The prevention of doping and the improper use of drugs and food supplements in sports and physical activities: a survey on the activity of the prevention departments of Italian local health authorities

INTRODUCTION

Doping is an important public health problem widespread not only among elite athletes, but also among amateur and recreational athletes and the general population. In Italy the introduction of doping prevention within the Essential Levels of Care (LEA) with the DPCM 12/1/2017 represents a crucial step towards the implementation of education and health promotion interventions. In this context, the Departments of Prevention (DP) of the Local Health Authorities (LHA) have to play a fundamental role, becoming the cultural and operational reference on this issue. As part of the "Doping prevention: development of a permanent educational tool coordinated by the National Health Service Prevention Departments" project, funded by the Italian Ministry of Health, a survey was conducted on the activities carried out by the DP regarding doping prevention and improper use and abuse of drugs and food supplements in sports and physical activities, as a basis for the harmonization of organizational structures and prevention programs and the creation of a collaboration network at a regional and national level.

METHODS

A semi-structured questionnaire consisting of 11 questions, prepared on an electronic platform, was sent to the DP of all the Italian LHA.

RESULTS

A total of 38 DP out of 131 (29%) completed the questionnaire, with representation from all regions. 42.1% of DP carried out or are still running programs for the prevention of doping, a percentage that decreases to 27% considering the programs for the prevention of misuse and abuse of drugs and food supplements in sports and in physical activities; in less than half of the DP, 37.5% and 41.7%, respectively, dedicated funds have been allocated. The professionals most involved in prevention of doping are the Specialists in Sport Medicine (81.3%) followed by Specialists in Hygiene (43.8%) and Psychologists (37.5%), while Health Care Assistants (50%) are the professionals most involved in the prevention of the improper use of drugs and food supplements, followed by Specialists in Hygiene and Specialists in Sport Medicine (40%). Most of the DP (71.9%) believe that the introduction of programs to prevent and counteract doping in the LEA will have repercussions on their approach against doping.

CONCLUSIONS

The survey, although conducted on a limited sample, has provided an important framework relating to programs for the prevention of doping and the misuse and abuse of drugs and food supplements in sports and in the physical activities carried out by DP. A remarkable heterogeneity has been highlighted, both at national and regional level. It is urgent to provide DP with homogeneous and effective organizational models and adequate operational tools, paying particular attention to the training of all the professionals involved. It is also essential to implement permanent monitoring tools.

Implementation of Acute Flaccid Paralysis Surveillance in Emilia-Romagna, Italy: 2018-2019 analysis

Problem

Acute flaccid paralysis (AFP) active surveillance is the gold standard in polio eradication process. Italy was classified in 2017 at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. The aim of this study was to restore an adequate level of AFP surveillance in Emilia-Romagna Region.

Description of the Problem

The Emilia-Romagna's Reference Centre for AFP surveillance, in collaboration with the regional Public Health Service identified a collaborative network for AFP Surveillance by analysing the 2015-2017 Hospital Discharge Registers in all region's hospitals. The surveillance protocol was reviewed with the development of a computerized system of Active Surveillance-Zero Reporting sent by e-mail to doctors in the network every 15 days since October 2018. The goal was to restore the AFP notification system to meet WHO requirements sensitivity, completeness of case investigation, completeness of follow-up and to monitor the active surveillance program adherence.

Results

The active surveillance network was composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the region. By the end of 2019, the mean response to each e-mail was 48.5% (SD 7.5%); 7 AFP cases have been reported; 85.7% received a full clinical and virological investigation and 83.3% completed the 60 day's follow-up. The final diagnosis of the cases was: 3 Guillain-Barre, 1 transient polyneuritis after HAV vaccination, 1 neuromyopathy from chronic disease, 1 acute myelitis in patient with DADA2. In 2 cases the paralysis persisted after 60 days.

Lessons

In 2019, the active surveillance system reached sensitivity, completeness of case investigation and follow-up required. Intervention had no expenses, is easily reproducible, created a direct collaboration between clinical colleagues in the network and the reference center which restored adherence to AFP surveillance.

