Ecological correlation between diabetes hospitalizations and fine particulate matter in Italian provinces

Background: Exposure to particulate matter has been associated with increased risk of cardiovascular and respiratory diseases. We evaluated the ecological correlation between standardized hospital discharges with diabetes in Italian provinces and fine particulate matter (PM2.5) adjusting for common risk factors, socioeconomic factors and differences in hospitalization appropriateness. Methods: We used cross sectional data aggregated at the province level and available from official institutional databases for years 2008–2010. Covariates included prevalence of adult overweight, obese, smokers, physically inactive, education and income (as average gross domestic product per person, GDP). We reduced the number of covariates to a smaller number of factors for the subsequent statistical model by extracting meaningful components using principal component analysis (PCA). Log-linear multiple regression analysis was used to model diabetes hospital discharges with PCA components and PM2.5 levels and hospitalization appropriateness for men and women. Results: The first PCA components for both men and women were characterized by larger loadings of risk factors (obesity, overweight, physical inactivity, cigarette smoking) and lower socioeconomic factors (educational level and mean GDP). Diabetes hospitalization increases with the first PCA component and decreases with the index of hospitalization appropriateness. In fully adjusted models, diabetes hospitalizations increase with increasing annual PM2.5 concentrations, with a rise of 3.5 % (1.3 %–5.6 %) for men and of 4.0 % (1.5 %-6.4 %) for women per unit of PM2.5 increase. Conclusions: We found a significant ecological relationship between sex and age standardised hospital discharge with diabetes as principle diagnosis and mean annual PM2.5 concentrations in Italian provinces, once that covariates have been accounted for. The relationship was robust to different means of estimating PM2.5 exposure. A large portion of the variance of diabetes hospitalizations was linked to differences of hospital care appropriateness between Italian regions and this variable should routinely be included in ecological analyses of hospitalizations

Relationships between Pressures, Chemical Status, and Biological Quality Elements. Analysis of the Current Knowledge Gaps for the Implementation of the Water Framework Directive

The general objective of the REBECCA project1 is to provide relevant scientific support for the implementation of the Water Framework Directive (WFD). The two specific aims of the project are, firstly, to establish links between ecological status of surface waters and physico-chemical quality elements and pressures from different sources, and, secondly, to develop and validate tools that member states can use in the process of classification, in the design of their monitoring programs, and in the design of measures in accordance with the requirements of the WFD. Historically, there has been great success in maintaining and improving the quality of surface waters by developing an understanding of the links between anthropogenic pressures (e.g. water abstraction, agriculture, and effluent discharges) and the chemical status of waters, although there remain many challenges in reliably designing and implementing the necessary programs of measures. Our present understanding of the link between chemical properties and ecological state, while good in some instances, is generally not adequate to support management intervention against ecological objectives. In this report we review and identify information gaps in our knowledge on relations between pressures, chemical and ecological status for the major pressures types and biological quality elements. We also give an overview of the chemical parameters that are used to determine the ecological status of water body types and of the biological indicators currently applied and/or potentially applicable as classification parameters for inland and coastal waters. This gap-analysis is needed to 1) identify the key areas of further work within the REBECCA project and 2) to identify the areas where further experimental or monitoring work would be needed (beyond the scope of REBECCA), due to lack of data or quantitative understanding of the functional relationships between chemical status and biological quality indicators. This report should help in focusing the on-going WFD intercalibration process in 2005-6. In particular it should provide insights on which biological and pressure parameters should be selected and which data there would be available to illustrate the degradation of the biological quality with respect of pressure gradients.JRC.H.5-Rural, water and ecosystem resource

Ecological Quality Ratios for Ecological Quality Assessment in Inland and Marine Waters

