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Background Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case/control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information. Methods The study was carried out in 14 Italian regions (78.3% of Italian population aged 0?10). It included leukaemia, NHL and neuroblastoma cases incident in 0?10 year olds in 1998-2001,registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP)(accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child?s bed (48 hours measurement). Results The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls.ELF-MF long term measurements were obtained for 61.1% of controls and 81.6% of leukaemia cases; 8.8% of controls were exposed at over 0.1 microTesla (μT), 3.5% and 2.1% at respectively over 0.2 and 0.3 μT. 25% of controls? fathers had smoked over 10 cigarettes/day during the year of conception, varying according to education and region. Maternal smoking was less common (71.4% did not smoke in pregnancy). Maternal passive smoking during pregnancy was reported by 31.2% of controls; the child?s passive smoking for 28.6%. Occupational exposure to solvents was estimated in 18.3% of controls? fathers and 7.7% of mothers. Contact with public was more frequent among mothers (36.1%) than fathers (23.4%). Conclusions SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors.

Background Parental smoking and exposure of the mother or the child to environmental tobacco smoke (ETS) as risk factors for Acute non-Lymphocytic Leukemia (AnLL) were investigated. Methods Incident cases of childhood AnLL were enrolled in 14 Italian Regions during 1998–2001. We estimated odds ratios (OR) and 95% confidence intervals (95%CI) conducting logistic regression models including 82 cases of AnLL and 1,044 controls. Inverse probability weighting was applied adjusting for: age; sex; provenience; birth order; birth weight; breastfeeding; parental educational level age, birth year, and occupational exposure to benzene. Results Paternal smoke in the conception period was associated with AnLL (OR for ≥11 cigarettes/day = 1.79, 95% CI 1.01–3.15; P trend 0.05). An apparent effect modification by maternal age was identified: only children of mothers aged below 30 presented increased risks. We found weak statistical evidence of an association of AnLL with maternal exposure to ETS (OR for exposure>3 hours/day = 1.85, 95%CI 0.97–3.52; P trend 0.07). No association was observed between AnLL and either maternal smoking during pregnancy or child exposure to ETS. Conclusions This study is consistent with the hypothesis that paternal smoke is associated with AnLL. We observed statistical evidence of an association between maternal exposure to ETS and AnLL, but believe bias might have inflated our estimates.

igiene, paziente,acqua

Introduzione La necessità di migliorare la qualità delle prestazioni ospedaliere ha sensibilizzato il Ministero della Salute all’elaborazione ed emanazione di Linee Guida sulle attività di sala operatoria per avere su tutto il territorio nazionale un documento unico e ufficialmente riconosciuto, adattabile alle esigenze locali. Obiettivi L’iter operatorio si compone di almeno tre grandi variabili: la complessità intrinseca caratterizzante tutte le procedure chirurgiche, la multidisciplinarietà delle figure professionali coinvolte e la componente organizzativo-strutturale. Si è confrontato il recepimento delle Linee Guida ministeriali in materia di sicurezza in sala operatoria in due realtà ospedaliere strutturalmente differenti quali l’Azienda Ospedaliera Universitaria Policlinico «P. Giaccone» (A.O.U.P.) e l’Ospedale Buccheri La Ferla-Fatebenefratelli, entrambe operanti sul territorio della Provincia di Palermo. Discussione Nelle due Strutture Ospedaliere prese in esame emerge una piena concordanza sulla applicazione delle linee guida ministeriali. Si può evidenziare infatti una totale compliance alle direttive ministeriali sulla prassi igienico-comportamentale e sulla preparazione e gestione del paziente sia nella fase preoperatoria che in quella postoperatoria. Coincidono inoltre le linee guida di gestione del rischio clinico dedicate al personale addetto al complesso operatorio. La principale difformità tra le due realtà, motivata principalmente da differenti esigenze strutturali, è la maggiore attenzione posta alla programmazione delle attività di sala operatoria da parte dell’Ospedale Buccheri La Ferla - Fatebenefratelli rispetto a quella dell’ A.O.U.P «P. Giaccone». Ciò dipende dall’organizzazione di un complesso operatorio unico per tutte le specialità al Buccheri La Ferla, tipico delle strutture monoblocco. Al contrario, la struttura dell’A.O.U.P., organizzata a padiglioni, consente di destinare alle singole specialità sale operatorie dedicate, con caratteristiche strutturali, modalità operative per l’accesso al complesso operatorio e procedure per la preparazione dell’equipe chirurgica adattate alle esigenze delle micro-aree che lo compongono. Conclusioni Le Linee Guida di entrambe le realtà esaminate riportano i principi ispiratori emanati nelle Linee Guida ministeriali e, conformemente alle rispettive caratteristiche architettoniche, tendono rispettare perfettamente lo schema proposto rispetto i punti cardine del documento con marginali e trascurabili differenze.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2–15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

