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The hypothesis that attendance at indoor chlorinated swimming pool is a risk factor for irritative ocular and respiratory symptoms and bronchial asthma is well known in literature, although epidemiological evidence is still inconclusive. The aim of this study was to evaluate the association between airborne trichloramine (NCl(3)) levels and irritative symptoms in swimming pool employees in order to obtain detailed data regarding dose-response relationships and to identify the airborne NCl(3) exposure level, if any, without health effects. A total of 20 indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a self-administered questionnaire. Exposure to airborne NCl(3) was evaluated in indoor swimming pools by a modified DPD/KI method. The results of the study evidenced a mean value of airborne NCl(3) of 0.65±0.20 mg/m(3) (ranging from 0.20 to 1.02 mg/m(3)). Both ocular and upper respiratory symptoms, in particular red eyes, runny nose, voice loss and cold symptoms, were declared more frequently by lifeguards and trainers when compared with employees working in other areas of the facility (office, cafe, and so on). Pool attendants exposed to airborne NCl(3) levels of >0.5 mg/m(3) experienced higher risks for runny nose (OR: 2.91; 95% CI: 1.22-6.93) red eyes (OR: 3.16; 95% CI: 1.46-6.82), voice loss (OR: 3.56; 95% CI: 1.60-7.95) and itchy eyes (OR: 2.23; 95% CI: 1.04-4.78) than other employees. Moreover, red eyes, itchy eyes, runny nose and voice loss are related to airborne NCl(3) levels, with strong dose-response relationships. In conclusion, this study shows that lifeguards and trainers experience ocular and respiratory irritative symptoms more frequently than employees not exposed. Irritative symptoms become significant starting from airborne NCl(3) levels of >0.5 mg/m(3), confirming that the WHO-recommended value can be considered protective in occupational exposure to airborne NCl(3) in indoor swimming pools.

Background: Epidemiological evidence of an association between disinfection by-products (DBPs) exposure via drinking water and reproductive outcomes is still inconclusive., Objective: The aim of this study was to investigate the association between trihalomethanes (THMs), chlorite and chlorate exposure and congenital anomalies., Methods: A case-control study was carried out in Emilia-Romagna Region (Italy). Data on 1917 different congenital anomalies (neural tube, cardiac, diaphragm and abdominal wall, oesophagus, cleft lip and palate, respiratory, urinary tract and chromosomal anomalies) observed in the period 2002-2005 were extracted from the Regional Malformation Registry. Four controls (newborns without anomalies) were randomly selected form the Regional Birth Register and frequency matched to cases according to pregnancy period. The network supplying water during the first trimester of pregnancy was identified on the basis of mother's address: DBPs data, technical and structural information were linked to each subject., Results: Overall, THMs exposure was very low (mean: 3.8±3.6 μg/l), and no risk excess was observed. Chlorite and chlorate values were fairly high (mean: 427±184 μg/l and 283±79 μg/l, respectively). Women exposed to chlorite level >700 μg/l were at higher risk of newborns with renal defects (OR: 3.30; 95% IC: 1.35-8.09), abdominal wall defects (OR: 6.88; 95% IC: 1.67-28.33) and cleft palate (OR: 4.1; 95% IC: 0.98-16.8); women exposed to chlorate level >200 μg/l were at higher risk of newborns with obstructive urinary defects (OR: 2.88; 95% IC: 1.09-7.63), cleft palate (OR: 9.60; 95% IC:1.04-88.9) and spina bifida (OR: 4.94; 95% IC:1.10-22)., Conclusions: This was the first study showing an excess risk of different congenital anomalies related to chlorite and chlorate exposure via drinking water: further research is needed to confirm the observed relationships in large datasets, specifically for chlorate, an unregulated DBP., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The Working Group "Movement Sciences for Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health has promoted the Italian translation of the WHO Guidelines for Safe Recreational Water Environments, relating to coastal and freshwater environments. In this article the authors briefly summarize the main areas covered in the guidelines, namely drowning and injury, exposure to cold, heat and sunlight, water quality, contamination of beach sand, exposure to algae and their products, aesthetic issues, exposure to chemical and physical agents, dangerous aquatic organisms, monitoring and assessment hazards and risks.

