Impact of communicative and informative strategies on influenza vaccination adherence and absenteeism from work of health care professionals working at the university hospital of palermo, Italy: A quasi-experimental field trial on twelve influenza seasons

Every year, about 20% of health care workers (HCWs) acquire influenza, continuing to work and encouraging virus spreading. Influenza vaccination coverage rates and absenteeism from work among HCWs of the University Hospital (UH) of Palermo were analyzed before and after the implementation of several initiatives in order to increase HCWs’ awareness about influenza vaccination. Vaccines administration within hospital units, dedicated web pages on social media and on the UH of Palermo institutional web site, and mandatory compilation of a dissent form for those HCWs who refused vaccination were carried out during the last four influenza seasons. After the introduction of these strategies, influenza vaccination coverage went up from 5.2% (2014/2015 season) to 37.2% (2018/2019 season) (p<0.001), and mean age of vaccinated HCWs significantly decreased from 48.1 years (95% CI: 45.7–50.5) to 35.9 years (95% CI: 35.0–36.8). A reduction of working days lost due to acute sickness among HCWs of the UH of Palermo was observed. Fear of adverse reactions and not considering themselves as a high-risk group for contracting influenza were the main reasons reported by HCWs that refused vaccination. Strategies undertaken at the UH of Palermo allowed a significant increase in vaccination adherence and a significant reduction of absenteeism from work

A simplified approach to evaluate the lung cancer risk related to airborne particles emitted by indoor sources

Indoor particle sources are recognized as detrimental for indoor air quality. Indeed, the high emission rates of the different aerosol metrics and carcinogenic compounds can lead to a high lung cancer risk for people exposed in indoor environments. A-priori lung cancer risk assessments could be very helpful to identify critical environments and sources, but they need complex and site-specific experimental analyses in order to measure particle concentration levels and chemical compositions. Thus, simplified assessments for lung cancer risks are highly welcomed. In the present paper, a simplified approach aiming at evaluating the lung cancer risk related to airborne particles emitted is proposed and applied to different indoor sources. The approach is based on the combination of (i) a recently developed approach to estimate the “emitted risk” of indoor particle sources and (ii) an easy-to-use mass balance equation to calculate the indoor “risk concentration” due to such emitted risk in an indoor environment. Simulations considering different scenarios in terms of previously characterized sources, ventilation rates, and exposure mitigation solutions were performed. The results show that the “risk emitted” is mostly related to sub-micron particles (with respect to super-micron ones) and that the lung cancer risk received by people in indoor environments can be extremely high for different sources, e.g. cooking activities. The ventilation rates of residential environments are not able to appreciably reduce the risk, whereas extraction hoods and air purifiers can significantly decrease it.</p

Effectiveness of eco-feedback in improving the indoor air quality in residential buildings: Mitigation of the exposure to airborne particles

Indoor air quality, a major concern for human health, is strongly influenced by occupants' behavior but people are not aware about how their everyday behavior affects their exposure to pollutants. In the present paper we tried to cope with the gap of knowledge between lack of awareness and the understanding of how occupants’ behaviors affect the environment. To this end we performed an evaluation of the IAQ awareness of 100 families through questionnaire surveys and an investigation of an “eco-feedback” strategy based on awareness-raising campaigns. In particular, information and experimental campaigns were conducted in 10 homes allowing the evaluation of its effectiveness in the short-term. Results showed that the occupants are not properly aware of the IAQ in their homes and of their exposure to airborne particles including the possible contribution of indoor sources. Anyway, the eco-feedback strategy adopted resulted successful both in terms of promoting behavioral changes of the occupants and reducing the concentration levels while airborne particle emitting sources (i.e. cooking) were in operation. Indeed, the exposure to airborne particles while cooking measured after the information campaign resulted lower than the baseline exposure with median relative reductions of 47% and 59% for PM10 and particle number concentration, respectively. The outcomes of the study could be of great interest for scientists involved in designing eco-feedback campaigns and indoor airborne particle monitoring since, for the first time, the potential effect of an eco-feedback strategy on indoor air quality was shown.</p

Sub-micron particle number emission from residential heating systems: A comparison between conventional and condensing boilers fueled by natural gas and liquid petroleum gas, and pellet stoves

