Search

The presence of Listeria monocytogenes (Lm) in the food processing environment (facilities and products) is a challenging problem in food safety management. Lm is one of the main causes of mortality in foodborne infections, and the trend is continuously increasing. In this study, a collection of 323 Lm strain isolates recovered from food matrices and food industry environments (surfaces and equipment) over four years from 80 food processing facilities was screened using a restriction site-associated tag sequencing (2b-RAD) typing approach developed for Lm. Thirty-six different restriction site-associated DNA (RAD) types (RTs) were identified, most of which correspond to lineage II. RT1, the most represented genotype in our collection and already reported as one of the most prevalent genotypes in the food environment, was significantly associated with meat processing facilities. The sequencing of the genomes of strains belonging to the same RT and isolated in the same facility in different years revealed several clusters of persistence. The definition of the persistent strains (PSs) allowed the identification of the potential source of contamination in the incoming raw meat that is introduced in the facility to be processed. The slaughterhouses, which, according to the European Union (EU) regulation, are not inspected for the presence of Lm could be hotspots for the persistence of Lm PSs. • Specific Listeria monocytogenes (Lm) genotypes are adapted to meat and dairy processing environments. • Genome analysis identified slaughterhouse as a Lm contamination source for meat processing facilities. • Several events of Lm persistence over four years were identified in food processing facilities in Italy. • Persistence seems not to be related to specific Lm genotypes. [ABSTRACT FROM AUTHOR]

Valcamonica is an Italian valley where ferro-manganese industries have been active for a century and where an increased prevalence of parkinsonism was observed. A group of 93 patients (65 from Valcamonica, 28 from the reference area of Brescia city) and 76 controls (52 from Valcamonica, 24 from Brescia) were screened for serum Cu, Zn, Fe, Mn in blood (MnB) and urine (MnU), transferrin, peroxides, alanine (ALT) and aspartate (AST) transaminases and direct bilirubin. Test results were compared among groups according to the residential area and related to the disease severity. Valcamonica patients had a serum-increase of Cu, as well as of AST/ALT ratio, and a serum-decrease of Zn and Fe compared with other subgroups of cases and controls. Cases and controls from Valcamonica had higher MnB and MnU levels compared to cases and controls from Brescia. After controlling for the duration of illness, the Unified Parkinson’s Disease Rating Scale III domain correlated with serum Cu and AST/ALT ratio. Our results suggest the possibility that, in this area, a lifetime exposure to neurotoxicants and to Mn in particular, when accompanied to a subclinical liver dysfunction, may pose an increased risk for neurodegenerative disorders via metal metabolism (Cu, Zn, Fe) abnormalities. [ABSTRACT FROM AUTHOR]

During the first wave of COVID-19 pandemic, the most affected area in Italy was the southeast part of the Lombardy region. The University of Brescia is one of the largest in Northern Italy. The aim of this study is to investigate the psychological and somatic symptoms driven by lifestyle changes due to the lockdown among the students of the University of Brescia.15261 University students were enrolled through institutional email;14302 were Master’s and Bachelor’s Degreestudents,724 were Residents and 235 doctorates.3553 students (23.28% of total),aged on average 22 years, completed the survey. Physical health, dietary and sleep habits, physical activities, economic and social issues were investigated through an anonymous, online ad hoc form, available until July 2020 and approved by the local Ethic Committee. Five psychosomatic outcomes were assessed: digestive disorders, headache, panic-anxiety crises, depression-sadness, fear od COVID-19.Factor analysis was applied to reduce the number of variables while logistic and ordinal logistic regression models were used to test the association between the latent variables and each outcome. Female gender, medium-intensive use of telephone, worsening of sleep quality, mnemonic difficulties and performance reduction were associated with all the outcomes. Low physical activity, increased time spent watching television and the worsening of dietary habits represented a significant risk factor for at least three of the outcomes. Despite the relatively low compliance, the survey clearly identified few priorities of intervention to prevent psychological and somatic effects of pandemic in the next future: circadian rhythm, nutritional habits, physical activity, use of media, gender issues. The results of this study show the psychosomatic effects of social isolation and the pandemic on a population at risk of young adults and can promote interventions to minimize the occurrence of psychosomatic consequences on young adults. Key messages: Analysis of the main risk and protection factors in a population of young adults in the development of psychophysical symptoms during the period of isolation due to the covid-19 pandemic. Support the need to implement public health services also to reduce health costs with possible methods of intervention, in harmony with the findings. [ABSTRACT FROM AUTHOR]

