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Heatwaves are increasing in frequency, intensity, and duration, and represent the category of extreme event that is most easily attributable to anthropogenic warming. Yet how the spatiotemporal patterns of attribution outcomes link to population dynamics is still poorly understood. Here we show that children and young people are already being affected by a disproportionately greater number of attributable heatwaves, especially in the Global South. Using observations, reanalysis, and simulations of temperature changes available through the ISIMIP3b and CMIP6 projects in combination with demographic data, we show that temperature extremes emerge more clearly and consistently from the noise across low-income countries in lower latitudes, which have some of the youngest populations. Our findings have important implications for children and young people seeking redress from climate harms, for example through climate lawsuits.

Background: Healthcare workers (HCWs) are considered at higher risk for hepatitis B virus infection compared to the general population, due to their potential contact with blood or body fluids and possible needle stick injuries. In turn, infected HCWs may be a risk for patients. Hepatitis B vaccination programs represent a strategic approach to control the infection. Objectives: In this study, we aimed to evaluate the serological status of HCWs employed at the teaching hospital of Rome Tor Vergata and their risk of occupational injuries after the adoption of directive 2010/32/EU. Methods: Medical records of 539 HCWs were evaluated during their occupational medical examination at the Tor Vergata teaching hospital (PTV). All subjects were screened for specific viral markers: Hepatitis B surface antibodies (anti-HBs IgG), antibodies to hepatitis core antigen (anti-HBc IgG), and hepatitis B surface antigen (HBsAg). Data regarding needlestick injuries were collected by the prevention service team during the same year. Results: In this sample population, we found five subjects (0.9%) positive to the HBsAg, and most of them (four) were born in foreign countries. Moreover, seven subjects (1.3% of our population) were HBsAg-positive and anti-HBc-positive. A protective anti-HBs titer was found in 462 out of 527 (85.7%) subjects. The risk of being serologically unprotected was higher in males and subjects aged 40 years or older. The nurses were more protected than other healthcare professionals considering the anti-hepatitis B surface antibody titer. In 2018, 16 needlestick injuries were reported among our population of HCWs, with a global risk of 2.9% per year. Conclusions: Although hepatitis B virus (HBV) infection rate among HCWs was similar to that of the general population, the risk of HBV transmission in HCWs was likely to be high due to suboptimal vaccination coverage.

Background: Measles is an infectious disease and a major health concern worldwide. Among individuals with a higher risk of exposure to measles, there are the Health Care Workers (HCWs), who may transmit the virus to other people. According to the Italian National Plan for Immunization and Prevention, all HCWs should have presumptive evidence of immunity to measles (documented two doses of MMR vaccination) or serological evidence of protective antibodies. Aim: The study aims to evaluate the immunological status, the vaccine coverage, and the protective IgG antibody titre for measles in medical students of the teaching hospital PoliclinicoTor Vergata (PTV). Methods: IgG measles antibodies titre was evaluated in a sample of 461 medical students undergoing annual health surveillance visits from January 1st to May 31th, 2020. Results: 73.7% of medical students showed protective measles IgG antibody levels. The immunization rate was higher among subjects aged less than 25 years with respect to students aged over 25 years (77.4% vs. 66.4%; P P Conclusion: Our study shows a non-protective measles IgG antibody titre, especially among the older students. Therefore, it is essential to evaluate the serological levels, to vaccinate those subjects whose antibody level is not adequate, and promote the vaccination even in the general population.

Healthcare workers (HCWs) have an increased risk to be exposed to infectious diseases compared to the general population. For this reason, according to the National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles, mumps, rubella, varicella and Hepatitis B. Earlier studies have already shown that a large percentage of Italian operators lacked immune protection for one or more of those pathogens. The aim of this study was to evaluate the immunization status for vaccine-preventable diseases of HCWs in a large Italian teaching hospital. We retrospectively evaluated clinical records and serological data of HCWs who followed the occupational health surveillance program between January 1 and December 31 2019. We reviewed the clinical records of 1,017 HCWs: 393 males and 624 females with a median age of 35.69 y (range: 19–67). Protective IgG antibody values were documented in the 88.0%, 75.7%, 90.3%, 87.4% and 85.7% of the HCWs screened, respectively, against measles, mumps, rubella, varicella and Hepatitis B. Age was significantly related to serological protection against measles, mumps and varicella but was not significantly related to protective IgG levels for rubella and HBV. Female gender was significantly related to a higher protection rate against Hepatitis B (87.8 vs 82.4%; p

Heavy rainfall in East Africa between late 2019 and mid 2020 caused devastating floods and landslides throughout the region. These rains drove the level of Lake Victoria to a record-breaking maximum in the second half of May 2020, when the lake reached its highest level since measurements began in 1948. The high lake levels and consequent shoreline flooding triggered international attention, with media sources proposing a causal link with climate change. However, a formal attribution study identifying the possible role of anthropogenic climate change in increasing the likelihood of such record-breaking water levels has not been carried out so far.We present an attribution study that estimates how anthropogenic climate change influenced the likelihood of observing the rate of change in Lake Victoria’s level that was recorded in 2020. To this end, we reconstruct the record-high lake level using an observational water balance model for Lake Victoria. We first investigate the influence of the different water balance terms on the resulting lake level. Then, we apply the water balance model in a probabilistic event attribution framework by forcing it with historical and natural forcing only (hist-nat) bias-adjusted precipitation from six Earth system models from the Coupled Model Intercomparison Project phase 6 (CMIP6) ensemble, as made available through the Inter-Sectoral Impact Model Intercomparison Project phase 3b (ISIMIP3b). The study contributes to a better understanding of impacts caused by climate and weather extremes in the Greater Horn of Africa by disentangling the role of anthropogenic climate change and natural internal variability in a high-impact flood event.

It is common to distinguish between disagreement in the state sense (being in disagreement) and disagreement in the activity sense (having a disagreement). This paper deals with the question of what it is for two people to have a disagreement. First, I present and reject the thesis according to which having a disagreement is a matter of expressing conflicting attitudes. I argue that this is not sufficient for having a disagreement: two people can express conflicting attitudes without having a disagreement. Second, I present and reject the thesis according to which having a disagreement involves not only the expression of conflicting attitudes, but also the persuasive attempt to bring the other around to one’s view. I argue that this is not necessary for having a disagreement: two people can have a disagreement without trying to change each other’s minds. Finally, I put forward an alternative account that goes beyond the mere expression of conflicting attitudes, but that does not go as far as to posit the attempt to change someone’s mind. Having a disagreement, I submit, is a matter of expressing conflicting attitudes and demanding agreement, that is, advancing the normative claim that the other should share one’s attitude.

[eng] This thesis is made up of two papers. Both of them are concerned with the “motive for altering or calling into question the attitude of the other” that Stevenson included in his characterization of disagreement. The first paper argues that Eriksson’s considerations are insufficient for drawing the conclusion that moral and taste judgments are different with respect to the presence of such a motive. The second paper offers an account of what it is to have disagreement in terms of “demanding” agreement, by developing the Stevensonian “calling into question” element. [spa] Esta tesis está compuesta por dos artículos. Ambos se relacionan con el “motivo para alterar o poner en cuestión la actitud del otro” que Stevenson incluyó en su caracterización del desacuerdo. El primer artículo argumenta que las consideraciones de Eriksson son insuficientes para sacar la conclusión de que los juicios morales y los juicios de gusto son diferentes con respecto a la presencia de tal motivo. El segundo artículo ofrece una definición de la actividad del desacuerdo, desarrollando el elemento stevensoniano de “poner en cuestión.”

Nanoparticles (NPs) are a wide class of materials currently used in several industrial and biomedical applications. Due to their small size (1-100 nm), NPs can easily enter the human body, inducing tissue damage. NP toxicity depends on physical and chemical NP properties (e.g., size, charge and surface area) in ways and magnitudes that are still unknown. We assess the average as well as the individual importance of NP atomic descriptors, along with chemical properties and experimental conditions, in determining cytotoxicity endpoints for several nanomaterials. We employ a multicenter cytotoxicity nanomaterial database (12 different materials with first and second dimensions ranging between 2.70 and 81.2 nm and between 4.10 and 4048 nm, respectively). We develop a regressor model based on extreme gradient boosting with hyperparameter optimization. We employ Shapley additive explanations to obtain good cytotoxicity prediction performance. Model performances are quantified as statistically significant Spearman correlations between the true and predicted values, ranging from 0.5 to 0.7. Our results show that i) size in situ and surface areas larger than 200 nm and 50 m2/g, respectively, ii) primary particles smaller than 20 nm; iii) irregular (i.e., not spherical) shapes and iv) positive Z-potentials contribute the most to the prediction of NP cytotoxicity, especially if lactate dehydrogenase (LDH) assays are employed for short experimental times. These results were moderately stable across toxicity endpoints, although some degree of variability emerged across dose quantification methods, confirming the complexity of nano-bio interactions and the need for large, systematic experimental characterization to reach a safer-by-design approach.

The main health effect of exposure to ionizing radiation on the eyes is lens opacities and cataracts. Recent findings have raised questions about the pathogenesis of lenticular damage and the exact threshold dose for the onset of this effect. Occupational dose limits for the lens have been therefore recently reduced to 0.02 Gy/year averaged over 5 years with no single year exceeding 0.05 Gy/year. Healthcare workers can be exposed to ionizing radiation during interventional and other medical procedures. The aim of our study was to evaluate the annual dose to the lens in a large group of healthcare workers exposed to ionizing radiation who are working in a university hospital in Rome and to evaluate a dose-response relationship between lens exposure and the onset of lenticular opacities. We reviewed the exposure data of 702 subjects; the average annual dose to the crystalline lens was calculated using a physical algorithm. Moreover, the clinical records of 107 radiation exposed workers were reviewed: the presence of radiation-compatible opacities were assessed for all operators according to the Lens Opacities Classification System (LOCS) III and Merriam-Focht classification. Annual doses exceeding 0.02 Gy were found in 2.1% of the exposed population. Incipient lenticular opacities were observed in 18.6% of the study population. The presence of alterations was associated with higher lens dose (>0.0092 Gy). Based on our results, optimization of procedures and protection of the lens from ionizing radiation by means of personal protection equipment are strongly recommended in higher exposure scenarios.

