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Surveys (2008-2018) carried out by the Local Health Agency of Trieste (ASUITS) in local collective catering (CC) services of schools, hospitals, nursing homes, and workplaces (25.000 daily meals) have shown some non - adherence to healthier food choices, food standards, procedures and green and social procurement as recommended by the WHO, FAO, UE, Ministry of Health and of Environment. The purpose of this project is to support local public and private organizations in transforming the national and regional catering services food standards related to health, nutrition, environment and social criteria into food procurement and food contracts specifications. This has been done by compiling the major obstacles to improved standards observed during surveys, and by sharing critical and relevant examples with major public contractors across local, regional and national level. The guidelines (GL) for public procurement of CC consist of five chapters: the elaboration of specifications; a response module to present the offer of services; selection and award criteria, an evaluation system of offers, and the technical specifications attached. Technical information fixes the constituent elements of the service in order to have similar and directly comparable offers. GL cover both the purchasing of food and the contracting of catering services. In this way public or private institutions are able to prepare tender documents suitable to respond to health, economic needs and Sustainable Development Goals (SDGs). The development of the GL has increased the awareness and real potential that local organizations have in enhancing the strategic use of purchasers to boost food qualification, jobs, growth and investment. As well as to create a more innovative economy, to be resource and energy efficient, and to be socially-inclusive. To meet population nutrient intake goals and SDGs it is necessary to increase co-operation and the sharing of the objectives of ’Health in All Policies’. Key messages Contractors need practical tools to apply sustainable development goals criteria in collective catering. The integrated collective catering guide is a key to improving capacity building in institutions.

According to the literature the prevalence of the risk of malnutrition o hospitalized people exceeds 25% of patients, this evidence is also related to low meal satisfaction. To reduce hospital malnutrition it is also important to improve the consumption of meals by implementing organoleptic and nutritional quality (O&NQ). The Local Health Agency of Trieste (ASUITS) has conducted surveys to find out how to evaluate and improve the procurement qualifications of hospital catering systems (HCS) and how to implement O&NQ. The production processes of meals served in two clinics using Cook Chill (CC) and Cook/Fresh - Hot Hold (CFHH) production process, respectively, were evaluated from 2017 - 2019. The Nutrient Analysis Critical Control Point process was applied for the evaluation of two catering systems. In addition, the antiradicalic power (ARP) of 120 samples of meals by the University of Trieste was analysed. In 2019 an investigation was conducted to compare the satisfaction and ARP content of meals served to patients in two hospital wards (N = 60). The meals to patients of two wards respectively with CC Cold Plating Retherm (PR) and CC Hot PR were served. Meals produced by the CC production process highlight the average loss of 50% of ARP compared to the CFHH. Meals produced by the CC Cold PR method limit the loss of ARP by 15-40% less compared to the CC Hot PR method. The satisfaction of patients who have consumed meals produced by the CC Cold PR method is double compared to that of patients who have consumed meals produced by the CC Hot PR method. The surveys have produced significant evidence to evaluate hospital meal production processes and to improve O&NQ. The results were used to develop recommendations for the drafting of tender specifications capable of also protecting nutritional variables. The evaluation of the O&NQ of HCS represents a central determinant of food safety and nutrition security and must be taken into consideration in the procurements procedure. Key messages Hospital catering contracts must evaluate and guarantee organoleptic and nutritional quality. Integrated evaluation of organoleptic and nutritional quality is an integral part of hospital meals.

Hemoglobin (Hb) variants involving alpha-chains are less common in the global population than Hb variants resulting from beta-chain alterations. Generally, alpha-chain Hb variants are caused by point mutations affecting alpha-1 and/or alpha-2 genes of the alpha-globin cluster (HBA1 and HBA2). In Brazil, the most prevalent alpha-chain Hb variant is Hb Hasharon. In this study, we present the first case of an Hb Val de Marne variant in the Americas, specifically in Brazil.

