Health inequalities and inadequate housing. The case of exceptions to hygienic requirements for dwellings in Italy

Negli ultimi decenni, i requisiti igienici italiani per le abitazioni sono stati modificati da più deroghe. Scopo del presente lavoro è analizzare le deroghe introdotte a livello nazionale, regionale e locale. Le deroghe più importanti riguardavano l'uso abitativo di seminterrati e sotterranei e il restauro di edifici. Il documento descrive anche le norme in materia di indennità per violazione degli abusi nell'edilizia. Gli autori sottolineano la necessità di maggiore uniformità e chiarezza nella determinazione degli standard sanitari delle abitazioni, nonché di una semplificazione della legislazione esistente.In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation

How walkable is the city? Application of the Walking Suitability Index of the Territory (T-WSI) to the city of Rieti (Lazio Region, Central Italy) // Quanto è pedonale la città? Applicazione dell’indice di idoneità territoriale al cammino (T-WSI) alla città di Rieti

È stato applicato un metodo atto a valutare la praticabilità pedonale di un quartiere urbano, basata sull’osservazione diretta. Lo strumento, denominato indice di idoneità territoriale al cammino (T-WSI), misura la praticabilità pedonale delle strade di un quartiere. Comprende 12 indicatori ponderati, suddivisi in 4 categorie: viabilità, sicurezza, urbanità, piacevolezza. Ciascun indicatore può appartenere a una di queste categorie, con relativo punteggio: eccellente (100), buono (75), scarso (35), cattivo (0). Nello studio il T-WSI è applicato a 12/15 quartieri di Rieti, una piccola città (47.912 abitanti) del Lazio. I punteggi medi di T-WSI rilevati nei quartieri variano tra 24,2 e 61,2. In media, la sicurezza e l’urbanità sono le categorie che raggiungono punteggi molto bassi. Il T-WSI ha permesso di mettere in evidenza le criticità delle strade che potrebbero ostacolare la praticabilità pedonale. Pertanto potrebbe essere una buona base per supportare le amministrazioni pubbliche nel processo decisionale relativo alla politica di sviluppo locale per favorire l’attività fisica.A method to evaluate the walkability of an urban neighbourhood based on direct observation has been applied. This tool, called the Walking Suitability Index of the Territory (T-WSI), measures the walkability of every street of an environmental area. It includes 12 weighted indicators, each divided into 4 categories: practicability, safety, urbanity, and pleasantness. Each indicator can obtain one of the following values: excellent (100), good (75), poor (35), bad (0). T-WSI is applied to 12/15 urban neighbourhoods of Rieti, a small city (47,912 inhabitants) located in Lazio Region (Central Italy). The average of T-WSI scores range from 24.2 to 61.2 among urban neighbourhoods. On average, safety and urbanity are the categories which reach very low scores. The T-WSI allows to underline several street criticalities that could hinder walkability and could be a good basis to support public decision-makers about health policy and local development aimed at encouraging physical activity

Influence of 3d-printing parameters on the mechanical properties of 17-4PH stainless steel produced through Selective Laser Melting

Additive Manufacturing (AM) is a technological process in which elements are fruitfully built up adding materials layer by layer. AM had a massive development in recent times, thanks to its intrinsic advantages, especially if compared with conventional processes (i.e. subtractive manufacturing methods), in terms of free-form design, high customization of products, a significant reduction in raw materials consumption, low request of postprocessing and heat treatments, use of pure materials and reduced time for final products to be marketed. In order to give an innovative contribution to the knowledge in the field of metal AM materials, this paper reports the main outcomes of an experimental campaign focused on the influence of several specific printing parameters on the mechanical features of the 17-4PH stainless steel, which is one of the most used metal for the Selective Laser Melting (SLM) technology. The influence of different printing directions and sample inclinations on the material mechanical behavior is assessed, with the aim of considering an innovative use in the field of structural engineering. Moreover, the effects due to scanning and recoating times are studied. In addition, the consequences of heat treatment (annealing) on both the residual stresses and the amount of residual austenite are appraised

Italian guidelines for management and treatment of hyperbilirubinaemia of newborn infants ≥ 35 weeks' gestational age

Hyperbilirubinaemia is one of the most frequent problems in otherwise healthy newborn infants. Early discharge of the healthy newborn infants, particularly those in whom breastfeeding is not fully established, may be associated with delayed diagnosis of significant hyperbilirubinaemia that has the potential for causing severe neurological impairments. We present the shared Italian guidelines for management and treatment of jaundice established by the Task Force on Hyperbilirubinaemia of the Italian Society of Neonatology.The overall aim of the present guidelines is to provide an useful tool for neonatologists and family paediatricians for managing hyperbilirubinaemia

Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica [Hygienic and sanitary aspects in urban planning: contradiction in national and local urban legislation regarding public health]

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection

Measuring transcutaneous bilirubin: a comparative analysis of three devices on a multiracial population

