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This study aims to evaluate the quality of life (QoL) of chronic myeloid leukemia (CML) patients prescribed with nilotinib as a second-line therapy and explores the influential factors. A multicenter retrospective survey was conducted via face-to-face interviews based on the EORTC QLQ-C30 questionnaire. A total of 121 adult CML patients resistant to imatinib and used nilotinib for at least 3 months were enrolled. The influential features were assessed by multiple linear regression models. Patients had the mean age of 47.49 (SD = 13.67) years, dominated by middle-aged and male groups. The mean scores of functions ranged from 75 to 83, and those of symptoms were from 5 to 28, with the highest of fatigue (28.28), insomnia (22.87), and pain (21.07). The mean global health status/QoL score was 67.70 (SD = 16.80) with considerable financial difficulties (52.34 (SD = 32.15)). Male patients reported higher functional scores and fewer symptoms compared with female patients. All aspects of QoL became worse with increasing age. Besides age and gender, level of education, duration of nilotinib usage, and comorbidities were also significantly influential factors in many QoL domains. A predicted model for expected mean scores of QoL domains was built based on these factors. The CML patients treated with nilotinib had the above-moderate QoL scores, a light decrease of functional scores, great financial difficulties, and still experienced symptoms. Strategies and more therapeutic considerations to enhance QoL for CML patients targeted toward women, the old, low educational level, and long duration of nilotinib usage, and many comorbidities are needed in the setting.

Malaria is a potentially deadly parasitosis. Due to its geographical distribution, seafarers are particularly exposed to it. This study is an epidemiological analysis on the morbidity of malaria onboard commercial ships without a physician, with the purpose of proposing solutions aimed at limiting further infections in this delicate and difficult working environment. Methods: We examined 17,212 health records of patients embarked on ships assisted by the CIRM from 2011 to 2015. All the diagnosed diseases have been categorized based on the ICD-10 classification system by the WHO. This study analyzed the cases of suspected malaria and the cases of malaria confirmed by clinical tests. The geographical distribution of infections and the drugs chosen by physicians are also assessed. Results: Although a reduction in malaria cases was appreciated during the 5-year period taken into consideration, this disease still covers an important percentage of all infectious diseases that occurred onboard. This proves that it is a major health problem for seafarers. Conclusions: In order to protect seafarers’ population, strengthen malaria prevention and control programs, as well to improve the availability of antimalarial drugs onboard ships is necessary. This may ensure rapid and efficient health interventions in case of need. (www.actabiomedica.it)

Background: The SARS-CoV-2 pandemic (Severe Acute Respiratory Syndrome Coronavirus 2) and the worldwide health crisis have significantly changed both people’s habits and lifestyles. Most of the studies found in the literature were carried out on specific professional categories in the socio-health sector, taking into consideration psychological disorders in relation to work. The purpose of this study was to analyze the psychological impact on a portion of the normal population subjected to lockdown. Methods: A questionnaire was distributed in the period between 23 March 2020 and 18 May 2020 (during Italian lockdown) using an online platform. The scales GAD-7, IES-r, PHQ-9 and MANSA were used to investigate the level of anxiety, the presence of post-traumatic stress disorder, the severity of depression and the perceived quality of life, respectively. Results: Four hundred and eight Italian subjects responded. Females and younger people were more affected by anxiety and depression. Post-traumatic stress disorder affected about 40% of the population sample, significantly young people and women, thus attesting to an important psychopathological response. About one-fifth of the sample population recorded an unsatisfactory quality of life. Conclusions: The results highlight the need to set up preventive interventions (primary and secondary), trying to focus on the most fragile group of subjects from a psychosocial point of view, in order to obtain a significant reduction in psychophysical damage in terms of relapses and outcomes.

Purpose: Culture method, Real-Time PCR (qPCR) and Ethidium Monoazide Bromide (EMA) qPCR have been compared in order to detect Legionella pneumophila (Lp) in water samples, to identify a method able to speed up the procedures, detect the “viable but not cultivable” bacteria (VBNC) and exclude dead bacteria using a commercial kit for extraction and amplification and modifying the protocol.Methods: Using these three methods, 34 environmental water samples and a series of samples artificially spiked with alive, dead and VBNC Lp ATCC 33152 were analysed. ISO 11731-2-2004 culture method was applied, whereas a commercial kit was selected for both qPCR and EMA qPCR pretreatment.Results: only 35% (12/34) of the environmental samples were positive in both culture and qPCR methods. With regard to EMA qPCR, results showed the absence of dye toxicity on viable and VBNC strains and an incomplete effectiveness on the dead ones. In both viable and VBNC strains a decrease of bacterial DNA amplification was recorded as a function of sample dilution but not of EMA concentration.Conclusions: Discrepancies between culture method and EMA-qPCR were observed and could be due to different causes as membrane-dye interactions, presence of interfering compounds and the relatively low sensitivity of the kit used.Significance and Impact of the Study: In presence of one or more suspected cases of nosocomial legionellosis, the application of a rapid molecular method able to identify only the viable and VBNC Lp would be useful in order to quickly identify the source of infection and to intervene with sanitation treatments. However, because in our experience EMA pretreatment on filter membrane has not given the expected results, it would be necessary to proceed with other experiments and different dyes.

