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The Erice 2018 Charter was unanimously approved at the conclusion of the 53rd Residential Course of the International School of Epidemiology and Preventive Medicine “Adapted Physical Activity in Sport, Wellness and Fitness; the role of the Departments of Prevention and of the National Health Service in doping prevention and health promotion”, held on 15-19 May 2018 in Erice, Italy, at the “Ettore Majorana” Foundation and Centre for Scientific Culture, and promoted by the Study Group on “Movement Sciences for Health” of the Italian Society of Hygiene, Preventive Medicine and Public Health. The event was part of a larger project supported by the Ministry of Health aimed at preventing doping in the general population involved in sport and physical activities. After an intense discussion the participants focused on ten statements involving the following critical issues: responsibility, priority, message, alphabetization, networks and alliances, school promoting health, player and opportunities, competences, know-how, programming and acting. These statements provide hints to approach doping within a public health frame and summarize the role of the Departments of Prevention and NHS in promoting and coordinating preventive actions with other institutions and stakeholders. Doping represents a complex phenomenon related to cultural, social, economic and legal issues. In addition to regulatory or repressive actions, education to health and legality is proposed as the fundamental strategy to contrast doping by promoting healthy lifestyles, based on scientific knowledge and respect for legality.

Introduction. Doping is an important public health problem widespread not only among elite athletes, but also among amateur and recreational athletes and the general population. In Italy the introduction of doping prevention within the Essential Levels of Care (LEA) with the DPCM 12/1/2017 represents a crucial step towards the implementation of education and health promotion interventions. In this context, the Departments of Prevention (DP) of the Local Health Authorities (LHA) have to play a fundamental role, becoming the cultural and operational reference on this issue. As part of the "Doping prevention: development of a permanent educational tool coordinated by the National Health Service Prevention Departments" project, funded by the Italian Ministry of Health, a survey was conducted on the activities carried out by the DP regarding doping prevention and improper use and abuse of drugs and food supplements in sports and physical activities, as a basis for the harmonization of organizational structures and prevention programs and the creation of a collaboration network at a regional and national level.Methods. A semi-structured questionnaire consisting of 11 questions, prepared on an electronic platform, was sent to the DP of all the Italian LHA.Results. A total of 38 DP out of 131 (29%) completed the questionnaire, with representation from all regions. 42.1% of DP carried out or are still running programs for the prevention of doping, a percentage that decreases to 27% considering the programs for the prevention of misuse and abuse of drugs and food supplements in sports and in physical activities; in less than half of the DP, 37.5% and 41.7%, respectively, dedicated funds have been allocated. The professionals most involved in prevention of doping are the Specialists in Sport Medicine (81.3%) followed by Specialists in Hygiene (43.8%) and Psychologists (37.5%), while Health Care Assistants (50%) are the professionals most involved in the prevention of the improper use of drugs and food supplements, followed by Specialists in Hygiene and Specialists in Sport Medicine (40%). Most of the DP (71.9%) believe that the introduction of programs to prevent and counteract doping in the LEA will have repercussions on their approach against doping.Conclusions. The survey, although conducted on a limited sample, has provided an important framework relating to programs for the prevention of doping and the misuse and abuse of drugs and food supplements in sports and in the physical activities carried out by DP A remarkable heterogeneity has been highlighted, both at national and regional level. It is urgent to provide DP with homogeneous and effective organizational models and adequate operational tools, paying particular attention to the training of all the professionals involved. It is also essential to implement permanent monitoring tools.

Hormones with anabolic properties such as growth hormone (GH) and insulin-like growth factor-1 (IGF-1) are commonly abused among professional and recreational athletes to enhance physical ability. Despite their adverse effects are well-documented, the use of GH and IGF-1 has recently grown. This article highlights the anabolic activity related to mechanisms of cancer development and progression. GH/IGF-1 axis is able to activate cellular mechanisms that modulate every key stage of cancer formation and progression, such as inhibition of apoptosis, resistance to treatments, and induction of angiogenesis, metastatic process and cell proliferation. Results from pre-clinical studies and epidemiological observations in patients with an excess of GH and IGF-1 production or treated with these hormones showed a positive association with the risk to develop several types of cancer. In conclusion, athletes should be made aware that long-term treatment with doping agents might increase the risk of developing cancer, especially if associated with other licit or illicit drugs and/or high-protein diet.

Healthcare associated infections (HAIs) represent a serious problem for public health, as they increase the morbidity and mortality rates, present a relevant financial burden, and significantly contribute to the antimicrobial resistance.The aim of this review was to investigate the literature about HAIs, with particular reference to hospital environments and the role of cleaning and disinfection procedures. Hospital environments are an essential reservoir for HAIs cross transmission, and the application of appropriate procedures related to hand hygiene and disinfection/sterilization of surfaces and instruments remain key strategies for controlling HAIs.Different procedures, based on the risk associated with the healthcare procedure, are recommended for hand hygiene: washing with soap and water, antiseptic rubbing with alcohol-based disinfectants, antiseptic and surgical hand washing. Environmental surfaces can be treated with different products, and the mostly used are chlorine-based and polyphenolic disinfectant. The reprocessing of instruments is related to their use according to the Spaulding's classification. In addition, scientific evidence demonstrated the great relevance of the "bundles" (small set of practices performed together) in controlling HAIs.Research agenda should include the improvement of well-known effective preventive procedures and the development of new bundles devoted to high-risk procedures and specific microorganisms.

