Parental and offspring psychopathological disorders after the 2012 Italian earthquake

Background

Parental mental health can affect offspring Post-Traumatic Stress Disorder (PTSD), but up to now few data focused on families exposed to natural disasters. Thus, this study aimed at investigating the association between parental and youth psychopathology after the Italian earthquake of 2012.

Methods

In this cross-sectional study, 1162 parents and 682 children and adolescents (9-14 years) living in two districts, earthquake area (EA) and control area (CA), were assessed for psychopathological distress two years after the earthquake. Children filled in the UCLA PTSD-Index for DSM-IV, an exposure questionnaire, and the Strengths and Difficulties Questionnaire (SDQ); parents the Symptom Checklist-90 (SCL-90).

Results

Parents in EA showed a higher frequency of psychopathological difficulties than those in CA (28% vs 17.5% had a SCL-90 global score over the cutoff, p < 0.001). Sleep disturbances were the most prevalent disorder, followed by obsessive-compulsive disorder, depression, somatization and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample.

Both SCL90 total and symptom domain scores correlated with PTSD total and clusters scores, especially for hyperarousal and re-experiencing. Parental anxiety, depression and somatization showed the highest correlations. Considering SDQ, mothers' psychopathology resulted to be associated mainly with offspring's emotional and peer problems, while fathers' disorders affected mainly children's hyperactivity.

Conclusions

This study showed a significant association between parental mental health and both PTSD and emotional/behavioral problems among offspring after earthquake. These results should be carefully considered when planning mental health support interventions in areas affected by earthquakes.

Key messages

Parental psychopathology and PTSD and other emotional/behavioral difficulties in children tend to cluster in families exposed to natural disasters, especially earthquakes. Parental and offspring psychopathological disorders should be considered when planning mental health support interventions in areas affected by earthquakes.

Illicit drugs and pharmaceuticals in swimming pool waters

The occurrence of illicit drugs (cocaine, opioids, amphetamines and cannabis derivatives), some of their metabolites and 48 pharmaceuticals, was investigated in pool and source waters in ten Italian indoor swimming pools. The samples were analyzed by highperformance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), after solid phase extraction (SPE). Cocaine and its metabolites were found in nine swimming pools, at concentrations from 0.3 to 4.2 ng/L for cocaine, 1.1 to 48.7 ng/L for norcocaine, 0.7 to 21.4 ng/L for benzoylecgonine and 0.1 to 7.3 ng/L for norbenzoylecgonine. Opioids, amphetamines and cannabis derivatives were never detected. The most frequent pharmaceuticals were anti-inflammatory drugs: ibuprofen was found in all the pool waters, with a maximum 197 ng/L and ketoprofen was detected in 9/10 samples (maximum 127 ng/L). Among anticonvulsants, carbamazepine and its metabolite, 10,11-dihydro-10,11dihydroxycarbamazepine, were frequent in swimming pool water (8/10 samples) at concentrations up to 62 ng/L. The cardiovascular drug valsartan was also found frequently (8/10 samples), but at lower concentrations (up to 9 ng/L). Other pharmaceuticals were detected occasionally and at lower concentrations (atenolol, enalapril, paracetamol, hydroclorothiazide, irbesartan and dehydro-erythromycin). Carbamazepine, irbesartan and dehydroerythromycin were detected at very low levels (up to 5 ng/L) in only one of the four source water samples. A quantitative risk assessment showed that the health risk for humans to these substance in swimming pool waters was generally negligible, even for vulnerable subpopulations such as children and adolescents.

Characteristics and outcome predictors of patients involved in an outbreak of Burkholderia cepacia complex

A Burkholderia cepacia complex outbreak occurred among ventilated non-cystic fibrosis patients in an intensive care unit (ICU) in Italy: 33 colonized and 13 infected patients were included in a retrospective study aimed at investigating factors related to clinical infection and mortality. Demographic/clinical conditions and mortality did not vary significantly between colonized and infected patients, both groups showing high mortality rates compared with the overall ICU population and similar to that observed in patients with other infections. In multivariate regression analysis, disease severity (defined by the Simplified Acute Physiology Score II) and age were the only independent predictors of early mortality (odds ratio: 1.12; 95% confidence interval: 1.02-1.26; and 1.07; 1.01-1.15, respectively).