The aim of the present study was to investigate the environmental and healthy aspects from a representative sample of indoor swimming pools located in the Emilia Romagna region. During the sampling sessions, the occupational environment was evaluated in terms of microclimate parameters and thermal comfort/discomfort conditions. Moreover the chemical risk was assessed by analyzing from the pool water the presence of disinfection by-products (DBPs), such as: trihalomethanes (THMs), haloacetic acids (HAAs), chlorite, chlorate and bromate. The analytical results are in agreement with the Italian legislation (Accordo Stato-Regioni; 2003) even if in some of the sampled indoor swimming pools, the dosed combined chlorine levels, were greater than the Italian limit. With the regard to the microclimate conditions evaluation, the considered thermal indices, Predicted Mean Vote (PMV) and Predicted Percentage of Dissatisfied (PPD%), described a satisfactory occupational environment. Among DBPs, the THMs mean levels (41.4 +/- 30.0 microg/l) resulted close to the values of the current Italian drinking water legislation, and seem to not represent an health issue. The pool waters chlorate levels (range: 5 - 19537 microg/l) need further investigations as recent epidemiological studies on drinking water hypothesized a potential genotoxicity effect of these compounds which are involved in cellular oxidative processes.

Objective: The objective of this study was to assess the relationship between active smoking as well as environmental tobacco smoke (ETS) exposure and severe small for gestational age (SGA) at term in a sample of pregnant Italian women., Methods: A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of severe SGA were singleton, live born, at term children with a birth weight 10(th) percentile for gestational age. A total of 84 cases of severe SGA and 858 controls were analyzed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders., Results: Multivariate logistic regression analysis showed a relationship between active smoking during pregnancy and severe SGA (adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.13-3.68). ETS exposure was associated with severe SGA (adjusted OR 2.51, 95% CI 1.59-3.95) with a dose-response relationship to the number of smokers in the home.

This study investigated the exposure to organohalogens compounds in drinking water from 9 Italian towns (Udine, Genova, Parma, Modena, Siena, Roma, L'Aquila, Napoli and Catania). Overall, 1199 samples collected from 72 waterworks were analyzed. THMs, trichloroethylene and tetrachloroethylene were evaluated using the head-space gas chromatographic technique (detection limit of 0.01 microg/l; chlorite and chlorate analysis was performed by ion chromatography (detection limit of 20 microg/l). THMs were evidenced in 925 samples (77%) (median value: 1.12 micro/l; range: 0.01-54 mciro/l) and 7 were higher than the THMs Italian limit of 30 microg/l. Chlorite and chlorate levels were higher than the detection limit in 45% for chlorite and in 34% for chlorate samples; median values were 221 microg/l and 76 microg/l, respectively. Chlorite values were higher than the chlorite Italian limit (700 microg/l) in 35 samples (8.7%). Trichloroethylene and tetrachloroethylene were measured in 29% and 44% of the investigated samples and showed values lower than the Italian limit (highest levels of 6 microg/l and 9 microg/l, respectively). The low levels detected of THMs, trichloroethylene and tetrachloroethylene have no potentials effects on human health, whereas, the levels of chlorite and chlorates should be further evaluated and their potential effects for the populations using these drinking waters, better understood.

The aim of this study was to assess the relationship between preterm/early preterm delivery and active smoking as well as environmental tobacco smoke (ETS) exposure in a sample of pregnant Italian women. A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of preterm birth were singleton babies born before the 37th gestational week; babies born before the 35th gestational week were considered early preterm births. Controls were babies with gestational ages >or= 37th week. A total of 299 preterm cases (including 105 early preterm) and 855 controls were analysed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. Multivariable logistic regression analysis showed a relationship between active smoking during pregnancy and preterm/early preterm delivery [adjusted ORs: 1.53; 95% CI 1.05, 2.21 and 2.00; 95% CI 1.16, 3.45, respectively]. A dose-response relationship was found for the number of cigarettes smoked daily. The adjusted ORs were 1.54 and 1.69 for preterm babies and 1.90 and 2.46 for early preterm babies for 1-10 and >10 cigarettes/day respectively. ETS exposure was associated with early preterm delivery [adjusted OR 1.56; 95% CI 0.99, 2.46] with a dose-response relationship with the number of smokers in the home. Smoking during pregnancy was strongly associated with preterm delivery with a dose-response effect. ETS exposure in non-smoking women was associated only with early preterm delivery.