Background: Microbiological monitoring of surfaces used for food preparation, as required by the Hazard Analysis and Critical Control Points (HACCP) plan, is important in risky conditions as those observed in the kitchens of ships. Limits to introduce a classification of risk levels and methods to adopt in conditions as those occurring in tankers have not been investigated. This paper presents the results of the “Healthy Ship” project on HACCP monitoring of surfaces used in food preparation on Italian flag tankers. Materials and methods: Microbiological monitoring was carried out on 19 tankers between 2013 and 2017. Food handlers were also trained on board ship according to HACCP standards. Contact plates (ISO 18593:2004 compliant) were used to determine the colonies and bacterial charge according to the Wirtanen and Salo’s method. Results: A total of 1074 samples, 108 before the first course, 168 after the first course, 390 during the period of refresher (2015–2016), and 408 after the refresher training, were obtained from the three main kitchen surfaces: the worktop, cutting board, and kitchen sink. A good level of hygiene was observed in 56.9% of all samples, 0.1% were classified as adequate, and the remaining 43% as poor. The highest contamination was observed on the cutting board and kitchen sink and involved the total aerobic count. The only surface with inadequate levels of hygiene was the worktop. A reduction of contaminated samples was noted after training. Conclusions: Our results suggest that continuous training should be provided for personnel responsible for handling foodstuffs on board ships.

The aims of this work were to apply the Environmental Cleanliness and Clutter Scale (ECCS) in order to assess domestic squalor in dwellings of hoarders, prevent sanitary risks, and intervene in solving the problem. The ECCS is a domestic squalor scale, developed as a quantitative descriptive tool, based on ten items and a four-point scale. ECCS was applied in addition to the usual procedure during 40 site inspections in Milan, in two different surveys of dwellings of hoarders (2016 and 2019). A correction only for companion animal hoarders was introduced. In the first investigation, which included animal accumulation, our 20 raters reported six cases of mild squalor and six and eight respectively of moderate and severe squalor. After our correction for animal hoarders’ dwellings, we identified six cases of mild, four of moderate, and ten of severe squalor. In the second part of our assessment involving another 20 home visits, object hoarding only was assessed in order to evaluate the reliability of the ECCS method. We found varying total scores between the operators with different experience on this issue, but the same evaluation of the severity of the squalor in 14/15 (93%) cases therefore resulted in the same type of intervention. The ECCS score made an evaluation of the severity of hoarding/squalor, and supported the Local Health Protection Agency personnel in making decisions about timing and type of intervention.

Aim: To analyze scientific literature on the development and implementation of the Chronic Care Model (CCM) in treating chronic diseases in the Italy context. Besides, to evaluate the effects of the activities carried out by the operators participating in the CCM on clinical care. Background: Italy is the second country globally for longevity, with 21.4% of citizens over 65 and 6.4% over 80. The CCM fits into this context, a care model aimed primarily at patients suffering from chronic diseases, especially in emergencies, as the recent COVID-19 pandemic. Methods: PubMed, Embase, Scopus, Cinahl, and Cochrane Library scientific databases were consulted, and the records selected as relevant by title and abstract by nine independent scholars, and disagreements were resolved through discussion. Finally, the studies included in this review were selected based on the eligibility criteria. Results: Twenty potentially relevant studies were selected, and after applying the eligibility criteria and screening by the Critical Appraisal Skills Program tool, eight included in this review. The studies showed the effectiveness of CCM for managing patients with heart failure in primary care settings and significant improvements in clinical outcomes, the reduction of inappropriate emergency room access for chronic patients, and the improvement of patients’ overall health with diabetes. The CCM organizational model is effective in improving the management of metabolic control and the main cardiovascular risk factors. Furthermore, this modality also allows doctors to dedicate more space to patients in the disease’s acute phase. Conclusion: The CCM, with its fundamental pillars of empowering self-management of care, could represent a valid alternative to health management. The managers of health services, especially territorial ones, could consider the CCM for the improvement of the treatments offered.

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

The childhood overweight and obesity epidemic has become a global emergency in public health and a crucial challenge of the twenty-first century. Nowadays, childhood and adolescent obesity represent a significant public health problem both in developing and developed countries. Globally, above 340 million children and adolescents aged 5–19 years were overweight or obese in 2016. Childhood obesity is a critical burden because it can be associated with a higher possibility of obesity, premature death, and disability in adults, as well as early markers of cardiovascular disease. In Europe, childhood obesity remains a significant health challenge and is distributed disparately across and between countries and population groups. In 2019, over 398,000 children aged 6–9 years were severely obese in Europe. Particularly, Southern European countries such as Greece, Italy, Malta, San Marino, and Spain had one in five children obese in 2018. In Europe, different initiatives and actions have been launched in recent years to fight childhood obesity. However, the progress on combating obesity in children has been slow and inconsistent across the region. In this chapter, we have discussed the prevalence of obesity in children and existing policies to combat childhood obesity in the World Health Organization (WHO) European Region.