Epidemiological studies have suggested that indoor hospital employees, either day or night shift workers, are at high risk of metabolic and cardiovascular diseases. Interestingly, previous reports have also described a higher prevalence of vitamin D (25OHD) deficiency among these workers. However, few studies have determined the monthly variations in 25OHD levels in indoor hospital employees. To address this lack of knowledge, in 2018, during the periodic health surveillance checks at the Service of Occupational Medicine, we measured 25OHD levels in a group of indoor hospital workers (88 rotating night shift workers vs 200 day workers). Each participant received a single annual health surveillance check. The mean levels of 25OHD were consistently below the lower limit of the normal range in both groups throughout the year. Only in the summer, day workers but not rotating night shift workers (mean 25.9 ± 11.3 ng/ml vs 23.1 ± 9.1 ng/ml; p = 0.042) showed levels significantly higher than those in the other seasons. This difference remained statistically significant even after correction for study covariates [β = − 1.649 (CI − 0.283/− 3.482), p = 0.039]. A cosinor analysis confirmed that the difference in the 25OHD levels between groups was present later in the year. We found that relatively young healthy hospital workers, especially those with rotating night shifts, in the absence of significant metabolic risk factors, have a high risk of 25OHD deficiency/insufficiency. Because 25OHD deficiency may lead to a progression to more severe conditions such as osteoporosis or bone fractures, our results should be verified in larger cohorts including different ancestries.

OBJECTIVES The potential of multi-walled carbon nanotubes (MWCNTs) in inducing airway hyperresponsiveness (AHR) was investigated in human airways. METHODS Human isolated bronchi were exposed to MWCNTs and the contractility to electrical field stimulation (EFS) was measured. Neuronal acetylcholine (ACh) and cyclic adenosine monophosphate (cAMP) were quantified. Some tissues were desensitized by consecutive administrations of capsaicin. RESULTS MWCNTs (100 ng/ml - 100 µg/ml) induced AHR (overall contractile tone vs. negative control: +83.43 ± 11.13%, P

Vision-based measurement (VBM) systems are powerful tool to extract quantitative information by acquiring video sequence or static images. When a VBM is applied to the evaluation of nominal properties, such as image characteristics, the term VBM is substituted with vision-based evaluation (VBE) by extending the framework of operation unit to a new concept of evaluation unit (EU) for the image analysis and machine learning phases. To this regard, deep learning (DL) approaches have gained an exponential interest in the research and industrial community, thanks to incredible flexibility toward visual words and the possibility to abandon subjective feature extraction procedures. From such an explosiveness of applications, it emerges the need to conduct studies on the capability of DL strategies to deal with uncertainty contributions, i.e., definitional uncertainty related to the measurand and reference uncertainty that may occur during the calibration process. In order to present a benchmark platform to analyze the effect of the major sources of uncertainties estimated, we use here an atomic force microscopy (AFM) imaging scenario for the evaluation of the effect of nanoparticles exposure on human cells in the laboratory. These studies are nowadays fundamental in toxicity analysis for monitoring the health conditions of workers and for protecting people from atherosclerosis disease. The performance of the proposed VBE-DL system to recognize cell alterations from the AFM images is related to three different sources of uncertainty and a critical analysis of the results achieved is provided.

Health Care Workers (HCWs) have an increased risk of contracting contagious disease, including mumps. In January 2017 the Italian National Vaccine Prevention Plan 2017–2019, recommended the administration of a dose of MMR vaccine (Measles-Mumps-Rubella) to the Health Care Workers (HCWs) that, working in a risky environment, did not carry out the complete vaccination cycle of MMR or that are seronegative for at least one of the three vaccine viruses. In October of the same year, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of a vaccine containing Mumps Virus for people previously vaccinated with 2 doses, belonging to a group or to a population at increased risk of acquire mumps in the event of an epidemic. We analyzed the clinical records and values of mumps-specific IgG antibodies of 3032 HCWs (mean age 32.80 ± 10.75 years), that underwent occupational health surveillance between January 1st 2017 and March 31th 2018. The HCWs were also screened for measles, rubella, mumps using serological methods. 13% (405) was seronegative for mumps, especially among HCWs between 18 and 36 years. We calculated the cost-effectiveness of two-doses and three-doses MMR vaccination. The cost of vaccination without screening was significantly more expensive (cost difference: 99 712 € and 184 996 €) both in case of two-dose and three-dose MMR vaccination respectively. Our study suggests that, in HCWs, the assessment of the mumps antibody titer before vaccination may be a useful complement to vaccination itself, because it is more accurate and cost-effective than direct immunization of unvaccinated subjects.

While associations between exposure to air pollutants and increased morbidity and mortality are well established, few rigorous studies on this issue are available. The aim of the current study is to implement a new approach to the spatial analysis of mortality and morbidity, based on testing for the presence of the same association in other areas of similar size. Additionally, we perform a case study in Val d’Agri (VA), an area of Basilicata Region, Southern Italy, where oil and natural gas extraction began in 1998. In order to examine the spatial distribution of morbidity and mortality in the region of interest, Hospital discharge (2001–2013) and mortality (2003–2014) rates for the main environment-related diseases were calculated. In addition, a comparison between the period 1980–1998 and the period 1999–2014 was performed for cardiovascular disease mortality. For the period under study, a neutral scenario emerged for cancer and respiratory diseases, where we found no differences in morbidity and mortality as compared to the national benchmark. In some cases significantly lower values (as compared to the nation-wide benchmark) were found. Conversely, a slight excess in morbidity and mortality (as compared to the nation-wide benchmark) emerged for cardiovascular diseases. Still, this excess was common to a number of municipalities in the surroundings of VA, and appeared to be already present in 1980. Higher rates of cardiovascular diseases, lower rates of neoplastic disorders no differences in mortality for respiratory causes (as compared to the nation-wide benchmark) were found in multiple areas of the region, and were therefore not specific to VA. In summary, our data do not support the hypothesis of a role of industrial activities related to oil extraction in VA in determining mortality and morbidity patterns and trends.

