[Gray water reuse in domestic environment: implications for public health]

The Authors describe the main microbiological characteristics of gray and rain waters, the evidence of infections related to the reuse of such waters and the main Italian and international standards and guidelines in this regard. In light of the review, the authors conclude that the limits defined by the Italian regulations are very precautionary and should ensure a very low risk of bacterial and/or viral infection (< 10.5 and 10.9 cases/year). It remains an open problem the risk of parasitic infections, for which the evidences to draw final conclusions are not sufficient yet.

Preparation of stable dispersion of barium titanate nanoparticles: Potential applications in biomedicine

Nanoscale structures and materials have been explored in many biological applications because of their extraordinary novel properties. Here we propose a study of cellular interactions with barium titanate nanoparticles, an interesting ceramic material that has received a lot of interest in the nanotechnology research, but without any attention about its biological potential. We introduced for the first time an efficient method for the preparation of stable aqueous dispersions of barium titanate nanoparticles, characterized with FIB, TEM and AFM imaging, light scattering, Z-potential and UV/vis analysis. Finally, we presented a systematic study of short-term cytotoxicity of the prepared dispersion based both on quantitative (metabolism, proliferation) and qualitative (apoptosis, viability, differentiation) assays.

Building a benchmark through active surveillance of intensive care unit-acquired infections: the Italian network SPIN-UTI

The Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) (SPIN-UTI) project of the Italian Study Group of Hospital Hygiene (GISIO - SItI) was undertaken to ensure standardisation of definitions, data collection and reporting procedures using the Hospital in Europe Link for Infection Control through Surveillance (HELICS)-ICU benchmark. Before starting surveillance, participant ICUs met in order to involve the key stakeholders in the project through participation in planning. Four electronic data forms for web-based data collection were designed. The six-month patient-based prospective survey was undertaken from November 2006 to May 2007, preceded by a one-month surveillance pilot study to assess the overall feasibility of the programme and to determine the time needed and resources for participant hospitals. The SPIN-UTI project included 49 ICUs, 3053 patients with length of stay >2 days and 35 498 patient-days. The cumulative incidence of infections was 19.8 per 100 patients and the incidence density was 17.1 per 1000 patient-days. The most frequently encountered infection type was pneumonia, Pseudomonas aeruginosa being the most frequent infection-associated micro-organism, followed by Staphylococcus aureus and Acinetobacter baumannii. Site-specific infection rates for pneumonia, bloodstream infections, central venous catheter-related bloodstream infections and urinary tract infections, stratified according to patient risk factors, were below the 75th centile reported by the HELICS network benchmark. The SPIN-UTI project showed that introduction of ongoing surveillance should be possible in many Italian hospitals. The study provided the opportunity to participate in the HELICS project using benchmark data for comparison and for better understanding of factors influencing risks.

[Indicators of water microbial pollution: problems and perspectives]

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

Development of an innovative method for the evaluation of fungal contamination of surfaces

The objective of this technical report is to compare the ability to capture fungal spores through samples performed with three different methods: Rodac contact plates, cotton pad and a pad prepared with a dusting cloth (DC pads) selected from those available on the market. The tests were conducted using a suspension of Aspergillus niger conidia equal to 0.5 MacFarland diluted 1/30, 1/40, 1/50, 1/100. With each of these dilutions 3 sterile tiles of stainless steel were contaminated, each divided into 16 small squares, in the center of which 0.1 ml of the dilution chosen was placed and left to dry (for a total of 12 sheets). In addition, we have used other 6 tiles to repeat the experience with dilutions 1/40 and 1/50. A total of 288 squared surfaces were contaminated: 96 of these were sampled with Rodac contact plates, 96 with cotton pads and 96 with DC and then inseminated in Petri plates. Sabouraud dextrose agar was used as culture medium for the first 12 plates, while, for the other 6 plates Sabouraud dextrose agar added with lecithin and polysorbate 80 was used. All plates were incubated at 37 degrees for 18 hours. To estimate the differences among the sampling methods and the dilutions tested, multiple linear regression was used. The analysis showed that the number of colonies harvested at dilution 1/40 is 13% higher (P = 0.09) than the number harvested at dilution 1/50 and the number of colonies harvested at dilution 1/30 is 6% higher than dilution 1/50 (P = 0.52). With regard to the comparison between the number of colonies harvested with Rodac contact plates, with cotton pads and DC pads, regression analysis shows that cotton pads harvest a number of fungal cfu 5 times higher than those detected with Rodac plates, while DC pads harvest a number of fungal ufc 6 times higher than those detected with Rodac plates (P < 0.00005). These results, although preliminary, indicate that DC pads are a sensitive and simple approach for the environmental control of fungal contamination.