Il diabete rappresenta una patologia in costante aumento: familiarità, età e stili di vita rappresentano i principali fattori di rischio per questa malattia e per le complicanze ad essa correlate. Considerando l'importanza del regime alimentare per la prevenzione e il trattamento di questa patologia, scopo del presente studio è stato quello di valutare le conoscenze alimentari di pazienti al primo accesso presso un centro di Diabetologia e di indagare sulla loro eventuale influenza su alcuni parametri ematici. È stato somministrato il questionario di Moynihan. La relazione tra i punteggi ottenuti e le variabili emoglobina glicata, BMI, glicemia a digiuno, è stata analizzata attraverso regressione multipla basata sul metodo dei minimi quadrati ordinari (modello OLS). Il response rate è stato del 73,3%. Il punteggio medio totale ottenuto dal questionario è stato di 23,61 ed è stata osservata una correlazione statisticamente significativa (p0,0473) tra i migliori punteggi del questionario e i valori di Hb1Ac. Questo studio è il primo passo di un'indagine più ampia che verrà condotta nell'ottica di promuovere una formazione del paziente volta a verificare nel tempo le ricadute positive sulle scelte alimentari e sui parametri clinici.

In 2005, a random sample of 200 people were assessed in Camerino, Italy, eight years after an earthquake. Psychological symptom levels were low and only one person had current Post-Traumatic Stress Disorder (PTSD). In 2016 a new earthquake occurred in Camerino. The study aims to assess the impact of the second exposure in the same cohort. A longitudinal study was conducted, 130 participants were re-interviewed between July and December 2017. Psychological symptoms were self-rated on the Brief Symptom Inventory (BSI) and the Global Severity Index (GSI) was analysed. Post-traumatic stress symptoms were self-rated on the Impact of Event Scale-Revised (IES-R). Subjective quality of life (SQOL) was assessed on the Manchester Short Assessment of Quality of Life (MANSA). Mean scores of GSI and IES-R were significantly higher than in 2005 (p

Background and aim: In recent years, self-medication is an increasing public health issue, also among the European young people. Only 48% of people throughout the world use prescribed medications, while the remainder admits that they self-medicate with over the counter drugs or leftover prescribed drugs. Also, the risk of antibiotic resistance, throughout the world, has doubled, due to the recourse to these drugs when they are not called for, or to failure to follow their instructions for use. Methods: A five-part questionnaire, translated into the national languages and validated, was given to Pharmacy students in Italy, Spain, the Czech Republic and Romania obtain anonymous information about their pharmaceutical drugs use. Results: Regarding the use of pharmaceutical drugs, students in Spain and Romania indicated the highest percentages of use. In Italy and Romania, the pharmacist is rarely consulted, while the advice of family members or friends is more frequently requested. In all four countries the problem of taking antibiotics without a medical prescription is significant, and 50% of Romanian students use antibiotics to treat the flu. Another important result is that, in Spain, 38.4% of the respondents admitted to using medicines with alcohol. Conclusions: Considering that the drug information leaflet is not read by 50% of young people interviewed, it would be important for public health entities to instruct the population, especially younger age groups such as secondary school students, about the importance of reading this information carefully. The use of mass media in such a preventive medicine campaign could be effective. (www.actabiomedica.it)

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

To review and assess the quality of the available evidence on the cost-effectiveness of erlotinib in the first-line treatment of advanced non-small cell lung cancer (NSCLC). A systematic review was conducted to identify full-text original economic evaluations of erlotinib in the first-line treatment of advanced NSCLC written in English and published from the year 2000 onwards. Study characteristics and results were recorded and compared. The quality of the studies was assessed by the Quality of Health Economic Studies (QHES) questionnaire. Eleven out of 130 papers were chosen for this review. Comparative regimens consisted of a best supportive care, reverse strategy, bevacizumab, cisplatin plus pemetrexed, carboplatin plus gemcitabine or gefitinib. The methods most used in these studies were modeling and sensitivity analysis and cost-effectiveness analysis. All of the studies evaluated direct costs and used quality-adjusted life-year (QALY) and life-years gained (LYG) as outcome, with 3% and 3.5% discount rate. The studies assigned ICER that ranged from dominant to I$305,510.31/QALY and from I$31,209.55/LYG to I$66,540.20/LYG. Based on the willingness to pay threshold, seven studies concluded that erlotinib was cost-effective, two studies showed that erlotinib was cost-effective on specific patients with certain conditions, and two studies comparing erlotinib with reverse strategy did not find a difference in cost-effectiveness. The high quality of these studies was confirmed using the QHES tool: the mean score was 75.77 out of 100 (SD 9.38). Most of these high-quality studies suggested that erlotinib was cost-effective in the first-line treatment of advanced NSCLC.

This paper outlines the characteristics of scientific leadership and the role of Scientific Associations with their specific activities. The recent activities of the Lombard Academy of Public Health are subsequently described, including the creation, in 2019, of the Academy of young leaders in public health. Comparing to other sectors, scientific leadership dynamics take into consideration different aspects. Besides awards (Nobel Prize or several other) and prestigious affiliations, eventual indicators might be academic roles, fundraising abilities, relevant positions among scientific associations, editors of prestigious journals or editorial series and, more recently, high bibliometric indicators. The peculiar topics of public health encompass interactions with institutions, authorities, politicians, involved in different levels in health policies. Recently, in Italy, the Ministry of Health has identified parameters to be accreditated as a scientific and technical association. The role of SItI (Italian Society of Hygiene), EUPHA, ASPHER, and WFPHA appears relevant in PH, in national and international contexts, with Italian praiseworthy members constantly achieving leading roles. Considering that few training opportunities aimed to improve research and leadership skills are available, Accademia Lombarda di Sanità Pubblica (ALSP) designed the AYLPH (Academy of Young Leaders in Public Health) program. AYLPH program is a 1-year training to shape leadership skills among young professionals. A set of didactic, theoretical and practical methods was offered and evaluated.