Nurse's job involves staying close to the patient for an extended time period and a high risk of transmission for airborne pathogens, including measles. Previous studies found high rate of operators unprotected for measles. We evaluated the immunization status for measles in nurses of a large hospital in Rome.We retrospectively evaluated the clinical records of nurses working in Tor Vergata hospital who underwent the occupational health screening program. Gender, age, work area and levels measles-specific IgG were evaluated.This study included 358 nurses. 77.7% (217) had a protective measles-specific IgG antibodies level. Protection rate was higher among workers aging 40 years (82.6% vs 68.7%; p0.01). The mean value of the anti-measles IgG was 217.2±91.1 AU/ml. Males showed higher values than females (253.3 vs 214.6; p0.01).Our study revealed a non-protective anti measles IgG level in a high percentage of nurses, even among those working in high risk areas.

Varicella is a potentially serious infectious disease caused by Varicella-Zoster Virus (VZV). In Italy childhood varicella vaccine have gradually introduced into national immunization program since 2003 and from 2017 a two-doses schedule has been stated nationally for all newborns and has become compulsory for school attendance. VZV exposures among healthcare workers (HCWs) and patients can be really dangerous and expensive. According to Centers of Disease Control and Italian national immunization plan health care, institutions should verify that all HCWs have clear evidence of immunity to VZV and should ensure that susceptible subjects will receive 2 doses of VZV vaccine. Currently, the vaccination of HCWs is not compulsory in Italy and the risk of varicella infection among these subjects is not well known. We evaluated the clinical records of 840 HCWs (256 male and 584 female) who underwent the annual occupational screening, from 1st January to 31st August 2018. HCWs were divided into three subgroups according to their age: 18–30, 31–40, and over 40 years old. We compared the mean values of IgG-specific antibodies between the age group through analysis of variance (ANOVA). A total of 784 (93.33%) HCWs were protected for VZV IgG antibodies level. There wasn’t a significant difference between male and female while was found between age group (P

Objectives. The night shift workers were reported to have health consequences, ranging from mild, as cluster headache, to severe, as heart attacks and hormonal irregularities. This study is aimed to perform a systematic review and meta-analyze of the association between the night shift work and the thyroid disorders. Methods. We comprehensively searched eight databases, including PubMed and Google Scholar for the relevant articles. This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Results. We finally included six papers involving 4074 participants. Four papers were eligible for meta-analysis involving 1864 night shift workers and 2017 day shift workers. We against found that thyroid stimulating hormone (TSH) is significantly higher in the night shift group compared to the day shift group. Conclusions. The higher TSH among the night shift workers is attributed to disruption of the circadian rhythm and sleep/wake cycle, with subsequent eating disorders. We proposed that more attention should be paid to the working pattern and the related health consequences.

To the editor,In this journal, we recently reported a study of measles-specific IgG antibody levels in Health Care Workers (HCWs) employed at the Policlinic Tor Vergata of Rome [1]. Among HCWs in t...

Objective: Allergic contact dermatitis (ACD) in the healthcare sector is a major occupational health hazard. There are many reasons for a higher frequency of ACD in healthcare personnel compared to other populations: among others, simultaneous exposure to multiple substances, use of aggressive detergents and wet work. However, studies that systematically correlate skin symptoms with the presence of sensitization investigated through patch tests in specific categories of health workers are very rare and conflicting. Although some studies have reported a correlation between skin disease and night shift, the strength of the evidence is rather limited. The purpose of our study was to investigate by means of patch testing the skin sensitization (SS) to common allergens in the hospital setting in a group of healthcare workers (HCW) reporting symptoms related to dermatitis, according to their job activity and their shift status. Methods: 132 HCWs visiting a health surveillance centre were investigated by means of specific questionnaire for dermatitis, followed by patch test evaluation including 40 haptens of the SIDAPA 2016 series. Results: Skin sensitization was observed in 1/3 of the subjects investigated by patch tests. The nursing job was strongly associated with cutaneous reactivity after controlling for the confounding of gender, age and other factors. Shift work was related to the prevalence of SS. Conclusions: In our study, the nurse's role and shift work were significantly associated with the risk of cutaneous sensitization, in particular for common antigens.

Objectives:Our study aims to evaluate whether the active use of the electronic cigarette (e-cig) can determine adverse effects on the respiratory function of healthy workers and whether potentially dangerous pollutants are released in the air.Methods:Thirty healthy workers (seventeen men and thirteen women, age range 27-37) were included in the study. Immediately before and after a 5-minute smoking session performed in two different days (first-day e-cig, second-day tobacco cigarette [t-cig]), they underwent spirometry evaluation. Furthermore, environmental particle monitoring was performed during the experimental procedure (i.e.before, during and after active smoking).Results:Our study showed slight reductions in the main pulmonary function data both after active e-cig and t-cig smoking. Changes in the main respiratory parameters were significantly different than baseline after 1 minute from e-cigarette smoking (3,95vs3,91 lt for FEV:P=0,03; 0,84vs0,83 for FEV1/FVC ratio:P=0,008; 4,23vs3,99 lt/min for FEF25-75%: P=0,03) but not after 15 minutes from active e-cigarette smoking, whereas after t-cig smoking, there was a significant drop in the 15 min value of FEV1(P=, FEF25-75% (P=0.01) and the FEV1/FVC ratio (P=0.007).Regarding environmental exposure, the e-cig smoking was associated with the transient release of particles with a diameter < 1 micron which dropped to baseline after 5 minutes, whereas in the case of t-cig, the particles persisted for 60 min.Conclusion:In this study, the active use of e-cig for a short time caused similar, although less pronounced effects as tobacco smoke on the pulmonary function. Similarly, the particles released in the environment had lower concentration and persistence than those of t-cig. These data suggest that e-cig may potentially be dangerous for active smokers and the environment. Long-term studies seem warranted to discover the health effects of active and passive exposure to e-cig.