Key messages

This work proposes how to improve AFP surveillance in a setting with low polio risk perception due to the absence of cases. Additionally, it reinforces the importance of direct collaboration/teamwork between institutions, regional reference centres and clinicians.

High hydrostatic pressure activity on the disinfection of clams artificially contaminated with feline calicivirus

BACKGROUND

The contamination of shellfish with gastroenteric viruses may cause outbreaks because they are often eaten raw or under-cooked. High-hydrostatic pressure treatments have already proven to be effective in reducing high viral load in shellfish samples. The objectives are the assessment of the viral load reduction of contaminated clams using HHP treatments at different pressures and times and the study of the changes caused by these treatments in some food physical parameters.

METHODS

Clams were contaminated with a solution containing Feline Calicivirus; they were closed in envelopes and treated with 300, 400, 500, 600 MPa for 1, 3, 5, 7 min for every pressure value. After the treatment the residual viral titre was calculated. The texture parameters were obtained after treating clams samples at the same pressure values but only for 3 and 7 min and analysing them with a TPA test.

RESULTS

HHP treatments of 500 and 600 MPa were sufficient to cause a total inactivation at every timelength considered while with 300 and 400 MPa after 1 min, concentrations of 1.13 and 0.55 respectively were found. In general hardness and gumminess tend to increase after the treatment whereas springiness and cohesiveness decrease a bit.

CONCLUSIONS

HHP treatments showed good sterilization ability against FCV but it's necessary to consider that FCV has a lower resistance to disinfection than Human norovirus. Texture changes are in line with what is reported in literature.

[Microbiological aspects of pool water]

It is well known that there is an elevated risk of diffusion of pathogenic micro-organisms in swimming pools. Preventive measures aimed at protecting the health of swimmers are complex because of the variety of micro-organisms involved, the different ways in which these can be transmitted and the involvement of both aquatic and environmental factors. In industrialised countries, the circulation of many pathogens which were common in the past has progressively decreased in recent years; in contrast, infections caused by emerging pathogens such as Pseudomonas, atypical mycobacteria, Aeromonas, Legionella, Cryptosporidium, Norwalk virus, adenovirus and rotavirus have increased in frequency. Such infections affect not only the gastrointestinal tract but also other body sites, in particular the skin, conjunctiva, respiratory tract and auditory apparatus. Opportunistic pathogens capable of causing potentially serious infections in debilitated and immunocompromised subjects may also be involved. It is clearly necessary, therefore, that preventive interventions and effective monitoring programs, regarding both pool water and environmental quality, be implemented in all swimming facilities.

Investigation on virucidal activity of chlorine dioxide. experimental data on feline calicivirus, HAV and Coxsackie B5

INTRODUCTION

The aim of this study was to evaluate the efficacy of ClO2 with regard to viruses which show a particular resistance to oxidizing agent such as HAV and Norwalk and Norwalk-like viruses, and which play an important role in the epidemiology of viral foodborne diseases. In the food industry, disinfection of processing systems and equipment is a very important instrument to prevent secondary contamination and to guarantee food safety. Among disinfectants, chlorine dioxide (ClO2) presents a good efficacy at wide range of pH values, its action is rapid and generates few reaction byproducts if compared to hypoclorite. Experimental studies have highlighted that ClO2 shows a good bactericidal activity and it is also active towards viruses. Furthermore, the low concentrations and low contact times required to obtain microbial load reduction are favourable elements for the application of this compound in the industrial sanitizing practices.

METHODS

As it is impossible to cultivate the Norwalk virus in vitro, we tested the resistance of Feline calicivirus (F9 strain) vs. ClO2, in comparison with HAV (strain HM-175) and Coxsackie B5. Chlorine dioxide was used at concentrations ranging from 0.2 to 0.8 mg/l in water solution, at pH 7 and at +20 degrees C. Viral suspensions were added to disinfecting solution and, at pre-set times, were sampled to undergo to titration after blocking the disinfectant action with thiosulphate 0.05 M. On the basis of the data obtained, for each virus and in relation to different concentrations, mean reduction times were calculated for 99%, 99.9% and 99.99% using the regression analysis model.