[Environmental surveillance of a sample of indoor swimming pools from Emilia Romagna region: microclimate characteristics and chemical parameters, particularly disinfection by products, in pool waters]

The aim of the present study was to investigate the environmental and healthy aspects from a representative sample of indoor swimming pools located in the Emilia Romagna region. During the sampling sessions, the occupational environment was evaluated in terms of microclimate parameters and thermal comfort/discomfort conditions. Moreover the chemical risk was assessed by analyzing from the pool water the presence of disinfection by-products (DBPs), such as: trihalomethanes (THMs), haloacetic acids (HAAs), chlorite, chlorate and bromate. The analytical results are in agreement with the Italian legislation (Accordo Stato-Regioni; 2003) even if in some of the sampled indoor swimming pools, the dosed combined chlorine levels, were greater than the Italian limit. With the regard to the microclimate conditions evaluation, the considered thermal indices, Predicted Mean Vote (PMV) and Predicted Percentage of Dissatisfied (PPD%), described a satisfactory occupational environment. Among DBPs, the THMs mean levels (41.4 +/- 30.0 microg/l) resulted close to the values of the current Italian drinking water legislation, and seem to not represent an health issue. The pool waters chlorate levels (range: 5 - 19537 microg/l) need further investigations as recent epidemiological studies on drinking water hypothesized a potential genotoxicity effect of these compounds which are involved in cellular oxidative processes.

[Exposure to organic halogen compounds in drinking water of 9 Italian regions: exposure to chlorites, chlorates, thrihalomethanes, trichloroethylene and tetrachloroethylene]

This study investigated the exposure to organohalogens compounds in drinking water from 9 Italian towns (Udine, Genova, Parma, Modena, Siena, Roma, L'Aquila, Napoli and Catania). Overall, 1199 samples collected from 72 waterworks were analyzed. THMs, trichloroethylene and tetrachloroethylene were evaluated using the head-space gas chromatographic technique (detection limit of 0.01 microg/l; chlorite and chlorate analysis was performed by ion chromatography (detection limit of 20 microg/l). THMs were evidenced in 925 samples (77%) (median value: 1.12 micro/l; range: 0.01-54 mciro/l) and 7 were higher than the THMs Italian limit of 30 microg/l. Chlorite and chlorate levels were higher than the detection limit in 45% for chlorite and in 34% for chlorate samples; median values were 221 microg/l and 76 microg/l, respectively. Chlorite values were higher than the chlorite Italian limit (700 microg/l) in 35 samples (8.7%). Trichloroethylene and tetrachloroethylene were measured in 29% and 44% of the investigated samples and showed values lower than the Italian limit (highest levels of 6 microg/l and 9 microg/l, respectively). The low levels detected of THMs, trichloroethylene and tetrachloroethylene have no potentials effects on human health, whereas, the levels of chlorite and chlorates should be further evaluated and their potential effects for the populations using these drinking waters, better understood.

[Halogenated volatile organic compounds in bottled mineral water and soft drinks]

74 mineral natural water samples and 56 samples of different commercial drinks have been analysed by head-space chromatography in order to evidence the presence of volatile halogenated organic compounds (VHO). Trihalomethanes (THM) as drinking water chlorination by-products and trichloroethane, carbon tetrachloride, trichloroethylene and tetrachloroethylene as ubiquitarious substances have been investigated. The presence of VHO has been evidenced in 20,3% of mineral natural water samples and in the 58,9% of the commercial soft drinks: this latest group has usually shown higher levels of the investigated compounds. The results of the present study has been compared with a similar study performed in 1991 in the same area: the VHO values observed in the present study appear to be lower than those obtained in the previous study.

[Epidemiology of work related injuries in young people: results of a survey carried out in Modena (Italy) between January and June 2000]

Work related injuries, above all those involving young people, are an important health and social issue, even though up to now small attention has been deserved in spite of the presence of about 68 workers per 1000 young people and the occurrence of 27400 injures in young people in 2000 in Italy. This study was aimed at improving the knowledge on work related injures occurring in Modena in 14-17 year old subjects in the period January-June 2000. A descriptive epidemiological study was carried out. Information was collected at the two emergency departments operating in Modena by checking hospital and INAIL records. Injures were defined as events caused by a violent external cause producing one or more lesions. Injuries were defined as work related when occurring during working activities or "in itinere". Work related injures and other injures were compared using the different statistical methods. Work related injuries occurring in young people during January-June 2000 in Modena were 76 (6-month incidence: 1.5 per 100 subjects of the same age) and represent 8.5% of all injuries. The most involved subjects were 17 year old males working in the industrial field, and in most cases prognoses were lasting less than 8 days. A Cluster Analysis identified two types of injures: the "in itinere" ones which resulted similar to the road accidents, both for body sites involved and for the way of occurrence and the injuries occurring at the working place characterised by a high frequency of lesions concerning hand, head, above all eyes. The study showed a remarkable incidence of work related injuries among 14-17 year old subjects in Modena in the first 6 months of 2000. Nevertheless many difficulties in finding information raised during the survey: a higher accuracy and completeness in collecting and recording of the data is needed to better define the epidemiological aspects of this issue.