Length and aspect ratio represent important toxicity determinants of fibrous nanomaterials. We have previously shown that anatase TiO

Background Workers in pathology and anatomy laboratories may be exposed to formaldehyde. An evaluation of the early effects of this substance is, therefore, paramount. This preliminary study was conducted to evaluate if nasal cytology could be used as a tool to detect changes in nasal mucosa in workers exposed to formaldehyde. Aims To assess whether nasal cytology was able to reveal any alteration of nasal mucosa in workers exposed to formaldehyde compared to unexposed subjects, and to ascertain whether a specific pattern of alterations correlated with years of exposure in order to evaluate long-term occupational exposure effects. Methods The study included a group of workers exposed to formaldehyde and a group of non-exposed workers. All subjects underwent clinical examination, followed by nasal cytology. Pathological indices from each rhinocytograms were compared between the two groups. Results Nasal cytology revealed a chronic inflammatory non-allergic condition in the exposed group. Qualitative analysis of data distribution of neutrophils and mucous-secreting/ciliated cells ratio showed data clustering with a cut-off set at 15 years of exposure. The mean formaldehyde concentrations ranged from

Background Healthcare workers (HCWs) have an increased exposure risk to measles, which can put them, their patients and their relatives at risk of infection. In Italy, 4617 cases of measles were reported in 2017; 302 involving HCWs. According to the Italian National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles. Aims To evaluate measles immunization status in HCWs at a large Italian teaching hospital. Methods We analysed clinical records and measles-specific IgG antibody titres of HCWs undergoing occupational health surveillance between 1 January and 31 August 2017. Results Among the 1532 HCWs (mean age 32.7 ± 10.4 years) included in the study, 87% (1328) had protective antibody titres. The proportion of protective titres was highest in those born before 1982. No significant gender differences in mean measles-specific IgG antibody titres were detected. Conclusions Our study shows non-protective measles IgG antibody titres in a substantial percentage of HCWs, especially those born in the 1980s and 1990s. Due to the increased risk of measles transmission in the hospital environment, increased prevention strategies are required, including rigorous screening and prompt vaccination of non-immune workers.

Background: Overgrowth syndromes are a heterogeneous group of conditions characterized by excessive body growth - localized or generalized - commonly associated with various malformities and an increased oncological risk. Case report: Here we present the case of a 59-years old man, employed in an office, who suffers from an asymmetric overgrowth of the lower limbs. Currently the patient presents malformations of the lower left limb (hip, knee and ankle), evident on the articular and periarticular level, where there are diffuse exostoses. This case discusses the main occupational concerns relating to the patient’s workspace at a high floor level that could create critical issues in the event of an emergency exodus. Given the impossibility of placing the patient in heavy manual activities, employment is limited to office activities. Adjustments were carried out at the patient’s workstation, and thus the patient has been recognized as fit to work. Increased frequency of breaks were prescribed in order to allow the physiological alternation of postures. Conclusions: In cases of overgrowth syndromes, the exact identification of the limitations presented by the patient and observations about ambulatory functions must be carefully evaluated in order to modulate the work environment.

There is evidence of adverse health impacts from human exposure to particulate air pollution, including increased rates of respiratory and cardiovascular illness, hospitalizations, and pre-mature mortality. Most recent hypotheses assign an important role to ultrafine particles (UFP) ( We performed experimental measurements during both morning and evening traffic peak hours throughout the winter season (December 2013–March 2014), for a total of 98 trips. Our results suggest that the lowest UFP exposures are experienced by underground train commuters, with an average number concentration of 14 134 cm −3 , and are largely a reflection of the routes being at greater distance from vehicular traffic. Motorcyclists experienced significantly higher average concentrations (73 168 cm −3 ) than all other exposure classes, and this is most likely a result of the presence of high-concentration and short-duration peaks which do not occur when the same routes are traveled by car. UFP concentrations in subway train environments were found to be comparable to urban background levels. Still, in underground trains we found the highest values of PM 10 mass concentration with a maximum value of 422 μg/m 3 . PM 10 concentration in trains was found to be four and two times higher than what was measured in car and motorbike trips, respectively. Transport mode contribution to total integrated UFP daily exposure was found to be 16.3%–20.9% while travelling by car, 28.7% for motorbike trips, and 8.7% for subway trips. Due to lower exposure times, commuting by car and motorbike is comparable to other daily activities in terms of exposure. Our data can provide relevant information for transport decision-making and increase environmental awareness in the hope that the information about inhaled pollutants can translate into a more rational approach to urban travelling.

Background: Tuberculosis prevention is a major goal in the hospital setting. Because of the possible progression or reactivation of latent disease, the screening of healthcare workers is an important issue in the TB control program. The aim of the study was to assess the prevalence of LTBI (latent tuberculosis infection) and to evaluate the main risk factors related to this condition in a teaching hospital in Italy. Methods: We reviewed the data of a tuberculosis screening conducted on 3622 healthcare professionals in a teaching hospital in Rome. All subjects were evaluated by QuantiFERON test which if positive, was followed by appropriate clinical and diagnostic procedures. Results: Latent Tuberculosis Infection LTBI condition was detected in 2.1% of the cases, most commonly in men. Male gender, higher age class, country of birth and nurse job were statistically related with the positivity to QuantiFERON test. Conclusion: LTBI was relatively uncommon in our population, however, given the potential risk of reactivation and progression to overt disease, the screening of healthcare workers and students is recommended in the hospital of low-incidence countries.

