Indoor Radon Exposure in Italian Schools

Sources, levels, and determinants of indoor air pollutants in Europe: A systematic review

Clean air is a requirement for life, and the quality of indoor air is a health determinant since people spend most of their daily time indoors. The aim of this study was to systematically review the available evidence regarding the sources, determinants and concentrations of indoor air pollutants in a set of scenarios under study in K-HEALTHinAIR project. To this end, a systematic review was performed to review the available studies published between the years 2013-2023, for several settings (schools, homes, hospitals, lecture halls, retirement homes, public transports and canteens), conducted in Europe, where sources and determinants of the indoor pollutants concentrations was assessed. After a two-stage screening in abstract and full-text, 148 papers were included for data extraction. For particulate matter, carbon dioxide and volatile organic compounds, several emission sources were identified (occupancy, human activities, resuspension, cleaning products, disinfectants, craft activities, cooking, smoking), with ventilation, number of occupants, building characteristics, being considered as important determinants. This review made also possible to discuss some of the actions that are already in place or should be implemented in the future to prevent and control the presence of pollutants indoors.

Quantifying indoor radon levels and determinants in schools: A case study in the radon-prone area Galicia-Norte de Portugal Euroregion

Radon is a carcinogenic compound, and is particularly concerning in the education sector, where children and teachers may be exposed even longer than at home. Thus, this study intended to characterise radon in the indoor air of scholar environments in different provinces/districts of the Euroregion Galicia-Norte de Portugal. With a pioneering approach, this study evaluated the influence of specific factors/characteristics (location, type of management, construction material, season and floor within the building) and quantified their relative contribution to indoor radon levels. Radon was continuously monitored in 416 classrooms from school buildings located in urban and rural sites from different provinces/districts both in the regions of Galicia (A Coruña and Lugo provinces) and Portugal (Porto and Bragança districts), considering rooms for different age groups (from nursery schools to universities). Single and multivariate linear regression models were built considering the radon concentrations as the outcome variable and different room/building characteristics as predictor variables. Mean and median radon concentrations were 332 Bq·m^-3 and 181 Bq·m^-3, respectively. The radon concentrations observed are a public health concern, as almost 1/3 of the places monitored exceeded the reference limit value of the European legislation (300 Bq·m^-3). Moreover, around 50 % of the indoor levels measured could be attributed to room/building characteristics: the building's location and the main construction material, as well as the occupants' age group, the floor within the building and the school's type of management (public/private). This study concluded that radon testing is needed in all school buildings and classrooms without exceptions. Thus, public administrations are urged to dedicate funds for testing, mitigation and public dissemination initiatives in schools. A special protocol for radon sampling in school buildings should also be developed.

Radon levels and indoor air quality after application of thermal retrofit measures-a case study

This study was conducted to evaluate the influence of thermal retrofit on radon levels in workrooms, and to determine whether the radon concentration in the building changes after the application of retrofit measures. In the first survey, digital Airthings Corentium Home radon detector was used for 1-month radon measurements during the heating season 2018/19. The daily averaged radon concentrations varied from 37 to 573 Bq/m³ for 10 selected workrooms, while hourly averaged radon measurements showed extreme variations from 6 to 1603 Bq/m³ due to radon fluctuations. In second survey, passive radon technique based on charcoal canister test kit was conducted in all basement workrooms in spring 2021. The averaged radon concentrations grouped according to flooring type in workrooms were 327 Bq/m³ for parquet, 227 Bq/m³ for ceramic tiles, 146 Bq/m³ for vinyl flooring and 71 Bq/m³ for laminate. Besides thermal insulation and airtight windows, noticeable differences in indoor radon concentration within the renovated building are primarily caused by different types of flooring. It includes various types of insulation from the ground/concrete slab: laminate, parquet (wood blocks), vinyl flooring, and ceramic tiles. Detailed analysis point out that laminate is more efficient way for radon protection than other types of flooring. An efficient ventilation system should be installed to avoid increasing occupational radon exposure and to provide healthy and comfortable indoor environment.

