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Purpose The aim of the study was to evaluate the caffeinated Energy Drinks (EDs) consumption among a large sample of Italian undergraduates and its association with some of the major lifestyle risk factors. Methods Students attending twelve public Italian universities were involved between October 2021 and May 2022. Information on socio-demographic characteristics, ED consumption, and on health-related behaviors of participants was collected by the use of a web-based questionnaire. Results A total of 2165 students participated in the study and 15.2% of them reported having used caffeinated EDs in the last six months, mainly once a month (41.5%). In comparison with non-users, ED users showed a higher proportion of males (p p = 0.003), came mainly from Northern universities (p = 0.004) and life sciences degree courses (p p = 0.003), more particular dietary regimens (p p p p = 0.003), and higher proportion of smokers (p p = 0.005). ED use was negatively related with female gender (OR 0.546; 95% CI 0.374–0.798), the Mediterranean diet (OR 0.587; 95% CI 0.362–0.951) and coming from the center of Italy (OR 0.500; 95% CI 0.275–0.909) and positively associated with tobacco smoke (OR 1.712; 95% CI 1.176–2.492) and participation in a team sport (OR 1.686; 95% CI 1.051–2.707). Conclusion These findings could encourage figures engaged in education to increase the students’ awareness on this issue in order to prevent the excessive use of EDs and associated unhealthy behaviors, especially in the most interested subgroups.

Prolonged human-crewed missions on the Moon are foreseen as a gateway for Mars and asteroid colonisation in the next decades. Health risks related to long-time permanence in space have been partially investigated. Hazards due to airborne biological contaminants represent a relevant problem in space missions. A possible way to perform pathogens’ inactivation is by employing the shortest wavelength range of Solar ultraviolet radiation, the so-called germicidal range. On Earth, it is totally absorbed by the atmosphere and does not reach the surface. In space, such Ultraviolet solar component is present and effective germicidal irradiation for airborne pathogens’ inactivation can be achieved inside habitable outposts through a combination of highly reflective internal coating and optimised geometry of the air ducts. The Solar Ultraviolet Light Collector for Germicidal Irradiation on the Moon is a project whose aim is to collect Ultraviolet solar radiation and use it as a source to disinfect the re-circulating air of the human outposts. The most favourable positions where to place these collectors are over the peaks at the Moon’s poles, which have the peculiarity of being exposed to solar radiation most of the time. On August 2022, NASA communicated to have identified 13 candidate landing regions near the lunar South Pole for Artemis missions. Another advantage of the Moon is its low inclination to the ecliptic, which maintains the Sun’s apparent altitude inside a reduced angular range. For this reason, Ultraviolet solar radiation can be collected through a simplified Sun’s tracking collector or even a static collector and used to disinfect the recycled air. Fluid-dynamic and optical simulations have been performed to support the proposed idea. The expected inactivation rates for some airborne pathogens, either common or found on the International Space Station, are reported and compared with the proposed device efficiency. The results show that it is possible to use Ultraviolet solar radiation directly for air disinfection inside the lunar outposts and deliver a healthy living environment to the astronauts.

Airborne ragweed pollen is one of the agents of respiratory allergies in our changing environment. The monitoring of pollen is essential to manage pollen allergy and to improve its forecasting methods. Moreover, the control and fight against ragweed plants is important. Aim of this study is to understand the scenario of the studies on ragweed over time.We searched PubMed and Scopus for articles published until July 2022 reporting the words "ragweed". Articles written in all languages were included.Scopus was the database with the highest number of published papers. Among the papers on ragweed, the papers citing the word "allergy" were 59.4% in PubMed and 37,6% in Scopus. The subject areas more addressed were medicine, immunology, genetics/molecular biology, but agricultural/biological sciences too and, interestingly, other subjects like social sciences, art, humanistic, etc.). Among the top 40 institutions supporting research, 8 were European, 4 Asian, 1 Russian and 21 were American, the other 6 were pharmaceutical companies.This study shows a picture of the ragweed studies and some related subjects over time. A gap between the number of biomedical and not biomedical issues was evident. There is a need for greater involvement of institutions into support of knowledge and fight ragweed. The results will provide a useful tool to identify future goals in a global approach of ragweed related issues.