[Study about noise pollution in the Nomentano quarter of Rome and its perception by residents]

The Authors describe the results of an investigation, carried out in the Nomentano quarter of Rome, to evaluate noise pollution level by road traffic and the annoyance in a resident sample. The measurement places have been subdivided according to three categories of streets ("flowing ", "quarter" and "local" streets); the LAeq (equivalent continuous level of noise) was taken during the day (from 7 am to 19 pm), the evening (from 19 pm to 23 pm) and the night (from 23 pm to 7 am). The results have been compared with previous study's data taken in 1988 and with the prescribed noise's limit values of the current national regulations. Lden values, the Community recommended acoustic parameter were also calculated. At the same time an interview was carried out to investigate resident's annoyance level; the results are discussed in relationship with registered noise levels.

Immunohistochemical demonstration of the small GTPase RhoA on epoxy-resin embedded sections

The purpose of the present study was to establish a method for light microscopical immunohistochemical localization of the small G protein RhoA on specimens treated and embedded for routine transmission electron microscopy. There are advantages in antigen immunolocalization on resin semi-thin sections compared to cryostat or paraffin sections: the preservation of morphological details, the well-defined immunoprecipitate localization and the possibility to correlate the immunohistochemical results with those obtained by electron microscope on neighbouring sections. These advantages are particularly useful for the subcellular localization of low molecular weight proteins such as RhoA, a small G protein able to cycle from the inactive cytoplasmic form to the plasma membrane-bound active form.

Requests of medical examinations after pneumococcal & influenza vaccination in the elderly

BACKGROUND & OBJECTIVES

There are no specific recommendations about pneumococcal vaccination (PV) in Italy. There are limited data on the requests of medical examination or hospitalization due to side effects of pneumococcal vaccination. In the present study we present our analyses on the requests of medical examination due to side effects of pneumococcal vaccination (PV) in 29,086 elderly aged >/=65 yr.

METHODS

Vaccination with influenza vaccine (IV) alone or in association with PV was offered during the IV campaign in the winter 1999-2000 in 8 counties of Sicily. General practitioners (GPs) provided the vaccination and, 72 h later, recorded local and systemic side effects by a telephonic interview with the waccinees. GPs recorded also the requests of medical treatments.

RESULTS

A total of 16,601 subjects (57.1%) were vaccinated with IV alone and 12,485 (42.9%) with the association IV+PV. Adverse effects were reported by 14.7 per cent of vaccinees. Out of 4,289 subjects with side effects, 305 (7.1%) looked for a medical examination. The factors associated with a significantly increased risk for medical examination after vaccination were symptoms duration >72 h (OR 2.04; 95% CI 1.38-3.01; P=0.0002); local induration (OR 3.26; 95% CI 2.07-5.13; P<0.0001); general malaise (OR 2.05; 95% CI 1.34-3.13; P=0.0009); fever >/=38 degrees C (OR 3.34; 95% CI 1.90-5.86; P<0.0001); myalgia (OR 2.80; 95% CI 1.46-5.37; P=0.0018) and dyspnea (OR 37.86; 95% CI 9.65-148.60; P=0.0001).

INTERPRETATION & CONCLUSION

The few requests for medical examination and the low rate of adverse effects confirmed the tolerability and safety of PV+IV; GPs consultation were related to the severity and duration of symptoms, but independent of the type of vaccine administered.