Emergency departments records from 33 hospitals were reviewed to disclose work-related injuries occurred in teen-subjects living in 14 Italian cities. During January-June 2000, 317 work-related injuries were reported. Male subjects, 17 year old, working in the industrial field, resulted the most affected, probably due to the fact that among young workers this sex and age class is the most represented one. Cluster analysis identified two groups of work-related injuries: one includes mainly transportation injuries causing lower extremities or multiple body sites traumas. The other is more strictly related to specific working tasks and includes mostly traumas and cut wounds in hand/wrist and head, together with eye lesions. A more intensive supervision on the use of protective equipment, a more appropriate training in hazard recognition and safe work practices, including operation of vehicles in the work site, must be implemented to reduce work-related injuries.

Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th-37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers' personal habits during pregnancy and by water sampling directly at mothers' homes. Levels of trihalomethanes (THMs) were low (median: 1.10 microg l(-1)), while chlorite and chlorate concentrations were relatively high (median: 216.5 microg l(-1) for chlorites and 76.5 microg l(-1) for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels > or =200 microg l(-1) combined with low and high levels of inhalation exposure are considered, suggested a dose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91-2.54 and 1.70, 95%CI: 0.97-3.0, respectively). A weak association with high exposure levels of either THMs (> or =30 microg l(-1)), or chlorite or chlorate (> or =200 microg l(-1)) was also found (adjusted-OR: 1.38, 95%CI: 0.92-2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.

A few epidemiologic studies have suggested that consumption of drinking water with high trihalomethane content increases the risk of cancer. We investigated the mortality of a cohort of 5144 residents in Guastalla, northern Italy, who were supplied tap water with high chloroform and trihalomethane content between 1965 and 1987. Using death rates of a nearby community as reference rates, the standardized mortality ratio from all cancers between 1987 and 1999 was slightly increased for both males (1.2, 95% confidence interval 1.1-1.4) and females (1.1, 95% confidence interval 1.0-1.3). This was mainly due to a higher mortality from stomach, liver, lung, prostate and bladder cancer in males and from stomach, pancreas, breast and ovarian cancer and lymphocytic leukemia in females. We also noted excess mortality from melanoma in both males and females. Overall, our findings were consistent with an association between trihalomethane exposure and increased cancer risk at some sites. However, the point estimates were statistically imprecise, due to the limited number of deaths for some site-specific cancers. In addition, we were unable to rule out the possibility of confounding due to smoking and other life-style factors with regard to some of the excess rates.

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 <100 microg/L and copper 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.

We studied the reliability of biologic indices for monitoring perchlorethylene (PCE) exposure at low environmental solvent concentrations. Environmental monitoring was performed by personal sampling, biologic monitoring by measuring PCE in alveolar air (PCE-Alv), blood (PCE-B), and urine (PCE-U) in 26 low-exposed dry-cleaners. Correlation coefficients (r) between environmental PCE and PCE-B, PCE-Alv, and PCE-U were 0.94, 0.81, and 0.67 respectively. A high correlation was also found among biologic indices: r value was 0.96 between PCE-B and PCE-Alv, 0.95 between PCE-B and PCE-U, and 0.87 between alveolar PCE-Alv and PCE-U. The examined biologic indices proved sensitive enough for biologic monitoring of low exposure to PCE and can give substantially similar information in terms of exposure evaluation. PCE-Alv offers some advantages because it correlated better with exposure and is analytically simpler.

Chlorination By Products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, such as small term birth (STB) and preterm delivery. Up to date epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level: in this study the exposure is evaluated at the individual level. A case control study with incident cases was performed in Modena between October 1999-September 2000. 332 subjects were enrolled: 93 preterm births (26th-37th week of pregnancy), 73 STB (from 38th week, and weight less than the lowest 10th percentile) and 166 controls. Exposure was assessed both by applying a questionnaire on personal habits and by personal water sampling directly at subjects' home. THMs were analysed in all samples, chlorite and chlorate in water samples treated with chlorine dioxide. Subjects usually drinking tap water were few (5.2%): most of them were living in areas supplied by water treated with chlorine dioxide (87%). Levels of THMs were low (mean: 0.73 microgram/l), while chlorite and chlorate concentrations were relatively high (mean: 217.8 microgram/l for chlorites and 95.2 microgram/l for chlorates). Preterm birth did not show any significant association with CBPs, while STB appeared significantly associated, after adjusting for many potential confounders, with CBPs induced by chlorine dioxide treatment, especially with levels of chlorate higher than 200 microgram/l (OR: 4.7; 95%CI: 1.15-19.72). The association between STB and chlorate must be investigated further as the number of water utilities applying chlorine dioxide as disinfection treatment is increasing.