Human papillomavirus infection is a cause of the development of invasive cervical cancer. Three types of vaccine are currently available to prevent precancerous/cancerous lesions due to persistent infection, which is supported mainly by 7 different high-risk genotypes. The aim of this pilot study was to acquire preliminary data on type-specific prevalence 10 years after the implementation of the HPV vaccination program in Italy, in order to subsequently plan appropriate observational studies in the Italian population. First-voided urine samples were collected from 393 consenting subjects, both females and males, aged 18–40 years, and HPV DNA was detected by PCR amplification of a 450 bp L1 fragment. All amplified products were genotyped by means of the Restriction Fragment Length Polymorphism (RFLP) method. The female population was divided into three cohorts (“vaccine-eligible”, “pre-screening” and “screening” cohorts) according to the preventive intervention scheduled by age; males were included in the same three cohorts according to their year of birth. The overall prevalence of HPV infection was 19%, being higher in females than in males (22.1% vs. 13.6%, p = 0.03729). In the female population, 10 years after the start of the national immunization program, we observed a reduction in the prevalence of vaccine types and the number of circulating genotypes, especially in the “vaccine-eligible” cohort. The frequency of HPV vaccine types increased with age, particularly in males in the “pre-screening” and “screening” cohorts. Our study highlights the importance of monitoring HPV infection in both genders, to validate the effect of the HPV vaccination program.

Novel composite materials PEn (n = 1–9) have been prepared by an easily up-scalable embedding procedure of three different families of Ag(I) acylpyrazolonato complexes in polyethylene (PE) matrix. In details, PE1–PE3 composites contain polynuclear [Ag(QR)]n complexes, PE4–PE6 contain mononuclear [Ag(QR)(L)m] complexes and PE7–PE9 are loaded with mononuclear [Ag(QR) (PPh3)2] complexes, respectively (where L = 1-methylimidazole or 2-ethylimidazole, m = 1 or 2, and HQR = 1-phenyl-3-methyl-4-RC(═O)-5-pyrazolone, where in detail HQfb, R = −CF2CF2CF3; HQcy, R = −cyclo-C6H11; HQbe, R = −C(H)═C(CH3)2). The PEn composites, prepared by using a 1:1000 w/w silver additive/polyethylene ratio, have been characterized in bulk by IR spectroscopy and TGA analyses, which confirmed that the properties of polyethylene matrix are essentially unchanged. AFM, SEM, and EDX surface techniques show that silver additives form agglomerates with dimensions 10–100 μm on the polyethylene surface, with a slight increment of surface roug...

Mangiferin is a natural xanthone glycoside with therapeutic potential. Herein, its cytotoxic properties were explored in a human cell model of breast adenocarcinoma. The results supported the multi-target nature of mangiferin action, as the inhibition of three enzymatic systems, namely HMG-CoA reductase, the proteasome and plasmin, respectively in charge of regulating cholesterol homeostasis, protein turnover and cell adhesion, was documented for the first time. Globally, mangiferin was able to selectively block breast cancer cell growth by inducing apoptosis and by arresting cell proliferation through a combined action on cholesterol and proteasome pathways, as well as to inhibit plasmin-mediated mechanisms of cell migration.

Background The recent COVID-19 pandemic has accelerated the treatment process through IT/technological supports, useful in the management of chronic patients such as those affected by type 1 Diabetes Mellitus (T1DM). Specific routes for fragile patients such as those with micro-infusers have been created thanks to the application of “Diabetes Technology,” which allows patients to monitor blood glucose quickly and easily. The present pilot study aimed to assess the quality of care provided to patients with micro-infusers in a delicate phase such as a pandemic lockdown. Materials and methods A mixed-methods approach was used. In the first part, with prior written consent, patients with insulin pumps enrolled voluntarily. In the second part, the focus group discussion (FGD) was carried out with the voluntarily enrolled participants. The FGD data were organized and analyzed by the thematic areas. Results The number of patients with afferent insulin pumps at the center was 50 individuals. Among them, 20 patients voluntarily joined the first part of the study by completing the PACIC questionnaire, which gave an average result of 3.34 (min. 2.2 and max. 4.2). In the second part, the application of the focus group technique demonstrated that technology is decisive in the management of diabetic pathology, not only in the emergency phase. Conclusions At the time of public health crises, alternative strategies such as Tele-Nursing or Telemedicine could be crucial for the management of patients with micro-infuser not only in critical moments, such as lockdown, but also in ordinary health management.