Previous studies proposed that myosin-Va regulates apoptosis by sequestering pro-apoptotic Bmf to the actin cytoskeleton through dynein light chain-2 (DLC2). Adhesion loss or other cytoskeletal perturbations would unleash Bmf, allowing it to bind and inhibit pro-survival Bcl2 proteins. Here, we demonstrated that overexpression of a myosin-Va medial tail fragment (MVaf) harboring the binding site for DLC2 dramatically decreased melanoma cell viability. Morphological and molecular changes, including surface blebbing, mitochondrial outer membrane permeabilization, cytochrome-c and Smac release, as well as caspase-9/-3 activation and DNA fragmentation indicated that melanoma cells died of apoptosis. Immobilized MVaf interacted directly with DLCs, but complexed MVaf/DLCs did not interact with Bmf. Overexpression of DLC2 attenuated MVaf-induced apoptosis. Thus, we suggest that, MVaf induces apoptosis by sequestering DLC2 and DLC1, thereby unleashing the pair of sensitizer and activator BH3-only proteins Bmf and Bim. Murine embryonic fibroblasts (MEFs) lacking Bim and Bmf or Bax and Bak were less sensitive to apoptosis caused by MVaf expression than wild-type MEFs, strengthening the putative role of the intrinsic apoptotic pathway in this response. Finally, MVaf expression attenuated B16-F10 solid tumor growth in mice, suggesting that this peptide may be useful as an apoptosis-inducing tool for basic and translational studies.

The organization of safety in the working places and the increasing attention to behaviours and life styles of workers that may lead to increasing occupational risks are the pick innovative aspects of the recent changes in our country's legislation about occupational safety. In this organization, the role of the company physician is becoming more and more important and his work of evaluation beginning with the knowledge both of the working places and of the workers's lifestyles, is irreplaceable. His role in organizing the managing standards of occupational safety and health cannot be limited to health supervision but must be an essential element in risk assessment in the prevision of workplaces and of safe working conditions, in workers training and information, in organizing the control system of each business. The present paper examines--referring to the current regulation--the duties and functions of a company physician when facing the problems concerning the working risks tied to alcohol assumption.

A morphologic study of the lungs was carried out in Swiss mice infected with yeast isolated from Paracoccidioides brasiliensis (Pb18). The lung was processed 1, 2, 4, and 8 weeks after inoculation for histologic staining with hematoxylin and eosin (HE), methenamine silver nitrate (Gomori-Grocott), and picrosirius to qualitative and quantitative analyses of the granulomas and the presence of fungal lesions. The numbers of CFUs/g counted in the lungs were 189.8 +/- 20.64, 353.6 +/- 46.21, 547.2 +/- 108.1, and 295.2 +/- 89.17 in the first, second, fourth, and eighth weeks, respectively. One week after infection, inflammatory cells and reticular and collagens fibers, the latest typical of fibrosis, were detected. After 2 and 4 weeks, a progressive intensification of the infection and fibrosis was observed, but in week 8 a more organized granuloma was evident, with macrophages, epithelioid cells, and yeasts in the central portion, and intense peripheral basophilia. Pycnotic structures typical of apoptotic bodies were observed in weeks 1 and 8. The different histologic staining used acted as a fundamental tool for the study of the morphologic organization of granuloma formation.

This chapter presents an overview of conditions that are identified to be caused by alcohol use. Some pathological states are briefly reviewed—such as those relating to the liver, the cardiovascular system, the neurological, endocrine systems, and a range of other conditions. The evidence reviewed indicates that if an individual has reasons for being a nondrinker, it is recommended that he or she refrain from drinking to prevent disease, for example, coronary heart disease. It is now fully recognized and accepted that drinking alcohol regularly for years is toxic to almost every tissue of the body. Alcohol's capacity to cause biological damage and, therefore disease has been widely demonstrated through biochemical studies, both experimental and epidemiological. Various meta-analyses have established alcohol's role in a wide range of physical, mental and social harms, with practically no organ in the body immune from alcohol-related harm. The WHO (1999) states that there is sufficient evidence to indicate that alcohol is a significant threat to world health and that 60% of the alcohol worldwide disability adjusted life years (DALYs) come from the years of disabled life.

This chapter illustrates certain epidemiological studies that demonstrate the way alcohol-related problems not only have an adverse effect on the health and on the well-being of workers, but also cause many work-related problems including deterioration in job performance, as well as a breakdown in co-worker relationships, whether alcohol is consumed on the job site or off. It discusses the risk factors present in the workplace, which may facilitate the consumption of alcohol and addresses the importance of developing the “employee assistance program” as a means to reduce the cost that alcohol use brings to business, in such a way that the burden from alcohol use is on the individual and the society as a whole because of lost productivity. Many epidemiological studies have demonstrated that a significant relationship exists among: high-risk and problem drinking and the occurrence of work injuries. The data indicate that reported drinking behavior is more disruptive for the aspects of job performance involving social relations with others than for the technical job performance itself, and that among the heavy drinkers there is evidence of deteriorating social relationship on the job prior to deterioration of technical performance.

