- Factors associated with SARS-CoV-2 infection risk among healthcare workers of an italian university hospital
[Articolo su rivista]
Modenese, A.; Casolari, L.; Rossi, G.; Della Vecchia, E.; Glieca, F.; D'Elia, C.; Garavini, D.; Righi, E.; Mariani, S.; Venturelli, L.; Vivoli, D.; Gobba, F.
abstract
We report the results of a study on the cumulative incidence of SARS-CoV-2 infections in about 6000 workers of the University Hospital of Modena, Northern Italy, in the period March 2020–January 2021, and the relations with some individual and occupational factors. Overall, in healthcare workers (HCW) the cumulative incidence of COVID-19 during the period was 13.8%. Results confirm the role of overweight and obesity as significant risk factors for SARS-CoV-2 infection. Chronic respiratory diseases, including asthma, also proved to be significantly associated with the infection rate. Considering occupational factors, the COVID-19 risk was about threefold (OR: 2.7; 95% CI 1.7–4.5) greater in nurses and nurse aides than in non-HCW, and about double (OR: 1.9; 95% CI 1.2–3.2) in physicians. Interestingly, an association was also observed between infection risk and nightshifts at work (OR: 1.8; 95% CI 1.4–2.3), significantly related to the total number of shifts in the whole eleven-month period. Even if the vaccination campaign has now greatly modified the scenario of SARS-CoV-2 infections among HCW, the results of this study can be useful for further development of health and policy strategies to mitigate the occupational risk related to the new variants of coronavirus, and therefore the evolution of the pandemic.
2021
- Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy.
[Articolo su rivista]
Forresi, B.; Caputi, M.; Scaini, S.; Caffo, E.; Aggazzotti, G.; Righi, E.
abstract
Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9–15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken
individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.
2021
- RISPOSTA ANTICORPALE ED EVENTI AVVERSI A VACCINAZIONE ANTI SARS-COV-2 NEGLI OPERATORI DELL’AZIENDA OSPEDALIERO-UNIVERSITARIA DI MODENA
[Abstract in Atti di Convegno]
Casolari, L.; Rossi, G.; Della Vecchia, E.; Glieca, F.; Muscatello, M.; Modenese, A.; Cannizzo, C.; D’Elia, C.; Garavini, D.; Neri, S.; Salvatori, D.; Mariani, S.; Righi, E.; Sarti, M.; Venturelli, L.; Vivoli, D.; Gobba, F.
abstract
2021
- SARS-COV-2 Infection in Children and Red Blood Cell Distribution Width
[Articolo su rivista]
Tchidjou Kuekou, Hyppolite; Palandri, Lucia; Pouplin, Suzanne; LiThiao Te, Valerie; Righi, Elena; Castelain, Sandrine; Ricard, Jannick
abstract
SARS-COV-2 infection due to Coronavirus is highly contagious and causes varying degrees of illness throughout the world. Recent literature has shown an association between red blood cell distribution width (RDW) and adverse outcomes among adult patients with COVID‐19. Multiple hypotheses can explain the potential prognostic role of RDW in COVID-19 infection. The aim of this study is to describe RDW values in SARS-COV-2 infected children admitted to the Pediatric Emergency Department to shed light on the potential role of RDW as a prognostic factor in this specific group.
Of 1086 tested children observed from March 2020 to April 2021, 36 positive SARS-COV-2 children (0-16 years) did not show clinically significant differences in RDW values according to illness categories, days of hospitalization, presence of multisystem inflammatory syndrome in children (MIS-C), or viral load (cycle threshold (CT) values).
This study is the first to investigate this issue in a SARS-COV-2 infected pediatric population.
Despite our negative results, given the high incidence of Delta variant in children, the low cost of the examination, its prognostic role described in adults, and its association to other pediatric illnesses, we believe that the role of RDW in SARS-COV-2 infected children should be deeper assessed and that larger collaborative studies on this issue are required.
2021
- The ontogeny of limbs movements towards midline in healthy infants born at term
[Articolo su rivista]
Lucaccioni, Laura; Bertoncelli, Natascia; Comini, Martina; Martignoni, Laura; Coscia, Alessandra; Lugli, Licia; Righi, Elena; Iughetti, Lorenzo; Berardi, Alberto; Ferrari, Fabrizio
abstract
Background: Movements towards midline are part of the age-adequate motor repertoire of infants. They develop contemporaneously to general movements, changing from occasional simple contact to proper midline motor patterns.
Aim: The aim of this study is to describe the ontogeny of movements towards midline in full term healthy infants.
Study design:Parents were asked to record their infant every second week, from term age to 22 weeks post-term.
Subjects:25 healthy full-term infants.
Result: Three main epochs of development were detected: in the first one, between birth and 4 weeks post-term, movements towards midline were occasional, apparently due to the dominant flexed posture of elbow and knees and the adducted posture of shoulders and hips. In the second epoch, from 4 to 8 weeks, the limbs movements towards midline markedly decreased. In the third one, after 8 weeks, movements towards midline increased again in frequency, first appearing in lower limbs then in upper limbs, first solely as contact and thereafter as manipulation. A temporal overlapping with the occurrence of intermittent or continual fidgety movements was detected.
Conclusions: Movements towards midline progressively change, through a defined timeline, in full term healthy infants. The increased knowledge about the normal age-adequate motor repertoire can help physicians in clinical assessment of high risk infants.
2021
- Trace elements in toenails in a population living near a modern municipal solid waste incinerator in Modena (Italy)
[Articolo su rivista]
Bechtold, Petra; Gatti, Maria Giulia; Quattrini, Giulia; Ferrari, Angela; Barbieri, Giovanna; Iacuzio, Laura; Carrozzi, Giuliano; Righi, Elena
abstract
Background and objectives: A cross-sectional biomonitoring study was performed in Modena (Italy) to assess trace element levels in toenails in a population living near a municipal solid waste incinerator (SWI), and investigate potential differences in their concentrations according to SWI emission exposure and other environmental and behavioral factors.
Methods: During the winter 2013/14 eligible subjects, aged 18e69 yrs, living within 4 km from SWI, were randomly selected from the population register. Toxic and essential element concentrations (As, Cd, Cr, Cu, Mn, Ni, Pb, Se, Zn) were analyzed in 489 toenail samples. Individual exposure to SWI emissions was estimated by using, as a tracer, fall-out maps of emitted particulate matter. Information on anthropometric parameters, lifestyles, diet, and road traffic, residential and work exposures were collected by questionnaires and objective measurements. Multivariate logistic regression analyses were carried out, separately for females and males.
Results: Excluding As, toxic elements were found, usually at low levels, in many samples, while essential elements, especially Cu and Zn, showed higher levels. Overall, no clear relationships between element levels and SWI exposure were observed, whereas associations with other environmental and lifestyle factors were found, including local food consumption, smoking and occupation.
Conclusions: The low pollutant concentrations measured in SWI emissions could explain the absence of clear patterns in toenail levels across SWI exposure levels. The associations observed with other factors suggest that, at least in this specific population, other environmental exposures and personal behaviors could act as more important predictors of trace element uptake.
2020
- ASSOCIATION BETWEEN PARENTAL PSYCHOPATHOLOGY AND THE DEVELOPMENT OF PTSD AND OTHER EMOTIONAL/BEHAVIORAL DIFFICULTIES IN CHILDREN AFTER THE 2012 EARTHQUAKE IN ITALY.
[Abstract in Rivista]
Forresi, B.; Soncini, F.; Botosso, E.; Di Pietro, E.; Scarpini, G.; Scaini, S.; Aggazzotti, G.; Caffo, E.; Righi, E.
abstract
BACKGOUND: Several studies have shown that parental mental health may have an impact on pediatric PTSD, with a few research focusing on families exposed to disasters. According to recent contributions, the severity of PTSD in children and adolescents can be affected by caregiver psychopathological symptoms and disorders (e.g., PTSD and Depression), This crosssectional study aimed at identifying main predictors of PTSD and other emotional/behavioral difficulties among youths two years after the earthquake that hit Northern Italy in 2012. The focus is on the association between parental and youth psychopathology, and on the role of parental symptoms/disorders in predicting PTSD and
specific symptom clusters in offspring.
METHODS: 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The assessment was made two years after the earthquake.
RESULTS: Parents in the earthquake area (EA) referred a high frequency of psychopathological difficulties. 28% had a global score at the SCL-90-R over the cutoff, showing a level of psychopathology and mental distress significantly higher than parents living in the control area (CA) (17.5%; p < 0.001). Parents in the EA had significantly higher scores than subjects living in the CA for most subscales: sleep disturbances was the subscale with the maximum prevalence, followed by obsessivecompulsive disorders, depression, somatization, and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample. The relationship between caregiver psychopathological symptoms and children/adolescents PTSD was examined, with correlation analysis including all the domains of SCL-
90 and the three symptom clusters of students PTSD. Statistically significant correlations were found for both total scores and all symptoms domains of the SCL90 and PTSD clusters, especially for hyperarousal and reexperiencing. In particular, greater parental symptomatology in the domains of anxiety, depression, and obsessive-compulsive disorder resulted to be specifically associated with hyperarousal symptoms in children. Pearson’s correlations showed moderate positive correlations between parents and children’ symptomatology, with particular reference to Total Difficulties Score and Hyperactivity/Disattention and behavioural difficulties scores. T-test analysis revealed higher SDQ scores in all
the subscales and in the Total Difficulties Score for children of parents with higher SCL-90 R scores. Regression
analysis showed that parental psychopathology was one of the most powerful predictor for both children total PTSD score (β = 0.147, p < 0.001) and the SDQ total difficulties score (β = 0.137, p < 0.001).
CONCLUSIONS: Despite some limitations, this study revealed a significant association between parental mental health and both PTSD and emotional/behavioural problems among offspring after earthquakes. These results should be carefully considered in mental health support interventions in the areas affected by earthquakes.
2020
- Air microbial contamination in dental clinics: comparison between active and passive methods
[Articolo su rivista]
Veronesi, Licia; Colucci, Maria Eugenia; Napoli, Christian; Castiglia, Paolo; Liguori, Giorgio; Torre, Ida; Righi, Elena; Farruggia, Patrizia; Tesauro, Marina; Montagna, Maria Teresa; Gallè, Francesca; Masia, Maria Dolores; Di Onofrio, Valeria; Caggiano, Giuseppina; Tinteri, Carola; Panico, Manuela; Pennino, Francesca; Cannova, Lucia; Pasquarella, Cesira
abstract
The aim of this study was to evaluate the correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA) and to calculate the corresponding equations. Air sampling was performed in ten dental clinics (DC), before (T0), during (T1) and after (T2) the clinical activity, for five consecutive days, once a month for a period of three months, for a total of 450 air samplings. The correlation was evaluated using the Spearman test, and a p value below 0.05 was considered statistically significant. A statistically significant correlation was found considering both the results obtained from the total observations and from the single sampling times, T0, T1 and T2. Different correlation patterns were observed stratifying by DC. Both methods were able to evaluate the microbial air quality and highlight critical situations; therefore, both can be used with this aim. However, in particular during the activity, passive sampling resulted more sensitive, and for its simplicity, economy and standardization by IMA, as suggested by several authors, can be suggested for routine monitoring.
2020
- Child growth, neurodevelopment and pre and postnatal exposure to phthalates: first exposure data
[Abstract in Rivista]
Maione, D; Lucaccioni, L; Arletti, M; Panciroli, G; Poluzzi, F; Ferrari, A; Facchinetti, F; Fantuzzi, G; Righi, E
abstract
2020
- Implementation of Acute Flaccid Paralysis Surveillance in Emilia-Romagna, Italy: 2018-2019 analysis.
[Abstract in Rivista]
Morgado, M; Palandri, L; E Colucci, M; Affanni, P; Zoni, R; Pasquarella, C; Righi, E; Veronesi, L
abstract
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
abstract
2020
- Parental and offspring psychopathological disorders after the 2012 Italian earthquake
[Abstract in Rivista]
Panciroli, G; Forresi, B; Soncini, F; Botosso, E; Di Pietro, E; Scarpini, G; Scaini, S; Aggazzotti, G; Caffo, E; Righi, E
abstract
2020
- Physical activity during pregnancy in Italy: prevalence, intensity and associated factors.
[Abstract in Rivista]
Fioretti, E; Palandri, L; Fantuzzi, G; Facchinetti, F; Righi, E
abstract
2020
- Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study
[Articolo su rivista]
Forresi, B.; Soncini, · F.; Botosso, · E.; Di Pietro, · E.; Scarpini, · G.; Scaini, · S.; Aggazzotti, · G.; Caffo, · E.; E. Righi., ·
abstract
Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9–14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.
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.
abstract
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
- THE EFFICACY AND SAFETY OF INFLUENZA VACCINATION IN OLDER PEOPLE: AN UMBRELLA REVIEW OF EVIDENCE FROM META-ANALYSES OF BOTH OBSERVATIONAL AND RANDOMIZED CONTROLLED STUDIES
[Articolo su rivista]
Demurtas, Jacopo; Celotto, Stefano; Beaudart, Charlotte; Sanchez-Rodriguez, Dolores; Balci, Cafer; Soysal, Pınar; Solmi, Marco; Celotto, Daniele; Righi, Elena; Smith, Lee; Lopalco, Pier Luigi; Noventa, Vania; Michel, Jean Pierre; Torbahn, Gabriel; Di Gennaro, Francesco; Pizzol, Damiano; Veronese, Nicola; Maggi, Stefania
abstract
Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1,240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for flu/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for flu/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes.
2020
- Trihalomethanes in drinking water and bladder cancer burden in the European Union
[Articolo su rivista]
Evlampidou, I.; Font-Ribera, L.; Rojas-Rueda, D.; Gracia-Lavedan, E.; Costet, N.; Pearce, N.; Vineis, P.; Jaakkola, J. J. K.; Delloye, F.; Makris, K. C.; Stephanou, E. G.; Kargaki, S.; Kozisek, F.; Sigsgaard, T.; Hansen, B.; Schullehner, J.; Nahkur, R.; Galey, C.; Zwiener, C.; Vargha, M.; Righi, E.; Aggazzotti, G.; Kalnina, G.; Grazuleviciene, R.; Polanska, K.; Gubkova, D.; Bitenc, K.; Goslan, E. H.; Kogevinas, M.; Villanueva, C. M.
abstract
BACKGROUND: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. OBJECTIVE: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. METHODS: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure–response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. RESULTS: We obtained 2005–2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11:7 μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0–23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. DISCUSSION: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures.
2019
- Esposizione prenatale e postnatale a ftalati ed effetti sullo sviluppo infantile: presentazione dei primi dati raccolti
[Abstract in Rivista]
Maione, Domenico; Lucaccioni, Laura; Facchinetti, Fabio; Plessi, Carlotta; Poluzzi, Francesca; Ferrari, Angela; Fantuzzi, Guglielmina; Righi, Elena
abstract
Gli ftalati, potenziali interferenti endocrini comunemente addizionati alle materie plastiche, si ritrovano in numerosi prodotti di largo consumo quali involucri alimentari, cosmetici, prodotti per l’igiene personale, giocattoli e articoli per l’infanzia. A causa dei processi di migrazione ed evaporazione essi sono in grado di contaminare diverse matrici ambientali, determinando una esposizione umana continua e diffusa che può avvenire attraverso diverse vie e modalità. In più tali sostanze sono capaci di attraversare la barriera placentare, interferendo così anche con lo
sviluppo fetale e neonatale. Le conoscenze sui livelli di esposizione prenatale e, soprattutto, postnatale a ftalati dei neonati sono tuttavia ancora molto limitate. Questo studio ha quindi l’obiettivo di valutare, attraverso il biomonitoraggio
urinario, l’esposizione prenatale e postnatale a questi composti in neonati della provincia di Modena e, di indagare
il potenziale effetto di questa esposizione sull’accrescimento corporeo, sui livelli ormonali e sullo sviluppo neuro-cognitivo nei primi due anni di vita
2019
- Esposizione prenatale e postnatale a ftalati ed effetti sullo sviluppo infantile: presentazione del protocollo di ricerca.
[Abstract in Rivista]
Maione, D; Lucaccioni, L; Facchinetti, F; Pignatti, L; Ferrari, A; Fantuzzi, G; Righi, E
abstract
Introduzione: Gli ftalati, potenziali endocrine disruptors comunemente addizionati alle materie plastiche, si ritrovano in numerosi prodotti di largo consumo quali involucri alimentari, giochi, cosmetici e prodotti per l’igiene personale. Le conoscenze sui livelli di esposizione prenatale e, soprattutto, postnatale a ftalati dei neonati sono tuttavia molto limitate.
Questo studio ha l’obiettivo di valutare, attraverso il biomonitoraggio urinario, l’esposizione prenatale e postnatale a ftalati in neonati della provincia di Modena e di indagare il ruolo/effetto di questa esposizione sull’accrescimento corporeo, sui livelli ormonali e sullo sviluppo neuro-cognitivo nei primi due anni di vita.
Materiali e metodi: Si tratta di uno studio di coorte che prevede l’arruolamento, subito dopo il parto, di donne e dei loro bambini, nati a termine e normopeso, presso l’AOU di Modena. L’esposizione prenatale verrà valutata tramite il dosaggio di ftalati nelle urine (materne e neonatali) raccolte all’arruolamento e la somministrazione di un questionario che indaga le fonti espositive durante la gravidanza. L’esposizione postnatale verrà valutata raccogliendo le urine
dei bambini a 6 mesi e la somministrazione di un secondo questionario espositivo. Alla nascita e durante i primi due anni di vita, mediante visite periodiche, verranno misurati accrescimento corporeo, livelli ormonali urinari (LH, FSH, testosterone/estradiolo), sviluppo neuro-motorio (metodo di Prechtl ed esame obiettivo neurologico) e sviluppo neuro-cognitivo (Scala di Griffiths). La determinazione analitica dei 6 diesteri più diffusi e dei relativi metaboliti
verrà effettuata tramite cromatografia liquida e spettrometria di massa.
Risultati: Le analisi dei campioni di urine raccolti dai neonati in diversi momenti permetteranno di quantificare sia l’esposizione prenatale che quella postnatale agli specifici ftalati e ai loro principali metaboliti, valutandone anche i trend temporali, di individuare le principali fonti espositive, sia durante la gravidanza che durante i primi 6 mesi di vita, e di indagare le correlazioni tra tali esposizioni e le caratteristiche antropometriche, i livelli ormonali del sistema riproduttivo e lo sviluppo neuro-motorio e neuro-cognitivo nei primi due anni di vita dei bambini.
Conclusioni: Grazie al coinvolgimento dei neonati nel monitoraggio biologico, questa indagine migliorerà le conoscenze dirette sui livelli di esposizione prenatale e, soprattutto, postnatale a ftalati dei neonati, e apporterà contributi su possibili effetti sul loro accrescimento corporeo e sviluppo neurocognitivo. Inoltre, le informazioni ottenute potranno essere utilizzate per la pianificazione di strategie di prevenzione e promozione della salute della popolazione femminile in età fertile al fine di ridurre l’esposizione a queste sostanze in gravidanza e nei primi mesi di vita neonatale.
2019
- L’offerta delle prestazioni sanitarie per la popolazione migrante irregolare: l’esperienza di Modena e Reggio Emilia
[Abstract in Rivista]
Fioretti, E; Creola, Giacomo; Righi, E; Kahfian, Z; Casaletti, G.
abstract
Introduzione: In Italia l’applicazione delle norme relative all’offerta sanitaria per la popolazione migrante irregolare risulta ancora disomogenea con un notevole impatto negativo sulla salute e con il rischio di non riuscire ad intercettare situazioni di vulnerabilità. Nell’ambito del progetto ministeriale FOOTPRINTS, volto a superare le disparità sul tema della salute dei migranti, è stata condotta un’indagine conoscitiva preliminare nelle province di Modena e Reggio Emilia al
fine di descrivere l’attuale organizzazione e offerta dei percorsi assistenziali per gli Stranieri Temporaneamente Presenti (STP), non in regola con il permesso di soggiorno e pertanto non iscritti al Servizio Sanitario Nazionale.
Metodi: Nel mese di aprile 2019 è stata realizzata un’analisi del contesto territoriale di Modena e Reggio Emilia. Sono stati intervistati i responsabili delle strutture coinvolte nell’assistenza sanitaria alla popolazione migrante STP ed è stata compilata una checklist relativa alla erogazione delle prestazioni sanitarie.
Risultati: Dall’indagine è emerso che nel 2018 oltre 5000 utenti hanno avuto accesso all’ambulatorio di volontari del centro Porta Aperta di Modena (convenzionato con l’AUSL) e al Centro Salute Famiglia Straniera dell’AUSL di Reggio Emilia (coadiuvato dall’ambulatorio dei volontari della Caritas). Sono garantiti i percorsi relativi alla gravidanza e la tutela della salute dei minori figli di stranieri STP mentre le offerte relative alle vaccinazioni e alle prestazioni specialistiche risultano disomogenee tra le due province. Le principali criticità e differenze riguardano le quote di partecipazione
alla spesa delle prestazioni sanitarie in caso di esami specialistici di approfondimento.
Conclusioni: L’indagine evidenzia come, anche in contesti territoriali e organizzativi simili, la gestione della salute della popolazione migrante irregolare possa risultare disomogenea. La mancanza di un’adeguata assistenza sanitaria a causa di problematiche amministrative e burocratiche si ripercuote in modo negativo sulla tutela della salute dei migranti e può comportare un aggravamento delle patologie di base con potenziali successivi costi superiori di gestione.
Occorre pertanto implementare e sostenere la realizzazione di progetti volti ad uniformare l’accesso alle cure anche delle persone che, per vari motivi (mancanza del permesso di soggiorno, mancanza di residenza), non possono essere iscritte al SSN al fine di garantire a tutti il diritto alla salute.
2019
- Natural Disaster—Environmental Health Preparedness
[Capitolo/Saggio]
Lauriola, Paolo; Leonardi, Giovanni; Righi, Elena; Bayleyegn, Tesfaye M.; Schnall, Amy Helene; Malilay, Josephine; Louca, Soulla; Behbod, Behrooz
abstract
This article will summarize a short, simple, and comprehensive description of natural disaster preparedness and response.
In particular, it will focus on the following:
• What they are in terms of qualitative and quantitative perspectives;
• How they can be addressed in terms of prevention and management;
• Innovations that may be piloted, evaluated, adopted, and diffused if appropriate
2019
- Sorveglianza e monitoraggio degli enterobatteri produttori di carbapenemasi (CPE): i risultati dell’ospedale G.B. Morgagni - L. Pierantoni di Forlì.
[Abstract in Rivista]
Fagioli, Francesca; Righi, E; Rossi, A; Amadori, A; Bergamini, R; Fabbri, E; Masperi, P.
abstract
Introduzione: Le antibiotico-resistenze rappresentano, a livello Nazionale, un problema clinico e organizzativo rilevante. La resistenza ai carbapenemi sviluppata da enterobatteri pone problemi al controllo delle infezioni in ambito ospedaliero determinando aumento di mortalità, degenza e costi. L’AUSL Romagna in ottemperanza alle direttive Regionali ha implementato misure specifiche di controllo con ricerca attiva dei colonizzati e isolamento preventivo dei pazienti a rischio.
Materiali e metodi: Dal 2017 è stato avviato uno specifico sistema di sorveglianza e gestione dei pazienti colonizzati/infetti da CPE, basato sull’identificazione precoce attraverso screening all’ingresso in Ospedale; attraverso una checklist vengono valutati 10 fattori di rischio e determinato uno score: se il risultato individua un paziente a rischio viene eseguito screening con tampone rettale. Nelle Unità Operative ad alto rischio (es. Rianimazione) sono screeenati tutti i pazienti in ingresso. Lo screening viene effettuato al momento del ricovero (o entro 24 ore): in attesa dell’esito del test il paziente viene gestito come positivo, applicando le misure di isolamento da contatto che saranno sospese in caso
di negatività e mantenute per tutto il ricovero in caso di positività. Il sistema informatizzato permette inoltre di identificare precocemente i pazienti già noti per colonizzazione/infezione da CPE che accedono alla struttura, tramite l’apertura di un “pop-up” di Alert inviato dal sistema al momento del ricovero. In caso di positività riscontrata in paziente
recentemente non noto è necessaria conferma attraverso la ripetizione del test; per confermare la negativizzazione è necessario ottenere 3 referti negativi eseguiti a 7 giorni di distanza. I pazienti positivi vengono valutati da Medico e Infermiere responsabili che ne dispongono l’isolamento in stanza singola, in coorting o il solo isolamento spaziale. Al fine di evitare e monitorare eventuali infezioni secondarie da trasmissione del microrganismo viene attivata sorveglianza attiva dei contatti. Sono stati eseguiti corsi di formazione rivolti agli operatori per aggiornamento e sensibilizzazione sul
tema.
Risultati: Dal 2017, anno di avvio del programma di sorveglianza, ad oggi nell’Ospedale di Forlì sono stati individuati 78 positività da tampone rettale su un complessivo di 51.921 ricoveri, con un’incidenza dell’1,55‰; inoltre, sono stati riscontrate 36 positività su campioni da altri materiali (incidenza 0,69‰) e 7 batteriemie (incidenza 0,13‰). Si è verificato un solo caso di infezione secondaria da trasmissione intra-ospedaliera.
Conclusioni: I risultati mostrano che l’attivazione del programma di sorveglianza e gestione ha permesso di individuare precocemente i pazienti colonizzati/infetti, adottare adeguate misure di isolamento e controllare la trasmissione
intra-ospedaliera nonostante l’aumento dei pazienti a rischio, della diffusione e della circolazione dei microrganismi.
2018
- Contaminazione chimica delle acque di piscina: valutazione del rischio per la salute
dei nuotatori
[Abstract in Atti di Convegno]
Fantuzzi, G.; Righi, E.; Predieri, G.; Castiglioni, S.; Riva, F.; Zuccato, E.; Aggazzotti, G.
abstract
SCOPO
I nuotatori possono essere esposti a contaminanti chimici di diversa origine e provenienza nelle acque di piscina attraverso l’ingestione di piccole quantità di acqua oppure mediante il contatto cutaneo e l’inalazione di aerosol. Scopo del presente studio è stato quello effettuare la valutazione del rischio per la salute dei nuotatori esposti a trialometani (THM), farmaci e droghe d’abuso, composti chimici di frequente riscontro in tali ambienti.
METODI
Lo studio è stato eseguito su campioni di acqua di 10 piscine coperte pubbliche in Emilia-Romagna nel 2016. Sono stati ricercati i THM, 31 farmaci di differenti classi farmacologiche e le principali droghe d’abuso. La valutazione del rischio umano (HRA) è stata condotta in varie classi di età (bambini, adolescenti e adulti) e in base al sesso. I valori ponderali di riferimento di ogni categoria e la quantità media di acqua ingerita durante il nuoto sono stati ricavati dalla letteratura. La HRA è stata condotta tenendo conto dello scenario peggiore, utilizzando la concentrazione più elevata di ciascun contaminante e ipotizzando un allenamento quotidiano.
RISULTATI
Nelle acque di piscina sono stati ritrovati THM in tutti i campioni di acqua analizzati (range 23 - 62 μg/L.), mentre solo 11 composti dei 31 farmaci ricercati sono risultati al di sopra del limite di quantificazione. Ibuprofene e ketoprofene sono presenti in tutte le piscine con valori massimi rispettivamente di 197 e 127 ng / L, mentre carbamazepina, valsartan, enalapril e atenololo sono apparsi più sporadicamente e in tracce. Cocaina e i suoi metaboliti sono stati trovati in 8 piscine a valori compresi tra 0,18 ng/l e 48,72 ng/l. L’HRA per singole sostanze e sul totale mostra rischi trascurabili per i nuotatori di qualsiasi età o sesso. I quozienti di rischio (HQ) dei THM variavano da 0.001 a 0.011, mentre quelli dei farmaci sono risultati inferiori a 0,001, con la sola eccezione del ketoprofene per i bambini di 3 anni (0,004 e 0,003 per maschi e femmine, rispettivamente). I HQ della cocaina e dei metaboliti sono risultati più elevati, con un massimo di 0,146, comunque ben al di sotto dell’unità che è il valore di riferimento. Il rischio cumulativo per tutte le sostanze è
risultato anch'esso inferiore a 1, anche nelle popolazioni infantili.
CONCLUSIONI
Il rischio per la salute umana derivante dalla esposizione a queste sostanze nelle piscine coperte appare generalmente trascurabile, anche per sottopopolazioni vulnerabili come quelle dei bambini e degli adolescenti.
2018
- Effect of Self-Adjusting file and WaveOne reciprocating file on the filling ability of oval-shaped canals with thermoplasticized gutta-percha
[Articolo su rivista]
Generali, L; Cavani, F; Righi, E; Murri Dello Diago, A; Spinas, E; Giannetti, L
abstract
The aim of the study was to compare the effect of Self-Adjusting Files (SAF) and WaveOne Primary file with syringe and needle irrigation on the filling ability of oval-shaped root canals obturated with thermoplasticized gutta-percha. Twenty-four single root teeth with single oval-shaped root canals were distributed in two experimental homogeneous group. One group was instrumented and cleansed using the SAF system while in the other group the WaveOne system with syringe and needle irrigation was used. After instrumentation, the roots were filled by Thermafil Obturators and TopSeal sealer. Specimens were transversally sectioned at 2-, 5- and 7-mm levels from the apex and observed under light microscope. The percentage of gutta-percha filled area (PGFA), the percentage of sealer filled area (PSFA) and the percentage of voids area (PVA) were measured for each section, moreover the percentage of completely filled sections was evaluated. At all levels, no significant differences in terms of PGFA, PSFA, PVA and percentage of completely filled canals between groups were obtained (P > .05). On the contrary, when the data were pooled, the mean PGFA in the SAF group was 95.8%, whereas it was 93.2% in the WaveOne group (P < 0.05). The percentage of sections completely filled was 77.8% in the SAF group, while 52.8% in the WaveOne group (P < 0.05). Overall, the use of the SAF system in oval canals allows to obtain a significantly greater complete filling than the use of the WaveOne system.
2018
- Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network
[Articolo su rivista]
Agodi, A; Barchitta, M; Auxilia, F; Brusaferro, S; D'Errico, M M; Montagna, M T; Pasquarella, C; Tardivo, S; Arrigoni, C; Fabiani, L; Laurenti, P; Mattaliano, A R; Orsi, G B; Squeri, R; Torregrossa, M V; Mura, ; I and 123 collaborators: Aiello, Mr; Alliani, C; Amatucci, Mr; Antoci, M; Antonelli, M; Astuto, M; Arnoldo, L; Arru, B; Baccari, G; Barbadoro, P; Barbara, A; Barilaro, C; Battaglia, P; Bellocchi, P; Bernasconi, Mo; Bianco, A; Bissolo, E; Bocchi, A; Bruno, A; Brusaferro, M; Buccheri, M; Campanella, F; Canino, R; Cannistrà, A; Carini, Sa; Catalano, S; Castellani, P; Castiglione, G; Coniglio, S; Consolante, C; Conte, C; Contrisciani, R; Corallini, R; Crollari, P; Damiani, G; Denaro, C; De Remigis, S; Diana, F; Di Bartolo, R; Di Benedetto, A; Di Fabio, G; Di Falco, C; Digeronimo, V; Di Gregorio, P; Distefano, R; Egitto, G; Falciani, E; Farruggia, P; Fenaroli, S; Ferlazzo, G; Garofalo, G; Girardis, M; Giovanelli, L; Giubbini, G; Graceffa, A; Guadagna, A; Gregu, G; Ingala, F; Innocenzi, L; La Camera, G; La Rosa, Mc; Lesa, L; Longhitano, Am; Luppino, G; Maida, Cm; Manta, G; Marino, G; Masia, Md; Maviglia, R; Mazzetti, M; Maugeri, A; Megna, Mt; Mella, Lm; Milazzo, M; Milia, M; Minari, C; Minerva, M; Mordacci, M; Murgia, P; Oliveri, P; Olori, Mp; Pagliarulo, R; Palermo, R; Pandiani, I; Pappalardo, F; Papetti, C; Partenza, A; Pascu, D; Pasculli, M; Pavia, M; Pavone, Ml; Pellegrino, Mg; Pelligra, F; Pillon, D; Pintaudi, S; Pitzoi, L; Pinto, A; Piotti, P; Pupo, S; Quattrocchi, R; Righi, E; Rigo, A; Rigo, A; Romeo, A; Rosa, E; Rutigliano, S; Sarchi, P; Scimonello, G; Seminerio, A; Stefanini, P; Sticca, G; Taddei, S; Tessari, L; Tetamo, R; Ticca, M; Tribastoni, S; Vallorani, S; Venturoni, F; Vitagliano, E; Vitali, P; Zappone, A; Zei, E; Zeoli, Mp.
abstract
Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project.
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)
abstract
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
- Illicit drugs and pharmaceuticals in swimming pool waters
[Articolo su rivista]
Fantuzzi, G.; Aggazzotti, G.; Righi, E.; Predieri, G.; Castiglioni, S.; Riva, F.; Zuccato, E.
abstract
The occurrence of illicit drugs (cocaine, opioids, amphetamines and cannabis derivatives), some of their metabolites and 48 pharmaceuticals, was investigated in pool and source waters in ten Italian indoor swimming pools. The samples were analyzed by highperformance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), after solid phase extraction (SPE). Cocaine and its metabolites were found in nine swimming pools, at concentrations from 0.3 to 4.2 ng/L for cocaine, 1.1 to 48.7 ng/L for norcocaine, 0.7 to 21.4 ng/L for benzoylecgonine and 0.1 to 7.3 ng/L for norbenzoylecgonine. Opioids, amphetamines and cannabis derivatives were never detected. The most frequent pharmaceuticals were anti-inflammatory drugs: ibuprofen was found in all the pool waters, with a maximum 197 ng/L and ketoprofen was detected in 9/10 samples (maximum 127 ng/L). Among anticonvulsants, carbamazepine and its metabolite, 10,11-dihydro-10,11dihydroxycarbamazepine, were frequent in swimming pool water (8/10 samples) at concentrations up to 62 ng/L. The cardiovascular drug valsartan was also found frequently (8/10 samples), but at lower concentrations (up to 9 ng/L). Other pharmaceuticals were detected occasionally and at lower concentrations (atenolol, enalapril, paracetamol, hydroclorothiazide, irbesartan and dehydro-erythromycin). Carbamazepine, irbesartan and dehydroerythromycin were detected at very low levels (up to 5 ng/L) in only one of the four source water samples. A quantitative risk assessment showed that the health risk for humans to these substance in swimming pool waters was generally negligible, even for vulnerable subpopulations such as children and adolescents.
2018
- Indagine di prevalenza sull'attività fisica in gravidanza e i fattori ad essa correlati in un campione di donne della provincia di Modena.
[Abstract in Atti di Convegno]
Fioretti, Elisabetta; Righi, E.; Fantuzzi, G.; Facchinetti, F.; Pignatti, Lucrezia; Aggazzotti, Gabriella
abstract
INTRODUZIONE
La gravidanza rappresenta un periodo durante il quale le donne possono essere più motivate a migliorare il proprio stile di vita. L’Organizzazione Mondiale della Sanità (OMS) e altre organizzazioni nazionali ed internazionali raccomandano la pratica di un’adeguata attività fisica sia prima che durante la gravidanza, in assenza di controindicazioni mediche. Lo scopo dello studio è stato quello di valutare le abitudini delle donne
in relazione all'attività fisica svolta prima e durante la gravidanza.
MATERIALI E METODI
Lo studio epidemiologico osservazionale trasversale ha coinvolto 390 donne in gravidanza (età media: 33±5 anni) arruolate presso l’U.O. di Ostetricia e Ginecologia dell’Azienda Ospedaliero-Universitaria del Policlinico di Modena. Le informazioni relative all’attività fisica sono state raccolte mediante un questionario costruito ai fini dello studio.
RISULTATI
Delle 390 donne che hanno partecipato allo studio, solo il 35,1% delle donne (137) ha dichiarato di aver svolto attività fisica sia prima che durante la gravidanza. Prima della gravidanza 196 donne (50,3%) hanno svolto attività fisica e, tra queste, il 53,1% (104) ha praticato
almeno 150 minuti di attività fisica a settimana come raccomandato dall'OMS. La ginnastica (33,2%) e le camminate (30,1%) rappresentano le attività maggiormente praticate. Durante la gravidanza 202 donne (51,8%) hanno dichiarato di aver svolto attività fisica: in particolare nel I
trimestre 145 donne (71,8%) hanno fatto esercizio fisico, nel II trimestre 176 (87,1%) e nel III trimestre 167 (82,7%). Solamente 116 donne (57,4%) hanno praticato attività fisica in tutti e 3 i trimestri e solo 107 donne hanno raggiunto gli standard consigliati dall'OMS. Le attività più rappresentate durante la gravidanza sono le camminate (62,9%) e il nuoto (27,7%). La pratica regolare dell’attività fisica risulta influenzata da variabili demografiche (età, nazionalità, titolo di studio, attività lavorativa) e dalle condizioni di salute delle donne.
CONCLUSIONI
Sebbene la pratica dell’attività fisica prima e durante la gravidanza apporti dei benefici per la salute sia della mamma che del bambino, il numero di donne che svolgono regolare attività fisica durante la gravidanza risulta limitato. Appare, quindi, necessario individuare efficaci strategie di promozione di un corretto stile di vita in questa fascia di popolazione.
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
abstract
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
abstract
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
- 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
abstract
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.
2017
- Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy
[Articolo su rivista]
Villanueva, Cristina M; Gracia Lavedan, Esther; Bosetti, Cristina; Righi, Elena; Molina, Antonio José; Martín, Vicente; Boldo, Elena; Aragonés, Nuria; Perez Gomez, Beatriz; Pollan, Marina; Gomez Acebo, Ines; Altzibar, Jone M; Jiménez Zabala, Ana; Ardanaz, Eva; Peiró, Rosana; Tardón, Adonina; Chirlaque, M. Dolores; Tavani, Alessandra; Polesel, Jerry; Serraino, Diego; Pisa, Federica; Castaño Vinyals, Gemma; Espinosa, Ana; Espejo Herrera, Nadia; Palau, Margarita; Moreno, Victor; La Vecchia, Carlo; Aggazzotti, Gabriella; Nieuwenhuijsen, Mark J; Kogevinas, Manolis
abstract
Evidence on the association between colorectal cancer and exposure to disinfection by-products in drinking water is inconsistent. We assessed long-term exposure to trihalomethanes (THMs), the most prevalent group of chlorination by-products, to evaluate the association with colorectal cancer.
Methods: A multicentre case-control study was conducted in Spain and Italy in 2008-2013. Hospital-based incident cases, population-based (Spain) and hospital-based (Italy) controls were interviewed to ascertain residential histories, water type consumed in each residence, frequency and duration of showering/ bathing, and major recognized risk factors for colorectal cancer. We estimated adjusted odds ratios (OR) for colorectal cancer in association with quartiles of estimated average lifetime THM concentrations in each participant’s residential tap water (μg/L, from age 18 to two years before the interview) and estimated average lifetime THM ingestion from drinking residential tap water (μg/day).
Results: Subjects analyzed were 2047 cases and 3718 controls. Median values (ranges) for average lifetime residential tap water concentrations of total THMs, chloroform, and brominated THMs were 30 (0-174), 17 (0-63), and 9 (0–145) μg/L, respectively. Total THM concentration in residential tap water was not associated with colorectal cancer (OR=0.92, 95%CI: 0.66-1.28 for highest vs. lowest quartile), but chloroform concentrations were inversely associated (OR=0.31, 95%CI: 0.24-0.41 for highest vs. lowest quartile). Brominated THMs concentrations showed a positive association among men at the highest vs. lowest quartile (OR=1.43, 95%CI: 0.83-2.46). Patterns of associations were similar for estimated average THM ingestion through residential water consumption.
Conclusions: We did not find clear evidence of an association between detailed estimates of lifetime total THM exposures and colorectal cancer in our large case-control study population. Negative associations with chloroform concentrations and ingestion suggest differences among specific THMs, but these findings need confirmation in other study populations.