Physical activity is recognized as a major health determinant. However, the prevalence of inactivity can be as high as 80% in some adult subpopulations. From the urgent need to implement strategies to fight sedentary behaviour, considering that physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure, the pilot study "Activate your Wait" was born. The project aim is to transform waiting pauses during everyday life into opportunities to perform simple stretching and active mobilization exercises.The pilot study was carried out in 2019 at Terme S. Egidio (Italy). It was divided in three phases: in the pre-intervention a questionnaire was used to evaluate the interest in the project (96 responders); during the intervention, examples of simple exercises that people can do by themselves were illustrated and undertaken by about 120 participants; in the post-intervention an evaluation questionnaire was administered (71 responders).The intervention aroused enthusiastic participation and high approval and resulted in an increase both in willingness to perform exercises during daily waiting pauses (68% vs 94%) and belief in positive results of physical activity on health (74% vs 96%).In a context where the opportunities for physical activity are decreasing and a sedentary lifestyle has reached a high level, this project represents a contribution to the increase in the awareness of the importance of physical activity and the promotion of the culture of movement in the entire population, with an opportunity of easy accessibility in different contexts of life, at all ages.

The educational background of the Top Managers of the Italian Health Authorities: results of a study on eight Regions A survey to investigate the educational background of the Health Top Managers recently appointed by Italian Regions as CEOs (Chief Executive Officer) of Local Health Authorities (ASL) and General Hospitals was performed in April 2019, approximately one year after the entry into force of the new law for their selection (D.Lgs 171/2016). The study follows a similar one carried out by Bocconi University in 2013 and focuses on 8 Italian Regions (Piedmont, Lombardy, Liguria, Umbria, Lazio, Basilicata, Sicily, Sardinia). The study examined the CVs of the 112 recently appointed CEOs: the average age is 58.7 years, with the proportion of female surprisingly low (16%). About half of them (50.5%) have a Degree in Medicine and Surgery. Among Managers with a non-medical degree (49.5%), Law (21) and Economic sciences (21) are the most common degrees. Among medical doctors, 33 (58.9%) are specialists in Hygiene and Preventive Medicine. Overall, our data are consistent with those recorded in 2013 (except a decrease in medical graduates -18.5%) and confirm the diversified backgrounds of Health Managers. The background in Public Health, acquired from the 35 Schools of Hygiene and Preventive Medicine, remains relevant among Managers of the Italian National Health Service. (www.actabiomedica.it)

Objectives: The aim of this study was to analyze the consumption of dietary supplements (DSs) and related sociodemographic characteristics or behaviors in Italian undergraduates. Methods: A questionnaire-based, cross-sectional study was carried out between October 2021 and May 2022 involving undergraduates from 12 public universities. The use of DSs in the previous 6 mo, the aim and reason for use, the purchasing channel, and related adverse effects were explored and compared by sex. A logistic regression was performed to highlight possible associations between sociodemographic, anthropometric, and behavioral characteristics of participants and supplement consumption. Results: The use of DSs was reported by 71.5% of the 2165 respondents. Supplementation was related to sex (odds ratio [OR] 0.690; 95% confidence interval [CI], 0.516-0.924, for men), vegetarian or vegan (OR 4.814; 95% CI, 1.669-13.887) and other particular diet regimens (OR 1.819; 95% CI, 1.282-2.580), sport (OR 1.688; 95% CI, 1.116-2.553), and type of sport (OR 0.629; 95% CI, 0.423-0.936, for team sports). Women were more likely to use DSs following a doctor's prescription and to buy them in a pharmacy (P < 0.001) but reported more adverse effects (P=0.018) than men. The main aim pursued was general health; proteins, amino acids, and non-caffeinated energy supplements were consumed to improve physical performance and caffeinated energy supplements for mental performance. Conclusions: Diet supplementation was common in the sample examined, especially in women, and associated with particular dietary regimens and sports, especially individual sports. Female consumers follow specialists' indications more than males. These results highlight the need for educational interventions about diet supplementation for this category of users.

Coronavirus Disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global public health emergency. The aim of this study was to investigate cases characteristics and Real Time RT PCR cycle threshold (Ct) values distribution of COVID-19 in an Italian Northern area during three periods: first period, February-May 2020; second period, June-August 2020; third period, September 2020-February 2021.Real Time RT PCR was used to detect SARS-CoV-2 in respiratory samples (oro/nasopharyngeal swabs).A total of 254,744 samples were tested during the study period. Out of 20,188 positive samples (7.92%), 10,303 were females (51.04%) and 9,885 were males (48.96%). The percentage of positivity varied during the three different periods: 14.1% in the first period, 1.4% in the second and 9.2% in the third. The lowest Ct values were observed in the first phase of pandemic, with an overall average of 25.64. Overall average of the Ct values was lower in males than in females, 26.29 ± 6.04 and 26.84 ± 5.99 respectively. The oldest patients recorded lower Ct values.The findings of our study represent further evidence in support of the fact that male sex and older age showed lower Ct values, which means higher viral loads and higher infectious potential. These knowledges are useful to better understand the epidemiological aspects of COVID-19 and to perform effective Public Health Policies.

Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0–11 for tattooing, 0–14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father’s education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.

The University Degree in Environment and workplace prevention techniques: a quasi unicum Course in the European panorama for non-medical professionals involved in prevention activities The University Degree programme in Environment and workplace prevention techniques (Tecniche della Prevenzione nell’Ambiente e nei Luoghi di Lavoro) is a 3-year course established in Italy in 2000 by the Ministry of University to train healthcare professionals responsible for prevention activities such as environment and food controls, and workplaces prevention, operating both in the National Health Service and in private settings. Frontal teaching activities and training programmes include a background in bio-medical sciences, epidemiology, public health, social sciences and law, including the inspection and control tasks of health and safety in living and working environment, food hygiene, environmental controls and veterinary public health, which represent the field of specific competences of graduates. Currently, 38 courses have been activated in 30 Italian Universities, but relatively few similar courses are present in Europe (similar programmes were found in France, Spain, UK and Belgium) causing the lack of internalization and student exchange programmes. It is essential to identify similar training tasks in other European countries, in order to enhance cultural exchanges and the development of research activities in these strategic areas. (www.actabiomedica.it)

Biological particles in heritage-related indoor environments (museums, libraries, archives) represent a hazard to artifacts (biodeteriogenic action), operators and visitors’ health. The aim of the study was to evaluate environmental biological contamination and microclimate conditions in different periods of the year in De Rossi room of the historical Palatina Library in Parma. Microclimatic measurements were recorded continuously for a period ranging from 11 to 17 days in: January–February, May and September 2017. Monitoring of bacterial and fungal contamination was performed for air by active and passive sampling and by nitrocellulose membranes on shelves and manuscripts. Microorganisms were isolated by in vitro culture (Tryptic Soy Agar and Sabouraud Dextrose Agar) and characterized by molecular investigation. Viable and non-viable fungal spores were collected by Hirst spore trap. Concerning air, the highest bacterial mean values were 76.67 cfu/m3 (in May) and 3.33 IMA (in February, May and September), while for fungi 60.67 cfu/m3 and 4.33 IMA in September. The highest fungal values, both on shelves and books, were recorded in September with Alternaria, Arthrinium, Aspergillus, Cladosporium and Penicillium spp. being the mainly isolated fungi. Air temperature, relative humidity and air velocity reached mean values ranging, respectively, from 14.71 to 26.60 °C, from 41.62 to 44.83% and from 0 to 0.04 m/s. This case study provides an assessment of the environmental quality over a long period, representing a reference model to better understanding microbiological contamination of cultural heritage environment toward the improvement of artwork conservation strategies and the safeguard of human health.

Background Depression is a leading cause of disability. International guidelines recommend screening for depression and the Patient Health Questionnaire 9 (PHQ-9) has been identified as the most reliable screening tool. We reviewed the evidence for using it within the primary care setting. Methods We retrieved studies from MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library that carried out primary care-based depression screening using PHQ-9 in populations older than 12, from 1995 to 2018. Results Forty-two studies were included in the systematic review. Most of the studies were cross-sectional (N=40, 95%), conducted in high-income countries (N=27, 71%) and recruited adult populations (N=38, 90%). The accuracy of the PHQ-9 was evaluated in 31 (74%) studies with a two-stage screening system, with structured interview most often carried out by primary care and mental health professionals. Most of the studies employed a cut-off score of 10 (N=24, 57%, total range 5 – 15). The overall sensitivity of PHQ-9 ranged from 0.37 to 0.98, specificity from 0.42 to 0.99, positive predictive value from 0.09 to 0.92, and negative predictive value from 0.8 to 1. Limitations Lack of longitudinal studies, small sample size, and the heterogeneity of primary-care settings limited the generalizability of our results. Conclusions PHQ-9 has been widely validated and is recommended in a two-stage screening process. Longitudinal studies are necessary to provide evidence of long-term screening effectiveness.

Background: tattooing and piercing are increasingly common, especially among youths. However, several health complications may be associated with these practices if basic hygiene rules are not respected. This multicenter study was aimed at exploring tattoo and piercing experiences reported by a large sample of Italian undergraduate students through a public health perspective. Methods: tattooed and/or pierced students attending 12 Italian universities were asked to complete a web-based questionnaire regarding their body art experience. Results: out of 1472 respondents, 833 (56.6%) were tattooed and 1009 (68.5%) were pierced. The greatest proportion of tattooed students (93.9%) got her/his first tattoo in a tattoo studio, while most of the pierced were serviced in a jewelry store (48.0%). The pierced ones were less informed on health issues related to the procedure (56.0% versus 77.8% of tattooed p < 0.001), and tattooists were reportedly more attentive to hygiene rules (instrument sterilization 91.5% versus 79.1% of piercers, p < 0.001; use of disposable gloves 98.2% versus 71% of piercers, p < 0.001). Conclusions: educational interventions for both professionals and communities are needed to improve the awareness and the control of health risks related to body art throughout the Italian territory.