Novel silver(I) acylpyrazolonato coordination polymers of formula [Ag(Q(R))](n) (1-3) have been synthesized by interaction of silver nitrate with HQ(R) in methanol in the presence of an equivalent quantity of KOH (in general HQ(R) = 1-phenyl-3-methyl-4-RC(=O)-5-pyrazolone, in detail HQ(fb), R = -CF2CF2CF3; HQ(cy), R = -cyclo-C6H11; HQ(be), R = -C(H)=C(CH3)(2))center dot[Ag(Q(R))](n) react with 2-ethylimidazole (2EtimH), 1-methylimidazole (Meim), and triphenylphosphine (PPh3), affording the mononuclear Ag(Q(fb))(EtimH) (4), Ag(Q(cy))(Meim)(2) (5), Ag(Q(be)) (meim) (6), and Ag(Q(R))(PPh3)(2) (7-9). All complexes have been analytically and spectroscopically characterized, and for some of them the X-ray crystal structure has been resolved. In particular, the single crystal molecular structure determination of Ag(Q(fb))(EtimH) and Ag(Q(be))(PPh3)(2) has cpnfirmed the different coordination modes of the HQ(fb) and HQ(be) acylpyrazolone ligands, the former being bound to the silver(I) ion in a monodentate fashion while the latter in the O-2-chelating mode. Density functional theory computations suggest new insights about metal-ligand interactions and the observed linkage isomerism. While phosphine-containing complexes Ag(Q(R)) (PPh3)(2) (7-9) seem not to be able to efficiently inhibit the growth of Escherichia coli and Staphylococcus aureus, the polynuclear complexes [Ag(Q(R))] (1-3) and the mononuclear Ag(Q(fb))(EtimH) (4), Ag(Q(cy))(Meim)(2) (5), and Ag(Q(be))(Meim) (6) show a high and almost steady in time antibacterial activity, comparable to that of AgNO3. This activity is likely related to the degree of saturation of the silver center and to the presence of different ancillary ligands in the diverse typologies of complexes.

The aim of this study was to evaluate the effect of Lactobacillus rhamnosus IMC 501 and Lactobacillus paracasei IMC 502 on oxidative stress in athletes during a four-week period of intense physical activity. Two groups of twelve subjects each were selected for this analysis. The first group consumed a daily dose of a mixture of the two probiotic strains (1:1 L. rhamnosus IMC 501 and L. paracasei IMC 502; ~10(9) cells/day) for 4 weeks. The second group (control) did not consume any supplements during the 4 weeks. Blood samples collected immediately before and after the supplementation were analyzed, and plasma levels of reactive oxygen metabolites and biological antioxidant potential were determined. Faeces were also collected and analyzed before and at the end of the probiotic supplementation. Antioxidative activity and oxidative stress resistance of the two strains were determined in vitro. Results demonstrated that intense physical activity induced oxidative stress and that probiotic supplementation increased plasma antioxidant levels, thus neutralizing reactive oxygen species. The two strains, L. rhamnosus IMC 501(®) and L. paracasei IMC 502(®), exert strong antioxidant activity. Athletes and all those exposed to oxidative stress may benefit from the ability of these probiotics to increase antioxidant levels and neutralize the effects of reactive oxygen species.

The WFD/60/2000/EC establishes the use of different biological indicators to assess the ecological status of rivers, in addition to chemical, physical and bacteriological parameters. At this purpose, the present study concerning the river Tenna, a central Apennine watercourse (Italy), aimed to analyse and discuss the information given by two biological indices: the Extended Biotic Index or E.B.I. that uses benthic macroinvertebrates, in the version adapted to the Italian rivers (I.B.E.), and the diatom-based Eutrophication and/or Pollution Index (EPI-D). Sampling has been carried out twice, in May (deep water conditions) and October 2006 (low water conditions), in ten stations along the hydrographic basin of the river. Chemical parameters have been determined monthly during a year because they present a higher variability than biotic indicators. The correlations between the biological and abiotic data obtained have been statistically analysed by means of the Spearman's test. The statistical data, in general, showed a direct correlation between the two biotic indices, and an inverse correlation between these and the chemical-physical and bacteriological parameters. Some of the differences of judgement emerging from the application of the two biotic indices showed a complementary response of the diatoms and macroinvertebrates to various environmental stresses. These results suggest the usefulness of an integrated multidisciplinary approach, in order to obtain a more accurate diagnosis of the health status of the watercourses.

The main data on oral health and dental pathologies affecting Alzheimer's disease (AD) patients were reviewed. Oral health declines and dental pathologies increase with progression of AD. Poor oral hygiene, difficulty in wearing dentures, and the inability to self-care, including carrying out oral hygiene procedures are the most probable cause of impaired oral health in AD. Collection of information on oral/dental conditions from AD patients or their caregivers/relatives is often difficult and scientific literature on the topic is sparse . The majority of data on the subject consist in retrospective studies affected to some extent by subjective views of dental professionals involved. Appropriate dental interventions in adult-onset dementia disorders will decrease pain and oral pathology and consequently could contribute to maintain enough oral and nutritional health in these patients. Dental treatment in early stages of the disease are important and should be finalized at producing a stable oral condition. This could improve the quality of life and contribute to decrease worsening of oral situations in the later stages of the disease when dental treatment may be difficult. The problem of awareness of good oral health for keeping quality of life more acceptable in adult-onset dementia disorders is discussed.

