Scielo RSS <![CDATA[Annali dell'Istituto Superiore di Sanità]]> vol. 50 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>The fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy): health impact and clues for environmental remediation</b>]]> Subsequently to the observation of a localized excess of mortality from malignant pleural neoplasms in the town of Biancavilla (Sicily), previously unknown amphibolic fibres with fluoro-edenitic composition were detected as naturally occurring soil contaminants. Less then two years after the initial report, ISS provided a set of public health recommendations that were complied by regional and local institutions. The recognition of Biancavilla as a National Priority Contaminated Site in 2002 opened the way to clean-up interventions. An up-dating of epidemiological studies, exposure assessment investigations and in vivo and in vitro mechanistic studies on fluoro-edenite fibres is provided in this issue. Scientific evidence can provide a sound foundation to public health action and environmental remediation. Finally, it is now necessary to properly tune the response of the health system to the community needs in terms of diagnostic procedures and medical treatment. <![CDATA[<b>Incidence of pleural mesothelioma in a community exposed to fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy)</b>]]> INTRODUCTION. Amphibolic fibres with fluoro-edenitic composition characterize Biancavilla soil, including the major quarry from which building materials have been extensively extracted. These fibres induce mesothelioma in experimental animals and their in vitro biological action is similar to that of crocidolite. MATERIALS AND METHODS. Malignant mesothelioma case series and incidence were examined to evaluate the disease burden on Biancavilla inhabitants. RESULTS. The incidence of pleural mesothelioma in Biancavilla is steadily higher than in the Sicilian Region, risk estimates are more elevated in women than in men, the most affected age class is constituted by subjects aged less than 50. DISCUSSION AND CONCLUSIONS. Environmental exposure to fibres with fluoro-edenitic composition appears to be causally related to the elevated mesothelioma occurrence in Biancavilla. In this frame, environmental clean-up is the main goal to be pursued in public health terms. A contribution of scientific research to public health decision making with respect to priority setting for environmental clean-up can derive from some further selected epidemiological investigations. <![CDATA[<b>Environmental concentrations of fibers with fluoro-edenitic composition and population exposure in Biancavilla (Sicily, Italy)</b>]]> INTRODUCTION. The town of Biancavilla (Sicily) was included in the National Priorities List of Contaminated Sites due to environmental dispersion of amphibole fibers owing to the extraction of materials from a local quarry. The present report summarizes results from several, hitherto unpublished, environmental surveys carried out in the area, as well as from published analyses of the chemistry and composition of fibers. METHODS. Data included here comprises environmental fiber concentrations by scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) analysis in soil, indoor and outdoor air, personal monitoring, as well as a chemical characterization of the fibers. The full chemical structure and spectroscopic characterization of fibers were obtained through a multi-analytical approach: SEM-EDS, X-ray powder diffraction (XRPD), as well as Mössbauer (MS) and Fourier transform infrared (FT-IR) spectroscopies. RESULTS. Data analyzed provided a spatial and temporal picture of fiber concentrations in Biancavilla, and a qualitative assessment of population exposure. Results suggest that until 2000, the population had been exposed to high levels of amphibole fibers. Mitigation measures adopted since 2001, gradually reduced exposure levels to about 0.10.4 ff/l. Previous studies on fibrous amphiboles from Biancavilla reported considerable chemical variability. Differences in composition, especially concerning the presence of Si, Ca, Fe, and Na, were found both within and between samples. Compared to the previously investigated prismatic fluoro-edenite, these fibrous fluorine amphiboles consistently showed higher average values of Si and Fe content, whereas Ca was significantly lower, which we consider a distinctive characteristic of the fluorine fibrous variety. CONCLUSIONS. The population of Biancavilla had been highly exposed to a suite of fibrous amphiboles for over 50 years. Dust mitigation measures have gradually reduced exposure, but continuous environmental follow-up is necessary in order to monitor exposure levels and prevent adverse health effects for future generations. <![CDATA[<b>Health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy): mortality and hospitalization from current data</b>]]> INTRODUCTION. The