Radon in Indoor Air: Towards Continuous Monitoring

Radon poses significant health risks. Thus, the continuous monitoring of radon concentrations in buildings’ indoor air is relevant, particularly in schools. Low-cost sensors devices are emerging as promising technologies, although their reliability is still unknown. Therefore, this is the first study aiming to evaluate the performance of low-cost sensors devices for short-term continuous radon monitoring in the indoor air of nursery and primary school buildings. Five classrooms of different age groups (infants, pre-schoolers and primary school children) were selected from one nursery and one primary school in Porto (Portugal). Radon indoor concentrations were continuously monitored using one reference instrument (Radim 5B) and three commercially available low-cost sensors devices (Airthings Wave and RandonEye: RD200 and RD200P2) for short-term sampling (2–4 consecutive days) in each studied classroom. Radon concentrations were in accordance with the typical profiles found in other studies (higher on weekends and non-occupancy periods than on occupancy). Both RadonEye low-cost sensors devices presented similar profiles with Radim 5B and good performance indices (R2 reaching 0.961), while the Airthings Wave behavior was quite different. These results seem to indicate that the RadonEye low-cost sensors devices studied can be used in short-term radon monitoring, being promising tools for actively reducing indoor radon concentrations.

First Steps towards a National Approach for Radon Survey in Romanian Schools

Schools are a category of public buildings with a high radon exposure risk, due to their high occupancy factor. In Romania, the elaboration of a methodology for radon measurements in schools is a necessity imposed both by the European legislation and by the relatively high percentage (about 10%) of the mapped territory with a potential increased risk of exposure to the action of ionizing radiation emitted by radon. In order to optimize the design of a national survey aimed to evaluate radon exposure of children in Romanian schools, we conducted a pilot study in two schools in Cluj-Napoca, following the screening measurements carried out in 109 schools and kindergartens from five counties. The specific steps that must be followed were described, taking into account the international protocols and particularities of Romanian territory. The proposed approach could act as a guide for other large buildings and is implicit for the implementation of National Radon Action Plan, approved by HG no. 526/12 July 2018 in accordance with Council Directive 2013/59/EURATOM. The obtained results indicate that a high probability of annual radon concentration above the national reference level is to be expected in schools.

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018-2021) in an Italian University Hospital

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018-2019, 2019-2020, and 2020-2021). A gap analysis was performed at the case base (2018-2019), on-site vaccination was trialled in the 2019-2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020-2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020-2021) and other variables related to the healthcare workers' characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020-2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

Monitoring Radon Levels in Hospital Environments. Findings of a Preliminary Study in the University Hospital of Sassari, Italy

Background: The aim of this preliminary study was to measure radon concentrations in a hospital in order to verify to what extent these concentrations depend on various environmental variables taken into consideration, and consequently to determine the urgency to implement mitigation actions. Methods: The rooms where the concentration of the gas was potentially highest were monitored. Investigators adopted a Continuous Radon Monitor testing device. Qualitative and normally distributed quantitative variables were summarised with absolute (relative) frequencies and means (standard deviations, SD), respectively. As regards environmental variables, the difference in radon concentrations was determined using the rank-based nonparametric Kruskal–Wallis H test and the Mann–Whitney U test. Results: All measurements, excluding the radiotherapy bunkers that showed high values due to irradiation of radiotherapy instruments, showed low radon levels, although there is currently no known safe level of radon exposure. In addition, high variability in radon concentration was found linked to various environmental and behavioural characteristics. Conclusions: The results on the variability of radon levels in hospital buildings highlighted the key role of monitoring activities on indoor air quality and, consequently, on the occupants’ health.

Determination of optimal ventilation rates in educational environment in terms of radon dosimetry

INTRODUCTION

New and renovated energy efficient buildings with minimised ventilation rates together with increased building airtightness are often associated with higher indoor radon concentrations compared to the concentrations in existing buildings. The purpose of our study is to analyse the problem associated with the increased radon concentration and ventilation requirements and recommendations in schools. The radon concentration was critically assessed by varying the design ventilation rates (DVRs) within fifteen cases according to legislative requirements and recommendations. The case study is a branch primary school in western part of Slovenia situated in a radon prone area.

METHODS

Radon (²²²Rn) concentrations were simulated in the classroom, using CONTAM 3.2.

PROGRAM

For validation, measurements were performed on 8 measuring days in September and 6 measuring days in March. The simulated and measured ²²²Rn concentrations are well correlated for all measurement days, with the simulated/measured ratio of 0.85-1.39. In order to define optimal DVRs in terms of dosimetry, the effective dose and its ratio to the worldwide average effective dose at workplace, received by radon progeny in 950 h (expected effective dose, 0.13 mSv/y), were calculated for each case.