[Presence of disinfection by-products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma]

The Authors report data about the presence of Disinfection By-Products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma (20 water supplies). Trihalomethanes, chlorite and chlorate (only in water samples treated with chlorine dioxide), and halogenated compounds were investigated. On the whole, trihalomethanes were evidenced in the 85% of the samples (n. 285) at low levels, while chlorite and chlorate were present in the 67% and 63% of the treated samples with chlorine dioxide (257 samples). Chlorite mean and median values were 225.70 microg/l and 136.75 microg/l respectively, ranging from 20 to 2000 microg/l. Chlorate concentrations were lower than chlorite: the mean value was 102.93 mg/l, while median level was 50 microg/l (range: 20-1500 microg/l). The high concentrations of chlorite and the wide range of values within each municipality plant in Modena and Parma suggest to investigate further in order to evaluate the human exposure in drinking water thoroughly.

[Exposure to water disinfection by-products and adverse pregnancy outcomes: results of a case-control study carried out in Modena (Italy)]

Chlorination By Products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, such as small term birth (STB) and preterm delivery. Up to date epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level: in this study the exposure is evaluated at the individual level. A case control study with incident cases was performed in Modena between October 1999-September 2000. 332 subjects were enrolled: 93 preterm births (26th-37th week of pregnancy), 73 STB (from 38th week, and weight less than the lowest 10th percentile) and 166 controls. Exposure was assessed both by applying a questionnaire on personal habits and by personal water sampling directly at subjects' home. THMs were analysed in all samples, chlorite and chlorate in water samples treated with chlorine dioxide. Subjects usually drinking tap water were few (5.2%): most of them were living in areas supplied by water treated with chlorine dioxide (87%). Levels of THMs were low (mean: 0.73 microgram/l), while chlorite and chlorate concentrations were relatively high (mean: 217.8 microgram/l for chlorites and 95.2 microgram/l for chlorates). Preterm birth did not show any significant association with CBPs, while STB appeared significantly associated, after adjusting for many potential confounders, with CBPs induced by chlorine dioxide treatment, especially with levels of chlorate higher than 200 microgram/l (OR: 4.7; 95%CI: 1.15-19.72). The association between STB and chlorate must be investigated further as the number of water utilities applying chlorine dioxide as disinfection treatment is increasing.

Air quality and well-being perception in subjects attending university libraries in Modena (Italy)

We studied four libraries in the University of Modena and Reggio Emilia (Northern Italy) to determine the presence of polluting agents such as total dusts, formaldehyde and other volatile organic compounds (VOCs) including benzene, toluene and xylenes and to assess the sense of well-being perceived by library users. This investigation was suggested by an increase in reported symptoms related to Sick Building Syndrome (SBS) observed in recent decades among people spending most of their time in various indoor environments, including libraries. The microclimatic conditions and the concentrations of pollutants indicated an acceptable situation on the whole, even though a wide range of total dust values (40-350 microg/m3) and total VOCs (203-749 microg/m3) was observed. However, the perception of the different environmental parameters by the 130 library users that were interviewed identified the existence of some discomfort mainly caused by the feeling of poor ventilation. Moreover, 78.5% of the subjects stated they had at least one of the 16 investigated symptoms potentially related to a SBS. The place of occurrence of the self-reported symptoms was also investigated, the symptoms arising during library attendance more frequently than elsewhere were only four, and in particular feeling hot, sore eyes, dry throat and breathing difficulties. Overall, our study has shown the existence of an association between microclimatic perceptions as reported by library users and subjective symptoms related to SBS, considering the four libraries separately, the highest prevalence of self-reported symptoms was found in the library where environmental discomfort as perceived by users was greatest. Nevertheless, an association between subjective self-reported symptoms and both microclimatic conditions as resulted by instrumental measurements and/or pollutants concentrations was not apparent.

