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Environmental health literacy (EHL) is a rather recent concept that applies health literacy skills to environmental issues. Research in this field is still at the beginning, and there is currently no existing tool in the literature designed to comprehensively assess individual general EHL among university students. The aim of our study is to fill this gap through the validation of the Environmental Health Literacy Index (EHLI) in such a target group. We adapted a previously administered survey, originally completed by 4778 university students from various Italian universities. Starting from the original questionnaire, our methodology involved a three-round item selection process, followed by a comprehensive evaluation of the instrument's psychometric properties. The EHLI consists of 13 Likert-type items, covering three primary domains of health literacy: functional (six items), interactive (three items), and critical (four items). The Cronbach's alpha coefficient is 0.808 for the global scale, while it stands at 0.888 for the functional, 0.795 for the critical, and 0.471 for the interactive components. The area under the receiver operating characteristic curve reached a value of 0.643. Spearman correlation analysis revealed a significant yet slight correlation between EHLI and both functional health literacy score and the extent of pro-environmental behaviors adoption. Our study serves as an important initial step in developing a tool able to evaluate the EHL of university-aged individuals. Further research efforts may improve the questionnaire's validity and completeness, as well as to explore its applicability to different age groups. [ABSTRACT FROM AUTHOR]

This study aims to estimate long-term survival, cancer prevalence, and several cure indicators for Italian women with gynecological cancers. Thirty-one cancer registries, representing 47% of the Italian female population, were included. Mixture cure models were used to estimate net survival, cure fraction, time to cure (when 5-year conditional net survival becomes > 95%), cure prevalence (women who will not die of cancer), and already cured (living longer than time to cure). In 2018, 0.4% (121 704) of Italian women were alive after diagnosis of corpus uteri cancer, 0.2% (52 551) after cervical cancer, and 0.2% (52 153) after ovarian cancer. More than 90% of patients with uterine cancers and 83% with ovarian cancer will not die from their neoplasm (cure prevalence). Women with gynecological cancers have a residual excess risk of death <5% at 5 years after diagnosis. The cure fraction was 69% for corpus uteri, 32% for ovarian, and 58% for cervical cancer patients. Time to cure was ≤10 years for women with gynecological cancers aged <55 years; 74% of patients with cervical cancer, 63% with corpus uteri cancer, and 55% with ovarian cancer were already cured. These results can contribute to improving follow-up programs for women with gynecological cancers and supporting efforts against discrimination of already cured ones. This article is part of a Special Collection on Gynecological Cancers. [ABSTRACT FROM AUTHOR]

Objectives: To describe the procedures to derive complete prevalence and several indicators of cancer cure from population-based cancer registries. Materials and methods: Cancer registry data (47% of the Italian population) were used to calculate limited duration prevalence for 62 cancer types by sex and registry. The incidence and survival models, needed to calculate the completeness index (R) and complete prevalence, were evaluated by likelihood ratio tests and by visual comparison. A sensitivity analysiswas conducted to explore the effect on the complete prevalence of using different R indexes. Mixture cure models were used to estimate net survival (NS); life expectancy of fatal (LEF) cases; cure fraction (CF); time to cure (TTC); cure prevalence, prevalent patients who were not at risk of dying as a result of cancer; and already cured patients, those living longer than TTC at a specific point in time. CF was also compared with long-term NS since, for patients diagnosed after a certain age, CF (representing asymptotical values of NS) is reached far beyond the patient's life expectancy. Results: For the most frequent cancer types, the Weibull survival model stratified by sex and age showed a very good fit with observed survival. For men diagnosed with any cancer type at age 65-74 years, CF was 41%, while the NS was 49% until age 100 and 50% until age 90. In women, similar differences emerged for patients with any cancer type or with breast cancer. Among patients alive in 2018 with colorectal cancer at age 55-64 years, 48% were already cured (had reached their specific TTC), while the cure prevalence (lifelong probability to be cured from cancer) was 89%. Cure prevalence became 97.5% (2.5% will die because of their neoplasm) for patients alive >5 years after diagnosis. Conclusions: This study represents an addition to the current knowledge on the topic providing a detailed description of available indicators of prevalence and cancer cure, highlighting the links among them, and illustrating their interpretation. Indicators may be relevant for patients and clinical practice; they are unambiguously defined, measurable, and reproducible in different countries where population-based cancer registries are active. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigates cancer in migrants in Southern Italy, who represent a neglected but vulnerable population. We used data from the Eastern Sicily Cancer Registry collected between 2004 and 2019 to compare the adjusted proportionate morbidity ratio for the most common cancer types in migrants and non-migrants, and we calculated the odds of migrant status for one cancer compared to all cancers. The migrants/non-migrants odds of cancer was 2.1%, with most cancers occurring in migrant women. We observed increased proportions in cervical and lung cancer, with higher odds of cervical cancer and lower odds of colorectal cancer in migrants. Measures should be implemented to enhance the access of migrants to prevention, early diagnosis and care for cancer. These interventions should account for the migrant's country of origin. Particular attention should be given to HPV vaccination, cervical cancer screening and tobacco control to reduce the cancer burden in this population. Background: Migrants are a vulnerable and neglected population. We aimed at investigating cancer proportionate rates in migrants in Sicily, Southern Italy. Methods: We extracted data on new cancer cases diagnosed between 2004 and 2019 from the Eastern Sicily cancer registry. We compared the adjusted proportionate morbidity ratio (PMR) for the most common cancer types among migrants and non-migrants. We fitted multivariate logistic regression models comparing one cancer to all other cancers to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for migration status. The analysis was stratified by region of origin. Results: Overall, 4726 new cancer cases occurred in migrants between 2004 and 2019, 63.5% of those among women and 224,211 in non-migrants, including 54.5% among men, with odds for migrants/non-migrants of 2.1%. Migrants had an increased proportion of cervical (PMR = 2.68, 95% CI = 2.29–3.10) and lung cancer (PMR = 1.20, 95% CI = 1.07–1.33). The highest OR in migrants was observed for cervical cancer (OR = 3.54, 95% CI = 2.99–4.20). Colorectal cancer was decreased among migrants (OR = 0.86, 95% CI = 0.77–0.96). Conclusions: Migrants to Sicily have higher odds of cervical cancer and a decreased risk of colorectal cancer compared to non-migrants. Increased odds were also detected for lung cancer, in particular in women. Different cancer patterns could be observed based on the region of origin. HPV-related cancers need targeted attention in migrants living in Sicily. [ABSTRACT FROM AUTHOR]