Hypothesis Elderly breast cancer patients are underdiagnosed and undertreated in our Breast Unit. Design and setting Retrospective study of Azienda Ospedaliera " Santa Maria" -- Terni Italy. Breast Unit Years 2003-2007. Patients A total of 87 breast cancer patients aged 70 years or older diagnosed between 2003 and 2007, treated in our Unit, was identified. The data for 3 prospectively chosen age subgroups (aged 70-74, 75-79, and 80 years) were subsequently analyzed. Main outcome measures Data were collected regarding the method of detection of cancer, tumor characteristics and staging, type of treatment, and patient comorbidities. Comparisons between age subgroups were made using a likelihood ratio 2 test. Results Forty-six percent (41) of all patients presented with palpable breast cancer. Mammography was frequently used as an adjunct to the physical examination but was helpful in detecting occult disease in only 54% (47) of all patients and 38% (33) of patients older than 80 years. Although more than 70% (61) of patients were considered stage I or II, complete pathologic staging was only performed in 64% (56) of patients. Approximately 50% (43) of patients were treated with breast-conservation surgery; however, adjuvant radiation therapy was omitted in 55% (46%) of these patients. Additionally, only 29% (25) of patients with positive lymph nodes received chemotherapy, and 67% (58) patients who were estrogen receptor-positive received adjuvant hormonal therapy. Conclusion Older breast cancer patients are more likely to be diagnosed and staged clinically. Mammography is underused as a screening modality. While breast conservation surgery was performed in about half of the patients, adjuvant radiation, chemotherapy, and hormonal therapies were frequently excluded. [ABSTRACT FROM AUTHOR]