RESULTS

Simulations showed that the highest radon concentrations were observed in case 1 with a DVR of 79.6 m³/h (621 Bq/m³) and case 4 with a DVR of 69.4 m³/h (711 Bq/m³), both defined by national regulations. The calculated values in both cases exceeded the national reference value for radon (300 Bq/m³) by 2.1 times and 2.4 times, and the WHO guideline value (100 Bq/m³) by 6.2 times and 7.1 times, respectively. The simulations are in line with the results of radon dosimetry. Both DVRs correspond to the highest effective doses, 1.88 mSv/y (about 14-fold higher than expected effective dose) for case 1 and 2.15 mSv/y (about 17-fold higher than expected effective dose) for case 4. Case 11_Cat I with a DVR of 1999.7 m³/h defined by EN 15251: 2007 resulted in minimal Rn concentration (35 Bq/m³) and corresponds to the lowest effective dose 0.11 mSv/y and its ratio to the expected effective dose 0.8.

CONCLUSIONS

Ventilation is an immediate measure to reduce radon concentration in a classroom and it must be performed in line with other holistic measures to prevent and control radon as a health risk factor.

Radiation Protection Legislation and Sustainable Development of a Rural Green Tuff Village of Ischia Island

Radiological risk affects the quality of the environment in buildings since population and workers can be potentially exposed to high levels of radiation. Radon gas emanating from both subsoil and building materials represents the most important source of radiation exposure for people. This study investigates the sustainability concept of a small rural village of Ischia Island, named Ciglio, in relation to radiation protection legislation concerning the radiological risk for workers. Radon activity concentration was measured in typical green-tuff dwellings and in water samples collected from a local waterfall E-Perm devices. Moreover, for green tuff as building material, the radon emanation coefficient was calculated by gamma spectroscopy. The results highlight the importance of performing environmental radon monitoring and investigating the radon content of building materials, especially in geographical areas characterized by traditional use of typical stones for constructions. In conclusion, the sustainable development of rural buildings is possible if the radiological risk for inhabitants and workers is assessed in line with the national radiation protection legislation.

COVID-19 and Living space challenge. Well-being and Public Health recommendations for a healthy, safe, and sustainable housing

BACKGROUND AND AIM OF THE WORK

The ongoing pandemic of COVID-19 is a strong reminder that the lockdown period has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the built environment, both outdoor and mainly the indoor spaces: housing, workplaces, public buildings, and entertainment facilities. How can we re-design the concept of Well-being and Public Health in relation to the living places of the future?

METHODS

According to the previous statements and scenario, this paper aims to integrate the building hygiene and well-being, focusing the possible responses, both existing and for the new buildings, taking home a strong message from this "period" of physical distancing.

RESULTS

The Well-being and Public Health recommendations for a healthy, safe, and sustainable housing are framed into the following key points: 1. Visible and accessible green elements and spaces; 2. Flexibility, adaptability, sharing, and crowding of living spaces, and compliant functions located into the buildings; 3. Re-appropriation of the basic principles and archetypes of sustainable architecture, thermal comfort and Indoor Air Quality (IAQ); 4. Water consumption and Wastewater Management; 5. Urban Solid Waste Management; 6. Housing automation and electromagnetic fields; 7. Indoor building and finishing materials.

CONCLUSIONS

The Well-being and Public Health recommendations for a healthy, safe and sustainable housing may provide a useful basis for Designers, Policy Makers (fostering tax incentives for building renewal), Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform living places in healthier and Salutogenic spaces.

How Can Design Features and Other Factors Affect the Indoor Air Quality in Inpatient Rooms? Check-Lists for the Design Phase, Daily Procedures and Maintenance Activities for Reducing the Air Concentrations of Chemical Pollution

Indoor Air Quality (IAQ) is one of main topics of Public Health on which international institutions and countries are taking action. With regards to healing architectures, several studies have reported data analysis and case studies to improve users' health (patients, and medical and administrative staffs), but there are not enough regarding volatile organic compounds (VOCs). Regarding chemical pollution of indoor air, the Scientific Community has highlighted that there are several factors that affect the IAQ, in particular the design and management, and energetic efficiency, of inpatient wards. Several stakeholders, from the designers to the managers, are responsible for the indoor air in healing environments. Supported by analysis of the State of the Art and the main factors that influence the heterogeneous scenario of inpatient wards, the paper presents three check-lists, designed for supporting the stakeholders during the design phase, or for the daily procedures and maintenance activities, for pre-assessment of factors that affect chemical pollution, and for the definition of strategies to be applied. In fact, in such environments IAQ assumes a particular meaning and importance, both for the vulnerability of the patients and for the long time spent by the sanitary staff. The multidisciplinary approach emphasizes the continuous need for interdisciplinary knowledge and skills aimed at finding solutions able to protect users' health status (including patients, workers and visitors), especially in the field of the indoor air issue.