Occupational exposure to trihalomethanes in indoor swimming pools

The study evaluated occupational exposure to trihalomethanes (THMs) in indoor swimming pools. Thirty-two subjects, representing the whole workforce employed in the five public indoor swimming pools in the city of Modena (Northern Italy) were enrolled. Both environmental and biological monitoring of THMs exposure were performed. Environmental concentrations of THMs in different areas inside the swimming pools (at the poolside, in the reception area and in the engine-room) were measured as external exposure index, while individual exposure of swimming pool employees was estimated by THMs concentration in alveolar air. The levels of THMs observed in swimming pool water ranged from 17.8 to 70.8 microg/l; the mean levels of THMs in ambient air were 25.6+/-24.5 microg/m3 in the engine room, 26.1+/-24.3 microg/m3 in the reception area and 58.0+/-22.1 microg/m3 at the poolside. Among THMs, only chloroform and bromodichloromethane were always measured in ambient air, while dibromochloromethane was detected in ambient air rarely and bromoform only once. Biological monitoring results showed a THMs mean value of 20.9+/-15.6 microg/m3. Statistically significant differences were observed according to the main job activity: in pool attendants, THMs alveolar air were approximately double those observed in employees working in other areas of the swimming pools (25.1+/-16.5 microg/m3 vs. 14.8+/-12.3 microg/m3, P < 0.01). THMs in alveolar air samples were significantly correlated with THMs concentrations in ambient air (r = 0.57; P < 0.001). Indoor swimming pool employees are exposed to THMs at ambient air levels higher than the general population. The different environmental exposure inside the swimming pool can induce a different internal dose in exposed workers. The correlation found between ambient and alveolar air samples confirms that breath analysis is a good biological index of occupational exposure to these substances at low environmental levels.

Prevalence of urinary incontinence among institutionalized patients: a cross-sectional epidemiologic study in a midsized city in northern Italy

OBJECTIVES

To determine the prevalence of urinary incontinence among institutionalized elderly people.

METHODS

A cross-sectional study was conducted on 839 subjects, resident in 14 residential or nursing homes. A questionnaire was administered to the study population and their clinical records were reviewed.

RESULTS

The overall prevalence of urinary incontinence was 54.5%, higher in women (59.8%) than in men (39.2%). The prevalence increased significantly with age, from 26.5% in subjects 65 years old or younger to 73.7% in subjects 95 years old or older; with worsening of mental status, from 36.2% in well-oriented subjects to 76.7% in poorly oriented subjects; and with worsening of mobility, from 23.8% in self-sufficient subjects to 82.1% in bedridden patients. The prevalence was significantly associated with parity, from 54.1% in nulliparous women to 65.4% in multiparous women. Urinary incontinence was also associated with urinary tract infection, constipation, and fecal incontinence.

CONCLUSIONS

The results of our study are in accordance with other similar studies. That more than one half of the elderly residents of nursing and residential homes have urinary incontinence shows the relevance of this condition. We believe that urinary incontinence in institutionalized elderly people can be managed essentially by measures of tertiary prevention, aimed at reducing the handicapping conditions and at slowing down the process of self-sufficiency impairment.

[Prevention and control of Legionella infection in the hospital environment]

An outbreak of nosocomial legionnaires' disease in a hospital of Northern Italy is described, together with the epidemiological survey and the control measures adopted. Two patients developed Legionella pneumophila (serogroup 1) pneumonia, one (immunodepressed) died. The Task Group organised by the Health Service excluded other previous nosocomial infections, and made controls on patients and personnel of at risk units (all negative). An intensive programme of environmental sampling and educational activities on personnel have been carried out. The environmental surveillance revealed that the centralised hot water distribution system of the hospital was colonised with Legionella. Shock heating and hyperchlorination of water were applied, which reduced the number of contaminated sites short term, but recolonisation took place two months later. We underline the difficulties encountered to control Legionella by active surveillance of water quality; once the system is contamined, Legionella eradication may be difficult and expensive, and cases of hospital-acquired legionnaieres' disease are likely to occur.