Traditional products are particularly appreciated by consumers and among these products, cheese is a major contributor to the Italian mountainous area economics. In this study, shotgun metagenomics and volatilomics were used to understand the biotic and abiotic factors contributing to mountain Caciotta cheese typicity and diversity. Results showed that the origin of cheese played a significant role; however, curd cooking temperature, pH, salt concentration and water activity also had an impact. Viral communities exhibited higher biodiversity and discriminated cheese origins in terms of production farms. Among the most dominant bacteria, Streptococcus thermophilus showed higher intraspecific diversity and closer relationship to production farm when compared to Lactobacillus delbrueckii. However, despite a few cases in which the starter culture was phylogenetically separated from the most dominant strains sequenced in the cheese, starter cultures and dominant cheese strains clustered together suggesting substantial starter colonization in mountain Caciotta cheese. The Caciotta cheese volatilome contained prominent levels of alcohols and ketones, accompanied by lower proportions of terpenes. Volatile profile not only demonstrated a noticeable association with production farm but also significant differences in the relative abundances of enzymes connected to flavor development. Moreover, correlations of different non-homologous isofunctional enzymes highlighted specific contributions to the typical flavor of mountain Caciotta cheese. Overall, this study provides a deeper understanding of the factors shaping typical mountain Caciotta cheese, and the potential of metagenomics for characterizing and potentially authenticating food products., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Origin authentication methods are pivotal in counteracting frauds and provide evidence for certification systems. For these reasons, geographical origin authentication methods are used to ensure product origin. This study focused on the origin authentication (i.e. at the producer level) of a typical mountain cheese origin using various approaches, including shotgun metagenomics, volatilome, near infrared spectroscopy, stable isotopes, and elemental analyses. DNA-based analysis revealed that viral communities achieved a higher classification accuracy rate (97.4 ± 2.6 %) than bacterial communities (96.1 ± 4.0 %). Non-starter lactic acid bacteria and phages specific to each origin were identified. Volatile organic compounds exhibited potential clusters according to cheese origin, with a classification accuracy rate of 90.0 ± 11.1 %. Near-infrared spectroscopy showed lower discriminative power for cheese authentication, yielding only a 76.0 ± 31.6 % classification accuracy rate. Model performances were influenced by specific regions of the infrared spectrum, possibly associated with fat content, lipid profile and protein characteristics. Furthermore, we analyzed the elemental composition of mountain Caciotta cheese and identified significant differences in elements related to dairy equipment, macronutrients, and rare earth elements among different origins. The combination of elements and isotopes showed a decrease in authentication performance (97.0 ± 3.1 %) compared to the original element models, which were found to achieve the best classification accuracy rate (99.0 ± 0.01 %). Overall, our findings emphasize the potential of multi-omics techniques in cheese origin authentication and highlight the complexity of factors influencing cheese composition and hence typicity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Although high sensitive imaging modalities such as MRI and PSMA PET/CT are becoming available for prostate cancer (PCa), the clinical benefit of an earlier detection of subclinical disease remains yet undetermined. Given these uncertainties, univocal recommendations are often lacking. The present survey was therefore developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of expert radiation oncologists and delineate a representation of current clinical practice in our country. A nationwide cross-sectional survey was conducted in Italy by administering an anonymous questionnaire to experienced radiation oncologists, representative of the genitourinary (GU) tumor board at their Institution, using the cloud-based platform SurveyMonkey®. For each question, a consensus was achieved when ≥ 75% of the responders agreed on the same response. Thirty nine AIRO members from different Italian centers who were deemed experts in GU field accessed the proposed survey and completed all sections. Explored topics included staging of organ-confined disease, management of biochemical and local recurrence, imaging in the metastatic setting, imaging following metastasis-directed therapy (MDT), and future considerations. Response rate for single item of the questionnaire ranged between 51.2% and 100%. Expert GU AIRO members agree that advanced molecular and functional imaging are expanding their role in local and distant staging of PCa, as well as in the oncologic management and in the assessment of treatment response. However, many controversial issues still exist on the best timing for a diagnostic evaluation and the most appropriate imaging to aim at this purpose., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Exposure assessment traditionally relies on biomarkers that measure chemical concentrations in individual biological media (i.e., blood, urine, etc.). However, chemicals distribute unevenly among different biological media; thus, each medium provides incomplete information about body burden. We propose that machine learning and statistical approaches can create integrated exposure estimates from multiple biomarker matrices that better represent the overall body burden, which we term multi-media biomarkers (MMBs). We measured lead (Pb) in blood, urine, hair and nails from 251 Italian adolescents aged 11-14 years from the Public Health Impact of Metals Exposure (PHIME) cohort. We derived aggregated MMBs from the four biomarkers and then tested their association with Wechsler Intelligence Scale for Children (WISC) IQ scores. We used three approaches to derive the Pb MMB: one supervised learning technique, weighted quantile sum regression (WQS), and two unsupervised learning techniques, independent component analysis (ICA) and non-negative matrix factorization (NMF). Overall, the Pb MMB derived using WQS was most consistently associated with IQ scores and was the only method to be statistically significant for Verbal IQ, Performance IQ and Total IQ. A one standard deviation increase in the WQS MMB was associated with lower Verbal IQ (β [95% CI] = -2.2 points [-3.7, -0.6]), Performance IQ (-1.9 points [-3.5, -0.4]) and Total IQ (-2.1 points [-3.8, -0.5]). Blood Pb was negatively associated with only Verbal IQ, with a one standard deviation increase in blood Pb being associated with a -1.7 point (95% CI: [-3.3, -0.1]) decrease in Verbal IQ. Increases of one standard deviation in the ICA MMB were associated with lower Verbal IQ (-1.7 points [-3.3, -0.1]) and lower Total IQ (-1.7 points [-3.3, -0.1]). Similarly, an increase of one standard deviation in the NMF MMB was associated with lower Verbal IQ (-1.8 points [-3.4, -0.2]) and lower Total IQ (-1.8 points [-3.4, -0.2]). Weights highlighting the contributions of each medium to the MMB revealed that blood Pb was the largest contributor to most MMBs, although the weights varied from more than 80% for the ICA and NMF MMBs to between 30% and 54% for the WQS-derived MMBs. Our results suggest that MMBs better reflect the total body burden of a chemical that may be acting on target organs than individual biomarkers. Estimating MMBs improved our ability to estimate the full impact of Pb on IQ. Compared with individual Pb biomarkers, including blood, a Pb MMB derived using WQS was more strongly associated with IQ scores. MMBs may increase statistical power when the choice of exposure medium is unclear or when the sample size is small. Future work will need to validate these methods in other cohorts and for other chemicals., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Adolescents living in communities with ferromanganese alloy plant activity have been shown to exhibit deficits in olfactory and fine motor function. Household dust may serve as an important manganese (Mn) exposure pathway to children, though dust Mn concentrations have not previously been measured to assess household contamination from ferromanganese alloy plant emissions. Here we determined the association between dust concentrations and surface loadings of Mn and other metals (Al, Cd, Cr, Cu, Fe, Pb, and Zn) in indoor and outdoor household dust from three Italian communities that differ by history of ferromanganese alloy plant activity: Bagnolo Mella, with an active ferromanganese alloy plant (n=178 households); Valcamonica, with historically active plants (n=166); and Garda Lake, with no history of ferromanganese plant activity (n=99). We also evaluated Mn levels in other environmental (soil, airborne particulates) and candidate biomarker (blood, hair, saliva, fingernails) samples from children within the households. Household dust Mn concentrations and surface loadings were significantly different between the three sites, with levels highest in Bagnolo Mella (outdoor median Mn concentration=4620, range 487-183,000µg/g), intermediate in Valcamonica (median=876, range 407-8240µg/g), and lowest in Garda Lake (median=407, range 258-7240µg/g). Outdoor dust Mn concentrations in Bagnolo Mella, but not the other communities, were significantly inversely related with distance from the plant (R(2)=0.6630, P<0.0001). Moreover, outdoor dust Mn concentrations and loadings were highly predictive of but significantly higher than indoor dust Mn concentrations and loadings by ~2 to ~7-fold (Mn concentrations) and ~7 to ~20-fold (Mn loadings). Finally, both indoor and outdoor dust Mn concentrations and outdoor dust Mn loading values were highly significantly correlated with both soil and air Mn concentrations, and with children's hair and fingernail Mn concentrations, but weakly or not associated with saliva or blood Mn levels. Given the evidence associating elevated Mn exposure with neurological impairments in children, these data support that dust Mn levels should be reduced in contaminated environments to protect the health of resident children., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The last decade has witnessed the affirmation of the paradigm Health Technology Assessment (HTA) as a tool for government innovation technology in health care. As is known, this is an approach of evaluation oriented policy making that, in addition to provide for the disclosure of its results, it is proposed to consider simultaneously the clinical, economic, organizational, ethical and social issues arising from the introduction or disposal of a health technology, understood in the broadest sense of the term. In order to reconstruct a realistic picture of its level of implementation we have reproduced a micro HTA which served to assess the Harmonic Focus® device usefulness in breast surgery.