2 Abstract: The caves of Acquasanta Terme (central Italy) open at the core of a wide anticline, in the valley of the Tronto River. Cave development is due to the rise of sulfidic thermal water flowing through a thick marine limestone sequence, overlain by thick, low- permeability formations. Some minor caves are developed in the terraced travertines deposited by the thermal water, but the major caves are developed in marine limestone in the small gorge of the Rio Garrafo stream, a tributary of the Tronto River. These caves have a rising pattern, due to the past flow of thermal water toward the surface. The deepening of the Tronto River Valley lowered the regional water table, perching the Rio Garrafo stream ,50 m above the thermal groundwater. At present, surface water sinks through the pre-existing karst passages to reach the thermal water flowing in the lower parts of the caves. Where these waters mix, rapid corrosion of the walls through sulfuric acid speleogenesis occurs. Annual temperature and chemistry monitoring of the cave water showed that freshwater contributes up to 45% of the volume at the water table. Dilution events are associated with falling water temperature, which ranges between 44uC and 32uC. At the main spring, 2 km downstream, groundwater dilution was higher resulting in lower temperatures (32uC-21uC) and salinity. The periods of high freshwater dilution correspond with a lowering of pH in the phreatic water and with the release of H2S and CO2 to the cave atmosphere. In the thermal zones, the concentration of H2S increased from 40 to over 240 ppm, while CO2 increased from 0.44% to 2.7%. These data evidence the influence of sinking surface water on the cave environment and speleogenesis.

The main data on oral health and dental pathologies affecting Alzheimers disease (AD) patients were reviewed. Oral health declines and dental pathologies increase with progression of AD. Poor oral hygiene, difficulty in wearing dentures, and the inability to self-care, including carrying out oral hygiene procedures are the most probable cause of impaired oral health in AD. Collection of information on oral/dental conditions from AD patients or their caregivers/ relatives is often difficult and scientific literature on the topic is sparse . The majority of data on the subject consist in retrospective studies affected to some extent by subjective views of dental professionals involved. Appropriate dental interventions in adult-onset dementia disorders will decrease pain and oral pathology and consequently could contribute to maintain enough oral and nutritional health in these patients. Dental treatment in early stages of the disease are important and should be finalized at producing a stable oral condition. This could improve the quality of life and contribute to decrease worsening of oral situations in the later stages of the disease when dental treatment may be difficult. The problem of awareness of good oral health for keeping quality of life more acceptable in adult-onset dementia disorders is discussed.

New silver(I) acylpyrazolonato derivatives display- ing a mononuclear, polynuclear, or ionic nature, as a function of the ancillary azole ligands used in the synthesis, have been fully characterized by thermal analysis, solution NMR spectroscopy, solid-state IR and NMR spectroscopies, and X- ray diffraction techniques. These derivatives have been em- bedded in polyethylene (PE) matrix, and the antimicrobial activity of the composite materials has been tested against three bacterial strains (E. coli, P. aeruginosa, and S. aureus): Most of the composites show antimicrobial action compara- ble to PE embedded with AgNO3. Tests by contact and re- lease tests for specific migration of silver from PE composites clearly indicate that, at least in the case of the PE, for com- posites containing polynuclear silver(I) additives, the antimi- crobial action is exerted by contact, without release of silver ions. Moreover, PE composites can be re-used several times, displaying the same antimicrobial activity. Membrane perme- abilization studies and induced reactive oxygen species (ROS) generation tests confirm the disorganization of bacterial cell membranes. The cytotoxic effect, evaluated in CD34 + cells by MTT (3-(4,5-dimethylthiazole-2-yl)-2,5-di- phenyltetrazoliumbromide) and CFU (colony forming units) assays, indicates that the PE composites do not induce cytotoxicity in human cells. Studies of ecotoxicity, based on the test of Daphnia magna, confirm tolerability of the PE composites by higher organisms and exclude the release of Ag + ions in sufficient amounts to affect water environment.

The quality of the river Chienti (eastern-central Apennines, Italy) has been evaluated according to the Water Framework Directive 2000/60/EC, taking into consideration both biotic (animal and vegetable) and chemical parameters. In studying the biotic component, two indices were used: the E.B.I, Extended Biotic Index (version adapted to the Italian rivers), based on macroinvertebrates, and the EPI-D, the Eutrophication and/or Pollution Index, based on diatoms. For both macroinvertebrates and diatoms, two samplings were conducted, one in June and the other in October 2003. Instead, according to the Italian Law 152/99 the chemical and bacteriological analyses were conducted monthly for the entire year. The results of biomonitoring and chemical-bacteriological analyses unanimously demonstrated a good ecological situation for the upper section of the Chienti, though the situation tends to worsen as the river continues its descent and undergoes increased anthropogenic pressure. Data obtained were correlated with Spearman's coefficients and principal component analysis. Both statistical calculations showed clear, direct correlation between the two biotic indices and an inverse correlation between these and the chemical and bacteriological parameters. However, a few differences of judgement that emerged among the various indices highlight the importance of using them simultaneously in order to obtain a more accurate diagnosis of the ecological status of the watercourses.

Health and diseases on board ships may depend on water. Interventions to improve the quality of water may bring to significant benefits to health and water stores/supply and should be controlledto protect health. This paper has reviewed the main regulations for the control of water safety and qualityon board ships and presents some practical recommendations for keeping water healthy and safe in passenger and cargo merchant ships.The main international regulations and guidelines on the topic were analysed. Guidelines forWater Quality on Board Merchant Ships Including Passenger Vessels of Health Protection Agency, World Health Organisation (WHO) Guide to Ship Sanitation, WHO Guidelines for Drinking Water Quality, WHO Water Safety Plan and the United States Center for Disease Control and Prevention Vessel Sanitation Program were examined. Recommendations for passenger and, if available, for cargo ships were collected and compared. Recommended questionnaire: A questionnaire summarising the main information to collect for assessingthe enough quality of water for the purposes it should be used on board is proposed. The need of havinga crew member with water assessment duties on board, trained for performing these activities properlyis discussed.Water quality on board ships should be monitored routinely. Monitoring should be directedto chemical and microbiological parameters for identifying possible contamination sources, using specifickits by a designed crew member. More detailed periodic assessments should be under the responsibility ofspecialised personnel/laboratories and should be based on sample collection from all tanks and sites of waterdistribution. It is important to select a properly trained crew member on board for monitoring water quality.