objective of this chapter is to study the health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy), in terms of mortality and hospitalization. The diseases which international scientific literature indicates as associated with asbestos exposure were taken into consideration: mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis testis, malignant neoplasm of larynx, malignant neoplasm of trachea, bronchus and lung, malignant neoplasm of ovary, pneumoconiosis; moreover, in order to describe the health profile of the study population, large groups of diseases were taken into consideration. MATERIAL AND METHODS. Current data (available in the Data Bases of the Unit of Statistics of ISS) regarding mortality and hospitalization were analyzed. Standardized Mortality Ratios, Standardized Hospitalization Ratios and Age-standardized Death Rates were calculated. The demographic background of the population residing in Biancavilla was also outlined. Conclusions. Our findings support the etiologic role of fibres with fluoro-edenitic composition in the occurrence of the above mentioned diseases, already observed in other studies. <![CDATA[<b>Mode of action of fibrous amphiboles: the case of Biancavilla (Sicily, Italy)</b>]]> BACKGROUND. The inhalation of fibrous amphiboles can result in pulmonary fibrosis, lung cancer and mesothelioma. Although these fibres have the same disease-causing potential, their different morphologies and chemical composition can determine different biological activities. An unusual cluster of mesothelioma was evidenced in Biancavilla (Sicily) where no inhabitant had been significantly exposed to asbestos. OBJECTIVE. We herein discuss the mechanism of action of amphiboles, focusing on the fibres identified in the study area. RESULTS. Human lung carcinoma cells have been exposed to two different materials: prismatic fluoro-edenite and fibres with fluoro-edenitic composition. Only in the second case, they exhibit features typical of transformed cells, such as multinucleation, prosurvival activity and pro-inflammatory cytokine release. Accordingly, in vivo studies demonstrated that the fibrous sample only could induce a mesotheliomatogenic effect. Conclusions. Fibres with fluoro-edenitic composition behave similarly to the asbestos crocidolite, whose connection with inflammation and lung cancer is well established. <![CDATA[<b>Use of thermographic imaging in clinical diagnosis of small animal: preliminary notes</b>]]> INTRODUCTION. The authors, after a description of the physics of infrared thermographic technique (IRT), analyze the reading of images and the main applications in the veterinary field, compared to the existing literature on the subject and to their experimental researches. IRT lends itself to countless applications in biology, thanks to its characteristics of versatility, lack of invasiveness and high sensitivity. Probably the major limitation to its application in the animal lies in the ease of use and in its extreme sensitivity. MATERIALS AND METHODS. From September 2009 to October 2010, the experimental investigation with the thermo camera took into consideration 110 animals (92 dogs and 18 cats), without any selection criteria. All patients were brought to the Faculty of Veterinary Medicine in Milan University by the owner, to be examined by a specialist, or to undergo one of the following diagnostic procedures: X-rays, computed tomography, or ultrasound examinations; finally some patients were brought in for surgical procedures. With the consent of the owner, 1 to 10 thermographic images were recorded from each clinical case. Results. In this first experimental investigation, thermography has shown a high sensitivity (100%), but a low specificity (44%). This figure excludes the use of thermal imaging technology to replace other imaging techniques such as radiography, computed tomography and magnetic resonance imaging. Furthermore, it does not show any ability to recognize the etiology of the disease, but only the thermal alteration, and this is restricting its use. However, this experimental study has demonstrated that thermography can be used in veterinary medicine, and specifically in dogs and cats. It is hoped that in the field of targeted diseases this technique will become an important tool for diagnostic purposes by using working protocols validated and repeatable. <![CDATA[<b>Potential application of thermography (IRT) in animal production and for animal welfare. A case report of working dogs</b>]]> INTRODUCTION. The authors describe the thermography technique in animal production and in veterinary medicine applications. The thermographic technique lends itself to countless applications in biology, thanks to its characteristics of versatility, lack of invasiveness and high sensitivity. Probably the major limitation to most important aspects for its application in the animal lies in