The aim of this research was to summarize available scientific evidence on the efficacy of medical hydrology for the management of any health condition. The search was conducted on 26th March 2021, in the following databases: Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, and Google Scholar. All relevant literature reviews investigating the clinical efficacy of interventions characterized by the use of natural mineral waters and muds were included. The quality of studies was assessed with the "AMSTAR 2" tool. After article screening, 49 reviews were included in this work. Overall, retrieved scientific evidence suggests that spa therapy is beneficial for patients affected by some specific musculoskeletal conditions, with improvements potentially lasting up to 9 months. Moreover, balneotherapy can be an integrative support for the management of chronic venous insufficiency and some inflammatory skin diseases like psoriasis. The role of spa therapy in rehabilitation appears relevant as well. More limited, although interesting evidence exists for inhalation and hydropinic therapies. Globally, retrieved evidence suggests that, besides individual wellbeing, medical hydrology can be useful for public health. In particular, higher-quality studies seem to support the integrative use of spa-related interventions for conditions like osteoarthritis, fibromyalgia, low back pain of rheumatic origin, and chronic venous insufficiency. However, the body of evidence has some limitations and further clinical trials should be designed for each relevant application to consolidate and expand acquired knowledge.

Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care units (ICUs) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions.To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAI risk prediction in ICUs, using both traditional statistical and machine learning approaches.Data for 7827 patients from the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' project were used in this study. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, and antibiotic therapy in 48 h preceding ICU admission.The performance of SAPS II for predicting HAI risk provides a receiver operating characteristic curve with an area under the curve of 0.612 (P0.001) and accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, the SVM classifier was found to have accuracy of 88% and an AUC of 0.90 (P0.001) for the test set. The predictive ability was lower when considering the same SVM model but with the SAPS II variable removed (accuracy 78%, AUC 0.66).This study suggested that the SVM model is a useful tool for early prediction of patients at higher risk of HAIs at ICU admission.

SARS-CoV-2 environmental contamination occurs through droplets and biological fluids released in the surroundings from patients or asymptomatic carriers. Surfaces and objects contaminated by saliva or nose secretions represent a risk for indirect transmission of COVID-19. We assayed surfaces from hospital and living spaces to identify the presence of viral RNA and the spread of fomites in the environment. Anthropic contamination by droplets and biological fluids was monitored by detecting the microbiota signature using multiplex RT-PCR on selected species and massive sequencing on 16S-amplicons.A total of 92 samples (flocked swab) were collected from critical areas during the pandemic, including indoor (3 hospitals and 3 public buildings) and outdoor surfaces exposed to anthropic contamination (handles and handrails, playgrounds). Traces of biological fluids were frequently detected in spaces open to the public and on objects that are touched with the hands (>80%). However, viral RNA was not detected in hospital wards or other indoor and outdoor surfaces either in the air system of a COVID-hospital, but only in the surroundings of an infected patient, in consistent association with droplets traces and fomites. Handled objects accumulated the highest level of multiple contaminations by saliva, nose secretions and faecal traces, further supporting the priority role of handwashing in prevention.In conclusion, anthropic contamination by droplets and biological fluids is widespread in spaces open to the public and can be traced by RT-PCR. Monitoring fomites can support evaluation of indirect transmission risks for Coronavirus or other flu-like viruses in the environment.ImportanceSeveral studies searched for SARS-CoV-2 in the environment because saliva and nasopharyngeal droplets can land on objects and surfaces creating fomites. However, the ideal indicator would be the detection of the biofluid. This approach was not yet considered, but follows a traditional principle in hygiene, using indicators rather than pathogens. We searched for viral RNA but also for droplets on surfaces at risk. For the first time, we propose to monitor droplets thorugh their microbiota, by RT-PCR or NGS.Even if performed during the pandemic, SARS-CoV-2 wasn’t largely spread on surfaces, unless in proximity of an infectious patient. However, anthropic contamination was frequently at high level, suggesting a putative marker for indirect transmission and risk assessment. Moreover, all SARS-CoV-2-contaminated surfaces showed the droplets’ microbiota.Fomites detection may have an impact on public health, supporting prevention of indirect transmission also for other communicable diseases such as Flu and Flu-like infections.GRAPHICAL ABSTRACT