The aim of the study was to evaluate the knowledge and attitudes on food hygiene in seafarers.The study was conducted using an anonymous questionnaire presented to the workers of 7 tankers of an Italian shipping company (Finaval S.p.A.). As a reference, the analysis was extended to office employees of the same firm. Data were divided according to the rank of seafarers to assess possible differences in perceiving the risk.Overall knowledge on food safety concept was not high among seafarers. In general, galley and catering workers group provided a lower percentage of correct answers than other crew members. Foodservices staff revealed little awareness of the risks linked with handling food and their perception of risk of disease transmission through food was low. Answers about risk related to specific food (eggs and fish) showed that knowledge about these problems was less than satisfactory. Moreover, the percentage of 'I don't know' answers was high. These findings suggest that this personnel is aware of the right stepsof health protection in terms of food hygiene, but does not understand why it is necessary.Galley and catering group workers were not the most informed about food hygiene problems.This highlights the need to hire qualified personnel of the food industry on board ships. All those working inthe food service area should be properly trained on food hygiene. Seafarers should be the target of specificinformative campaigns about health risks linked with aliments, possible consequences of it and also oneson how to minimise the exposure to potentially dangerous agents/behaviours during travel/life at sea.

Coupling the rigid spacer 4,4'-bipyrazole (H(2)BPZ), in its anionic or neutral form, to different silver(I) salts allowed isolation of the novel coordination polymers [Ag(2)(BPZ)] (1) and [Ag(H(2)BPZ)(X)] (X = NO(3), 2; ClO(4), 3; BF(4), 4; PF(6), 5; CH(3)SO(3), 6; CF(3)SO(3), 7), which were fully characterized by infrared and emission spectroscopies, thermal analysis, and X-ray powder diffraction. The crystal structure of 1 consists of 2-D layers containing 1-D chains of Ag(I) ions bridged by exo-tetradentate bipyrazolato moieties. The crystal structures of the [Ag(H(2)BPZ)(X)] species 2-7 feature 1-D chains of [Ag(H(2)BPZ)] stoichiometry, along which the metal centers are bridged by exo-bidentate bipyrazolyl spacers. Contacts among adjacent chains are mediated by the counterions through nonbonding interactions involving the Ag(I) ions and the pyrazolyl N-H groups. Thermogravimetric analyses disclosed the good thermal stability of these materials, decomposing in the range 200-300 °C. Under UV irradiation at room temperature, all the species showed a yellow-green emission centered in the range 520-522 nm. When embedded into polyethylene disks, 1, 2, and 4-7 demonstrated their activity as topical antibacterial agents against suspensions of E. coli, P. aeruginosa, and S. aureus: complete reduction of the three bacterial strains was achieved in 24 h, reduction of S. aureus reaching ca. 90% in only 2 h. Biocidal action was expressed also by contact susceptibility tests.

A number of studies suggest that postprandial hyperglycemia produces oxidative stress, leading to complications associated with diabetes. However, hyperglycemia-induced oxidative stress may affect groups of people other than diabetics, such as smokers and athletes with specific diet plans. Based on previous reports that seated breathing meditation reduces hyperglycemia, the present study was designed to determine the effects of diaphragmatic breathing on postprandial plasma glycemia, insulin, oxidative stress, and antioxidant levels in athletes with normal glucose metabolism.Data collected before and after consumption of a 900-calorie breakfast composed of 80% carbohydrates, 10% proteins, and 10% lipids were analyzed. Ten (10) minutes after the meal, 8 subjects spent 40 minutes performing diaphragmatic breathing in a quiet place. The other 8 subjects, representing the control group, spent the same time sitting in an equivalent quiet place reading a magazine.Data from 16 amateur male cyclists age 30.12±4.9 years (±SD) were analyzed. Their mean height and weight were 177.81±5.3 cm and 71.40±5.2 kg, respectively. All subjects underwent a physical examination and were determined to be in good health.Blood samples were collected immediately before the meal as well as 1 hour and 2 hours after the meal, and plasma levels of glucose, insulin, reactive oxygen metabolites, and biologic antioxidant potential were determined. Heart rate was also recorded.Results show that in normal subjects, acute hyperglycemia induces free-radical production while reducing the antioxidant levels (p0.05). Diaphragmatic breathing reduces heart rates (p0.01), increases insulin (p0.05), reduces glycemia (p0.01), and reduces free-radical production as indicated by the higher antioxidants levels (p0.05).Diaphragmatic breathing, likely through the activation of the parasympathetic nervous system, increases insulin, reduces glycemia, and reduces reactive oxygen species production.