the ease of use and in its extreme sensitivity. Materials and methods. This review provides an overview of the possible applications of the technique of thermo visual inspection, but it is clear that every phenomenon connected to temperature variations can be identified with this technique. Then the operator has to identify the best experimental context to obtain as much information as possible, concerning the physiopathological problems considered. Furthermore, we reported an experimental study about the thermography (IRT) as a noninvasive technique to assess the state of wellbeing in working dogs. RESULTS. The first results showed the relationship between superficial temperatures and scores obtained by the animal during the behavioral test. This result suggests an interesting application of infrared thermography (IRT) to measure the state of wellbeing of animals in a noninvasive way. <![CDATA[<b>How are the temporary workers? Quality of life and burn-out in a call center temporary employment in Italy: a pilot observational study</b>]]> OBJECTIVES. The aim of this study was to quantify the level of health related quality of life and burnout in a call centers sample of precarious workers. METHODS. An observational study was carried out in Italy. A self-reported anonymous questionnaire was administered to temporary workers in order to estimate burn-out and quality of life levels. RESULTS. 227 questionnaires were collected. 78% of the sample was female and the mean age was 35.48 years (SD = 9.91). Among the participants, 40% were smokers, 42% regularly drinkers, 65% changed the body weight (more than 5 kg, in 1 year). The mental component score (MCS) was significantly better in subject that have a regularly life style, for example in those no change their body weight (p = 0.001), sleep more than 7 hours (p = 0.018) and followed a diet (p = 0.035). The DP (depersonalization) is significant higher in former smokers (p = 0.031), in underweight subjects (p = 0.025) and in the group that have a precarious employment of over 2 years (p = 0.013). CONCLUSIONS. This investigation shows that in this particular category of atypical workers depressive symptoms and quality of life were lower than the general population. It is important to underline that the interpretation of the results is limited partly by the observational character of the study. <![CDATA[<b>Some comments on the new regulations governing Ethics Committees in Italy</b>]]> Italy has recently introduced regulations that profoundly change the arrangement of ethics committees. Specifically, their numbers have been reduced from more than 200 to a few dozen.The decree defining the criteria for their composition and functioning includes regulations intended to improve efficiency and efficacy. The present article provides a brief overview of the new provisions and identifies some critical aspects. <![CDATA[<b>Communication with the public in the health-care system: a descriptive study of the use of social media in Local Health Authorities and public hospitals in Italy</b>]]> INTRODUCTION. In 2010 the Italian Ministry of Health set out recommendations for the use of social technology and Web 2.0, inviting organisations within the Italian national health service (Servizio Sanitario Nazionale, SSN) to equip themselves with instruments. Objectives. 1. to ascertain how many local health authorities (Aziende Sanitarie Locali, ASL) and public hospitals have a presence on the most widely used social media websites in Italy: Facebook, Twitter and YouTube; 2. to find out how well the Facebook, Twitter and YouTube pages of ASLs and public hospitals are known among the general population; 3. to find out how ASLs and public hospitals engage with the general public on social media sites. MATERIALS AND METHODS. The websites of all ASLs and public hospitals across the country were visited to look for the icons of the social media sites under examination. The data considered were publicly available upon access. RESULTS. A total of 245 websites were analysed. 7.34% ASLs and hospitals had social media accounts. 8 organisations had an account on all three of the social media sites considered in the study. CONCLUSIONS. The results show a low presence of ASLs and hospitals on social media. Other studies are needed in this field. <![CDATA[<b>Cross-sectional seroprevalence of antibodies against 6, 11, 16 and 18 human papilloma virus (HPV) types among teenagers and young women in Italy</b>]]> BACKGROUND. Little is known about human papilloma virus (HPV) seroprevalence in the healthy Italian population. The aim of the study was to assess seroprevalence of antibodies against HPV 6, 11, 16 and 18 among girls and young women in Italy. METHODS. Sera were tested with a commercially available ELISA assay detecting specific IgG. Results. Seroprevalence was 54.1% in girls between 11 to 18 years old and 8.2% in over 18s. Overall