Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter

A methodological proposal to evaluate the health hazard scenario from COVID-19 in Italy

2019 Coronavirus disease (COVID-19) had a big impact in Italy, mainly concentrated in the northern part of the Country. All this was mainly due to similarities of this area with Wuhan in Hubei Province, according to geographical, environmental and socio-economic points of view. The basic hypothesis of this research was that the presence of atmospheric pollutants can generate stress on health conditions of the population and determine pre-conditions for the development of diseases of the respiratory system and complications related to them. In most cases the attention on environmental aspects is mainly concentrated on pollution, neglecting issues such as land management which, in some way, can contribute to reducing the impact of pollution. The reduction of land take and the decrease in the loss of ecosystem services can represent an important aspect in improving environmental quality. In order to integrate policies for environmental change and human health, the main factors analyzed in this paper can be summarized in environmental, climatic and land management. The main aim of this paper was to produce three different hazard scenarios respectively related to environmental, climatic and land management-related factors. A Spatial Analytical Hierarchy Process (AHP) method has been applied over thirteen informative layers grouped in aggregation classes of environmental, climatic and land management. The results of the health hazard maps show a disparity in the distribution of territorial responses to the pandemic in Italy. The environmental components play an extremely relevant role in the definition of the red zones of hazard, with a consequent urgent need to renew sustainable development strategies. The comparison of hazard maps related to different scenarios provides decision makers with tools to orient policy choices with a different degree of priority according to a place-based approach. In particular, the geospatial representation of risks could be a tool for legitimizing the measures chosen by decision-makers, proposing a renewed approach that highlights and takes account of the differences between the spatial contexts to be considered - Regions, Provinces, Municipalities - also in terms of climatic and environmental variables.

Measuring Risk Perception in Pregnant Women in Heavily Polluted Areas: A New Methodological Approach from the NEHO Birth Cohort

Risk perception (RP) evaluation during pregnancy and its relationship with lifestyles are considered useful tools for understanding communities living in high-risk areas and preventing dangerous exposure. It is well known that exposure to pollutants and less-healthy lifestyles may result in increased disease occurrence during life. Our work investigated environmental RP through ad hoc questionnaires administered to 611 mothers within the NEHO birth cohort, recruited in three heavily contaminated areas of Southern Italy. Four different RP indices, an exploratory factorial analysis (EFA), and a latent class analysis were evaluated from questionnaires. The highest values of risk perception index were observed in the Milazzo site (0.64 ± 0.16) and the lowest in the Crotone site (0.5 ± 0.18). EFA revealed four latent factors, including different items describing environmental pollution, and subjects were classified into four latent classes with different RP indices. Significant RP profiles were different among the sites (p < 0.001). Our results did not demonstrate any association between RP and lifestyles during pregnancy. Improving healthy lifestyle behaviours, particularly in polluted areas, would generate co-benefits by preventing further risk factors. As remediation interventions can take a long time, it needs to improve healthy lifestyles in residents until remediation is completed.

Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy

Children obesity is a serious public health issue. This study aimed to investigate physical/sedentary activities of first-year primary schools children in Modena, and their association with overweight/obesity and dietary habits of children and family characteristics to identify the risk factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anonymous questionnaire administered to parents, as well as family characteristics and weight/height of child and parents. Logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of which 72 without anthropometric data were excluded. Three out of four children spent in physical activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated to physical/sedentary activities. Our results suggest the need of interventions to increase time for physical activity and to promote a responsible use of digital media involving the entire families to reach all parents regardless of their education and nationality with a possible relapse on other family members.

Air pollutants and risk of death due to COVID-19 in Italy

The present work aims to study the role of air pollutants in relation to the number of deaths per each Italian province affected by COVID-19. To do that, specific mortality from COVID-19 has been standardized for each Italian province and per age group (10 groups) ranging from 0 to 9 years to >90 years, based on the 2019 national population figures. The link between air pollutants and COVID-19 mortality among Italian provinces was studied implementing a linear regression model, whereas the wide set of variables were examined by means of LISA (Local Indicators of Spatial Autocorrelation), relating the spatial component of COVID-19 related data with a mix of environmental variables as explanatory variables. As results, in some provinces, namely the Western Po Valley provinces, the SMR (Standardized Mortality Ratio) is much higher than expected, and the presence of PM₁₀ was independently associated with the case status. Furthermore, the results for LISA on SMR and PM₁₀ demonstrate clusters of high-high values in the wide Metropolitan area of Milan and the Po Valley area respectively, with a certain level of overlap of the two distributions in the area strictly considered Milan. In conclusion, this research appears to find elements to confirm the existence of a link between pollution and the risk of death due to the disease, in particular, considering land take and air pollution, this latter referred to particulate (PM₁₀). For this reason, we can reiterate the need to act in favour of policies aimed at reducing pollutants in the atmosphere, by means of speeding up the already existing plans and policies, targeting all sources of atmospheric pollution: industries, home heating and traffic.