The COVID-19 pandemic, affecting 213 countries, with more than 10 million cases and over 500,000 deaths is still causing serious health, social and economic emergency worldwide. Italian Northern regions are among the most badly affected areas. Surfaces represent matrices to which particular attention should be paid for prevention and control of SARS-CoV-2 transmission. A few studies have highlighted virus presence on surfaces. We report the evidence of its presence on hospital surfaces, in a single room hosting a patient whose nose-pharyngeal swab resulted positive for SARS-CoV-2 RNA at the admission. The surfaces sampling was carried out using pre-wetted swabs followed by extraction and amplification of viral RNA by reverse Real-Time Polymerase Chain Reaction (rRT-PCR). A total of 4/15 (26.66%) surfaces were positive for SARS-CoV-2 RNA: the right bed rail, the call button, the bed trapeze bar, the stethoscope; moreover, the patient’s inner surgical mask was positive, showing the emission of the virus from the patient. This study is a further confirmation that the surfaces represent a potential vehicle of transmission. This supports the need for strict adherence to hand and environmental hygiene. (www.actabiomedica.it)

“Activate your wait” project: pilot study carried out at a thermal centre: Physical activity is recognised as a major health determinant, with positive effects on health, environmental sustainability and economy. National surveillance data show that one out of three Italians - adult and elderly alike - declares to be sedentary, with a progressively increasing trend. From the urgent need to implement strategies to promote physical activity the “Activate your Wait” (“Attiva l’Attesa”) project was born, aimed at transforming the waiting pauses during day to day life into opportunities to perform simple stretching and active mobilization exercises. The pilot study was carried out at the Terme S. Egidio, Suio Terme Castelforte (Latina). The results of the questionnaire distributed in the pre-intervention phase, aimed at assessing the users’ interest in the project and physical activity in general, are reported. The questionnaire was administrated in the waiting rooms in September 2018 and September 2019. A total of 129 subjects responded to the questionnaire: 43% declared themselves sedentary, 73% reported willingness to perform simple physical exercises while waiting, and 76% believed that physical activity during waiting moments could have a positive impact on health. The project’s subsequent goal is to identify suitable exercises to be proposed during the intervention period, which can be easily reproduced independently by users in their everyday life.

The aim of this study was to evaluate the correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA) and to calculate the corresponding equations. Air sampling was performed in ten dental clinics (DC), before (T0), during (T1) and after (T2) the clinical activity, for five consecutive days, once a month for a period of three months, for a total of 450 air samplings. The correlation was evaluated using the Spearman test, and a p value below 0.05 was considered statistically significant. A statistically significant correlation was found considering both the results obtained from the total observations and from the single sampling times, T0, T1 and T2. Different correlation patterns were observed stratifying by DC. Both methods were able to evaluate the microbial air quality and highlight critical situations; therefore, both can be used with this aim. However, in particular during the activity, passive sampling resulted more sensitive, and for its simplicity, economy and standardization by IMA, as suggested by several authors, can be suggested for routine monitoring.

Operating theatres are among the hospital’s most risky environments as far as infections are concerned. Surgical site infection is a serious complication of surgery, associated with increased morbidity, mortality and costs. The ambient air of the operating theatre represents an important vehicle of micro-organisms causing surgical site infection, in particular in clean operations. The aim of this paper is to give a brief historical excursus of the milestones of the prevention of airborne surgical site infections. The debated issue on the use of unidirectional airflow ventilation system is presented. Some national recommendations for threshold air microbial contamination values are reported, and the need for a European standard on air quality to provide a safe operating theatre environment for surgical patients is underlined.

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved &ldquo, incorrectly&rdquo, Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.

Chronic migraine is a debilitating headache, whose treatment is often complicated by the concomitant overuse of symptomatic medication and by the poor efficacy of standard prophylactic treatments. The PREEMPT studies have demonstrated the efficacy and tolerability of onabotulinum toxin A (Botox(®)) in the treatment of this headache type. Data about its use in clinical practice are still scarce. Our study evaluated all subjects with chronic migraine who were treated with onabotulinum toxin A between February 2014 and November 2015 at the Parma Headache Centre. Botox was injected according to the PREEMPT paradigm every 3 months. The data about variations in the number of headache days and in symptomatic medication intake before and after the Botox injections were collected from the patients' headache diaries. The study also evaluated tolerability to treatment, disability, and depressive symptoms. Of the 52 treated subjects, 14 received Botox treatment for at least 9 months and showed a significant decrease in the median number of headache days (from 19 to 14.5, p = 0.011) and in the median number of days of symptomatic medications intake and symptomatic drugs. Overall, the treatment was well tolerated. The average MIDAS and BDI-II scores after 9 months were reduced, though not significantly. The treatment with Botox proved effective and well tolerated in our clinical practice. Further studies on larger patient samples will help shed light on the persistence of the drug's effect at long term and identify the predictive factors of response to treatment.