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
abstract
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
- DETERMINAZIONE DI ENDOCRINE DISRUPTORS NEL LATTE MATERNO IN UN CAMPIONE DI DONNE DELLA PROVINCIA DI MODENA – RISULTATI PRELIMINARI DI UNO STUDIO EPIDEMIOLOGICO TRASVERSALE
[Abstract in Atti di Convegno]
Scelsa, F; Righi, E; Fantuzzi, G; Predieri, G; Bargellini, A; Borella, P; Aggazzotti, G
abstract
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
2017
- DROGHE DI ABUSO E PRODOTTI FARMACEUTICI NELLE ACQUE DI PISCINA
[Abstract in Atti di Convegno]
Prengka, Anna; Fantuzzi, G; Righi, E; Predieri, G; Castiglioni, S; Riva, F; Zuccato, E; Aggazzotti, G.
abstract
INTRODUZIONE: Le informazioni in letteratura sulla presenza nelle acque di piscina dei prodotti farmaceutici e dei residui di droghe illegali sono scarse. Tali sostanze sono liberate nell’acqua della piscina dai nuotatori mediante urine e sudore. Scopo dello studio è indagare sulla presenza di farmaci, droghe e loro metaboliti in un campione di piscine coperte pubbliche italiane, per valutare la possibile esposizione dei nuotatori.
MATERIALI E METODI: Lo studio è stato eseguito su campioni di acqua di 10 piscine coperte pubbliche in Emilia-Romagna nel 2016. Per ogni piscina sono state registrate le caratteristiche strutturali, i trattamenti di disinfezione, il tempo dall’ultimo ricambio delle acque e il numero di nuotatori. In 4 piscine è stata campionata anche l’acqua di approvvigionamento. Sono stati indagati 31 farmaci di differenti classi farmacologiche e le principali droghe d’abuso. L’analisi chimica effettuata è la cromatografia liquida ad alta prestazione - spettrometria di massa tandem (HPLC-MS / MS), dopo estrazione in fase solida (SPE).
RISULTATI: Nelle acque di piscina è stata osservata la presenza di 11 farmaci al di sopra del limite di quantificazione. I più rilevanti sono ibuprofene e ketoprofene, presenti in tutte le piscine, con valori massimi rispettivamente di 197 e 127 ng / L. Farmaci presenti in quantità minori sono carbamazepina , 10,11 -dihidro-10,11-diidrossicarbamazepina, valsartan, enalapril e atenololo. Nei campioni di acqua di approvvigionamento esaminati sono stati rilevati solo carbamazepina, irbesartan e deidroeritromicina a livelli molto bassi. Oppioidi, anfetamine e cannabis non sono mai stati rilevati mentre la cocaina e i suoi metaboliti sono stati trovati in 8 piscine a concentrazioni comprese tra 0,18 ng/l e 48,72 ng/l. Le maggiori concentrazioni di droghe sono state rilevate nelle piscine che non utilizzavano i filtri di sabbia con carbonio attivo granulare.
CONCLUSIONI: In tutte le acque di piscina esaminate è stata rilevata la presenza in concentrazioni ridotte di farmaci e droghe, tra cui i più diffusi sono risultati gli anticonvulsivanti e gli antiinfiammatori. Sono necessari ulteriori indagini per caratterizzare i rischi potenziali per la salute derivanti dall’esposizione a lungo termine a bassi livelli di queste sostanze, in particolare per le sottopopolazioni sensibili.
2017
- ELEMENTI IN TRACCIA NEL LATTE MATERNO: STUDIO ANALITICO TRASVERSALE SU UN CAMPIONE DI DONNE DELLA PROVINCIA DI MODENA
[Abstract in Atti di Convegno]
Pescarolo, L.; Fantuzzi, G.; Righi, E.; Ferrari, A.; Marchesi, I.; Borella, P.; Bargellini, A.
abstract
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
- Effect of Different Irrigation Systems on Sealer Penetration into Dentinal Tubules
[Articolo su rivista]
Generali, Luigi; Cavani, Francesco; Serena, Valentina; Pettenati, Corinne; Righi, Elena; Bertoldi, Carlo
abstract
Introduction: Different irrigation systems have been developed to improve the efficacy and distribution of the irrigants. The aim of this study was to compare the effect of conventional endodontic needle irrigation with other irrigant delivery and/or agitation systems on sealer penetration into dentinal tubules. Methods: Fifty single-rooted teeth with round-shaped root canals were distributed in 5 homogeneous groups character- ized by the different cleansing system used: conven- tional endodontic needle irrigation, EndoActivator, Irrisafe, Self-Adjusting File, and EndoVac. After instru- mentation, all teeth were filled by Thermafil obturators and rhodamine B dye labeled TopSeal sealer. Teeth were transversally sectioned at 2-, 5-, and 7-mm levels from the apex and observed under confocal laser scanning microscope. Maximum, mean, and percentage of sealer penetration inside tubules around the root canal were measured. Moreover, the integrity of the sealer layer perimeter was evaluated. Results: No significant differ- ences both in mean (p > .05) and in maximum penetra- tion depth (p > .05) were observed among groups, whereas both parameters showed an increased trend within each group from the 2- to the 7-mm level from apex. Similarly, the percentage of penetration around the root canal wall did not differ among groups (p > .05) and showed an increasing trend within each group from the apical to the coronal portion of the canal. Conclusions: Sealer penetration into dentinal tubules is not affected by the irrigant delivery and/or agitation sys- tems studied. Thermafil with TopSeal technique achieves complete sealer perimeter integrity in all groups.
2017
- Impact of Pre-Analytical Time on the Recovery of Pathogens from Blood Cultures: Results from a Large Retrospective Survey
[Articolo su rivista]
Venturelli, Claudia; Righi, Elena; Borsari, Lucia; Aggazzotti, Gabriella; Busani, Stefano; Mussini, Cristina; Rumpianesi, Fabio; Rossolini, Gian Maria; Girardis, Massimo
abstract
Prompt identification of bloodstream pathogens is essential for optimal management of patients. Significant changes in analytical methods have improved the turnaround time for laboratory diagnosis. Less attention has been paid to the time elapsing from blood collection to incubation and to its potential effect on recovery of pathogens. We evaluated the performance of blood cultures collected under typical hospital conditions in relation to the length of their pre-analytical time. We carried out a large retrospective study including 50,955 blood cultures collected, over a 30-month period, from 7,035 adult septic patients. Cultures were accepted by the laboratory only during opening time (Mon-Fri: 8am±4pm; Sat: 8am±2pm). Samples collected outside laboratory hours were stored at room temperature at clinical wards. All cultures were processed by automated culture systems. Day and time of blood collection and of culture incubation were known for all samples. A maximum pre-analytical interval of 2 hours is recommended by guidelines. When the laboratory
was open, 57% of cultures were processed within 2 h. When the laboratory was closed, 4.9% of cultures were processed within 2 h (P<0.001). Samples collected when the laboratory was closed showed pre-analytical times significantly longer than those collected when laboratory was open (median time: 13 h and 1 h, respectively, P<0.001). The prevalence
of positive cultures was significantly lower for samples collected when the laboratory was closed compared to open (11% vs 13%, P<0.001). The probability of a positive result decreased of 16% when the laboratory was closed (OR:0.84; 95%CI:0.80±0.89, P<0.001). Further, each hour elapsed from blood collection to incubation resulted associated with a
decrease of 0.3% (OR:0.997; 95%CI:0.994±0.999, P<0.001) in the probability of a positive result. Delayed insertions of cultures into automated systems was associated with lower detection rates, with potentially important consequences for patients. In each hospital setting the logistic factors able to shorten pre-analytical time should be carefully investigated and specifically targeted.
2017
- L'ATTIVITÀ FISICA IN GRAVIDANZA: RISULTATI PRELIMINARI DI UN’INDAGINE DI PREVALENZA SU UN CAMPIONE DI DONNE DELLA PROVINCIA DI MODENA.
[Abstract in Atti di Convegno]
Fagioli, F; Righi, E; Fantuzzi, G; Aggazzotti, G.
abstract
INTRODUZIONE:
Praticare attività fisica in gravidanza contribuisce al mantenimento della salute della donna e del nascituro: l’OMS
consiglia di svolgere esercizio fisico regolare durante tutta la gestazione. Spesso tuttavia, specie nell’ultimo trimestre,
le donne tendono a ridurre o cessare l’attività fisica, rinunciando ai benefici apportati dal movimento e andando incontro
ad un possibile eccessivo aumento ponderale. Lo scopo dello studio è valutare le abitudini delle gestanti, analizzando
diversi aspetti dell’attività fisica svolta prima e durante la gravidanza (tipo, frequenza, durata) ed i fattori comportamentali
ad essi potenzialmente correlati.
MATERIALI E METODI:
Si tratta di uno studio epidemiologico osservazionale trasversale in corso presso l’U.O. di Ostetricia e Ginecologia
dell’Azienda Ospedaliero-Universitaria Policlinico di Modena. Attualmente sono state reclutate, su base volontaria e
previo rilascio del consenso informato, 211 puerpere (età media: 33 anni, nazionalità Italiana: 81%), le informazioni sono
state raccolte tramite questionario appositamente predisposto.
RISULTATI:
Delle 211 donne arruolate, 103 (48.8%) hanno dichiarato di aver svolto esercizio regolare prima della gravidanza;
le attività più rappresentate sono risultate le camminate (14,2%) e la ginnastica (13,3%). Durante la gravidanza, si
osserva un lieve calo della prevalenza (che si attesta al 46,4%) di donne che praticano esercizio fisico. La camminata
si conferma l’attività più praticata: il 22,7% delle donne dichiara di averla svolta nel I trimestre, il 26% nel II trimestre e il
24,2% nel III trimestre. Tuttavia, solo il 16,6% delle donne ha svolto attività fisica per un tempo complessivo ≥150 minuti
a settimana, valore indicato come ottimale dall’OMS. La sedentarietà risulta più diffusa in donne con età ≥40 anni, con
basso livello di istruzione, di nazionalità extraeuropea, tra le fumatrici e le donne ipertese.
CONCLUSIONI:
La gravidanza può rappresentare il momento ideale per iniziare ad adottare uno stile di vita sano. Tuttavia, sebbene
in aumento rispetto al passato, un numero ancora limitato di donne in gravidanza pratica regolarmente attività fisica.
E’ auspicabile quindi che efficaci interventi di sanità pubblica volti a promuovere l’esercizio fisico possano essere
identificati, predisposti e implementati anche per questo specifico gruppo di donne.
2017
- Trace element concentrations in breast milk
[Abstract in Rivista]
Borella, Paola; Fantuzzi, Guglielmina; Righi, Elena; Marchesi, Isabella; Ferrari, Angela; Paduano, Stefania; Bargellini, Annalisa
abstract
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
abstract
2016
- A Case-Control Study on Leisure Time Physical Activity (LTPA) during the Last Three Months of Pregnancy and Foetal Outcomes in Italy
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Aggazzotti, Gabriella
abstract
The association between Leisure Time Physical Activity (LTPA) during pregnancy and foetal outcomes has been extensively investigated. However, epidemiological studies specifically referred to LPTA in the last months of pregnancy are scarce. We evaluated the association between LPTA and the risk of both preterm delivery and small for gestational age (SGA) during the last three months of pregnancy in Italy. A nationwide case-control study was performed in nine Italian cities. A total of 299 preterm delivery, 364 SGA and 855 controls were enrolled in the study. A self-administered questionnaire was used to assess socio-demographic variables, medical and reproductive history, life-style habits and LTPA referred to the last three months of pregnancy. Univariate and multivariate regression analyses were performed in order to estimate Odds ratios and 95% CI. LTPA during the last three months of pregnancy decreases the risk of preterm delivery (adjusted OR = 0.56; 95% CI 0.39 - 0.79). Among the different types of physical activity, walking, the most frequently referred activity, appears significantly protective against preterm delivery (adjusted OR = 0.53; 95% CI 0.36 - 0.81). Moreover, a small protective effect of walking was evidenced against SGA (adjusted OR = 0.72; 95% CI 0.51 - 1.00). In conclusion, a mild physical activity such as walking in the last three months of pregnancy seems to reduce the risk of preterm delivery and, at a lesser extent, of SGA, confirming the beneficial effects of physical activity along the whole pregnancy.
2016
- Colorectal cancer risk and nitrate exposure through drinking water and diet
[Articolo su rivista]
Espejo Herrera, Nadia; Gràcia Lavedan, Esther; Boldo, Elena; Aragonés, Nuria; Pérez Gómez, Beatriz; Pollán, Marina; Molina, Antonio J.; Fernández, Tania; Martín, Vicente; La Vecchia, Carlo; Bosetti, Cristina; Tavani, Alessandra; Polesel, Jerry; Serraino, Diego; Gómez Acebo, Inés; Altzibar, Jone M.; Ardanaz, Eva; Burgui, Rosana; Pisa, Federica; Fernández Tardón, Guillermo; Tardón, Adonina; Peiró, Rosana; Navarro, Carmen; Castaño Vinyals, Gemma; Moreno, Victor; Righi, Elena; Aggazzotti, Gabriella; Basagaña, Xavier; Nieuwenhuijsen, Mark; Kogevinas, Manolis; Villanueva, Cristina M.
abstract
Ingested nitrate leads to the endogenous synthesis of N-nitroso compounds (NOCs), animal carcinogens with limited human evidence. We aimed to evaluate the risk of colorectal cancer (CRC) associated with nitrate exposure in drinking water and diet. A case-control study in Spain and Italy during 2008-2013 was conducted. Hospital-based incident cases and population-based (Spain) or hospital-based (Italy) controls were interviewed on residential history, water consumption since age 18, and dietary information. Long-term waterborne ingested nitrate was derived from routine monitoring records, linked to subjects' residential histories and water consumption habits. Dietary nitrate intake was estimated from food frequency questionnaires and published food composition databases. Odd ratios (OR) were calculated using mixed models with area as random effect, adjusted for CRC risk factors and other covariables. Generalized additive models (GAMs) were used to analyze exposure-response relationships. Interaction with endogenous nitrosation factors and other covariables was also evaluated. In total 1,869 cases and 3,530 controls were analyzed. Average waterborne ingested nitrate ranged from 3.4 to 19.7 mg/day, among areas. OR (95% CIs) of CRC was 1.49 (1.24, 1.78) for >10 versus ≤5 mg/day, overall. Associations were larger among men versus women, and among subjects with high red meat intake. GAMs showed increasing exposure-response relationship among men. Animal-derived dietary nitrate was associated with rectal, but not with colon cancer risk. In conclusion, a positive association between CRC risk and waterborne ingested nitrate is suggested, mainly among subgroups with other risk factors. Heterogeneous effects of nitrate from different sources (water, animal and vegetables) warrant further research.
2016
- IL TERREMOTO DELL’EMILIA ROMAGNA DEL 2012: PREVALENZA E PERSISTENZA DEL DISTURBO POST-TRAUMATICO DA STRESS NEI BAMBINI E NEGLI ADOLESCENTI
[Capitolo/Saggio]
Righi, Elena; Forresi, Barbara; Aggazzotti, Gabriella; Caffo, Ernesto
abstract
Il Disturbo Post Traumatico da Stress (PTSD) è uno dei disturbi che più frequentemente si manifesta nei bambini e negli adolescenti a seguito di disastri naturali come i terremoti, con percentuali che, secondo gli studi, oscillano tra il 5 e il 60% dei soggetti esposti. La maggior parte dei casi va incontro a una remissione spontanea entro 12 mesi, tuttavia in circa 1/3 dei soggetti questo disturbo progredisce verso un decorso cronico, con potenziali serie conseguenze a medio e lungo termine associate, tra l’altro, a gravi disturbi del sonno e ad abuso di sostanze. Una indagine epidemiologica di tipo cross-sectional, approvata dal comitato etico provinciale, è stata condotta nella provincia di Modena nel periodo Maggio 2013-Maggio 2014 con l’obiettivo di riconoscere i potenziali casi di PTSD di tipo cronico (con sintomi manifesti a più di un anno dall’episodio stressante) in bambini e adolescenti residenti nella zona del cratere sismico e di identificare i potenziali fattori di protezione e di rischio di natura sociale, familiare e demografica associati con l’insorgenza e la cronicizzazione di tale disturbo.
2016
- Influence of different irrigation techniques on sealer penetration into dentinal tubules: a confocal laser scanning microscope analysis
[Abstract in Rivista]
Generali, Luigi; Serena, V; Cavani, Francesco; Righi, Elena; Pettenati, C; Bellini, Pierantonio; Consolo, Ugo
abstract
BACKGROUND: The instrumentation of roots canals pro- duces smear layer, which consists of organic and inorganic material and may also contain bacteria and they by-products. This layer covers the root canal walls, could obliterate den- tinal tubules and consequently can inhibit the penetration of irrigants and endodontic sealers. To obtain a good seal is necessary to use an endodontic sealer in association with a core filling material in order to fill any voids, morphological irregularities, apical deltas and dentinal tubules and to create an obturation as much as possible impervious. The aim of the study was to compare the effect of conventional endodontic needle irrigation and different irrigation systems on sealer penetration into dentinal tubules.
METHODS: 40 single round root canals were selected and divided into four groups (n=10) before root canal preparation according to the final irrigation protocol: group 1 (conventional endodontic needle irrigation), group 2 (EndoActivator) group 3 (Irrisafe) group 4 (EndoVac). The root canal were shaped using Path File and ProTaper Universal rotary system in a crown-down sequence to size #40 at the WL. Obturation of the teeth was done with Thermafil Obturators size 40 with TopSeal sealer labeled with 0,1% wt Rhodamin B dye. Transverse sec- tion at 2-, 5- and 7-mm from the apex were analyzed by means of confocal laser scanning microscopy. Percentage of pen- etration around the root canal and the mean penetration into dentinal tubules at eight standardized points were calculated. RESULTS: No significant differences in percentage of pen- etration around the root canal and mean penetration depth into dentinal tubules were observed among groups when same levels were compared. Within each group both variables are significantly higher at the coronal and middle level with respect to the apical one.
CONCLUSIONS: The use of the techniques employed in the present study did not significantly improve the sealer pen- etration into dentinal tubules compared with conventional endodontic needle irrigation.
2016
- Monitoring metals in toenail samples of a population living in the vicinity of the solid waste incinerator of Modena, Northern Italy
[Abstract in Rivista]
Gatti, Mg; Bechtold, P; Barbieri, G; Iacuzio, Laura; Borsari, Lucia; Casari, A; Ferrari, Angela; Righi, Elena; Quattrini, G; Botosso, E; Carluccio, Eugenia; Gherardi, B; Soncini, Francesco; Schiavi, A; Ranzi, A; Lauriola, P; Aggazzotti, Gabriella; Goldoni, Ca
abstract
Introduction: As part of the authorization process for the expansion of the solid waste incinerator (SWI), a cross-sectional biomonitoring study was conducted to identify markers of chronic exposure. Metals were measured in toenails, as a single sample is assumed to represent long-term exposure. Methods: Around 500 subjects aged 18-69 yrs. and living within 4-km from the plant were enrolled between Oct. 2013-May 2014. Sampling method implied stratification by exposure, gender and age-group. Toenails were disintegrated by acid mineralization and analyzed through inductively coupled plasma mass spectrometry for concentrations of Cd, Cr, Mn and Ni. SWI exposure was estimated through fallout maps. Biannual PM10 level prior to sampling was assigned according to subjects’ residence and workplace. Confounders were assessed by questionnaire covering personal and health data, lifestyle, residential and occupational information, traffic exposure and diet. Multivariate regression models were performed. Results: Cd, not detectable in >50% of samples, was not further analyzed. Cr, Mn and Ni were detectable in >95% of samples. Significant positive relations were observed for diet, personal and lifestyle characteristics, as well as for SWI exposure. Conclusions: results appear consistent with literature-known associations, suggesting that toenails can be appropriate in assessing chronic exposures of Ni, Mn and Cr, while Cd is probably poorly accumulated in nails. Relations observed with SWI exposure should be accurately considered.
2016
- Occurrence of DBPs in Drinking Water of European Regions for Epidemiology Studies
[Articolo su rivista]
Krasner, Stuart W.; Kostopoulou, Maria; Toledano, Mireille B.; Wright, John; Patelarou, Evridiki; Kogevinas, Manolis; Villanueva, Cristina M.; Turigas, Gloria Carrasco; Santa Marina, Loreto; Fernandez Somoano, Ana; Ballester, Ferran; Tardon, Adonina; Grazuleviciene, Regina; Danileviciute, Asta; Cordier, Sylvaine; Costet, Nathalie; Righi, Elena; Aggazzotti, Gabriella; Stephanou, Euripides G.; Kargaki, Sophia; Nieuwenhuijsen, Mark J.
abstract
A three-year study was conducted on the occurrence of disinfection by-products (DBPs)—trihalomethanes (THMs),
haloacetic acids (HAAs), and haloacetonitriles—in drinking water of regions of Europe where epidemiology studies were being carried out. Thirteen systems in six countries (i.e., Italy, France, Greece, Lithuania, Spain, United Kingdom) were sampled. Typically chlorinated DBPs dominated. However, in most of Catalonia (Spain) and in Heraklion (Greece), brominated DBPs dominated. The degree of bromine incorporation into the DBP classes was in general similar among them. This is important, as brominated DBPs are a greater health concern. In parts of Catalonia, the reported levels of tribromoacetic acid were higher than in other parts of the world. In some regions, the levels of HAAs tended to be peaked in concentration in a different time period than when the levels of THMs peaked. In most epidemiology studies, THMs are used as a surrogate for other halogenated DBPs. This study provides exposure assessment information for epidemiology studies.
2016
- Pharmaceuticals and illicit drugs in surface, drinking and swimming pool waters in the Province of Modena: preliminary investigation.
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Castiglioni, S; Zuccato, E.
abstract
Introduction: Pharmaceuticals and illicit drug residues are common contaminants of the aquatic environments and appear to be widespread, with consumers being the major source. Even if environmental levels are low, risks for human health cannot be excluded.
Methods: We present the results on the environmental levels of a group of pharmaceuticals and illicit drugs in surface waters, drinking and pool waters in the Province of Modena (Italy). We tested drugs of abuse (cocaine, opioids, amphetamines and cannabis derivatives), and/or their metabolites and 31 pharmaceuticals which have been previously found in significant concentrations in the environment in Italy. Surface waters of Panaro River were sampled upstream, before receiving the input of waters from the sewage treatment plant of Modena, and then downstream. Drinking waters were collected from three different points in water supplies in the Province and one swimming pool water sample was also investigated, because human release of body fluids may be relevant in swimming pool settings. Pharmaceuticals and illicit drug residues were measured by (HPLC–MS/MS), after solid phase extraction (SPE).
Results: Surface water from the Panaro River, before receiving wastewaters, shows the presence, at very low levels, of 9 out of 31 investigated pharmaceutical substances: cocaine and its metabolites were the most detected among illicit drugs. High levels of both pharmaceuticals and illicit drugs were observed in surface waters, immediately after receiving wastewaters from the sewage treatment plant. Pharmaceuticals were rarely detected in drinking water samples, while in swimming pool water the anti-inflammatory pharmaceuticals ibuprofen and ketoprofen were observed. Illicit drugs were found at trace levels both in drinking and in swimming pool waters.
Conclusions: Future research is needed to characterize potential health risks from long-term, low-level exposure to these substances, particularly for sensitive subpopulations.
2016
- Prevalence and risk factors of chronic Post-Traumatic Stress Disorder in children and adolescents after the 2012 earthquake affecting the province of Modena (Northern Italy).
[Abstract in Rivista]
Righi, Elena; Forresi, Barbara; Caffo, Ernesto; Aggazzotti, Gabriella
abstract
Introduction: Post-traumatic stress disorder (PTSD) is the most frequent psychological disorder occurring after natural disasters. Some cases have a chronic, unremitting course causing long term health impacts and relevant social costs. On May 2012, two earthquakes of high Richter magnitude hit Modena (Italy), causing 27 deaths, several hundred of injured citizen and more than 15000 homeless. The aim of this study was to investigate the prevalence of chronic PTSD in children and adolescents, two extremely sensitive subpopulations, and to identify individual and social predictive risk and protective factors
Methods: A cross-sectional study approved by Ethical Committee was conducted. Subjects aged 9-14, providing a written informed consent, were recruited from local schools, randomly selected from the earthquake area (EA) and an extra-earthquake area (EEA), with similar demographic and geographic characteristics. The UCLA-PTSD Index for DSM-IV was used to assess PTSD in students; risk/protective factors were investigated using a traumatic exposure checklist and the Strengths and Difficulties Questionnaire. Parental psychopathology was assessed by Symptom Checklist-90-R.
Results: 683 students (2% of residents) and 1161 parents were enrolled. Overall, 9 subjects (1.3%) showed chronic PTSD symptoms. Most (8) were living in EA. The risk of suffering from PTSD symptoms was higher in girls, older students and subjects most directly affected by earthquake. Distressing factors no earthquake-related appeared predictive of distress as well. Further, psychopathological symptoms in parents were significantly associated with high PTSD scores in children.
Conclusions: PTSD prevalence appeared lower than observed in similar studies. However, anxiety and depressive symptoms were widespread and correlate with several predictive factors. We hope that our findings will help planning future preventive and supportive effective public health interventions in similar distressing situations.
2015
- Biomonitoring of the population living near the solid waste incinerator plant in Modena, Italy.
[Abstract in Atti di Convegno]
Iacuzio, Laura; Gatti, Mg; Bechtold, P; Barbieri, G; Righi, Elena; Ferrari, Angela; Gherardi, B; Alice, Casari; Ranzi, A; Borsari, Lucia; Carluccio, Eugenia; Bottosso, Emanuele; Soncini, Francesco; Lauriola, P; Aggazzotti, Gabriella
abstract
Background and aims: As part of the authorization process for the expansion of the municipal solid waste incinerator of Modena, a cross-sectional biomonitoring study on toenail samples was conducted to identify biomarkers of exposure in resident population.
Methods: Approximately 500 people were enrolled between October 2013 and May 2014, among residents for at least 3 years within 4 km from the plant. Sampling method implied stratification by exposure, gender and age-group (18-34, 35-49 and 50-69 years). Sampling exposure level was measured through the annual mean PM10 concentration map for 2010. Toenail samples were disintegrated by acid mineralization and tested through inductively coupled plasma mass spectrometry for concentrations of cadmium, chromium, manganese and nickel. Confounders were assessed through a questionnaire covering: personal and biometric data, lifestyle, residential information including traffic exposure, occupational history, health condition and diet. Effective exposure was estimated through fall-out maps from a quasi-gaussian dispersion model. Biannual PM10 concentration prior to the collection date (second semester 2013/first semester 2014) was assigned according to subjects residence and workplace address; exposure values were divided into quartiles. Multivariate regression analyses were performed.
Results: Chromium, manganese and nickel were measurable in >95% of samples. Concentrations varied between 0.02-35.11 µg/g for chromium (median 0.52, 5th-95th perc 0.09-4.95), 0.02-7.23 for manganese (median 0.25, 5th-95th perc 0.07-0.97), 0.004-39.28 for nickel (median 0.28, 5th-95th perc 0.03-3.74). Cadmium resulted under the limit of quantification in 74.1% of the samples (range 0.006-0.19 µg/g), and was not included in the analysis.
Multivariate regression models showed the following relations:
- Chromium: positive relation with incinerator exposure, female gender, education level, hair dye, permanent make-up, woodworking hobby, locally-grown food consumption, orange juice consumption; negative relation with foreign citizenship.
- Manganese: positive relation with incinerator exposure, female gender, occupational exposure, sculpture/building hobby, time spent outdoor, presence of prostheses, use of wood as heating system, locally-grown food and red wine consumption; negative relation with age and with all the months of collection except for the last one (May 2014) compared with the first (Oct 2013).
- Nickel: positive relation with use of costume jewelry, presence of amalgam fillings, consumption of tomatoes and vegetable pies; negative relation with age.
Conclusions: The analysis of heavy metal levels in toenails is a relatively recent technique, therefore reference levels are not available in literature and an analysis on the general distribution of sample levels cannot be performed. However, the presence of some expected associations in multivariate analysis (nickel with use of costume jewelry and tomatoes consumption; manganese with firewood use) suggests that our study method can be appropriate in assessing chronic exposures. Results showed association trends with incinerator exposure for manganese and chromium levels. Findings should be reassessed as soon as more accurate traffic exposure control is available.
2015
- Comparison on sealer penetration into dentinal tubules using self-adjusting file cleaning- shaping-irrigation system and conventional endodontic needle irrigation
[Abstract in Rivista]
Generali, Luigi; Pettenati, C.; Righi, Elena; Bertoldi, Carlo; Consolo, Ugo
abstract
2015
- Indexes of disinfection by-product (DBPs) exposure and irritant symptoms in swimming pool workers
[Capitolo/Saggio]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
Exposure to disinfection by-products (DBPs) in indoor swimming pool is regarded as a risk factor for ocular, respiratory and bronchial asthma symptoms in pool workers, although evidence is still inconclusive. Exposure to trichloramine (NCl3) and trihalomethanes (THMs) in relation to the occurrence of irritant symptoms has been evaluated in 165 subjects working in 23 indoor swimming pools. NCl3 was measured in environmental air, while THMs exposure was evaluated using both environmental (water and air) and biological monitoring (alveolar air). Pool water physical-chemical parameters were evaluated as well. Information about workers’ personal data, habits, working tasks and health status was collected using a self-administered questionnaire. NCl3 (660±217 µg/m3) and THMs (98.6±59.9 µg/m3) airborne levels appeared significantly correlated (rs=0.498, p<0.01). THMs in alveolar air (28.9±20.4 µg/m3) were significantly correlated with airborne levels of both THMs (rs=0.624, p<0.01) and NCl3 (rs=0.450, p<0.01). Different acute ocular and respiratory symptoms resulted closely associated both with airborne NCl3 and THMs alveolar air levels; moreover THMs exposure showed a significant correlation with some asthma-related symptoms. Overall, both NCl3 and THMs exposure appeared related to irritant health endpoints in swimming pool workers. NCl3 is probably directly involved in the pathogenic mechanism, however NCl3 analyses are limited to ambient matrix, while for THMs both environmental and personal biological monitoring can be performed. THMs in alveolar air should be, therefore, carefully considered as a proxy measure of exposure to irritant chemicals in epidemiological studies involving swimming pool attendants.
2015
- Leisure Time Physical Activity (LTPA) during the Last Three Months of Pregnancy and Pregnancy Outcomes. A Case-Control Study in Italy
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Aggazzotti, Gabriella
abstract
INTRODUCTION: Studies about the influence of leisure time physical activity (LTPA) during the last three months of pregnancy on pregnancy outcomes are scarce. The aim of this study was to explore the association between LTPA and preterm birth and low birth weight.
METHODS: A population-based case-control study was performed in nine Italian cities. Preterm births were singleton births occurring before a gestational age of 37 complete weeks, while low birth weight (LBW) cases were newborns with weight less than 2500 g. Controls were babies with gestational ages > 37th completed week of pregnancy and a birth weight over 2500 g. A total of 299 preterm births, 364 LBW cases and 855 controls were enrolled in the study. A self-administered questionnaire was used to assess socio-demographic variables, medical and reproductive history, life-style habits and LTPA, referred to the last three months of pregnancy. Univariate and multivariate regression analyses were performed in order to estimate odds ratios and 95% CI.
RESULTS: LTPA during the last three months of pregnancy seems to be protective against preterm delivery (adjusted OR= 0.56; 95% CI 0.39-0.79). The frequency of LTPA, expressed as times/week, doesn’t show a dose-response relationship. Among the different types of physical activity, only walking activity, the most frequently referred activity, appears significantly protective on preterm delivery (adjusted OR= 0.53; 95% CI 0.36-0.81). Swimming, physical training, go biking do not evidence a protective effect after controlling for confounding variables. LTPA was not found significantly associated with LBW, even if walking activity shows a light protective effect (adjusted OR= 0.72; 95% CI 0.51-1.00).
CONCLUSIONS. LTPA and in particular walking activities during the last three months before delivery was associated with a significantly reduced risk of preterm delivery. Walking was found to be lightly protective on LBW.
2015
- Prevalence and risk factors of chronic Post-Traumatic Stress Disorder in children and adolescents after the 2012 earthquake affecting the Modena province: preliminary results of a cross-sectional study
[Abstract in Rivista]
Bottosso, Emanuele; Carluccio, Eugenia; Soncini, Francesco; Daolio, Omar; Di Pietro, E.; Gueraldi, D.; Scarpini, G.; Giamboni, L.; Maini, I.; Leonardi, S.; La Torre, R.; Forresi, Barbara; Righi, Elena
abstract
Background
Post-traumatic stress disorder (PTSD) is the most frequent psychological disorder occurring after natural disasters (with a prevalence ranging from 5 to 60% in the first 1-2 years after the event). Many cases remit within 12 months, but nearly one-third have a chronic, unremitting course determining long term negative health impacts and relevant social costs. On May 2012, two earthquakes of high Richter magnitude hit the province of Modena, causing 27 deaths, several hundred of injured citizen and more than 15000 homeless. The aim of this study was to investigate the prevalence of chronic PTSD in children and adolescents, two particularly sensitive subpopulations, and to identify PTSD potentially related individual and social risks and protective factors to be addressed in future effective preventive interventions.
Methods
A cross-sectional study approved by the local Ethical Committee was conducted between May 2013 and May 2014. Subjects aged 9- 14 were recruited from Primary and Secondary schools of Modena District, which were randomly selected after being assigned to two areas: earthquake area (19 municipalities most affected by the earthquake; EA) and extra-earthquake area (EEA). The two areas had similar demographic and geographic characteristics. Only subjects providing written informed consent from parents were included in the study. The Italian version of the UCLA PTSD Index for DSM-IV (UPID) was used to assess PTSD in students from primary (face to face interviews) and secondary school (self-reported), while risk/protective factors for the development and persistence of PTSD were investigated using the traumatic exposure checklist on objective/subjective experiences during the earthquake and the Strengths and Difficulties Questionnaire (SDQ). This instrument was also administered to subjects’ parents along with the Symptom Checklist-90-R (SCL-90), which aimed to investigate parental psychopathology.
Findings
We included in our study 682 subjects (male: 349, 51%; mean age: 11,2 ±1,4; 1,8% of the total residents of the same age in the two areas). The prevalence of people hit by the earthquake (damages to properties or people) and forced to leave their homes was significantly higher in the EA than in the EEA (78% vs 14%; 54% vs 2%: p<0.001). Overall, 9 subjects (1,3 %) reported symptoms of chronic PTSD. Most (8) were living in the EA. In this area the prevalence of chronic PTSD was equal to 1,9% and appeared particularly high in girls (2,4%) and in secondary school’s subjects (2,2%).
Discussion
A higher prevalence of chronic PTSD in children and adolescents living in the most affected area by the earthquake was observed. PTSD prevalence in our study however appeared lower than those observed in similar investigations: specific protective factors related to the social context together with differences in the time elapsed between the traumatic event and PTSD evaluation could partially explain these findings. Further analyses aimed at pointing out potentially protective individual, familiar and social factors will be sooner performed. We believe that any potential significant finding will give an effective contribution in the planning of future preventive and protective interventions in similar distressing situations.
2015
- Prevention of healthcare-associated infections: knowledge among dental students in seven Italian universities
[Articolo su rivista]
Pasquarella, C; Veronesi, L; Castiglia, P; D'Alessandro, D; Legnani, P; Minelli, L; Montagna, Mt; Napoli, C; Righi, Elena; Strohmenger, L; Tesauro, M; Torre, I; Tanzi, M. L; SItI working group “Hygiene in, Dentistry
abstract
Background: Lack of knowledge is the major reason for non-compliance with correct healthcare-associated infections (HAI) prevention procedures. The aim of this study was to evaluate knowledge of the Dental School (DSS) and Dental Hygiene (DHS) students with regard to the prevention of HAI, as basic knowledge for improving and harmonizing the educational content in the different Italian Universities. Methods: A cross-sectional study was carried out using an anonymous questionnaire that was completed by DSS (I, II, III, IV, and V year) in seven Universities and DHS (I, II, and III year) in three Universities. The questions dealt with three specific areas: healthcare-associated infections, standard recautions and hand hygiene. Factors associated with an unacceptable level of knowledge (score <17.5) were analyzed using a logistic regression model. A p value <0.05 was considered to be significant. Results: Five hundred and four questionnaires were collected: 81.5% for DSS and 18.5% for DHS. Mean overall score (±DS) achieved by the total number of students was 18.2±2.93 on an overall perfect score of 25; 18.2±3.04 for DSS and 17.8±2.31 for DHS. Stratifying by area, the average score 2.7±1.07 (53%) for
HAI, 10.3±1.61 (85.9%) for standard precautions, and 5.2±1.44 (64.8%) for hand hygiene was observed. A significantly different level of knowledge (p<0.001) between DSS and DHS was observed only for HAI (2.8±1.07 for DSS vs 2.1±0.96 for DHS). Significant differences among the academic years were found only for DSS concerning HAI and standard precautions. The logistic regression model showed that an age <23 years was a risk factor for lack of knowledge on HAI, but a protective factor for lack of knowledge
about standard precautions and hand hygiene; attending DH degree course was associated with lack of knowledge on HAI.
2014
- A confocal microscopic evaluation of dentinal tubule penetration and percentage of root canal sealer using three different instrumentation techniques
[Abstract in Rivista]
Generali, Luigi; Pettenati, C.; Gandolfi, M. G.; Righi, Elena; Franchi, I.; Bertoldi, Carlo; Giannetti, Luca; Consolo, Ugo
abstract
Vedasi l'allegato
2014
- Bromate, chlorite, chlorate, haloacetic acids, and trihalomethanes occurrence in indoor swimming pool waters in Italy
[Articolo su rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
Subjects attending indoor swimming pools are exposed to disinfection by-products (DBPs) by inhalation, dermal
contact and/or ingestion, as a consequence of water disinfection treatments with chlorine and related compounds.
The occurrence of trihalomethanes (THMs) in poolwaters has been well documented, while information
about other DBPs, including bromate, chlorite, chlorate and haloacetic acids (HAAs), is very limited even though
someof these substances are potentially dangerous for human health. The aimof this studywas to investigate the
occurrence of bromate, chlorite, chlorate, HAAs and THMs both in pool and in source water of 24 public indoor
swimming pools in Emilia Romagna Region, Northern Italy. THMs were evaluated with a standardized method
involving the head-space gas-chromatographic technique, while HAAs, bromate, chlorite, and chlorate were
detected by Ion Chromatography with Mass Spectrometry. THMs were measured in all the pool water samples
(mean value: 36.9 ± 28.2 μg/l), while they were detectable in less than 50% of source waters and always at
very low levels (mean value: 2.0 ± 4.1 μg/l), as a consequence of drinking water disinfection with chlorine
dioxide, a widespread disinfection method in Italy. Bromate was always absent in source water samples, and it
was detected in 3 samples of poolwater only (range: 10–48 μg/l). HAAs were scarcely detected in sourcewaters
(3 positive samples, maximum level observed: 21 μg/l), while in pool water theywere always present at detectable
levels and showed high concentrations (range: 11–403 μg/l, mean value of 164 ± 108 μg/l). Chlorite was
present in 22 water supply samples (mean value: 149 ± 122 μg/l) but only in one pool water. Chlorate, on the
contrary, resulted as the most prevalent DBP both in source (range: 2–499 μg/l) and in pool waters, where it
showed the highest levels, with a mean value of 3661 μg/l and a maximum value of 19537 μg/l. Such environmental
levels could result in an important human exposure, mainly by ingestion and/or dermal contact, to non
volatile DBPs different than THMs. Exposure to those DBPs, therefore, needs to be further investigated and strategies
aimed at minimizing it should be identified and undertaken. Attention should be paid, above all, to chlorate:
this substance appears reallywidespread in swimming pool water and, according to themost recent toxicological
studies, its potential human health effects could be relevant.
2014
- Canal shaping with WaveOne reciprocating files: influence of operator experience on instrument breakage and canal preparation time
[Articolo su rivista]
Generali, Luigi; Righi, Elena; Maria Vittoria, Todesca; Consolo, Ugo
abstract
The aim of this study was to determine the fracture incidence of WaveOne Primary reciprocating files and the time required for shaping of curved canals based on the experience of the operator. A total of 109 mesiobuccal canals of permanent molars extracted with an angle of curvature of[25°–45° according to Schneider were ran- domly assigned to four groups. An experienced operator (endodontist) and an inexperienced operator (student) each shaped one of two groups: one with the instrument WaveOne Primary to WL and the other after creation of a glide path with PathFile 1, 2 and 3 at the WL. Any frac- tures or visible deformations of the instruments during the shaping phase and the effective time required to prepare the canals for each instrument were recorded. No visible deformation or fracture was observed. The experienced operator tended to finish their shape faster than the inex- perienced operator regardless of the technique applied. For the inexperienced operator, the usage time with only WaveOne Primary was significantly lower when the canals were preliminarily instrumented with the PathFile than when these instruments were not used (average time, 22.03 vs. 36.22 s, respectively; p \ 0.001). The experience of the operator did not influence fracture of the WaveOne Pri- mary instruments. The time required to prepare the canals was instead inversely proportional to the experience of the operator. However, the creation of a glide path with PathFile instruments reduced the time required by the inexperienced operator to prepare the canal.