Background: The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. Objectives: We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia‐Romagna Region (northern Italy). Methods: Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003–2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age‐standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. Results: Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (−2.3) and non‐significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182–0.216; women, 0.157–0.191). Conclusions: In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis—if any—is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy. [ABSTRACT FROM AUTHOR]

Simple Summary: This study addressed the under-investigated issue of second primary cancer occurring in colorectal cancer survivors. Our aim was to explore whether patients recovered from a first colorectal cancer were at higher risk of developing a subsequent primary cancer. The hypothesis was that exposure to cancer treatment, enhanced health surveillance and shared risk factors may lead to an excess risk of second primary cancer in this population. The number of cases of second primary cancer exceeded the expected in this population, mainly driven by female genital cancers, and especially observed in the first years after colorectal cancer diagnosis. Our findings are overall consistent with previous studies, providing valuable information to better characterize and predict mortality from second primary cancer in subjects who suffered from first colorectal cancer. Background: Cancer survivors are at risk of developing second primary cancers (SPC). We investigated the risk of SPC in colorectal cancer (CRC) survivors in Sicily, Southern Italy. Methods: We analyzed data from the Eastern Sicily cancer registry covering 2.5 million people diagnosed and followed up between 2003 and 2017. We calculated the standardized incidence ratio (SIR) and 95% confidence interval (CI) of SPC overall and by cancer type, using the general Sicily population rates as reference. Results: A total of 19,040 cases of CRC and 1453 cases of SPC were included in the analysis. Mean age of occurrence of SPC was 68.1. The SIR for any SPC was 1.11 (95% CI 1.05–1.17); it was higher in women (1.18; 95% CI 1.08–1.29) than in men (1.07; 95% CI 0.97–1.14, p-value of difference 0.07). The SIR was increased for SPC from the ovary (SIR 2.01; 95% CI 1.33–2.95), kidney (SIR 2.00; 95% CI 1.54–2.56), endometrium (SIR 1.94; 95% CI 1.45–2.54), bladder (SIR 1.22, 95% CI 1.04–1.43) and stomach (1.29; 95% CI 0.98–1.66). The SIR for CRC as SPC was 0.84 (95% CI 0.70–1.01). No increased incidence was found for lung, prostate, breast, thyroid and liver cancer. The SIR for SPC overall and several cancers decreased with time of follow-up. Conclusions: In this population, CRC survivors have an 11% higher risk of developing a SPC than the general population, particularly cancers of the ovary, kidney, endometrium, bladder and stomach. Follow-up for SPC is required, especially during the first 5 years from CRC diagnosis. [ABSTRACT FROM AUTHOR]

Background: The long‐term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor. Objectives: To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy. Methods: Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age‐standardized 5‐year net survival was calculated. Multivariate analysis of 5‐year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. Results : Over the study period, tumour thickness was inversely associated with 5‐year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003–2007, 0.85 mm in 2008–2012 and 0.75 mm in 2013–2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5‐year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013–2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013–2017 vs. 2003–2007 increase from 0.64 [95% confidence interval (CI) 0.51–0.80] to 0.70 (95% CI 0.57–0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58–0.93) to 0.82 (95% CI 0.66–1.02) in 2013–2017. Conclusions: For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013–2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement. [ABSTRACT FROM AUTHOR]

Introduction: Primary brain tumors (PBTs) account for approximately 2% of all cancers and are associated with significant morbidity and mortality. However, only few epidemiological studies focus on PBTs in Italy. The aim of this study was to evaluate incidence, temporal trend, and survival rate of all PBTs in the province of Catania during the study period. Methods: All patients diagnosed with PBTs in the province of Catania during the 2003-2016 were identified through the local cancer registry. All cases were classified by histology according to 2007 WHO classification of central nervous system tumors, using the International Classification of Diseases for Oncology, 3rd edition codes. The incidence rate (IR) was calculated for all PBTs and by gender, histology, age-groups, and behavior. Trend analysis was performed using a piecewise log-linear model. Results: A total of 3,819 cases were identified with a female/male ratio of 1.45. The IR for all PBTs was 25.3/100,000 person-years (95% confidence interval 24.5–26.1). Most PBTs were nonmalignant (59.5%, IR = 15.0) with a female predominance. Conversely, malignant tumors (32.4%, IR = 8.2) were more common among men, with a female/male ratio of 0.9. The most frequently reported histology was meningioma (39.0%, IR = 9.8), followed by glioblastoma (11.6%, IR = 2.9). A peak of incidence was found in the 75–84 years age-group, with an IR of 77.6/100,000 person-years. Overall, no increase in incidence was observed along the study period. Conclusions: The IR of PBTs in the province of Catania is close to incidence reported worldwide. Further studies on risk factors are necessary. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the extent of the Hg geochemical anomaly arising in the Amiata and Tolfa complex to the coastal area of northern Latium and to examine the possible influence on this area by the Mignone River, and by the small coastal basins, which are characterized by both previous mining activities and decades of past industrial impact. The results confirm the extension of the anomaly of concentrations of Hg in the coastal area of northern Latium, with the northern sector influenced by the contributions of the Fiora and Mignone Rivers and the southern sector influenced by the contributions of minor basins. The results show high values of the Adverse Effect Index throughout the considered area and highlight the need for further investigation in order to assess the impact of human activities on the present and past values of Hg in marine sediments. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean Diet (MeDi) is associated with a reduced risk of several non-communicable chronic diseases. High levels of nutrition knowledge are associated with greater MeDi adherence irrespective of education and other socio-economic factors. The present study investigates whether attending medical school changes students' adherence to the MeDi. Methods: A cross-sectional study was conducted in November-December 2014 using the 16-item KIDMED questionnaire, which inquiries into eating habits. Each respondent's KIDMED index (range 0-12), whose scores reflect 'poor', 'average' or 'good' MeDi adherence, was calculated. Scores were analyzed for gender, age and early/late medical school year. The Mann-Whitney U-test and the chi-square test were used for group comparisons. Ordinal logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for changes in MeDi adherence from early to late medical school after adjustment for potential confounders. Results: Participants were 1038 medical students (573 females) aged 18-34 years (mean 21.9±2.4). There were 20.8% 'poor', 56.5% 'average' and 22.7% 'good' scores. Gender significantly affected scores (P<0.01). In the ordinal logistic regression model the odds for greater MeDi adherence increased for the female gender (P<0.05); females were 48% more likely to have a 'good' KIDMED score than their male peers, whereas early/late medical school year did not affect results [adjusted odds ratio (OR) = 0.95; P=0.15]. Conclusions: More than 70% of our medical students know very little about healthy eating and the MeDi. However, this knowledge is essential in their future profession both to support therapeutic decision-making and effective preventive actions. [ABSTRACT FROM AUTHOR]

Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. High blood pressure (BP) with diastolic BP ≥ 90 mm Hg and/or systolic BP ≥ 140 mm Hg arising after week 22 of pregnancy and resolving after delivery is defined as gestational hypertension (GHY). The aim of this cross-sectional study was to investigate whether occupational and/or environmental exposure to organophosphorus (OP) pesticide affects GHY. Women at approximately 22 weeks of gestation were recruited. OP pesticide exposure in the first trimester of pregnancy was classified into four categories: no exposure, indirect exposure, domestic exposure, and occupational exposure. Application of the exclusion criteria left 2203 participants (mean age 30.4 ± 11.6 years). Data analysis showed that in women with indirect OP pesticide exposure the incidence of GHY was slightly higher than that in the world population, whereas domestic exposure involved a 7% increase and occupational exposure a 12% increase. Analysis of the pesticides used by participants highlighted a possible role for malathion and diazinon (adjusted OR 1.09 and 1.14, resp.). Further investigation of exposed workers and the general population is clearly warranted given the broad diffusion of OP pesticides and their possible public health impact, maybe by including a wider range of health outcomes. [ABSTRACT FROM AUTHOR]

Background: A recent study demonstrates that inhalation of airborne particulate from Mount Etna eruptions may induce fibrotic lung disease. The occupational exposure of construction workers from the Etna area, who excavate building sites and use basalt dust to make mortar, has never been assessed. Methods: Samples of basalt, volcanic ash, basalt + cement and cement dust were collected on the construction site of a subway tunnel, ground to dust and subjected to the Microtox® solid-phase test to evaluate the toxicity of dust suspensions. Samples were investigated by scanning electron microscopy equipped with energy dispersive X-ray analysis (EDX). Minerals were identified and characterized by their morphology and elemental composition. Results: The elements found most frequently were C, Na, Mg, Al, Si, K, Ca, Ti, Mn, Fe and O. All four dusts were toxic: basalt and ash were significantly less toxic than basalt + cement and cement, which shared a similar and very high degree of toxicity. Higher Fe, Ca and Mg concentrations were associated with greater toxicity. Conclusions: The risk related to long-term occupational exposure to various dusts on constructions sites in the Mount Etna area should be further assessed. [ABSTRACT FROM AUTHOR]

Abstract: A multibiomarkers approach was used in order to estimate and monitor marine pollution. Coris julis (Linneaus, 1758) was chosen as a sentinel organism, and the specimens were collected from three well-known sites along the Ionic coast of Sicily: the protected marine area (P.M.A) “Cyclop’s Islands” of Acitrezza (CT), used as a control site, Riposto (CT), and the industrial site of Augusta (SR). Abiotic levels of contaminants were also detected. High levels of biotic and abiotic accumulation were found at the industrial site in which the presence of genotoxic and oxidative damage were also evidenced, measured by Micronuclei, Alkaline and Fpg-modified Comet assays. The protein expression analysis showed metallothioneins (MTs) as good tissue-specific markers of metal accumulation. Their levels were significantly higher in muscle than in liver tissue for all the sampling sites, with a positive correlation among tissue levels and the degree of pollution at the sites. Conversely, heat shock proteins 70 (HSP70) expression was higher in Augusta and Riposto than in the control site, but no significant difference was found between the examined tissues among all sites. [Copyright &y& Elsevier]

Our study is a preliminary step to evaluate water contamination of the Mediterranean Sea surrounding Lampedusa island and health risks for fish consumers. We analyzed muscle tissue of Mullus barbatus specimens to detect metals and polycyclic aromatic hydrocarbons (PAHs). Results show the following average concentrations of heavy metals: Pb 0.035, Cd 0.001, Hg 0.027, Cr 0.524, As 27.01, Cu 0.433, Co 0.013, Ni 0.042, Se 0.487, V 0.072, U 0.055 and Zn 3.360 ppm. PAHs ranged from 0.250 to 13.16 ppb. A possible risk to human health was determined based on consumption limits data and the content of total PAHs in fillets of this species. [ABSTRACT FROM AUTHOR]

Background: Weight-related issues such as obesity, dieting and eating disorders in adolescents are major public health problems. Moreover, undertaking a diet tends to be common among school children and the reasons for doing so are not always related to weight status. The objectives of the study were to evaluate the role of body mass index (BMI), gender and self-esteem in the adoption of a diet in middle-school Sicilian children.Methods: The survey included middle-school children in some Sicilian provinces. Weight status was determined by sex-specific body mass index for age according to the international BMI cut-off proposed by Cole. Classic chi-square test and linear trend chi-square were used to compare percentages. Univariate and multivariate logistic regressions were computed to study the risk of dieting according to weight status (with the underweight group as the reference group), gender, self-esteem adjusted for province. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) along with associated p-values were furnished.Results: The survey showed that 45.2% of the children were of average-weight, 6.6% were underweight, 12.6% were overweight and 2.9% were clinically obese. The missing data were up to 32.8%. Regarding dieting, 26.3% of the children stated that they had been on a diet during the last three months, 56.4% claimed they had not, and 17.2% did not answer. Age was not associated with dieting (p = 0.76). More girls than boys had undertaken a diet (31.4% versus 21.4%, p < 0.0001). Self-esteem had an influence on the choice of following a diet; in fact, 40.8%, 28.5% and 20.9% of the children with negative, normal and positive self-esteem were following a diet (trend p < 0.0001). The multivariate analysis showed that self-esteem seemed to influence more girls than boys (p = 0.06), and stratified analysis by gender indicated that it seemed more influent in girls (p = 0.0008) than in boys (p = 0.01).Conclusions: In addition to the relation between dieting and BMI, our results highlight the link between dieting, gender and self-esteem. We underline the importance of interventions within the context of health education in order to improve global self-esteem and to encourage proper eating habits to prevent weight-related health problems. [ABSTRACT FROM AUTHOR]