Background Meningococcal disease is generally caused by A, B, C, W and Y subgroups of Neisseria meningitidis. In 2015, the Italian mass media focused on this disease due to the death of two nurses. This generated alarm in the general population, especially in healthcare workers (HCWs). The Occupational Medicine department of the Foundation PTV Polyclinic Tor Vergata (PTV) offered free MenACWY vaccine to HCWs and to students of the University of Rome Tor Vergata. Aims To analyse the prevalence of N. meningitidis in PTV, a large teaching hospital, and to evaluate preventive measures offered to individuals at risk (i.e. HCWs and students). Methods The Hospital Informatic Service provided data about patients admitted to PTV from January 2012 to December 2016. Hospital Discharge Registers were analysed and all cases of meningitis were selected. MenACWY vaccine administered to HCWs and students of PTV in 2017 was analysed. Results There was just one case of meningococcal disease in 2016. Of the 117 MenACWY vaccines administered, 42% were given to students, 32% to doctors, 8% to nurses, 2% to clerks and 16% to other healthcare professionals. Conclusions International guidelines recommend MenACWY vaccine for microbiologists exposed to N. meningitidis isolates. The Italian Legislative Decree 81/2008, however, states that occupational physicians can adopt special protective measures such as vaccination programmes for HCWs. The response rate highlights how perceived risk may influence behaviour even in populations with a higher background knowledge than the general population.

Amorphous silica nanoparticles (SiO2NPs) have been recognized as safe nanomaterial, hence their use in biomedical applications has been explored. Data, however, suggest potential toxicity of SiO2 NPs in pregnant individuals. However, no studies relating nanoparticle biokinetic/toxicity to the different gestational stages are currently available. In this respect, we have investigated the possible embryotoxic effects of three-size and two-surface functionalization SiO2NPs in mice. After intravenous administration of different concentrations at different stages of pregnancy, clinical and histopathological evaluations, performed close to parturition, did not show signs of maternal toxicity, nor effects on placental/fetal development, except for amino-functionalized 25 nm NPs. Biodistribution was studied by ICP-AES 24 h after administration, and demonstrates that all particles distributed to placenta and conceptuses/fetuses, although size, surface charge and gestational stage influenced biodistribution. Our data suggest the need of comprehensive toxicological studies, covering the entire gestation to reliably assess the safety of nanoparticle exposure during pregnancy.

Cement is widely used for construction and several reports have suggested a potential toxicity of cement dusts although it has never been definitively assessed. To determine the cytotoxic and bioactive effects of cement dusts, cultures of normal rat fibroblasts were exposed to different types of cements and cell growth parameters, apoptosis and the occurrence of DNA damage (both in terms of DNA breaks and oxidative damage) were analyzed. Cells were exposed to cement extracts or cultured in direct contact with cement dusts and the results obtained were compared to cells cultured in fresh medium. A dose-dependent decrease in viable cells was observed with all tested cements. Different results were obtained in the cell-cement direct contact tests compared to the indirect contact tests performed using extracts. Inhibition of cell growth was associated in most cases with an accumulation of cells in the S-phase of the cell-cycle and the appearance of an apoptotic peak. DNA strand breaks, assessed by comet test, and increase in the levels of 8-OHdG, an important marker of DNA oxidative damage, always occurred by incubating cells in the presence of cement extracts or dusts. However, after removal of cement, a rapid damage repair was generally observed with an almost complete recovery within 12 hours. In conclusion, all cements analyzed in this study displayed a limited toxicity in vitro without significant differences amongst them. Overall, the results obtained indicate that cements should be treated as hazardous materials but they do not allow to make accurate predictions regarding the in vivo effects. Further studies are warranted to reach a better understanding of the potential toxic effects of cements, to identify the responsible mechanisms and to evaluate the possibility of modulating and/ or preventing them.

Recently, interest for the potential impact of consumer-relevant engineered nanoparticles on pregnancy has dramatically increased. This study investigates whether inhaled silver nanoparticles (AgNPs) reach and cross mouse placental barrier and induce adverse effects. Apart from their relevance for the growing use in consumer products and biomedical applications, AgNPs are selected since they can be unequivocally identified in tissues. Pregnant mouse females are exposed during the first 15 days of gestation by nose-only inhalation to a freshly produced aerosol of 18-20 nm AgNPs for either 1 or 4 hours, at a particle number concentration of 3.80 × 107 part. cm(-3) and at a mass concentration of 640 µg/m³. AgNPs are identified and quantitated in maternal tissues, placentas and foetuses by Transmission Electron Microscopy coupled with Energy-dispersive X-ray spectroscopy and single-particle Inductively Coupled Plasma Mass Spectrometry. Inhalation of AgNPs results in increased number of resorbed foetuses, associated to reduced oestrogen plasma levels, in the 4h/day exposed mothers. Increased expression of pregnancy-relevant inflammatory cytokines is also detected in the placentas of both groups. These results proof that NPs are able to reach and cross the mouse placenta, and suggest that precaution should be taken with respect to acute exposure to nanoparticles during pregnancy.