Surveillance of legionellosis within a hospital in northern Italy: May 1998 to September 1999

The incidence of legionella infection in Europe overall in 1997 was 3.9 cases per million population, with the lowest rates reported by Malta and Norway and the highest by Denmark. Ninety cases were reported in Italy (1.5 cases/million), 20% of which were

Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools

In this article, exposure to trihalomethanes (THMs) in indoor swimming pools as a consequence of water chlorination is reported. Environmental and biological monitoring of THMs was performed in order to assess the uptake of these substances after a defined period in five competitive swimmers, regularly attending an indoor swimming pool to train for competition during four sampling sessions. Analyses were performed by gas-chromatography and the following THMs were detected: chloroform (CHC13), bromodichloromethane (CHBrC12), dibromochloromethane (CHBrsC1) and bromoform (CHBr3). CHC13 appeared the most represented compound both in water and in environmental air before and after swimming. CHBrC1w and CHBr2C1 were always present, even though at lower levels than CHC13, CHBr3, was rarely present. In relation to biological monitoring, CHC13, CHBrC12 and CHBr2C1 were detected in all alveolar air samples collected inside the swimming pool. Before swimming, after 1 h at rest at the pool edge, the mean values were 29.4 +/- 13.3, 2.7 +/- 1.2 and 0.8 +/- 0.8 micrograms/m3, respectively, while after spending 1 h swimming, higher levels were detected (75.6 +/- 18.6, 6.5 +/- 1.3 and 1.4 +/- 0.9 micrograms/m3, respectively). Only CHC13 was detected in all plasma samples (mean: 1.4 +/- 0.5 micrograms/1) while CHBrC1x and CHBr2C1 were observed only in few samples at a detection limit of 0.1 micrograms/1. After 1 h at rest, at an average environmental exposure of approx. 100 micrograms/m3, the THM uptake was approx. 30 micrograms/h (26 micrograms/h for CHC1c, 3 micrograms/h for CHBrC12 and 1.5 micrograms/h for CHBr2C1). After 1 h swimming, the THM uptake is approx. seven times higher than at rest: a THM mean uptake of 221 micrograms/h (177 micrograms/h, 26 micrograms/h and 18 micrograms/h for CHC13, CHBrC12 and CHBr2C1, respectively) was evaluated at an environmental concentration of approx. 200 micrograms/m3.

Two-year evolution of perchloroethylene-induced color-vision loss

Progression of perchloroethylene-induced color-vision impairment was studied in 33 dry-cleaner workers at 12 establishments in Modena, Italy. In an initial survey, we evaluated exposure with personal passive samplers, and we assessed color vision with the Lanthony D-15 desaturated panel. Two years later, workers were reexamined. In 19 workers (subgroup A), exposure to perchloroethylene had increased (median of 1.7 ppm versus 4.3 ppm, respectively), whereas in the remaining 14 workers (subgroup B) exposure was reduced (2.9 ppm versus 0.7 ppm, respectively). Color vision worsened in subgroup A, but no vision changes were apparent in subgroup B. The results indicated that an increase in exposure during a 2-y period, even if slight, can cause color vision to deteriorate. A similar slight reduction in exposure did not lead to color-vision improvement; perhaps this lack of improvement resulted from (a) an insufficient reduction in exposure, (b) an insufficient reduction in duration of exposure, or (c) irreversible perchloroethylene-induced color-vision loss.

Indoor air quality in the university libraries of Modena (Italy)

We carried out a survey in 16 libraries of the University of Modena, Northern Italy, to assess the indoor exposure to volatile organic compounds (VOCs), including formaldehyde, and total dusts. Data were collected on the main structural characteristics of the buildings; indoor microclimate parameters, such as temperature, relative humidity and ventilation rate were measured and air samples taken inside and outside the libraries. The mean value of total dusts was 190 +/- 130 microg/m3 with a wide range of values. Formaldehyde was found in only ten out of 16 libraries and the indoor concentrations ranged from 1.70 to 67.8 microg/m3 with an average value of 32.7 +/- 23.9 microg/m3. On the whole, VOCs were present in all the libraries investigated with an average value was 433 +/- 267 microg/m3 (range 102-936 microg/m3). No correlation was found among VOCs, formaldehyde and total dusts nor was a significant association observed with microclimatic parameters or the structural characteristics of the buildings. The general situation found in this study suggests no major problems related to indoor pollution. However, some of the pollutants investigated such as total dust and total VOCs deserve further investigation. It is important to identify the possible sources of contaminants and to define the relationship between indoor and outdoor levels of pollutants more accurately, taking into account the effects of air recycling due to natural ventilation systems.