The entireor =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake40 g/day in men and20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gaveor =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants agedor =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.

The evaluation of the efficacy of two different forms of scientific information concerning alcohol-related problems (ARP), among Italian trainee nurses.A specific questionnaire, investigating the awareness of ARP, was distributed to 193 trainee nurses, 158 enrolled in the Italian Red Cross School for Professional Nurses at S. Orsola-Malpighi Hospital in Bologna and 35 enrolled in the Professional Nursing School at the Social Security Institute in the Republic of San Marino, who had attended a scientific meeting on ARP in the last year. Eighty-one nurses (62 belonging to the Red Cross School of Bologna and 19 to the Professional Nursing School of San Marino), had previously been given an information package on ARP (Group A). One hundred twelve subjects (96 belonging to the Red Cross School of Bologna and 16 to the Professional Nursing School of San Marino) did not read the specialized material (Group B).The results showed a statistically significant difference in the percentage of correct answers between Group A (25.98%) and Group B (21.80%). The percentage of correct answers among the Bologna trainee nurses were always significantly lower than that of the San Marino nurses.These results suggest a scant awareness and interest in ARP among trainee nurses and show that courses and lectures are more effective than scientific printed material.

Introduction Parental alcoholism may lead to adverse psychological outcomes for those who grow up in such family environments. Objectives Several studies show that children of alcoholics (COAs) live in family climates characterized by conflict, unpredictability, and manifestations of contempt. Moreover, COAs are exposed to a high level of expressed emotion due, for instance, to threats and denigration. Aims We compared a group of COAs with a group of non COAs measuring the family climate, the level of expressed emotion and the parental attitudes on the basis of both children and parents' point of view. Methods 25 COAs (mean age 17,8 ± 3,3 years) and 25 non COAs (mean age 18,3 ± 3,3 years), matched for age and sex, were evaluated in the frame of an observational naturalistic study design. Self-administered rating scales were used to assess the level of expressed emotion in the family (Level of Expressed Emotion Scale - LEES), the parental (Parental Attitudes Scales - PAD) and family (Family Attitudes Questionnaire - FAQ) attitudes. Results The two groups did differ for FAQ total score and for the FAQ subscale assessing the relation between parents. They also differed for the level of expressed emotion (i.e., LEES total score) and for the LEES subscale assessing tolerance and expectations. Conclusions COAs are characterized by the perception of a negative family climate that is primarily expressed in terms of conflict and deterioration of relationship between parents.

The results are reported of an epidemiological study carried out in the province of Treviso in north-east Italy. The research was designed to ascertain the sensitization, through an IgE mechanism, to the main allergens present on cattle farms. Also reported are the results of a mite survey undertaken in ten barns in the same region. Investigations revealed a significantly larger degree of sensitization to storage mites among cattle farmers than in the control subjects. This sensitization was well correlated with mite species to be found in cattle barns. However, the frequent co-sensitization to Dermatophagoides offers a topic for further study.

IntroductionIndividuals who grow up in alcoholic families seem to have a family environment and climate different from those who grow up in non alcoholic families.ObjectivesData on expressed emotion and parental attitudes in alcoholic family are lacking.AimsStudy the level of expressed emotion and the parental attitudes in children of alcoholics (COAs) compared with children of non alcoholics (non COAs).MethodsThe Level of Expressed Emotion Scale (LEES) and the Parental Attitudes Scale (PAD) were used to measure respectively the expressed emotion and the family climate. The LEES was filled by the COAs or by the non COAs; the PAD was filled by their significant parent. COAs and non COAs were matched for age and gender.ResultsCOAs perceived a statistically lower level of intrusiveness from their parents and a significantly higher emotional response and attitudes toward illness from their parents than non COAs. According to the PAD, there was no difference in the family climate between the two groups. When correlations between LEES and PAD were evaluated, among COAs high level of expressed tolerance (LEES tolerance/expectation subscale) was significantly correlated with a low dominance in the children (PAD Dominance/Submissiveness); among controls, high level of expressed emotion (LEES total score) was significantly correlated with lower pleasure in the children (PAD Pleasure/Displeasure subscale).ConclusionsCOAs and non COAs seem to perceive the emotion expressed in their family environment differently and correlate it with their parental attitudes according to a different pattern.