Workers have the highest chance of being exposed to engineered nanomaterials; therefore, if such materials display hazardous effects, workers might develop adverse health effects upon exposure. In the absence of definitive information about the possible biological risk posed by nanomaterials, evaluation of exposure and implementation of measures avoiding or reducing exposure are mandatory. This chapter discusses the modalities of exposure to nanomaterials in workers according to the specific occupational settings, and to the routes of exposure. Emphasis is placed on the physicochemical modifications, which the nanomaterials may undergo before coming in contact with the biological barriers of the workers (i.e., lung, skin, and the gastrointestinal tract) and how these modifications may translate into different biological outcomes. We highlight some of the challenges in assessing exposure in the workplace including measurement strategies, metrics, and instrumentations. Finally, considerations on the most appropriate health surveillance programs, based on the current, albeit incomplete knowledge of the biological effects of nanomaterials, are discussed.

Objective: Night-shift work is associated with ischaemic cardiovascular disorders. It is not currently known whether it may be causally linked to metabolic syndrome (MS), a risk condition for ischaemic cardiovascular disorders. The syndrome presents with visceral obesity associated with mild alterations in glucidic and lipidic homeostasis, and in blood pressure. The aim of this study was to assess whether a causal relationship exists between night-shift work and the development of MS. Methods: Male and female nurses performing night shifts, free from any component of MS at baseline, were evaluated annually for the development of the disorder during a 4-year follow-up. Male and female nurses performing daytime work only, visited during the same time period, represented the control group. Results: The cumulative incidence of MS was 9.0% (36/402) among night-shift workers, and 1.8% (6/336) among daytime workers (relative risk (RR) 5.0, 95% CI 2 2.1 to 14.6). The annual rate of incidence of MS was 2.9% in night-shift workers and 0.5% in daytime workers. Kaplan-Meier survival curves of the two groups were significantly different (log-rank test; p

The novel physicochemical properties of engineered nanoparticles (ENPs) make them very attractive for industrial and biomedical purposes, but concerns have been raised regarding unpredictable adverse health effects in humans. Current evidence for the risk posed by ENPs to exposed workers is the subject of this review.To perform an in-depth review of the state of art of nanoparticle exposure at work.Original articles and reviews in Pubmed and in principal databases of medical literature up to 2013 were included in the analysis. In addition, grey literature released by qualified regulatory agencies and by governmental and non-governmental organizations was also taken into consideration.There are significant knowledge and technical gaps to be filled for a reliable evaluation of the risk posed for workers by ENPs. Evidence for potential workplace release of ENPs however seems substantial, and the amount of exposure may exceed the proposed occupational exposure limits (OELs). The rational use of conventional engineering measures and of protective personal equipment seems to mitigate the risk.A precautionary approach is recommended for workplace exposure to ENPs, until health-based OELs are developed and released by official regulatory agencies.

The potential (eco)toxicological hazard posed by engineered nanoparticles is a major scientific and societal concern since several industrial sectors are exploiting the innovative properties of nanostructures resulting in their large-scale production. Many consumer products contain nanomaterials and, given their complex life-cycle, it is essential to anticipate their (eco)toxicological properties in a fast and inexpensive way in order to mitigate adverse effects on human health and the environment. In this context, the application of the structure–toxicity paradigm to nanomaterials represents a promising approach. Indeed, according to this paradigm, it is possible to predict toxicological effects induced by chemicals on the basis of their structural similarity with chemicals for which toxicological endpoints have been previously measured. These structure–toxicity relationships can be quantitative or qualitative in nature and they can predict toxicological effects directly from the physicochemical properties of the entities (e.g. nanoparticles) of interest. Therefore, this approach can aid in prioritizing resources in toxicological investigations while reducing the ethical and monetary costs that are related to animal testing. The purpose of this review is to provide a summary of recent key advances in the field of QSAR modelling of nanomaterial toxicity, to identify the major gaps in research required to accelerate the use of quantitative structure–activity relationship (QSAR) methods, and to provide a roadmap for future research needed to achieve QSAR models useful for regulatory purposes., JRC.I.5-Systems Toxicology

Tuberculosis screening is recommended for all health care workers. We evaluated the prevalence of latent tuberculosis infection among 939 hospital workers of Tor Vergata University teaching hospital in Rome, Italy, in the period 2007-2013, by using the QuantiFERON Gold In-Tube (QFT) test. The mean age of subjects tested was 31 years. The prevalence of positive subjects (cut-off 0.35 UI/ml) was 5.5% (46/939) and the mean age of those who tested positive was 39 years. The low rate of positivity may be partly related to the higher reliability of QFT in comparison to tuberculin skin testing.

There is recent mounting evidence that nanoparticles may have enhanced toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method for unmask asbestos nanofibers from Formalin-Fixed, Paraffin-Embedded tissue. There is an increasing amount of evidence that nanoparticles may enhance toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method to unmask asbestos nanofibers from Formalin-Fixed Paraffin-Embedded (FFPE) tissue. For the first time, in this study we applied Energy Dispersive X-ray (EDX) microanalysis through transmission electron microscopy to demonstrate the presence of asbestos nanofibers in histological specimens of patients with possible occupational exposure to asbestos. The diagnostic protocol was applied to 10 randomly selected lung cancer patients with no history of previous asbestos exposure. We detected asbestos nanofibers in close contact with lung cancer cells in two lung cancer patients with previous possible occupational exposure to asbestos. We were also able to identify the specific asbestos iso-type, which in one of the cases was the same rare variety used in the workplace of the affected patient. By contrast, asbestos nanofibers were not detected in lung cancer patients with no history of occupational asbestos exposure. The proposed technique can represent a potential useful tool for linking the disease to previous workplace exposure in uncertain cases. Furthermore, Formalin-Fixed Paraffin-Embedded (FFPE) tissues stored in the pathology departments might be re-evaluated for possible etiological attribution to asbestos in the case of plausible exposure. Since diseases acquired through occupational exposure to asbestos are generally covered by workers’ insurance in most countries, the application of the protocol used in this study may have also relevant social and economic implications.Â