Environmental and biological monitoring of chloroform in indoor swimming pools

The presence of chloroform as the result of disinfection with sodium hypochlorite was demonstrated in the water and ambient air of indoor swimming pools. Environmental monitoring was performed in 12 indoor swimming pools in northern Italy and the level of human exposure was assessed. Biological monitoring performed by gas chromatography on human plasma and alveolar air samples evidenced that the uptake of chloroform in swimmers varies according to the intensity of the physical activity and age. The elimination of chloroform in alveolar air in one subject showed a very short half-life (from 20 to 27 min) and a complete clearance within 10 h after the end of exposure.

Indoor exposure to perchloroethylene (PCE) in individuals living with dry-cleaning workers

Perchloroethylene (PCE) is the most widely used solvent in dry-cleaning; it is toxic to the liver, kidney and central nervous system and may be a human carcinogen. PCE levels in the ambient air of dry-cleaners' homes were measured, and samples of end-exhaled air (alveolar air) from subjects who were not themselves occupationally exposed, but who were members of the household of dry-cleaners were compared with samples from the general population. Thirty apartments were visited housing dry-cleaners and their families, and located well away from the dry-cleaning premises. Indoor air samples and alveolar air samples were collected contemporaneously from the dry-cleaners (36) and members of their household (34). The same sampling procedure was followed in 25 private homes where samples of alveolar air were collected from 41 subjects who were not occupationally exposed and who acted as control group. All the samples were analysed by direct-injection gas-chromatography. PCE levels in dry-cleaners' homes proved to be significantly higher than in control houses (geometric means: 265 vs. 2 micrograms/m3, P < 0.001). PCE levels in the alveolar air exhaled by dry-cleaners, their family members and control subjects were statistically different (geometric means: 5140, 225 and 3 micrograms/m3, respectively; P < 0.001). PCE is a ubiquitous substance in indoor air, but is present at higher concentrations in apartments where dry-cleaners and their families live. Biological monitoring of PCE in alveolar air confirms that family members of dry-cleaners are more exposed than the general population.

Occupational and environmental exposure to perchloroethylene (PCE) in dry cleaners and their family members

Perchloroethylene exposure in 28 dry-cleaning establishments and in 25 homes occupied by dry cleaners in Modena, Italy, was investigated. Environmental air samples and alveolar air samples from dry cleaners (n = 60) and from their family members (n = 23) were collected. The degree of perchloroethylene on the dry-cleaning premises varied widely from establishment to establishment. Spot sampling ranged from 0.6 to 75 mg/m3, whereas sampling by personal passive dosimeters ranged from 2.6 to 221.5 mg/m3 (8-h time weighted average values). Perchloroethylene in alveolar air samples collected at the end of the work day correlated closely with the 8-h time weighted average values (r = .750, p = .001), and correlated also with alveolar air samples collected at home in the evening (r = .665, p = .001) and the following morning (r = .549, p < .001). Perchloroethylene levels inside the homes of dry cleaners appeared significantly higher than in 29 houses selected as controls (Mann Whitney U test, p < .001). Perchloroethylene in alveolar air samples collected at home suggests that nonoccupational exposure to perchloroethylene for family members of dry cleaners exists.

Perchloroethylene exposure can induce colour vision loss

We evaluated colour vision in 35 dry-cleaners exposed to perchloroethylene (PCE) and in a paired number of controls matched for sex, age, alcohol consumption and cigarette smoking. A subclinical colour vision loss, mainly in the blue-yellow range, was present in dry-cleaners. This effect was related to PCE exposure levels, and appeared at environmental concentrations of the solvent well below the current exposure limits for exposed workers. The results suggest that PCE exposure, even at low environmental levels, can induce a dose-related impairment of colour vision.

Trace elements in saliva and dental caries in young adults

The results of a study on Zn, Cu, Ca and Mg content in whole saliva and supernatant of young adults in relation to caries prevalence are reported. A total of 225 university students were selected for the study on the basis of voluntary participation. The salivary electrolytes showed a high intersubjective variability and females had significantly lower levels than males. In whole saliva, the trace elements were highly correlated, whereas the correlations were weaker in the supernatant. The ratio supernatant/whole saliva varied between subjects and according to the examined electrolytes. No association could be found between the measured trace elements and DMFT. When we analysed the relation with recent caries experience in the subgroup of subjects undergoing oral examinations for at least 1 year, we found evidence that the Zn/Cu molar ratios in whole saliva were significantly decreased in subjects with more than three decayed teeth compared with those with no caries (1.54 vs. 1.11, P < 0.05). No significant association was found when supernatant was analysed. We conclude that the electrolytes' levels in whole saliva might be more adequate than the levels in supernatant to evaluate the relationship with caries.