Background The association of childhood leukemia with traffic pollution was considered in a number of studies from 1989 onwards, with results not entirely consistent and little information regarding subtypes. Aim of the study We used the data of the Italian SETIL case-control on childhood leukemia to explore the risk by leukemia subtypes associated to exposure to vehicular traffic. Methods We included in the analyses 648 cases of childhood leukemia (565 Acute lymphoblastic–ALL and 80 Acute non lymphoblastic-AnLL) and 980 controls. Information on traffic exposure was collected from questionnaire interviews and from the geocoding of house addresses, for all periods of life of the children. Results We observed an increase in risk for AnLL, and at a lower extent for ALL, with indicators of exposure to traffic pollutants. In particular, the risk was associated to the report of closeness of the house to traffic lights and to the passage of trucks (OR: 1.76; 95% CI 1.03–3.01 for ALL and 6.35; 95% CI 2.59–15.6 for AnLL). The association was shown also in the analyses limited to AML and in the stratified analyses and in respect to the house in different period of life. Conclusions Results from the SETIL study provide some support to the association of traffic related exposure and risk for AnLL, but at a lesser extent for ALL. Our conclusion highlights the need for leukemia type specific analyses in future studies. Results support the need of controlling exposure from traffic pollution, even if knowledge is not complete.

Obiettivo. Rilevare la presenza di Legionella spp. nell’aria attraverso un protocollo standardizzato, a fianco dei tradizionali metodi impiegati per la rete idrica. Disegno. In dieci strutture sanitarie è stato selezionato un bagno, la cui acqua presentava una contaminazione da Legionella >1.000 unità formanti colonie (ufc)/litro. La contaminazione dell’aria è stata valutata tramite campionamento attivo (Surface Air System, SAS) e passivo, impiegando piastre di sedimentazione per la valutazione dell’Indice Microbico Aria (Index of Microbial Air, IMA). I campionamenti sono stati effettuati per 8 ore consecutive, a circa 1 m dal pavimento e a 50 cm dal rubinetto. Con il campionamento attivo, 200 litri di aria erano aspirati ogni 12 min, dopo flussaggio dell’acqua per 2 min. Il valore IMA era calcolato come valore medio di ufc/16 piastre esposte nel corso del campionamento (due per ogni ora). La contaminazione dell’acqua è stata valutata al tempo zero, dopo 4 e 8 ore, secondo le procedure descritte nelle linee guida del 2000. Risultati. Legionella spp. è stata rilevata nell’aria di tre strutture sanitarie (in una con il metodo SAS, in due con il metodo IMA), la cui contaminazione idrica è risultata compresa tra 1.100 e 43.000 ufc/l (mediana=40.000). I restanti sette ospedali hanno riportato una contaminazione da Legionella solo nell’acqua (mediana=8.000; range 1.200-70.000 ufc/l), mai nell’aria circostante. Conclusioni. I nostri dati suggeriscono che la valutazione della contaminazione ambientale da Legionella spp, quando effettuata esclusivamente attraverso il campionamento dell’aria, può portare a una sottostima del rischio, anche in presenza di un elevato grado di contaminazione idrica

Background Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case–control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information. Methods The study was carried out in 14 Italian regions (78.3% of Italian population aged 0–10). It included leukaemia, NHL and neuroblastoma cases incident in 0–10 year olds in 1998–2001, registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP) (accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child’s bed (48 hours measurement). Results The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls. ELF-MF long term measurements were obtained for 61.1% of controls and 81.6% of leukaemia cases; 8.8% of controls were exposed at over 0.1 microTesla (μT), 3.5% and 2.1% at respectively over 0.2 and 0.3 μT. 25% of controls’ fathers had smoked over 10 cigarettes/day during the year of conception, varying according to education and region. Maternal smoking was less common (71.4% did not smoke in pregnancy). Maternal passive smoking during pregnancy was reported by 31.2% of controls; the child’s passive smoking for 28.6%. Occupational exposure to solvents was estimated in 18.3% of controls’ fathers and 7.7% of mothers. Contact with public was more frequent among mothers (36.1%) than fathers (23.4%). Conclusions SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors. Electronic supplementary material The online version of this article (doi:10.1186/s13052-014-0103-5) contains supplementary material, which is available to authorized users.