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

The Authors report data about the presence of Disinfection By-Products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma (20 water supplies). Trihalomethanes, chlorite and chlorate (only in water samples treated with chlorine dioxide), and halogenated compounds were investigated. On the whole, trihalomethanes were evidenced in the 85% of the samples (n. 285) at low levels, while chlorite and chlorate were present in the 67% and 63% of the treated samples with chlorine dioxide (257 samples). Chlorite mean and median values were 225.70 microg/l and 136.75 microg/l respectively, ranging from 20 to 2000 microg/l. Chlorate concentrations were lower than chlorite: the mean value was 102.93 mg/l, while median level was 50 microg/l (range: 20-1500 microg/l). The high concentrations of chlorite and the wide range of values within each municipality plant in Modena and Parma suggest to investigate further in order to evaluate the human exposure in drinking water thoroughly.

Objectives: To determine the prevalence of urinary incontinence among institutionalized elderly people., Methods: A cross-sectional study was conducted on 839 subjects, resident in 14 residential or nursing homes. A questionnaire was administered to the study population and their clinical records were reviewed., Results: The overall prevalence of urinary incontinence was 54.5%, higher in women (59.8%) than in men (39.2%). The prevalence increased significantly with age, from 26.5% in subjects 65 years old or younger to 73.7% in subjects 95 years old or older; with worsening of mental status, from 36.2% in well-oriented subjects to 76.7% in poorly oriented subjects; and with worsening of mobility, from 23.8% in self-sufficient subjects to 82.1% in bedridden patients. The prevalence was significantly associated with parity, from 54.1% in nulliparous women to 65.4% in multiparous women. Urinary incontinence was also associated with urinary tract infection, constipation, and fecal incontinence., Conclusions: The results of our study are in accordance with other similar studies. That more than one half of the elderly residents of nursing and residential homes have urinary incontinence shows the relevance of this condition. We believe that urinary incontinence in institutionalized elderly people can be managed essentially by measures of tertiary prevention, aimed at reducing the handicapping conditions and at slowing down the process of self-sufficiency impairment.

Progression of perchloroethylene-induced color-vision impairment was studied in 33 dry-cleaner workers at 12 establishments in Modena, Italy. In an initial survey, we evaluated exposure with personal passive samplers, and we assessed color vision with the Lanthony D-15 desaturated panel. Two years later, workers were reexamined. In 19 workers (subgroup A), exposure to perchloroethylene had increased (median of 1.7 ppm versus 4.3 ppm, respectively), whereas in the remaining 14 workers (subgroup B) exposure was reduced (2.9 ppm versus 0.7 ppm, respectively). Color vision worsened in subgroup A, but no vision changes were apparent in subgroup B. The results indicated that an increase in exposure during a 2-y period, even if slight, can cause color vision to deteriorate. A similar slight reduction in exposure did not lead to color-vision improvement; perhaps this lack of improvement resulted from (a) an insufficient reduction in exposure, (b) an insufficient reduction in duration of exposure, or (c) irreversible perchloroethylene-induced color-vision loss.

We carried out a survey in 16 libraries of the University of Modena, Northern Italy, to assess the indoor exposure to volatile organic compounds (VOCs), including formaldehyde, and total dusts. Data were collected on the main structural characteristics of the buildings; indoor microclimate parameters, such as temperature, relative humidity and ventilation rate were measured and air samples taken inside and outside the libraries. The mean value of total dusts was 190 +/- 130 microg/m3 with a wide range of values. Formaldehyde was found in only ten out of 16 libraries and the indoor concentrations ranged from 1.70 to 67.8 microg/m3 with an average value of 32.7 +/- 23.9 microg/m3. On the whole, VOCs were present in all the libraries investigated with an average value was 433 +/- 267 microg/m3 (range 102-936 microg/m3). No correlation was found among VOCs, formaldehyde and total dusts nor was a significant association observed with microclimatic parameters or the structural characteristics of the buildings. The general situation found in this study suggests no major problems related to indoor pollution. However, some of the pollutants investigated such as total dust and total VOCs deserve further investigation. It is important to identify the possible sources of contaminants and to define the relationship between indoor and outdoor levels of pollutants more accurately, taking into account the effects of air recycling due to natural ventilation systems.