2014
- Differential efficacy of endodontic obturation procedures: an ex vivo study
[Articolo su rivista]
Ardizzoni, Andrea; Generali, Luigi; Righi, Elena; Baschieri, MARIA CRISTINA; Cavani, Francesco; Manca, Lidia; Lugli, Eleonora; Migliarese, Luigi; Blasi, Elisabetta; Neglia, Rachele Giovanna
abstract
By means of a double-chamber model, different root canal filling materials and procedures were compared. Briefly, the root canals of single-rooted human teeth, extracted for periodontal reasons, were instrumented and obturated by gutta-percha/Pulp Canal Sealer EWT (PCS) or by Resilon, in association with different sealers (Real Seal, RelyX Unicem or Meta). Obturation was achieved by traditional continuous wave of condensation technique (TCWCT), a modified version of it (MCWCT), or single cone technique (SCT). The obturated roots, inserted in a double-chamber model, were sterilized by gamma irradiation. Next, Enterococcus faecalis was added to the upper chamber and the specimens were incubated at 37 °C for up to 120 days; the development of turbidity in the lower chambers' broths indicated bacterial leakage through the obturated root canals. The kinetics of leakage were analyzed in different groups by means of Kaplan-Meier statistics and compared by log-rank test. The results showed that root canals obturated with either gutta-percha/PCS using the MCWCT, Resilon/Real Seal SCT or Resilon/RelyX Unicem using the TCWCT displayed significantly better performance than the remaining groups (p < 0.01). Histological evaluation, performed to investigate microbial localization inside specimens, confirmed that this parameter varied according to the obturation procedures and materials employed. This ex vivo study indicates that gutta-percha/PCS, if used with the MCWCT, is as effective as Resilon when coupled to Real Seal with the SCT or, interestingly, to RelyX Unicem with the TCWCT. These data suggest that further improvement of the currently employed root canal filling procedures is achievable, depending on both the filling materials and the technique employed, thus encouraging clinical studies in this direction.
2014
- Filling ability of carrier-based obturation system in oval-shaped canals prepared with reciprocating and adaptative instruments.
[Abstract in Rivista]
Generali, Luigi; L., Pastorello; M. G., Gandolfi; Righi, Elena; Giannetti, Luca; Bertoldi, Carlo; C., Prati
abstract
Vedi Allegato
2014
- Prevention of healthcare associated infections: Medical and nursing students' knowledge in Italy
[Articolo su rivista]
D’Alessandro, D; Agodi, A; Auxilia, F; Brusaferro, S; Calligaris, L; Ferrante, M; Montagna, Mt; Mura, I; Napoli, C; Pasquarella, C; Righi, Elena; Rossini, A; Semeraro, V; Tardivo, S.
abstract
Background: The training of health workers is a key issue for the prevention of healthcare associated infections.
Objectives: To evaluate knowledge of nursing and medical students concerning the prevention of healthcare associated
infections.
Design: A cross-sectional study.
Setting: University hospitals in nine Italian cities.
Participants: One thousand four hundred sixty one healthcare students (607 medical students and 854 nursing students).
Methods: The study was performed using a questionnaire investigating 3 areas, each having different possible points: standard precautions = 12; hand hygiene = 8; healthcare associated infections = 5, for an overall perfect score of 25. Scores that met a cutoff ≥17.5 were considered to be indicative of an acceptable level of knowledge.
Factors associated with an acceptable level of knowledge were analyzed using a logistic regression model.
Results: Mean overall score (±SD) was 18.1 ± 3.2. Nursing students (18.6 ± 2.9) obtained a higher overall score than medical students (17.4 ± 3.5) (p b 0.001). Weighed scores (±SD) by area were: 10.3 (±2.0) for standard precautions, 5.0 (±1.3) for hand hygiene and 2.8 (±1.1) for healthcare associated infections. Knowledge level concerning the three areas was different between medical and nursing students (p b 0.001). The probability of finding acceptable knowledge was smaller formedical students (OR: 0.54 p b 0.0001) and for students aged ≥24 years (OR: 0.39 p b 0.0001).
Conclusion: The overall score showed an acceptable level of knowledge for the whole sample; but, considering separately the two curricula, only nursing students reached the minimum acceptable score. It seems important to investigate what is working better in nursing than in medical education in order to implement and validate new teaching approaches.
2014
- Trends in ventilator-associated pneumonia: Impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit
[Articolo su rivista]
Righi, Elena; Aggazzotti, Gabriella; Elena, Ferrari; Chiara, Giovanardi; Stefano, Busani; Laura, Rinaldi; Girardis, Massimo
abstract
Background: The impact on ventilator-associated pneumonia (VAP) occurrence of a multifaceted program,
including progressive strategies for VAP prevention, implemented in an Italian intensive care unit (ICU) is reported.
Methods: All adults admitted to the ICU in 2004-2010 with a length of stay 72 hours and mechanical ventilation time 48 hours were included in the study. Demographics, clinical information, and data on VAP were extracted from the ICU-acquired infection surveillance dataset. A standardized bundle for VAP prevention was implemented in 2004. In 2008, selective digestive tract decontamination (SDD) was
added to the protocol. Changes in VAP incidence were evaluated.
Results: There were 1,372 subjects included in the study. Overall, 156 (11.4%) developed VAP. In the second part of the study VAP incidence decreased from 15.9% to 6.7% (P <.001). Reductions both in early-onset VAP (6.6% to 1.9%; P < .001) and late-onset VAP (9.3% to 4.7%; P < .001) incidence were observed. Multivariate analysis showed a significant reduction in the risk of developing VAP from multidrug resistant pathogens in the bundle plus SDD period as well (odds ratio, .54; 95% confidence interval,
.31-.91).
Conclusion: The implementation of a standardized approach to patient care, including a number of key
reduction interventions, was associated with a significant reduction in the risk of developing VAP.
2013
- Airborne trichloramine (NCl3) levels and self-reported health symptoms in indoor swimming pool workers: dose-response relationships.
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, P; Petra, B; Aggazzotti, Gabriella
abstract
The hypothesis that attendance at indoor chlorinated swimming pool is a risk factor for irritative ocular and respiratorysymptoms and bronchial asthma is well known in literature, although epidemiological evidence ìs stili inconclusive. The aimof this study was to evaluate thè association between airborne trichloramine (NCI3) levels and irritative symptoms in swimmingpool employees in order to obtain detailed data regarding dose-response relationships and to ìdentìfy thè airborne NCI3exposure level, if any, without health effects. A total of 20 indoor swimming poois in thè Emilia Romagna region of Italy wereincluded in thè study. Information about thè health status of 128 employees was collected using a self-administeredquestìonnaire. Exposure to airborne NCI3 was evaluated in indoor swimming poois by a modified DPD/KI method. The resultsof thè study evidenced a mean value of airborne NCI3 of 0.65 ± 0.20 mg/m3 (ranging from 0.20 to T.02 mg/m3). Both ocular andupper respiratory symptoms, in particular red eyes, runny nose, voice loss and cold symptoms, were declared more frequentlyby lifeguards and trainers when compared with employees working in other areas of thè facility (office, cafe, and so on). Poolattendants exposed to airborne NCI3 levels of > 0.5 mg/m3 experlenced higher risks for runny nose (OR: 2.91; 95%CI: 1.22-6.93) red eyes (OR: 3.16; 95% CI: 1.46-6.82), voice loss (OR: 3.56; 95% CI: 1.60-7.95) and itchy eyes (OR: 2.23; 95%CI: 1.04-4.78) than other employees. Moreover, red eyes, itchy eyes, runny nose and voice loss are related to airborne NCI3levels, with strong dose-response relationships. In conclusion, this study shows that lifeguards and trainers experience ocularand respiratory irritative symptoms more frequently than employees not exposed. irritative symptoms become significantstarting from airborne NCI3 levels of > 0.5 mg/m3, confìrming that thè WHO-recommended value can be consìdered protectivein occupational exposure to airborne NCI3 in indoor swimming poois
2013
- BROMATE, CHLORITE, CHLORATE, HALOACETIC ACIDS (HAAS), AND TRIHALOMETHANES (THMS) DETERMINATION IN INDOOR SWIMMING POOLS
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
People attending indoor swimming pools are exposed to Disinfection By-Products (DBPs) by ingestion and also by dermal contact and/or inhalation, as a consequence of water disinfection treatments with chlorine and related compounds. The occurrence of Trihalomethanes (THMs) in pool waters has been well documented while information about the presence of other DBPs (bromate, chlorite, chlorate, haloacetic acids) in indoor swimming pools is very limited and needed to be further investigated as some of these substances are potentially dangerous for human health. The aim of this study was to investigate the presence of bromate, chlorite, chlorate, halogenated acetic acids and THMs in some Italian indoor swimming pools in order to evaluate the potential exposure in competitive swimmers and pool attendants. In this study, starting from February 2005 in the Emilia Romagna Region, in the North of Italy, 24 indoor swimming pools were investigated. THMs were evaluated with a standardized method involving the head-space gas chromatographic technique while HAAs, bromate, chlorite, chlorate were detected by ion chromatography with mass spectrophotometry. THMs, bromates, chlorates and chlorites and HAAs were investigated not only in pool waters but also in water feed. THMs were present in all the pool water samples (41.4±30.0 μg/L), while they were present above the detection limit in only 50% of the water supply: in the latter, the average concentrations of THMs were generally low (4.8±1.5 μg/L), a consequence of the treatments for drinking water disinfection with chlorine dioxide, widespread in Italy. Bromate has never been detected in water supply samples, while it was observed only in 3 samples of pool water (range: 10-48 μg/L). Chlorite were present in 15 samples of water supply and only in one sample of pool water. Chlorates have been detected in high concentrations in pool waters, with a mean value of 4717±5758 μg/L. Regarding to haloacetic acids, the levels ranged from 11 to 403 μg/L, with a mean value of 170±122 μg/L. In people attending swimming pools, the health risks from exposures to THMs, bromate, chlorite and haloacetic acids can be considered to be small. However, the high levels of chlorates sometimes observed should be further evaluated for their potential effects even if, at the moment, there is no epidemiological evidences and/or associations between environmental exposure to these compounds and human health.
2013
- Characteristics and outcome predictors of patients
involved in an outbreak of Burkholderia cepacia
complex
[Articolo su rivista]
Righi, Elena; Girardis, Massimo; P., Marchegiano; C., Venturelli; S., Tagliazucchi; M., Pecorari; Borsari, Lucia; Carluccio, Eugenia; M., Codeluppi; Mussini, Cristina; Aggazzotti, Gabriella
abstract
A Burkholderia cepacia complex outbreak occurred among ventilated non-cystic fibrosis patients in an intensive care unit (ICU) in Italy: 33 colonized and 13 infected patients were included in a retrospective study aimed at investigating factors related to clinical infection and mortality. Demographic/clinical conditions and mortality did not vary significantly between colonized and infected patients, both groups showing high mortality rates compared with the overall ICU population and similar to that observed in patients with other infections. In multivariate regression analysis, disease severity (defined by the Simplified Acute Physiology Score II) and age were the only independent predictors of early mortality (odds ratio: 1.12; 95% confidence interval: 1.02-1.26; and 1.07; 1.01-1.15, respectively).
2013
- PREVALENCE OF SELF-REPORTED CUTANEOUS SYMPTOMS IN SUBJECTS WORKING AT INDOOR SWIMMING POOLS
[Abstract in Rivista]
Aggazzotti, Gabriella; Righi, Elena; Predieri, Guerrino; Fantuzzi, Guglielmina
abstract
As a part of an Italian study on health effects of swimming pools employees, the aim of this study was to investigate the prevalence of self-reported cutaneous symptoms in subjects working at indoor swimming pools, as some epidemiological studies suggested high prevalence rates of eczema in subjects working inside the pool water as trainers, pool attendants and hydro therapists. Information about the health status of 133 employees was collected by a structured questionnaire. The questionnaire recorded demographic characteristics, lifestyle, working related activities (kind of job, number of working hours by day and week, previous or parallel jobs) and symptoms related to cutaneous apparatus (verruca, mycosis, eczema and rash). Most of the swimming pool workers were females (52.6%), with a mean age of 33 ys, non-smokers (48.9%), working in swimming pools for an average of 8 years: no statistical differences were observed. The employees had a mean work engagement of 25.2±14.1 hour/week corresponding to 4.7±2.4 hour/day. According to the questionnaire data, 50% of the subjects had attended indoor swimming pools for more than 20 years, mainly as swimmers. The prevalence of cutaneous diseases in all the investigated subjects was: rash (20.3%), verruca (16.5%), mycosis (15.8%) and eczema (9.0%). However, subjects who declared to spend some hours inside the pool water during their working activities experienced generally more verruca (20.8% vs 3.1%), mycosis (17.8% vs 9.4%) and eczema (9.9% vs 6.2%) than other employees without any activities in the pool water. Rash frequency was very similar (20.3% and 21.9%) in both the categories of workers. This study confirms that lifeguards and trainers are more at risk for cutaneous diseases than subjects with other occupations at swimming pool facilities. However, even though our study does not specifically include hydro-therapists, we did not find more eczema or rash in trainers who entered the pool water during their teaching activities when compared with other investigated employees.
2013
- Prevalence and Risk Factors of PTSD in Children and Adolescents after the 2012 Earthquake in the Emilia Romagna Region: implications for intervention
[Abstract in Rivista]
Forresi, Barbara; DEL GIOVANE, Cinzia; Soncini, Francesco; Aggazzotti, Gabriella; D'Amico, Roberto; Parmelli, Elena; Righi, Elena; Caffo, Ernesto
abstract
PTSD is one of the psychological disorders that occurs after natural disasters. Many cases will remit within a few months, however in some estimates nearly one-third of cases have a chronic course. Delay-onset PTSD and progressive increase of symptoms seem to be very common. Given the significant rates of PTSD among children and adolescents after earthquakes and the long-term impact on their mental health, it is of primary importance to identify and treat symptoms effectively. The authors will present preliminary data from a cross-sectional study aimed at evaluating the prevalence of PTSD in a sample of children and adolescents nine months after the 2012 earthquake that hit the Emilia Romagna region in northern Italy. Data concerning risk (e.g., level of trauma exposure and parental psychopathology) and protective factors for the development and the persistence of the disorder will be also presented. Children and adolescents (age range: 9–14 years), randomly selected from schools in the Province of Modena, have been assessed using an exposure questionnaire on objective/subjective experiences during the earthquake, the UCLA PTSD index for DSM-IV (UPID), and the strengths and difficulties questionnaire (SDQ). Parental symptomatology has been also assessed, in order to evaluate the influence of parental psychopathology on offspring's adjustment. Given the few studies conducted in Italy about the long-term psychological impact of natural disaster on children and adolescents, the present research has important implications for the prevention and treatment of traumatized children and adolescents in Italy, as well as for the development of effective posttrauma interventions.
2013
- Prevalence and risk factors of Post-Traumatic Stress Disorder in children and adolescents after the 2012 earthquake affecting the Emilia Romagna Region (Italy).
[Abstract in Rivista]
Righi, Elena; Forresi, Barbara; Soncini, Francesco; DEL GIOVANE, Cinzia; D'Amico, Roberto; Caffo, Ernesto; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
On May 2012, two major earthquakes hit the Province of Modena (Emilia Romagna Region, Northern Italy): the country suffered 27 deaths and several hundred injured citizen; 15000 local resident were left homeless. Post-Traumatic Stress Disorder (PTSD) is a major debilitating psychological disorder that frequently occurs after natural disasters, including earthquakes, with a prevalence ranging, according to different authors, from 28 to 70%. Many cases will remit within 12 months, however about one-third of cases will have a chronic course. Given the high PTSD rates in children and adolescents, the long term impact on their well-being and the relevant social costs of chronic mental disorders, it is of primary importance to recognize and effectively treat cases as soon as possible and to identify potential individual and social risk and protective factors to be addressed in future effective preventive interventions. An epidemiological cross-sectional study has been set up and is on progress in a randomly selected sample of school children and adolescents (9-14 years) exposed to the earthquake with the aim to assess the PTSD prevalence and to explore potential risk (demographic, parental factors and level of trauma exposure) and protective factors (e.g. social support) associated to PTSD development and persistence. The assessment protocol includes the administration of an exposure questionnaire on objective/subjective experiences during the earthquake, the UCLA PTSD Index for DSM-IV questionnaire, and the Strengths and Difficulties Questionnaire. Parental symptomatology will be also assessed using the Symptom Checklist-90-R questionnaire, in order to evaluate the influence of parental psychopathology on children conditions. The present research will have important implications for the prevention in Italy of chronic PTSD, for treatment of traumatized children and adolescents, as well as for the development of effective post-trauma interventions.
2013
- Prevalence of self-reported cutaneous symptoms in subjects working at indoor swimming pools
[Abstract in Rivista]
Aggazzotti, Gabriella; Righi, Elena; Predieri, Guerrino; Fantuzzi, Guglielmina
abstract
As a part of an Italian study on health effects of swimming pools employees, the aim of this study was to investigate the prevalence of self-reported cutaneous symptoms in indoor swimming pools workers, as some epidemiological studies suggested high prevalence rates of eczema in subjects working inside the pool water as trainers, pool attendants and hydro therapists. Information about the health status of 133 employees was collected by a structured questionnaire. The questionnaire recorded demographic characteristics, lifestyle, working related activities (kind of job, number of working hours by day and week, previous or parallel jobs) and symptoms related to cutaneous apparatus (verruca, mycosis, eczema and rash). Most of the swimming pool workers were females (52.6%), with a mean age of 33 ys, non-smokers (48.9%), working in swimming pools for an average of 8 years: no statistical differences were observed. According to the questionnaire data, 50% of the subjects had attended indoor swimming pools for more than 20 years, mainly as swimmers. The prevalence of cutaneous diseases in the investigated subjects was: rash (20.3%), verruca (16.5%), mycosis (15.8%) and eczema (9.0%). However, subjects who declared to spend some hours inside the pool water during their working activities experienced generally more verruca (20.8% vs 3.1%), mycosis (17.8% vs 9.4%) and eczema (9.9% vs 6.2%) than other employees without any activities in the pool water. Rash frequency was very similar (20.3% and 21.9%) in both the categories of workers. This study confirms that lifeguards and trainers are more at risk for cutaneous diseases than subjects with other occupations at swimming pool facilities. However, even though our study does not specifically include hydro-therapists, we did not find more eczema or rash in trainers who entered the pool water during their teaching activities when compared with other investigated employees.
2013
- RESPIRATORY AND OCULAR SYMPTOMS IN SWIMMING POOLS WORKERS AND AIRBORNE TRICHLORAMINE (NCl3) EXPOSURE
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
The aim of this cross-sectional study was to investigate the association between airborne NCl3 exposure in indoor swimming pools and the prevalence of self-reported respiratory and ocular symptoms in occupationally exposed subjects. Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a structured questionnaire. Exposure to airborne NCl3 was evaluated in indoor swimming pools by a modified DPD/KI method. The airborne NCl3 levels showed a mean value of 0.65 ± 0.20 mg/m3 ranging from 0.2 to 1.02 mg/m3 with. More than 50% the swimming pools showed airborne NCl3 levels higher than 0.5 mg/m3 (recommend WHO guidelines). Both ocular and upper respiratory symptoms were very frequent in the investigated employees: red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants exposed to airborne NCl3 levels higher than 0.5 mg/m3 experienced higher risks for runny nose (OR: 2.9; 95% CI: 1.22-6.94) red eyes (OR: 3.2; 95% CI: 1.5-6.8), voice loss (OR: 3.6; 95% CI: 1.6-8.0), itchy eyes (OR: 2.2; 95% CI: 1.0-4.8) than other employees. When very high levels of airborne NCl3 were taken into account (airborne NCl3 levels ≥0.80 mg/m3 vs <0.80 mg/m3) ocular and respiratory symptoms became much more evident, with higher risks (as ORs) in exposed subjects (lifeguards and trainers) compared with other employees. This study confirms that lifeguards and trainers are at risk for respiratory and ocular irritative symptoms more than other employees in indoor swimming pools, in particular in presence of high airborne NCl3 levels.
2013
- Riflessioni sulla didattica relativa all’insegnamento dell’igiene ospedaliera nei corsi di laurea delle professioni sanitarie.
[Abstract in Rivista]
Piana, A; Mura, I; Agodi, A; D'Alessandro, D; Destrebecq, A; Nobile, M; Pasquarella, C; Righi, Elena; Rossi, F; Tardivo, S; Torregrossa, V; Zannini, L; Auxilia, F; Et, Gisio
abstract
OBIETTIVI: Il Gruppo Italiano di Studio di Igiene Ospedaliera della Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica ha promosso e condotto in diverse sedi universitarie italiane un’indagine sul grado di conoscenza degli studenti che frequentano i corsi di laurea in Medicina e Infermieristica in merito alla prevenzione delle infezioni correlate alle pratiche assistenziali. Sulla base dei risultati è stato realizzato un focus group (FG) che ha rappresentato la premessa allo sviluppo di un questionario volto ad indagare le percezioni dei docenti di
Igiene rispetto a tale tematica. METODI: È stato realizzato un FG con docenti di Igiene dei corsi di laurea in Medicina e Chirurgia e Infermieristica con l’obiettivo di individuare le competenze core che l’insegnamento dell’igiene ospedaliera deve sviluppare nei diversi corsi di laurea. Sulla base di quanto emerso è stato predisposto un questionario online strutturato in 6 sezioni relative ad alcuni aspetti dell’insegnamento: la rilevanza, l’integrazione con le altre discipline e con i tirocini, gli obiettivi, i metodi,
la collocazione temporale, il monte ore. RISULTATI : È stato effettuato un pre-test dello strumento di indagine per verificarne l’efficacia e la fruibilità via web.È stato inviato il link di accesso al questionario ai docenti delle sedi di Milano, Roma “La Sapienza”,
Catania, Verona, Parma, Sassari e Palermo. Dai risultati preliminari emerge che il tema dell’Igiene Ospedaliera
nella pianificazione didattica è tenuto in maggior considerazione nei corsi di infermieristica rispetto a quelli di medicina con conseguente minore consapevolezza della rilevanza del tema da parte di questi ultimi studenti. I docenti che hanno risposto sono concordi sia nell’individuazione degli obiettivi dell’insegnamento sia sull’utilizzo di modalità didattiche alternative rispetto alla lezione frontale. Tali metodologie di insegnamento non sono però
ritenute sempre fattibili in relazione alla disponibilità di tempo e strutture. L’indagine ha ricevuto in generale una valutazione positiva. CONCLUSIONI: I contenuti dell’Igiene ospedaliera sono ritenuti fondamentali sia per medici che per gli infermieri, pur con qualche differenziazione. I metodi di insegnamento dovrebbero essere diversificati al fine di aumentare la consapevolezza dell’impatto delle tematiche dell’igiene ospedaliera nell’attività pratica. Sono state raccolte osservazioni che permetteranno di precisare alcuni quesiti e predisporre la versione definitiva
del questionario che verrà inviato a tutti i docenti su territorio nazionale al fine di costruire un quadro sufficientemente
completo della problematica e formulare proposte di miglioramento da condividere.
2013
- Trends, risk factors and outcomes of healthcare-associated infections within the Italian network SPIN-UTI
[Articolo su rivista]
A., Agodi; F., Auxilia; M., Barchitta; S., Brusaferro; D., D’Alessandro; O. C., Grillo; M. T., Montagna; C., Pasquarella; Righi, Elena; S., Tardivo; V., Torregrossa; I., Mura
abstract
Background: Implementing infection control measures in light of healthcare-associated infection (HAI) surveillance data can prevent HAIs. Surveillance has been associated with a reduction of HAI in intensive care unit (ICU) patients, though the reasons for this improvement remain unclear.
Aim: To evaluate changes in healthcare-associated infection (HAI) rates during three surveys of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network (SPIN-UTI) six-year project and to explore sources of variation of indicators of HAI in the 65 participating ICUs.
Methods: The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Cumulative incidence, incidence density, infection rates adjusted for device-days, and device utilization ratios were calculated for each survey and compared. To identify risk factors multiple logistic regression analyses were performed. Crude excess mortality was computed as the difference between the crude overall case-fatality rate of patients with and without HAI.
Findings: The risk of ICU-acquired infections increased in the third survey compared with previous (relative risk: 1.215; 95% confidence interval: 1.059e1.394). Among risk factors,
the number of hospitalized patients requiring ICU admission and the Simplified Acute Physiology Score II increased from 73.7% to 78.1% and from 37.9% to 40.8% respectively.
Although mortality rates remained unchanged, HAIs trebled the risk of death. Acinetobacter baumannii was the most frequently reported micro-organism in the third survey (16.9%), whereas in the previous surveys it ranked third (7.6%) and second (14.3%).
Conclusions: The study highlighted the increased risk of HAI, at least partially explained by the greater severity and number of hospitalized patients requiring ICU admission. Furthermore, the management of intubation procedures and of ventilated patients was identified as a potential target for infection control interventions to decrease the growing risk of HAI in ICUs.
2013
- Tricloroammina nell’aria di piscine coperte: approfondimenti metodologici.
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
OBIETTIVI: La presenza nell’aria di piscina di tricloroammina,
sottoprodotto volatile ad azione irritante, viene frequentemente
associata alla comparsa di sintomi respiratori e/o asmatici nei frequentatori di piscina. Un aspetto critico degli studi fin qui condotti riguarda la valutazione dell’esposizione, di solito condotta utilizzando indicatori di esposizione proxy e raramente mediante la determinazione analitica di tricloroammina nell’aria di piscina. Non esiste, infatti, a tutt’oggi un metodo analitico che possa essere adottato in modo semplice, maneggevole e poco costoso in indagini epidemiologiche su vasta scala. Recentemente è stato messo a punto un metodo colorimetrico di facile applicazione e di costo contenuto capace di rilevare in campioni ambientali la presenza di composti volatili del cloro tra cui la tricloroammina, certamente il composto più rappresentato per la sua elevata volatilità. Scopo del presente studio è stato quello di valutare la presenza di composti volatili (prevalentemente tricloroammina)
nell’aria di piscina nel corso di una giornata di attività e di
indagare quali parametri fisici e chimici che ne possono
influenzare la diffusione. METODI: Lo studio è stato condotto in una piscina coperta di Modena nel 2010. Nel corso di alcune sedute di campionamento in differenti giornate di attività natatoria
abbiamo effettuato 11 campionamenti di aria ambientale
al giorno, campionando dalle 10,00 del mattino alla 22,00
circa. La determinazione di tricloroammina è stata effettuata
utilizzando il metodo clororimetrico recentemente proposto
da Predieri e Giacobazzi nel 2011. RISULTATI: I risultati dello studio evidenziano concentrazioni di tricloroammina relativamente elevate nelle giornate di campionamento, con valori compresi tra 0,9 mg/m3 e 1,5 mg/ m3, con un leggero incremento durante le ore centrali della giornata in cui è maggiore il numero di soggetti che svolgono attività natatoria in vasca. Le concentrazioni di tricloroammina nell’aria sono risultate del tutto sovrapponibili nelle giornate di campionamento a conferma della costante presenza di questo sottoprodotto in questi ambienti. Per quanto riguarda i parametri chimici esaminati, il cloro residuo libero e soprattutto quello combinato sono risultati correlati ai valori di tricloroammina. Il numero di nuotatori in vasca non sembra influenzare in modo significativo la presenza di tricloroammina nell’aria nei vari momenti della giornata. CONCLUSIONI: Le concentrazioni di tricloroammina nell’aria di piscina sono risultate mediamente superiori ai livelli raccomandati nelle linee guida dell’OMS e costanti nell’arco della giornata, senza fluttuazioni legate al numero dei bagnanti in vasca.
2012
- Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values.
[Articolo su rivista]
Pasquarella, C; Veronesi, L; Napoli, C; Castiglia, P; Liguori, G; Rizzetto, R; Torre, I; Righi, Elena; Farruggia, P; Tesauro, M; Torregrossa, Mv; Montagna, Mt; Colucci, Me; Gallè, F; Masia, Md; Strohmenger, L; Bergomi, Margherita; Tinteri, C; Panico, M; Pennino, F; Cannova, L; Tanzi, Ml; SItI Working Group Hygiene in, Dentistry
abstract
A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200 cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000 cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (pb0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics.
2012
- Occurrence and Toxicity of Disinfection Byproducts in European Drinking Waters in Relation with the HIWATE Epidemiology Study.
[Articolo su rivista]
Jeong, Ch; Wagner, Ed; Siebert, Vr; Anduri, S; Richardson, Sd; Daiber, Ej; Mckague, Ab; Kogevinas, M; Villanueva, Cm; Goslan, Eh; Luo, W; Isabelle, Lm; Pankow, Jf; Grazuleviciene, R; Cordier, S; Edwards, Sc; Righi, Elena; Nieuwenhuijsen, Mj; Plewa, M. J.
abstract
The HIWATE (Health Impacts of long-term exposure to disinfection byproducts in drinking WATEr) project was a systematic analysis that combined the epidemiology on adverse pregnancy outcomes and other health effects with long-term exposure to low levels of drinking water disinfection byproducts (DBPs) in the European Union. The present study focused on the relationship of the occurrence and
concentration of DBPs with in vitro mammalian cell toxicity. Eleven drinking water samples were collected from five European countries. Each sampling location corresponded with an epidemiological study for the HIWATE program. Over 90 DBPs were identified; the range in the number of DBPs and their levels reflected the diverse collection sites, different disinfection processes, and the different characteristics of the source waters. For each sampling site, chronic mammalian cell cytotoxicity correlated highly with the numbers of DBPs identified and the levels of DBP chemical classes. Although there was a clear difference in the genotoxic responses among the drinking waters, these data did not correlate as well with the chemical analyses. Thus, the agents responsible for the genomic DNA damage observed in the HIWATE samples may be due to unresolved associations of
combinations of identified DBPs, unknown emerging DBPs that were not identified, or other toxic water contaminants. This study represents the first to integrate quantitative in vitro toxicological data with analytical chemistry and human epidemiologic outcomes for drinking water DBPs.
2012
- Performance of two commercial real-time PCR assays for the detection of Aspergillus and Pneumocystis DNA in bronchoalveolar lavage fluid samples from critical care patients.
[Articolo su rivista]
Orsi, C. F.; Gennari, W.; Venturelli, C.; La Regina, A.; Pecorari, M.; Righi, E.; Machetti, M.; Blasi, E.
abstract
This article investigates the performance of 2 commercial real-time polymerase chain reaction (PCR) assays, MycAssay™ Aspergillus (MycAspAssay) and MycAssay™ Pneumocystis (MycPCPAssay), on the ABI 7300 platform for the detection of Aspergillus (Asp) or Pneumocystis jirovecii (Pj) DNA in bronchoalveolar lavage (BAL) samples from 20 patients. Operationally, patients enrolled were clustered into 3 groups: invasive aspergillosis group (IA, 7 patients), Pj pneumonia group (PCP, 8 patients), and negative control group (5patients). All the IA patients were MycAspAssay positive, whereas 12 non-IA patients returned negative PCR results. Furthermore, 7 of 8 PCP patients were MycPCPAssay positive, while 9 non-PCP patients were PCR negative. In conclusion, these data provide an early indication of the effectiveness of both the MycAspAssay and MycPCPAssay on the ABI 7300 platform for the detection of either Asp or Pj DNA in BAL from patients with deep fungal infections.
2012
- Sorveglianza delle infezioni ospedaliere nell’Unità di Rianimazione dell’Azienda Ospedaliera-Universitaria Policlinico di Modena
[Abstract in Rivista]
Righi, Elena; Barbieri, Alberto; Conigliaro, Concetta; Giuliani, Enrico; Carluccio, Eugenia; Bisaccia, Eufemia; Marchigiano, P; Aggazzotti, Gabriella
abstract
Nell’Unità di Rianimazione dell’Azienda Ospedaliero-Universitaria Policlinico di Modena è stato applicato un sistema di sorveglianza delle infezioni ospedaliere (IOS) denominato SPIN-UTI (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unita di Terapia Intensiva), un sistema di rilevazione utilizzato in diverse terapie intensive italiane, costruito e messo punto utilizzando la metodologia dal network europeo di sorveglianza delle infezioni HELICSICU, con l’obiettivo di consentire valutazioni e confronti sul fenomeno estesi ed affidabili sia a livello nazionale che internazionale.La sorveglianza, di tipo prospettico e patient-based, è durata per 6 mesi (ottobre 2010-marzo 2011): tutti i pazienti ricoverati in TerapiaIntensiva per più di 48h sono stati monitorati per tutto il tempo del ricovero e le IOS sorvegliate sono state le polmoniti nosocomiali; le infezioni del torrente ematico; le infezioni associate a cateteri intravascolari centrali; le infezioni delle vie urinarie. 70 pazienti (51% maschi) con una età media pari a 74 anni (± 15) sono stati ospitati per più di 48 ore prevalentemente (91%) per un ricovero di tipo medico. Durante la sorveglianza sono state registrate 24 infezioni in 15 soggetti: l’incidenza cumulativa di soggetti con infezione potenzialmente correlata alla attività assistenziale risulta così pari al 21.4%, mentre la densità di incidenza pari a 23.7 infezioni ogni 1000 giornate di degenza. Le infezioni più diffuse sono risultate le polmoniti (16 episodi pari al 67% delle infezioni registrate) seguite da quelle delle vie urinarie (6 episodi- 25%). La durata della degenza in rianimazione (34 vs 9 giorni) così come la mortalità ospedaliera (67% vs 26%) appaiono significativamente più elevate per i pazienti con IOS rispetto a quelle registrate per i soggetti privi di infezioni.I dati rilevati risultano in linea con quanto osservato nello stesso periodo nelle altre TI italiane aderenti al sistema di sorveglianza SPINUTI.
2012
- Sorveglianza epidemiologica delle infezioni ospedaliere condotta all’interno di una convenzione tra il Dipartimento di Scienze di Sanità Pubblica dell’Università Modena e Reggio Emilia e l’Azienda Ospedaliero-Universitaria Policlinico di Modena.
[Abstract in Rivista]
Righi, Elena; Aggazzotti, Gabriella; Cattani, S; Girardis, Massimo; Vecchi, E; Marchegiano, P; Cencetti, S.
abstract
A partire da settembre 2007 il Dipartimento di Scienze di Sanità Pubblica dell’Università di Modena e Reggio-Emilia e la Direzione Generale dell’Azienda Ospedaliero-Universitaria Policlinico di Modena hanno attivato una convenzione con l’obiettivo di effettuare una mappatura dei sistemi di sorveglianza già in atto, valutarne i risultati, identificare e implementare gli eventuali interventi migliorativi e rafforzativi.L’attività, svolta grazie ad una stretta collaborazione con il CIO, ha seguito diversi step metodologici: – individuazione delle infezioni prioritarie da includere nella sorveglianza e delle popolazioni target; – individuazione delle definizioni di caso e degli indicatori già riconosciuti ed utilizzati da protocolli regionali nazionali o internazionali; – censimento dei sistemi di sorveglianza già in essere; – raccolta e analisi dei dati disponibili con particolare attenzione agli indicatori selezionati; – confronto dei dati delle IOS specifiche per tipologia o per reparto con dati regionali, nazionali o internazionali; – individuazionedelle criticità emerse da confronti interni ed esterni; – messa a punto di interventi di miglioramento della sorveglianza e delle misure di controllo basate su linee guida internazionali o nazionali. La mappatura dei sistemi di sorveglianza delle IOS presso l’Azienda ha evidenziato la presenza di sistemi già attivi da alcuni anni nella Terapia Intensiva Neonatale, nelle terapie intensive per gli adulti e nelle Chirurgie. I tassi di incidenza delle IOS sono risultati in linea con i dati dei sistemi di sorveglianza regionali (SIChER), nazionali (SPINUTI, GiViTI) ed internazionali (NNIS e VON). La collaborazione attivata in questi anni ha permesso, inoltre, di ampliare e rinforzare i sistemi di sorveglianza già in essere, con l’obiettivo di aumentare il numero e la tipologia di IOS sorvegliate, di estendere la sorveglianza anche ad altre unità, di migliorare la completezza e l’accuratezza della raccolta dati, con particolare attenzione ai patogeni emergenti e alle ntibioticoresistenze.
2012
- Trihalomethanes, chlorite, chlorate in drinking water and risk of congenital anomalies: A population-based case-control study in Northern Italy
[Articolo su rivista]
Righi, Elena; Petra, Bechtold; Danila, Tortorici; Paolo, Lauriola; Elisa, Calzolari; Gianni, Astolfi; Mark J., Nieuwenhuijsen; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Background: Epidemiological evidence of an association between disinfectionby-products (DBPs) exposure via drinking water and reproductive outcomes is still inconclusive.Objective: The aim of this study was to investigate the association between trihalomethanes (THMs), chlorite and chlorate exposure and congenital anomalies.Methods: A case-control study was carried out in Emilia-Romagna Region (Italy). Data on 1917 different congenital anomalies (neural tube, cardiac, diaphragm and abdominal wall,oesophagus, cleft lip and palate, respiratory, urinary tract and chromosomal anomalies) observed in the period 2002–2005 were extracted from the Regional Malformation Registry. Four controls (newborns without anomalies) were randomly selected form the Regional Birth Register and frequency matched to cases according to pregnancy period. The network supplying water during the first trimester of pregnancy was identified on the basis of mother’s address: DBPs data, technical and structural information were linked to each subject.Results: Overall, THMs exposure was very low (mean:3.8 +/- 3.6 mg/l), and no risk excess was observed. Chlorite and chlorate values were fairly high (mean:427+/-184 mg/l and 283+/-79 mg/l, respectively). Women exposed to chlorite level >700 mg/l were at higher risk of newborns with renal defects (OR: 3.30; 95%IC:1.35–8.09),abdominal wall defects(OR:6.88;95%IC:1.67–28.33) and cleftpalate (OR: 4.1; 95%IC:0.98–16.8); women exposed to chlorate level >200 mg/l were at higher risk of newborns with obstructive urinary defects (OR:2.88;95%IC:1.09–7.63), cleftpalate (OR:9.60;95%IC:1.04–88.9) and spina bifida (OR:4.94;95%IC:1.10–22).Conclusions: This was the first study showing an excess risk of different congenital anomalies related to chlorite and chlorate exposure via drinking water: further research is needed to confirm the observed relationships in large datasets, specifically for chlorate, an unregulated DBP.
2011
- A CASE-CONTROL STUDY ON CONGENITAL ANOMALIES AND TRIHALOMETHANES EXPOSURE IN EMILIA ROMAGNA (NORTHERN ITALY).