seropositivity in birth cohorts invited for free immunization reached 72.8% and was significantly higher than in other age subgroups. The highest levels of antibodies were detected in girls of 12 years old that should have just completed the vaccination schedule. Conclusion. A standardized seroepidemiological survey on HPV represents a useful tool for identifying groups at risk in which immunization is recommended, monitoring of vaccinated women, assessing whether booster vaccination is required. <![CDATA[<b>The European Research Infrastructures of the ESFRI Roadmap in Biological and Medical Sciences: status and perspectives</b>]]> INTRODUCTION. Since 2002, the European Strategy Forum on Research Infrastructures identified the needs for Research Infrastructures (RIs) in Europe in priority fields of scientific research and drafted a strategic document, the ESFRI Roadmap, defining the specific RIs essential to foster European research and economy. The Biological and Medical Sciences RIs (BMS RIs) were developed thanks to the active participation of many institutions in different European member states associated to address the emerging needs in biomedicine and, among these, the Italian National Institute of Health (ISS), in virtue of its role in public health and research, has been specifically involved in the national development and implementation of three RIs: the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI), the European Advanced Translational Research Infrastructure in Medicine (EATRIS) and the European Clinical Research Infrastructures Network (ECRIN). AIM. This article outlines the design and development of these RIs up to the recent achievement of the ERIC status, their importance in the Horizon 2020 programme and their societal and economic potential impact, with special attention to their development and significance in Italy. CONCLUSIONS. The ISS plays a unique role in fostering a coordinated participation of excellence Italian institutes/facilities to different European biomedical RIs, thus contributing to health innovation, healthcare optimization, and healthcare cost containment. <![CDATA[<b>Cancer incidence in Italian contaminated sites</b>]]> INTRODUCTION. The incidence of cancer among residents in sites contaminated by pollutants with a possible health impact is not adequately studied. In Italy, SENTIERI Project (Epidemiological study of residents in National Priority Contaminated Sites, NPCSs) was implemented to study major health outcomes for residents in 44 NPCSs. METHODS. The Italian Association of Cancer Registries (AIRTUM) records cancer incidence in 23 NPCSs. For each NPCSs, the incidence of all malignant cancers combined and 35 cancer sites (coded according to ICD-10), was analysed (1996-2005). The observed cases were compared to the expected based on age (5-year period,18 classes), gender, calendar period (1996-2000; 2001-2005), geographical area (North-Centre and Centre-South) and cancer sites specific rates. Standardized Incidence Ratios (SIR) with 90% Confidence Intervals were computed. RESULTS. In both genders an excess was observed for overall cancer incidence (9% in men and 7% in women) as well as for specific cancer sites (colon and rectum, liver, gallbladder, pancreas, lung, skin melanoma, bladder and Non Hodgkin lymphoma). Deficits were observed for gastric cancer in both genders, chronic lymphoid leukemia (men), malignant thyroid neoplasms, corpus uteri and connective and soft-tissue tumours and sarcomas (women). DISCUSSION. This report is, to our knowledge, the first one on cancer risk of residents in NPCSs. The study, although not aiming to estimate the cancer burden attributable to the environment as compared to occupation or life-style, supports the credibility of an etiologic role of environmental exposures in contaminated sites. Ongoing analyses focus on the interpretation of risk factors for excesses of specific cancer types overall and in specific NPCSs in relation to the presence of carcinogenic pollutants. <![CDATA[<b>Classification and management of animal anthrax outbreaks based on the source of infection</b>]]> Anthrax is a non-contagious infectious disease; it primarily affects herbivores, but all mammals, including humans, can be affected. Humans may contract anthrax directly or indirectly from infected animals. Veterinary surveillance systems, providing information about animal and human cases, should increase the efficacy of the animal anthrax management in order to protect population. Any aspect of the disease should be carefully monitored to implement effective prevention and control strategies. In this paper we propose a new, detailed classification of anthrax outbreaks, based on the source of the infection and the risk level for humans. We describe three different types of animal outbreaks and suggest the most effective procedures for their management and prevention.