In recent years there has been growing attention to the importance of indoor air quality on which scientist and experts have no doubts since in modern society we tend to spend most of the time in various types of indoor environments (office, private homes, etc.). Laser printers, in particular, release an aerosol into the environment including solid and liquid particles and gaseous compounds. The measurement of all these components is not practically feasible. Therefore, it is necessary to identify a marker which, when measured, shows accurately the frequency, duration and magnitude of the exposure. The measure with an optical particle counter (OPC) and a condensation particle counter (CPC) is an indicator with high sensitivity and representativeness. The major advantage of using these tools is the ability to detect the presence of ultrafine particles and also detect the particles in the liquid phase. The continuous recording of submicron particulate matter emitted during the printing activity allows to measure the exposure of personnel, while the ratio between the peak values and the values without printing activity can be used to classify the printers according to their emissivity. The particulate generated during the processes of printing has size less than 0.3 micron and therefore extends in the size range of nanoparticles (ultrafine particles less than 100 nm). These activities lead to high concentrations of ultrafine particles with a variability related to factors such as type of printer, toner, paper type, frequency of maintenance and air exchange. The concentrations of ultrafine particles in office environments can be reduced by proper choice of the printers, with the use of appropriate filtration techniques and placing the equipment away from workstations.

The approach to the treatment of Helicobacter pylori infection has changed during the last years. In fact, during the last decade, the success rate of usual eradication regimens, based on a proton pump inhibitor plus clarithromycin associated with amoxicillin or metronidazole, declined from over 90% to about 80%, a critical threshold under which the eradication rate is considered unsatisfactory, according to current guidelines. This finding is mainly due to the raising prevalence of clarithromycin resistance, which is in turn linked to the widespread use of this antibiotic for respiratory tract infections. Therefore, obtaining a personal history negative for a previous use of macrolides is now mandatory, before administering clarithromycin-based antibiotic therapy. Should history data be uncertain, local resistance rates (if available) may be considered, with levels higher than 20% precluding the use of clarithromycin. In this case, alternative antibiotic combinations, previously used in the rare instances of failure of clarithromycin-based therapy, should be used. We examined also the possible additional beneficial effect of some novel non antibiotic agents such as lactoferrin, probiotics and natural substances. Other advances in the treatment of the infection are represented by the discovery that some extragastric disorders such as unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, may be causally linked to Helicobacter pylori, and that eradication therapy may lead to their regression in many cases. Finally, some "gray areas" (nonulcer dyspepsia, concomitant use of nonsteroidal anti-inflammatory drugs) which are the subject of debate as far the indication to treatment is concerned, have been discussed.

In October of 2014, a meeting jointly organized by the EU Nanosafety Cluster and the COST Action TD 1204, was held on the beautiful island of Ortygia in Syracuse (Sicily). The meeting was specifically conceived to give the opportunity to young researchers in the field of nanotoxicology to present and discuss the results of their research. Presentations were divided into eight sessions over 2 days, reflecting the eight working groups of the Nanosafety Cluster. This report gives a description of the meeting activities and a summary of the data presented there.

An in-depth assessment of work-related stress was conducted in a major national telecommunications company undergoing major changes. The assessment was made on three homogeneous groups of workers and covered a large representative sample of the corresponding populations.To identify the main sources of stress for the three populations of workers, stimulate a discussion on the possible corrective actions, and assess the impact of the on-going organizational changes on workers' health.The assessment started with an analysis of the objective stress indicators listed in the INAIL (National Insurance Institute for Occupational Diseases and Accidents) Checklist. This was followed by a combination of qualitative and quantitative investigations on work context and tasks and on the subjective perceptions of workers, which were carried out by using: semi-structured interviews with management, field observations of work tasks, focus groups and questionnaires (GHQ-12, HSE Indicator Tool, ad-hoc questionnaire).The assessment allowed identification of the critical areas to be addressed with specific interventions: relationship with the company, work performance, work organization, and equipment.the investigation allowed to identification of specific practical actions (improvement of technological tools; professional development through training courses) as well as strategic actions ( re-establish relationship of trust with the company) so as to mitigate the workers' level of stress. Analysis of the results also showed that the three targeted populations differed in the degree of acceptance and understanding of the organizational changes.

The involvement of Helicobacter pylori in the pathogenesis of extragastric diseases continues to be an interesting topic in the field of Helicobacter-related pathology. Although conflicting findings have been reported for most of the disorders, a role of H. pylori seems to be important especially for the development of cardiovascular and hematologic disorders. Previously isolated human and animal Helicobacter sp. flexispira and "Helicobacter heilmannii" strains have been validated using polyphasic taxonomy. A novel enterohepatic Helicobacter has been isolated from mastomys and mice, adding to the list of helicobacters that colonize the liver. Genetic targets that may aid the classification of novel Helicobacter species have emerged. Animal models of Helicobacter-induced gastric and hepatobiliary diseases have offered insights to the mechanisms associated with premalignant transformation.