The health risk level in operating rooms is correlated to the safety levels of microclimatic parameters, thermal indices, anesthetic gases and microbiological parameters. The objective of this study was to estimate the staff and medical service management compliance with the suggestions resulting from monitoring. Methods: The environmental conditions of 38 different operating rooms in the Sicily region, Italy, from January 2011 to December 2020 were monitored. The results were compared with specific standards suggested by national and international laws and guidelines. Results: Almost all microclimatic and microbiological parameters were outside the limits. The monitoring of the anesthetic gases showed that 5.6% of sevoflurane measurements exceeded the limit values. Conclusions: Constant environmental monitoring is an essential element for maintaining optimal living conditions in the working environment. The compliance of staff with guidelines and rules is a fundamental parameter for achieving this objective. [ABSTRACT FROM AUTHOR]

The study aimed to highlight the degree of trace element contamination along three sites of Sicily: the Magnisi peninsula (MP), located in proximity to the Augusta–Priolo–Melilli petrochemical plant; the Ragusa agro-ecosystem (RA), characterized by a rural landscape; and the Gela plain (GP), characterized by intensive agriculture and a disused petrochemical plant. We collected biological samples (abraded back feathers and blood) of the Stone Curlew (Burhinus oedicnemus Linnaeus, 1758) as well as soil samples to determine the trace elements concentrations of As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn, Se and V using ICP-MS analysis. The results found for the three sites show different trends of accumulation, which depend on the different management and geological characteristics of the areas. The Gela plain and Magnisi peninsula showed a higher degree of contamination (As, Co, Cu, Mn and Se for the Gela plain; Pb and Hg for the Magnisi peninsula). Nevertheless, no critical values were found for either the environment—if the results are compared with the legal limits fixed by the Legislative Decree No. 152/2006, approving the Code on the Environment—or for living organisms—if the results are compared with the toxicological thresholds for birds, especially if the short-term exposure results from the blood values are considered. Only the Se levels in animal blood from the RA and GP were found slightly higher than the minimum level required in bird diets. The positive scenario can be attributed on the one hand to the interruptions of emissions of the Gela refinery around 5 years ago, and on the other hand to the more intense and strict controls that are implemented in the area surrounding the petrochemical pole of Augusta–Priolo–Melilli. [ABSTRACT FROM AUTHOR]

An increasing incidence of MS in the city of Catania was reported during 1975–2004, with a higher incidence along the south-eastern flank of the Mt.Etna. We evaluated the incidence of MS in the entire province of Catania during 2005–2015 and the spatial distribution of MS-cases using a cluster analysis. Patients were considered as incident MS-cases if they fulfilled the revised McDonald criteria for MS during 2005–2015 and were residents in the province of Catania at the time of disease onset. Cluster analysis was performed using both LISA and Kulldorff's spatial scan statistic. Residence address at disease onset was considered for each case. Communalities were assessed considering the centroid of their inhabited area. A total of 973 MS-cases were identified. Mean annual incidence risk was 8.2/100,000 person-years (95%CI 7.7–8.7), significantly higher among women (10.5/100,000 versus 5.7/100,000). LISA identified a spatial aggregation of MS-cases in the eastern side of the province of Catania and Kulldorff's statistics confirmed the existence of a statistically significant spatial cluster in this area (SIR 1.23,95%CI 1.08–1.23, p-value 0.04). Our study confirms a high incidence of MS in the province of Catania and the presence of a spatial cluster along the eastern side of the province. This area is considered the most exposed to volcanogenic ashes due to the prevailing westerly to north-westerly trade winds. Even if such distribution could be related with a greater exposure to volcanogenic metals, further studies are needed to explore possible alternative hypotheses. • Incidence of MS in the province of Catania is higher than rates recorded in continental Italy. • A MS cluster was identified in the South-Eastern side of the Province of Catania. • The South-Eastern side of the province is the most exposed area to the ashes emitted by the Etna volcano. • Volcanoes represent the main natural source of heavy metals. • Heavy metals may contribute to the environmental risk factors for MS. [ABSTRACT FROM AUTHOR]

Background: In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy)., Methods: The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios., Results: In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions., Conclusions: In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

People alive many years after breast (BC) or colorectal cancer (CRC) diagnoses are increasing. This paper aimed to estimate the indicators of cancer cure and complete prevalence for Italian patients with BC and CRC by stage and age. A total of 31 Italian Cancer Registries (47% of the population) data until 2017 were included. Mixture cure models allowed estimation of net survival (NS); cure fraction (CF); time to cure (TTC, 5-year conditional NS >95%); cure prevalence (who will not die of cancer); and already cured (prevalent patients living longer than TTC). 2.6% of all Italian women (806,410) were alive in 2018 after BC and 88% will not die of BC. For those diagnosed in 2010, CF was 73%, 99% when diagnosed at stage I, 81% at stage II, and 36% at stages III-IV. For all stages combined, TTC was >10 years under 45 and over 65 years and for women with advanced stages, but ≤1 year for all BC patients at stage I. The proportion of already cured prevalent BC women was 75% (94% at stage I). Prevalent CRC cases were 422,407 (0.7% of the Italian population), 90% will not die of CRC. For CRC patients, CF was 56%, 92% at stage I, 71% at stage II, and 35% at stages III-IV. TTC was ≤10 years for all age groups and stages. Already cured were 59% of all prevalent CRC patients (93% at stage I). Cancer cure indicators by stage may contribute to appropriate follow-up in the years after diagnosis, thus avoiding patients' discrimination., (© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

A recent research project using data from a total of 40 cancer registries has provided new epidemiologic insights into the results of efforts for melanoma control in Italy between the 1990s and the last decade. In this article, the authors present a summary and a commentary of their findings. Incidence increased significantly throughout the study period in both sexes. However, the rates showed a stabilization or a decrease in men and women aged below 35 years. The risk of disease increased for successive cohorts born until 1973 (women) and 1975 (men) while subsequently tending to decline. The trend towards decreasing tumor thickness and increasing survival has continued, but a novel favorable prognostic factor has emerged since 2013 for patients - particularly for males - with thick melanoma, most likely represented by molecular targeted therapies and immune checkpoint inhibitors. Due to this, the survival gap between males and females has been filled out. In the meanwhile, and despite the incidence increase, dermatologists have not lowered their threshold to perform skin biopsy. Skin biopsy rate has increased because of the increasingly greater volume of dermatologic office visits, but the proportion of skin biopsies out of dermatologic office visits has remained constant. In summary, an important breakthrough in melanoma control in Italy has taken place. Effective interventions have been implemented across the full scope of care, which involve many large local populations - virtually the whole national population. The strategies adopted during the last three decades represent a valuable basis for further steps ahead in melanoma control in Italy.