The swimming pool legislation is extremely various and uneven. This diversity is related to the different approaches of individual health authorities, attributable to the different social, economic and cultural conditions of each country. In Italy the regulation about sanitary aspects for the construction, maintenance and control of swimming pools refers to the Agreement of January 16, 2003 among the Ministry of Health, the Regions and the Autonomous Provinces of Trento and Bolzano. The Agreement is not a jurisprudential act, but has the character of a document approved by constitutional organs of the same level, aimed to promote the harmonization of respective legislations or the attainment of unitary positions. The controls and the related samples will be collected by Local Health Authority in compliance with criteria established by each region on the basis of specific control plans and supervision and in a manner and frequency that take into account the type of existing facilities inside the specific territorial areas, with particular attention to the critical points highlighted in the protocols of management and the self-prepared safety plans. In this regard, the working Group of Movement Sciences for the Health (GMSH) of the Italian Society of Preventive Medicine and Hygiene (SItI), proposes a checklist to complete during inspections routinely conducted by Local Health Authorities in swimming facilities. The aim is to have a single tool that can homogenize supervisory activities, procedures and types of controls in different realities, both locally and nationally.

The ETS1 gene encodes a sequence-specific transcription factor binding to purine-rich DNA sequences (-GGAA-) present in the transcriptional regulatory regions of many cellular and viral promoters/enhancers, including many lymphokine genes. The ETS1 gene is expressed at high levels in resting T cells and at very low levels after T cell activation, suggesting it may suppress the expression of genes induced during T cell activation. To find out if ETS1 regulates expression of the IL-2 gene, we have ectopically expressed antisense (AS) ETS1 in Jurkat T cells to block the formation of ETS1 proteins. AS ETS1 transfectants produce higher levels of IL-2 compared with sense ETS1 transfectants. Expression of ETS1 DNA binding domain in Jurkat T cells also decreased the production of IL-2. In AS ETS1 transfectants, IL-2 formation was completely inhibited by cyclosporin A and FK590. The IL-2 promoter linked to a chloramphenicol acetyl transferase reporter gene has high activity in AS ETS1 transfectants, indicating that increased IL-2 production seems to be a result of transcriptional induction. Taken together, these results suggest the possibility that ETS1 may act as a negative regulator of IL-2 gene transcription and provide a rational approach toward engineering the endogenous expression of IL-2 in T cells.

Obiettivi: materie prime e derivati da organismi geneticamente modificati (OGM) sono autorizzati e regolamentati sia per il consumo umano, che per quello animale. Sono stati svolti da alcuni autori lavori che evidenziano la permeabilità della barriera intestinale di mammiferi a molecole di DNA di dimensioni superiori ad 1 kB. Tali molecole (non necessariamente provenienti da OGM) una volta attraversata la barriera rimangono nei tessuti, fino alla loro completa degradazione. Non ci sono comunque prove di funzionalità del DNA ingerito e recuperato nei tessuti. Lo scopo è stato quello di valutare la presenza di DNA, in tessuti di pesci di allevamento, nutriti con mangimi a base di soia.Metodi: campioni di mangime ed esemplari di pesci sono stati raccolti in alcuni allevamenti del centro Italia. Il contenuto di soia OGM nei mangimi è stato quantificato mediante real time PCR. Frammenti di vari organi sono stati prelevati dagli esemplari e sottoposti ad estrazione di DNA. La presenza di frammenti di geni vegetali e transgeni è stata valutata mediante specifiche reazioni di PCR.Risultati: il 90% dei mangimi raccolti è risultato OGM positivo in misura variabile tra lo 0.5% ed il 60%. Sono stati analizzati 75 pesci (spigole e orate) provenienti da 5 allevamenti. Non è stata riscontrata presenza di DNA esogeno nei tessuti analizzati tranne deboli segnali positivi nel tessuto intestinale. Questo dato è presumibilmente da imputare alle difficoltà di ottenere preparazioni di DNA intestinale prive di contaminazione alimentare.Conclusioni: i risultati ottenuti non rilevano attraversamento della parete intestinale da parte del DNA ingerito. Le motivazioni del disaccordo con i dati di letteratura possono essere ricercate nella scelta del modello ittico, distante dai mammiferi sia in termini filogenetici quanto in modalità alimentari. Il destino del DNA ingerito rimane in ogni caso una problematica che richiede ulteriori approfondimenti.