Background: Comparisons between animal and human neurotoxicology studies are a foundation of risk assessment, but are hindered by differences in measured behaviors. The radial arm maze (RAM), a rodent visuospatial learning and memory task, has a computerized version for use in children, which may help improve comparisons between animal and human studies., Objective: To describe the characteristics and correlates of the virtual radial arm maze (VRAM) in 255 children age 10-15 years from Italy., Methods: We administered the VRAM using a laptop computer and measured children's performance using the latency, distance, and working/reference memory errors during eight trials. Using generalized linear mixed models, we described VRAM performance in relation to demographic factors, child activities, and several standard neuropsychologic tests (Italian translations), including the Conners Parent Rating Scales-Short Version (CPRS), California Verbal Learning Test (CVLT), Wechsler Intelligence Scales for Children, finger tapping speed, reaction time, and motor skills., Results: Children's VRAM performance tended to improve between trials 1 and 6 and then plateaued between trials 6 and 8. Males finished the task 14 s faster (95% confidence interval [CI]: -20, -9) than females. Children who played 2+h of video games per day finished 16 s faster (CI: -26, -6) and with 34% (CI: 5, 54%) fewer working memory errors than children who reported not playing video games. Higher IQ and better CVLT scores were associated with better VRAM performance. Higher cognitive/inattention CPRS scores were associated with more working (11%; CI: 1, 22) and reference memory errors (7%; CI: 1, 12)., Conclusions: Consistent with animal studies, VRAM performance improved over the course of test trials and males performed better than females. Better VRAM performance was related to higher IQ, fewer inattentive behaviors, and better verbal memory. The VRAM may help to improve the integration and comparison between animal and epidemiological studies of environmental neurotoxicants., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Prevalence of overweight and obesity has been reported as high even in preschool age children. However, recent international reports suggest that prevalence is now plateauing in pediatric age. Up to now no data are available on prevalence changes in Italy in the new Millennium. Aim of the study was to describe changes of overweight and obesity prevalence during the last decade in 5-6 y children in a large Health Unit in Northern Italy., Methods: The Health Report n 8, used at 5-6 y and containing body mass index (BMI), was utilized for prevalence estimation from 2002 to 2011 according to BMI cut-offs proposed by Cole et al., Results: Overweight and obese children progressively decreased during the study period (p 0.0002) with a minimum observed in 2011, showing a cumulative frequency of 23.1% in 2002 and of 16.6% in 2011 (-6.5%). Mean BMI values progressively decreased with time so that BMI values in 2010-2011 were significantly lower than in 2002-2003 (p < 0.0001). Underweight subjects increased with time (p 0.013), from 8.2% in 2002 to 9.9% in 2011, but grade 3 underweight (i.e., severe thinness) did not increase during the study period. In years 2010 plus 2011, not Italians children showed higher percentages of underweight (12.5%) and overweight plus obesity (23.5%) respect to Italian peers (9.0% and 18.1%, respectively, p values <0.01 and 0.0029)., Conclusions: This is the first report suggesting a possible decrease of overweight and obesity at 5-6 y in Italy in the last decade. As the study focused only on 5-6 y children, we don't know if the true overweight prevalence in pediatric age is really reducing or the starting age of overweight status is simply delayed. The higher risk for malnutrition, both for excess or defect, found in our Area in not Italian children respect to Italian peers, strongly suggests to implement weight control especially for those children. Our finding needs further confirm studies but seems encouraging for true prevention of such condition.

Background: The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods., Methods: The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs) to evaluate the association between mother's region of birth and perinatal outcomes., Results: Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively): 1.80 (95%CI:1.44-2.28) and 1.95 (95%CI:1.72-2.21) for very preterm births, and 1.32 (95%CI:1.16-1.50) and 1.32 (95%CI:1.25-1.39) for preterm births; 1.18 (95%CI:0.99-1.40) and 1.17 (95%CI:1.03-1.34) for a low Apgar score; 1.22 (95%CI:1.15-1.31) and 1.24 (95%CI:1.17-1.32) for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66) and 1.45 (95%CI:1.34-1.57) for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15) and 1.07 (95%CI:1.00-1.15) for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations., Conclusion: Our findings suggest that migrant status is a risk factor for adverse perinatal health. Moreover, they suggest that perinatal outcomes improved over time in some immigrant women. This could be due to a general improvement in immigrants' health in the past decade, or it may indicate successful application of policies that increase accessibility to mother-child health services during the periconception and prenatal periods for legal and illegal immigrant women in Italy.

Total Reflection X-ray Fluorescence (TXRF) is a well-established technique for chemical analysis, but it is mainly employed for quality control in the electronics semiconductor industry. The capability to analyze liquid and uniformly thin solid samples makes this technique suitable for other applications, and especially in the very critical field of environmental analysis. Comparison with standard methods like inductively coupled plasma (ICP) and atomic absorption spectroscopy (AAS) shows that TXRF is a practical, accurate, and reliable technique in occupational settings. Due to the greater sensitivity necessary in trace heavy metal detection, TXRF is also suitable for environmental chemical analysis. In this paper we show that based on appropriate standards, TXRF can be considered for non-destructive routine quantitative analysis of environmental matrices such as air filters. This work has been developed in the frame of the EU-FP6 PHIME (Public Health Impact of long-term, low-level Mixed element Exposure in susceptible population strata) Integrated Project (www.phime.org). The aim of this work was to investigate Mn air pollution in the area of Vallecamonica (Italy)., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Epidemiological data show excess of respiratory, dermatological, infectious, carcinogenic and musculoskeletal disorders among agricultural workers. Nevertheless, the national rates of reported cases do not correspond to the expected epidemiological data. In 2009, 3.914 cases of occupational diseases were reported to the national work compensation Institute (INAIL), as related to 1,200.000 agricultural workers employed in Italy. About 71% of these cases were related to musculoskeletal disorders. This shows a relevant difference between observed and expected cases, even more evident than in other sectors like constructions. More efficient preventive intervention is needed to improve this situation of under-reporting, through the implementation of epidemiological surveillance based on multiple sources of information. These sources should include the periodical health surveillance of active workers, the databank of General Practitioners, the hospital admission charts, and the case-lists of patients admitted to the Institutes of Occupational Health, according to a systematic active search of occupational cases.

Ferroalloy industries have been active for more than a century in the province of Brescia, Northern Italy. Air emission and water discharge have contaminated the environment in the surroundings of four plants with several metals including manganese. The presence of manganese in this region is especially interesting, because of the observed relationship between manganese exposure and Parkinsonism in a previous epidemiological survey. The aim of this study was represented by an initial screening of metal exposure in this area, using a geographic information system. X-ray fluorescence (XRF) was applied to identify heavy metals in deposited dust samples, collected in representative residential households throughout the province. The results were interpreted through a systematic mapping of all municipal districts of the Brescia province. A more frequent distribution of manganese and other metals was observed in the municipalities where the plants were located and differences in the geochemical and anthropogenic origin of metals were discussed, according to the point sources.

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003-2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks' of gestation in order to minimize neonatal respiratory morbidity.

The board of the Thematic Section on Preventive Medicine for Health Care Workers of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) programmed a national conference on occupational risks of health care workers to be held in late 2009. Main topics will be: a) biohazards; b) biomechanical risk; c) psychosocial factors. Three different working groups were established to tackle critical aspects and suggest practical recommendations to occupational health professionals. Preliminary issues are presented while final results will be presented at the conference on September 2009.

Several countries within the European Union (EU) have successfully eradicated Infectious Bovine Rhinotracheitis (IBR), while others (e.g. Germany) are making efforts to achieve IBR-free status. EU member states IBR eradication programmes must meet Community legislation requirements that ban breeding farms from purchasing positive animals, from using whole-virus IBR vaccines, and from inseminating cows with semen from positive bulls. A follow-up study from 2002 to 2005 was carried out in the province of Trento (Italy), where a compulsory programme for IBR eradication was started in 1998. IBR outbreaks (identified on the basis of seroconversion of sentinel animals) were concentrated in larger positive herds. A higher incidence was recorded between 2003 and 2004. An association between markedly high temperatures in the summer of 2003 and virus reactivation has been suggested but is yet to be confirmed. The practice of driving cattle to common alpine pastures for the summer season did not play a significant epidemiological role in IBR transmission. Premising that only seronegative animals are allowed to enter dairy farms, animal movement increases the infection risk to a moderate extent. The long-term persistence of IBR antibodies was more pronounced in animals positive for antibodies to the glycoprotein E (gE). Scattered seroconversions, occurring mostly in positive herds, require careful interpretation in order to avoid overestimating the incidence of the infection at herd level.

Background: Manganese exposure can cause neurobehavioral and neurological signs and symptoms. A review of the literature was carried out in order to identify the most sensitive and effective methods to assess these outcomes., Methods: Studies on manganese exposure performed with neuropsychological tests were reviewed using Medline. Test methods, obtained outcomes, and dose-response relationships were considered. Based on the review and additional considerations, a testing battery for adult and children was identified., Results: A total number of 31 studies were reviewed and divided in 18 occupational, 7 environmental, and 6 on children. A large variety of tests exploring motor and cognitive functions and mood were applied. Neurobehavioral effects were dose-dependent in several studies and determined by much lower exposure levels compared to 1 mg Mn/m(3) in total dust which is considered to be the minimum concentration able to induce the classical clinical features of "manganism." Although through a wide variety of tests, the observed outcomes support the knowledge that manganese exposure can cause neurobehavioral effects. Motor functions are mainly affected in adults, and cognitive functions and behavior are more affected in children., Conclusions: Literature on manganese neurobehavioral effect is quite consistent, however, further improvement may be achieved by using better structured and more comparable evaluation methods. Based on the analysis of the existing experiences a test battery including tests of motor functions, response speed, cognitive functions, intellectual abilities, mood, and symptom questionnaires is suggested. We recommend that the tests indicated should always be included in future studies as a core battery., ((c) 2007 Wiley-Liss, Inc.)

Background: Studies have reported associations between manganese (Mn) exposures and Mn levels in blood and urine, though the suitability of these biological measures as biomarkers of exposure is not well known., Methods: We evaluated whether whole blood, plasma, and urine Mn levels reflect exposures in occupationally exposed humans., Results: In active ferroalloy workers, blood Mn was associated with total air Mn levels in subjects currently exposed to low (median = 0.42 microg/m(3), P = 0.009) and moderate (median = 4.2 microg/m(3), P = 0.007) air Mn levels, but not in workers exposed to the highest Mn levels (median = 292 microg/m(3), P = 0.31). In bridge welders blood Mn (P < 0.01), but not plasma or urine Mn was significantly associated with their cumulative respiratory exposure index. In welders, approximately 6% (range approximately 3-9%) of whole blood Mn was contained in the plasma fraction, though there was no association between whole blood and plasma Mn levels (Pearson's R = 0.258, P = 0.12). In contrast, in fresh whole blood samples spiked with Mn ex vivo approximately 80% or more of added Mn partitioned in the plasma, while only approximately 20% or less partitioned in the cellular fraction., Conclusions: These data suggest a complex and limited relationship between exposure and blood Mn levels that may depend upon exposure attributes and the latency of blood sampling relative to exposure; plasma and urine Mn appear to be of little utility as exposure biomarkers. This underscores the need to fully characterize and validate these or other biomarkers for use in constructing appropriate exposure metrics and determining exposure-effect relationships., ((c) 2007 Wiley-Liss, Inc.)

Background: Environmental exposure to heavy metals and especially manganese (Mn) took place in Valcamonica, Italy, where a high prevalence of Parkinsonism was observed (age and sex standardized 407/100,000; 95% CI: 393.87-420.12), and the Standardized Morbidity Ratios was associated with environmental Mn levels., Methods: A cross sectional study compared Parkinsonian patients residents in Valcamonica with patients from Brescia, Italy. Age- and sex-matched healthy individuals were recruited as controls. The protocol included information on clinical, occupational, residential history and life habits, neuro-psychological testing, and assessment of genetic polymorphism., Results: The target group included 65 patients and 52 controls from Valcamonica, 28 patients and 14 controls from Brescia. Age at onset of the disease was lower in women from both areas. After adjusting for age and age at onset, patients from Valcamonica showed more severe motor impairment at the UPDRS scale, higher damage of cognitive and motor functions at MMSE, Token and Trial Making tests. Genetic variables showed a different allelic distribution of DRD4 gene between cases and controls, outside Valcamonica, where a less frequent familiarity for parkinsonism was reported., Conclusions: Parkinsonian patients with previous exposure to metals showed a more severe neuropsychological phenotype, without detectable contribution from genetic factors.

Using the Hospital computerized database, individual variables including referral source, gender; age, life style, work sector, clinical and work history, final clinical diagnosis and work-relatedness evaluation were retrieved and analysed. The results of this survey showed a significant increase of number of cases, especially from 1999 to 2006. Shoulder disorders showed a significant increase in the latest years of the observation period, while the other upper limb districts remained constant. The work sectors mostly affected were textile, construction, metalmechanical and food industry. The findings of this study indicates an increasing demand for clinical assessment of work-related musculoskeletal disorders of the upper limb. Therefore, it is important that a standardized diagnostic procedure is applied together with an accurate evaluation of biomechanical overload.

Introduction: Stress is usually defined as the experience of negative events or the perceptions of distress and negative affect that are associated with the inability to cope with them. The parameter most suitable for large-scale field studies is the determination of endocrine activity by measurement of salivary cortisol. The aim of the present study is to identify the presence of sources of stress in an emergency team of urban police and to objective such stress using the PSS (Professional Stress Scale) test and bioumoral markers as salivary cortisol and interleukin 1 /f (IL-IB)., Materials and Methods: We studied 30 policemen who belonged to an emergency team. Salivary samples were collected at the start and at the end of the work-shift. As control we used the same subjects during the holiday. T test was performed to evaluate the differences between the means, the Chi Square's Test was performed to determine the statistically significant association between PSS subscales and salivary cortisol and ILl-B concentrations., Results: Thirty policeman were evaluated, their mean age was 44,5 years, their mean work experience was 17,1 years. The PSS test indicated high scores in three subscales, they were work load, organizational structure and processes and lack of resources. SALIVARY CORTISOL: The mean concentration at the start of work-shift was higher than at the end of shift-work (p<0,05). T test indicated a statistically significant difference between mean cortisol concentrations at the same hour during the work (start and end) and during the holiday (P<0,05). A statistically significant negative association was noted between the PERC1 and PSS subscale called "work load" (p<0,05). SALIVARY IL-1B: the mean concentration of ILl-B at the start of the work-shift resulted higher than at the end, such reduction was statistically significant (P<0.05). We verified a positive association between the subclass of PSS Test called "conflict with other professionals" and salivary IL-1B concentration at the start of shift-work (p<0,05). DISCUSSION. Several precedent studies agree with our results. Our study has suggested a work related stress in urban police employed in an emergency team. We might conclude that salivary IL-1B and cortisol are useful markers of stress. We think that our findings, surely preliminary, have be corroborated by the study of vegetative parameters (heart rate, heart rate variability) that is still current. It might be useful to evaluate again the cortisol and IL-1B variations after some structure organizational modifications and after training that will teach the workers coping strategies. We might conclude that the stress discovered in this study is not hazardous for the health, if the workers have adequate holidays.