(1) Background: Healthcare providers have a crucial role in contrasting vaccine hesitancy (VH). We aimed to investigate opinions, knowledge, and attitudes toward vaccines in healthcare students (HS) at the University of Catania (Italy). (2) Methods: A survey was conducted from 1 October 2019 to 31 January 2020. Data on the opinions, knowledge, and attitudes of HS toward vaccinations were collected using an anonymous self-administered questionnaire. The opinion answers were added to calculate the VH index (<18 = low, 19−22 = medium, >23 = high). Data were summarized by the VH index, degree, year of study, and sex differences, using descriptive statistics. (3) Results: A total of 1275 students (53.7% females) participated in the study, with a median (IQR) age of 21 (19−22) years. The median level of VH was 20 (17−23), with slightly higher values in males. We found an inverse trend between VH and opinions, knowledge, and attitudes toward vaccines. The same trend was confirmed in all study courses. Furthermore, the comparison between sexes revealed a higher level of knowledge in women. (4) Conclusions: The results highlight a lack of knowledge about vaccines, as well as contrasting opinions and attitudes among future health professionals. Therefore, future interventions on these topics in the preparation of future healthcare providers are needed.

The awareness of citizens concerning the health risks caused by environmental pollution is growing, but studies on determinants of pro-environmental behaviors have rarely examined health-related aspects. In this study, we investigated these determinants using data from a large survey among Italian university students (15 Universities: 4778 filled questionnaires). Besides the health-related aspects, represented by environmental health risk perception and functional health literacy, we considered social and demographic characteristics (gender, area of residence, sources of information, trust in institutional and non-institutional subjects, and students' capacity of positive actions, indicated as internal locus of control). The attitudes towards pro-environmental behaviors were positive for more than 70% of students and positively related with health risk perception, internal locus of control, and health literacy. The correspondence between the positive attitudes towards pro-environmental behaviors and the real adoption of such behaviors was approximately 20% for most behaviors, except for the separate collection of waste (60%). Such a discrepancy can be attributable to external obstacles (i.e., lack of time, costs, lack of support). The health-related aspects were linked to the pro-environmental attitudes, but to a lesser extent to pro-environmental behaviors, owing to the complexity of their determinants. However, they should be taken in account in planning education interventions.

An increased incidence of thyroid cancer has been reported in the area close to Mount Etna, the largest volcano in Europe located in Northeastern Sicily. We tested the hypothesis that exposure to the emissions from the volcano is associated with thyroid cancer in 186 municipalities from three provinces surrounding the volcano (1.9 million inhabitants). We measured the angle between the bearing of the municipalities and each direction, with special focus on South-East, the prevalent direction of the plume, and conducted a regression analysis on 2003-2016 incidence rates of thyroid cancer, adjusting for distance from Mount Etna, population size, and income. A 10-degree increase in the angle with South-East was associated with a decrease in thyroid cancer rates in the whole population (- 0.67 cases/100,000, p = 0.002) and in women (- 1.54/100,000, p < 0.001), and were robust to several sensitivity analyses. Similar results were obtained for East-South-East direction. These results support the hypothesis of a potential role of exposure to the plume from Mount Etna in determining the high rates of thyroid cancer. The results need to be confirmed in analytical studies, in which information of exposure to chemicals originating from the volcano, as well as other possible causes, should be carefully measured, molecular characteristics of the tumors and taken into account.