Diaphragmatic breathing is relaxing and therapeutic, reduces stress, and is a fundamental procedure of Pranayama Yoga, Zen, transcendental meditation and other meditation practices. Analysis of oxidative stress levels in people who meditate indicated that meditation correlates with lower oxidative stress levels, lower cortisol levels and higher melatonin levels. It is known that cortisol inhibits enzymes responsible for the antioxidant activity of cells and that melatonin is a strong antioxidant; therefore, in this study, we investigated the effects of diaphragmatic breathing on exercise-induced oxidative stress and the putative role of cortisol and melatonin hormones in this stress pathway. We monitored 16 athletes during an exhaustive training session. After the exercise, athletes were divided in two equivalent groups of eight subjects. Subjects of the studied group spent 1 h relaxing performing diaphragmatic breathing and concentrating on their breath in a quiet place. The other eight subjects, representing the control group, spent the same time sitting in an equivalent quite place. Results demonstrate that relaxation induced by diaphragmatic breathing increases the antioxidant defense status in athletes after exhaustive exercise. These effects correlate with the concomitant decrease in cortisol and the increase in melatonin. The consequence is a lower level of oxidative stress, which suggests that an appropriate diaphragmatic breathing could protect athletes from long-term adverse effects of free radicals.

Objective. The aim of this work was to assess the effects of hexavalent chromium [Cr(VI)] on shoe, leather, and hide industry workers, based on the assumption that Cr(VI) can behave as an environmental immunological “stressor.” Methods. The immunological patterns of 84 male subjects were studied in relation to Cr(VI) hematic and urinary levels. Cr(VI) was measured through atomic absorption. Lymphocyte subsets, mitogen-mediated lymphocyte-proliferation, cytokine levels, and natural killer (NK) cytotoxic activity were also assayed. Results. The urinary levels of the total amount of Cr(VI) were significantly higher in a subgroup of exposed subjects (group B) than in the control or in the lower exposed (group A). In group B, Cr(VI) caused a decrease in the density of glucocorticoid receptors (GR) on peripheral blood mononuclear cells (PBMC) and a increase of IL-6. Cr(VI) did not modify NK-mediated cytotoxicity, the plasmatic levels of inflammatory cytokines and related soluble receptors, and prostaglandin levels, while it tended to increase lymphocyte sensitivity to mitogens and the production of immunomodulant cytokines (IFN-γ, IL-4, and IL-2). The experimental addition of Cr(VI) to the in vitro lymphocyte culture determined a significant inhibition of phagocytosis percentage, index, and killing percentage. These effects were neutralized by exogenous IFN-γ. Conclusion. Cr(VI) could represent an environmental immunological stressor whose effects can be evaluated through laboratory surveys. The lymphocyte mitogen-induced proliferation, GR receptor on PBMC, and IL-6 plasma levels may represent a discriminating element between Cr(VI)-induced stress and other kinds of stress. © 2008 Wiley Periodicals, Inc. Environ Toxicol, 2009.

Chemical, chemical-physical and biological procedures were employed to carry out a hydrobiological study of a reservoir in the central Apennines (Italy), designed for the supply of drinking and irrigation water, and tourist recreation facilities. Potentiometric, volumetric, spectrophotometric, and chromatographic techniques were used for the chemical-physical analyses, while the OECD method was adopted to assess the trophic level. The phosphorus and chlorophyll values evidenced the oligomesotrophic condition of the reservoir, with a dominance of the oligotrophic level. The analysis of the net-phytoplankton community showed the prevalence of the oligotrophic level, with a smaller tendency to the mesotrophic one. The dominant species were Dinobryon divergens Imhof and D. sertularia Ehrenb. among the Chrysophyceae, and Ceratium hirundinella (O.F. Mull.) Dujardin and Peridinium cinctum Ehrenb. among the Dinophyceae. However, some potentially dangerous inocula (Planktothrix agardhii (Gom.) Anagnostidis et Komarek and Microcystis aeruginosa (Kutz.) Kutzing were present, suggesting that the reservoir should be kept under accurate observation.

The acylpyrazolone proligands HQR (HQR in general, in detail: HQCy = 1-phenyl-3-methyl-4-carbonylcyclohexyl-5-pyrazolone, 4-C(O)-phenyl, HQPh = 1-phenyl-3-methyl-4-benzoyl-5-pyrazolone, HQC17 = 1-phenyl-3-methyl-4-stearoyl-5-pyrazolone, HQC17,Ph = 1-phenyl-3-stearyl-4-benzoyl-5-pyrazolone) were synthesized and reacted with (arene)Ru(II) acceptors affording complexes [(arene)Ru(QR)Cl] (arene = cymene (cym) or hexamethylbenzene (hmb)). The complexes were characterized by elemental analyses, thermogravimetric analysis-Differntial Thermal Analysis (TGA-DTA), IR spectroscopy, ESI-MS and 1H, and 13C NMR spectroscopy. Complexes [(arene)Ru(QR)Cl] where QR = QC17 and QC17,Ph, due to the long aliphatic chain in the ligand, afford nanometric dispersions in methanol via self-assembly into micellar aggregates of dimensions 50&ndash, 200 nm. The antibacterial activity of the complexes was established against Escherichia coli and Staphylococcus aureus, those containing the ligands with a long aliphatic chain being the most effective. The complexes were immobilized on polystyrene by a simple procedure, and the resulting composite materials showed to be very effective against E. coli and S. aureus.