BACKGROUND: Hyperbilirubinemia can lead to potentially irreversible bilirubin-induced neurotoxicity. Transcutaneous bilirubin (TcB) determination has become a valuable aid in non invasive screening of neonatal jaundice. The aim of this study is to compare the performance of three most widespread transcutaneous bilirubinometers on a multiracial population of term and late pre-term neonates. METHODS: Bilirubin concentration was determined using traditional photometric determination and transcutaneously with Bilicheck, BiliMed and JM-103, in random order. Total serum bilirubin (TSB) was determined over a wide concentration range (15,8–0,7 mg/dl) with a mean of 9,5 mg/dl. Related TcB values using Bilicheck (TcB-BC), BiliMed (TcB-BM), and JM-103 (TcB-JM) are reported in Table 1. RESULTS: A multiracial population of 289 neonates was enrolled with a gestational age ranging from 35 to 41 weeks; birth weight ranging from 1800to 4350 grams; hours of life ranging from 4 to 424. In the total study population correlation analysis using Pearson coefficients showed good results for Bilicheck (r = 0.86) and JM-103 (r = 0.85) but poor for BiliMed (r = 0,70). Similar results were found for the non-Caucasian neonates subgroup. Bilicheck and JM-103 had a greater area under the curve than BiliMed when TSB =14 mg/dl was chosen as a threshold value both for the total study population and the non-Caucasian subgroup. CONCLUSIONS: Bilicheck and JM-103, but not BiliMed, are equally reliable screening tools for hyperbilirubinemia in our multiracial neonatal population

Neonatal isolated coronary artery dilatation: to treat (and how) or not to treat, that’s the question!

We describe the clinical presentation of a newborn, who received diagnosis of diffuse right coronary artery dilatation and a high origin of the same vessel, in the absence of intrauterine hypoxia or other identifiable causes of coronary artery ectasia. The relevance of the case is in the complex aetiology of congenital heart malformation. In addition, we also highlight the difficult therapeutic management of these patients, in lack of guidelines for newborn population

Orexin-A Prevents Lipopolysaccharide-Induced Neuroinflammation at the Level of the Intestinal Barrier

In states of intestinal dysbiosis, a perturbation of the normal microbiome composition, the intestinal epithelial barrier (IEB) permeability is increased as a result of the disruption of the epithelial tight junction protein network, in which occludin is mostly affected. The loss of IEB integrity promotes endotoxemia, that is, bacterial lipopolysaccharide (LPS) translocation from the intestinal lumen to the circulatory system. This condition induces an enhancement of pro-inflammatory cytokines, which leads to neuroinflammation through the gut-brain axis. Orexin-A (OX-A), a neuropeptide implicated in many physiological functions and produced mainly in the brain lateral hypothalamic area, is expressed also in several peripheral tissues. Orexin-producing neurons have been found in the myenteric plexus to project to orexin receptor 1 (OX-1R)-expressing enterocytes of the intestinal villi. In the present study we investigated the protective role of OX-A against LPS-induced increase of IEB permeability and microglia activation in both an in vivo and in vitro model of the gut-brain axis. By exploiting biochemical, immunocytochemical, immunohistochemical, and functional approaches, we demonstrate that OX-A preserves the IEB and occludin expression, thus preventing endotoxemia and subsequent neuroinflammation

Whole Lung Irradiation after High-Dose Busulfan/Melphalan in Ewing Sarcoma with Lung Metastases: An Italian Sarcoma Group and Associazione Italiana Ematologia Oncologia Pediatrica Joint Study

SIMPLE SUMMARY: The lung is the most frequent site of metastasis in Ewing sarcoma, the second most common bone cancer affecting children, adolescents and young adults. The five-year overall survival of patients with isolated lung metastasis is approximately 50% after multimodal treatments including chemotherapy, surgery and radiotherapy. This retrospective study aimed to investigate the feasibility and the predictors of survival in 68 Ewing sarcoma patients with lung metastases who received high-dose chemotherapy with busulfan and melphalan, followed by reduced dose whole-lung irradiation, as part of two prospective and consecutive treatment protocols. This combined treatment strategy is feasible and might contribute to the disease control in lung metastatic Ewing sarcoma with responsive disease. Furthermore, the results of this study provide support to explore the treatment stratification for lung metastatic Ewing sarcoma based on the histological response of the primary tumor. ABSTRACT: Purpose: To analyze toxicity and outcome predictors in Ewing sarcoma patients with lung metastases treated with busulfan and melphalan (BU-MEL) followed by whole-lung irradiation (WLI). Methods: This retrospective study included 68 lung metastatic Ewing Sarcoma patients who underwent WLI after BU-MEL with autologous stem cell transplantation, as part of two prospective and consecutive treatment protocols. WLI 12 Gy for <14 years old and 15 Gy for ≥14 years old patients were applied at least eight weeks after BU-MEL. Toxicity, overall survival (OS), event-free survival (EFS) and pulmonary relapse-free survival (PRFS) were estimated and analyzed. Results: After WLI, grade 1–2 and grade 3 clinical toxicity was reported in 16.2% and 5.9% patients, respectively. The five-year OS, EFS and PRFS with 95% confidence interval (CI) were 69.8% (57.1–79.3), 61.2% (48.4–71.7) and 70.5% (56.3–80.8), respectively. Patients with good histological necrosis of the primary tumor after neoadjuvant chemotherapy showed a significant decreased risk of pulmonary relapse or death compared to patients with poor histological necrosis. Conclusions: WLI at recommended doses and time interval after BU-MEL is feasible and might contribute to the disease control in Ewing sarcoma with lung metastases and responsive disease. Further studies are needed to explore the treatment stratification based on the histological response of the primary tumor