This report addresses the issue: What is a WFD compliant assessment method? This is done by focusing on the concept of the Ecological Quality Ratio (EQR). The EQR incorporates the key WFD requirements for ecological classification: typology, reference conditions, and class boundary setting. The Deliverable is targeted both to the policy makers and competent authorities implementing the Water Framework Directive and the scientists supporting them with their specific knowledge. The Classification Guidance separates three levels in the biological assessment: the parameter level, the quality element level, and the status classification. The main conclusion is that the WFD requires classification of water bodies at the quality element level, and that the worst of the relevant quality elements determines the final classification (the “one out, all out” principle). How the different parameters within a quality element are combined is not prescribed; this can either be done by combining them in a multimetric index, or in any other way. WFD- compliance criteria for assessment methods include reference conditions setting, definition of quality classes, and intercalibration of those boundaries. Those are currently addressed in the WFD intercalibration exercise, with a strong focus on specific quality elements and pressures. It is expected that the remaining quality elements and pressures will be addressed in the next couple of years, and that there will be a tendency from very specific, single-parameter, pressure-specific methods towards more general multimetric approaches. Quantification of EQR uncertainty should be implemented in future assessment programs. Software like starbugs (http://www.eu-star.at/) may help in the assessment of EQR uncertainty and provides a first attempt into this direction. It should be remarked that the analysis of uncertainty of EQR classification of a given site resulting from the use of a specific assessment scheme does not reveal the (unknown) real quality class of that site. If the EQR assessment outcome can be incorporated into a modelling framework, uncertainties may be assessed through careful evaluation of model predictions.JRC.H.5-Rural, water and ecosystem resource

Efficacy of acoustic waves in preventing Streptococcus mutans adhesion on dental unit water line

Background: nei riuniti odontoiatrici, la qualità dell'acqua utilizzata per la refrigerazione e il risciacquo di manipoli, siringhe e altri componenti è un aspetto di notevole importanza sanitaria. L'acqua attraversa questi dispositivi mediante un circuito interconnesso di tubi di piccole dimensioni (circa 2 mm di diametro), denominato “dental unit water line” (DUWL). I DUWL possono essere fortemente colonizzati da varie specie batteriche sia in fase planctonica, che adesi o organizzati in biofilm, rappresentando una potenziale causa di infezione, non solo per i professionisti che usano abitualmente questi dispositivi, ma anche per pazienti occasionali, in particolare per i pazienti immunocompromessi. La contaminazione dei DUWL può essere prevenuta o ridotta con l'uso dei disinfettanti, ma l'eradicazione dei microrganismi adesi alle superfici interne dei DUWL o organizzati in forma di biofilm, è una sfida assai più complessa e spesso i normali metodi di disinfezione non sono pienamente efficaci. Inoltre, in ambito odontoiatrico, i disinfettanti utilizzati abitualmente per disinfettare i DUWL possono alterare la capacità adesiva del materiale utilizzato nella pratica restaurativa. Obiettivi: individuare una strategia innovativa, in grado di contrastare l'adesione batterica alle superfici dei DUWL mediante un approccio di tipo fisico, che sia più efficace nel superare il problema della contaminazione dei DUWL e ridurre il rischio di infezione rispetto ai normali metodi già in uso. A tal fine, fra le molte specie batteriche potenzialmente riscontrabili nei circuiti idrici odontoiatrici, si è deciso di avviare questo studio pilota utilizzando la specie batterica patogena S. mutans, per il suo indubbio interesse in ambito odontoiatrico e per la sua spiccata capacità di aderire e persistere su superfici inerti. Metodi: utilizzo di onde acustiche elastiche ad alta energia nel contrastare l'adesione di Streptococcus mutans alle pareti interne di un circuito idrico sperimentale riproducente un DUWL. Per evidenziare l’efficacia delle onde acustiche anche in condizioni estreme, è stata utilizzata un’elevata carica contaminante di S. mutans. Risultati: Si osserva una significativa riduzione dei batteri adesi soggetti a trattamento con onde acustiche rispetto al controllo (P = 0,003)