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Epidemiological studies suggest that exposure during pregnancy to Disinfection by-products (DBPs), mainly Trihalomethanes (THMs), can increase the risk of congenital malformations, however evidence is not conclusive. This study, funded under the EU Sixth Framework Programme for Research and Technological Development (FP6) (“Hiwate” project), had the aim to assess congenital anomalies risk associated with exposure to THMs during pregnancy.A retrospective register based case-control study was carried out in Emilia-Romagna region (Northern Italy). Data on chromosomal anomalies and different congenital anomalies (neural tube, cardiovascular, abdominal wall, cleft lip and palate, respiratory, genital organs and urinary tract defects) occurred in the period 2002-2005 were extracted from the Regional Malformation Registry. 4 Controls (newborns without malformations) were randomly selected form the Regional Birth Register and frequency matched to cases according to pregnancy period. The network supplying drinking water during the first trimester of pregnancy was identified on the basis of mother’s address: THMs data, technical and structural information (disinfection treatment, water type and quality) were linked to each subject.6140 subjects, 1242 cases and 4984 controls, were included in the study: age, reproductive history and zonal deprivation index distribution (Caranci index) resulted significantly different in mothers of cases and controls. Both total brominated-THMs and total THMs levels appeared very low: mean values were respectively 3.8(±3.6)µg/l and 3.2(±2.6)µg/l and maximum values were respectively 22,8µg/l and 19.7µg/l. No significant increased risks for the different congenital anomalies included in the study were observed, also after adjusting for potential confounders, in mother exposed to levels >10µg/l of total brominated THMs or Total THMs in comparison to mothers exposed to levels lower than 5 µg/l.The low levels of THMs observed in drinking water in the study area did not appear to be associated with a significant increase in the risk of selected congenital malformation
2011
- AIRBORNE TRICHLORAMINE (NCl3) EXPOSURE IN INDOOR SWIMMING POOLS AND PREVALENCE OF SELF-REPORTED RESPIRATORY AND OCULAR SYMPTOMS IN OCCUPATIONALLY EXPOSED SUBJECTS
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, P; Bechtold, P; Mastroianni, K.
abstract
Background and Aims: The aim of this cross-sectional study was to investigate the association between airborne NCl3 exposure in indoor swimming pools and the prevalence of self-reported respiratory and ocular symptoms in occupationally exposed subjects.Methods: Twenty indoor swimming pools in the Emilia-Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a self-administered questionnaire. Exposure to airborne NCl3 was evaluated in indoor swimming pools by a modified DPD/KI method. Results: The airborne NCl3 levels ranged from 204 to 1020 μg/m3 with a mean value of 648.7 ± 201.4 μg/m3. More than 50% of the swimming pools showed airborne NCl3 levels higher than 500 μg/m3 recommended WHO guidelines). Both ocular and upper respiratory symptoms were very frequent in the 128 employees: red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants exposed to airborne NCl3 levels higher than 500 μg/m3 experienced higher risks for runny nose (OR: 2.9; 95% CI: 1.22-6.94), red eyes (OR: 3.2; 95% CI: 1.5-6.8), voice loss (OR: 3.6; 95% CI: 1.6-8.0), itchy eyes (OR: 2.2; 95% CI: 1.0-4.8) than other employees. When high levels of airborne NCl3 were taken into account (airborne NCl3 levels ≥ 800 μg/m3 vs. < 800 μg/m3) ocular and respiratory symptoms became much more evident, with higher risks (as ORs) in exposed subjects (lifeguards and trainers) compared with other employees. Conclusions: This study confirms that lifeguards and trainers are at risk for respiratory and ocular irritative symptoms more than other employees in indoor swimming pools, in particular in presence of high airborne NCl3 levels.
2011
- APPLICATION OF A NEW METHOD FOR TRICHLORAMINE DETERMINATION IN AMBIENT AIR OF INDOOR SWIMMING POOLS.
[Abstract in Rivista]
Fantuzzi, Guglielmina; Predieri, Guerrino; Giacobazzi, P; Mastroianni, K; Righi, Elena; Aggazzotti, Gabriella
abstract
Background and Aims: Trichloramine (NCl3) is a volatile disinfection by-product (DBP) which is formed when chlorine in water reacts with nitrogen-containing compounds. NCl3 is a strong mucous membrane irritant and it has been recently linked with respiratory symptoms and asthma in swimmers, mainly in children, and in pool attendants. However, there are some issues to clarify about NCl3 exposure in indoor swimming pools and one of them deals with the analytical determination of NCl3 in ambient air. The aim of this study was to investigate the feasibility of a new modified DPD/KI colorimetric method, recently proposed in literature, for the analysis of airborne NCl3 in indoor swimming pools. The relationships between NCl3 ambient air levels and some other DBPs in these environments were also evaluated.Methods: Airborne NCl3 levels were investigated in 20 indoor swimming pools. Technical characteristics and disinfection treatments were collected together with physical and chemical parameters in water. Trihalomethanes (THMs) levels in water and air were also investigated.Results: The airborne NCl3 levels ranged from 204 to 1020 μg/m3 and the mean value was 648.7 ± 201.4 μg/m3. High levels of combined chlorine in water were observed: only 25% of the investigated swimming pools showed levels ≤ 0,4 mg/l, which is the Italian limit value. The average and highest THMs levels in water were 41.4 and 134 μg/l, respectively. Mean ambient air THMs value was 86.0 ± 47.9 μg/m3 and 187 μg/m3 was the maximum value. Airborne NCl3 levels were found associated only with combined chlorine (r= 0.441; p < 0.05) and with THMs levels in ambient air (r= 0.554; p < 0.05).Conclusions: Airborne NCl3 levels are in line with other studies in literature. However more than 50% of the investigated indoorswimming pools showed NCl3 levels higher than the recommend provisional value of 500 μg/m3, as suggested in WHO guidelines
2011
- Acqua potabile e tutela della salute.
[Articolo su rivista]
Righi, Elena; Tortorici, D.
abstract
I trattamenti di disinfezione delle acque destinate al consumo umano producono sottoprodotti che possono avere effetti negativi sulla salute. Una valutazione approfondita sarà effettuata dal progetto europeo HiWate.
2011
- CHLORATE AND CHLORITE EXPOSURE VIA DRINKING WATER DURING PREGNANCY AND THE RISK OF CONGENITAL ANOMALIES
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Experimental data suggest that chlorite and chlorate, the main disinfection by-products (DBPs) when chlorine dioxide is used, can be related to developmental toxicity, however no epidemiological evidence is available. This study is a part of the international project “HiWate” (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water), funded under the EU Sixth Framework Programme for Research and Technological Development (FP6), and had the aim to evaluate the risk of congenital anomalies related to chlorite and chlorate exposure during pregnancy.METHODS: A case-control study was carried out in a Northern Italy region (Emilia-Romagna). During the study period (2002-2005), newborns with different congenital anomalies (neural tube, cardiovascular, abdominal wall, cleft lip and palate, respiratory, genital organs and urinary tract defects) or chromosomal anomalies were extracted from the Regional Malformation Registry, while controls (newborns without malformations) were randomly selected from the Regional Birth Register. On the basis of each mother’s address the network supplying drinking water during the period of interest (first trimester of pregnancy) was identified: data on disinfection, water quality and DBPs were linked to each subject.RESULTS: Chlorite levels were available for 5494 subjects (mean value:427±184µg/l; range <200-1283µg/l); chlorate levels were available for 1178 women (mean value:283±78µg/l; range <200-1140µg/l). In comparison to subjects exposed to levels below 200µg/l, women exposed to chlorite level >700µg/l resulted, after adjusting for personal, reproductive and socio-economical confounders, at higher risk of newborns with renal defects (OR:3.3; 95%IC:1.4-8.1), abdominal wall defects (OR:6.9; 95%IC:1.7-28), cleft palate (OR:4.1; 95%IC:0.98-16.8); while women exposed to chlorate level >200µg/l resulted at higher risk of newborns with obstructive urinary defects (OR:2.9; 95%IC:1.1-7.6), spina bifida (OR:4.94; 95%IC:1.1-22).CONCLUSIONS: This was the first epidemiological study evaluating the relationship between chlorite and chlorate exposure and congenital anomalies and, despite of the ecological exposure assessment, significant increased risks were observed, mainly for urinary tract defects
2011
- Colorectal Cancer and Disinfection By-Products in Italy and Spain
[Abstract in Rivista]
Villanueva, Cm; Bosetti, C; Righi, Elena; Moreno, V; La Vecchia, C; Aggazzotti, Gabriella; Castaño Vinyals, G; Carrasco, G; Tavani, A; Bustamante, M; Talamini, R; Pisa, F; Rantakokko, P; Kogevinas, M; Nieuwenhuijsen, M.
abstract
Background/Aims: Experimental data suggests that disinfection by-products (DBPs) are colorectal carcinogens but epidemiological evidence is contradictory. To evaluate colorectal cancer risk associated with long-term DBP exposure. Methods: A case-control study was conducted in Italy and Spain. Cases were newly diagnosed and histollogically confirmed, 20-85 years old and living in the study areas. Controls were matched to cases by age, gender and area of residence. Study area comprised Barcelona (Spain) and Milan, Pordenone and Udine (Italy). Study subjectswere interviewed on potential risk factors of colorectal cancer, residential history and water uses including ingestion, showering, bathing, dishwashing and swimming in pools. Blood samples were collected to obtain DNA sample. Retrospective data ontrihalomethane levels in the study areas has been collected through water companies and water samples have been collected to measure a range of DBPs.Results: Based on 500 cases and 436 controls in Spain and 400 cases and 363 controls in Italy, the longest residence lasted 35 years on average in Spain and 37 years in Italy. Drinking water at the longest residence was from public water supply among 56% subjects in Spain and 46% in Italy. The rest consumed bottled water or from othersources. Those drinking water from public supplies compared to bottled water had an odds ratio (OR) and 95% confidence interval of 1.17 (0.87-1.58) in Spain and 1.18 (0.79-1.77) in Italy, adjusting for potential confounders. Taking long compared to short showers(above vs. below median) yield an OR of 1.04 (0.80-1.40) in Spain and 1.16 (0.83-1.63) in Italy. Mean trihalomethane levels in Italy wereConclusion: These initial results suggest a weak association between colorectal cancer and DBP exposure
2011
- Detection of follicular fluid and serum antibodies by protein microarrays in women undergoing in vitro fertilization treatment.
[Articolo su rivista]
Ardizzoni, Andrea; Manca, Lidia; Capodanno, F; Baschieri, MARIA CRISTINA; Rondini, I; Peppoloni, Samuele; Righi, Elena; LA SALA, Giovanni Battista; Blasi, Elisabetta
abstract
A protein microarray serological assay was used to assess the antibody profile of 102women subjected to in vitro fertilization treatment. The studies were conducted on pairs of serum and follicular fluid samples, collected from each woman on the same day at the time of oocyte recovery. The samples, stored as frozen aliquotes, were assessed by both microarray and ELISA. Follicular fluids and sera were screened to detect the presence of specific IgG and IgM antibodies against seven vertically transmitted pathogens. The IgG reactivityof follicular fluids closely mirrored that of serum in all the patients and for all the antigens, with an agreement of more than 85%. IgM antibodies were undetectable in follicular fluids. The antibody patterns were subsequently related to the biological and clinical outcomesof in vitro fertilization cycles. The results showed that varicella zoster virus (VZV) IgG positive women and cytomegalovirus (CMV) IgG negative women had on average a higher number of inseminated, good quality oocytes compared to VZV IgG negative and CMV IgG positive women. In addition, the rate of successful embryo transfers was significantly higher in Toxoplasma gondii IgG negative women than in their positive counterparts. Overall, the microarray was proven to be a suitable tool for detecting analytes in follicular fluids, therefore supporting its application in a wide spectrum of investigations.
2011
- EMERGING DISINFECTION BY PRODUCTS (DBPS): CHLORATE IN ITALIANDRINKING AND SWIMMING POOL WATERS
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; P., Giacobazzi; P., Bechtold; K., Mastroianni; Aggazzotti, Gabriella
abstract
Background and Aims: Chlorate is a disinfection by-product (DBP) originating from chlorine dioxide water disinfection, which can be a contaminant of sodium hypochlorite solutions as well. Due to its not yet well investigated genotoxic and carcinogenic potential effects, it is considered, together with other DBPs, an emerging DBP for which further research on occurrence levels and toxicological properties is a prior need. The aim of this study was to evaluate in some Italian regions the potential exposure to chlorate via drinking water of the general population and of a specific population (swimmers).Methods: Chlorate levels were investigated in drinking water samples collected form 12 waterworks located in Emilia-Romagna, Friuli Venezia Giulia and Lombardia Regions. To investigate spatial and seasonal variability, different water samples (n.194) were collected at different points along the distribution system and over four seasons. In the same period 20 swimming pools in the Emilia-Romagna Region were investigated for the occurrence of chlorate in water pools. Chlorate analysis was performed by ion chromatography (detection limit: 1 μg/l).Results: Chlorate occurred in 97% of the drinking water samples, (median:18, range: 2-399μg/l) and resulted always below theprovisional WHO guidelines (700μg/l). Nevertheless, significant differences in levels were observed according to disinfectionmethods, and the highest levels occurred in water disinfected both with chlorine dioxide and ozone (median:163, range:83-399μg/l). No clear spatial or seasonal trends were observed. Swimming pool waters showed much more higher chlorate levels (median:4347, range: 5-19537μg/l) and significant differences according to disinfectant applied were also observed. Conclusions: In the Italian investigated regions, chlorate appears to be widespread both in drinking and swimming pool waters; in the latter particularly high levels were observed in different settings. Swimmers are therefore a potentially highly exposed population subgroup: to evaluate health implications of this specific exposure pathway, however, further investigation is needed.
2011
- EPIDEMIOLOGIA DEGLI ISOLAMENTI DI ACINETOBACTER PRESSO L’AZIENDA OSPEDALIERO - UNIVERSITARIA POLICLINICO DI MODENA.
[Abstract in Rivista]
Righi, Elena; Scannavini, P; Bianchini, G; Venturelli, C; Vecchi, E; Marchegiano, P; Morandi, Matteo; Floramo, Maria; Aggazzotti, Gabriella
abstract
Negli ultimi anni si è assistito ad una sempre maggiore diffusione in ambito ospedaliero di colonizzazioni e di infezioni, spesso a carattere epidemico, determinate da microrganismi appartenenti al genere Acinetobacter, ed in particolare A. baumannii, caratterizzati frequentemente da una resistenza elevata agli antibiotici (MDR). In questo studio viene descritta la sorveglianza epidemiologia eseguita nei confronti di questo microrganismo gram-negativo nel corso del 2009 presso l’Azienda Ospedaliero - Universitaria (AOU) Policlinico di Modena. A differenza dell’anno 2008, durante il quale erano stati segnalati solamente isolamenti sporadici di Acinetobacter spp (14 soggetti), all’inizio del 2009 il laboratorio microbiologico, grazie al sistema di segnalazione di eventi sentinella, ha evidenziato un improvviso aumento degli isolamenti di questo patogeno opportunista, tendenza che si è prolungata per tutto l’anno in questione. Gli isolamenti hanno coinvolto in totale 134 soggetti, ricoverati in numerosi reparti. La terapia intensiva post-operatoria (con 24 casi) e la rianimazione (17 casi) sono risultate le unità più frequentemente coinvolte negli isolamenti. L’analisi del trend temporale ha evidenziato un andamento stagionale con un picco di isolamenti nei mesi estivi. I microrganismi sono stati isolati in diversi materiali biologici e sono risultati sensibili nella quasi totalità dei casi sia alla tigeciclina che alla colistina. Diverse azioni sono state intraprese per contenere la diffusione di A. baumannii, tra cui l’isolamento funzionale dei pazienti colonizzati secondo i protocolli prestabiliti e condivisi, la diffusione di linee guida per un corretto approccio terapeutico mirato ad evitare l’insorgenza di resistenze (l’uso di tigeciclina nella terapia empirica è sconsigliato ad esclusione di casi particolari) e la segnalazione della positività nella lettera dimissione.
2011
- Epidemiological trends of emerging organisms and antimicrobialresistance in Italian ICUs: risk adjusted rates from the SPIN-UTI project
[Abstract in Rivista]
A., Agodi; F., Auxilia; M., Barchitta; S., Brusaferro; D., D'Alessandro; M. T., Montagna; C., Pasquarella; Righi, Elena; S., Tardivo; V., Torregrossa; I., Mura
abstract
Objectives: The main aims of our study were to compare risk adjusted rates from the first two editions of the SPIN-UTI, Italian Nosocomial Infections (NIs) Surveillance in Intensive Care Units (ICUs), project and to follow up epidemiological time-trends of nosocomial pathogens, emerging organisms and their antimicrobial resistance patterns. Methods: The SPIN-UTI methodology is based on the HELICS-ICU protocol (version 6.1, 2004) (Agodi et al., 2010). Prospective patient-based surveillance was implemented from October 2006 to March 2007 by 49 ICUs in the first edition and from October 2008 to March 2009 in the second one by 28 ICUs. Results: In the first study, the cumulative incidence of ICU-acquired infections for all sites was 19.8 per 100 patients and the incidence density 17.1 per 1000 patient-days. The most frequently reported NI type was pneumonia (PN, 53.6%) followed by bloodstream infections (BSIs, 23.4%), urinary tract infections (UTIs, 16.7%) and catheter-related infections (6.3%). In the second study, the cumulative incidence and the incidence density were 19.9 per 100 patients and 19.0 per 1000 patient-days, respectively. Comparing the proportion of infections by type, a decrease of PN (from 53.6% to 47.3%) and a significant increase of UTIs (from 16.7% to 22.3%; p < 0.000) were shown. In the first edition, bacterial species most frequently detected were: Pseudomonas aeruginosa (19.0%), Staphylococcus aureus (9.4%) and Acinetobacter baumannii (7.5%) (Agodi et al., 2010). In the second, P. aeruginosa remained the most frequently reported micro-organism (16.9%), while the proportion of A. baumannii (14.2%) and K. pneumoniae (9.6%) significantly increased. Trend of resistance rates were as follows: imipenem-resistant A. baumannii revealed no change (76.9% and 77.3%), imipenem-resistant K. pneumoniae increased (from 8.3% to 13.9%), and imipenem-resistant or ciprofloxacin-resistant P. aeruginosa revealed an increase from 40.5% to 48.1% and from 42.7% to 50.6% respectively. Conclusion: Our risk estimates of ICU-acquired PN and BSI reflect the European scenario, as reported by the BURDEN project (Lambert et al., 2010). Furthermore, our study revealed an increasing risk of UTIs as a target for infection control and highlighted the emerging role of A. baumannii and K. pneumoniae in Italy as well as an increasing trend in time of specific resistance patterns. National and international cooperative efforts are needed to prevent NIs in ICUs.
2011
- Esposizione a tricloroammina e sintomi irritativi a carico dell’apparato oculare e respiratorio nei lavoratori di piscine coperte.
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, P; Bechtold, P; Aggazzotti, Gabriella
abstract
Questa indagine è stata condotta con lo scopo di valutare la prevalenza di sintomi irritativi a carico dell’apparato oculare e respiratorio nei lavoratori di piscine coperte in relazione alla loro esposizione ambientale a tricloroammina, composto tossico volatile che si forma nell’acqua di piscina a seguito dei trattamenti di disinfezione.METODI: Attraverso la somministrazione di un questionario autocompilato, sono state raccolte informazioni relative a sintomi di tipo irritativo in 128 soggetti che lavorano in 20 piscine coperte della Regione Emilia Romagna. Sono stati contemporaneamente valutati i livelli di tricloroammina nell’aria delle 20 piscine esaminate. La determinazione della tricloroammina è stata condotta utilizzando il metodo colorimetrico DPD, modificato.RISULTATI: Le concentrazioni ambientali di tricloroammina sono risultate comprese tra 204 e 1020 μg/m3, con un valore medio di 648,7 ± 201,4 μg/m3. Sintomi oculari e respiratori si sono dimostrati frequenti nei 128 lavoratori esaminati: occhi rossi, naso gocciolante, perdita della voce, e raffreddori sono risultati più frequenti negli addetti all’assistenza dei bagnanti e negli allenatori rispetto ai soggetti che, pur lavorando in piscina, non soggiornano a bordo vasca (bar, reception, ecc). In particolare, in condizioni di esposizioneambientale a tricloroammina superiore a 500 μg/m3, negli addettiall’assistenza dei bagnanti e negli allenatori si è osservato un significativo incremento del rischio di manifestare occhi rossi (OR: 3.2; 95% CI: 1.5-6.8), naso gocciolante (OR: 2.9; 95% CI: 1.22-6.94), perdita della voce (OR: 3.6; 95% CI: 1.6-8.0), irritazione oculare (OR: 2.2; 95% CI: 1.0-4.8) rispetto agli altri lavoratori. L’incremento di rischio si è rivelato dose dipendente. CONCLUSIONI: Questo studio conferma che i soggetti che lavorano abordo vasca manifestano con più frequenza sintomi di tipo irritativo acarico della mucosa oculare e respiratoria e che questi sintomi sono associati alla presenza di tricloroammina in tali ambienti.
2011
- Infezioni correlate all’assistenza sanitaria in terapia intensiva: risultati di un sistema di sorveglianza attuato in un ospedale accreditato di alta specialità
[Articolo su rivista]
Righi, Elena; Carla, Tucci; Stefano, Reggiani; Marco, Meli; Nicola, D’Apollo; Margherita De, Santis; Simonetta, Ragazzi
abstract
Recentemente in un ospedale privato accreditato di alta specialità di Modena è stata condotta una sorveglianza attiva delle infezioni acquisite in terapia intensiva allo scopo di quantificare le dimensioni del fenomeno, riconoscere i principali fattori di rischio ed identificare le potenziali specifiche aree di intervento. I pazienti ricoverati per almeno 48h sono stati sorvegliati per tutta la degenza, raccogliendo le informazioni su una scheda appositamente ideata ed utilizzandole linee guida dei CDC americani per identificare i casi di infezione.Tra i 229 soggetti arruolati, 73 (31,9%) hanno sviluppato infezioninosocomiali (23,9 infezioni ogni 1000 giorni degenza). Infezioni delle vie urinarie, prevalentemente asintomatiche, sono state osservate nel 17,0% dei pazienti; (15 casi ogni 1000 giorni di catetere), infezioni del torrente ematico nel 13,1% dei soggetti, polmoniti nel 9,2% dei ricoverati (14 casi ogni 1000 giorni di ventilazione meccanica) ed infezioni del sito chirurgico nel 3,5% dei ricoverati. I soggetti che hanno sviluppato una infezione erano più anziani e presentavano condizioni sanitarie più critiche rispetto agli altri pazienti ricoverati. Per questi soggetti la durata della degenza è risultata significativamente prolungata così come è aumentato il rischio di morte. La diffusione delle infezioni nosocomiali è risultata in linea con quanto osservato in altre realtà italiane ed estere. La conoscenza delle dimensioni del fenomeno e l’identificazione di aree di criticità/miglioramento, hanno stimolato la predisposizione di metodologie operative comuni e condivise e l’identificazione di specifici interventi mirati alla riduzione dell’incidenza delle infezioni: l’efficacia di tali strategie è attualmente in fase di valutazione grazie alla predisposizione e alla conduzione di un nuovo periodo di sorveglianza
2011
- Influence of hyaluronic acid on bacterial and fungal species, including clinically relevant opportunistic pathogens.
[Articolo su rivista]
Ardizzoni, Andrea; Neglia, Rachele Giovanna; Baschieri, MARIA CRISTINA; Cermelli, Claudio; Caratozzolo, M; Righi, Elena; Palmieri, Beniamino; Blasi, Elisabetta
abstract
Hyaluronic acid (HA) has several clinical applications (aesthetic surgery, dermatology, orthopaedics and ophtalmology). Following recent evidence, suggesting antimicrobial and antiviral properties for HA, we investigated its effects on 15 ATCC strains, representative ofclinically relevant bacterial and fungal species. The in vitro system employed allowed to assess optical density of broth cultures as a measure of microbial load in a time-dependent manner. The results showed that different microbial species and, sometimes, different strains belonging to the same species, are differently affected by HA. In particular, staphylococci, enterococci, Streptococcus mutans, twoEscherichia coli strains, Pseudomonas aeruginosa, Candida glabrata and C. parapsilosis displayed a HA dosedependent growth inhibition; no HA effects were detected in E. coli ATCC 13768 and C. albicans; S. sanguinis was favoured by the highest HA dose. Therefore, the influence of HA on bacteria and fungi warrants further studies aimedat better establishing its relevance in clinical applications.
2011
- La contaminazione microbica dell’aria negli ambulatori odontoiatrici: risultati di uno studio multicentrico condotto in 9 città italiane.
[Abstract in Rivista]
Pasquarella, C; Veronesi, L; Castiglia, P; Liguori, G; Montagna, Mt; Napoli, C; Rizzetto, R; Torre, I; Deriu, Mg; Strohmenger, L; Di Onofrio, V; Tesauro, M; Colucci, Me; Righi, Elena; Bergomi, Margherita; Farruggia, P; Torregrossa, Mv; Tinteri, C; Panico, M; Pennino, F; Cannova, L; Tanzi M. e., Gruppo di Lavoro SItI “Igiene in Odontoiatria”
abstract
OBIETTIVI: Nell’ambito dello studio multicentrico sulla valutazione dellaqualità microbiologica ambientale degli ambulatori odontoiatrici, condotto dal Gruppo “Igiene in Odontoiatria” della S.It.I., è stata effettuata la rilevazione della contaminazione microbica dell’aria allo scopo di: fornire un quadro relativo alla qualità microbiologica; standardizzare i metodi di campionamento; definire valori soglia di riferimento; identificare i fattori associati ad elevati livelli di contaminazione microbica. METODI: Lo studio è stato effettuato nelle sedi di Bologna, Genova,Milano, Modena, Napoli 1, Napoli 2, Palermo, Parma, Sassari, Taranto. Icampionamenti sono stati effettuati nell’arco di tre mesi, una settimanaal mese, nei 5 giorni lavorativi della settimana, prima (T0), durante (T1) e al termine (T2) dell’attività ambulatoriale. Il campionamento attivo è stato eseguito utilizzando il campionatore Surface Air System, SAS (Pbi, Milano), con un’aspirazione di 500 L, mentre il campionamento passivo ha previsto l’utilizzo di piastre di sedimentazione di 9 cm di diametro, esposte per 1 ora, per la determinazione dell’Indice Microbico Aria (IMA). Il terreno Tryptone Soya Agar, incubato a 36°C per 48 ore, è stato utilizzato per lavalutazione della carica batterica totale, mentre il terreno glicinavancomicina polimixina cicloexamide (GVPC) per l’isolamento di Legionella spp.RISULTATI: I valori mediani di ufc/m3 sono passati da 78 a T0 a 166 a T1 (p<0,001), con un successivo decremento a 110 a T2 (p<0,001). Lostesso andamento si è osservato per i valori mediani di IMA, che da 12a T0 sono aumentati fino a 27,5 a T1 (p<0,001) e successivamentediminuiti a 14 a T2 (p<0,001). Un’ampia variabilità nei livelli di contaminazione è stata osservata durante l’attività nelle diverse sedi: ivalori mediani hanno oscillato da 7 a 38 IMA, con un valore massimo di200 IMA, e da 52 a 250 ufc/m3, con un picco di 2.614 ufc/m3. Il 54,7%delle rilevazioni effettuate mediante campionamento attivo e il 45,3% diquelle effettuate mediante campionamento passivo sono risultate al disotto di 180 ufc/m3 e 25 IMA raccomandati per ambienti a flusso d’ariaturbolento. È stata evidenziata una correlazione significativa tra valori di ufc/m3 e IMA (p<0,001). In nessuna sede è stata isolata Legionella spp.CONCLUSIONI: Lo studio effettuato rappresenta un utile contributo verso la standardizzazione dei metodi di rilevazione e la definizione di valori soglia. L’ampia variabilità dei dati ottenuti nelle varie sedi indica la presenza di fattori che favoriscono l’innalzamento della carica microbica; la loro identificazione consentirà l’attuazione di efficaci interventi correttivi.
2011
- La qualità microbiologica dell’acqua negli ambulatori odontoiatrici: indagine in 9 città Italiane.
[Abstract in Rivista]
Tanzi, M; Veronesi, L; Castiglia, P; Liguori, G; Montagna, Mt; Napoli, C; Rizzetto, R; Torre, I; Deriu, Mg; Strohmenger, L; Gallè, ; Tesauro, M; Colucci, Me; Righi, Elena; Bergomi, Margherita; Farruggia, P; Torregrossa, Mv; Tinteri, C; Panico, M; Pennino, F; Cannova, L; Pasquarella, C; E., Gruppo di Lavoro SItI “Igiene in Odontoiatria”
abstract
OBIETTIVI: Lo studio multicentrico sulla contaminazione microbica ambientale negli ambulatori odontoiatrici del Gruppo di Lavoro ItI “Igienein Odontoiatria” ha previsto la rilevazione della contaminazione dell’acqua del riunito odontoiatrico e del lavandino, con lo scopo di valutare i livelli di contaminazione, individuare i fattori correlati all’aumento delle cariche microbiche ed efficaci misure di prevenzione.METODI: I campionamenti sono stati effettuati nell’arco di tre mesi, unasettimana al mese, nei 5 giorni lavorativi della settimana, prima (T0),durante (T1) e al termine (T2), dell’attività. Campioni di acqua sono stati prelevati dal riunito odontoiatrico (manipoli e fontanella) e dal lavandino per valutare la carica microbica totale (CMT) e la presenza di Legionella spp. e Pseudomonas aeruginosa (cfr normativa vigente).RISULTATI: Un’ampia variabilità nella CMT è stata riscontrata nelle variesedi sia a livello del lavandino che a livello del riunito, con una riduzionesignificativa tra T0 e T1 (p<0,001). Nell’acqua prelevata dal lavandinoprima dell’inizio dell’attività i valori mediani di CMT a 22°C e a 36°C hanno oscillato in totale rispettivamente da 7 a 2.304 ufc/mL e da 3 a 1.072 ufc/mL, mentre al termine dell’attività sono risultati tra 0,40 e 1.030 ufc/mL a 22°C e tra 0,60 e 500 a 36°C. I valori massimi di CMT, sia a 22°C che a 36°C, sono stati registrati prima dell’attività: rispettivamente 51.200 ufc/mL e 23.500 ufc/mL. I campionamenti effettuati il lunedì a T0 hanno mostrato una CMT significativamente più elevata rispetto agli altri campionamenti (p<0,001). Il 33,6% dei campioni è risultato contaminato da Legionella spp, raggiungendo in una sede un valore mediano di 6.000 ufc/mL, con un massimo di 9.000 ufc/mL. P. aeruginosa è stato isolato nel 2,4% dei campioni. A livello del riunito, i valori mediani si sono abbassati, fra T0 e T1, da 2.900 ufc/mL a 730 ufc/mL per la CMT a 22°C e da 1.325 ufc/mL a 450 per quella a 36°C. In diverse sedi, più del 90% dei campioni hanno fatto registrare una CMT superiore al limite di 500 ufc/mL indicato dai CDC, e si è raggiunto un valore mediano di 300.000 ufc/mL. A livello della siringa aria/acqua è stato riscontrato il valore massimo di contaminazione: 872.000 ufc/mL. Legionella spp. e P. aeruginosa sono stati isolati rispettivamente dal 15,6% e dal 20,1% dei campioni.CONCLUSIONI: Il monitoraggio effettuato ha evidenziato situazioni molto critiche che necessitano di efficaci interventi correttivi. E’ auspicabile che questo studio non rimanga una semplice ricerca scientifica, ma rappresenti la base conoscitiva per una comune strategia verso un’attenta gestione della qualità dell’acqua negli ambulatori odontoiatrici.
2011
- Le infezioni correlate alle pratiche assistenziali nelle unità di terapia intensiva italiane: i risultati del Progetto SPIN-UTI, GISIO-SItI, dal 2006 al 2011
[Relazione in Atti di Convegno]
Agodi, A; Auxilia, F; Barchitta, M; Brusaferro, S; D’Alessandro, D; Montagna, Mt; Pasquarella, C; Righi, Elena; Tardivo, S; Torregrossa, V; Mura, I; Gisio, Siti
abstract
La rete SPIN-UTI (Sorveglianza Prospettica Infezioni Nosocomiali in Unità di Terapia Intensiva) è partner del progetto europeo BURDEN (WP6, HELICS-ICU) dal 2005 e i risultati sono stati inclusi nei report annuali dell’ECDC (2008, 2009 e 2010). Dal 2010, la rete SPIN-UTI partecipa al progetto SITIN del CCM, per la costituzione di un archivio nazionale. Gli obiettivi principali della sorveglianza di livello 2 sono di confrontare i tassi di infezione aggiustati per rischio rilevati nelle tre edizioni del progetto SPIN-UTI, e di valutarne i trend temporali e l’impatto clinico. La metodologia adottata, basata sul protocollo HELICS-ICU, è stata rispettivamente condotta da 49, 28 e 27 UTI, nella prima, seconda e terza edizione, dal 2006 al 2011. La prevenzione delle ICPA necessita di essere ribadita a livello internazionale e nazionale quale priorità per la ricerca in Sanità Pubblica con il disegno, la gestione e la valutazione d’efficacia di appropriate strategie di intervento.
2011
- NITROGEN TRICHLORIDE (NCl3) DETERMINATION IN INDOOR SWIMMING POOLS: PROPOSAL FOR A NEW METHOD.
[Relazione in Atti di Convegno]
Predieri, Guerrino; Giacobazzi, Pierluigi; Fantuzzi, Guglielmina; Righi, Elena; Aggazzotti, Gabriella
abstract
It is well known that water disinfection treatments in indoor swimming pools generate a mixture of potentially harmful disinfection by-products (DBPs). Among them, nitrogen trichloride (NCl3), a powerful irritant, has been linked with respiratory symptoms and asthma in swimmers, mainly in children, and in occupationally exposed subjects. Accurate NCl3 exposure assessment in indoor swimming pools is difficult, because NCl3 presence in air is influenced by different factors, including the pool water quality and the number of swimmers in the pool. Moreover, the analytical method usually adopted for the determination of NCl3 in air samples shows some problems such as the use of particular filters for the air sampling procedures and the expansive instrumental equipments for the laboratory quantification of this volatile DBPs. The aim of this study was to identify a new analytical method for NCl3 air determination that could be used directly in swimming pool facilities for the human exposure assessment procedures. This new protocol is based on a colorimetric reaction commonly employed to detect the total and free chlorine levels in water. Particularly, it allows the entrapment of NCl3 in air into a water solution containing diethyl-p-phenylenediamine (DPD 1) and Potassium Iodide (DPD 3). Therefore, NCl3 from the air environment reacts with DPD 3 realising iodine, which reacts with DPD 1 and produces a pink colour. The intensity of the colour is proportional to the amount of NCl3 from the sampled indoor swimming pool air, and can be easily measured using a portable photometer for DPD analyses.The proposed method has been validated in terms of linearity, limit of detection (LOD) and repeatability. We tested the linearity by creating an artificial swimming pool environments under a closed chemical safety cabinet, and reading solutions of NCl3 in air sampling deriving from standards in water at different concentrations (5, 10, 20 mg/l of NCl3 standards). The actual concentration of NCl3 in the water was verified by adopting the same DPD method used in the real swimming pools. This linearity test was repeated three times and showed R2 values of: 0.996; 0.998 and 0.996. The LOD was measured either as standard deviation, which according to the instrument sensitivity and liters of air sampled, has values of 3.6 and 8.5 mg/l respectively. The repeatability showed a coefficient of variation (CV%) equal to 1.7%. The proposed method which is patent pending, is a method that does not use toxic substances, is easy to use, efficient and economical and gives good results in terms of linearity and repeatability.
2011
- Occurrence of Disinfection By products (DBPs) in drinking water in different Italian northern regions
[Abstract in Rivista]
Righi, Elena; Giacobazzi, Pierluigi; Predieri, Guerrino; Mastroianni, Katia; Rantakokko, P; Del Bianco, F; Sesana, G; Tortrici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Background/Aims: Drinking water chlorination treatments produce different Disinfection By Products (DBPs) as a consequence of the reaction between chlorine in water and natural organic matter. This study is part of the international project HiWATE (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water) funded by the EU Sixth Framework Programme (FP6). The aim was to investigate the presence of DBPs in drinking water in different northern regions in Italy, where groundwater with low organic matter is generally supplied and where the use of chlorine dioxide as chlorination treatment is widespread.Methods: Bromate, chlorite, chlorate, haloacetic acids (HAAs) and 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and trihalomethanes (THMs) levels were investigated in drinking water samples collected form 12 waterworks located in Emilia Romagna, Friuli Venezia Giulia and Lombardia Regions. To investigate seasonal variability, water samples were collected over four seasons from 2007 to 2008.Results: MX and HAAs were never detected (detection limit: 0.5ng/l and 1μg/l, respectively). THMs were always found at very low concentrations regardless of the disinfection treatment (mean: 2.04μg/l, maximum value: 26.9μg/l). Bromate was detected only in 1 waterworks in which disinfection was performed by ozone and chloride dioxide (range 2-14μg/l). Chlorite was found only in chlorine dioxide disinfected drinking water (4 waterworks; mean value: 136μg/l; range:28-523μg/l), while chlorate resulted the most widespread DBP (>85% of the samples), with concentrations ranging from 1μg/l to 399μg/l. No consistent general trends were observed, in terms of DBPs seasonal variations, in the investigated Italian drinking waters.Conclusion: DBPs levels in Italian drinking water appear generally low, however individual DBPs and levels vary according to the different disinfection treatments: when chlorine dioxide is applied as disinfection method high values of chlorite and chlorate could have been detected. Due to their potential health effects, the presence of chlorite and chlorate in drinking water deserve further investigation.
2011
- Outbreak of Burkholderia cepacia in an intensive care unit: temporal trend, clinical characteristics and outcomes of patients
[Abstract in Rivista]
Righi, Elena; Aggazzotti, Gabriella; Borsari, Lucia; Fantuzzi, A.; Ferrari, E.; Vecchi, E.; Venturelli, C.; Marchegiano, P.; Girardis, Massimo; Centetti, S.
abstract
Burkholderia cepacia, an environmental microorganism which can be an opportunistic pathogen in patients with cystic fibrosis, is emerging as a causative agent of nosocomial outbreaks involving bloodstream,respiratory tract, and urinary tract infections in intensive care unit (ICU) settings. An outbreak of B.cepacia has recently occurred in ICU at the teaching hospital in Modena (northern Italy). A sudden increaseof B. cepacia positive cultures has been highlighted thank to the alert organisms laboratory surveillance activities routinely performed at the structure. The outbreak lasted 18 months and involved 46 patients(25 males and 21 females, mean age 63±18years): 63% of the subjects were colonized and 37% developed an infection (respiratory tract infection). The analysis of spatial and temporal trends of cases together with different environmental investigations and the genotyping of the isolated microorganisms allowed to identify and to remove the source of the outbreak, a contaminated mouthwash for oral hygiene of patients, determining the rapid resolution of the outbreak. A descriptive epidemiological survey of cases has been performed as well, in order to investigate the relationship between host, pathogen and environment and to identify potential predictors to clinical response. Characteristics of infected and colonized patients were compared: no significant differences were found as thetwo groups showed very really similar demographic and clinical conditions and outcomes (mortality rate: 50% in both groups). Severity of the underlying disease resulted the main factor influencing mortality risk, however it did not appear to be related to thecolonized or infected status of patients.
2011
- PREVENZIONE LESIONI DA DECUBITO E DELLE INFEZIONI CORRELATE PRESSO L’A.O.U. POLICLINICO DI MODENA
[Abstract in Rivista]
Righi, Elena; Morandi, Matteo; Barbieri, M; Mantovani, M; Vecchi, E; Marchegiano, P; Floramo, Maria; Aggazzotti, Gabriella
abstract
Le lesioni da decubito (LDD) costituiscono un importante problema assistenziale in grado di peggiorare la qualità delle prestazioni erogate favorendo, tra l’altro, l’insorgenza di infezioni. In questo studio vengono a confrontati i risultati di tre indagini sulla prevalenza di LDD e sulla applicazione delle misure di prevenzione/gestione condotte a febbraio 2007, novembre 2007 e febbraio/marzo 2009 in 7 Strutture complesse (SC) ad alto/medio rischio dell’Azienda Ospedaliero-Universitaria (AOU) Policlinico di Modena. I dati sono stati raccolti in giornate prestabilite su tutti i pazienti ricoverati. Per la stratificazione del rischio è stato impiegato l’indice di Braden (iB). Nelle tre indagini sono stati valutati rispettivamente 205, 185 e 187 pazienti; le caratteristiche socio-demografiche e la distribuzione nei reparti dei soggetti arruolati sono risultate simili nelle 3 rilevazioni. Nell’ultima indagine sono risultati tuttavia più numerosi i soggetti ad elevato rischio di LDD (iB≤16 38% contro 31% -novembre 2007 e 29% -febbraio 2007), nonostante questo la prevalenza di LDD nel 2009 (15,5%) è risultata inferiore rispetto a quelle rilevate a novembre 2007 (17,3%) e a febbraio 2007 (16,1%). I soggetti con LDD nel 2009 sono più anziani, hanno una degenza più lunga e un iB inferiore rispetto a quanto osservato nelle indagini precedenti. Decisamente inferiore risulta la proporzione di LDD insorte durante il ricovero nei soggetti privi di lesioni all’ingresso nel 2009 (10% dei soggetti rispetto al 16,2% osservato nel novembre 2007 e al 17,5% del febbraio 2007). L’utilizzo dei presidi di prevenzione appare significativamente aumentato, così come risultano più appropriati i trattamenti offerti ai soggetti con LDD. In conclusione, le attività di prevenzione adottate nel corso degli ultimi anni si sono dimostrate efficaci nel ridurre il rischio di sviluppare LDD durante il ricovero diminuendo anche il rischio potenziale di infezioni correlate all’assistenza di soggetti spesso lungodegenti e caratterizzati da scarsa mobilità, incontinenza e ridotte capacita sensoriali.