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

The relationship between Legionella and Pseudomonas spp contamination and mineral content of domestic hot waters was investigated in a cross-sectional Italian survey. Pseudomonas spp contamination was associated with elevated Ca, but lower Fe and free chlorine content in the water. Waters with Cu concentrations50 microg/L prevented Legionella spp colonisation (OR = 0.14, 95% CI = 0.02-1.13), whereas the risk of legionellae occurrence increased in waters with Mn levels3 microg/L (OR = 2.37, 95% CI = 1.06-5.30). Furthermore, Mn was positively associated with the risk of colonisation by eterotrophic bacteria growing at either 22 and 36 degrees C. Legionella species and serogroups were differently distributed according to Cu and Mn concentrations, suggesting that Legionella strains may have a different sensibility/resistance to trace elements. A specific action of Cu as decontamination factor is suggested and the consideration of Mn as a risk indicator for bacterial colonisation and biofilm presence is proposed.

Left ventricular hypertrophy in patients with hypertension is a main clinical prognostic entity The aim of this study was to evaluate the association between mutations at genes of the renin-angiotensin system (RAS) and the development of left ventricular hypertrophy. Genetic polymorphism in angiotensinogen (AGT) and angiotensin Il-type 1 receptor (AT1R) genes was examined in a group of well-selected essential hypertensive caucasians with left ventricular involvement (n = 40) and a group of healthy unrelated caucasians (n = 150). Cardiac morphology and function were assessed by M-mode echocardiography. Molecular variants were analysed by amplified fragment length polymorphism. We observed a statistically significant difference both for AGT and AT1R genotype distribution in patients with left ventricular hypertrophy compared with controls (p0.05). A 0.49 and 0.225 frequency was detected among cases for T and C mutant alleles at AGT and AT1R genes. Mutations in RAS genes are involved in the pathophysiology of target-organ damage in essential hypertension. Evaluation of molecular factors conferring a risk of developing heart involvement may lead to better identification of patient subgroups and more effective control of the clinical course.

Administration of prohibited substances to enhance athletic performance represents an emerging medical, social, ethical and legal issue. Traditional controls are based on direct detection of substances or their catabolites. However out-of-competition doping may not be easily revealed by standard analytical methods. Alternative indirect control strategies are based on the evaluation of mid- and long-term effects of doping in tissues. Drug-induced long-lasting changes of gene expression may be taken as effective indicators of doping exposure. To validate this approach, we used real-time PCR to monitor the expression pattern of selected genes in human haematopoietic cells exposed to nandrolone, insulin-like growth factor I (IGF-I) or growth hormone (GH). Some candidate genes were found significantly and consistently modulated by treatments. Nandrolone up-regulated AR, ESR2 and PGR in K562 cells, and SRD5A1, PPARA and JAK2 in Jurkat cells; IGF-I up-regulated EPOR and PGR in HL60 cells, and SRD5A1 in Jurkat; GH up-regulated SRD5A1 and GHR in K562. GATA1 expression was down-regulated in IGF-1-treated HL60, ESR2 was down-regulated in nandrolone-treated Jurkat, and AR and PGR were down-regulated in GH-treated Jurkat. This pilot study shows the potential of molecular biology-based strategies in anti-doping controls.

Sequence-based approaches to prokaryotic systematics and typing represent a modern and promising strategy in epidemiology and environmental microbiology. GenEnv, a database-driven system for bacterial typing, was developed in order to provide user friendly tools for supporting biomolecular analysis of bacteria. The family Vibrionaceae represents a heterogeneous taxon of aquatic microrganisms, harbouring a plethora of genomes currently analyzed by different molecular techniques. Under the query ?Vibrio?, GenEnv retrieved 256 organisms, included in a total number of 19 families. Overall, 548 sequences, comprising 16S rRNA(n = 402), rpoB (n = 1), gyrB (n = 145) were available. In addition, GenEnv system allowed primer design, homology analysis and restriction maps, for immediate applications to the study of Vibrionaceae., Journal of Preventive Medicine and Hygiene, Vol 47, No 3 (2006)

Exposure to single and multiple carcinogenic metals and/or semimetals represents a major environmental risk factor for public health. In particular, children are more susceptible to environmental pollutants than adults, but specific studies are still limited. The aims of the present study were: 1) to trace the exposure and co-exposure profiles to eight known or suspected carcinogenic metals and semimetals (As, Be, Cd, Co, Cr, Ni, Pb, and Sb); and: 2) to evaluate the influence of some possible interfering/confounding factors on the exposure to these elements during childhood.Cross-sectional study.We recruited 159 healthy Italian children attending a primary school of the urban area of Rome, Italy. Selected metals were determined by inductively coupled plasma mass spectrometry on urinary samples collected at the end of a "typical" day (one sample for each child), while information about possible confounding/interfering factors were collected via questionnaires.The great part of the studied children resulted co-exposed to the monitored metals: 83.2%, 69.2%, 51.0% and 29.3% of the participants were concurrently exposed to at least two, three, four and five trace elements, respectively. Gender was the only one among the investigated variable that significantly influenced the co-exposure, with females resulting at lower risk (OR = 0.392; 95 IC = 0.156 - 0.989; p0.047).Given the importance of protecting child's health and the risks related to the exposure to carcinogenic metals, especially when they occur simultaneously, other researches in this field are strongly recommended.

We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of 50 microg/L appeared to be protective against Legionella colonization [corrected]. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches.