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Objectives: To assess the incidence of colonization and infection with carbapenemase producing Enterobacteriaceae (CPE) and carbapenem resistant Acinetobacter baumannii (CR-Ab) in the ICUs of our city hospitals before and during COVID-19 pandemic. Methods: Multicentre before-after cross sectional study to compare the rates of colonization and infection with CPE and/or CR-Ab in two study periods, period 1 (Jan-Apr 2019) and period 2 (Jan-Apr 2020). Incidence rate ratios (IRR) and 95% CI of weekly colonization and infection rates for each period were compared for the two study periods with Poisson regression. Weekly trends in the incidence of colonization or infection for each study period were summarized using local weighted (Loess) regression. Results: There was no significant change in either IRR and weekly trend in CPE colonization and infection during the two study periods. A shift from KPC to other CPE mechanisms (OXA-48 and VIM) was observed during period 2. Compared to period 1, during period 2 the IRR of colonization and infection with CR-Ab increased of 7.5 and 5.5-fold, respectively. Genome sequencing showed that all CR-Ab strains belonged to the CC92/IC2 clonal lineage. Clinical strains clustered closely into a single monophyletic group in one of the three centres, whereas segregated in two different clusters in the other two centres, strongly appoints for the occurrence of horizontal transmission. Conclusion: Our findings remark the need of pursuing infection control activities targeted against the spread of antimicrobial resistance intra and inter hospitals during COVID-19 pandemic, and if necessary re-modulating them according to the new organizational structures imposed by the pandemic.

The paper focuses on the social, economic and environmental trends of recent years in Italy, highlighting the issue of housing emergency, both in quantitative and qualitative terms. What emerges are several shortages in housing especially in the suburbs of large cities, emphasizing the relevance of this issue in terms of health consequences and its priority for the definition of local policies. The authors underline that the availability of accessible and healthy housing is a human right, and a multisectoral responsibility, achievable only if a contribution is made by all relevant sectors including housing, environmental, social welfare, urban planning, building management and public health. The authors conclude by stressing the strategic role of training and illustrating a proposal addressed to all stakeholders, aiming to provide health evidences in terms of impact of housing hazards on health and to describe good building practices, helpful in order to obtain safe and healthy homes.

In recent years, growing interest was devoted to housing conditions from both scientific community and public health, so they are now considered among the main environmental and social health determinants of health of the population. Aim of the study is to analyze and compare the current regulations regarding housing sanitary requirements in different Countries of the EU (Sweden, United Kingdom, Denmark, the Netherlands, France, Germany, Portugal, Spain) with the contents of the Italian Health Ministerial Decree 5th July 1975. From the websites of the official channels of the various countries the regulations have been downloaded. For the comparison, only the aspects of BCs concerning the scale of the building were examined; the comparison concerned all the requirements of the Health Ministerial Decree of 5.07.1975 and some other parameters (e.g. indoor chemical pollution, ionizing radiation, non-ionizing radiation) not provided for in the Ministerial Decree, treated in the other standards regulations, and relevant for the indoor well-being of the occupants. The authors observe a wide variability in the contents and in the formulation of the hygienic-sanitary requirements among the different Building Codes, above all as regards the dimensional data and some fundamental themes (e.g. heating systems, mechanical ventilation) whose treatment is often not it is updated with respect to the technological-scientific innovation consolidated over the past few years. A diverse approach among European Countries is also observed: from a market-oriented logic (e.g. UK), to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The comparative analysis we carried out made it possible to identify convergences and divergences in the standards analysed for the different European countries. As far as the Italian legislation on the usability of residential premises, finally, considering the health, social, environmental and economic trends, many standards contained in the MD 5th July 1975 should be reviewed and updated.

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues.The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects.The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc.The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces.Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces.Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment.The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

In our HIV outpatient centre where over 1,200 patients are followed, maraviroc as an entry inhibitor was introduced in 2010. We aimed to assess the background, the therapeutic challenges and the prospective monitoring of all patients treated with a combination antiretroviral therapy (cART) including maraviroc. Sixty-six patients started a maraviroc-containing cART with a history of HIV infection lasting 13.9±10.7 years. This interim analysis presents patients who had at least 12 (mean 16.9±12.8) months of follow-up. One to 17 previous cART changes prompted the introduction of maraviroc in rescue regimens in the great majority of patients considered (53 of 66); in 13 cases, maraviroc was given to patients with advanced HIV disease and no immune recovery after 2-3 years of a virologically-effective cART. The most frequent companion antiretroviral agents were: darunavir/ritonavir (51 cases), raltegravir (49 subjects), and etravirine (36 cases). The most common underlying conditions were: AIDS (41 cases), liver cirrhosis (21), AIDS-related or other malignancies (20 cases), major cardiovascular events (18 cases), osteonecrosis and haemodialysis-treated kidney failure (3 cases each). A chronic HCV and HBV hepatitis were of concern in 25 and 13 patients. The addition of maraviroc added favourably to clinical-laboratory markers of HIV disease progression, and those of comorbid conditions. HIV viraemia became (or remained) undetectable in 55 patients of 66 (83.3%). An improvement in CD4+ count was observed in all 66 patients, based on a mean 24.9±19.2% increase versus baseline, paralleled by an improvement in mean absolute CD4+ count of 134.7±121.1 cells/μL. A tendency towards an increased mean and peak CD4+ count was observed in the subgroup receiving a maraviroc-raltegravir-based cART. As no clinical-laboratory adverse events attributable to maraviroc occurred, nobody discontinued the study drug. Only mild-transient gastrointestinal disturbances, fatigue and anorexia, were reported during maraviroc administration, but their relationship with the study drug was difficult to assess because of the multiple comorbidities and polypharmacy. Our preliminary experience with maraviroc, even considering the limits of the proportionally reduced sample, the patients' salvage stage of advanced disease and the related-unrelated morbidities, underlines its excellent efficacy and safety profile.