Environmental Factors and Ventilation Affect Concentrations of Microorganisms in Hospital Wards of Southern Thailand

Hospitals tend to have high density of occupancy. Poor indoor environmental quality in hospital buildings can exacerbate the health problems of patients and also harm visitors and staff. This study investigated the environmental characteristics and ventilation affecting the concentration of microorganisms in multiple-bed hospital wards. The measurements were accomplished by using a biosampler and an open plate method at four wards, different positions of electric fans, and different times. Data were analyzed by t-test and MANOVA. The results revealed that the concentrations of airborne bacteria were higher than the concentrations of fungi. There were significant differences in the concentrations of bacteria and fungi between sampling times and between hospital wards (p < 0.05), while no difference was observed by positions of electric fans. Correlations between the concentrations and other environmental parameters indicate that temperature, number of occupants, and humidity were physical factors associated with the concentrations of microorganisms. In addition, mostly, Gram-positive bacteria were observed. This indicates the conditions in buildings in the tropical climate, and regular housekeeping of all room areas is needed to prevent the growth of airborne contaminants and the related risks to patients, visitors, and staff.

COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities

BACKGROUND AND AIM OF THE WORK

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the systems and local capacities to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

METHODS

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the "period" of physical distancing.  Results. Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism.  Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.

CONCLUSIONS

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it).

Flu Vaccination Attitudes, Behaviours, and Knowledge among Health Workers

The aim of this work is to evaluate the attitudes, behaviours, and knowledge of health workers employed at an Italian University Hospital on the topic of vaccinations and in regard to flu vaccination. To this end, the study provided for the articulation of a computerised questionnaire on the digital platform EUSurvey which was administered online via e-mail to a sample of 457 health workers, in the period between November 2018 and March 2019. The data were subjected to descriptive and inferential statistical analysis. In particular, a logistic regression analysis was carried out in order to evaluate the relationship between the variables collected and the dichotomous outcome (vaccinated/unvaccinated subjects in the 2018–2019 season). The results, in line with what has been reported by the literature, highlighted that vaccine hesitancy is prevalent also among health workers. Furthermore, according to our study, only 30.6% of the health care workers had the flu vaccination. The survey points out the need to plan educational and informative interventions aimed at changing the attitudes, behaviours, and knowledge of health workers in the field of flu vaccination, for the purpose of protecting the health of healthcare personnel and their patients.

Indoor Radon Measurements in Finnish Daycare Centers and Schools-Enforcement of the Radiation Act

BACKGROUND

Indoor radon exposure is the second leading cause of lung cancer. Finnish radiation legislation obligates employers to measure indoor radon concentrations in workplaces, including schools and daycare centers, if they are in radon prone areas. Surveillance campaigns were conducted to ensure that the required radon measurements were performed and to gain knowledge on current indoor radon levels in daycare centers and schools.

METHODS

Daycare centers located in the high-radon risk municipalities were identified. Schools where indoor radon level measurements were obligatory but not performed, were identified.

RESULTS

Indoor radon measurements were performed in 633 daycare centers where the mean radon concentration was 86 Bq/m³ and the median 40 Bq/m³. The radon level was greater than 300 Bq/m³ in 8% (n = 49) of daycare centers. The radon measurements were performed in 1176 schools, which is 95% of the schools to be measured. The mean radon concentration was 82 Bq/m³ and the median 41 Bq/m³. The radon levels were greater than 300 Bq/m³ in 14% (n = 169) of the schools.

CONCLUSIONS

The systematic surveillance campaigns by the radiation protection authority were very efficient in order to ensure that the measurements are performed in schools and daycare centers. The campaigns also reduced the radon exposure of employees, children, and adolescents, where necessary.