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
abstract
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.
2010
- "Impinger Method": un nuovo metodo per la determinazione dei livelli di tricloroammina nell'aria delle piscine coperte
[Abstract in Rivista]
Mastroianni, Katia; Predieri, Guerrino; Giacobazzi, Pierluigi; Righi, Elena; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Obiettivi. La triclorammina è un composto altamente irritante per le mucose dell’apparato respiratorio ed oculare la cui presenza nell’aria di piscina viene associata agli episodi asmatici segnalati nei nuotatori, soprattutto bambini, e nei soggetti che svolgono attività lavorativa in questi ambienti. Il metodo attualmente utilizzato per la determinazione di questo composto prevede il passaggio dell’aria attraverso specifici filtri contenenti triossido di arsenico, composto dotato di elevata tossicità, e una successiva determinazione analitica mediante cromatografia ionica. Scopo di questa sperimentazione è stato quello di identificare un nuovo metodo analitico per la determinazione della triclorammina nell’aria di piscina che potesse essere utilizzato direttamente in situ.Materiali e metodi. Il metodo analitico proposto, denominato “Impinger Method” (IM) e attualmente sottoposto a brevettazione, prevede la captazione per gorgogliamento della triclorammina dall’aria di piscina in una soluzione acquosa contenente gli stessi reattivi (Dietil-Parafenilen Diammina (DPD1) e Potassio Ioduro (DPD3) utilizzati per la determinazione dei livelli di cloro libero e combinato nell’acqua di piscina. La triclorammina solubilizzata reagisce con il DPD3 rilasciando iodio, che reagendo con il DPD1 produce una soluzione di colore rosa di intensità proporzionale alla concentrazione di triclorammina nell’aria. La valutazione quantitativa di triclorammina viene condotta per via colorimetrica direttamente in piscina. Risultati. L’IM è stato applicato per la misurazione dei livelli di triclorammina in 17 piscine comunali coperte distribuite nella regione Emilia Romagna, ed è stato validato in termini di linearità, limite di detection (LOD) e ripetibilità. Il valore medio di triclorammina nell’aria di piscina è risultato di 637 ± 220 μg/l (range: 204-1020 μg/l). Il test di linearità ha presentato un valore di R2 uguale a 0,996. Il LOD è stato misurato sia come deviazione standard, che in funzione alla sensibilità strumentale e dei litri di aria campionati, presenta valori di 3,6 e 8,5 μg/l rispettivamente. La ripetibilità ha mostrato un coefficiente di variazione (CV) pari ad 1,7%.Conclusioni: L’IM è un metodo che non utilizza sostanze tossiche, facile da utilizzare, efficiente ed economico. I risultati ottenuti utilizzando questo metodo sono sovrapponibili a quelli ottenuti in altri studi che utilizzano metodi diversi per la quantificazione di triclorammina nell’aria di piscina. Il nuovo metodo ha dato buoni risultati anche in termini di linearità e ripetibilità.
2010
- Aspetti igienico-ambientali di un campione di piscine coperte della Regione Emilia Romagna: valutazione delle condizioni microclimatiche, di alcuni parametri chimici delle acque con particolare riferimento alla presenza di sottoprodotti della disinfezione.
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; Mastroianni, Katia; Aggazzotti, Gabriella
abstract
Nella presente indagine sono stati valutati i principali requisiti igienico-ambientali di un campione di impianti natatori della regione Emilia Romagna. Sono state raccolte informazioni sulle caratteristiche microclimatiche delle piscine e sulle condizioni di comfort/discomfort termico dei soggetti che vi lavorano. Sono stati valutati, inoltre, alcuni parametri fisico-chimici delle acque in vasca, unitamente ai principali sottoprodotti della disinfezione (DBPs), quali i trialometani (THMs), gli acidi aloacetici (HAAs), i cloriti, clorati e bromati. Dai risultati dello studio emerge che i requisiti igienico-ambientali previsti dalla normativa italiana (Accordo Stato- Regioni del 2003) vengono complessivamente soddisfatti anche se in alcuni impianti natatori sono state rilevate concentrazioni di cloro attivo combinato superiori ai limiti previsti. L’analisi dei parametri microclimatici ed il calcolo degli indici di comfort termico (Predicted Mean Vote - PMV e Predicted Percentage of Dissatisfied - PPD%) descrivono gli impianti natatori esaminati come ambienti lavorativi termicamente accettabili. Fra i DBPs, le concentrazioni medie di THMs (41,4 ± 30,0 µg/l), prossime ai limiti della normativa sulle acque potabili, non sembrano di rilievo sanitario, mentre i valori di clorati rilevati nelle acque in vasca (range: 5 – 19537 µg/l) costituiscono un interessante motivo di approfondimento in quanto recenti studi epidemiologici, condotti per lo più nelle acque potabili, hanno ipotizzato un loro coinvolgimento nei processi ossidativi a livello cellulare ed un eventuale effetto genotossico.
2010
- Colorectal cancer and disinfection by-products in Italy and Spain.
[Abstract in Rivista]
Bosetti, C; Villanueva, Cm; Righi, Elena; Moreno, V; Aggazzotti, Gabriella; Castaño Vinyals, G; Carrasco, G; Tavani, A; Bustamante, M; Talamini, R; Pisa, F; Rantakokko, P; Kogevinas, M; Nieuwenhuijsen, M; La Vecchia, C.
abstract
Introduction: Experimental data suggest that disinfection by-products (DBPs) are possible colorectal carcinogens, but epidemiological evidence is inconclusive. Objectives: To evaluate colorectal cancer risk in relation to long-term DBP exposure. Methods: A case-control study is ongoing in the greater Milan area and the provinces of Pordenone and Udine, Italy, and the metropolitan area of Barcelona, Spain. Cases are incident, histollogically confirmed colon and rectal patients, aged 20-85 years and resident in the study areas. Controls are hospital-based (Italy) or population-based patients (Spain) matched to cases by age and sex. Besides data on known or potential risk factors of colorectal cancer, information is collected on residential and water source history, water consumption and use, including ingestion, showering, bathing, dishwashing and swimming pool attendance. Retrospective data on DPB (mainly trihalomethane, THM) levels in the study areas is collected through local water companies. Results: Based on 400 cases and 363 controls from Italy, and 500 cases and 436 controls from Spain, 46% of Italian subjects and 56% of Spanish subjects drunk water from public water at the longest residence (mean duration 37 years in Italy and 35 years in Spain); the remaining consumed water from bottles or other sources. The multivariate odds ratio (OR) for subjects drinking water from public supplies as compared to those drinking bottled water was 1.17 (95% confidence interval, CI, 0.87-1.58) in Italy and 1.18 (95% CI, 0.79-1.77) in Spain. Taking long compared to short shower yield an OR of 1.16 (95% CI, 0.83-1.63) in Italy and of 1.04 (95% CI, 0.80-1.40) in Spain. Mean THM levels in Italy were <10 ug/l, and ranged between 17.6 and 134 ug/l in Spain. No clear dose-risk relations between residential THM exposure and colorectal cancer risk were observed. Conclusions: Preliminary results suggest a weak – if any – association between colorectal cancer and DBPs.
2010
- Conoscenza degli studenti di medicina e scienze infermieristiche sulle infezioni correlate alle pratiche assistenziali. Risultati di uno studio multicentrico del GISIO
[Abstract in Rivista]
Auxillia, F; D'Alessandro, D; Calligaris, L; Colosi, A; Ferrante, M; Montagna, Mt; Mura, I; Pasquarella, C; Pippia, V; Righi, Elena; Tardivo S., et GISIO
abstract
Il lavoro riporta i risultati di uno studio di prevalenza condotto in 10 università italiane e mirato a valutare il grado di conoscenza degli studenti di medicina e di scienze infermieristiche delle modalità di prevenzione delle infezioni correlate alle pratiche assistenziali
2010
- EPIDEMIA DA INFEZIONE DI BURKHOLDERIA CEPACIA IN TERAPIA INTENSIVA: SORVEGLIANZA E CONTROLLO
[Abstract in Rivista]
Borsari, Lucia; Righi, Elena; Aggazzotti, Gabriella; Fantuzzi, A; Ferrari, Elena; Vecchi, E; Venturelli, C; Marchigiano, P; Girardis, Massimo
abstract
Obiettivo: Burkholdera cepacia, microrganismo conosciuto soprattutto per la sua patogenicità in soggetti con fibrosi cistica, negli ultimi anni sta sempre più emergendo come causa di importanti epidemie in ambito ospedaliero. In questo studio viene descritto un caso di epidemia da B. cepacia verificatosi nell’unità di terapia intensiva dell’Azienda Ospedaliero Universitaria Policlinico di Modena e vengono prese in analisi le misure adottate per il controllo dell’epidemia stessa.Metodi: Tutti i pazienti ricoverati in terapia intensiva da gennaio 2005 ad aprile 2006 con almeno un riscontro positivo per B. cepacia sono stati inclusi nell’analisi descrittiva. Le misure di controllo adottate e le indagini di laboratorio e ambientali eseguite al fine di identificare la fonte d’infezione sono state poi esaminate e descritte.Risultati: Grazie al sistema di segnalazione di eventi sentinella attivo nella struttura all’inizio del 2005 è stato evidenziato un improvviso aumento degli isolamenti di B. cepacia in terapia intensiva. Tra il 2005 e il 2006 sono stati identificati in totale 46 casi, di cui 63% colonizzazioni e 37% infezioni, soprattutto polmonari. I microrganismi isolati in diversi materiali biologici sono risultati sensibili a piperacillina e sulfametoxazolo/trimetropin. Per contenere la diffusione sono state adottate immediatamente diverse misure di controllo quali l’isolamento dei casi e la stretta osservanza delle misure di asepsi e del lavaggio delle mani. Le indagini ambientali sono state numerose e hanno permesso di evidenziare la presenza di B. cepacia in acqua deionizzata utilizzata dalla farmacia ospedaliera per la preparazione di un collutorio impiegato di routine per le procedure di igiene orale. Rimossa la fonte di trasmissione e grazie alle misure specifiche di controllo messe in atto, l’epidemia è stata risolta completamente.Conclusioni: L’inclusione di B. cepacia tra i patogeni ‘sentinella’ monitorati routinariamente presso il Policlinico di Modena ha permesso di identificare rapidamente un’epidemia dovuta a un patogeno che nella maggior parte dei casi non da sintomi d’infezione. E’ stato quindi possibile adottare rapidamente misure di controllo appropriate, identificare la fonte di trasmissione e ridurre in modo significativo l’impatto dell’infezione. Questo microrganismo, solitamente non presente in modo endemico nei reparti, viene considerato un tracciante dell’andamento generale del rischio infettivo nosocomiale: la sua identificazione ha permesso di riconoscere e modificare pratiche assistenziali non completamente corrette al fine di migliorare sempre più la qualità dell’assistenza erogata.
2010
- Effects of selective decontamination of the digestive tract on Acinetobacter baumanii related ventilation acquired pneumonia: preliminary data
[Abstract in Rivista]
Ferrari, E; Serio, L; Venturelli, C; Codeluppi, M; Righi, Elena; Mussini, Cristina; Marchegiano, P; Bosi, I; Girardis, Massimo
abstract
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2010
- Epidemiologia ambientale: attualità e prospettive
[Capitolo/Saggio]
Vinceti, Marco; Righi, Elena; Malagoli, Carlotta; Fantuzzi, Guglielmina
abstract
Le tematiche prese in esame dall’epidemiologia ambientale appaiono oggi sempre più rilevanti e nello stesso tempo più complesse rispetto al passato, ponendo ai ricercatori sfide particolarmente impegnative. L’attenzione posta dall’opinione pubblica e dalle istituzioni politico-amministrative nei confronti dei determinanti ambientali di rischio è molto elevata, si pensi a tematiche come il rischio sanitario di insediamenti industriali, l’inquinamento da traffico, i rischi legati ai campi elettromagnetici, la pericolosità di pesticidi, contaminanti organici clorurati e metalli pesanti. Quindi sempre maggior impegno dovrebbe essere posto dai ricercatori sia nel condurre studi sulle problematiche dell’epidemiologia ambientale sia nel contribuire ad una definizione più chiara del suo ambito di competenza affinchè si possa anche rafforzarne il ruolo nei suoi aspetti formativi e metodologici all’interno dei curricula di corsi di laurea, scuole di specializzazione, dottorati di ricerca e master.
2010
- Esposizione a sottoprodotti della disinfezione delle acque potabili durante la gravidanza e anomalie congenite: risultati di uno studio di caso-controllo condotto nella Regione di Emilia-Romagna
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Studi tossicologici ed epidemiologici suggeriscono come l’esposizione durante la gravidanza a sottoprodotti della disinfezione nelle acque potabili (DBPs), principalmente Trialometani (THMs), possa aumentare il rischio di malformazioni congenite; tuttavia tale evidenza non è conclusiva. Questo studio, parte del programma di ricerca “Hiwate” (VI Programma Quadro UE), ha avuto l'obiettivo di indagare questa associazione in un'area dove diversi disinfettanti sono utilizzati e dove differenti categorie di DBPs possono essere presenti nelle acque.
2010
- Esposizione a sottoprodotti di disinfezione delle acque potabili durante la gravidanza e anomalie congenite: risultati di uno studio di caso-controllo condotto nella Regione di Emilia-Romagna
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Studi tossicologici ed epidemiologici suggeriscono che l’esposizione durante la gravidanza a sottoprodotti della disinfezione nelle acque potabili (DBPs), principalmente Trialometani (THMs), può aumentare il rischio di malformazioni congenite; tuttavia tale evidenza non è conclusiva. Questo studio, parte del programma di ricerca “Hiwate” (VI Programma Quadro UE), ha mirato a indagare questa associazione in un'area dove diversi disinfettanti sono utilizzati e dove differenti categorie di DBPs possono essere presenti nelle acque.Uno studio caso-controllo basato su dati di registro è stato condotto in Emilia-Romagna. Tutti i casi di anomalie cromosomiche e congenite (difetti del tubo neurale, del sistema cardiovascolare, della parete addominale, delle labbra e del palato, dell’apparato respiratorio e urogenitale), verificatisi nel periodo 2002-05, sono stati estratti dal Registro regionale delle malformazioni (Registro IMER). 4 controlli (neonati senza malformazioni) sono stati selezionati con modalità random dal Registro regionale delle nascite (CedAP) e appaiati ai casi in base al periodo di gravidanza. L’impianto che forniva l’acqua potabile durante il primo trimestre di gravidanza è stato identificato in base alla residenza della madre e le concentrazioni di DBPs (THM singoli e totali, clorito e clorato) e le principali informazioni tecniche e strutturali sono state estratte. In totale, 1242 casi e 4984 controlli sono stati arruolati.Complessivamente, i livelli di THMs sono risultati bassi (media:3,8±3,6μg/l) e nessun eccesso di rischio di malformazioni è stato osservato. I valori di clorito e di clorato sono apparsi al contrario più elevati (media:427±18μg/l e 283±78μg/l, rispettivamente). Dopo aver aggiustato per potenziali fattori confondenti (età, storia riproduttiva e caratteristiche socio-economiche), le donne esposte a concentrazioni di clorito >700μg/l hanno presentato, rispetto a quelle esposte a <200µg/l, un rischio più alto di neonati con anomalie renali (OR:3,3;IC95%:1,4-8,1), difetti della parete addominale (OR:6,9;IC95%:1,7-28), palatoschisi (OR:4,1;IC95%:0,98-16,8); mentre le donne con livelli di clorato >200µg/l sono risultate ad elevato rischio di neonati con difetti urinari ostruttivi (OR:2,9;IC95%:1,1-7,6) e spina bifida (OR:4,94;IC95%:1,1-22).Questo è stato il primo studio epidemiologico a valutare la relazione tra malformazioni e la contemporanea esposizione a diversi DBPs: un aumento significativo del rischio di anomalie, in particolare per l'apparato urinario, è stato osservato in relazione all’esposizione a clorito e clorato, i principali DBPs presenti nelle acque quando biossido di cloro viene utilizzato per la disinfezione.
2010
- Esposizione attraverso l’acqua potabile a cloriti e clorati durante la gravidanza e rischio di anomalie congenite
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Dati sperimentali suggeriscono che l’esposizione a cloriti e clorati, principali sottoprodotti della disinfezione delle acque (DBP) in presenza di biossido di cloro, può essere associata a tossicità embrionale. Tuttavia, nessuna evidenza epidemiologica è ad oggi disponibile. Questa indagine, parte di "HiWate", progetto finanziato dalla Comunità Europea (VI Programma Quadro), ha avuto lo scopo di valutare il rischio di malformazioni in relazione all’esposizione a cloriti/clorati in gravidanza. Tutti i casi di anomalie cromosomiche o congenite rilevati in Emilia Romagna negli anni 2002-2005 sono stati estratti dal Registro Regionale delle malformazioni. Controlli, neonati senza malformazioni, sono stati selezionati casualmente dal Registro regionale delle nascite. Sulla base dell’indirizzo delle madri durante il primo trimestre di gravidanza sono state identificate le reti idriche attive e ad ogni madre sono state associate informazioni sul tipo di disinfezione e sui livelli di DBP.Dati su cloriti erano disponibili per 5.494 soggetti (media:427±18μg/l); su clorati per 1178 donne (media:283±78μg/l). Donne con livelli di cloriti >700μg/l appaiono a rischio più elevato di neonati con anomalie renali (OR:3.3;IC95%:1.4-8.1), della parete addominale (OR:6.9;IC95%:1.7-28), palatoschisi (OR:4.1;IC95%:0.98-16.8); mentre donne esposte a clorati >200μg/l hanno un rischio più alto di neonati con difetti obstruttivi urinari (OR:2.9;IC95%:1.1-7.6) e spina bifida (OR:4.94; IC95%:1.1-22).Questo è il primo studio epidemiologico condotto con l’obiettivo di valutare la relazione tra esposizione a cloriti e clorati e anomalie congenite. Nonostante le difficoltà nella valutazione dell'esposizione ambientale, un aumento significativo del rischio di malformazione è stato osservato, principalmente per i difetti a carico dell’apparato urinario, all’aumentare dell’esposizione sia a cloriti che a clorati. Questi risultati suggeriscono la necessità di ulteriori indagini.
2010
- Exposure to Disinfection By-Products in drinking water during pregnancy and congenital anomalies - a case-control study in the Emilia-Romagna Region (Northern Italy)
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Introduction: Epidemiological and toxicological studies suggest that exposure during pregnancy to various Disinfection by-products (DBPs), mainly Trihalomethanes (THMs), can increase the risk of congenital malformations (CA), however evidence is not conclusive. This study aimed at investigating the association between CA and different DBPs in an area, where various disinfectants are used. Methods: A register based case-control study was carried out in Emilia-Romagna region. Data on chromosomal anomalies and different CA (neural tube, cardiovascular, abdominal wall, cleft lip and palate, respiratory, genital and urinary tract defects) occurred in the period 2002-2005 were extracted from the Regional Malformation Registry. 4 Controls (newborns without malformations) were randomly selected form the Regional Birth Register and frequency matched to cases according to pregnancy period. The network supplying drinking water during the first trimester of pregnancy was identified on the basis of mother’s address: DBPs data, technical and structural information were linked to each subject. Results: Overall, THMs levels were very low (3.8±3.6μg/l), and no risk excess was observed. Chlorite and chlorate values were fairly high, (427±184μg/l and 283±78μg/l, respectively). In comparison to those exposed to levels 700µg/l were, after adjusting for personal, reproductive and socio-economical confounders, at higher risk of newborns with renal defects (OR:3.3;95%IC:1.4-8.1), abdominal wall defects (OR:6.9; 95%IC:1.7-28), cleft palate (OR:4.1; 95%IC:0.98-16.8); while women with chlorate level >200µg/l were at higher risk of newborns with obstructive urinary defects (OR:2.9; 95%IC:1.1-7.6), spina bifida (OR:4.94; 95%IC:1.1-22). Conclusions: This was the first study evaluating the relationship between CA and both THMs and chlorite/chlorate exposure: significant increased risks were observed, mainly for urinary tract defects, when chlorite and chlorate exposure occurred.
2010
- HiWATE (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water): caratterizzazione dei sottoprodotti della disinfezione (Disinfection By-Products - DBPs) nelle acque potabili di 12 reti idriche del Nord Italia
[Abstract in Rivista]
Righi, Elena; Giacobazzi, Pierluigi; Predieri, Guerrino; Mastroianni, Katia; Rantakokko, P; Del Bianco, F; Sesana, G; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Nell’ambito del progetto europeo HiWATE (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water) sono state esaminate le acque potabili distribuite in alcune reti idriche del Nord Italia con lo scopo di valutare la formazione di DBPs in acque caratterizzate da una ridotta presenza di sostanze organiche in origine. Sono stati ricercati bromati, cloriti, clorati, acidi aloacetici (cloroacetici, bromoacetici e clorobromoacetici), 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) e trialometani (THMs) in campioni di acque potabili raccolti da 12 reti idriche in Emilia Romagna, Friuli Venezia Giulia and Lombardia. Per indagare l’eventuale influenza delle stagioni, sono stati effettuati prelievi di acqua nelle quattro differenti stagioni nel periodo 2007-2008 MX e acidi aloacetici non sono mai stati rilevati. THMs sono stati ritrovati in tutti i campioni di acque esaminate a concentrazioni ridotte indipendentemente dal tipo di trattamento utilizzato per la disinfezione (valore max: 27µg/l). Il bromato è stato rilevato in una sola rete idrica (range 2-14µg/l) in cui la disinfezione è attuata con sistema misto (ozono - biossido di cloro).I cloriti sono stati rilevati nelle acque delle 4 reti che disinfettano con biossido di cloro (range: 28-523µg/l), mentre i clorati sono rilevati nella maggior parte dei campioni di acqua analizzati (>85% dei campioni) a concentrazioni variabili da 1µg/l a 399µg/l. Non è stato osservato alcun trend in relazione alla stagionalità.Le concentrazioni di DBPs nelle acque esaminate appaiono generalmente basse anche se variabili a seconda del tipo di trattamento di disinfezione utilizzato. Nelle reti idriche che utilizzano biossido di cloro per la disinfezione delle acque sono state rilevati frequentemente cloriti e clorati. Degno di nota è la diffusione dello ione clorato, un potenziale endocrine disruptor, interferente con il metabolismo dello iodio, non ancora regolamentato dalla normativa italiana.
2010
- Igiene epidemiologia e sanità pubblica
[Curatela]
S., Capolongo; E., Colzani; Limina, R. M.; C., Pasquarella; M., Riccò; Righi, Elena; L., Veronesi; Vinceti, Marco
abstract
Il volume è indicato per gli studenti di tutti i corsi di laurea dove vengono insegnate le materie igienistiche e per gli operatori sanitari che vi troveranno informazioni aggiornate sulle principali tematiche della sanità pubblica, novità normative e nuovi argomenti di crescente interesse per la comunità scientifica degli igienisti.
2010
- Kowledge of healthcare students about prevention of nosocomial infection and standard precaution in Italy
[Abstract in Rivista]
F., Auxilia; D., D'Alessandro; L., Calligaris; A., Colosi; M., Ferrante; M. T., Montagna; I., Mura; C., Pasquarella; V., Pippia; Righi, Elena; A., Rossini; S., Tardivo
abstract
Objective: To evaluate the knowledge of healthcare students fromMedicine and Nursing School on infection control.Methods: To measure students’ knowledge of infection across-sectional study was performed using a 6 multiple-choicequestionnaire, regarding 3 specific areas: standard precautions(SP), hand hygiene (HH) and nosocomial infection (NI). The overallperfect score was 25, obtained adding 12 (SP) + 8 (HH) + 5 (NI).The cut off was a score of 17.5. Data were collected in 10 Schoolof Medicine and Nursing, coming from all part of Italy. T test wasused to compare score.Results: 1569 students (629 medical students and 940 nursingstudents) were included in the study. The mean overall score(±SD) was 18.00±3.29. Nursing student had a better mean overallscore (18.5±3.01) than medical students (17.3±3.53) and thedifference was at a significant level (p < 0.001). The same significantdifference was observed stratifying results by investigated area:for SP 10.36±1.94 vs. 10.0±2.24; for HH 4.63±1.10 vs. 4.12±1.22;NI 2.89±1.03 vs. 2.73±1.26.Conclusion: As already observed in other studies, the instructionlevel was effective (18/25); however, knowledge levels weredifferent by area and curriculum.
2010
- Prevalence of Ocular, Respiratory and Cutaneous Symptoms inIndoor Swimming Pool Workers and Exposure to DisinfectionBy-Products (DBPs)
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; Mastroianni, Katia; Aggazzotti, Gabriella
abstract
The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptomsand occupational exposure to disinfection by-products (DBPs). Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 133 employees was collected using a self-administered questionnaire. Subjects working at swimming pools claimed to frequently experience the following symptoms: cold (65.4%), sneezing (52.6%), red eyes (48.9%) and itchy eyes (44.4%).Only 7.5% claimed to suffer from asthma. Red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants experienced generally more verrucas, mycosis, eczema and rash than others workers; however, only the difference in the frequency of self-declared mycosis wasstatistically significant (p = 0.010). Exposure to DBPs was evaluated using both environmental and biological monitoring. Trihalomethanes (THMs), the main DBPs, were evaluated in alveolar air samples collected from subjects. Swimming pool workers experienced different THM exposure levels: lifeguards and trainers showed the highest mean values of THMs in alveolar air samples (28.5 ± 20.2 µg/m3), while subjects workingin cafe areas (17.6 ± 12.1 µg/m3), offices (14.4 ± 12.0 µg/m3) and engine rooms (13.6 ± 4.4 µg/m3) showed lower exposure levels. Employees with THM alveolar air values higher than 21 µg/m3 (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6–14.9), itchy eyes (OR 3.5; 95% CI 1.5–8.0), dyspnea/asthma (OR 5.1; 95% CI 1.0–27.2) and blocked nose (OR 2.2; 95% CI 1.0–4.7) than subjects with less exposure.This study confirms that lifeguards and trainers are more at risk for respiratory and ocular irritative symptoms and cutaneous diseases than subjects with other occupations at swimming pool facilities.
2010
- Sottoprodotti emergenti della disinfezione delle acque (EDBPs): i clorati nelle acque potabili e nelle acque di piscina
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Mastroianni, Katia; Predieri, Guerrino; Giacobazzi, Pierluigi; Righi, Elena
abstract
Obiettivo. Sono definiti Sottoprodotti Emergenti della Disinfezione delle acque (EDBPs) quei sottoprodotti non ancora regolamentati dalle principali organizzazioni internazionali. Nonostante siano stati evidenziati in letteratura oltre 600 composti chimici che rientrano in questa definizione, solo una piccola parte di questi è stata valutata ai fini di un possibile danno sulla salute dell’uomo. Appartengono a questa categoria di composti i clorati, sottoprodotti che si formano nelle acque dalla decomposizione del biossido di cloro o dalla produzione e stoccaggio dell’ipoclorito. Decisamente limitate sono le informazioni relative a possibili danni sulla salute anche se alcuni studi di tossicità cronica sembrano evidenziare una possibile azione tossica/cancerogena sull’apparato tiroideo. Obiettivo di questa indagine è stata quella di valutare la presenza di questi composti nelle acque destinate al consumo umano e nelle acque di piscina al fine di valutare una eventuale esposizione per la popolazione di riferimento.Metodi. I clorati sono stati ricercati in campioni di acque potabili raccolti da 12 reti idriche in Emilia Romagna, Friuli Venezia Giulia e Lombardia, nell’ambito del progetto finanziato dalla Comunità Europea chiamato HiWATE (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water), ed in acque di 20 piscine coperte della Regione Emilia Romagna. I campioni di acqua potabile e di piscina sono stati raccolti nel periodo 2007-2009 e la determinazione analitica è stata condotta mediante cromatografia ionica/spettrometria di massa.Risultati. I clorati sono risultati dosabili nel 97% dei campioni di acqua esaminati e le concentrazioni sono risultate comprese tra 2 e 399 µg/l con differenze significative in relazione al tipo di disinfettante utilizzato (p< 0.001). Le concentrazioni di clorato più elevate sono state ritrovate nelle reti idriche che utilizzano una disinfezione mista biossido di cloro/ozono (206±106 µg/l) mentre nelle reti che utilizzano solo biossido o solo ipoclorito le concentrazioni sono risultate decisamente ridotte (18±7 µg/l e 18±16 µg/l, rispettivamente). Valori più elevati sono stati ritrovati nelle acque di piscina dove le concentrazioni di clorato sono risultate comprese tra 5 e 19537 µg/l.Conclusioni. L’elevata frequenza di clorati nelle acque potabili e le elevate concentrazioni osservate nelle acque di piscina costituiscono a nostro avviso un interessante motivo di approfondimento, in quanto recenti studi epidemiologici, condotti per lo più sulle acque potabili, hanno ipotizzato un coinvolgimento di questi composti nei processi ossidativi a livello cellulare ed un eventuale effetto genotossico.
2010
- Studio caso-controllo sull’esposizione a trialometani durante al gravidanza e rischio di anomalie congenite nella regione Emilia Romagna.
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Alcuni studi epidemiologici indicano che il rischio di malformazioni congenite può aumentare con l'esposizione in gravidanza a sottoprodotti della disinfezione (DBP), principalmente Trialometani (THM), tuttavia questa associazione non è stata ancora pienamente dimostrata. Il presente studio, finanziato nell'ambito del VI Programma Quadro dell'UE (progetto "Hiwate”), ha avuto l’obiettivo di valutare del rischio di anomalie congenite associato all'esposizione a THM in gravidanza.Uno studio caso-controllo è stato condotto in Emilia-Romagna. I casi di anomalie cromosomiche o congenite verificatisi nel periodo 2002-2005 sono stati estratti dal Registro Regionale delle malformazioni. I controlli (nati senza malformazioni) sono stati selezionati con modalità random dal Registro regionale delle nascite. Dati tecnici, strutturali e sui livelli di THM sono stati ottenuti dalle diversi reti idriche attive nel territorio ed associati a ciascun soggetto sulla base della residenza.Nello studio sono stati inclusi 1.242 casi e 4.984 controlli. Età, storia riproduttiva e caratteristiche socio-economiche sono apparse significativamente diverse nelle madri dei casi e dei controlli. I livelli THM totali e di THM-bromurati sono risultati molto bassi (media:3.8±3.6µg/l e 3.2±2.6µg/l, rispettivamente). Nessun aumento significativo nel rischio di malformazione è emerso per le madri esposte a livelli più alti di THM, anche dopo aver tenuto sotto controllo diversi fattori confondenti.I livelli di THM osservati nelle acque potabili distribuite nell'area sotto osservazione appaiono contenuti e sempre inferiori ai limiti di legge (30 µg/l); tali concentrazioni non risultano associate ad un significativo aumento del rischio di malformazioni congenite nella popolazione indagata.
2010
- The encapsulated strain TIGR4 of Streptococcus pneumoniae is phagocytosed but is resistant to intracellular killing by mouse microglia
[Articolo su rivista]
Peppoloni, Samuele; S., Ricci; Orsi, Carlotta Francesca; Colombari, Bruna; M. M., De Santi; Messinò, Massimino; G., Fabio; Zanardi, Alessio; Righi, Elena; V., Braione; S., Tripodi; D., Chiavolini; M., Cintorino; Zoli, Michele; M. R., Oggioni; Blasi, Elisabetta; G., Pozzi
abstract
The polysaccharide capsule is a major virulence factor of Streptococcus pneumoniae as it confers resistance to phagocytosis. The encapsulated serotype 4 TIGR4 strain was shown to be efficiently phagocytosed by the mouse microglial cell line BV2, whereas the type 3 HB565 strain resisted phagocytosis. Comparing survival after uptake of TIGR4 or its unencapsulated derivative FP23 in gentamicin protection and phagolysosome maturation assays, it was shown that TIGR4 was protected from intracellular killing. Pneumococcal capsular genes were up-regulated in intracellular TIGR4 bacteria recovered from microglial cells. Actual presence of bacteria inside BV2 cells was confirmed by transmission electron microscopy (TEM) for both TIGR4 and FP23 strains, but typical phagosomes/phagolysosomes were detected only in cells infected with the unencapsulated strain. In a mouse model of meningitis based on intracranic inoculation of pneumococci, TIGR4 caused lethal meningitis with an LD(50) of 2 × 10(2) CFU, whereas the LD(50) for the unencapsulated FP23 was greater than 10(7) CFU. Phagocytosis of TIGR4 by microglia was also demonstrated by TEM and immunohistochemistry on brain samples from infected mice. The results indicate that encapsulation does not protect the TIGR4 strain from phagocytosis by microglia, while it affords resistance to intracellular killing.
2010
- VALUTAZIONE DELLA PREVALENZA DELLE LESIONI DA DECUBITO E DELL’ADESIONE ALLE MISURE DI PREVENZIONE E GESTIONE PRESSO L’A.O.U. POLICLINICO DI MODENA
[Abstract in Rivista]
Floramo, Maria; Righi, Elena; Barbieri, M; Mantovani, M; Morandi, Matteo; Vecchi, E; Marchegiano, P; Aggazzotti, Gabriella
abstract
Le lesioni da decubito (LDD) rappresentano un importante problema di assistenza sanitaria sia in ambito ospedaliero che domiciliare, costituendo una diffusa complicanza in anziani allettati ed in soggetti con patologie croniche concomitanti e favorendo l’insorgenza di infezioni correlate all’assistenza. Le LDD richiedono un notevole impegno gestionale in termini di risorse umane e la loro prevenzione e gestione deve prevedere un team professionale preparato e aggiornato e un uso dei dispositivi di prevenzione/gestione puntuale ed appropriato. In questo studio vengono confrontati i risultati di 4 indagini sulla prevalenza di LDD e sulla applicazione delle misure di prevenzione/gestione condotte a febbraio 2007, novembre 2007, febbraio/marzo 2009 e marzo 2010 in 7 Strutture complesse (SC) ad alto/medio rischio di LDD dell’Azienda Ospedaliero-Universitaria (AOU) Policlinico di Modena. I dati sono stati raccolti in giornate prestabilite su tutti i pazienti ricoverati nei reparti selezionati e per la stratificazione del rischio è stato impiegato l’indice di Braden (iB). Nelle 4 indagini sono stati valutati rispettivamente 205, 185 187 e 191 pazienti. Le caratteristiche socio-demografiche dei soggetti sono risultate simili nelle 4 rilevazioni; tuttavia negli ultimi 2 anni sono risultati più numerosi i soggetti ad elevato rischio di LDD (iB≤16: 39% e 38% rispettivamente nel 2010 e nel 2009) rispetto a quanto osservato precedentemente (31% e 29% novembre 07 e febbraio 07). Complessivamente, la prevalenza di LDD nel 2010 (17,2%) è apparsa leggermente superiore a quella rilevata nel 2009 (15,5%) ma risulta simile a quella rilevata nel novembre 07 (17,3%) e febbraio 2007 (16,1%). Tuttavia, la proporzione di LDD insorte durante il ricovero nei soggetti privi di lesioni all’ingresso nel 2010 risulta significativamente inferiore rispetto alle precedenti rilevazioni (8,4% nel 2010 contro il 10% del 2009, 16,2% del novembre 07 e 17,5% del febbraio 07). I soggetti con LDD nel 2010 presentano un’età media pari a 71±15,6 anni ed hanno una degenza notevolmente inferiore rispetto a quelli rilevati a febbraio/marzo 2009. L’utilizzo dei presidi di prevenzione appare significativamente aumentato rispetto alle prime indagini così come risultano più appropriati i trattamenti offerti ai soggetti con LDD. In conclusione, le attività di prevenzione adottate nel corso degli ultimi anni si sono dimostrate efficaci nel ridurre il rischio di sviluppare LDD durante il ricovero e quindi anche nel diminuire il rischio potenziale di infezioni correlate all’assistenza di soggetti lungodegenti, con scarsa mobilità, incontinenza e ridotte capacita sensoriali.
2009
- An in vitro and ex vivo study on two antibiotic-based endodontic irrigants: a challenge to sodium hypochlorite
[Articolo su rivista]
Ardizzoni, Andrea; Blasi, Elisabetta; C., Rimoldi; L., Giardino; E., Ambu; Righi, Elena; Neglia, Rachele Giovanna
abstract
Amongst the bacterial species which most often cause endodontic failures, Enterococcus faecalis is the most important. This study compared the effectiveness of sodium hypochlorite and two new generation antibiotic-based endodontic irrigants, Tetraclean and MTAD. By means of an in vitro agar dilution assay, we show that both Tetraclean and MTAD are 100% effective against 54 clinical isolates at dilutions up to 1:256 and 1:1048, respectively, whereas sodium hypochlorite completely loses its effectiveness when diluted more than 32 times. The bactericidal effect of both Tetraclean and MTAD can be ascribed not just to their antibiotic component per se, but also to a synergistic effect among the several ingredients included in the formulations. Moreover, by an ex vivo model of teeth extracted and experimentally infected with E. faecalis ATCC 29212, we show that both the antibiotic-based endodontic irrigants are effective in eliminating bacterial cells in 93 to 100% of the test samples. The results of these pre-clinical studies strongly supporta wider use of this new group of endodontic irrigants in daily clinical practice.
2009
- Disuguaglianze negli accessi al PS tra popolazione italiana e straniera residente nel distretto di Modena
[Abstract in Atti di Convegno]
Morandi, Matteo; Ganzerla, G; Pelloni, Diletta; Vecchi, E; Colantoni, A; Luciani, A; Righi, Elena; Aggazzotti, Gabriella
abstract
OBIETTIVI E METODI: Analisi retrospettiva secondo nazionalità dei tassi e delle caratteristiche di accesso al PS (A.O.U. Policlinico di Modena) della popolazione residente dal 1/1/07 al 31/12/07.RISULTATI: Nel 2007 i residenti a Modena hanno effettuato 34516 accessi, nell’83% italiani e nel 17% stranieri, in prevalenza maschi (53% vs 58%). Il 48% degli accessi stranieri e’stato effettuato da africani (30% del Maghreb), il 36% da europei (23% extra CEE), l’8% da americani e l’8% da asiatici. L’età media e’ molto inferiore per gli immigrati (34 vs 52 anni). Il tasso di accesso risulta di 296 su 1000 residenti stranieri e di 178 su 1000 residenti italiani (RR 1.7; 95%IC:1.6-1.7). Rispetto agli italiani si osserva un RR di accesso di 1.6 (95%IC: 1.5-1.6) per europei extra CEE, 2.1 (95%IC: 2.0-2.1) per africani, 3.0 (95%IC: 2.8-3.2) per americani, 0.8 (95%IC: 0.8-0.9) per asiatici. Circa 38 su 1000 residenti stranieri utilizzano l’ambulanza (vs 32 su 1000 res. italiani). Considerando i traumatismi gli stranieri presentano una maggiore probabilità di accessi per aggressioni opera terzi (RR 5.7; 95%IC: 4.8-6.8), infortuni sul lavoro (RR 3.7; 95%IC 3.4-4.0) e incidenti stradali (RR 2.2; 95%IC: 2.0-2.4). Nel 95% gli stranieri hanno un codice di dimissione a bassa gravità (vs 88,7%).CONCLUSIONI: L’analisi retrospettiva degli accessi in PS fornisce importanti informazioni sugli stranieri residenti a Modena. Queste persone affluiscono al PS più frequentemente degli italiani (eccetto gli asiatici), utilizzano maggiormente l’ambulanza, tendono a presentare diagnosi di dimissione meno gravi e più spesso l’accesso avviene per motivi traumatici. Questi dati confermano la fragilità sociale e la difficoltà a fruire dei servizi territoriali per le patologie di pertinenza, con aumento dei tempi di attesa e della spesa sanitaria. Inoltre l’evidenza di maggior rischio per traumatismi deve stimolare la promozione di campagne specifiche di prevenzione ed informazione per sottogruppi a rischio.
