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The Erice Charter was unanimously approved at the conclusion of the 47th Residential Course "Adapted Physical Activity in Sport, Wellness and Fitness: New Challenges for Prevention and Health Promotion", held on 20-24 April 2015 in Erice, Italy, at the "Ettore Majorana" Foundation and Centre for Scientific Culture, and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health. After an intense discussion the participants identified the main points associated with the relevance of physical activity for Public Health, claiming the pivotal role of the Department of Prevention in coordinating and managing preventive actions. The participants underlined the importance of the physicians specialized in Hygiene, Preventive Medicine and Public Health. The contribution of other operators such as physicians specialized in Sport Medicine was stressed. Further, the holders of the new degree in Human Movement and Sport Sciences were considered fundamental contributors for the performance of physical activity and their presence was seen as a promising opportunity for the Departments of Prevention. Primary prevention based on recreational physical activities should become easily accessible for the population, avoiding obstacles such as certification steps or complex bureaucracy. The Sport Doctor is recognized as the principal referent for preliminary physical evaluation and clinical monitoring in secondary and tertiary prevention actions based on adapted physical activities. Developing research in the field is essential as well as implementing higher education on physical activity management in Schools of Public Health.

Several epidemiologic studies have suggested an association between childhood asthma and exposure to disinfection by-products (DBPs) in the swimming pool environment. In August 2007 a group of clinicians, epidemiologists, exposure scientists, pool operations experts, and analytical chemists met to discuss the literature on childhood asthma and swimming pools, and to develop recommendations for future research. In a review based on the results of that workshop, the authors state that current evidence, while suggestive, is inconclusive for an association with childhood asthma, and they point to several substantial data gaps that must be filled [EHP 117:500–507; Weisel et al.]. The authors articulate several variables that must be measured in more detail to properly characterize inhalation exposure to chemicals around pools. The review calls for a comprehensive assessment of a substantially larger number of chemicals in the pool area than the limited number of DBPs studied to date. Earlier epidemiologic studies suggested trichloramine as a DBP of interest, but one 2007 study revealed previously unknown volatile DBPs in the air surrounding swimming pools. The frequency and extent of exposure to chemicals around pools also must be studied. In research to date, only simple exposure indices have been used, including whether the pool was indoors or outdoors, specific disinfection treatment, whether the child swam in or was simply present at an indoor pool, and cumulative duration of swimming. But to evaluate the breathing rate and DBP dose delivered to the lungs, more detailed, validated assessments of activity levels are needed. To obtain these data, the authors recommend that future studies use prospective questionnaires in which participants report their pool use and activity levels over time as they occur. The authors also point to the need for studies that define asthma cases in a rigorous, reproducible way, utilizing the International Study of Asthma and Allergy in Children questionnaire. Previous studies have often used clinical diagnoses, but this may be insufficient for epidemiologic studies because asthma is a heterogeneous disease with no single reliable diagnostic test. Additional needs include development and validation of new biomarkers for asthmatic reactivity and studies designed to refine guidelines for proper pool maintenance and disinfection to reduce levels of DBPs. The authors conclude this research area requires studies across multiple disciplines. Once chemicals of interest are identified, studies of the mechanisms behind the possible association—such as oxidative stress, inflammation, and changes in lung permeability—may be useful. But long-range prospective studies starting in early childhood will be needed to better gauge the relationship between swimming pools and childhood asthma. Absent conclusive studies, the authors say children’s exposures should be minimized. Pool managers must be well educated about pool chemistry so they can understand the potential dangers of disinfectants and DBPs. Swimmers, too, must be educated about the need for proper pool hygiene (for example, showering before swimming and not urinating in the pool), as swimmer hygiene can affect the formation of DBPs and the amount of disinfectant used.

Obiettivi: gli infortuni lavorativi, in particolare quelli subiti da minorenni, rappresentano un problema di notevole importanza sociale: in Italia, da dati INPS, risultano lavorare circa 68 adolescenti su 1000. L’obiettivo di questo studio è stato quello di raccogliere informazioni sugli infortuni lavorativi avvenuti a minori (14-17 anni) in 14 città italiane nel periodo gennaio-giugno 2000. Metodi: si tratta di uno studio epidemiologico descrittivo, basato sulle informazioni raccolte consultando direttamente le cartelle cliniche presso centri di Pronto Soccorso (PS) attivi nelle città coinvolte. Sono stati presi in considerazione tutti gli infortuni avvenuti a minori: tra questi sono stati considerati come lavorativi quelli accaduti nel corso di attività descritta come lavorativa e quelli occorsi “in itinere”. Le analisi statistiche sono state condotte con SPSS; è stata effettuata una cluster analysis per evidenziare eventuali sottogruppi omogenei. Risultati: la popolazione residente nelle aree indagate di età tra 14 e 17 anni è stata stimata in circa 850.000 soggetti, pari al 31% della popolazione italiana della stessa età: gli infortuni totali sono risultati 13423 di cui 317 lavorativi (2.4%). I soggetti di sesso maschile, diciassettenni, impiegati nel comparto industriale sono risultati il gruppo maggiormente coinvolto: la prognosi è risultata per lo più inferiore a 8 giorni. Sono apparse due diverse tipologie di infortunio: una riguarda i casi avvenuti in itinere, con caratteristiche molto simili agli incidenti stradali, e un’altra, più specifica, riguarda gli eventi sul posto di lavoro, dove si registrano lesioni al polso, alle mani, al capo e agli occhi con frequenza superiore rispetto agli infortuni in genere.Conclusioni: il fenomeno è risultato non trascurabile, soprattutto tenendo conto del fatto che si riferisce solamente al lavoro minorile regolarmente denunciato. Nonostante le notevoli lacune nelle informazioni si è potuto rilevare come vi sia una tipologia di infortunio minorile peculiare, che merita provvedimenti di prevenzione specifici.