Indoor Air Quality: A Focus on the European Legislation and State-of-the-Art Research in Italy

The World Health Organization (WHO) has always stressed the importance of indoor air quality (IAQ) and the potential danger of pollutants emitted from indoor sources; thus, it has become one of the main determinants for health. In recent years, reference documents and guidelines have been produced on many pollutants in order to: i) decrease their impact on human health (as well as the number of pollutants present in indoor environments), and ii) regulate the relevant levels of chemicals that can be emitted from the various materials. The aim of this paper is to discuss and compare the different legislations present in the European Union (EU). Furthermore, a focus of this paper will be dedicated at Italian legislation, where there is currently no specific reference to IAQ. Although initiatives in the pre-regulatory sector have multiplied, a comprehensive and integrated policy on the issue is lacking. Pending framework law for indoor air quality, which takes into account WHO indications, the National Study Group (GdS) on Indoor Air Pollution by the Italian Institute of Health (IIS) is committed to providing shared technical-scientific documents in order to allow actions harmonized at a national level. An outlook of the main Italian papers published during these last five years will be reported and discussed.

Effect of ventilation strategies and air purifiers on the children's exposure to airborne particles and gaseous pollutants in school gyms

Indoor school gyms are environments characterized by high concentrations of different airborne particulate and gaseous pollutants. In particular, like other naturally-ventilated school environments, in addition to indoor pollutants children can be exposed to sub-micron particles and gaseous pollutants emitted by outdoor sources and penetrating the building envelope; moreover, high concentrations of super-micron particles can be reached due to the resuspension phenomena related to the physical activity performed therein. The present paper aims to evaluate the effect of different ventilation methods (natural ventilation, manual airing) and the use of air purifiers in reducing the indoor concentrations of different airborne particles and gaseous pollutants in school gyms. To this end, an experimental campaign was performed in two naturally-ventilated school gyms in Barcelona (Spain) of different volumes and different distance to major urban roads. Indoor and outdoor measurements of particle number, black carbon and PM_1-10 concentrations were performed as well as indoor measurements of CO₂ and NO₂ concentrations. The study revealed that the use of air purifiers with windows kept closed (natural ventilation) can lead to a significant reduction in terms of indoor-to-outdoor concentration ratios. In the smaller gym (air changes per hour of the purifiers, ACH, equal to 9.2 h^-1) the I/O ratios were reduced by 93% and 95% in terms of particle number and PM_1-10, respectively; whereas in the larger school gym (ACH = 1.7 h^-1) the corresponding reductions were 70% and 84%. For manual airing scenarios, the effect of the air purifiers on outdoor-generated sub-micron particles is reduced; in particular, for low ACH values (i.e. ACH = 1.7 h^-1), the reduction is quite negligible (6%).

The Relevance of Indoor Air Quality in Hospital Settings: From an Exclusively Biological Issue to a Global Approach in the Italian Context

In the context of the architectures for health, it is an utmost priority to operate a regular and continuous updating of quality, efficacy, and efficiency’s processes. In fact, health promotion and prevention take place through a proper management and design of healing spaces, in particular with regard to the most sensitive users. In recent decades, there has been increasing attention to indoor air quality in healthcare facilities. Nowadays, this issue must involve the implementation of a series of appropriate interventions, with a global approach of prevention and reduction of risk factors on users’ health, which allows, in addition to a correct management of hospital settings, the realization of concrete actions. To date, in Italy, despite the indoor air being taken in consideration in numerous activities and studies aimed at understanding both building hygiene and environmental aspects, the greatest difficulty is strongly related to the absence of an integrated national policy. The scope of the paper is to underline the relevance of indoor air quality in hospital settings, highlighting the need of procedures, protocols, and tools for strengthening and improving interventions for health prevention, protection, and promotion of users.