Several studies have investigated the role of diet as a risk and/or protective factor against thyroid cancer, both considering individual foods, groups of foods and dietary patterns, but the results are not consistent. The aim of the study was to investigate the relationship between dietary habits and thyroid cancer. Cases and controls were recruited at the University Hospital "G. Rodolico" of Catania. The dietary habits were defined through the "Lifestyle Assessment Questionnaire". The frequency of consumption of each food item was reported on a 4-level scale (never, one time a week, 2-3 times a week, every day of the week). We computed the odds ratios (ORs) of thyroid cancer and the corresponding 95% confidence intervals (CIs) according to the median of control group daily intake of each food group, using multiple logistic regression models adjusted for major confounding factors. Starchy foods (OR = 1.39, 95% CI 0.83-2.32), sweets (OR = 1.39, 95% CI 0.81-2.40) and products rich in salt and fat showed a positive association with thyroid cancer risk. Conversely, an inverse association with disease risk was found for vegetables (cruciferous OR = 0.30, 95% CI 0.10-0.92, non cruciferous OR = 0.57 (0.20-1.57) milk and dairy products (OR = 0.68, 95% CI 0.40-1.13) and seafood (OR = 0.68, 95% CI 0.34-1.22). An increased risk was observed for consumption of iodized salts (OR 2.06, 95% CI 1.21-3.51), tea (OR = 1.42, 95% CI 0.84-2.41) and coca-cola (OR = 3.08, 95% CI 1.53-6.20). Finally, our results confirm the protective effect of a daily water intake of 1-2 L, but unfortunately this quantity is usually consumed by about a quarter of the sample. Dietary habits appear to modify the risk of thyroid carcinoma. A diet with a limited consumption of starchy foods, products rich in salt, fat and sugar and a higher consumption of, cruciferous/non-cruciferous vegetables, milk and dairy products and seafood could be protective towards thyroid cancer. Moreover, the water intake should be increased and the actual need to consume iodized salt should be verified for each subject/area. These results warrant further investigations and, if confirmed, they might have important public health implications for the reduction of thyroid cancer through the improvement of dietary habits., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of the central nervous system (CNS) that causes progressive and irreversible damage in motor neurons. Different causal hypotheses include genetic, viral, traumatic and environmental mechanisms, such as exposure to heavy metals. The aim of this study was to compare metal/metalloid levels in cerebro-spinal fluid of ALS subtypes (spinal vs bulbar clinical onset)., Material and Methods: This observational study consecutively screened all ALS patients referring to the Neurology Clinic of the University of Catania (Italy). Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify magnesium (Mg), cuprum (Cu), selenium (Se), iron (Fe), manganese (Mn), vanadium (V), zinc (Zn), alluminium (Al), arsenic (As), cobalt (Co), nickel (Ni), mercury (Hg), lead (Pb), cadmium (Cd) and palladium (Pd) levels., Results: Thirty-seven patients were enrolled (62.2% females), median age of 65 years (IQR: 59-71 years). Thirty-one (83.8%) patients had a spinal onset and 6 (16.2%) a bulbar onset. Se and As levels were higher compared to the reference values (RV) both in spinal and bulbar onset, while Cu was higher than RV only in bulbar onset. Moreover, Cu (129.8 μg/L vs 29.8 μg/L), Fe (54.5 μg/L vs 33.3 μg/L), Mn (3.4 μg/L vs 1.8 μg/L), Zn (46.1 μg/L vs 35.7 μg/L), Al (12.2 μg/L vs 6.7 μg/L), Ni (2.80 μg/L vs 1.40 μg/L), and Pb (0.60 μg/L vs 0.30 μg/L) levels were higher in bulbar than in spinal onset, conversely As was slightly higher in spinal than in bulbar onset (1.40 μg/L vs 1.10 μg/L). Overall, Cu (129 μg/L vs 31 μg/L), Fe (92.2 μg/L vs 32.9 μg/L), Mn (3.35 μg/L vs 1.80 μg/L), Zn (56.5 μg/L vs 35.2 μg/L), Al (14.45 μg/L vs 6.70 μg/L), and Cd (0.40 μg/L vs 0.08 μg/L) levels were higher in patients with disease duration less than 19 months., Conclusion: Our results supported the hypothesis that metals/metalloids with neurotoxic effects could be involved in the etiology of ALS, showing higher levels of Cu, Se and As. Relevant differences in Cu and Mn levels were found between bulbar and spinal onset patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Epidemiological studies highlighted the possibility that exposure to cyanotoxins leads to the development of the neurodegenerative disease amyotrophic lateral sclerosis (ALS)., Methods: We devised a population-based case-control study in two Italian populations. We used residential proximity of the residence to water bodies as a measure of possible exposure to cyanotoxins., Results: Based on 703 newly-diagnosed ALS cases and 2737 controls, we calculated an ALS odds ratio (OR) of 1.41 (95% CI: 0.72-2.74) for current residence in the vicinity of water bodies, and a slightly lower estimate for historical residence (OR: 1.31; 95% CI: 0.57-2.99). Subjects <65 years and people living in the Northern Italy province of Modena had higher ORs, especially when historical residence was considered., Conclusions: Overall, despite some risk of bias due to exposure misclassification and unmeasured confounding, our results appear to support the hypothesis that cyanotoxin exposure may increase ALS risk., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with still unknown etiology. We aimed at investigating the association between environmental and occupational factors with ALS risk. Methods: We performed a population-based case-control study in four Italian provinces (Catania, Modena, Novara, and Reggio Emilia) by administration of tailored questionnaires to ALS cases ( n = 95) and randomly selected population referents ( n = 135). We estimated ALS risk by calculating the odds ratio (OR) with its 95% confidence interval (CI) using an unconditional logistic regression model. Results: We found a positive association with disease risk for history of occupation in the agricultural sector (OR = 2.09, 95% CI 0.79-7.54), especially for longer than 10 years (OR = 2.72, 95% 1.02-7.20). Overall occupational exposure to solvents also suggested a positive association, especially for thinners (OR = 2.27, 95% CI 1.14-4.54) and paint removers (OR = 2.01, 95% CI 0.90-4.48). Both occupational and environmental exposure to electromagnetic fields show a slightly increased risk with OR = 1.69 (95% CI 0.70-4.09) and 2.41 (95% CI 1.13-5.12), respectively. Occupational but not environmental exposure to pesticides (OR = 1.22, 95% CI 0.63-2.37), particularly fungicides, and exposure to metals (OR = 4.20, 95% CI 1.88-9.38), particularly lead, mercury, and selenium, showed an imprecise but positive association. Finally, there was an indication of increased risk for living in proximity to water bodies. Conclusions: Despite the caution that needs to be used due to some study limitations, such as the low number of exposed subjects and the possibility of recall bias, these results suggest the potential role of some environmental and occupational factors in ALS etiology.

Background : Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods : We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results : We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19-5.72), electric shock (OR = 2.09, 95% CI 0.62-7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73-2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88-2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12-0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions : Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk., Competing Interests: The authors declare no conflict of interest.

Background: Autism Spectrum Disorder (ASD) is a complex disorder with heterogeneous etiology and wide clinical severity which supports the needs of recognizing biological and clinical features in patient subsets. The present study aimed to understand possible associations between the hair levels of metals and essential elements and some specific features of ASD measured by the Autism Diagnostic Observation Schedule (ADOS) that represents the gold-standard instrument to objectively confirm ASD diagnosis., Methods: A cross-sectional study was performed in the province of Catania (Sicily, South Italy). Forty-eight subjects with ASD (70.8% male), aged from 2 to 17 years were studied. Metals (Li, Be, Al, Ni, As, Mo, Cd, Hg, U, Pb) and essential trace elements (Cr, Co, Mn, Zn, Cu, Se) were quantified in hair by inductively coupled plasma mass spectrometry analysis. Participants were characterized by measuring the severity of autism symptoms and cognitive levels., Results: A significant and positive correlation was found between hair metal burden (lead, aluminum, arsenic and cadmium levels) and severity of ASD symptoms (social communication deficits and repetitive, restrictive behaviors). Hair zinc level were inversely related with age while there was a negative, significant association between hair zinc level and severity of autistic symptoms (defective functional play and creativity and increase of stereotyped behavior). Lead, molybdenum and manganese hair levels were inversely correlated with cognitive level (full intelligence quotient) in ASD individuals., Conclusions: The present study suggests the importance to combine metallomics analysis with pertinent disease features in ASD to identify potential environmental risk factors on an individual level possibly in the early developmental period., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Among the determinants of environmental health risk perception, health literacy and social media messages have been generally neglected. This study details the environmental health risk perception and its determinants in Italian university students, including a measure of functional health literacy and an analysis of newspapers and social media. A cross sectional survey was carried out among students from 15 Italian universities and different disciplines (grouped into Scientific-Health and Humanistic-Legal-Social sectors) using a self-administered anonymous questionnaire, divided into six sections: socio-demographic characteristics, information on health and environment, environmental health risk perception, trust, attitudes and behaviors and functional health literacy. Local newspapers and tweets in the same areas and period were analyzed in relation to quantity and topics. The study population included 4778 students (65.1% female) aged 21 ± 4.3 years, and functional health literacy was low (below the cutoff value) for 44.4% of students. A new outcome of the survey is that the detected association between high functional health literacy a higher global health risk perception and trust in institutions both as sources of information and as actors for protection against environmental risks. The internet and social networks were the most frequently consulted sources of information (77.7%), which was predictive of a higher risk perception. The possible relation between environmental health risk perception and tweet communication was highlighted by a comparison between the risk perception in the city with the highest number of tweets (Modena) and another one similar for socio-demographic characteristics (Pisa). In conclusion, the results of our study may be of help to strengthen information and education programs: functional health literacy should be taken into account in school programs, to produce a basic knowledge for a better understanding of health and environment. Moreover, mass and social media should be included in planning communication intervention and in verifying their results., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The health benefits of physical activity are well established, but the association between physical activity and thyroid cancer remains poorly understood. The aim of the study was to investigate the relationship between physical activity and thyroid cancer in order to determine type, frequency, and duration of exercise needed to maximize prevention., Method: Cases, diagnosed from January 2009 to July 2018, and controls were enrolled at the University Hospital "Policlinico-Vittorio Emanuele" of Catania (South Italy). Logistic regression models were used to estimate the crude and adjusted odds ratios (ORs) and their 95% confidence intervals., Results: A total of 106 cases (91.2% papillary type) and 217 controls were enrolled. Physical activity was rare in Catania (32.8%) and was not correlated to risk of total thyroid cancer (OR: 0.997; 95% CI: 0.515-1.929). Conversely, walking every day for at least 60 minutes reduced the risk of thyroid cancer (OR: 0.357; 95% CI: 0.157-0.673)., Conclusions: Our study showed that daily walking duration was associated with lower risk of thyroid cancer using a case-control study. Unfortunately, the frequency of physical activity often declines with age, particularly among the elderly, thus more research on physical activity adherence is needed to determine which approaches are most effective in promoting sustained physical activity participation.