Pollutant emissions from residential heating systems represent a main concern in terms of outdoor air quality. Differently from other pollutants, sub-micron particle emission from heating systems has not yet been exhaustively characterized by the scientific literature, with limited data available, in particular, for gas-fueled boilers. In the present paper, an experimental campaign to measure the sub-micron particle number concentrations and distributions at the stack of different automatically-fed small-scale heating systems (conventional and condensing boilers fueled by natural gas and liquid petroleum gas, and pellet stoves) was performed. Based on the measured concentrations, corresponding emission rates and emission factors were also estimated. The results of the experimental campaign revealed that the highest concentrations were measured for pellet stoves (median value >107 part. m−3), whereas conventional (about 1 × 106 part. m−3) and condensing boilers (6 part. m−3) presented much lower concentrations. No effect of the fuel (natural gas, liquid petroleum gas) on the total concentration measured at the stack of boilers was recognized, whereas a smaller distribution mode (at 10 nm) was measured for gas-fired boilers. Because of the particle concentration values, the highest particle emission rates and factors were the pellet stove ones (median values of 2.1 × 1015 part. h−1 and 8.4 × 1013 part. kWh−1, respectively), whereas emission rates for conventional and condensing boilers were about 5 × 1013 part. h−1 and 2 × 1013 part. h−1, respectively. The estimated emission factors were also adopted to perform a simplified evaluation of the relative contributions of the investigated automatically-fed small-scale heating systems in terms of particle number on a national scale (Italy): we obtained that the pellet stove contribution is the main one as it accounts for 87% of total emissions of particle number for heating purpose.</p

Performance measurement in response to the Tallinn Charter: experiences from the decentralized Italian framework.

BACKGROUND: The Italian National Health Plan 2011-2013 expressly recognizes the Tallinn Charter as the most solid international reference for the definition of National priorities. At sub-national level, many regions apply performance monitoring as an integral part of quality improvement policies. METHODS: A national workshop allowed reviewing the state of the art of performance monitoring in Italian regions and Autonomous Provinces in relation to the Tallinn Charter. Participants included representatives of regions and Autonomous Provinces, the National Agency of Regional Health Services, the Italian Ministry of Health and WHO Europe. Six specific questions were used to facilitate brainstorming and to collect updated information. RESULTS: A total of eighteen regions out of twenty-one participated in the meeting. Ten regions were found to use different systems for performance evaluation: two adopting a unique balanced scorecard, two applying different systems for different levels of governance, six using a structured multidimensional system. Different organizational and operational capacities affect the ability to uptake information for policy making. CONCLUSIONS: Italian regions are striving to respond to the collective need of performance improvement, through an increased production of systems of indicators and achievement reports that still need to be made comparable across the country. The Tallinn Charter may provide a common platform to improve and share best practices in performance monitoring. The experience of Italian regions is relevant for the international debate and provides specific responses to general questions that can be usefully applied in other decentralized contexts

Development of Nanostructured Lipid Carriers for the Delivery of Idebenone in Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay

Oxidative stress occurs when physiological antioxidant systems do not manage to counteract the excessive intracellular production of reactive oxygen species (ROS), which accumulate leading to irreversible oxidation of DNA and other biomacromolecules, and thus to the onset of pathological conditions. Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurodegenerative disease characterized by autosomal recessive mutations in the sacsin gene (SACS). It has been demonstrated that cells of ARSACS patients show bioenergetic and mitochondrial impairment, denoted by reduced respiratory chain activities and ATP synthesis. In order to design a suitable therapy for ARSACS, it is essential to consider that treatments need to cross the blood-brain barrier (BBB), a specialized structure that separates the subtle environment of the brain from blood circulation. Nanostructured lipid carriers (NLCs), constituted by a solid lipid shell and a liquid lipid phase in the core, have been fabricated for loading hydrophobic molecules, improving their bioavailability. Idebenone (IDE), a synthetic analogue of coenzyme Q10, is able to inhibit lipid peroxidation and detoxify several free radicals. However, because of its poor solubility, it requires ad hoc drug-delivery systems for enhancing its pharmacokinetic properties, preventing undesired cytotoxicity. In this work, NLCs loaded with idebenone (IDE-NLCs) have been prepared. The nanovectors have been physicochemically characterized, and their biological activity has been evaluated on different central nervous system cell lines. IDE-NLCs demonstrated to be stable in water and in cell culture media, and showed a sustained drug release profile. Interestingly, preliminary data demonstrated their ability to permeate an in vitro BBB model. Their protective antioxidant activity in human healthy primary skin fibroblasts and their therapeutic efficacy in ARSACS-derived primary skin fibroblasts have been also investigated, showing their potential for future development as therapeutic agents