Diagnostic-therapeutic itineraries and treatment profiles are instruments of clinical management. The authors report on their experience with the experimental creation of such itineraries in thyroid nodular pathology. These are the fruit of collaboration between the management team, endocrinological surgeons, and the hospital computer staff. The drawing-up of guidelines in the hospital setting allows the systematic organisation of clinical activities to be accomplished in the health-care facility, quantifying costs for all diseases in order to be able to plan and implement changes in resources and staff utilisation. Application of the method, in addition, helps to develop a common language among hospital doctors and nurses, facilitates proper communication with patients, and ensures adequate patient information regarding the clinical itinerary the patient will have to take for his or her condition.

Background: Fitness for work (FW) in certain clinical cases poses significant professional challenges for Occupational Physicians (OPs)., Objectives: to discuss the role of a public Institute of Occupational Medicine (IOM) in FW, thorough description of clinical cases., Methods: the IOM at the University of Brescia is a public clinic available to general practitioners, OPs, other specialists, insurance companies, health authorities, employers, trade unions. IOM expert opinion on FW may be requested by OPs, employers or workers. In each case, occupational and clinical histories are taken, physical examinations, laboratory and instrumental tests might be performed, and technical and clinical documentation is acquired; expert opinions from other specialists might also be sought. Risk assessment (RA) stems from worksite inspections and information from company health and safety representatives, or health authorities., Results: a few peculiar clinical cases are reported: tremors in a dental hygienist trainee, chorioretinitis in a welder, spasmofilia in a nursing aide, obstructive sleep apnoea in a steel worker, epilepsy in a metal engineering worker, as well as a number of cases fom the same workplace., Conclusions: FW judgement made by a IOM had several advantages from clinical and RA aspects. Work restrictions may not always be evidence based and it might be difficult to balance rights and duties of patients, employers and OPs; the IOM's wider experience, case discussion with the relevant parties, scientific and technical documentation of diagnostic and FW processes, strengthen the role of the IOM in dealing with difficult cases and as a guarantee from technical and ethical viewpoints.

The Diagnostic and Therapeutic Programs are instruments of clinical management. The authors report on their experience with the construction of a Diagnostic and Therapeutic Program in the field of breast cancer. This is the result of collaboration between the Breast Unit, an administrative team and a computer team at the "S. Maria" Hospital in Terni. The implementation of the guidelines in the hospital setting makes it possible to systematise the clinical activities, to quantify the economic impact for each disease, and to plan any changes in the use of resources. The application of this method, moreover, makes it possible to develop a common language between medical and nursing staff which can be easily understood by the patients and to inform patients adequately with regard to the diagnostic and therapeutic program they will have to comply with for their respective conditions.

Background: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained., Objectives: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research., Methods: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance., Results: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%)., Conclusions: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

The prevalence of parkinsonian syndromes was studied in the province of Brescia (Northern Italy), in order to verify its possible increase in the surroundings of ferroalloy plants located in a valley of the pre-Alps. A case-list of subjects affected by these disturbances was identified using four different sources of information: a) registers from local medical clinics; b) admission charts from local hospitals; c) consumption of levodopa; d) NHS list of exemption from prescription payment, due to the illness. Exploratory data show a frequency of parkinsonian disturbances among the residents in the surroundings of the ferroalloy plants and downwind (crude prevalence = 358/100,000 population, standardized for age and sex = 438) significantly higher (s.m.r, = 1.58; C.I. = 1.41-1.76) than the entire Province (crude prevalence 246/100,000). This preliminary result could indicate the interaction of prolonged environmental exposure to heavy metals, such as manganese, and genetic factors, potentially relevant in this mountain population.

In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.

Aims: The "Mercury Multicentric Project" data-set was analysed with the aim to identify a group of biological variables associated with different types of Hg exposure (occupational exposure, fish dietary intake, exposure due to amalgam restorations). The distribution of socio-demographic, biological and surrogate outcome variables was rather different among the collaborating Units., Methods: Mixed linear models (MLM) were used to overcome the problems related to the heterogeneity of variances among Units. MLM are a generalization of the standard linear models, the generalization being that the data are permitted to exhibit correlation and non constant variability. MLM therefore provide with the flexibility of modelling not only the means of the dependent variable, but also their variances and co-variances as well. This allows to represent the total variability of the dependent variable as a sum of two components: the first attributable to the Units and the other one to the random error., Results and Conclusions: A set of biological variables significantly associated with at least one of the Hg exposure variables or with the HgU/creatinine ratio (as surrogate variable for Hg exposure) was identified by means of MLM. This set includes beta 2-MG, sIL8, CD4+, sPRL, FT dominant, BAMT, and some variables related to neurological behaviour. An extension of this analysis will be performed with a structural equations approach in order to study the dose-response relationships among the various variables according to a hierarchical path defined on biological basis. One of the possible simplified general models including all the selected variables is described.