Tools for the development of a benthic quality index for Italian lakes

In this paper, we propose a methodology to develop a benthic quality index useful for Italian lakes. The existing data about benthic macroinvertebrates of the Italian lakes were collected over a period of 50 years, but only a few lakes such as the Maggiore and the Mergozzo have been intensely studied. Some large lakes such as Lake Como are still almost uninvestigated. In total, 570 benthic macroinvertebrate taxa were identified; of which 373 belong to Chironomidae and 85 to Oligochaeta. With the aim of relating environmental variables with macrobenthos assemblages, we carried out a canonical correlation analysis (CANON) using a database that included 1060 sampling points. Both environmental (13 variables describing morphometry and hydrochemistry) and biological data (57 taxa) were available, but only taxa present in at least 10 samples were selected for data analysis. Three canonical variates were ecologically significant. The first one was correlated with conductivity, pH and alkalinity and accounted for 20% of the total variation. The second one was positively correlated with total phosphorus and N-NH4, and inversely with dissolved oxygen, and accounted for 18% of the total variation. The third one showed a direct correlation with maximum lake depth and volume and an inverse correlation with water temperature, and accounted for 17% of the total variation. A Trophic Status Index (TSI), based on the table 11 of the Italian Law 152/99 (without including chlorophyll), was calculated by ranking percent oxygen saturation, transparency and total phosphorus. TSI was used to test a Benthic Quality Index for Italian Lakes (BQIL) which is proposed in the present paper. The algorithm considered three steps. First, the means of three variables were calculated: percent oxygen saturation, transparency and total phosphorus weighted by the taxa abundances. These values are interpreted as optimum for each taxon and used to assign an indicator weight (BQIW). Second, the mean of these three variables was calculated for each taxon (mean BQIW). Third, the mean BQIW was multiplied by taxa abundance and divided by the total number of specimens present at each site for which the BQIL was obtained. Using a regression between BQIL and TSI values, lake sites were assigned to 5 quality classes as required by the Italian Law 152/99 and the WFD 2000/60/CE. This assignment must be considered as tentative, because different lake types should be considered separately to develop an index. At present the lack of information from different lake typologies hinders the development of a more sophisticated index such as the French Lake Biotic Index (LBI).Studio iniziale per la messa a punto di una metrica (indice di qualit?) delle acque dei laghi Italiani con l\u27utilizzo del macrobenthos per l\u27assegnazione dei suddetti laghi a 5 categorie di qualit?, cos? come previsto dalla Direttiva Quadro sulle Acque (WFD 2000/60/CE). Sono presentati dati abiotici (parametri considerati dalla Legge 152/99) e biotici che sono risultati correlati all\u27idrochimica lacustre. Nel lavoro si evidenziano carenze sulla presenza di alcune tipologie lacustri presenti in Italia

Efficient sampling methodologies for lake littoral invertebrates in compliance with the European Water Framework Directive

Lake shores are characterised by a high natural variability, which is increasingly threatened by a multitude of anthropogenic disturbances including morphological alterations to the littoral zone. The European Water Framework Directive (EU WFD) calls for the assessment of lake ecological status by monitoring biological quality elements including benthic macroinvertebrates. To identify cost- and time-efficient sampling strategies for routine lake monitoring, we sampled littoral invertebrates in 32 lakes located in different geographical regions in Europe. We compared the efficiency of two sampling methodologies, defined as habitat-specific and pooled composite sampling protocols. Benthic samples were collected from unmodified and morphologically altered shorelines. Variability within macroinvertebrate communities did not differ significantly between sampling protocols across alteration types, lake types and geographical regions. Community composition showed no significant differences between field composite samples and artificially generated composite samples, and correlation coefficients between macroinvertebrate metrics calculated with both methods and a predefined morphological stressor index were similar. We conclude that proportional composite sampling represents a time- and cost-efficient method for routine lake monitoring as requested under the EU WFD, and may be applied across various European geographical regions

Factors influencing persistence of Legionella pneumophila serogroup 1 in laboratory cocultures

Background: Risk for infections from Legionella pneumophila for immunocompromised individuals increases greatly when this species is present within the biofilm of the water distribution systems of hospitals or other health facilities. Multiplication and persistence of Legionella may dependent also upon planktonic growth in alternative to sessile growth. Here we compared the persistence of L. pneumophila serogroup 1 in experimental planktonic co-cultures subsided with iron, Pseudomonas aeruginosa and other non Legionella bacteria (quantified as Heterotrophic Plate Count, HPC at 37°C), isolated from drinking water sources of a large hospital. Results: Concentrations of L. pneumophila showed a decreasing pattern with incubation time in all co-cultures, the degree of reduction depending on the experimental treatment. In co-cultures with added P. aeruginosa, no L. pneumophila was detectable already after 4 days of incubation. In contrast in co-cultures without P. aeruginosa, HPC but not iron were significant factors in explaining the pattern of L. pneumophila, although the HPC effect was different according to the incubation time (HPC x time interaction, p < 0.01). Conclusions: Our results highlight the need of controlling for both HPC and metal constituents of the water systems of buildings used by individuals at particular risk to the effects of Legionella exposure