The possible effects of moderate lead exposure on human growth and development are not well defined. This study was carried out in order to evaluate the relationship between somatic growth and lead exposure. 418 subjects (202 males and 216 females) aged 11-13 years in good health and living in an area of the northern region of Italy were submitted to the following determinations: blood lead levels (PbB), serum concentrations of gonadotropins (LH, FSH) and sex-steroid hormones (DHA-S, T, E2) and anthropometric measurements (stature and weight). The mean blood levels were 85.39 and 70.08 micrograms/1, respectively, for males and females. Significant and negative relationships were found between blood lead levels and stature in 13 years old males and 12 years old females (p = 0.009 and p = 0.006, respectively). Negative relationships between lead in blood and LH and FSH were found only in males with lead levels higher than 90 micrograms/1. Our findings seem to suggest that even for low lead exposure this metal may affect stature growth and gonadotropins levels.

This study evaluated swimmers and visitors who were exposed to chloroform (CHCl3) at three indoor swimming pools in Modena, Italy. Chloroform was measured in plasma samples of 127 subjects present at the pools and in 40 nonexposed subjects. The analyses were performed by head-space gas chromatography. Chloroform was present in all samples collected from the 127 subjects who attended the pools (median = 7.5 nmol/l; range = 0.8-25.1 nmol/l). Agonistic swimmers who trained for competitions showed a significantly higher mean value of plasma CHCl3 than nonagonistic swimmers and visitors. Plasma CHCl3 levels were significantly correlated with (a) CHCl3 concentrations in water and in environmental air, (b) the number of swimmers in the pools, and (c) the time spent swimming. Covariance analysis showed that plasma CHCl3 levels also depended on the intensity of the sport activity (total explained variance = 67.4%).

The Authors confirm the importance of fluoroprophylaxis in the prevention of Dental caries. They analyze the main methods of fluoroprophylaxis pointing out the systemic fluoroprophylaxis, effected by means of water fluoruration, as the best one for a valid prevention of dental caries on a large scale. In view of such a kind of fluoroprophylaxis in our country the Authors considered quite interesting to effect a research about the amount of fluoride in the waters of the district of Modena. The whole of results are reported.

There is a general agreement that children are a population at increased risk with respect to lead and cadmium exposure and to adverse health effects resulting from increased exposure. Different biological indicators such as blood hair and teeth have been used to evaluate lead and cadmium exposure in humans. However, up to date, it has not been established which is the best indicator to provide an assessment of internal exposure. The aim of the present study was to examine the levels of lead and cadmium in hair, blood and teeth of children living from birth in an industrialized area near Modena. The relationship between these indicators of exposure and children characteristics such as sex, weight, height, blood pressure and smoking habits of parents was also examined. 142 children (71 males and 71 females) representing 20.8% of those aged 6-7 years living in Sassuolo (Modena) have been included in the study. The geometric means of lead in blood, hair and teeth were 11.2 micrograms/dl, 7.24 micrograms/g and 6.16 micrograms/g, respectively. Hair lead were significantly related to both blood and teeth values (r = 0.226, p = 0.007 and r = 0.186, p = 0.027, respectively). Mean cadmium concentrations were 0.47 mu/l in blood, 0.17 micrograms/g in hair and 47.9 ng/g in teeth and no significant correlation was observed between the three biological matrixes examined. Significant correlations were found between lead and cadmium in both hair (r = 0.427, p = 0.000) and teeth (r = 0.224, p = 0.007). In addition, for lead content in teeth, a significant difference between boys and girls was observed; females showed higher values than males (6.77 micrograms/g vs 5.61 micrograms/g; t = 2.23 p = 0.028). Taking into account the individual characteristics of children, a negative relationship was found between Pb levels in teeth and height (r = -0.217, p = 0.024). Systolic blood pressure values were positively associated to cadmium hair levels in males but not in females (r = 0.281; p = 0.053). From the results of the present study it appears that blood, hair and teeth provide different information to predict lead and cadmium exposure of children. Hair seem to be a useful global indicator of total environmental pollution.