Chloroform in alveolar air of individuals attending indoor swimming pools

Alveolar air samples were collected from 163 subjects at indoor swimming pools and from 77 nonexposed subjects. Chloroform was present in all samples collected from exposed subjects (median = 695.02 nmol/m3). It was found at very low levels in 53% of samples from nonexposed subjects. Alveolar air chloroform levels from people attending indoor swimming pools (mean value within each sampling session) were correlated with environmental air concentration (r = 0.907, p = .002). Analysis of variance showed that levels of chloroform in alveolar air depend on environmental air concentration, age, intensity of the sport activity, and kind of swimming. Chloroform levels in samples collected from competitive swimmers versus nonswimming visitors were different (F = 10.911, p = .001). Moreover, their pattern of swimming may affect chloroform concentration in alveolar air. The analysis of chloroform in alveolar air assesses indoor exposure in healthy subjects simply and at low cost.

Plasma chloroform concentrations in swimmers using indoor swimming pools

This study evaluated swimmers and visitors who were exposed to chloroform (CHCl3) at three indoor swimming pools in Modena, Italy. Chloroform was measured in plasma samples of 127 subjects present at the pools and in 40 nonexposed subjects. The analyses were performed by head-space gas chromatography. Chloroform was present in all samples collected from the 127 subjects who attended the pools (median = 7.5 nmol/l; range = 0.8-25.1 nmol/l). Agonistic swimmers who trained for competitions showed a significantly higher mean value of plasma CHCl3 than nonagonistic swimmers and visitors. Plasma CHCl3 levels were significantly correlated with (a) CHCl3 concentrations in water and in environmental air, (b) the number of swimmers in the pools, and (c) the time spent swimming. Covariance analysis showed that plasma CHCl3 levels also depended on the intensity of the sport activity (total explained variance = 67.4%).

[Evaluation of fluoride content in Modena water]

The Authors confirm the importance of fluoroprophylaxis in the prevention of Dental caries. They analyze the main methods of fluoroprophylaxis pointing out the systemic fluoroprophylaxis, effected by means of water fluoruration, as the best one for a valid prevention of dental caries on a large scale. In view of such a kind of fluoroprophylaxis in our country the Authors considered quite interesting to effect a research about the amount of fluoride in the waters of the district of Modena. The whole of results are reported.

[Presence of bacteria belonging to the genus Yersinia in surface and ground water]

Yersinia strains in surface waters and ground waters. After reviewing national and international writing regarding the prevalence of yersiniae in surface waters and ground waters, the Authors report data about a research carried out in the province of Modena (Italy). Over a period of 16 months (february 1986-may 1987) 89 water samples were examined (55 samples collected from rivers and streams and 34 from wells). During every sampling session two samples were collected; one was taken in a sterile bottle (1000 cm3), one by means of the Moore tampon, allowed to float in the stream for 48 h. Yersinia strains were isolated from 37% of the water samples; 33 samples gave a positive result. Forty one strains were isolated on the whole; filtration method by Millipore membrane appeared the most suitable technique in order to obtain a good recovery rate. Y. enterocolitica appeared the most represented species (43.8%), followed by Y. intermedia (21.9%) and Y. fredericksenii (17.1%). Five atypical strains were isolated, while no strain belonging to the species Y. kristensenii has been evidenced. No relevant difference in Yersinia presence appeared between surface waters and ground waters. No human pathogenic strain has been evidenced and all the isolates appeared belonging to environmental biogroups, serogroups and phage-types.