Background Legionella is an intracellular microorganism living in natural and artificial aquatic environments. Although its transmission to humans is linked to the inhalation of contaminated aerosols, there is no validated air sampling method for the control and prevention of the disease. The aim of the present study was to provide more information on the distribution of Legionella spp. in indoor environments and to determine whether the same Legionella strains are isolated from air and water samples. Methods Ten healthcare facilities located in seven regions of Italy were enrolled. The serological typing of Legionella spp. from water samples and the surrounding air by active and passive sampling was assessed using polyvalent and monovalent antisera. Subsequently, the strains identified as Legionella pneumophila ( Lpn ) underwent molecular typing by sequence-based typing (SBT) using seven genes ( flaA , pilE , asd , mip , mompS , proA , and neuA ). The allelic profile number was assigned using the European Working Group for Legionella Infections–SBT database. Results Lpn serogroup 6 was the most prevalent serogroup; it was found simultaneously in the air and water samples of three different healthcare facilities. In the remaining seven hospitals, Lpn serogroups 1, 6, 7, 9, and 12 were isolated exclusively from water samples. The molecular investigation showed that Lpn strains in the water and air samples of each positive healthcare facility had the same allelic profile. Strains, identified as sequence types (STs) 728 and ST 1638+ST 1324, were isolated in two respective healthcare facilities, and a new strain, identified as ST 1989, was obtained in one healthcare facility. Conclusion The application of the SBT method allowed to verify the homology among Legionella strains from water samples and the surrounding air. The results showed that the same Lpn strains were present in the air and water samples, and a new Legionella strain was identified.

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

This study examines variations in the start date, end date, duration, date of peak, peak value and Seasonal Pollen Index (SPI) of airborne pollen seasons recorded in Parma, Northern Italy, in relation to meteorological data (1994–2011). Pollen data were collected in the city of Parma by volumetric spore trap. The following taxa were analysed: Alnus, Ambrosia, Artemisia, Betula, Amaranthaceae, Corylus, Cupressaceae, Plantago, Platanus, Poaceae and Urticaceae. Spearman’s rank correlation tests were used to establish whether significant relationships existed between the different characteristics of the pollen seasons. Simple linear regression analysis was also carried out in order to investigate trends over time. Only 12 % of the 66 characteristics examined showed significant changes over the study period. Temperatures increased significantly during the spring, but this did not appear to have a corresponding impact on seasonal characteristics related to the timing of pollen seasons (i.e. start date, peak date and end date). All of the observed changes were associated with characteristics that can be related to exposure (i.e. duration, peak value and SPI). For arboreal taxa, the SPI of Betula decreased significantly, and Platanus pollen seasons became significantly shorter. For herbaceous species, the SPI and peak values of Artemisia became significantly lower, whereas the SPI and peak values of Ambrosia became significantly higher. The SPI of Poaceae and Urticaceae also decreased significantly. The results of correlation analysis showed that various characteristics of pollen seasons are significantly related. This study provides an essential baseline for determining exposure of the allergic population to allergenic pollen and aids understanding of the incidence of pollinosis in Parma. Gaps still exist in current knowledge; not least, the need to quantify the degree of influence exerted by some of the principal factors driving environmental change, climate and land use.

We would like to thank Collins andWalker for their comments and for acknowledging that this is an area requiring more research to improve our basic understanding of Legionella [1]. [...]