2009
- Health impacts of long-term exposure to disinfectionby-products in drinking water in Europe: HIWATE
[Articolo su rivista]
M. J., Nieuwenhuijsen; R., Smith; S., Golfinopoulos; N., Best; J., Bennett; Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; L., Bucchini; S., Cordier; C. M., Villanueva; V., Moreno; C., La Vecchia; C., Bosetti; T., Vartiainen; R., Rautiu; M., Toledano; N., Iszatt; R., Grazuleviciene; M., Kogevinas
abstract
There appears to be very good epidemiological evidence for a relationship between chlorination by-products, as measured by trihalomethanes (THMs), in drinking water and bladder cancer,but the evidence for other cancers, including colorectal cancer appears to be inconclusive and inconsistent. There appears to be some evidence for a relationship between chlorinationby-products, as measured by THMs, and small for gestational age (SGA)/intrauterine growth retardation (IUGR) and preterm delivery, but evidence for other outcomes such as low birth weight (LBW), stillbirth, congenital anomalies and semen quality appears to be inconclusive and inconsistent. The overall aim of the HIWATE study is to investigate potential human health risks (e.g. bladder and colorectal cancer, premature births, SGA, semen quality, stillbirth, congenital anomalies)associated with long-term exposure to low levels of disinfectants (such as chlorine) and DBPs occurring in water for human consumption and use in the food industry. The study will compriserisk–benefit analyses including quantitative assessments of risk associated with microbial contamination of drinking water versus chemical risk and will compare alternative treatmentoptions. The outcome will be improved risk assessment and better information for risk management. The work is divided into different topics (exposure assessment, epidemiology, riskassessment and management) and studies.
2009
- INDAGINE GISIO SULLA CONOSCENZA DEGLI STUDENTI DEI CDLDELLE PROFESSIONI SANITARIE A PROPOSITO DELLE INFEZIONICORRELATE ALLE PRATICHE ASSISTENZIALI (ICPA). RISULTATIPRELIMINARI
[Abstract in Rivista]
Auxilia, F; Calligaris, L; D'Alessandro, D; Montagna, Mt; Mura, I; Napoli, C; Pasquarella, C; Righi, Elena; Rossini, A; Tardivo, S.
abstract
In questo lavoro vengono riportati e discussi i risultati preliminari di uno studio che ha avuto l’obiettivo di valutare il grado di conoscenza degli studenti dei corsi di laurea delle professioni sanitarie di alcune università italiane circa la prevenzione delle infezioni correlate all’assistenza (ICPA) e di individuare le eventuali aree di criticità
2009
- PREVALENZA DELLE LESIONI DA DECUBITO E ADESIONE ALLE MISURE DI PREVENZIONE PRESSO L’AZIENDA OSPEDALIERO-UNIVERSITARIA POLICLINICO DI MODENA
[Abstract in Rivista]
Morandi, Matteo; Righi, Elena; Barbieri, M; Mantovani, M; Vecchi, E; Marchegiano, P; Aggazzotti, Gabriella
abstract
Questo studio si è proposto di quantificare la prevalenza delle lesioni da decubito (LDD) in reparti ad alto e medio rischio dell’Azienda Ospedaliero-Universitaria (AOU) Policlinico di Modena e di verificare l’aderenza alle misure di prevenzione e gestione delle LDD incluse nella procedura aziendale. In giornate definite di febbraio e marzo 2009 si è svolta la valutazione di tutti i pazienti ricoverati presso 7 Strutture complesse (SC) dell’AOU Policlinico di Modena considerate ad alto/medio rischio per LDD (es. SC di medicina interna, oncologia, rianimazione ed ortopedia). I dati sono stati raccolti su apposite schede e per la valutazione del rischio di LDD è stata utilizzata la scala di Braden. Nei 7 reparti sono stati valutati 187 pazienti (51% donne) con età media 70 anni (mediana 76, range:1-96 anni) e con degenza media 12 giorni (range <24h–167 g). Al momento della rilevazione 72 soggetti (38.5%) presentavano un indice di Braden ≤16, indicativo dell’alto rischio per LDD e 5 soggetti su 23 (22%) risultavano privi di presidi ed ausili preventivi nonostante ricoverati da oltre 24 ore e ad elevato rischio di LDD in quanto non autonomi nei movimenti. La prevalenza di LDD è risultata del 15.5% (29 soggetti su 187). In totale sono state osservate 44 LDD: 7 in stadio I°, 20 in stadio II°, 4 in stadio III° e 7 in stadio IV°; in 6 casi erano presenti escare. La maggior parte delle lesioni si è manifestata a livello dell’osso sacro (48%) o del tallone (36%). I pazienti con LDD già presenti al ricovero erano l’8.6% (16 soggetti su 187); 4 di questi (25%) avevano sviluppato LDD presso altri reparti. La prevalenza di LDD nei soggetti privi di lesioni al ricovero è risultata pari al 10.0% (17 soggetti su 169). I soggetti con LDD presentano prevalentemente un indice di Braden ≤16 (83%) ed una età ≥60 anni (97%). Nell’84% dei casi le lesioni risultavano trattate in modo appropriato tuttavia non sempre è sta messa in atto una gestione adeguata della terapia del dolore. La prevalenza di LDD osservata in questa indagine risulta più bassa, anche se in linea, con quella evidenziata nelle rilevazioni effettuate nel 2007 [15.5% vs 17.3% (novembre 2007).I risultati di questa indagine indicano una tendenziale riduzione delle LDD rispetto alle rilevazioni precedenti; tuttavia è ancora presente una variabilità all’interno delle diverse strutture, sia nei dati di prevalenza che nei dati di appropriato utilizzo dei presidi preventivi e di gestione terapeutica delle LDD. Ulteriori indagini permetteranno di identificare le cause di tali differenze allo scopo di migliorare ulteriormente la prevenzione e la gestione delle LDD.
2009
- SOTTOPRODOTTI DELLA DISINFEZIONE (DBPS) NELLE ACQUE POTABILI DI 12 RETI IDRICHE ITALIANE: RISULTATI DI UNO STUDIO MULTICENTRICO
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Giacobazzi, Pierluigi; Predieri, Guerrino; Mastroianni, Katia; Castriotta, L; Del Bianco, F; Tortorici, D; Aggazzotti, Gabriella
abstract
Una delle attività programmate all’interno del progetto finanziato dalla Comunità europea (VI programma Quadro) denominato “Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water (HiWate)” consiste nella determinazione dei livelli e della distribuzione di sottoprodotti della disinfezione delle acque potabili (DBPs) in diverse regioni europee. L’Università di Modena e Reggio Emilia ha coordinato l’attività di monitoraggio per Italia. Le principali caratteristiche strutturali e funzionali di 12 reti idriche distribuite in 3 regioni italiane (Friuli Venezia Giulia; Lombardia ed Emilia-Romagna) sono state registrate e campioni di acqua sono stati raccolti per valutare la presenza di trialometani (THMs), di ioni clorito, clorato e bromato, di acidi aloacetici (HAAs) e di 3-cloro-4-(diclorometil)-5-idrossi-2(5H)-furanone (MX). Potenziali variazioni spaziali e stagionali nelle concentrazioni di DBPs sono state valutate pianificando per ogni acquedotto 4 sessioni di campionamento (1 per stagione) e raccogliendo campioni di acqua in punti diversi dell’impianto di trattamento e della rete di distribuzione. Il campionamento è iniziato nell’autunno 2007 e si è concluso nell’autunno 2008. Nelle 12 rete idriche monitorate MX e HAAs risultano sempre assenti (limite di rilevabilità: 0.5ng/l e 1µg/l, rispettivamente), mentre lo ione bromato è risultato dosabile (media: 5.7; range 2-14µg/l) solamente in una rete dove viene distribuita acqua trattata con ozono. THMs, in particolare cloroformio, risultano più diffusi (>63% dei campioni), e le concentrazioni più elevate si osservano negli acquedotti che per la disinfezione delle acque impiegano ipoclorito di sodio (media 2.9µg/l, valore max 26.9µg/l). Le concentrazioni di THMs osservate sono sempre risultate inferiori al limite di legge (30µg/l). Cloriti risultano presenti nelle acque trattate con biossido di cloro e mostrano concentrazioni variabili (valore max: 523µg/l), sempre tuttavia inferiori al valore limite indicato dalla legge (700µg/l). I DPBs più diffusi sono risultati i clorati (presenti in oltre l’85% dei campioni); anche questi composti mostrano livelli molto variabili (range: nd-399µg/).Negli acquedotti monitorati non sono mai stati evidenziati valori superiori ai limiti di legge per THMs, bromato e clorato; MX e HAAs sono risultati sempre assenti. Lo ione clorato, un potenziale endocrine disruptor, interferente con il metabolismo dello iodio, non regolamentato dall’attuale normativa italiana, è al contrario risultato particolarmente diffuso: questa situazione risulta meritevole di ulteriori approfondimenti.
2009
- VARIAZIONI SPAZIALI DEI CASI DI MALFORMAZIONE CONGENITA IN EMILIA ROMAGNA: PRIMI RISULTATI DI UNO STUDIO CONDOTTO NELL’AMBITO DEL PROGETTO EUROPEO HIWATE
[Abstract in Rivista]
Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, Daniela; Giacobazzi, Pierluigi; Mastroianni, Katia; Calzolari, E; Rivieri, F; Astolfi, G; Lauriola, P; Borgoni, R; Fantuzzi, Guglielmina; Tortrici, D; Aggazzotti, Gabriella
abstract
HiWate (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water), un programma di ricerca finanziato dalla Comunità Europea - VI Programma Quadro, ha l’obiettivo di valutare i potenziali effetti sulla salute umana, cancerogeni e riproduttivi, esercitati dall’esposizione a sottoprodotti della disinfezione nelle acque potabili (DBPs).Grazie ad una collaborazione con il Registro delle malformazioni congenite della regione (Registro IMER), l’Università di Modena e Reggio Emilia sta conducendo, uno studio caso-controllo per valutare l’effetto della esposizione a DBPs durante la gravidanza su specifiche malformazioni (anomalie cromosomiche; difetti tubo neurale; sistema cardiovascolare; parete addominale; labbra e palato; apparato respiratorio; organi genitali e apparato urinario). La prima fase di questo studio ha previsto un’analisi della distribuzione spaziale dei casi di malformazione con l’obiettivo di identificare potenziali trend/cluster spazio-temporali. Metodi statistici appropriati (stimatori bayesiani empirici) in grado di controllare l’effetto dell’errore casuale, potenzialmente molto rilevante quando l’evento preso in considerazione è raro, sono stati applicati ai dati. In Emilia Romagna negli anni 2002-2005 sono stati identificati 1246 soggetti con le malformazioni selezionate (totale malformazioni: 2420). La prevalenza complessiva di malformazioni è risultata pari a 8.4 per 1000 nati (95%IC:7.93-8.87); la prevalenza a livello provinciale e comunale risulta molto variabile e compresa tra 3.8 -11,2 per 1000 nati (prevalenza provinciale) e tra 0 e 71,4 casi per 1000 nati (prevalenza comunale). La distribuzione spaziale dei tassi grezzi provinciali e comunali evidenzia un rischio di malformazione congenita più elevato al centro e al nord-est della regione, valutazione confermata da tutti gli indicatori di autocorrelazione spaziale calcolati. I tassi di prevalenza comunali calcolati utilizzando stimatori bayesiani empirici sono caratterizzati da variazioni sempre consistenti anche se di minore ampiezza (range: 2,4 -14,7 casi per 1000 nati), e confermano i trend/cluster spaziali precedentemente osservati I tassi di malformazione congenita osservati nel periodo 2002-2004 tendono ad essere più elevati ad ovest, a nord-est e nella zona centrale della regione Emilia Romagna. Ulteriori indagini sono in corso per valutare le cause e i fattori potenzialmente in grado di influenzare le differenze osservate
2009
- la sorveglianza delle infezioni in chirurgia (progetto SICHER)
[Abstract in Rivista]
Pederzini, L; Cencetti, S; Vecchi, E; Marchegiano, P; Barbieri, M; Morandi, Matteo; Righi, Elena; Aggazzotti, Gabriella
abstract
Le infezioni del sito chirurgico (SSI) rappresentano una quota importante delle infezioni ospedaliere. L’Azienda Ospedaliera Universitaria Policlinico di Modena aderisce ad un sistema di sorveglianza continuativa delle infezioni della ferita chirurgica attivato dalla regione Emilia Romagna (Progetto SIChER), con l’obiettivo di determinare le dimensioni del fenomeno e di identificare aree di intervento per migliorare la qualità dell’assistenza.Il periodo di sorveglianza effettuato si estende dal settembre 2006 al dicembre 2008. ed ha riguardato gli interventi di ernioplastica e laparoplastica (HER), colecistectomia (CHOL), mastectomia/quadrantectomia (MAST), appendicectomia (APPY), protesi d’anca e del ginocchio (HPRO e KPRO). Dal 1° luglio 2008 e’ stata avviata anche la sorveglianza per gli interventi al colon (COLO) e dal 1° settembre è partita la sorveglianza degli interventi di chirurgia toracica (THOR).Tra i 2534 interventi non protesici sono state identificate 31 infezioni della ferita chirurgica in altrettanti pazienti (incidenza cumulativa 1.3%), di cui 20 MAST, 10 APPY (4 adulti e 6 bambini), 1 HER; in 18 casi si è trattato di infezioni profonde (in grandissima parte MAST), 1 caso ha coinvolto organi e spazi, le restanti erano infezioni superficiali. Ad eccezione di un intervento APPY pediatrico, tutte le infezioni in interventi non protesici sono state rilevate nel periodo post-dimissione, dopo un intervallo medio di quattordici giorni di sorveglianza dall’intervento. La distribuzione temporale dei casi di infezione indica un incremento consistente delle infezioni registrate in seguito ad interventi della sola categoria MAST, situazione che è stata affrontata con la urgenza attraverso il rafforzamento delle misure di prevenzione e di controllo. Nelle categorie di interventi protesici si è verificata 1 sola infezione a seguito di intervento di protesi al ginocchio.Il sistema di sorveglianza non ha evidenziato né situazioni di rischio particolare né variazioni temporali consistenti per numero e tipologia di inferi ad esclusione della categoria MAST, per la quale sono state prontamente adottate adeguate misure di controllo.Per gli interventi COLO e THOR, inseriti nella sorveglianza solamente in periodi di tempo più recenti, al momento non sono state registrate infezioni; tuttavia per valutazioni più approfondite ed affidabili relativamente a queste categorie di interventi sarà necessario un più prolungato periodo di osservazione che permetta l’ampliamento della casistica sorvegliata.
2008
- Attivazione di un sistema di sorveglianza delle infezioni in terapia intensiva – Hesperia Hospital Modena.
[Abstract in Rivista]
Righi, Elena; Tucci, C; D’Apollo, N; De Santis, M; Ragazzi, S.
abstract
Le unità di terapia intensiva sono caratterizzate da una frequenza di infezioni nosocomiali più alta rispetto a quella osservata in altri reparti ospedalieri a causa dei numerosi fattori di rischio (gravità patologia, immunodepressione, manovre invasive, età avanzata) che caratterizzano i soggetti ricoverati in queste unità. A partire dal 2005 in HESPERIA HOSPITAL (Modena) è stato attivato un sistema di sorveglianza delle infezioni in TI allo scopo di quantificare le dimensioni del fenomeno, di riconoscere i principali fattori di rischio ed identificare le potenziali specifiche aree di intervento. I pazienti ricoverati per almeno 48 h sono stati sorvegliati per tutta la degenza fino a 3 giorni dopo la dimissione, raccogliendo le informazioni su una scheda appositamente ideata ed utilizzando le linee guida dei CDC americani per identificare i casi di infezione.Nel periodo aprile 2005-marzo 2007 sono stati arruolati 229 soggetti; di questi 73 (31.9%) hanno sviluppato infezioni (23.9 casi ogni 1000 giorni degenza in TI). IVU sono state osservate nel 17.0% dei pz; (15 casi ogni 1000 gg catetere), batteriemie/sepsi nel 13.1% dei soggetti, polmoniti nel 9.2% (14 casi ogni 1000 gg ventilazione meccanica) ed infezioni del sito chirurgico nel 3.5% dei ricoverati. I soggetti con infezione sono, rispetto ai soggetti non affetti, più anziani, hanno un indice SAPSII all’ammissione più elevato, e sono sottoposti a manovre invasive per periodi più lunghi. Anche la durata della degenza risulta significativamente prolungata così come aumenta il rischio di morte: decessi si verificano nel 21.9% dei soggetti con infezione e nel 9.0% dei soggetti privi di infezione.La conoscenza delle dimensioni del fenomeno e l’identificazione di aree di criticità/miglioramento, stanno stimolando la predisposizione di metodologie operative comuni e condivise e l’identificazione di specifici interventi mirati alla riduzione dell’incidenza delle infezioni: i risultati di tali attività potranno essere valutati nei prossimi periodi di osservazione
2008
- Comparative in vitro and ex vivo studies on the bactericidal activity of Tetraclean, a new generation endodontic irrigant, and sodium hypochlorite
[Articolo su rivista]
Neglia, Rachele Giovanna; Ardizzoni, Andrea; L., Giardino; E., Ambu; S., Grazi; S., Calignano; C., Rimoldi; Righi, Elena; Blasi, Elisabetta
abstract
The aim of this study was to compare the efficacy of a new generation endodontic irrigant, Tetraclean, to the widely used sodium hypochlorite. Tetraclean combines a powerful detergent effect with a strong antimicrobial efficacy, whereas sodium hypochlorite has several drawbacks and is sometimes ineffective in preventing microbial-mediated endodontic failure. The bactericidal activity of both irrigants against Enterococcus faecalis, the most commonly isolated species from root canals of teeth with post-treatment disease, was assessed i) in vitro, according to the European Standard lines for the evaluation of the bactericidal activity of chemical disinfectants, and ii) with an ex vivo model of extracted and decoronated human teeth, infected with E. faecalis and subsequently irrigated with either of the irrigants. Both irrigants display very similar bactericidal activity against E. faecalis in vitro. However, the ex vivo model shows that only in the teeth irrigated with Tetraclean did the bacterial burden gradually drop until no bacteria were detectable a few days post-irrigation. Vice versa, in the teeth irrigated with sodium hypochlorite, the drop in the bacterial burden was rapid but temporary and most of the teeth were colonized again by 48 hours post-irrigation.
2008
- Determinazione di acidi aloacetici, cloriti, clorati, bromati e trialometani, in impianti natatori della regione Emilia-Romagna
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Giacobazzi, Pierluigi; Predieri, Guerrino; Mastroianni, Katia; Aggazzotti, Gabriella
abstract
La disinfezione delle acque di piscina con prodotti a base di cloro può indurre la formazione di diverse categorie di sottoprodotti della disinfezione (DBPs), quali trialometani (THMs), cloriti, clorati, bromati e acidi aloacetici (HAAs). Tali composti, potenzialmente nocivi per la salute umana, possono essere introdotti all’interno del corpo umano dai frequentatori di piscine attraverso la via cutanea, orale ed inalatoria. 20 piscine coperte della Regione Emilia Romagna sono state monitorate e campioni di acqua di alimentazione degli impianti, di acqua della vasca e di aria sono stati raccolti per valutare la presenza nelle diverse matrici ambientali di THMs, HAAs, cloriti, clorati, bromati.THMs, in particolare cloroformio, sono stati evidenziati nell’acqua e nell’aria di tutti gli impianti monitorati (range: 6.8-134µg/l e 12.6-187µg/l, rispettivamente). Anche clorati sono stati riscontrati in tutti gli impianti considerati e presentano concentrazioni estremamente variabili (5-19537µg/). Nella maggior parte delle vasche, inoltre, sono risultati dosabili, gli acidi mo-di- e tricloroacetico (range: 11- 403µg/). Cloriti e bromati, al contrario, risultano presenti in un numero limitato di vasche (1 e 3 impianti rispettivamente) e a concentrazioni più ridotte. In tutti i casi le concentrazioni di DBPs rilevate sono apparse sempre superiori a quelle osservate nelle acque di alimentazione degli impianti; le diverse tipologie di disinfettanti utilizzati non sembrano influenzare le loro contrazioni, con l’eccezione dei clorati che tendono ad essere più diffusi dove viene impiegato ipoclorito di sodio. Vista la sempre più diffusa abitudine di compiere attività sportiva all’interno di impianti natatori, i dati rilevati, indicanti la presenza diffusa in tali ambienti di DBPs di diversa natura e a concentrazioni a volte decisamente superiori a limiti previsti dalla legge per le acque destinate al consumo umano, suggeriscono la necessità di effettuare ripetuti controlli ambientali e di valutare con più attenzione le modalità di disinfezione adottate nelle diverse strutture.
2008
- Effetti dell’attività fisica in gravidanza sulla nascita pretermine
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Morandi, Matteo; Mastroianni, Katia; Giacobazzi, Pierluigi; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca; Aggazzotti, Gabriella
abstract
Nell’ambito di uno studio multicentrico sullo stato di salute delle donne in gravidanza è stato condotto uno studio caso controllo con lo scopo di valutare gli effetti della attività fisica svolta durante il terzo trimestre di gravidanza sulla nascita pretermine. Lo studio è stato condotto in Italia nel periodo 1999–2000 e ha riguardato 9 città italiane (Genova, Udine, Modena, Parma, Siena, L’Aquila, Roma, Napoli e Catania). Sono stati identificati come casi (299) i bambini nati entro la 37° settimana di gravidanza, mentre come controlli (855) erano arruolati neonati a termine, partoriti successivamente all’identificazione del caso. Attraverso un questionario appositamente disegnato sono state raccolte informazioni relative alle caratteristiche sociodemografiche, alle abitudini sportive delle donne esaminate oltre che ad informazioni sulla anamnesi medica e riproduttiva. Dall’indagine è emerso che nel campione complessivamente esaminato una donna su quattro pratica attività sportiva regolare durante il terzo trimestre di gravidanza; in particolare praticano sport con maggiore frequenza le donne di età superiore ai 20 anni (51,1%), laureate con eventuali specializzazioni (34,9%). Tra le diverse zone geografiche valutate, è più frequente la pratica sportiva nelle province del nord, con valori che oscillano tra il 31% di Modena e il 24% di Udine. Frequenze più basse si registrano al sud, dove Napoli è l’unica eccezione (29,6%). Le attività sportive più frequentemente rilevate sono risultate il camminare, fare sport d’acqua, ginnastica e bicicletta. Le donne che svolgono attività fisica durante la gravidanza hanno un rischio significativamente minore di partorire precocemente (OR=0,52; CI:0,38-0,73). L’effetto protettivo viene confermato anche quando vengono tenute sotto controllo alcune variabili socio-sanitarie delle madri quali l’età, la scolarità, le abitudini tabagiche e la possibile gravidanza a rischio (OR corretto =0,60; CI:0,42-0,85). I risultati di questo studio confermano il ruolo positivo esercitato dalla attività fisica sullo stato di salute delle donne in gravidanza.
2008
- Esposizione a sottoprodotti della disinfezione (DBPs) nelle acque potabili di 12 reti idriche italiane: primi risultati di uno studio multicentrico
[Abstract in Rivista]
Righi, Elena; Giacobazzi, Pierluigi; Predieri, Guerrino; L., Castriotta; F., Del Bianco; Mastroianni, Katia; D., Tortorici; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Nel programma europeo “Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water (HiWate)” mirato a monitorare l’esposizione della popolazione a sottoprodotti della disinfezione delle acque potabili (DPBs), sono state campionate 12 reti idriche in 3 regioni italiane: Friuli Venezia Giulia; Lombardia ed Emilia-Romagna. Le principali caratteristiche strutturali e funzionali degli acquedotti coinvolti nel monitoraggio sono state raccolte ed è stata ricercata la presenza di trialometani (THMs), di ioni clorito, clorato e bromato, e di acidi aloacetici (HAAs). Per valutare potenziali variazioni spaziali e stagionali nelle concentrazioni di DBPs, per ogni acquedotto sono state pianificate 4 sessioni di campionamento (1 per stagione) e vengono raccolti campioni di acqua in punti diversi dell’impianto di trattamento e della rete di distribuzione. Il campionamento è iniziato nell’autunno 2007 e si protrarrà fino all’autunno 2008. I primi risultati, (autunno 2007 – primavera 2008), indicano come HAAs siano sempre assenti (limite di rilevabilità: 1µg/l); e come il bromato sia risultato dosabile solamente in una rete dove viene distribuita acqua trattata con ozono e a concentrazioni sempre molto basse (range 2-4µg/l). THMs, in particolare cloroformio, risultano più diffusi (>70% dei campioni), anche se a concentrazioni sempre inferiori al limite di legge (30µg/l). Cloriti risultano presenti nelle acque trattate con biossido di cloro e mostrano concentrazioni più variabili (valore max: 385µg/l) sempre inferiori al valore limite indicato dalla legge (700 µg/l). I DPBs più diffusi nel complesso sono risultati i clorati (presenti in oltre l’85% dei campioni); anche questi composti mostrano livelli molto variabili (range: nd-366µg/).Al momento nei campioni osservati non si evidenziano mai valori superiori ai limiti di legge per THMs, bromato e clorato; da notare tuttavia la particolare diffusione dello ione clorato, un potenziale endocrine disruptor, interferente con il metabolismo dello iodio, non regolamentato dall’attuale normativa italiana.
2008
- Exposure to active and passive smoking during pregnancy and severe small for gestational age at term
[Articolo su rivista]
Fantuzzi, Guglielmina; Vaccaro, Valentina; Aggazzotti, Gabriella; Righi, Elena; Kanitz, S; Barbone, F; Sansebastiano, G; Battaglia, Ma; Leoni, V; Fabiani, L; Triassi, M; Sciacca, S; Facchinetti, Fabio
abstract
The objective of this study was to assess the relationship between active smoking as well as environmental tobacco smoke (ETS) exposure and severe small for gestational age (SGA) at term in a sample of pregnant Italian women. METHODS: A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of severe SGA were singleton, live born, at term children with a birth weight 10(th) percentile for gestational age. A total of 84 cases of severe SGA and 858 controls were analyzed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. RESULTS: Multivariate logistic regression analysis showed a relationship between active smoking during pregnancy and severe SGA (adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.13-3.68). ETS exposure was associated with severe SGA (adjusted OR 2.51, 95% CI 1.59-3.95) with a dose-response relationship to the number of smokers in the home.
2008
- La lotta alle infezioni in Terapia Intensiva
[Articolo su rivista]
Girardis, Massimo; C., Venturelli; Aggazzotti, Gabriella; Righi, Elena
abstract
In questo articolo vengono presentati i risultati relativi alla sorveglianza delle infezioni nosocomiali condotta nella Unità Operativa di Terapia Intensiva Post-Operatoria (TIPO) dell'Azienda Ospedaliera Universitaria Policlinico di Modena
2008
- Occupational exposure in Italian swimming pools and self-reported health conditions
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi
abstract
In indoor swimming pools both chemical substances in water and air and microclimate parameters influence health status and well-being of subjects employed in these environments. In order to investigate on the possible detrimental impacts of occupational exposure for trainers, lifeguards and facility operators 20 indoor swimming pools in Emilia Romagna have been visited in 2007 and 133 workers were enrolled in the study.Microclimate parameters (dry and radiant air temperature, air speed, relative humidity, illumination levels) were measured by a multi-data logger (BABUC A-LSI Lastem) equipped by a software (InfoGAP) aimed to calculate microclimate indices for moderate environments, taking into account personal clothing. Disinfection By Products (DBPs) such as trihalomethanes (THMs) and residual combined chlorine were evaluated in pool water: THMs were analysed in indoor air and in alveolar air samples collected from 115 workers. Head space gaschromatography was used for THMs in water samples, while THMs both in indoor air and alveolar air samples were analysed by direct injection. Information about personal data and job description was collected. Self-reported health conditions were recorded by a questionnaire: upper respiratory symptoms (runny nose, nasal obstruction, voice loss, etc), lower respiratory symptoms (wheezing, asthma, etc), ocular symptoms (itchy, red and watering eyes) and ever presence of fungal diseases, warts and dermal irritative symptoms were registered, together with self-reported information about dermal comfort/discomfort.On the whole, microclimate parameters are within the range of values suggested by the Italian guidelines for indoor swimming pools. In 19 environments (95%) illumination levels were in agreement with the above guidelines (≥150 lux); similarly, air speed values and relative humidity levels were adequate (≤0.1 m/s and ≤70% respectively) for 14 (70%) and 13 (65%) swimming pools. 14 swimming pools (70%) showed dry air temperature values lower than water temperature, and so associated with a thermal discomfort condition. The Predicted Mean Vote (PMV) is a thermal index which scores the comfort/discomfort level for workers, taking into account dry air temperature, relative humidity and air speed levels. The values showed a generally acceptable thermal condition shifted towards a warm sensation. The most prevalent health symptoms were nasal obstruction (21,1%), voice loss (17.3%) and mucosal irritative symptoms (15.8%), followed by red eyes (13.5%), itchy eyes (12.8%) and watery eyes (6%). THMs in indoor air (range: 1.7-187.5 mcg/m3) were highly correlated with THMs in alveolar air samples (range: 1.0-123 mcg/m3) (r = 0.68; P = 0.001). Chloroform, the most prevalent compound, and dichloro bromo methane (DCBM) were detected in all indoor air samples, while they were present in 98.3% and 82.6% of alveolar air samples respectively. Swimming pools have been splitted according to the suggested Italian guideline for combined chlorine in water (≤0.4 mg/l) assumed as the source of trichloramine, volatile irritative compound in indoor air. Subjects working in environments (15 swimming pools) where combined chlorine levels were above 0.4 mg/l experienced more symptoms of nasal obstruction and ocular irritative symptoms compared to those employed in swimming pools with lower levels in water.
2008
- Prevalenza di sintomi irritativi e respiratori negli addetti alle piscine coperte
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; Mastroianni, Katia; Aggazzotti, Gabriella
abstract
E’ noto come la disinfezione delle acque di piscina con composti a base di cloro determini la formazione di vari sottoprodotti tra cui le cloroammine. Le cloroammine sono composti volatili che, disperdendosi parzialmente dall’acqua all’aria sottoforma di gas, causano il tipico odore di cloro presente nelle piscine e i ben noti effetti irritanti per il nuotatore. Scopo del presente studio è stato quello di valutare eventuali effetti irritativi a carico della cute, delle mucose congiuntivali e naso faringee negli addetti alle piscine coperte in relazione alla presenza di cloro attivo combinato nell’acqua, ma anche di sostanze irritanti nell’aria ambientale. L’indagine è stata condotta su 133 lavoratori aventi diverse mansioni all’interno dei 20 impianti natatori della regione Emilia Romagna. A ciascun soggetto è stato distribuito uno specifico questionario che prevedeva la raccolta di dati personali quali età, sesso, tipologia di attività svolta all’interno dell’impianto ecc. Nell’ultima parte del questionario venivano raccolte informazioni relativamente a sintomi propri delle vie respiratorie e degli apparati visivo e cutaneo. L’arrossamento congiuntivele, l’irritazione oculare e la perdita della voce sono risultati significativamente più frequenti in coloro che lavoravano in piscine dove i livelli di cloro attivo combinato erano superiori a 0,4 mg/l, valore da non superarsi secondo la normativa vigente. Nessuna relazione è stata rilevata con ostruzione nasale, lacrimazione e asma. Degno di nota è il reperto di concentrazioni medie di cloro attivo combinato nell’acqua in vasca pari a 0.5 ± 0.2 mg/l con un valore massimo di 0,9 mg/l.
2008
- Primi risultati di uno studio condotto nell’ambito del progetto europeo HIWATE sull’esposizione a sottoprodotti della disinfezione (DBPs) nelle acque potabili in Emilia-Romagna e malformazioni congenite
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Giacobazzi, Pierluigi; E., Calzolari; F., Rivieri; P., Lauriola; Bechtold, PETRA ELISABETH; D., Tortrici; Aggazzotti, Gabriella
abstract
HiWate (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water) è un programma di ricerca finanziato dalla Comunità Europea all’interno del VI Programma Quadro, che ha come principale obiettivo la valutazione dei potenziali effetti sulla salute umana, cancerogeni e riproduttivi, esercitati dall’esposizione a sottoprodotti della disinfezione nelle acque potabili (DBPs). L’Università di Modena e Reggio Emilia coordina gli studi epidemiologici sulla sfera riproduttiva e conduce, all’interno di questa area di ricerca, uno studio caso-controllo sulle malformazioni congenite. Grazie ad una collaborazione con il Registro delle malformazioni congenite della regione (Registro IMER) sono stati arruolati tutti casi di specifiche malformazioni (anomalie cromosomiche; difetti del tubo neurale; del sistema cardiovascolare; della parete addominale; delle labbra e del palato; dell’apparato respiratorio; degli organi genitali e dell’apparato urinario) verificatisi in Emilia Romagna nel periodo gennaio 2002-dicembre 2005 (totale nati nel periodo: 147.910); sono stati poi selezionati random 4 controlli per caso tra tutti i nati privi di malformazioni nello stesso periodo. Sono stati identificati 6230 soggetti: 1246 malformati (totale malformazioni: 2420) e 4984 controlli. Le malformazioni più frequenti sono risultate i difetti cardiaci maggiori, le anomalie cromosomiche e i difetti dell’apparato urinario. I parti gemellari e i neonati di sesso maschile sono significativamente più diffusi tra i casi rispetto ai controlli, mentre il livello di educazione scolastica e la percentuale di madri lavoratrici non differiscono nei due gruppi. L’esposizione a DBPs durante il primo trimestre di gravidanza viene valutata identificando, tra oltre 2000 acquedotti, l’impianto che distribuiva acque potabili presso l’abitazione delle madri; ai soggetti vengono poi associate le concentrazioni dei principali DBPs osservate in quel periodo e le informazioni sul tipo di disinfezione effettuato e sulla natura dell’acqua di approvvigionamento. Entro il 2008 sarà completata la valutazione dell’esposizione, seguita poi dalle analisi epidemiologico-statistiche; i risultati definitivi sono previsti per luglio 2009.
2008
- Requisiti igienico-ambientali in un campione di piscine coperte della regione Emilia-Romagna
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; Mastroianni, Katia; Aggazzotti, Gabriella
abstract
Sono stati recentemente definiti nell’Accordo “Stato-Regioni” del 16 gennaio 2003 gli aspetti igienico ambientali relativi alla costruzione, manutenzione e vigilanza delle piscine ad uso natatorio. Scopo della presente indagine è stato quello di verificare la conformità ai requisiti legislativi di un campione di piscine coperte della Regione Emilia Romagna. Nel 2007 sono state esaminate 20 piscine coperte: in ciascuna piscina venivano verificate le condizioni illuminotecniche, termoigrometriche e di ventilazione, nonché i requisiti fisici e chimici (temperatura, pH, cloro attivo libero e combinato e acido isocianurico) dell’acqua in immissione e dell’acqua in vasca.Per quanto riguarda le condizioni illuminotecniche, i livelli sono risultati > 150 lux in 19 piscine (95%), mentre, relativamente alle condizioni microclimatiche, i valori di umidità relativa e di velocità dell’aria sono risultati idonei solo nel 65% e nel 70 % delle piscine esaminate. Per quanto riguarda la temperatura dell’aria solo in 6 piscine (30%) si sono osservati valori superiori ai corrispettivi valori di temperatura nell’acqua, secondo quanto prescritto dalla normativa. Per quanto riguarda, infine, i requisiti fisici e chimici dell’acqua, la temperatura (28,4 ± 0,8 °C) è risultata idonea in tutte le piscine esaminate, mentre i valori di pH e di acido cianurico risultano idonei nel 90% delle piscine. Valori elevati sono stati ritrovati, invece, relativamente al cloro attivo combinato: solo il 25% delle piscine presenta concentrazioni ≤ 0,4 mg/l.L’indagine condotta evidenzia una generale idoneità delle piscine della nostra Regione ai requisiti igienico ambientali definiti nell’Accordo “Stato–Regioni” del 16 gennaio 2003: una maggiore attenzione deve essere posta, a nostro avviso, ad alcuni parametri quali ad es la temperatura dell’aria ambientale che se non conformi possono condizionare le condizioni di comfort/discomfort, non solo degli utenti ma anche di coloro che lavorano in tali ambienti.
2008
- Sorveglianza delle infezioni in terapia intensiva postoperatoria dell’Azienda Ospedaliera-Universitaria Policlinico di Modena
[Abstract in Rivista]
Righi, Elena; Girardis, Massimo; Assenza, Silvia; Donno, Lara; Morandi, Matteo; Zambelli, Ilaria; Aggazzotti, Gabriella
abstract
La Terapia Intensiva Post Operatoria (TIPO) dell’Azienda Policlinico di Modena aderisce al Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI), e partecipa al Petalo “Sorveglianza Infezioni” con l’obiettivo di descrivere l'epidemiologia delle infezioni nei reparti di terapia Intensiva (TI) in Italia, di individuare e descrivere i principali fattori di rischio e fattori prognostici delle infezioni e di confrontare i diversi reparti in termini di incidenza di infezioni e loro gravità, di flora batterica prevalente, di incidenza di infezioni sostenute da germi multiresistenti.Nell’anno 2006 sono stati sorvegliati 767 soggetti; al momento dell’ammissione in TIPO 43 di essi presentavano infezioni (incidenza cumulativa di infezione all’ammissione: 5,6%). Durante la degenza 45 soggetti hanno poi acquisito una o più infezioni (incidenza cumulativa di infezione acquisita durante la degenza: 5,9%). Trenta polmoniti sono insorte durante la degenza; tra quelle manifestate dopo 48 h di ventilazione artificiale, 8 sono risultate sicuramente associate a ventilazione meccanica invasiva (VAP) (incidenza cumulativa 1.0%). Tra le batteriemie acquisite dai soggetti durante la degenza 3 sono risultate sicuramente associate all’utilizzo di catetere venoso centrale (CVC) evidenziando una incidenza cumulativa pari a 0.4%.Almeno la metà degli episodi infettivi insorge entro la terza giornata di degenza (mediana 3 giorni; media 4.3 ±5 giorni). Infezioni multiple sono state osservate in 15 soggetti (62.5% degli infetti). I microrganismi più frequentemente associati ad infezioni appartengono al genere stafilococco (43.9% degli isolamenti) ed in particolare molto diffuso è risultato Staphylococcus aureus (16 isolamenti). Anche Enterococchi (10 isolamenti) e Candide (10 isolamenti), in particolare Candida albicans, risultano diffusi. Microrganismi resistenti (appartenenti ai generi Pseudomonas e Stenotrophomonas) sono stati isolati in 6 episodi infettivi (14.6%). I dati rilevati risultano in linea con quanto osservato nelle altre TI aderenti Petalo “Sorveglianza Infezioni” del GiViTI.
2007
- Determinazione di tricloroammina nell’aria ambientale di piscine coperte: aspetti metodologici
[Abstract in Rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; L., Caporali
abstract
Recentemente si è sviluppato un notevole interesse nello studio degli effetti di tipo irritativo per le vie aeree dovuto a triclorammina (NCl3) per i frequentatori degli impianti natatori, soprattutto per i bambini e gli addetti quotidianamente esposti. Scopo della presente indagine è stato quello di testare un nuovo metodo per la determinazione di triclorammina nell'aria delle piscine coperte. In 14 piscine comunali nella regione Emilia Romagna sono stati valutati i livelli di triclorammina nell'aria secondo una nuova metodica che si basa sull'intrappolamento di NCl3 per gorgogliamento d'aria in una soluzione acquosa contenente Dietil Parafenilen Diammina (DPD) e Potassio Ioduro (KI). Per ciascun campionamento sono stati fatti gorgogliare con una pompa (A.P. Buck, Inc) 100 litri di aria ad una velocità di aspirazione di 1 l/min. Sulla soluzione così ottenuta è stata effettuata l'analisi quantitativa direttamente a bordo vasca, utilizzando il metodo colorimetrico impiegato per le determinazioni del cloro libero e combinato nell'acqua (Palin, 1960) con il fotometro portatile PC-compact (Aqua Lytic).La concentrazione media di NCl3 nell'aria ambientale delle 14 piscine indagate è risultata di 594 ± 179 µg/m3 con un valore massimo di 1020 µg/m3. Per quanto riguarda il cloro libero e combinato nell'acqua, i valori medi sono risultati di 1,4 ± 0,3 mg/l Cl2 e di 0.5 ± 0.2 mg/l Cl2, rispettivamente. I valori di cloro residuo combinato nei campioni di acqua ed i valori ambientali di NCl3 non appaiono significativamente correlati in questa prima fase di indagine. L'intervallo di valori ottenuti è confrontabile con i dati riportati in letteratura basati sul metodo di quantificazione di Hery (1995). La metodica proposta, in corso di validazione, ha il vantaggio di non utilizzare Arsenico (As) e risulta di più facile applicazione in quanto non prevede l'utilizzo di apparecchiature complesse ma di strumentazione già normalmente impiegata nel settore delle piscine.