Obiettivi: alcune abitudini di vita possono influenzare lo sviluppo fetale durante il periodo di gravidanza. Lo scopo di questo studio è stato quello di indagare gli effetti di alcune abitudini voluttuarie sulle nascite premature e sul basso peso alla nascita.Metodi: è stato condotto uno studio caso controllo nel periodo ottobre 1999 settembre 2000 in 9 città italiane (Genova, Udine, Modena, Parma, Siena, Roma, L’Aquila, Napoli e Catania). Sono stati identificati come casi 525 neonati pretermine (26ma, 38ma settimana di gravidanza) e 317 neonati a termine ma con peso ‹ al 10° P. Sono stati arruolati come controllo 871 bambini nati a termine e normopeso. Le informazioni relative all’esposizione al fumo attivo e passivo e al consumo di caffè e i dati personali sono stati raccolti attraverso un apposito questionario.Risultati: dai risultati dell’analisi univariata è emerso un maggior rischio di basso peso alla nascita nei bambini le cui madri avevano fumato durante l’ultimo trimestre di gravidanza, con un chiaro effetto dose risposta. (OR: 2.09, 95% CI:1.45 - 3.00 per 1 9 sigarette/giorno, e OR= 2.76, 95% CI: 1.67 - 4.45 per 10 ed oltre sigarette al giorno). Anche la nascita pretermine sembra influenzata dall’abitudine tabagica della madre anche se in modo meno evidente. OR: 1.47, 95% CI: 1.05 - 2.04 per 1 9 sigarette/giorno e un OR: 1,30 95% CI: 0.78 - 4.81 per 10 e più sigarette/giorno. Per quanto riguarda l’esposizione al fumo passivo (più di due fumatori nelle abitazioni) è stata osservata una positiva associazione con il basso peso alla nascita (OR: 3.05, 95% CI: 1.19 - 7.79). Il consumo di caffè non sembra influenzare lo sviluppo fetale. La regressione logistica multipla ha confermato solo l’influenza del fumo attivo della madre sulla basso peso alla nascita. (AOR= 2.49, 95% CI: 1.74 - 3.56).Conclusioni: questo studio conferma che l’abitudine tabagica delle donne durante la gravidanza aumenta significativamente il rischio di nascite di bambini di basso peso alla nascita.

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.

Exposure assessment to chlorination by-products(CBPS) in drinking water during the last trimester of pregnancy

Work related injuries, above all those involving young people, are an important health and social issue, even though up to now small attention has been deserved in spite of the presence of about 68 workers per 1000 young people and the occurrence of 27400 injures in young people in 2000 in Italy. This study was aimed at improving the knowledge on work related injures occurring in Modena in 14-17 year old subjects in the period January-June 2000. A descriptive epidemiological study was carried out. Information was collected at the two emergency departments operating in Modena by checking hospital and INAIL records. Injures were defined as events caused by a violent external cause producing one or more lesions. Injuries were defined as work related when occurring during working activities or "in itinere". Work related injures and other injures were compared using the different statistical methods. Work related injuries occurring in young people during January-June 2000 in Modena were 76 (6-month incidence: 1.5 per 100 subjects of the same age) and represent 8.5% of all injuries. The most involved subjects were 17 year old males working in the industrial field, and in most cases prognoses were lasting less than 8 days. A Cluster Analysis identified two types of injures: the "in itinere" ones which resulted similar to the road accidents, both for body sites involved and for the way of occurrence and the injuries occurring at the working place characterised by a high frequency of lesions concerning hand, head, above all eyes. The study showed a remarkable incidence of work related injuries among 14-17 year old subjects in Modena in the first 6 months of 2000. Nevertheless many difficulties in finding information raised during the survey: a higher accuracy and completeness in collecting and recording of the data is needed to better define the epidemiological aspects of this issue.

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.