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

Background: Reactive oxygen species (ROS) in biological tissues of elected biosentinels represent an optimal biomarker for eco-monitoring of polluted areas. Electron spin resonance (ESR) is the most definitive method for detecting, quantifying and possibly identifying radicals in complex systems., Objective: A non-invasive method for monitoring polluted areas by the quantitative determination of ROS in frog skin biopsy is presented., Methods: We assessed by ESR spectroscopy the ROS level in adult male of Pelophylax bergeri, specie not a risk of extinction, collected from the polluted Sarno River (SA, Italy) basin. The spin-trap ESR method was validated by immunohistochemical analysis of the well-assessed pollution biomarkers cytochrome P450 aromatase 1A (CYP1A) and glutathione S-transferase (GST), and by determining the poly(ADPribose) polymerase (PARP) and GST enzymatic activity., Results: ROS concentration in skin samples from frogs collected in the polluted area is significantly higher than that determined for the unpolluted reference area. Immunohistochemical analysis of CYP1A and GST supported the reliability of our approach, even in the absence of evident morphological and ultrastructural differences. PARP activity assay, connected to possible oxidative DNA damage, and the detoxification index by GST enzymatic assay give statistically significant evidence that higher levels of ROS are associated to alterations of the different biomarkers., Conclusions: ROS concentration, measured by ESR on isolated frog skin, through the presented non-lethal method, is a reliable biomarker for toxicity screening and represents a useful basic datum for future modelling studies on environmental monitoring and biodiversity loss prevention., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The purpose of this study is to report the experience of the implementation and application of a 3-year Water Safety Plan (WSP) together with the secondary disinfection of water by monochloramine to control and prevent healthcare-associated legionellosis in an Italian hospital strongly colonized by Legionella . Risk assessment was carried out by the WSP team. The main critical control points focused on in developing the WSP for the control of Legionella was the water distribution system. A sampling plan for the detection of Legionella was implemented. A widespread contamination of the hot water distribution system by L. pneumophila sg5 was found. Results after 3 years of the continuous disinfection of hot water with monochloramine indicate the eradication of Legionella . The implementation and application of a WSP in a hospital, together with the disinfection of the water distribution system with monochloramine, can be effective in controlling the growth of Legionella and in preventing nosocomial legionellosis.

This study evaluated the distribution pattern and pollution of chromium, arsenic (As), manganese (Mn), nickel, lead, and copper in surface sediments along the northern Latium coast of the Tyrrhenian Sea in Italy. The enrichment factor, geoaccumulation index, and potential toxicity response index were used to evaluate the degree of contamination. These results show As and Mn contamination. The high enrichment and contamination levels of As and Mn are located in two hot spots. These elevations are due to naturally high levels of As and Mn in the Mignone River and the Marangone Stream as well as the intense human activity in the area including the largest energy production site in Europe (Torrevaldaliga Nord coal-fired power plant) and of one of the most important ports for cruise traffic in the Mediterranean Sea.

This article summarizes recent evidence regarding brominated flame retardants. These represent the most common type of flame retardants used and recent studies have highlighted their presence in various concentrations in different environmental matrices, including areas distant from production areas, and in human biological samples. Many doubts persist regarding exposure sources, toxicity, metabolism and transformation processes once these products are released into the environment.

This study evaluated for the first time the concentrations of 10 metals in wild specimens of abalone, Haliotis tuberculata (Ht) (Linnaeus, 1758) from three sites along the southern Italian coast: Gulf of Catania (CT), the Northern Coast of Messina (ME) and the harbor of Villa San Giovanni (VSG). The species is commonly found in the area and has significant commercial value. Additionally, it is long lived, thus suitable as bioindicator of the environmental monitoring. The potential human health risks due to consumption of Ht have been assessed by estimated average daily intake (EDI) and target hazard quotient (THQ) of metals, respectively. In particular arsenic (As), cadmium (Cd), copper (Cu), chromium (Cr), iron (Fe), lead (Pb), manganese (Mn), mercury (Hg), selenium (Se) and vanadium (V) were quantified in the edible tissue of specimens by acid digestion of the samples and ICP-MS determination. The highest concentrations were found in CT sample area for most metals analyzed. Mean values for Pb, Cd and Hg were lower than the maximum levels (MLs) set for bivalve mollusks by Regulation (CE) no. 1881/2006 in all sites, and average intake values below the risk levels for human consumption., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Vanadium(V) can be found in natural waters in the form of V(IV) and V(V) species, which have different biological properties and toxicity. The purpose of this study was to determine the concentrations of total V and V(V) in groundwater from the area of Mt. Etna and to assess the estimated daily intake (EDI) of V(V) of adults and children through drinking water. Water was sampled monthly at 21 sites in 2011. Total vanadium was determined by inductively coupled plasma-mass spectrometry (ICP-MS) and speciation by ion chromatography-ICP-MS (IC-ICP-MS). The concentration of V(V) species ranged from 62.8 to 98.9% of total V, with significantly higher concentrations in samples from the S/SW slope of Mt. Etna. The annual mean concentrations of total V exceeded the Italian legal limit of 140 μg/L at four sites on the S/SW slope. In the absence of thresholds for V(V) intake, only the Environmental Protection Agency (EPA) has calculated a reference dose. Children's EDI of V(V) at the sites with the higher V concentrations exceeded EPA thresholds (9 μg/kg/day). In particular, we found in Camporotondo, Mascalucia, Ragalna and San Pietro Clarenza sites children's EDIs of 11, 9.3, 11 and 9.9, respectively. The EDI of V(V) was significantly higher than the literature range (0.09-0.34 μg/kg/day).