2007
- Disinfection by-products in drinking water: a comparison between chlorine and chlorine dioxide
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi
abstract
To evaluate Disinfection By Products (DBPs) and relative amounts in drinking water following chlorine and/or chlorine dioxide treatments in comparison. In July 2005 to February 2006 12 waterworks (managed by Agenzia d'Ambito per i Servizi Pubblici di Modena-ATO) in Northern Italy were sampled twice, in summer and winter. In each sampling session 4 samples were collected: just before and immediately after the treatment, at the tap close to the disinfection plant and far from the plant. Main DBPs (trihalomethanes, chlorite, chlorate, bromate, and haloacetic acids) were investigated by headspace gas chromatography and ionic chromatography/mass spectrometry techniques.Nine water networks were supplied by ground water and 3 by mixed spring and surface water: chlorine was used for disinfection in 4 water systems and chlorine dioxide in 8. Bromate and haloacetic acids were never evidenced, whereas trihalomethanes showed very low values, increasing according to the distance from the disinfection plant and higher in summer. In chlorine dioxide-treated samples THMs ranged from <0.01 to 1 μg/L, whereas in chlorine-treated they ranged from 0.3 to 25 μg/L. Brominated THMs were measured at detectable levels in chlorine-treated samples only (range: 0.1-1 μg/L). Chlorite was evidenced in chlorine dioxide-treated samples only (range: 21-290 μg/L). Chlorate was measured in samples collected from all water networks (range: 2-276 μg/L).Neither chlorine nor chlorine dioxide form THMs at high levels in our samples; this is due to source water, which contains very low levels of organic substance even in case of surface water. Chlorite, produced by chlorine dioxide only, deserves attention as little information is available on its chemical reactions and fate in drinking water within water systems. More important to be investigated is the presence of chlorate, unexpectedly present in several water samples whatever disinfection treatment is used.
2007
- Environmental monitoring of Disinfection by-products (DBPs) in water and air in indoor swimming pools
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi
abstract
To evaluate the presence of volatile (THMs) and nonvolatile [chlorite, chlorate, bromate, haloacetic acids (HAAs)] disinfection by-products (DBPs) in indoor swimming pools.Some indoor swimming pools in Emilia Romagna region (Northern Italy) were visited and water and environmental air samples were collected. Sodium hypochlorite or dichloroisocyanurate were involved in water disinfection treatments. THMs in water and air were evaluated by head-space gas chromatographic technique, whereas HAAs, bromate, chlorite, chlorate in water were detected by ion chromatography with mass spectrophotometry.THMs were always present in pool water (range: 27-98 μg/L) and in environmental air (range: 39-119 μg/m3), with chloroform as the main by-product. Levels in air were persistent and higher above and around the pool than in the surroundings. Bromate was never found while among HAAs monochloro, dichloro, and trichloroacetic acids were measured in all water samples (range: 109-387 μg/L). Chlorite in pool water was rarely evidenced, whereas it was always present in water supplying the pool. Chlorate was present in source water and also in pool water samples showing unexpectedly high concentrations (range: 192- 12,537 μg/L), with an increase of about 50 times with respect to source water.THMs, as index of the total amount of volatile DBPs, represent an additional source of human exposure as present in water and air. Among nonvolatile DBPs, only HAAs and chlorate were detected, sometimes at very high levels. Chlorate, usually considered as a by-product when drinking water treatment is made by chlorine dioxide, seems associated with disinfection processes usually adopted for swimming pool water, such as sodium hypochlorite or dichloroisocyanurate. The origin and chemical reactions of nonvolatile DBPs deserve further evaluation to refine exposure for subjects attending indoor swimming pools.
2007
- Esposizione a sostanze chimiche in piscina
[Capitolo/Saggio]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino
abstract
Diversi composti chimici potenzialmente dannosi per la salute umana, quali alghicidi, correttori del pH, coagulanti/flocculanti, disinfettanti e sottoprodotti della disinfezione delle acque (DBPs), possono essere presenti nell'acqua e nell'aria delle piscine. Le possibilità di esposizione attraverso la via cutanea, inalatoria e orale a queste sostanze, ed in particolare ai DBPs, da parte dei frequentatori di piscine vengono qui analizzate e discusse.
2007
- Malformazioni congenite ed esposizione a sottoprodotti della disinfezione (DBPs) nella acque potabili in Emilia Romagna: protocollo di uno studio nell’ambito del VI programma quadro dell’Unione Europea
[Abstract in Rivista]
Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; Giacobazzi, Pierluigi; L., Caporali; E., Calzolari; F., Rivieri; P., Lauriola; Bechtold, PETRA ELISABETH; D., Tortrici
abstract
Il programma di ricerca europeo “Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water (HiWate)” ha come principale obiettivo la valutazione dei potenziali effetti sulla salute umana, cancerogeni e riproduttivi, esercitati dall’esposizione a sottoprodotti della disinfezione nelle acque potabili (DBPs). L’Università di Modena e Reggio Emilia coordina gli studi epidemiologici sulla sfera riproduttiva e conduce uno studio caso-controllo sulle malformazioni congenite il cui protocollo viene qui presentato. Le malformazioni considerate coinvolgono difetti del tubo neurale; del sistema cardiovascolare; della parete addominale; delle labbra e del palato; dell’apparato respiratorio; degli organi genitali (ipospadie) e dell’apparato urinario. Lo studio prevede l’arruolamento di tutti casi delle malformazioni selezionate verificatisi in Emilia Romagna nel periodo gennaio 2002-dicembre 2005 (totale nati nel periodo: 147.910; totale malformazioni selezionate 1251) e prevede la selezione con modalità random di 3 controlli per caso tra tutti i bambini privi di malformazioni nati nello stesso periodo. L’esposizione a DBPs durante il primo trimestre di gravidanza viene valutata identificando tra gli oltre 2000 acquedotti attivi nella regione, l’impianto responsabile della distribuzione delle acque potabili presso l’abitazione delle madri e associando ai soggetti le concentrazioni dei principali DBPs osservate in quel periodo in quell’acquedotto. Vengono considerate anche informazioni aggiuntive quali il tipo di disinfezione effettuato, la natura e le principali caratteristiche dell’acqua di approvvigionamento e di quella distribuita in rete. I livelli espositivi dei casi e dei controlli verranno confrontati e adeguate misure di associazione (ORs) verranno calcolate considerando anche potenziali confondenti quali le caratteristiche socio-demografiche e la storia riproduttiva dei soggetti. Principali fonti informative sono il registro Malformazioni della Regione Emilia Romagna (IMER), le schede CEDAP e SDO, l’Agenzia Regionale Prevenzione e Ambiente (ARPA) Emilia Romagna e il Servizio Veterinario e Igiene degli alimenti della Regione Emilia Romagna. Lo studio è iniziato nel gennaio 2007 e terminerà nel luglio 2009.
2007
- Preterm delivery and exposure to active and passive smoking during pregnancy: a case-control study from Italy
[Articolo su rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Facchinetti, Fabio; Bertucci, Emma; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
The aim of this study was to assess the relationship between preterm/early preterm delivery and active smoking as well as environmental tobacco smoke (ETS) exposure in a sample of pregnant Italian women. A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of preterm birth were singleton babies born before the 37th gestational week; babies born before the 35th gestational week were considered early preterm births. Controls were babies with gestational ages ≥ 37th week. A total of 299 preterm cases (including 105 early preterm) and 855 controls were analysed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. Multivariable logistic regression analysis showed a relationship between active smoking during pregnancy and preterm/early preterm delivery [adjusted ORs: 1.53; 95% CI 1.05, 2.21 and 2.00; 95% CI 1.16, 3.45, respectively]. A dose-response relationship was found for the number of cigarettes smoked daily. The adjusted ORs were 1.54 and 1.69 for preterm babies and 1.90 and 2.46 for early preterm babies for 1-10 and >10 cigarettes/day respectively. ETS exposure was associated with early preterm delivery [adjusted OR 1.56; 95% CI 0.99, 2.46] with a dose-response relationship with the number of smokers in the home. Smoking during pregnancy was strongly associated with preterm delivery with a dose-response effect. ETS exposure in non-smoking women was associated only with early preterm delivery.
2007
- Valutazione del confort termico negli addetti alle piscine coperte: risultati preliminari
[Abstract in Rivista]
Righi, Elena; Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Giacobazzi, Pierluigi; L., Caporali
abstract
Obiettivi: E’ stato avviato un progetto di ricerca mirato a valutare le condizioni microclimatiche nelle piscine coperte al fine di valutare il benessere termico dei soggetti professionalmente esposti.Materiali e metodi: Sono stati monitorati 14 impianti natatori della regione Emilia Romagna ed arruolati, su base volontaria, 107 lavoratori del settore. Ciascun campionamento ha previsto l’utilizzo di un multiacquisitore Babuc (LSI-Lastem) per la registrazione dei parametri termoigrometrici e di ventilazione. Parallelamente, è stato somministrato un questionario di raccolta dati personali per definire i parametri anagrafici, anamnestici e di vestiario che permettono di calcolare gli indici di comfort termico di questi ambienti.Risultati: Il monitoraggio microambientale ha evidenziato valori medi di umidità relativa pari al 61.7%, di temperatura radiante di 27.81.8°C e una velocità dell’aria pari a 0.11m/s. E’ stato rilevato un valore medio di illuminamento pari a 892 lux. Il gruppo di lavoratori (età compresa tra 20 e 55 anni) è prevalentemente composto da donne (59%) con un’anzianità lavorativa media di 8.3 anni. I soggetti esaminati svolgono per lo più attività a bordo vasca (57%) ed indossano vestiario che offre un isolamento termico pari a 0.270.08 Clo. Il “voto medio previsto” (PMV) è risultato pari a 0.7 con una “percentuale prevista di insoddisfatti” (PPD) del 20.7%.Conclusioni: Gli addetti alle piscine coperte della regione Emilia Romagna sono esposti ad un ambiente occupazionale che rispetta i valori indicati dall’attuale legislazione (Accordo Stato Regioni–16 gennaio 2003, Accordo Interregionale 2004). Il microclima medio degli impianti natatori indagati può essere definito come termicamente accettabile anche se tendente ad una condizione più calda rispetto al range di comfort termico previsto dalla normativa UNIEN-ISO 7730 che definisce un valore di PMV compreso tra -0.5 e 0.5.
2007
- Valutazione dell’esposizione a composti organoalogenati nelle acque potabili di 9 Province italiane: indagine sulla presenza di cloriti, clorati, trialometani, trielina e tetracloetilene.
[Articolo su rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; S., Kanitz; F., Barbone; G., Sansebastiano; C., Ricci; V., Leoni; L., Fabiani; M., Triassi; S. SCIACCA E., COLLABORATIVE GROUP FOR THE STUDY OF CHLORINATED DRINKING WATER AND PREGNANCY
abstract
This study investigated the exposure to organohalogens compounds in drinking water from 9 Italian towns (Udine, Genova, Parma, Modena, Siena, Roma, L'Aquila, Napoli and Catania). Overall, 1199 samples collected from 72 waterworks were analyzed. THMs, trichloroethylene and tetrachloroethylene were evaluated using the head-space gas chromatographic technique (detection limit of 0.01 microg/l; chlorite and chlorate analysis was performed by ion chromatography (detection limit of 20 microg/l). THMs were evidenced in 925 samples (77%) (median value: 1.12 micro/l; range: 0.01-54 mciro/l) and 7 were higher than the THMs Italian limit of 30 microg/l. Chlorite and chlorate levels were higher than the detection limit in 45% for chlorite and in 34% for chlorate samples; median values were 221 microg/l and 76 microg/l, respectively. Chlorite values were higher than the chlorite Italian limit (700 microg/l) in 35 samples (8.7%). Trichloroethylene and tetrachloroethylene were measured in 29% and 44% of the investigated samples and showed values lower than the Italian limit (highest levels of 6 microg/l and 9 microg/l, respectively). The low levels detected of THMs, trichloroethylene and tetrachloroethylene have no potentials effects on human health, whereas, the levels of chlorite and chlorates should be further evaluated and their potential effects for the populations using these drinking waters, better understood
2006
- Chlorinated drinking water exposure and bladder and colon-rectum cancers in the province of Modena (Northern Italy): An ecological study
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; A., Biggeri; Aggazzotti, Gabriella
abstract
Introduction: Different by-products in chlorinated drinking waters, including cloroform, brominated trihalomethanes and halacetones, are causing concern over human health, due to their potential carcinogenicity. Epidemiological studies have reported exceeding risks for bladder, colon and rectum cancers in subjects living in areas where chlorinated drinking waters are distributed in comparison with subjects living in areas where no chlorinated drinking water is used. However, up to now, major difficulties in assessing past-exposure do not allow to formulate final conclusions. An Italian association on cancer research has recently granted a study with the aim to evaluate the relationship between chlorinated drinking water consumption and the incidence of bladder and colon-rectum cancers in the province of Modena (Northern Italy).Methods: This study has an ecological design: the units are the 47 municipalities in the province of Modena and the outcomes the incidence rates of bladder (IX-ICD:188), colon (IX-ICD:153) and rectum (IX-ICD:154) cancer, observed in these areas in 1988-94 as reported by Modena Cancer Registry. To evaluate each municipality exposure, information on the main characteristics (disinfection treatment, source and quality) of drinking waters were collected asking local waterworks managers to fill in a questionnaire. As in the mountainous municipalities many little springs represent the watersource, many waterplants are operative inside each unit (overall, more than 200 waterplants were identified). In this case municipality exposure was evaluated by combining information collected by each waterwork. A municipality was considered exposed if in 1980-90 drinking waters were disinfected with chorine. Hierarchical Bayesian methods were applied to calculate smoothed standardized incidence rates (SIRs), relative risks (RRs), and 95% CI.Results: The overall incidence of bladder, colon and rectum cancer in Modena in 1988-1994 was 24.6, 30.5 and 15.8 (x104) respectively. Spatial differences were observed mainly for bladder cancer. In subjects living in areas supplied in 1980-1990 by chlorinated drinking waters in comparison with subjects living in areas supplied by untreated drinking waters an increased risk for bladder cancer (RR = 1.17; 95% CI: 1.02-1.37) was observed, while no differences were evidenced for colon (RR = 1.07; 95% CI: 0.96-1.24) and rectum (RR = 1.02; 95% CI: 0.90-1.16) cancer. Ecological covariates, including population density and % of subjects living in the same house in period 1980-1990 in each municipality were included in the model.Conclusion: Nevertheless the difficulties in determining past-exposure and the weaknesses of the study design (ecological fallacy), this study suggests, in accordance with literature data, an exceeding risk for bladder cancer in subjects living in areas where chlorinated drinking waters are supplied.
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
abstract
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
- Nonsurgical management of blunt splenic injury: our preliminary experience.
[Abstract in Rivista]
Trenti, Loris; Ranieri, Valerio; Zaccherini, Luca; Sforza, N; Marcella, M; Bertocchi, C; Amorino, Mg; Righi, Elena; Rossi, Aldo
abstract
Splenic injury is a common finding in patients after blunt abdominal trauma. Traetment of splenic rupture has been shifted from total splenectomy to nonoperative management (MOM) and conservative surgery (CS) in the absence of haemodynamic instability and other intrabdominal injuries requiring laparotomy. Controversy exits about selection of patients for NOM or CS.
2006
- Sottoprodotti della clorazione ed altri composti alogenati nelle acque potabili della Provincia di Modena
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Giacobazzi, Pierluigi; Aggazzotti, Gabriella
abstract
Obiettivo di questa indagine è stato quello di identificare nelle acque potabili della Provincia di Modena i principali sottoprodotti della clorazione quali trialometani (THMs), clorito, clorato, bromato e acidi aloacetici (HAAs) ed altri composti indicatori di inquinamento urbano e industriale. Nel periodo luglio 2005 – febbraio 2006 sono stati effettuati prelievi in 12 reti idriche della Provincia di Modena. Ogni acquedotto è stato campionato in due diverse stagioni; per ogni campionamento sono stati raccolti 4 campioni di acqua (prima della disinfezione, subito dopo il trattamento, in rete a breve distanza dall’impianto e sempre in rete lontano dall’impianto).Gli HAAs e il bromato sono risultati sempre assenti in tutte le reti indagate, mentre i THMs sono risultati dosabili nel 35% dei campioni e sono risultati sempre inferiori al limite di 30 µg/l previsto dall’attuale normativa italiana (valore massimo osservato: 25,5 µg/l). Cloriti e clorati sono risultati dosabili rispettivamente nel 48% e nel 89% dei campioni con valori più elevati nei mesi invernali. In alcuni casi il clorito è risultato superiore ai 200 mg/l, limite che entrerà in vigore nel 2007, ma mai superiore ai 800 mg/l, limite attualmente in vigore.Lo ione clorato è risultato presente (max: 276 µg/l in un acquedotto) in quasi tutti i campioni di acqua, indipendentemente dal tipo di disinfettante utilizzato. Relativamente agli altri composti indagati, in quattro reti idriche è stata evidenziata la presenza in tracce di trielina, percloroetilene, metilcloroformio e tetracloruro di carbonio.Dai risultati ottenuti si può affermare che le acque potabili della Provincia di Modena sono di buona qualità, sia per quanto riguarda le acque di alimentazione che le acque distribuite in rete, e che la concentrazione dei vari composti indagati non devono destare preoccupazioni per quanto riguarda la salute della collettività.
2006
- Sulla presenza di composti alogenati organici in acque potabili italiane
[Abstract in Rivista]
Righi, Elena; Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Giacobazzi, Pierluigi; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
Numerose indagini hanno documentato la presenza nelle acque potabili di composti alogenati organici come conseguenza di fenomeni di inquinamento ambientale o di trattamenti di disinfezione (DBPs). Trialometani (THMs), cloriti e clorati sono i DBPs più diffusi: la loro presenza è associata ad un aumentato rischio di tumori, soprattutto della vescica e del colon, e di effetti tossici sulla gravidanza. Tricloroetilene e tetracloroetilene sono legati a fenomeni di inquinamento e rappresentano un rischio per la salute umana di tipo prevalentemente tossico. Scopo di questa indagine è stato quello di indagare sulla presenza dei principali composti alogenati organici nelle acque potabili distribuite in 9 città italiane (Udine, Genova, Parma, Modena, Siena, Roma, L’Aquila, Napoli e Catania). Complessivamente sono stati analizzati 1199 campioni provenienti da 72 reti idriche. THMs, tricloroetilene e tetracloroetilene sono stati indagati mediante gascromatografia in spazio di testa statico, (detection limit: 0.1µg/l); cloriti e clorati mediante cromatografia a scambio ionico (detection limit: 20µg/l).Per quanto riguarda i DBPs, THMs sono stati ritrovati in 874 (73%) campioni (valore mediano: 1.2µg/l; range:0.1-55µg/l) e solo 7 campioni hanno presentato valori superiori a 30µg/l, limite di legge italiano. Cloriti e clorati, rilevabili nel 45% e 34% dei campioni esaminati presentano un valore mediano rispettivamente di 221µg/l e 76.0µg/l. I valori di cloriti sono risultati superiori al limite di 200µg/l in vigore dal 2007 in 213 campioni (24%). Tricloroetilene e tetracloroetilene, rilevati nel 19.3% e 18.1% dei campioni, presentano concentrazioni sempre inferiori ai limiti di legge (valori massimi osservati 6µg/l e 9µg/l, rispettivamente). I ridotti livelli di THMs, tricloroetilene e tetracloroetilene rilevati depongono per l’assenza di preoccupazioni di tipo sanitario per le popolazioni che utilizzano queste acque a scopo potabile. Tuttavia la presenza, in qualche occasione, di cloriti in concentrazioni elevate indica la necessità di ulteriori approfondimenti e controlli.
2006
- Work-related injuries in young workers: an Italian multicentric epidemiological survey.
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Patorno, Elisabetta; Fantuzzi, Guglielmina; L., Fabiani; A. R., Giuliani; I., Grappasonni; F., Petrelli; W., Ricciardi; G., LA TORRE; S., Sciacca; I., Angelillo; A., Bianco; C., Nobile; P., Gregorio; S., Lupi; V., Perlangeli; C., Bonazzi; F., Laviola; M., Triassi; E., Iorfida; S., Montegrosso; P., Rivosecchi; Mc, Serra; E., Adorisio; A., Gramoccia; I., Mura; P., Castiglia; G., Romano; A., Poli; S., Tardivo
abstract
Emergency departments records from 33 hospitals were reviewed to disclose work-related injuries occurred in teen-subjects living in 14 Italian cities. During January-June 2000, 317 work-related injuries were reported. Male subjects, 17 year old, working in the industrial field, resulted the most affected,probably due to the fact that among young workers this sex and age class is the most represented one. Cluster analysis identified two groups of work-related injuries: one includes mainly transportation injuries causing lower extremities or multiple body sites traumas. The other is more strictly related to specific working tasks and includes mostly traumas and cut wounds in hand/wrist and head, together with eye lesions. A more intensive supervision on the use of protective equipment, a more appropriate training in hazard recognition and safe work practices, including operation of vehicles in the work site, must be implemented to reduce work-related injuries.
2005
- Active smoking and environmental tabacco smoke (ETS) exposure in pregnancy and preterm/very preterm delivery: a multicentric italian study
[Abstract in Rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
Introduction: Smoking during pregnancy is a well recognized risk of preterm delivery while ETS exposure is still questionable. The aim of this study is to assess the relationship between active smoking and ETS exposure with preterm/very preterm delivery.Methods: A case control study was carried out in Italy during October 1999 and September 2000 in nine cities. Singleton babies born between 26th and 37th week were considered as cases (among them, babies born between 26th and 35th week were considered very preterm cases). Controls (babies of gestational age >37th week) were enrolled among singleton births occurred in the same hospitals within a few days after the case delivery. A total of 299 preterm cases (including 105 very preterm) and 855 controls were considered. A self-administrated questionnaire was used to assess exposure.Results: The prevalence of active smoking during pregnancy was 14.8% among controls and 20.2% among cases. ETS exposure (yes/no) during pregnancy was reported in 34.7% of controls and 37.4% of cases. Multivariate logistic regression analysis was carried out adjusting for maternal age, previous preterm deliveries, miscarriages, and hypertension. A relationship was observed between active smoking during pregnancy and preterm/very preterm delivery (adjusted ORs: 1.58; 95%CI 1.10-2.28 and 2.06; 1.21-3.51, respectively). A dose-response relationship according to the number of cigarettes/day (none, < 10 and > 10) was observed (adjusted ORs: 1. 54 and 1.69 for preterm babies and 1.90 and 2.46 for very preterm babies). No association was observed between ETS exposure and preterm delivery on the whole, while when taking into account the subset of very preterm cases, the adjusted OR is 1.66 (95% CI 1.06-2.59) with a dose response according to the number of cohabitant smokers (none, 1, 2 or more subjects) (Adjusted ORs 1.47 and 3.57 respectively). When classifying, considering both active smoking and ETS exposure (no active smoking/no ETS exposure as referent) ETS exposure in non-smokers is associated with very preterm delivery (Adjusted OR 1.70; 95% CI: 1.01-2.86).Discussion: Smoking during pregnancy is strongly associated with preterm delivery, with a dose-response. ETS exposure in non-smoker women is associated with very preterm delivery only.
2005
- Active smoking and environmental tabacco smoke (ETS) exposure in pregnancy and small for gestational age at term (term SGA): a multicentric italian study
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
Introduction: Smoking during pregnancy and ETS exposure are recognized risk factors of term SGA: the aim of this study was to assess the strength of the relationship between these factors in a wide sample of Italian pregnant women.Methods: A case control study was carried out in Italy during October 1999 and September 2000 in nine Italian cities. Singleton children born 37th week weighted under the lowest 10th percentile were considered as cases, while controls were enrolled among singleton babies weighted 10th percentile born in the same hospitals within a few days after the case delivery. A total of 345 cases and 855 controls were considered. A previously validated self-administered questionnaire was used to assess exposure.Results: The prevalence of active smoking during pregnancy was 14.8% among controls and 28.6% among cases. ETS exposure (yes/no) during pregnancy was reported in 34.7% of controls and 41.5% of cases. Multivariate logistic regression analysis was carried out adjusting for gender, previous SGA babies, coffee consumption. Active smoking during pregnancy shows an adjusted OR = 2.12 (95%CI: 1.54-2.92), with a dose response according to the number of cigarettes/day (none, less than 10 and 10: adjusted ORs: 1.95 and 2.57 respectively). ETS exposure and term SGA on the whole, regardless of smoking status, show an adjusted OR = 1.27; 95%CI: 0.97-1.66; when there are two or more smokers at home, the risk value is 2.49 (95%CI: 1.33-4.64). When classifying considering active smoking, smoking habits before pregnancy and ETS exposure (both no active smoking before and during pregnancy and no ETS exposure as referent) non-smoker women exposed to ETS show an adjusted OR of 1.32 (95%CI: 0.92-2.89). In active smokers, the association is very similar between subjects with and without ETS exposure (adjusted ORs = 2.12, 95%CI: 1.42-3.16 and 1.96, 95%CI: 1.17-3.26).Discussion: This study confirms the strong association between maternal smoking during pregnancy and term SGA. ETS exposure in active smokers does not increase the risk, while in non-smokers there is a slight but non-significant association
2005
- Consumo di caffè e bevande contenenti caffeina durante la gravidanza ed effetti sulla sfera riproduttiva
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
Obiettivi: Valutare l’associazione tra il consumo materno di caffeina durante la gravidanza e il basso peso alla nascita e la nascita pretermine.Metodi: E’ stato condotto uno studio epidemiologico di tipo caso – controllo nel periodo ottobre 1999 – settembre 2000 in nove città italiane (Genova, Udine, Modena, Parma, Siena, Roma, L’Aquila, Napoli e Catania).Sono stati identificati come casi 364 bambini nati sottopeso (neonati a termine ma con peso < al 10° P) e 229 bambini nati pretermine (26ma – 37ma settimana di gravidanza). Sono stati arruolati come controlli 855 bambini nati a termine normopeso.Il consumo di caffè durante la gravidanza è stato valutato mediante la somministrazione di un questionario autocompilato, in cui erano contenute domande sul consumo quotidiano di caffè, cappuccini, ed altre bevande a base di caffeina. Inoltre, sono state raccolte informazioni su altri fattori quali l’età materna, scolarità, stato coniugale, parità, precedenti figli di basso peso alla nascita o parti pretermine, diabete ed ipertensione, e abitudini personali quali il fumo e il consumo di alcolici.Risultati: Dai risultati dell’analisi univariata è emerso una associazione tra basso peso alla nascita nei bambini le cui madri avevano bevuto caffè durante l’ultimo trimestre di gravidanza (OR: 1,36, 95% CI; 1,05 – 1,76). Questo dato è stato confermato anche dalla analisi della regressione logistica multipla: dopo aver controllato per numero di sigarette fumate, età, diabete ed ipertensione si è osservato un OR di 1,32 (95% CI: 0,99 – 1,74). Nessuna associazione è stata evidenziata con la nascita pretermine.Conclusioni: In base a questi risultati si osserva un’associazione, anche se debole, tra consumo di caffè e bevande contenenti caffeina e la presenza di basso peso alla nascita a termine.
2005
- Determinazione di acidi aloacetici ed altri sottoprodotti della disinfezione (DBPs) nelle acque di piscina tramite cromatografia ionica/spettrometria di massa (IC/MS)
[Abstract in Rivista]
Fantuzzi, Guglielmina; Predieri, Guerrino; S., Cavalli; Righi, Elena; Aggazzotti, Gabriella
abstract
Obiettivi: I trattamenti di disinfezione tramite prodotti a base di cloro delle acque di piscina producono sottoprodotti (DBPs), quali Trialometani (THMs) in elevata quantità ma anche Acidi Aloacetici (HAAs) ed altri composti recentemente individuati e studiati. L’obiettivo di questa ricerca è stato quello di indagare sulla presenza di questi composti nelle acque di piscina della città di Modena. Metodi: I THMs sono stati ricercati utilizzando una collaudata tecnica gascromatografica in spazio di testa statico (HSS-HRGC-ECD); gli HAAs ed eventuali altri DBPs (cloriti, clorati e bromati) sono stati analizzati tramite cromatografia ionica accoppiata ad uno spettrometro di massa (IC/MS). La ricerca ha coinvolto 4 piscine coperte (7 vasche in totale) della città di Modena, visitate 5 volte tra febbraio-marzo 2005. Due piscine (4 vasche) utilizzano per la disinfezione delle acque calcio ipoclorito e 2 piscine (3 vasche) sodio isocianurato (DCN). Risultati: Le analisi hanno evidenziato concentrazioni di DBPs mediamente più elevate nelle piscine trattate con calcio ipoclorito rispetto a quelle trattate con DCN. In particolare è stata rilevata la presenza di clorato a valori più elevati nelle acque trattate con ipoclorito di calcio (valore max: 799.1 ppb). Per quanto riguarda gli HAAs i livelli di tali composti superano sempre il limite indicato dall’EPA per le acque potabili (60 ug/l).Conclusioni: La ricerca di DBPs nelle acque di piscina evidenzia una maggiore formazione di tali sostanze quando la disinfezione è condotta mediante ipoclorito di calcio. I THMs hanno evidenziato concentrazioni pari a qualche decina di ug (max: 57.5 ug/l) mentre gli elevati valori HAAs meritano attenzione dato che tra essi è compreso l’acido dibromoacetico (DBA) classificato 2B dalla IARC. Resta da indagare ulteriormente la elevata concentrazione di clorato, derivante probabilmente dall’ipoclorito di calcio che può contenere tale sostanza come impurezza.
2005
- Recenti sviluppi strumentali nella determinazione simultanea di sottoprodotti della disinfezione (DBPs) nelle acque potabili
[Abstract in Rivista]
Righi, Elena; Predieri, Guerrino; S., Cavalli; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
OBIETTIVI: I sottoprodotti della disinfezione (DBPs) delle acque potabili sono stati associati a possibili danni per la salute umana. La determinazione qualitativa e quantitativa di alcuni di questi composti quali acidi aloacetici, cloriti, clorati e bromati è complessa, date anche le concentrazioni solitamente ridotte. E’ stato messo a punto un metodo analitico che consente la simultanea analisi di tali composti in campioni di acqua potabile, al fine di valutare l’esposizione umana a queste sostanze per svolgere adeguate indagini epidemiologiche.METODI: E’ stato ottimizzato un metodo di cromatografia ionica associata alla rivelazione mediante spettrometria di massa (IC/MS) impiegando una colonna di nuova generazione (AS 19) in grado di separare i composti di interesse anche in presenza di elevate concentrazioni di cloruri, solfati e nitrati, sali presenti naturalmente nelle acque da trattare di solito ad alti livelli in acque di origine profonda. Questo sistema permette l’iniezione diretta fino a 500 ul di campione senza pretrattamenti o concentrazioni.RISULTATI: La metodica ha evidenziato una sensibilità anche migliore rispetto a quanto previsto dal Decreto Legislativo 31/2001 (attuazione della direttiva 98/83/CE relativa alla qualità delle acque destinate al consumo umano) per quanto riguarda clorito e bromato (20 ug/l e 2 ug/l, rispettivamente). Per clorato e acidi aloacetici si è raggiunto un valore di sensibilità di 1 ug/l.CONCLUSIONI: Nonostante la complessità della strumentazione impiegata la metodologia qui presentata permette di analizzare simultaneamente questi DBPs, anche se presenti a basse concentrazioni, tramite iniezione diretta del campione. In tal modo è possibile disegnare studi epidemiologici che si basano su di una misura della esposizione umana più valida e più precisa.
2004
- Aspetti del rischio biologico e chimico in piscina
[Abstract in Rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
I principali aspetti igienico sanitari per la costruzione, la manutenzione e la vigilanza delle piscine ad uso natatorio definiti dal recente accordo fra il Ministro della Salute, le Regioni e le Province autonome di Trento e Bolzano ed altri indicatori di rischio chimico e biologico vengono qui discussi ed approfonditi
2004
- Chlorination By-Products (CBPs) in drinking water and adverse pregnancy outcomes in Italy
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; B., Biasotti; G., Ravera; S., Kanitz; F., Barbone; G., Sansebastiano; M. A., Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., SCIACCA AND COLLABORATIVE GROUP FOR THE STUDY OF CHLORINATED DRINKING WATERS AND PREGNANCY
abstract
Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th–37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers’ personal habits during pregnancy and by water sampling directly at mothers’ homes.Levels of trihalomethanes (THMs) were low (median: 1.10 µg l−1), while chlorite and chlorate concentrations were relatively high (median: 216.5 µg l−1 for chlorites and 76.5 µg l−1 for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels ≥200 µg l−1 combined with low and high levels of inhalation exposure are considered, suggested adose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91–2.54 and 1.70, 95%CI: 0.97–3.0, respectively). A weak association with high exposure levels of either THMs (≥30 µg l−1), or chlorite or chlorate (≥200 µg l−1) was also found (adjusted-OR: 1.38, 95%CI: 0.92–2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.
2004
- Composti Alogenati Organici Volatili (AOV) nelle acque minerali naturali e in altre bevande di largo consumo
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Ma, Pinotti; Aggazzotti, Gabriella
abstract
74 mineral natural water samples and 56 samples of different commercial drinks have been analysed by head-space chromatography in order to evidence the presence of volatile halogenated organic compounds (VHO). Trihalomethanes (THM) as drinking water chlorination by-products and trichloroethane, carbon tetrachloride, trichloroethylene and tetrachloroethylene as ubiquitarious substances have been investigated.The presence of WHO has been evidenced in 20,3% of mineral natural water samples and in the 58,9% of the commercial soft drinks: this latest group has usually shown higher levels of the investigated compounds. The results of the present study has been compared with a similar study performed in 1991 in the same area: the WHO values observed in the present study appear to be lower than those obtained in the previous study.
2004
- Il fenomeno infortunistico nei minori: analisi descrittiva
[Abstract in Rivista]
Patorno, Elisabetta; Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; L., Fabiani; I., Grappasonni; G., Ricciardi; G., La torre; S., Sciacca; I., Angelillo; P., Gregorio; C., Bonazzi; M., Triassi; P., Rivosecchi; L., Sebastiani; I., Mura; G., Romano; il gruppo di studio sull’infortunistica nel lavoro, Minorile
abstract
L'infortunistica nei minori è stata affrontata in uno studio multicentrico finanziato dal Ministero del Lavoro e della Previdenza Sociale e condotto organizzando un rete di raccolta di informazioni presso i posti di pronto soccorso di 14 città italiane. In questa sede vengono presentani i principali risultati di tale indagine.
2004
- Is JPEG compression of videomicroscopic images compatible with telediagnosis? Comparison between diagnostic performance and pattern recognition on uncompressed TIFF images and JPEG compressed ones
[Articolo su rivista]
Seidenari, Stefania; Pellacani, Giovanni; Righi, Elena; A., Di Nardo
abstract
Early melanoma diagnosis is an important goal for dermatologists. Polarized light systems are increasingly employed for dermatoscopic diagnosis of melanocytic lesions. For the purpose of teledermoscopy, whose importance is increasingly growing for consultation and teaching purposes, it is of utmost importance to establish whether, after compression, polarized light images maintain their informativeness. The aim of our study was to check the effects of compression on melanocytic lesion images acquired by means of a digital videomicroscope on the identification of morphological details of the image and on diagnostic accuracy. A total of 170 50-fold-magnified pigmented skin lesion images, acquired in Tagged Image File Format (TIFF) by a digital videomicroscope, were compressed using joint Photographic Experts Group (JPEG) algorithms (compression factor 30). Two experts in videomicroscopy evaluated both original and compressed images twice by describing single lesion features and expressing a diagnosis. Reproducibility in the assessment of dermoscopic parameters and observer performance were studied by kappa statistics and Receiver Operating Characteristic (ROC) analysis. Both intra- and interobserver reproducibility in the assessment of morphological details were higher when TIFF images were considered, indicating a better image quality. Nonetheless, there was no significant difference in the diagnostic accuracy between uncompressed images and compressed ones, although the intraobserver reproducibility in the diagnostic judgement was higher for uncompressed images. Despite loss in image details, factor 30 compressed videomicroscopic images enable a good diagnostic accuracy.
2004
- Sottoprodotti della disinfezione delle acque potabili ed effetti sulla sfera riproduttiva
[Abstract in Rivista]
Righi, Elena; Aggazzotti, Gabriella; Fantuzzi, Guglielmina; B., Biasotti; G., Ravera; S., Kanitz; F., Barbone; G., Sansebastiano; Ma, Battaglia; V., Leoni; L., Fabiani; M., Triassi; S., Sciacca
abstract
L’esposizione a sottoprodotti della disinfezione (DBPs) nelle acque potabili è stata associata a diversi effetti avversi sulla sfera riproduttiva come natimortalità, aborto, ritardo nella crescita uterina, basso peso alla nascita, prematurità e malformazioni. Le evidenze epidemiologiche sono a tutt’oggi deboli a causa delle difficoltà nel valutare l’esposizione individuale a DBPs, nell’identificare le abitudini personali che possono influenzare l’entità dell’esposizione e nel controllare l’azione esercitata da numerosi fattori di confondimento. In più prevalentemente sono state considerate acque trattate con cloro o ipocloriti, mentre gli effetti esercitati da acque trattate con biossido di cloro sono ancora poco noti.Uno studio caso controllo con casi incidenti è stato condotto in 9 città italiane e sono state arruolate 1194 puerpere. L’esposizione a DPBs e le informazioni sulle abitudini di vita delle donne sono state valutate a livello individuale tramite un questionario e l’analisi di campioni di acqua prelevati direttamente presso le abitazioni dei soggetti inclusi nello studio. Le concentrazioni di trialometani sono risultate sempre molto basse (mediana: 1.10 g/l), mentre i livelli di cloriti e clorati sono apparsi più alti e variabili (mediana: 216.5 e 76.5 g/l, rispettivamente). Le nascite pretermine non sono risultate associate all’esposizione a DBPs, mentre è emersa una relazione dose risposta tra il rischio di nascite a termine ma sottopeso e concentrazioni di cloriti > 200 g /l combinate con diversi livelli di esposizione per via inalatoria (OR corretti: 1.52; 95%CI:0.91–2.54 per bassi livelli e 1.70; 95%CI:0.97–3.0, per alti livelli espositivi). Il trattamento delle acque potabili con biossido di cloro, principale responsabile della neoformazione di cloriti e clorati, è molto diffuso in Italia; i livelli di tali sostanze devono essere quindi attentamente monitorati e i loro potenziali effetti sulla sfera riproduttiva ulteriormente indagati.
2003
- ANALISI DI UN'AREA OMOGENEA NELL'AZIENDA OSPEDALIERA POLICLINICO DI MODENA UTILIZZANDO I DIAGNOSIS RELATED GROUP (DGR)
[Articolo su rivista]
E., Vecchi; Righi, Elena; L., Cavazzuti; M., Bicocchi; Aggazzotti, Gabriella
abstract
The authors have assessed the activity of a complex division (three wards) at the Modena General Hospital. The parameters used were DRG indicators: Case-Mix Index; Performance Index and Resources Index. It is a in-house hospital analysis, since the benchmark is based on the three units average figures. The analysis covers 1479 patients hospitalized during the first 6 months of the year 2000. The authors have taken into account overall DGRs, surgical DGRs and recurrent DGRs. Making allowance for the limits of such comparison, the study shows some differences as regards efficiency and cost-curbing policies, with the surgical unit having the largest and most diversified number of cases
2003
- Alogenati organici volatili (AOV) in campioni di acque minerali naturali e di bibite del commercio
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Pinotti, Ma; Montanari, M; Aggazzotti, Gabriella
abstract
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2003
- Caratterizzazione microbiologica dei rifiuti solidi e degli aerosol che si generano nelle discariche controllate di rifiuti solidi urbani.