Reliability of T-WSI to Evaluate Neighborhoods Walkability and Its Changes over Time

More walkable neighborhoods are linked to increased physical activity. The Walking Suitability Index of the territory (T-WSI) is an easy method to evaluate walkability on the basis of direct observation. T-WSI provides 12 indicators divided into 4 categories (practicability, safety, urbanity, pleasantness); the weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. The aim of the study is to evaluate the ability of T-WSI’ indicators to measure, in a reliable way, any street’s walkability variations occurred over time. The investigation was performed in 2018 in nine urban neighborhoods of Rieti city. Cronbach’s α is used to evaluate internal consistency of T-WSI; Intraclass Correlation Coefficient (ICC) is used to evaluate the reproducibility of measurements (or ratings) made by different investigators. Cronbach’s α is 0.89 (± 0.02); ICC is also good (ICC = 0.89; 95% CI: 0.84–0.92). The results of the 2018 investigation are also compared with those collected in 2016 in the same districts. The results show that T-WSI is a reliable and easy to use tool, useful to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects.

Indoor Air Quality Levels in Schools: Role of Student Activities and No Activities

This work describes a methodology for the definition of indoor air quality monitoring plans in schools and above all to improve the knowledge and evaluation of the indoor concentration levels of some chemical pollutants. The aim is to guide interventions to improve the health of students and exposed staff connected with the activities carried out there. The proposed methodology is based on the simultaneous study of chemical (indoor/outdoor PM_2.5, NO₂, CO₂) and physical (temperature, humidity) parameters by means of automatic analyzers coupled with gaseous compounds (benzene, toluene, ethylbenzene, xylenes, formaldehyde and NO₂) sampled by denuders. The important novelty is that all the data were collected daily in two different situations, i.e., during school activities and no-school activities, allowing us to evaluate the exposure of each student or person. The different behaviors of all the measured pollutants during the two different situations are reported and commented on. Finally, a statistical approach will show how the investigated compounds are distributed around the two components of combustion processes and photochemical reactions.

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.

Corruption and Solid Waste Management in Mbarara Municipality, Uganda

Mbarara Municipality in Western Uganda has for many years struggled to manage municipal solid waste. Leaders in this municipality have mainly attributed this persistent problem to poor financing, failure to enforce existing solid waste management laws and regulations, limited community participation, deprived attitude by the public towards waste collection, and tendency of municipal dwellers to litter. No in-depth academic study in Mbarara Municipality has ever been done to expose and illustrate how corruption directly happens and influence solid waste management. This study fills this knowledge gap by illustrating how corruption influences poor solid waste management in Mbarara Municipality. The study finds that municipal technical officials, garbage truck drivers, their turn boys, garbage sorters, factory owners, and private land grabbers all involved in different forms of corruption have directly and indirectly turned solid waste collection and disposal into a very costly problem to the municipal council and the general public. The article recommends that fighting corruption in all its forms without fear or favor, encouraging them to play their role particularly in sorting waste, adoption of smart technologies, and putting in place measures that attract private investors while protecting the public can help in the effective management of solid waste in Mbarara Municipality.