Background: The training of health workers is a key issue for the prevention of healthcare associated infections., Objectives: To evaluate knowledge of nursing and medical students concerning the prevention of healthcare associated infections., Design: A cross-sectional study., Setting: University hospitals in nine Italian cities., Participants: One thousand four hundred sixty one healthcare students (607 medical students and 854 nursing students)., Methods: The study was performed using a questionnaire investigating 3 areas, each having different possible points: standard precautions=12; hand hygiene=8; healthcare associated infections=5, for an overall perfect score of 25. Scores that met a cutoff ≥17.5 were considered to be indicative of an acceptable level of knowledge. Factors associated with an acceptable level of knowledge were analyzed using a logistic regression model., Results: Mean overall score (±SD) was 18.1 ± 3.2. Nursing students (18.6 ± 2.9) obtained a higher overall score than medical students (17.4 ± 3.5) (p<0.001). Weighed scores (±SD) by area were: 10.3 (±2.0) for standard precautions, 5.0 (±1.3) for hand hygiene and 2.8 (±1.1) for healthcare associated infections. Knowledge level concerning the three areas was different between medical and nursing students (p<0.001). The probability of finding acceptable knowledge was smaller for medical students (OR: 0.54 p<0.0001) and for students aged ≥24 years (OR: 0.39 p<0.0001)., Conclusion: The overall score showed an acceptable level of knowledge for the whole sample; but, considering separately the two curricula, only nursing students reached the minimum acceptable score. It seems important to investigate what is working better in nursing than in medical education in order to implement and validate new teaching approaches., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: To examine smoking prevalence, attitudes, knowledge and behaviours/beliefs among Health Professional School students according to the Global Health Professional Student Survey (GHPSS) approach., Methods: A cross-sectional study was carried out in Catania University Medical Schools. The GHPSS questionnaires were self-administered. Logistic regression model was performed. The level of significance was p ≤ 0.05., Results: 422 students answered to the questionnaire. Prevalence of current smokers was 38.2%. 94.3% of the total sample believe that health professionals should receive specific training to quit smoking, but only 21.3% of the sample received it during the study courses., Conclusions: Given the high prevalence of smokers among health professionals and their key role both as advisers and behavioral models, our results highlight the importance of focusing attention on smoking cessation training addressed to them.

Background: Mass strandings of sperm whales (Physeter macrocephalus) remain peculiar and rather unexplained events, which rarely occur in the Mediterranean Sea. Solar cycles and related changes in the geomagnetic field, variations in water temperature and weather conditions, coast geographical features and human activities have been proposed as possible causes. In December 2009, a pod of seven male sperm whales stranded along the Adriatic coast of Southern Italy. This is the sixth instance from 1555 in this basin., Methodology/principal Findings: Complete necropsies were performed on three whales whose bodies were in good condition, carrying out on sampled tissues histopathology, virology, bacteriology, parasitology, and screening of veins looking for gas emboli. Furthermore, samples for age determination, genetic studies, gastric content evaluation, stable isotopes and toxicology were taken from all the seven specimens. The animals were part of the same group and determined by genetic and photo-identification to be part of the Mediterranean population. Causes of death did not include biological agents, or the "gas and fat embolic syndrome", associated with direct sonar exposure. Environmental pollutant tissue concentrations were relatively high, in particular organochlorinated xenobiotics. Gastric content and morphologic tissue examinations showed a prolonged starvation, which likely caused, at its turn, the mobilization of lipophilic contaminants from the adipose tissue. Chemical compounds subsequently entered the blood circulation and may have impaired immune and nervous functions., Conclusions/significance: A multi-factorial cause underlying this sperm whales' mass stranding is proposed herein based upon the results of postmortem investigations as well as of the detailed analyses of the geographical and historical background. The seven sperm whales took the same "wrong way" into the Adriatic Sea, a potentially dangerous trap for Mediterranean sperm whales. Seismic surveys should be also regarded as potential co-factors, even if no evidence of direct impact has been detected.

The authors discuss harmful algal bloom, a seasonal phenomenon that in recent years has become increasingly frequent along Italian coasts. A classification of algal bloom is given and algal toxins and their effects on human health are discussed. The authors then describe the algal bloom phenomenon observed in Italy from the 1960s to the present time. Finally they briefly describe Italian legislation on the subject matter and highlight its shortcomings.

The aim of this study was to evaluate the toxicity of sludge produced by wastewater treatment, by using both chemical and ecotoxicological evaluations. Samples of sludge from treatment of urban and industrial wastewater were analysed. Toxicity of sludge was evaluated by measuring Vibrio fischeri, polychlorobyphenyls, polycyclic aromatic hydrocarbons and metals. Results of chemical and ecotoxicological evaluations were found to be discordant. In all samples, contaminants were found to be below the accepted threshold levels; on the contrary, toxicological evaluations of sludge samples obtained from industrial wastewater found these samples to be toxic. These findings indicate that the evaluation of sludge to be used in agriculture should include an ecotoxicological evaluation, as suggested by the European Community in 1999. Furthermore, chemical evaluation of sludge should be performed by using a single method and the chosen method should have the most restrictive threshold levels of all methods currently in use in the EU.

Previous studies conducted in Catania hospitals have revealed a high burden of contamination in the air of operating rooms and have recommended measures to improve air quality. In this study we verified the effectiveness of the undertaken measures. Furthermore we evaluated the possibility of using microclimatic parameters as "markers" of operating room contamination. Changes made to ventilation systems and to waste gas scavenging systems in the monitored operating rooms were remarkably effective. Microclimatic conditions and degree of chemical contamination improved over time; nevertheless airflow velocity values were found to be insufficient and nitrous oxide values, in some cases, remained slightly elevated. A significant correlation was observed only between some nitrous oxide values and relative humidity. Monitoring important marker levels is useful for correctly evaluating operating room thermal, chemical and microbiological air quality.