[Articolo su rivista]
Fantuzzi, Guglielmina; M., Bergonzoni; P., Neri; C., Colombari; Righi, Elena; C., Davoli
abstract
Authors report data about microbiological characterization of solid wastes and aerosol in the municipal solid waste landfill site in Poiatica (RE). In solid waste samples high values of total coliform and fecal coliform were observed (10(5)-10(6) CFU/g): total bacterial counts at 22 degrees, at 36 degrees and at 44 degrees ranged from 10(7) to 10(9) CFU/g. Aerosol samples collected during waste movement in the landfill site showed values of total and fecal bacterial ranging from 10(3)-10(4) CFU/m3. Staphylococci and fungi reported the same values while streptococci, total and fecal coliform and spore evidenced lower values. Municipal solid wastes and aerosol have to be considered as an infective substrate: it is necessary to adopt protective barriers in occupationally exposed subjects.
2003
- Epidemiologia degli infortuni lavorativi in minori: risultati di una indagine condotta nella città di Modena nel periodo gennaio-giugno 2000.
[Articolo su rivista]
Righi, Elena; G., Gatti; Marcheselli, Raffaella; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
Gli autori analizzano i dati di dimissione ospedaliera e dati INAIL relativi agli infortuni lavorativi occorsi in minori (14-17 anni) nella citta di Modena nel periodo gennaio - giugno 2000
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
abstract
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
- Exposure to chlorite and chlorate in drinking water and adverse pregnancy outcomes in Italy.
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Biasotti, B; Ravera, G; Kanitz, S; Barbone, F; Sansebastiano, G; Battaglia, Ma; Leoni, V; Fabiani, L; Triassi, M; Sciacca, S.
abstract
Introduction: Chlorite and chlorate are the main Disinfection By Products (DBPs) in drinking water when chlorine dioxide treatment is applied. Exposure to DBPs during pregnancy has been associated with adverse outcomes, such as miscarriage, preterm delivery, Small for Gestational Age at term (term-SGA): however to date epidemiological evidence is inconclusive, mainly due to inaccurate exposure assessment. At the moment chlorine dioxide treatment is widely used in Italy: a multicentric study was carried out in Italy, aimed to evaluate the association, if any, between chlorite and chlorate in drinking water and both preterm delivery and term-SGA.
Methods: A case control study with incident cases was performed in 9 Italian towns between October 1999-September 2000. Preterm deliveries and term-SGA newborns in the areas were cases, and singleton births, at term and weight >10th percentile were controls; n.1194 subjects were enrolled and n.893 water samples were collected from subjects' homes (433 cases and 460 controls) where drinking water was treated with chlorine dioxide or both with chlorine and chlorine dioxide. Chlorite and chlorate levels and also concentrations of other DBPs as total Trihalomethanes (tTHMs) were evaluated; moreover each subject was required to fill out a previously validated questionnaire about personal habits associated with exposure to DBPs, both by inhalation and ingestion. Also information about those characteristics which could act as confounders was collected. Multivariate logistic analysis was carried out adjusting for those variables significantly associated in univariate analyses.
Results: Levels of tTHMs were generally very low (median: 0.01 [mu]g/l), while chlorite and chlorate, when detectable (45% of the sample for chlorite and 34% for chlorate), showed high concentrations (median: 216.5 [mu]g/l for chlorite and 76.5 [mu]g/l for chlorate). Multivariate logistic analysis adjusted for sex of the newborn, education, water-based beverages, kind of water usually drank (tap or bottled mineral water) and tobacco smoke showed an association between term-SGA and chlorite when levels were >= 200 [mu]g/l and also high exposure both by ingestion and inhalation (daily showering and bathing) was present. (OR: 1.99, 95%CI: 1.06-3.74). An even weak association is suggested with either tTHMs >= 30 [mu]g/l, or chlorite/chlorate >= 200 [mu]g/l present in water (OR: 1.38, 95%CI: 0.92-2.07), while preterm delivery did not show any association with DBPs exposure.
Conclusions: The association between term-SGA and chlorite in drinking water may be due to chlorite itself, or to a different DBP produced by chlorine dioxide, or to a not yet identified confounder: anyway as levels of chlorite and chlorate appeared sometimes very high, the presence and significance of these substances in drinking water must be investigated further as the number of water utilities applying chlorine dioxide is increasing.
2003
- Fumo attivo e passivo, consumo di caffè ed effetti sulla gravidanza
[Abstract in Rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Biasotti, B; Ravera, G; Kanitz, S; Barbone, F; Sansebastiano, G; Battaglia, Ma; Leoni, V; Triassi, M; Sciacca, S.
abstract
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2003
- Gli infortuni lavorativi in minori: risultati di uno studio multicentrico in Italia.
[Abstract in Rivista]
Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; Fabiani, L; Grappasonni, I; Ricciardi, G; La torre, G; Sciacca, S; Angellilo, I; Gregorio, P; Bonazzi, C; Triassi, M; Rivosecchi, P; Sebastiani, L; Mura, I; Romano, G.
abstract
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2003
- Indagine sulla presenza di sottoprodotti della clorazione (Disinfection by-products:DBPs) ed altri composti alogenati nelle acque potabili di Modena e Parma.
[Articolo su rivista]
Fantuzzi, Guglielmina; G., Sansebastiano; Righi, Elena; Predieri, Guerrino; C., Cesari; R., Zoni; L., Veronesi; S., Saglia; Aggazzotti, Gabriella
abstract
The Authors report data about the presence of Disinfection By-Products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma (20 water supplies). Trihalomethanes, chlorite and chlorate (only in water samples treated with chlorine dioxide), and halogenated compounds were investigated. On the whole, trihalomethanes were evidenced in the 85% of the samples (n. 285) at low levels, while chlorite and chlorate were present in the 67% and 63% of the treated samples with chlorine dioxide (257 samples). Chlorite mean and median values were 225.70 microg/l and 136.75 microg/l respectively, ranging from 20 to 2000 microg/l. Chlorate concentrations were lower than chlorite: the mean value was 102.93 mg/l, while median level was 50 microg/l (range: 20-1500 microg/l). The high concentrations of chlorite and the wide range of values within each municipality plant in Modena and Parma suggest to investigate further in order to evaluate the human exposure in drinking water thoroughly.
2003
- Perchloroethylene in alveolar air, blood and urine as biological indices of low level exposure
[Articolo su rivista]
Gobba, Fabriziomaria; Righi, Elena; Fantuzzi, Guglielmina; L., Roccatto; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
We studied the reliability of biologic indices for monitoring perchlorethylene (PCE) exposure at low environmental solvent concentrations. Environmental monitoring was performed by personal sampling, biologic monitoring by measuring PCE in alveolar air (PCE-Alv), blood (PCE-B), and urine (PCE-U) in 26 low-exposed dry-cleaners. Correlation coefficients (r) between environmental PCE and PCE-B, PCE-Alv, and PCE-U were 0.94, 0.81, and 0.67 respectively. A high correlation was also found among biologic indices: r value was 0.96 between PCE-B and PCE-Alv, 0.95 between PCE-B and PCE-U, and 0.87 between alveolar PCE-Alv and PCE-U. The examined biologic indices proved sensitive enough for biologic monitoring of low exposure to PCE and can give substantially similar information in terms of exposure evaluation. PCE-Alv offers some advantages because it correlated better with exposure and is analytically simpler.
2003
- Rassegna di episodi di gastroenteriti acute da Norwalk like virus.
[Abstract in Rivista]
Pecone, Lf; Vecchi, E; Righi, Elena
abstract
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2003
- Smoking habits, environmental tobacco smoke exposure, coffee intake and adverse pregnancy outcomes: a case-control study in Italy.
[Abstract in Rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Biasotti, B; Ravera, G; Kanitz, S; Barbone, F; Sansebastiano, G; Battaglia, Ma; Leoni, V; Fabiani, L; Triassi, M; Sciacca, S.
abstract
Introduction: It is well known that some life-style habits in pregnancy may influence fetal growth. Active maternal smoking is a well recognised risk of adverse pregnancy outcome, mainly low birth weight. Recent studies report that environmental tabacco smoke (ETS) exposure adversely affects fetal growth with an elevated risk of low birth weight. Also coffee or alcohol intake during pregnancy has been linked to adverse reproductive outcomes. The aim of this study was to investigate the effects of maternal smoking habits, ETS exposure and maternal coffee and alcohol intake throughout the last trimester of pregnancy on preterm delivery (PD) and on small for gestational age at term (term SGA).
Methods: A case-control study was carried out between October 1999 and September 2000 in 9 italian cities (Genoa, Udine, Modena, Parma, Siena, Roma, L'Aquila, Naples and Catania). 525 preterm cases (children born between the 26th to the 38th week of pregnancy) and 317 term SGA (children born fron the 38th week and weighted under the 10th percentile of weight) were recruited. Controls (n. 871) were singleton birth matched to the cases by sex, center and calendar week of birth, whose gestational age was >=38 weeks and weight >=10th percentile. Data were collected by a validated, self-administered questionnaire; it referred the last trimester of pregnancy and included four parts. The first collected socio-demographic data, the second gathered information about nutritional habits and water consumption, the third assessed the woman's life stile during the last three months of pregnancy, the fourth gathered data on woman's health status. Univariate and multivariate logistic regression analyses were performed in order to estimate odds ratios.
Results: According to univariate analyses, risk of term SGA increased with increasing cigarette smoking during pregnancy (OR: 2.09, 95%CI: 1.45-3.00 for 1-9 cigarettes/day, and OR = 2.76, 95%CI: 1.67-4.45 for 10 cigarettes and more/day). Regarding to PD, it was observed a OR: 1.47, 95%CI: 1.05-2.04 for 1-9 cigarettes/day and a OR: 1,30 95%CI: 0.78-4.81 for 10 cigarettes/day. Exposure to ETS appeared to be mainly related to term SGA, when there were more than two smokers at home (OR: 3.05, 95%CI: 1.19-7.79). Alcohol and coffee intake were not associated with term SGA (OR: 1.31, 95%CI: 0.89-1.93 and OR: 0.90, 95%CI: 0.42-1.93, respectively). According to multivariate logistic analyses, adjusting for socio-demografic variables and life-stile habits, only the influence of active smoking on term SGA was confirmed (Adjusted OR = 2.49, 95%CI: 1.74-3.56).
Conclusions: This study provides clear evidence that maternal smoke in pregnancy influence term SGA. No adverse effect on fetal growth was observed in ralation to coffee and alcohol intake, while maternal EST exposure didn't reach the statistical significance due to the small number of women heavily exposed.
2003
- Valutazione epidemiologica di una gastroenterite da Norwalk like virus (NLV).
[Abstract in Rivista]
Vecchi, E; Pecone, Lf; Righi, Elena
abstract
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2002
- Air quality and well-being perception in subjects attending university libraries in Modena (Italy)
[Articolo su rivista]
Righi, Elena; Aggazzotti, Gabriella; Fantuzzi, Guglielmina; V., Ciccarese; Predieri, Guerrino
abstract
We studied four libraries in the University of Modena and Reggio Emilia (Northern Italy) to determine the presence of polluting agents such as total dusts, formaldehyde and other volatile organic compounds (VOCs) including benzene, toluene and xylenes and to assess the sense of well-being perceived by library users. This investigation was suggested by an increase in reported symptoms related to Sick Building Syndrome (SBS) observed in recent decades among people spending most of their time in various indoor environments, including libraries. The microclimatic conditions and the concentrations of pollutants indicated an acceptable situation on the whole, even though a wide range of total dust values (40-350 mug/m(3)) and total VOCs (203-749 nug/m(3)) was observed. However, the perception of the different environmental parameters by the 130 library users that were interviewed identified the existence of some discomfort mainly caused by the feeling of poor ventilation. Moreover, 78.5% of the subjects stated they had at least one of the 16 investigated symptoms potentially related to a SBS. The place of occurrence of the self-reported symptoms was also investigated, the symptoms arising during library attendance more frequently than elsewhere were only four, and in particular feeling hot, sore eyes, dry throat and breathing difficulties. Overall, our study has shown the existence of an association between microclimatic perceptions as reported by library users and subjective symptoms related to SBS, considering the four libraries separately, the highest prevalence of self-reported symptoms was found in the library where environmental discomfort as perceived by users was greatest. Nevertheless, an association between subjective self-reported symptoms and both microclimatic conditions as resulted by instrumental measurements and/or pollutants concentrations was not apparent.
2002
- Assessing the exposure of pregnant women to drinking water disinfection byproducts
[Articolo su rivista]
F., Barbone; F., Valent; V., Brussi; L., Tomasella; M., Triassi; A., Di Lieto; G., Scognamiglio; Righi, Elena; Fantuzzi, Guglielmina; L., Casolari; Aggazzotti, Gabriella
abstract
Background. To evaluate associations between exposure to disinfection byproducts in drinking water and adverse birth outcomes, personal exposure to disinfection byproducts must take into consideration multiple routes of exposure. Methods. We assessed the reproducibility and validity of a questionnaire measuring water consumption, showering and bathing habits, use of chlorine-based products, and swimming pool attendance in 237 pregnant Italian women enrolled between June and December 1999. The questionnaire was completed during the last trimester of pregnancy (preQ) and again a few days after delivery (postQ). Data from postQ were compared with a 7-day diary completed during the last trimester. Results. According to postQ, total water intake was 2.6 liters per day, whereas tap water intake was 0.6 liters per day. Intraclass correlation coefficients of postQ compared with preQ were 0.85 for tap water daily intake and 0.77 for duration of showering and bathing. Pearson's correlation coefficients were 0.84 for tap water daily intake, 0.81 for frequency of showering, and 0.94 for bathing. The kappa statistics were 0.76 (95% confidence limits = 0.68, 0.85) for use of domestic chlorine-based products and 0.82 (0-70, 0.94) for indoor swimming. Pearson's coefficients for postQ compared with the diary were 0.78 for tap water daily intake, 0.62 for frequency of showering, and 0.64 for bathing. Compared with the diary, the sensitivity and specificity of postQ in assessing indoor swimming were 75% and 90%, respectively. Conclusions. The questionnaire appears to be a valid and reliable method for assessing exposure to disinfection byproducts in the last trimester of pregnancy.
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
abstract
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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
abstract
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2002
- How to assess exposure to chlorination by-products (CBPs) in drinking water during the last trimester of pregnancy.
[Abstract in Rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Triassi, M; Di Lieto, A; Scognamiglio, G; Barbone, F; Valent, F; Brussi, V; Tomasella, L.
abstract
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2002
- Is JPEG-compression of videomicroscopic images compatible with telediagnosis? Comparison between diagostic performance and pattern recognition of uncompressed TIFF images and JPEG compressed ones.
[Abstract in Rivista]
Seidenari, S; Pellacani, Giovanni; Righi, Elena; Di Nardo, A; Martella, A.
abstract
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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
abstract
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2002
- Valutazione del rischio biologico degli operatori delle discariche controllate dei rifiuti solidi urbani.
[Abstract in Rivista]
Cintori, C; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
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2001
- A phase IV trial of an adjuvanted vaccine
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Bellelli, E.; Tanzi, M. l.; Lambertini, A.; Ferrari, L.; Impallomeni, M.
abstract
A large scale paese IV single blind field trial was performed in elderly subjects in the provinces of Modena and Parma in 1997-98 in order to measure the safety and the effectiveness of a recently formulated Adjuvanted flu vaccine against that of a traditional flu vaccine.
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
abstract
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
- Incremento della sopravvivenza nei pazienti affetti da AIDS ospiti in una casa alloggio
[Abstract in Atti di Convegno]
Guaraldi, Giovanni; Lodesani, C.; Righi, Elena; Bedini, A.; Della Loggia, P.; Bertani, R.; Orlando, G.; Esposito, Roberto
abstract
In letteratura vi sono pochi dati relativi al cambiamento della morbilità e mortalità nei pazienti ospiti in case alloggio per malati di AIDS.
2001
- Infortuni sul lavoro nei minori. Studio multicentrico italiano. Anni 1994-1998
[Articolo su rivista]
Fabiani, L.; Giuliani, A. R.; Scatigna, M.; Righi, Elena; Fantuzzi, Guglielmina; Aggazzotti, Gabriella
abstract
gli autori analizzano i dati relativi agli infortuni lavorativi registrati in minori (14-17 anni) durante il periodo 1994-1998 in 15 province italiane
2001
- Inquinamento delle acque potabili: effetti sul DNA e sulla riproduzione umana
[Articolo su rivista]
S., Monarca; A., Mantovani; Righi, Elena; C., Zani; Aggazzotti, Gabriella
abstract
Gli autori descrivono e analizzano i rischi per la salute umana correlati all'esposizione ad inquinanti idrici potenzialmente cancerogeni e/o mutageni
2001
- La casa alloggio: ospite, centro riabilitativo o entrambi?
[Abstract in Atti di Convegno]
Guaraldi, Giovanni; Lodesani, C.; Righi, Elena; Bedini, A.; Della Loggia, P; Bertani, R.; Orlando, G.; Esposito, Roberto
abstract
La casa alloggio San Lazzaro di Modena ospita pazienti affetti da infezione da HIV dal 1991. Obiettivo: valutare lo stato di salute al momento dell'ingresso e al follow up in un gruppo di 96 pazienti HIV+ assistiti presso la Casa alloggio. Valutare il tasso di ospedalizzazione nel periodo 1991-1999
2001
- Occupational exposure to trihalomethanes in indoor swimming pools
[Articolo su rivista]
Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; G., Ceppelli; Gobba, Fabriziomaria; Aggazzotti, Gabriella
abstract
The study evaluated occupational exposure to trihalomethanes (THMs) in indoor swimming pools. Thirty-two subjects, representing the whole workforce employed in the five public indoor swimming pools in the city of Modena (Northern Italy) were enrolled. Both environmental and biological monitoring of THMs exposure were performed. Environmental concentrations of THMs in different areas inside the swimming pools (at the poolside, in the reception area and in the engine-room) were measured as external exposure index, while individual exposure of swimming pool employees was estimated by THMs concentration in alveolar air. The levels of THMs observed in swimming pool water ranged from 17.8 to 70.8 ug/l; the mean levels of THMs in ambient air were 25.6 +/- 24.5 ug/m3 in the engine room, 26.1 +/- 24.3 ug/m3 in the reception area and 58.0 +/- 22.1 ug/m3 at the poolside. Among THMs, only chloroform and bromodichloromethane were always measured in ambient air, while dibromochloromethane was detected in ambient air rarely and bromoform only once. Biological monitoring results showed a THMs mean value of 20.9 +/- 15.6 ug/m3. Statistically significant differences were observed according to the main job activity: in pool attendants, THMs alveolar air were approximately double those observed in employees working in other areas of the swimming pools (25.1 +/- 16.5 ug/m3 vs. 14.8 +/- 12.3 ug/m3, P < 0.01), THMs in alveolar air samples were significantly correlated with THMs concentrations in ambient air (r = 0,57, P < 0.001). Indoor swimming pool employees are exposed to THMs at ambient air levels higher than the general population. The different environmental exposure inside the swimming pool can induce a different internal dose in exposed workers. The correlation found between ambient and alveolar air samples confirms that breath analysis is a good biological index of occupational exposure to these substances at low environmental levels.
2001
- Ruolo della casa alloggio per il miglioramento dell’aderenza alle terapie antiretrovirali, nelle persone con gravi problemi di aderenza
[Abstract in Atti di Convegno]
Guaraldi, Giovanni; Lodesani, C.; Righi, Elena; Bedini, A.; Della Loggia, P.; Bertani, R.; Orlando, G.; Esposito, Roberto
abstract
La maggior parte degli ospiti afferenti alla casa alloggio presentano, all'anamnesi, gravi problemi di aderenza alla HAART. La casa alloggio ha assunto progressivamente una valenza terapeutica riabilitativa in cui l'assunzione delle terapie antiretrovirali è parte del progetto socio sanitario dell'utente.
2000
- Declining morbidity and mortality in AIDS patients of an Italian nursing home
[Abstract in Atti di Convegno]
Guaraldi, Giovanni; Lodesani, C.; Righi, Elena; Bedini, A.; Agazzotti, G.; Esposito, Roberto
abstract
The San Lazzaro nursing home in Modena was the first hospice caring for AIDS patients in Emilia Romagna (North of Italy). Since October 1991, 95 patients have been assisted. At present it can assist 14 in-patients and 2 out-patients.
2000
- Inquinamento idrico: effetti sul DNA e sulla sfera riproduttiva.
[Relazione in Atti di Convegno]
S., Monarca; Righi, Elena; L., COTTI PICCINELLI; Aggazzotti, Gabriella
abstract
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2000
- L’esposizione a Percloroetilene nelle lavanderie a secco e nelle case degli addetti: monitoraggio ambientale, monitoraggio biologico e studio degli effetti precoci sulla funzione visiva.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Gobba, Fabriziomaria
abstract
Gli autori riportano i risultati di due indagini condotte sull'esposizione a percloroetilene nelle lavanderie del comune di Modena
2000
- Prevalence of urinary incontinence among institutionalized patients: A cross-sectional epidemiologic study in a midsized city in northern Italy
[Articolo su rivista]
Aggazzotti, Gabriella; F., Pesce; D., Grassi; Fantuzzi, Guglielmina; Righi, Elena; D., De Vita; S., Santacroce; Artibani, Walter
abstract
Objectives. To determine the prevalence of urinary incontinence among institutionalized elderly people. Methods. A cross-sectional study was conducted on 839 subjects, resident in 14 residential or nursing homes. A questionnaire was administered to the study population and their clinical records were reviewed. Results. The overall prevalence of urinary incontinence was 54.5%, higher in women (59.8%) than in men (39.2%). The prevalence increased significantly with age, from 26.5% in subjects 65 years old or younger to 73.7% in subjects 95 years old or older; with worsening of mental status, from 36.2% in well-oriented subjects to 76.7% in poorly oriented subjects; and with worsening of mobility, from 23.8% in self-sufficient subjects to 82.1% in bedridden patients. The prevalence was significantly associated with parity, from 54.1% in nulliparous women to 65.4% in multiparous women. Urinary incontinence was also associated with urinary tract infection, constipation, and fecal incontinence. Conclusions. The results of our Study are in accordance with other similar studies. That more than one half of the elderly residents of nursing and residential homes have urinary incontinence shows the relevance of this condition. We believe that urinary incontinence in institutionalized elderly people can be managed essentially by measures of tertiary prevention, aimed at reducing the handicapping conditions and at slowing down the process of self-sufficiency impairment.
1999
- Assessment of Indoor exposure to perchloroethylene (PCE) in dry-cleaners' family members
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Gobba, Fabriziomaria
abstract
this study evaluated the exposure to perchlorothylene for dry-cleaners' family member occuring inside their private houses
1999
- Il fenomeno dei ricoveri ripetuti nella realtà del Presidio Ospedaliero Modena Centro dell’Azienda Sanitaria Locale di Modena
[Articolo su rivista]
M., Capalbo; S., Venturi; A., Messori; Righi, Elena; C., Gibertoni; Becchi, Maria Angela; Aggazzotti, Gabriella
abstract
E' stato effettuato uno studio epidemiologico descrittivo dei ricoveri nel Presidio Ospedaliero Modena Centro della Azienda USL di Modena relativamente al periodo 1.1.1997-31.12.1997. per ogni paziente è stato fissato un follow-up osservazionale di 28 giorni dalla prima dimissione da un Reparto medico e di 6 e 14 giorni dalla prima dimissione da un Reparto chirurgico. I ricoveri ripetuti sono stati il 13.8% dei ricoveri totali annuali. L'indice di riammissione a 28 giorni è risultato del 6.28% per i Reparti medici e del 1.9% e 3.1% rispettivamente a 6 e 14 giorni per i Reparti chirurgici.
1999
- Incidenza delle infezioni della ferita chirurgica nella Divisione di chirurgia d’urgenza dell’Azienda Ospedaliera Policlinico di Modena
[Articolo su rivista]
Cavazzuti, L; Righi, Elena; Landolfo, G; Rossi, Aldo; Zaccarelli, V; Barbieri, M; Aggazzotti, Gabriella
abstract
Gli autori riportano i risultati di uno studio di incidenza delle infezioni della ferita chirurgica condotto presso l'Azienda Ospedaliera Policlinico di Modena
1999
- La metodologia epidemiologica nello studio delle infezioni ospedaliere della ferita chirurgica
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Fantuzzi, Guglielmina; G., Ceppelli
abstract
In questa review gli autori analizzano le possibilità di utilizzo della metodologia epidemiologica nello studio e nella sorveglianza delle infezioni ospedaliere con particolare attenzione alle infezioni della ferita chirurgica
1999
- La valutazione dell’esposizione a cloroformio (CHCl3) nelle piscine coperte e il monitoraggio biologico dei soggetti esposti.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino
abstract
gli autori riportano i risultati di una indagine sulla valutazione dell'esposizione a cloroformio nelle piscine coperte effettuata tramite monitoraggio ambientale e monitoraggio biologico sia dei soggetti esposti professionalmente che dei soggetti abituali frequentatori delle piscine coperte.
1999
- Un nuovo corso di laurea della facoltà di Medicina e Chirurgia
[Articolo su rivista]
Aggazzotti, Gabriella; Borella, Paola; Righi, Elena
abstract
-
1998
- Assorbimento di Trialometani (THM) nelle piscine coperte.
[Abstract in Rivista]
Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; Aggazzotti, Gabriella
abstract
-
1998
- Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino
abstract
In this article, exposure to trihalomethanes (THMs) in indoor swimming pools as a consequence of water chlorination is reported. Environmental and biological monitoring of THMs was performed in order to assess the uptake of these substances after a defined period in five competitive swimmers, regularly attending an indoor swimming pool to train for competition during four sampling sessions. Analyses were performed by gas-chromatography and the following THMs were detected: chloroform (CHCl3), bromodichloromethane (CHBrCl2), dibromochloromethane (CHBr2Cl) and bromoform (CHBr3). CHCl3 appeared the most represented compound both in water and in environmental air before and after swimming. CHBrCl2 and CHBr2Cl were always present, even though at lower levels than CHCl3, CHBr3 was rarely present. In relation to biological monitoring, CHCl3, CHBrCl2 and CHBr2Cl were detected in all alveolar air samples collected inside the swimming pool. Before swimming, after 1 h at rest at the pool edge, the mean values were 29.4 +/- 13.3, 2.7 +/- 1.2 and 0.8 +/- 0.8 ug/m3, respectively, while after spending Ih swimming, higher levels were detected (76.5 +/- 18.6, 6.5 +/- 1.3 and 1.4 +/- 0.9 ug/m3, respectively). Only CHCl3 was detected in all plasma samples (mean: 1.4 +/- 0.5 ug/l) while CHBrCl2 and CHBr2Cl were observed only in few samples at a detection limit of 0.1 ug/l. After 1 h at rest, at an average environmental exposure of approx. 100 ug/m3, the THM uptake was approx, 30 ug/h (26 ug/h for CHCl3, 3 ug/h for CHBrCl2 and 1.5 ug/h for CHBr2Cl). After 1 h swimming, the THM uptake is approx, seven times higher than at rest: a THM mean uptake of 221 ug/h (177 ug/h, 26 ug/h and 18 ug/h for CHCl3, CHBrCl2 and CHBr2Cl, respectively) was evaluated at an environmental concentration of approx. 200 ug/m3.
1998
- Cause di ospedalizzazione della comunità nomade di Modena: studio epidemiologico descrittivo.
[Abstract in Rivista]
Figna, P; Guaraldi, N; Martella, Dm; Accardo, A; Righi, Elena; Aggazzotti, Gabriella
abstract
-
1998
- Incidenza delle infezioni della ferita chirurgica in sette divisioni del Policlinico di Modena.
[Abstract in Rivista]
Cavazzuti, L; Righi, Elena; Marchegiano, P; Zaccarelli, V; Barbieri, M; Marata, Am; Aggazzotti, Gabriella
abstract
-
1998
- Two-years evolution of perchloroethylene-induced colour vision loss
[Articolo su rivista]
Gobba, Fabriziomaria; Righi, Elena; Fantuzzi, Guglielmina; Predieri, Guerrino; L., Cavazzuti; Aggazzotti, Gabriella
abstract
Progression of perchloroethylene-induced color-vision impairment was studied in 33 dry-cleaner workers at 12 establishments in Modena, Italy In an initial survey, we evaluated exposure with personal passive samplers, and we assessed color vision with the Lanthony D-15 desaturated panel. Two years later, workers were reexamined. in 19 workers (subgroup A), exposure to perchloroethylene had increased (median of 1.7 ppm versus 4.3 ppm, respectively), whereas in the remaining 14 workers (subgroup B) exposure was reduced (2.9 ppm versus 0.7 ppm, respectively), Color vision worsened in subgroup A, but no vision changes were apparent in subgroup B. The results indicated that an increase in expo sure during a 2-y period, even if slight, can cause color vision to deteriorate. A similar slight reduction in exposure did not lead to color-vision improvement; perhaps this lack of improvement resulted from (a) an insufficient reduction in exposure, (b) an insufficient reduction in duration of exposure, or
1997
- Incidenza delle infezioni delle vie urinarie in pazienti cateterizzati nell'Azienda Ospedaliera policlinico di Modena
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; L., Cavazzuti; K., Petropulacos; V., Zaccarelli; O., Zini; P., Marchegiano; C., Casolari; Fabio, Ugo
abstract
Gli autori riportano i risultati di uno studio di incidenza delle infezioni delle vie urinarie in pazienti con cateterizzati ricoverati presso l'Azienda Ospedaliera Policlinico di Modena
1996
- Indoor air quality in the university libraries of Modena (Italy)
[Articolo su rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; L., Cavazzuti; G., Predieri; A., Franceschelli
abstract
We carried out a survey in 16 libraries of the University of Modena, Northern Italy, to assess the indoor exposure to volatile organic compounds (VOCs), including formaldehyde, and total dusts. Data were collected on the main structural characteristics of the buildings; indoor microclimate parameters, such as temperature, relative humidity and ventilation rate were measured and air samples taken inside and outside the libraries. The mean value of total dusts was 190 +/- 130 mu g/m(3) with a wide range of values. Formaldehyde was found in only ten out of 16 libraries and the indoor concentrations ranged from 1.70 to 67.8 mu g/m(3) with an average value of 32.7 +/- 23.9 mu g/m(3). On the whole, VOCs were present in all the libraries investigated with an average value was 433 +/- 267 mu g/m(3) (range 102-936 mu g/m(3)). No correlation was found among VOCs, formaldehyde and total dusts nor was a significant association observed with microclimatic parameters or the structural characteristics of the buildings. The general situation found in this study suggests no major problems related to indoor pollution. However, some of the pollutants investigated such as total dust and total VOCs deserve further investigation. It is important to identify the possible sources of contaminants and to define the relationship between indoor and outdoor levels of pollutants more accurately, taking into account the effects of air recycling due to natural ventilation systems. Copyright
1996
- Potenzialità degli studi descrittivi nell’analisi epidemiologica dei servizi sanitari
[Articolo su rivista]
Aggazzotti, Gabriella; Righi, Elena; Rovesti, Sergio
abstract
Gli autori evidenziano le molteplici possibilità di utilizzo degli studi epidemiologici di tipo descrittivo nella programmazione e nella valutazione dei servizi sanitari e di specifici interventi sanitari. I principali indicatori sanitari, basati su informazioni ottenibili con l’epidemiologia descrittiva, vengono riportati e analizzati partendo dai più classici indicatori dello stato di salute, (mortalità e morbosità, funzionalità e disfunzione, “health profiles” e indicatori globali) fino ad arrivare ai più recenti indicatori di efficienza e di qualità emanati con il DM 24.7.95; particolare attenzione viene rivolta agli indici adottati per la valutazione dell’area dell’assistenza ospedaliera.
1995
- ENVIRONMENTAL AND BIOLOGICAL MONITORING OF CHLOROFORM IN INDOOR SWIMMING POOLS
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino
abstract
The presence of chloroform as the result of disinfection with sodium hypochlorite was demonstrated in the water and ambient air of indoor swimming pools. Environmental monitoring was performed in 12 indoor swimming pools in northern Italy and the level of human exposure was assessed. Biological monitoring performed by gas chromatography on human plasma and alveolar air samples evidenced that the uptake of chloroform in swimmers varies according to the intensity of the physical activity and age. The elimination of chloroform in alveolar air in one subject showed a very short half-life (from 20 to 27 min) and a complete clearance within 10 h after the end of exposure.
1994
- Considerazioni epidemiologiche sulle infezioni respiratorie acute in età pediatrica: dati di dimissione ospedaliera a Modena (USL n16) e nella Regione Emilia Romagna.
[Articolo su rivista]
Fantuzzi, Guglielmina; Petropoulakos, K; Righi, Elena; Aggazzotti, Gabriella
abstract
Gli autori analizzano i dati di dimissione ospedaliera per infezioni respiratorie acute nella popoalzione pediatrica della regione Emilia Romagna e della città di Modena.
1994
- Esposizione a Percloroetilene nell’ambiente indoor
[Capitolo/Saggio]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena
abstract
-
1994
- Indoor exposure to perchloroethylene (PCE) in individuals living with dry-cleaning workers.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Righi, Elena; Moscardelli, S.
abstract
Perchloroethylene (PCE) is the most widely used solvent in dry-cleaning; it is toxic to the liver, kidney and central nervous system and may be a human carcinogen. PCE levels in the ambient air of dry-cleaners' homes were measured, and samples of end-exhaled air (alveolar air) from subjects who were not themselves occupationally exposed, but who were members of the household of dry-cleaners were compared with samples from the general population. Thirty apartments were visited housing dry-cleaners and their families, and located well away from the dry-cleaning premises. Indoor air samples and alveolar air samples were collected contemporaneously from the dry-cleaners (36) and members of their household (34). The same sampling procedure was followed in 25 private homeswhere samples of alveolar air were collected from 41 subjects who were notoccupationally exposed and who acted as control group. All the samples wereanalysed by direct-injection gas-chromatography. PCE levels in dry-cleaners'homes proved to be significantly higher than in control houses (geometric means: 265 vs. 2 micrograms/m3, P < 0.001). PCE levels in the alveolar air exhaled bydry-cleaners, their family members and control subjects were statisticallydifferent (geometric means: 5140, 225 and 3 micrograms/m3, respectively; P <0.001). PCE is a ubiquitous substance in indoor air, but is present at higherconcentrations in apartments where dry-cleaners and their families live.Biological monitoring of PCE in alveolar air confirms that family members ofdry-cleaners are more exposed than the general population.
1994
- OCCUPATIONAL AND ENVIRONMENTAL EXPOSURE TO PERCHLOROETHYLENE (PCE) IN DRY CLEANERS AND THEIR FAMILY MEMBERS
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Predieri, Guerrino; Gobba, Fabriziomaria; M., Paltrinieri; A., Cavalleri
abstract
Perchloroethylene exposure in 28 dry-cleaning establishments and in 25 homes occupied by dry cleaners in Modena, Italy, was investigated. Environmental air samples and alveolar air samples from dry cleaners (n = 60) and from their family members (n = 23) were collected. The degree of perchloroethylene on the dry-cleaning premises varied widely from establishment to establishment. Spot sampling ranged from 0.6 to 75 mg/m3, whereas sampling by personal passive dosimeters ranged from 2.6 to 221.5 mg/m3 (8-h time weighted average values). Perchloroethylene in alveolar air samples collected at the end of the work day correlated closely with the 8-h time weighted average values (r = .750, p = .001), and correlated also with alveolar air samples collected at home in the evening (r = .665, p = .001) and the following morning (r = .549, p < .001). Perchloroethylene levels inside the homes of dry cleaners appeared significantly higher than in 29 houses selected as controls (Mann Whitney U test, p < .001). Perchloroethylene in alveolar air samples collected at home suggests that nonoccupational exposure to perchloroethylene for family members of dry cleaners exists.
1994
- PERCHLOROETHYLENE EXPOSURE CAN INDUCE COLOR-VISION LOSS
[Articolo su rivista]
A., Cavalleri; Gobba, Fabriziomaria; M., Paltrinieri; Fantuzzi, Guglielmina; Righi, Elena; Aggazzotti, Gabriella
abstract
We evaluated colour vision in 35 dry-cleaners exposed to perchloroethylene (PCE) and in a paired number of controls matched for sex. age, alcohol consumption and cigarette smoking. A subclinical colour vision loss, mainly in the blue-yellow range, was present in dry-cleaners. This effect was related to PCE exposure levels. and appeared at environmental concentrations of the solvent well below the current exposure limits for exposed workers. The results suggest that PCE exposure, even at low environmental levels, can induce a dose-related impairment of colour vision.
1993
- Chloroform in alveolar air of people attending indoor swimming pools.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena; Tartoni, Pier Luigi; T., Cassinadri; Predieri, Guerrino
abstract
Alveolar air samples were collected from 163 subjects at indoor swimming pools and from 77 nonexposed subjects. Chloroform was present in all samples collected from exposed subjects (median = 695.02 nmol/m3). It was found at very low levels in 53% of samples from nonexposed subjects. Alveolar air chloroform levels from people attending indoor swimming pools (mean value within each sampling session) were correlated with environmental air concentration (r = 0.907, p = .002). Analysis of variance showed that levels of chloroform in alveolar air depend on environmental air concentration, age, intensity of the sport activity, and kind of swimming. Chloroform levels in samples collected from competitive swimmers versus nonswimming visitors were different (F = 10.911, p = .001). Moreover, their pattern of swimming may affect chloroform concentration in alveolar air. The analysis of chloroform in alveolar air assesses indoor exposure in healthy subjects simply and at low cost.
1993
- Epidemiologia delle infezioni da Streptococcus pyogenes.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena
abstract
gli autori riportano i dati di incidenza e di prevalenza delle infezioni sostenute da streptococcus pyogenes nel mondo e in Italia
1993
- Impianti di depurazione dei liquami urbani e aloderivati organici volatili.
[Articolo su rivista]
Righi, Elena
abstract
l'articolo illustra i risultati relativi ad una indagine volta ad approfondire le conoscenze sul livello di contaminazione da parte degli aloderivati organici volatili esistente nelle acque di scarico prodotte dai centri urbani
1993
- Indagine preliminare sulla esposizione ambientale e professionale a percloroetilene negli addetti alle lavanderie a secco e nei loro familiari.
[Articolo su rivista]
Fantuzzi, Guglielmina; Aggazzotti, Gabriella; Righi, Elena; Predieri, Guerrino; Tartoni, Pg
abstract
gli autori riportano i risultati preliminari di una indagine volta a valutare l'esposizione a percloroetilene negli addetti alle lavanderie e nei loro familiari.
1992
- Epidemiologia dell'insufficienza cardiaca
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Righi, Elena
abstract
Gli autori riportano i principali dati relativi alla epidemiologia dell'insufficienza cardiaca in Italia
1992
- Epidemiologia di labiopalatoschisi nel Comune di Modena e nella Regione Emilia Romagna
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Lamma, L; Righi, Elena; Tartoni, P; Contrino, C; Calzolari, E.
abstract
gli autori riportano i dati di prevalenza delle labiopalatoschisi nella municipalità di Modena e nella regione Emilia-Romagna nel periodo 1978-1990.
1992
- Esposizione ad aloderivati organici volatili nelle piscine coperte.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Righi, Elena
abstract
Gli autori riportano i risultati relativi alla valutazione esposizione ad aloderivati organici volatili, ed in particolare a cloroformio, nei soggetti frequentori di piscine coperte.
1992
- Il nuoto nelle piscine coperte come fonte di esposizione ad aloderivati organici volatili.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Righi, Elena
abstract
gli autori riportano i risultati relativi all'esposizione ad aloderivati organici volatili nei soggetti frequentatori di piscine coperte
1991
- Aloderivati organici volatili nelle acque minerali naturali da tavola e nelle bevande del commercio.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Righi, Elena
abstract
103 campioni di acque minerali naturali e 51 campioni di diverse bevande del commercio sono stati analizzati per evidenziare la presenza di aloderivati organici volatili.
1990
- Il cloroformio nell'aria alveolare di frequentatori di piscine coperte.
[Articolo su rivista]
Aggazzotti, Gabriella; Fantuzzi, Guglielmina; Predieri, Guerrino; Tartoni, Pl; Righi, Elena; Bernini Carri, E; Richeldi, Luca
abstract
gli autori riportano i isultati relativi ad una indagine volta a valutare l'esposizione a cloroformio nelle piscine coperte.
1990
- Zootecnia padana ed eutrofizzazione dell'Adriatico
[Articolo su rivista]
R., Della Casa; Righi, Elena
abstract
gli autori riportano i risultati emersi in un Congresso internazionale sul problema svoltosi recentemente a Bologna