[Exposure to chloroform in persons frequenting an indoor swimming pool]

Exposure to chloroform (CHCl3) in indoor swimming pool swimmers. CHCl3 presence has been evidenced many times in water and air of indoor pools as a consequence of water chlorination with sodium hypochlorite or other chlorinated disinfectants. In previous studies CHCl3 in environmental air appeared at a high concentration within one meter over the surface of the water and was correlated to the number of swimmers inside the pool. CHCl3 has also been evidenced in blood serum samples of people present at the swimming pool, at different levels depending on: the concentration in the environmental air, the intensity and the length of the sport activity and the number of swimmers in the pool. At the end of the swimming session CHCl3 concentration tends to lower quickly and usually is no longer detectable within half an hour. Other studies have evidenced CHCl3 in breath samples (alveolar air) of a volunteer subject who swam one hour every day in an indoor pool in Modena. The spirometric parameters of the same subject were evaluated in order to estimate his CHCl3 uptake during time spent at the swimming pool, both resting and swimming in different modes. In the present paper the A.A. report data about CHCl3 exposure, intake and uptake bin five agonistic swimmers (three males and two females), members of the same sport association, and regularly attending the same indoor swimming pool in Modena. The five subjects have been examined during four different sessions. Within every session the samples were collected in five different moments according to the following scheme: 1) Hygiene Institute: samples of blood, alveolar air, environmental air. 2) Swimming pool, after 1 hour sitting near the pool edge: samples of alveolar air, environmental air (within 1 m on the water surface). 3) Swimming pool, after 1 hour swimming: samples of blood, alveolar air, environmental air (within 1 m on the water surface). 4) Hygiene Institute, 1 hour after the end of the swimming time: samples of alveolar air, environmental air. 5) Hygiene Institute, 30 min after the previous sampling: samples of alveolar air, environmental air. Spirometric parameters have been evaluated in every subject, after resting and swimming (point 2 and 3). CHCl3 uptake has been calculated using the following formula: U = V(CI--CA)t where: U = uptake (microgram/h) V = pulmonary ventilation (l/min) CI = inspired (environmental) concentration (microgram/m3) CA = alveolar concentration (microgram/m3) t = exposure time (min) CHCl3 levels after swimming always appeared quite high; however low levels were evidenced also before exposure (point 1).(ABSTRACT TRUNCATED AT 400 WORDS)

[Evaluation of the immunoenzymatic method for the study of rubella virus antibodies in relation to the traditional hemagglutination-inhibition test]

The authors compare enzyme immunoassay for rubella virus antibodies (ELISA) with a customary test, hemoagglutino-inhibition test. 392 sera samples were collected from healthy boys and girls; 304 girls had been vaccinated five years before. The authors research sensitivity and specificity of ELISA in comparison with hemoagglutino-inhibition test; ELISA proves to have a high degree of sensitivity, but it is less specific than hemoagglutino-inhibition test. This underlines the possibility to have false positive results from ELISA which appears a very useful test for epidemiological screenings, but less reliable for the diagnosis of recent rubella infections. As ELISA results are usually expressed in Optical Density values, and hemoagglutino-inhibition test results in antibodies dilutions, the authors have performed a graphic analysis; Optical Density values were evaluated in correspondence to the log2 of reciprocal dilutions of hemoagglutino-inhibition test positives. There is evidence of a linear correlation; in this way one can transform ELISA values in their correspondent antibodies dilutions, which are easily understood by general physicians.

[Evaluation of the immunoenzymatic method for the study of anti-Toxoplasma gondii type IgG antibodies in relation to the indirect immunofluorescence method]

The indirect immunofluorescence assay for detecting anti-Toxoplasma gondii serum IgG is compared with the enzyme immunoassay employing a commercial kit for IgG. Enzyme immunoassay test shows a high degree of sensitivity, but it is less specific in comparison with indirect immunofluorescence test. There is evidence of direct relation between values expressed in Optical Density and reciprocal dilutions of sera; moreover a direct relation appears between Optical Density values and International Units/cm3. The authors claim that is advisable to give enzyme immunoassay test results, not only as Optical Density values, but also as antibody dilutions and International Units/cm3.

[Determination of IgM anti-Toxoplasma gondii antibodies with the immunoenzymatic (IE) method]

The immunoenzymatic method for the research of specific IgM antibodies anti-Toxoplasma gondii is compared to the traditional methods of dosage: absorption of the IgG on staphylococcus and depolymerization of the IgM with 2-mercaptoethanol. The sensitivity and specificity of this method have been analyzed on a sample of 193 serums in order to consider the probabilities of false positive and negative reactions. The simplicity of method and the possibility of expressing values as reciprocal of the maximum dilution make this an elected method for the research of specific IgM. The reduced quantity of serum necessary in carrying out the test represents such a prerogative as to make this method particularly fit for researches on new-born babies.