[Hospitals between present and future]

What role will hospitals play in the future of the healthcare system, and how this role will be changing? Hospitals of the future will confront difficult challanges: new kinds of disease, rapidly evolving medical technologies, aging of the population and evolving budget restrictions. All features that make it difficult to foresee the hospital of the future. The aim of this paper is to analyze the different challanges that hospital have to face in a modern scenario of evolution of public health services.

[Preventive measures suggested to protect health workers from the risk due to a potential exposure to SARS agents]

The Authors describe the personal and environmental preventive measures suggested to protect health workers from the risks due to a potential exposure to SARS agents. The Authors stress the need that workers are allowed to wear individual protective disposable complying with technical regulations in order to be assured the best protection.

[Water for human consumption and health]

Providing enough water of good quality to all human communities is a difficult task, which has been satisfied only recently and only for the developed world. A large part of the developing world still suffers from scarcity and/or bad quality of water supply. Examples from the past are described, including the cholera epidemics of London 1848-1853 and the chromium pollution of the Milan area, 1958. A synthetic description of the different kinds of biological and chemical pollution are also described, then the complex mechanisms of biological and chemical pollution of the waters are illustrated, which require complicated interventions for reclamation after pollution or, better, even more complicated surveillance to avoid pollution. Finally the problem of safeguard of waters during the distribution is illustrated, when a bad maintenance of the aqueducts can inactivate all the precautions taken during the supply an the treatment of waters.

Factors influencing hospital infection control policies in Italian hospitals

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

[Costs of pneumococcal infections and cost evaluation of heptavalent conjugate vaccine]

The results of six economic evaluations on heptavalent conjugate pneumococcal vaccination in children are discussed. Although the data of most studies come from estimates, the last study from US, in which data are based on a large randomized trial, shows encouraging results. Similar results are obtained in an economic evaluation performed in Germany, although the study is based on estimated data. The paper concludes stressing the need to improve epidemiological, clinical and economical knowledge on the pneumococcal diseases, in order to identify the best cost-effectiveness strategy to prevent a diseases so important for children and the elderly.

An acute, traumatic supraspinatus lesion in an intercollegiate football player: a case report

OBJECTIVE

To describe the evaluation, management, and rehabilitation of an acute, supraspinatus tendon injury in an intercollegiate football player.

BACKGROUND

While attempting to block a defender, a 19-year-old collegiate football player slipped on the artificial turf and landed on his right elbow, causing an injury to his right shoulder. The athlete was initially seen by the head athletic trainer and then referred to the team physician for further evaluation.

DIFFERENTIAL DIAGNOSIS

acromioclavicular joint sprain, brachial plexopathy, subacromial impingement syndrome, supraspinatus lesion.

TREATMENT

The athlete was managed surgically with an open acromioplasty and a 3-bone tunnel repair of the supraspinatus tendon. After surgery, the athlete underwent a 4-month rehabilitation protocol in preparation for return to competition.

UNIQUENESS

This case involved a teenage athlete rather than the older individuals who normally sustain rotator cuff lesions. Also, the mechanism was a compressive force on the supraspinatus tendon rather than the tensile force common to rotator cuff lesions.

CONCLUSIONS

By presenting this case report, we hope to give sports medicine clinicians a better understanding of rotator cuff injuries and how to successfully manage and rehabilitate supraspinatus lesions.

National Surveillance System and Hib meningitis incidence in Italy

In 1994, the Italian Ministry of Health implemented a National Surveillance System to obtain data on the incidence of bacterial meningitis and its causative agents, including Haemophilus influenzae type b (Hib). As a consequence, case reporting of Hib meningitis is increasing year by year; in 1996, there were 126 notifications, of which 73% were in children under 2 years of age. Although underreporting still exists, parallel prospective or retrospective epidemiological surveys conducted in some Italian Regions allowed for partial correction of the incidence of Hib meningitis (up to 18.5/100,000 population in 1994).