Meat intake and non-Hodgkin lymphoma: a meta-analysis of observational studies

Purpose: High intake of meat has been inconsistently associated with increased risk of NonHodgkin Lymphoma (NHL). We carried out a meta-analysis to summarise the evidence of published observational studies reporting association between red meat and processed meat intake and NHL risk. Methods: Analytical studies reporting relative risks with 95% confidence intervals (95% CI) for the association between intake of red and/or processed meat and NHL or major histological subtypes were eligible. We conducted random-effects meta-analysis comparing lowest and highest intake categories and dose-response meta-analysis when risk estimates and intake levels were available for more than three exposure classes. Results: Fourteen studies (4 cohort and 10 case-control) were included in the meta-analysis, involving a total of 10121 NHL cases. The overall relative risks of NHL for the highest versus the lowest category of consumption were 1.14 (95%CI: 1.03, 1.26) for red meat and 1.06 (95%CI: 0.98, 1.15) for processed meat. Significant associations were present when the analysis was restricted to case-control studies but not when restricted to cohort studies. No significant associations were found for major NHL etiological subtypes. Dose response meta-analysis could be based only on 8 studies that provided sufficient data and, compared to no meat consumption, the overall NHL relative risk increased not linearly with increased daily intake of red meat. Conclusion: The observed positive association between red meat consumption and NHL is mainly supported by the effect estimates coming from case-control studies and is affected by multiple sources of heterogeneity. This meta-analysis provided mixed and inconclusive evidences on the supposed relationship between red and processed meat consumption and NHL

The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014–June 2015

In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epi- demiology of the EVD outbreak during July 2014–June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/ suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44–2.50; P &lt; 0.01) and those attending funeral (OR 1.02; 95% CI 1.01–1.04; P &lt; 0.01). EVD cases from Kunike chief- dom had a lower odds of death (OR 0.22; 95% CI 0.08–0.44; P &lt; 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23–4.57; P &lt; 0.05). Only 25.1% of alerts were gen- erated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice dur- ing funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness

Spatial and temporal hot spots of Aedes albopictus abundance inside and outside a South European metropolitan area

Aedes albopictus is a tropical invasive species which in the last decades spread worldwide, also colonizing temperate regions of Europe and US, where it has become a public health concern due to its ability to transmit exotic arboviruses, as well as severe nuisance problems due to its aggressive daytime outdoor biting behaviour. While several studies have been carried out in order to predict the potential limits of the species expansions based on eco-climatic parameters, few studies have so far focused on the specific effects of these variables in shaping its micro-geographic abundance and dynamics. The present study investigated eco-climatic factors affecting Ae. albopictus abundance and dynamics in metropolitan and sub-urban/rural sites in Rome (Italy), which was colonized in 1997 and is nowadays one of the most infested metropolitan areas in Southern Europe. To this aim, longitudinal adult monitoring was carried out along a 70 km-transect across and beyond the most urbanized and densely populated metropolitan area. Two fine scale spatiotemporal datasets (one with reference to a 20m circular buffer around sticky traps used to collect mosquitoes and the second to a 300m circular buffer within each sampling site) were exploited to analyze the effect of climatic and socio-environmental variables on Ae. albopictus abundance and dynamics along the transect. Results showed an association between highly anthropized habitats and high adult abundance both in metropolitan and sub-urban/ rural areas, with “small green islands” corresponding to hot spots of abundance in the metropolitan areas only, and a bimodal seasonal dynamics with a second peak of abundance in autumn, due to heavy rains occurring in the preceding weeks in association with permissive temperatures. The results provide useful indications to prioritize public mosquito control measures in temperate urban areas where nuisance, human-mosquito contact and risk of local arbovirus transmission are likely higher, and highlight potential public health risks also after the summer months typically associated with high mosquito densities