Repetitive motions of the upper limb at work can induce muskulo-skeletal alterations, therefore a specific medical surveillance is needed, according to the intensity of risk. In low risk conditions, the medical surveillance is aimed at the identification of hyper-susceptible individuals and the administration of specific information programs. When the risk intensity is higher, medical surveillance should add the recognition of early symptoms and signs of muskulo-skeletal disturbances, in order to remove workers showing early alterations from the exposure and allow medical rehabilitation. The diagnostic protocols with the adequate instrumental evaluation are provided, and the required legal reporting is discussed.

A cross sectional field study was planned to assess neurotoxic effects caused by low-level occupational lead exposure. Two groups of 66 workers and 86 controls were examined with a battery including a questionnaire on neurotoxic symptoms, the measure of performance at neurobehavioral testing, the detection of visual contrast sensitivity, and the dosage of serum prolactin. Both current and cumulative exposure to lead were defined. The average PbB was 27.50 +/- 28 microg/dl (median 28, range 6-61) in the exposed and 8.11 +/- 4.47 microg/dl (median 7, range 2-21). The test results were controlled for possible confounders including age, schooling, alcohol and coffee intake. Significant differences were observed between exposed and controls regarding neurotoxic symptoms reporting, the exposed reporting more frequently mood changes and abnormal fatigue. The exposed subjects showed a decreased visual contrast sensitivity, and a marked increase of prolactin secretion. No changes emerged regarding neurobehavioral testing. The alterations observed resulted associated to the current lead exposure and not to the cumulative indices. A safe exposure level was calculated on the basis of dose-response relationship with prolactin alteration, yielding a PbB value of 10 microg/dl.

In 50 female workers of a manufacturing plant employed on the assembly line of metal and plastic products with cloth covering, we found a high prevalence of Carpal Tunnel Syndrome (16 cases, 32%, 5 of whom had already undergone surgical treatment). The subjects with positive diagnosis of Carpal Tunnel Syndrome also had a longer occupational exposure to repetitive movements, compared to the other subjects. Among the subjects with this disorder, the length of exposure was also significantly associated with the reported symptoms and the extension threshold measured on the 2nd finger of the dominant hand. Ergonomic assessment of the assembly lines revealed high-frequency repetitive movements and application of force, with insufficient rest intervals.

The meaning and usefulness of biological indicators in the study of occupational exposure to aluminium (Al) was assessed on the basis of the most recently acquired knowledge on the toxicokinetics of aluminium absorbed by inhalation, results of environmental and biological investigations recently carried out in industrial sectors with low risk of aluminium absorption (refining, casting and pressure moulding covering a total of 8 plants and 119 workers) and the results of investigations on a group of welders exposed to Al concentrations between 5 and 10 mg/m3. It was confirmed that not only the environmental Al concentrations but also certain chemical and physical characteristics (particle size, allotropic state, solubility), simultaneous exposure to other dusts, and mode of exposure (existence of exposure peaks) play a significant role in lung absorption of Al. Urinary Al (AlU) may be considered as an indicator of "recent" exposure with biphase excretion kinetics influenced also by duration of exposure, whereas Al in serum (AlS) can probably furnish indications both on overall exposure and on body burden. In low-level Al exposure (below 0.5 mg/m3), these indicators (especially AlU) permit differentiation of the exposed groups from the general population without, however, any clear relationship with the various environmental Al concentrations. It was also seen that AlU increased with increasing work seniority and was more marked in certain processes, such as casting, and in the first few months or years of work.(ABSTRACT TRUNCATED AT 250 WORDS)

In the past years the problem related to occupational exposure to anaesthetic gases in operating rooms has been dealt with in different ways by each hospital administration, and frequently with little cooperation between the health departments involved. At the Spedali Civili of Brescia in the five year period, 1987-1991, a monitoring activity of nitrous oxide (N2O) and halogenated anaesthetics was performed in 30 operating rooms. This lead to a noticeable reduction of environmental concentrations of these substances. Favourable results have been achieved principally by maintenance and/or substitution of anesthesiological machine parts. In order to organize and facilitate this program a close collaboration was accomplished between the Medical Direction of the Hospital and the Occupational Health Department, with the support of the Technical Assistance Department.

A follow-up study was planned to evaluate the frequency of the breast feeding babies in Rome and its district. 918 subsequently born babies were followed for 6 months. At 3 months of age only the 35,4% of them was still breast fed. We point out that babies born from spontaneous delivery present a higher frequency and a prolonged breast feeding statistically significant v/s babies born from cesarean section, and that the early initiation of breast feeding has a marked positive influence.