The behaviour of swimming pool users plays an important role in the prevention of chemical, microbial and physical risks associated with these recreational water environments. The aim of this study was to evaluate the hygiene-related behaviours and knowledge of users of indoor swimming pools in five Italian cities. A cross-sectional study was carried out using an anonymous self-administered questionnaire. The association between specific variables and patterns of behaviours and knowledge was assessed. A total of 4315 questionnaires were analysed. Of all respondents, 41.7% declared they had never read the swimming pool rules; 70.9% take a shower before entering the swimming pool; 13.5% said they urinated at least once in a swimming pool; 93.9% always wear proper footwear; 92.1% know what warts are and 69.3% know what mycosis is. A significant association was found between not reading the pool rules and unsafe behaviours, such as not showering (OR: 1.44, 95% CI 1.25–1.65), urinating in the pool (OR: 1.70, 95% CI 1.41–2.03) and not wearing any footwear (OR: 1.24, 95% CI 0.96–1.62). Male gender was significantly associated with urinating in the swimming pool (OR: 1.45, 95% CI 1.21–1.74) and not wearing footwear (OR: 1.71, 95% CI 1.32–2.23), but it showed to be protective against not showering (OR: 0.78, 95% CI 0.68–0.89). An age ≤ 18 years was a risk factor for not reading the pool rules (OR: 2.32, 95% CI 2.05–2.63), not wearing footwear (OR: 2.16, 95% CI 1.67–2.82) and not knowing what mycosis (OR: 7.04, 95% CI 5.34–9.27) and warts (OR: 7.94, 95% CI 6.86–9.20) are. Results reveal that incorrect behaviours are widespread among swimming pool users and that there is little awareness of the importance of reading pool rules for reducing health risks.

The aim of this study is to investigate the impact of surgical staff on the indoor air quality in a uni-directional ventilation Operating Theatre (OT). Experimental measurements of particles and microclimate were acquired at rest and in operational conditions. The real OT (operational) use was simulated by a sham hip arthroplasty. CFD simulations were carried out outlining the studied environment used for experimental measurement campaign. A standard k-e closure scheme based on RANS equations was implemented to solve the velocity and pressure field using an eddy viscosity approach. Temperature and relative humidity distributions were also computed keeping into account sensible and latent heat sources inside the OT. An Euler-based approach was applied to solve the concentration fields of gaseous contaminant and small particles (up to 5 μm in diameter) in the indoor air. An innovative strategy is proposed to estimate, by an iterative comparison between experimental data and numerical results, the emission rate of particles (differentiated by diameters) released by the occupants to be considered as source terms in the numerical model. Compliance with literature evidence concerning thermal and velocity fields and CO2 concentration was confirmed. From our analyses, some IAQ indexes were deduced, allowing monitoring of the local and overall OT air quality level supplied by the ventilating system during real operational conditions. The highest values of microbial air contamination were recorded during surgical activity; nevertheless, results showed the suitability of the ventilation system in providing the expected air quality.

Postoperative infections are a concern, especially in total knee and total hip arthroplasty. We evaluated the air quality in orthopaedic operating theatres in southeastern Italy to determine the level of bacterial contamination as a risk factor for postoperative infection. Thirty-five hospitals with operating theatres focused on total knee and total hip arthroplasty participated. We sampled the air passively and actively before surgeries began for the day (at rest) and 15 min after the surgical incision (in operation). We evaluated bacterial counts, particle size, mixed vs turbulent airflow systems, the number of doors, number of door openings during procedures and number of people in the operating theatre. We found no bacterial contamination at rest for all sampling methods, and significantly different contamination levels at rest vs in operation. We found no association between the number of people in the surgical team and bacteria counts for both mixed and turbulent airflow systems, and low bacterial loads, even when doors were always open. Overall, the air quality sampling method and type of ventilation system did not affect air quality.

Objective: The aim of the present study was to estimate the preventable proportion of Intubation-Associated Pneumonia (IAP) in the Intensive Care Units (ICUs) participating in the Italian Nosocomial Infections Surveillance in ICUs (SPIN-UTI) network, taking into account differences in intrinsic patients’ risk factors, and additionally considering the compliance with the European bundle for IAP prevention. Methods: A prospective patient-based survey was conducted and all patients staying in ICU for more than 2 days were enrolled in the surveillance. Compliance with the bundle was assessed using a questionnaire for each intubated patient. A twofold analysis by the parametric g-formula was used to compute the number of infections to be expected if the infection incidence in all ICUs could be reduced to that one of the top-tenth-percentile-ranked ICUs and to that one of the ICU with the highest compliance to all five bundle components. Results: A total of 1,840 patients and of 17 ICUs were included in the first analysis showing a preventable proportion of 44% of IAP. In a second analysis on a subset of data, considering compliance with the European bundle, a preventable proportion of 40% of IAP was shown. A significant negative trend of IAP incidences was observed with increasing number of bundle components performed (p Conclusions: The g-formula controlled for time-varying factors is a valuable approach for estimating the preventable proportion of IAP and the impact of interventions, based entirely on an observed population in a real-world setting. However, both the study design that cannot definitively prove a causative relationship between bundle compliance and IAP risk, and the small number of patients included in the care bundle compliance analysis, may represent limits of the study and further and larger studies should be conducted.