Environmental Risks Perception Among Citizens Living Near Industrial Plants: A Cross-Sectional Study

The present work is a cross-sectional study aimed at assessing the risk perception and evaluating the community outrage linked to environmental factors among a self-selected sample of citizens living in an area characterized by the presence of industrial structures of high emotional impact. An anonymous questionnaire was administered to the population by publishing a Google form URL code in local and regional newspapers and via social media. The resulting data were entered on Excel and analyzed. Qualitative variables were summarized with absolute and relative (percentage) frequencies. The results showed that the event that causes the greatest worry was air pollution, with 92.6% of the respondents stating that they perceived the problem as "very" or "quite" worrying. Furthermore, all the health problems investigated in relation to environmental quality aroused concern among the interviewees, with 93.1% believing there was a cause-effect relationship between environmental quality and health. Overall, as other studies had previously underlined, the survey shows that the perceived risks are not always in line with the real ones, Thus, it is imperative to articulate interventions aimed at offering the population objective tools to enable them to interpret the risks themselves. In this regard, a fundamental role is played by adequate communication between the competent bodies and political decision-makers and the population.

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).

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.

Population Distrust of Drinking Water Safety. Community Outrage Analysis, Prediction and Management

The aim of the work is to evaluate the effectiveness of the risk communication strategies in cases of unsafe drinking water supply in Sardinia, the Italian context with the highest population distrust in drinking water safety. During the period 2010–2015, the ordinances published on the institutional websites were analyzed, and the population risk perception was evaluated by applying, for the first time in public health threats, the “OUTRAGE Prediction & Management” software released by Sandman. Overall, 417 ordinances issued by the Sardinian Municipalities were found. Only 1.5% of the ordinances reported information about parameters, concentrations, and risks to health, whereas 4.8% indicated only the parameters and non-standard levels. By contrast, 53.2% specified only the non-standard parameter, and 40.5% indicated a generic non-drinking motivation. The outrage assessment showed values exceeding the threshold of risk acceptance, attributable to the lack and low clarity of the information reported by the ordinances. The present study allowed us to highlight critical issues in risk communication of the quality of drinking water.

Social deprivation indexes and anti-influenza vaccination coverage in the elderly in Sardinia, Italy, with a focus on the Sassari municipality

The aim of the present study was to evaluate the relationship between social deprivation indexes and anti-influenza vaccination coverage in the elderly population (over 65 years old) in Sardinia.

This relationship was first observed in a regional context. An already-known deprivation index was used, and its trivial relationship with anti-influenza vaccination coverage was evaluated. Secondly, the same relationship was assessed in the homogeneous area of the Municipality of Sassari. This required the adoption of an ad hoc deprivation index, which allowed us to stratify the population into deprivation groups and to correlate vaccination coverage with socio-economic variables.

The results showed that regional anti-influenza vaccination coverage increased linearly as deprivation decreased. This trend was confirmed in the Municipality of Sassari. Pearson’s analysis highlighted factors that significantly correlate with vaccination coverage.

In Sardinia, the relationship between anti-influenza vaccination coverage and socio-economic status is consistent with the international panorama, and highlights the necessity to implement interventions to promote vaccination coverage among the elderly.

Root structural changes of two remediator plants as the first defective barrier against industrial pollution, and their hyperaccumulation ability

In the present day, plants are increasingly being utilized to safeguard the environment. In this study, we used Salsola crassa M. B. and Suaeda maritima L. Dumort for phytoremediation of water contaminated with heavy metals and simultaneous examination of the effect of industrial pollution on their root structures. After irrigation of a treatment group with wastewater and a control group with fresh water for 3 months, we fixed the root parts in the FAA fixator for developmental study, and measured the concentrations of Co, Ni, Zn, As, Cu, and Pb in the roots, shoots, soil, and irrigating water. The plants irrigated with wastewater showed significant accumulation of heavy metals in the roots and some translocation of heavy metals from the roots to the shoots. We also performed an experiment with two 0.3 m³ pools to more closely study the feasibility of these plants for filtering water of contaminants, including mineral compounds, and altering its chemical characteristics. In our anatomical studies, the cells of the treatment roots showed irregularities and abnormal appearances in all tissue layers. The diameter and area of the xylem and the size of the cortical parenchyma have increased in the treatment plants of both species, confirmed by Stereolite software. Phytoremediation studies indicated that S. crassa accumulated As, Cu, Zn, Pb, Co, and Ni, and S. maritima accumulated As, Co, Zn, and Cu. S. crassa accumulated more heavy metals in its roots, whereas S. maritima accumulated more in its shoots. The biological oxygen demand and chemical oxygen demand were also significantly reduced in the wastewater passed through pools with S. crassa. Our results indicate that both genera are hyperaccumulators of heavy metals and therefore hold promise for industrial wastewater treatment, especially the absorption of As.

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.