Ninety-three patients with gallstones were selected for extracorporeal shock wave lithotripsy (ESWL) with a piezoelectric device (EDAP LT-OI) to verify the efficacy and safety of this technique. Neuroleptoanalgesia with intravenous diazepam and phentanyl was performed in almost all patients. The treatment was combined with adjuvant litholytic therapy using oral ursodeoxycholic acid. Follow-up period was nine months. Piezoelectric ESWL was able to disintegrate radiolucent gallstones in 97.9% of cases. By the ninth month 68 patients (73.1%) were stone-free. Best results were obtained with single stones smaller than 20 mm. After ESWL, surgical cholecystectomy was necessary in 2.1% of cases. This study confirms the efficacy and safety of piezoelectric extracorporeal shock wave lithotripsy combined with ursodeoxycholic acid adjuvant therapy for selected cases of gallstone disease.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

Two-point discrimination (TPD) and depth sense perception (DSP) were measured by means of two aesthesiometers in the fingertips of 65 forestry workers exposed to chain saw vibrations and 46 shoe industry workers exposed to neurotoxic solvents (n-hexane). Two control groups, consisting of 31 and 46 healthy subjects, were also examined. The compound means of the TPD and DSP threshold values for the 2nd, 3rd and 4th digits of the right and left hands were significantly higher in the chain saw workers suffering from peripheral sensorineural disorders than in the asymptomatic chain saw workers and the controls (p less than 0.001). Among the forestry workers, a significant relationship was found between loss of tactile perception and vibration dose expressed in terms of four-hour energy-equivalent frequency-weighted acceleration (ISO 5349). The shoe workers, who were asymptomatic, had higher DSP threshold values than the controls (p less than 0.01). No differences in the mean values of TPD thresholds were observed between the exposed and control subjects. These results indicate that DSP is more sensitive than TPD in detecting "sub-clinical neuropathy". On the basis of our previous investigations, the specificity of aesthesiometric threshold testing was high, ranging from 93 to 100%. The sensitivity of the aesthesiometric method was lower than the specificity, varying from 52-56% for TPD to 67-72% for DSP. These findings suggest that aesthesiometry may be considered as a useful testing method to differentiate on a group basis between healthy subjects and workers exposed to physical and chemical agents affecting the peripheral nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

The results of a study on a sample of 301 farms of the province of Treviso are here presented. The aim of our study was the evaluation of the quantity of pesticides, considered as active principle, spread over this territory in 1987. Our data stress that arboreal cultivations need the major quantity of fungicides, insecticides and acaricides while the use of herbicides and soil insecticides is almost exclusive to grassy cultures. The fungicides result the most widely used pesticides followed by herbicides and, to a less degree, the other products. In our case they are used nearly exclusively in vine growing. We underline that, although the consumption of pesticides fell within correct agronomic standards, this quantity could be considerably reduced by modern technology.

In this study we investigated the HBeAg/anti HBeAg status, the liver histological features, the intrahepatic localization of HBcAg, and the presence of serum HBV DNA in a group of 79 HBsAg-positive patients. We found a close relationship between the presence of HBV DNA and intrahepatic HBcAg in HBeAg-positive patients. Among the 56 anti-HBeAg-positive patients considered, 13 (23.2%) showed the presence of intrahepatic HBcAg and serum HBV DNA. In this group of patients, active viral replication was associated with a chronic inflammatory liver disease and particularly with CAH. Furthermore, a prevalent cytoplasmic localization of HBcAg was found in 66.6% of patients affected by CAH, showing that this peculiar distribution of HBcAg seems to be associated with a poor prognosis.

A group of 41 patients (25 males and 16 females) with mild chronic active hepatitis was studied for a mean follow-up period of 6.5 years. All patients had liver biopsy on admission and a second biopsy during the follow-up period. All but 7 patients were treated with prednisolone. Most of the patients were asymptomatic. There was no history of alcohol abuse or chronic administration of drugs. Fourteen patients were HBsAg positive and 27 HBsAg negative. Circulating autoantibodies were absent. Thirty-three patients did not demonstrate any change in disease activity. Four developed liver cirrhosis and four were apparently cured.