Scant data is available on immunization policies and practices among professional athletes. Following up on a recent review on the topic, we conducted a survey among Italian Serie A soccer teams during the influenza season 2015-16, to explore vaccination practices and attitudes as well as influenza vaccine uptake. The survey covered a sample of over 600 professional athletes from 20 teams and was carried out in collaboration with the Italian Association of Physicians of Professional Football Teams (L.A.M.I.CA.). For each team, the head of the medical staff was interviewed (structured telephone interviews, 100% response rate). Seasonal influenza vaccine was actively offered in 75% of Serie A teams with a median coverage rate of 40% (range 0%-100%). Vaccines are often administered after matches or training sessions. We report vaccine hesitancy associated with fear of adverse events, poor communication and other selected determinants. Vaccination in elite athletes, if correctly managed, represents a powerful, cost-effective and long lasting preventive tool. In times where vaccines are losing public confidence, our findings are a useful basis to inform the planning, implementation and evaluation of interventions to promote prevention in sports medicine.

We suggest a method to identify the suitability of a chosen indoor environment for paper material conservation in historical libraries. Our approach is based on two steps: numerical simulation for solving the air velocity, moisture and temperature fields, and then post-processing indexes evaluation to assess how the indoor microclimatic conditions can be favourable or not to the growth and development of microorganisms responsible for paper deterioration. A real case study was analysed in two different conditions: one the present situation and the other proposed by the authors with a HVAC system assuring controlled air temperature and RH levels. Numerical models, validated by experimental data published in previous works, were used to carry out microclimatic results. Starting from these results, some indexes suggested by the scientific literature were computed to check the suitability of the indoor environment for preserving a library heritage. Boolean parameters were also deduced from the combination of microclimatic factors favouring the growth of microorganisms responsible for paper material deterioration. Our research can provide a methodological approach that predictively allows one to know when, where and how the processes responsible for indoor microorganism activity can find the microclimatic conditions for their kick-off and triggering, and then their areas of potential growth. The proposed method highlights the main causes of the deterioration processes connected to building thermo-physics. Simulation results turned out to be a fundamental approach to identify the risky zones and potential areas of triggering deterioration processes of all the materials present.

Background:Physical education (PE) can be considered an instrument for active lifestyle promotion, and PE teachers can motivate youths to continue their studies in the field of Movement Sciences (MS).Methods:To evaluate the role of PE in higher secondary school in promoting physical activity (PA) and MS careers, previous PE experiences and current PA practice were investigated in a sample of Italian freshmen enrolled in different university degree courses.Results:A total of 7033 questionnaires were completed by students from 14 universities (41.3% males, mean age 20 ± 2.76 years). Recreation seemed to be the principal aim (42.2%) pursued during PE lessons, which are based mainly on practical activities (51.7%). Of all respondents, 67.2% were satisfied with the PE received during higher secondary school, and 51.6% participated in extracurricular PA. Current practice of PA was reported by 58.1% of the sample. Extracurricular activities were associated with choice of MS curricula (odds ratio: 2.15; 95% confidence interval, 1.85–2.50) and with current practice of PA (odds ratio: 1.68, 95% confidence interval, 1.51–1.87). Geographical differences concerning lessons organization and satisfaction were registered (P < .01).Conclusions:To enhance its role in health promotion, PE teaching should be improved by increasing the time allocated to PE and by strengthening the provision of school-based extracurricular PA.

Sexual health education through sport: issues for further perspectives in health promotion - WHO and the EU encourage the development of initiatives to promote teen-age sexual health. In Italy, though, adolescents sexually active age (15-17 years), adequate educational support seems to be lacking. Sexual education programs require a multidisciplinary approach, adequate staff and a conducive and appropriate environment. Sports and Physical Activity may provide additional and complementary support to school-sponsored activities. The sample (57% males and 43% females), stated that they participated in sexual education programs during their school years (58%). The schools do not seem to play an effective role, and friends continue to be the main source of information on sexuality-related issues (70%). Motor activities in schools and sports facilities may provide a useful education and prevention opportunity for youths and the Motor science graduate students may be a possible point of reference in schools or sports centers. They may also play a role in the multidisciplinary teams called to address adolescent issues, by actively participating in sexual education programs promoted by the public health system with other professionals Key words: sexual education, sexual health, physical activity, prevention, sexual behaviour, sport.

Preventing healthcare-associated infections requires a number of actions, including adequate disinfection and sterilization of medical devices. A cost analysis of hospital sterilization processes is fundamental to increase quality and safety, reduce costs and to make a decision about outsourcing. The aim of this analysis was to determine the cost of sterilization and the average cost of surgical procedures at the Rizzoli hospital in Bologna (Italy), a largesurgical hospital that performs more than 11,000 surgical procedures per year.