Housing Demand in Urban Areas and Sanitary Requirements of Dwellings in Italy

The phenomenon of urbanisation is becoming increasingly prevalent on a global level, and the health issues regarding the urban environment are of primary importance in public health. Accordingly, the present manuscript describes an analysis of the housing conditions of Italian urban areas, referring to the city of Sassari (Sardinia), Italy, focused on the dwelling structural and sanitary conditions issued by the Italian regulations. Data relating to the housing conditions of the population were acquired by the Local Hygiene and Public Health Service (SISP), in a period between 2012 and 2016. Qualitative variables were summarised with absolute and relative (percentages) frequencies, whereas quantitative variables with means and standard deviations depending on their parametric distribution. Statistical comparisons for qualitative and quantitative variables were performed with the χ ² test or Student's t-test, respectively. A p value less than 0.05 was considered statistically significant. Finally, the dwellings and the collected variables were georeferenced on a city map. During the 2012-2016 observation period, 363 certification requests were received from 193 (53.2%) foreign-born citizens and 170 (46.8%) Italians at the SISP offices. The main reasons relate to the request for a residency permit (46.6%) and to obtain a subsidy from the local government (32.8%). Overall, 15.4% of dwellings were found to be improper, while 35.3% and 22.0% were found to be unhygienic and uninhabitable, respectively. The foreigners' homes were found to be suitable in 82.7% of cases; the housing of Italian citizens, on the contrary, was found to be suitable in 28% of the observations. The present study offers a cross section of the housing conditions of Italian urban areas, referring to the city of Sassari. To the authors' best knowledge, this observation is the first one carried out in Sardinia and one of the first observations in Italy. It has emerged that "hygienically unsuitable" homes are those that, in most cases, are located in the city centre. Moreover, the Italian population is hit by a significant housing problem, due to overcrowding, uninhabitability, and unhygienic conditions. Overall, our findings suggest that it is necessary to develop a multidisciplinary approach to guarantee public health, with safe dwellings homes and the surrounding urban context alongside the development of social relations. Nevertheless, there is still little evidence available today on the population housing conditions, especially regarding the private indoor environment, and further research is needed to bridge this knowledge gap.

COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities

Background and aim of the work.

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it’s necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

Methods.

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.

Results.

Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services’ plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services’ network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders’ awareness of the factors affecting Public Health in the cities.

Conclusions.

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it)

The Effect of Ventilation Strategies on Indoor Air Quality and Energy Consumptions in Classrooms

Most of the school buildings in Italy are high energy-demanding buildings with no ad-hoc ventilation systems (i.e., naturally-ventilated buildings). Therefore, reducing the heat losses of schools represent the main aspect to be dealt with. Nonetheless, the indoor air quality of the building should be simultaneously considered. Indeed, to date, energy consumptions and air quality are considered as incompatible aspects especially in naturally-ventilated buildings. The aim of the present paper is to evaluate the effect of different ventilation and airing strategies on both indoor air quality and energy consumptions in high energy-demanding naturally-ventilated classrooms. To this purpose, an Italian test-classroom, characterized in terms of air permeability and thermophysical parameters of the envelope, was investigated by means of experimental analyses and simulations through CO2 mass balance equation during the heating season. The air quality was assessed in terms of indoor CO2 concentrations whereas the energy consumptions were evaluated through the asset rating approach. Results clearly report that not adequate indoor CO2 concentrations are measured in the classroom for free-running ventilation scenarios even in low densely populated conditions (2.2 m2 person−1), whereas scheduled airing procedures can reduce the indoor CO2 levels at the cost of higher energy need for ventilation. In particular, when airing periods leading to the air exchange rate required by standards are adopted, the CO2 concentration can decrease to values lower than 1000 ppm, but the ventilation losses increase up to 36% of the overall energy need for space heating of the classroom. On the contrary, when the same air exchange rate is applied through mechanical ventilation systems equipped with heat recovery units, the ventilation energy loss contribution decreases to 5% and the overall energy saving results higher than 30%. Such energy-saving was found even higher for occupancy scenarios characterized by more densely populated conditions of the classroom typically occurring in Italian classrooms.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

Radon in Schools: A Brief Review of State Laws and Regulations in the United States

Exposure to Radon, a colorless, naturally occurring radioactive gas, is one of leading causes of lung cancer, and may pose a significant long-term risk for school age children. We examined the regulations and statutes in each US state related to radon in schools to delineate key features of policies and discrepancies among states that may have public health implications. Search terms such as "radon", "school", "mitigation", "certification", "licensing", and "radon resistant new construction" were used to scan current statutes from each state legislature's website and regulations from official state government websites for relevant regulatory and statutory requirements concerning radon in schools. State regulations related to the testing, mitigation, and public dissemination of radon levels in schools are inconsistent and the lack of nationwide indoor radon policy for schools may result in unacceptably high radon exposure levels in some US schools. We highlight the features and discrepancies of state laws and regulations concerning radon in schools, and offer several constructive means to reduce risks associated with radon exposure in school children.