RESULTS

As regards Feline calicivirus, at a concentration of 0.8 mg/l of ClO2, we obtained the complete elimination of the viral titre in 2 min while 30 min were required at concentrations of 0.2 mg/l. Coxsackie B5 showed a similar behaviour, being completely inactivated in 4 min with 0.4 mg/l of ClO2 and after 30 min at a concentration of 0.2 mg/l. Inactivation was quicker for HAV, which was eliminated after only 30 sec at a concentration of 0.8 mg/l and after 5 min at 0.4 mg/l.

CONCLUSION

Our data show that for complete inactivation of HAV and Feline calicivirus, concentrations > or = 0.6 mg/l are required. This observation is true for Coxsackie B5 too, but this virus has shown a good sensitivity at all concentration tested according to regression analysis results. For Feline calicivirus and HAV, at low concentrations of disinfectant, prolonged contact times were needed to obtain a 99.99% reduction of viral titres (about 16 and 20 minutes respectively).

[Integrate cell culture--PCR (ICC/PCR) in viruses researches in environmental and food samples. Note I]

We carried out an experimental work integrating cell-culture and PCR to follow the HAV replication, to verify the PCR positiveness times and to confirm infectious viral particles presence. In tests HAV strain H59-175 was used. We proceeded to an initial valuation of the lowest viral concentration detectable by PCR. With viral titres between 10(5)-10(7) PFU/ml, the highest positive dilution resulted 10(-4)-10(-5). Then the 1 log lower dilution was inoculated in cell culture. At fixed times we proceeded to take surnatant and lisate samples for PCR test. After cell culture integration, positiveness was obtained in 72-120 hours against the 10-18 days necessary for CPE appearance.

[The concentration of viruses in water using the tangential flow ultrafiltration. Recovery effectiveness in experimental conditions]

Poliovirus 1 concentration tests were carried out in artificially contaminated water by tangential flow ultrafiltration with Polisulfone filters 100000 MWCO. The tests were performed in 1 and in 20 liters of waters. The filters were conditioned and eluted respectively with Beef extract 3% and with glicina 1% at pH 7 and pH 9. The recovery mean using Beef extract resulted properly good, about the 83% and comparable to percentages we obtained in previous works with filters in cellulose nitrate and Virosorb filters. The viral recovery was low using the glicina for conditioning and eluting the filters.

[Air pollution and mortality and hospital admission for respiratory disease in Parma on 1992-2001 period]

A study into the effects of atmospheric pollution on the health of people living in the city of Parma (population 170,000) shows motor vehicle traffic of average density and light industrial activities that have little impact on air pollution. General mortality and hospitalisation for all causes and for DRG specific were considered as sanitary events. The day values of the total PT, PM10, SO2 and NO2, CO and benzene were analysed. In addition, atmospheric conditions and outbreaks of flu were considered. The study results for the period 1992-2001 show quite moderate pollution levels with the sole exception of PM10 that shows average values often higher than 40 microg/l. An analysis of the associations between mortality and climatic parameters shows the role of temperature with RR equal to 1.0064 (CI95% 1.0046-1.0082) and epidemics of influenza with RR 1.042 (CI95% 1.0219-1.0671). As regards the pollution parameters, the total PT and SO2 turned out to be related to increases in mortality of respectively 0.6% for 100 microg/m3 of PT and 1.72% for 50 microg/m3 of SO2 while the NO2 turned out to be related to an increase in hospitalisations of 1.9% for 10 microg/m3 of NO2.

[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.

[Comparative study on HAV and Poliovirus 2 inactivation cinetics with peracetic acid]

Hepatitis A virus and Poliovirus 2 inactivation tests were carried out using three peracetic acid concentrations (160, 320 and 640 mg/l) at different pH condition and at +20 degrees C temperature. HAV HM-175 strain was grown in FRhK4 cells and titrated in PFU (plaque technique) and the Poliovirus 2 strain was grown in monkey kidney cells RC-37 and titred in TCID50. The viral titration reduction was determined in the space of an hour with the disinfectant contact at 10-15 minutes intervals. The results obtained with the hepatitis A virus have shown a good linear trend between viral titration and contact time at the highest concentrations without any particular pH influence. The complete viral activity absence was achieved after 30-60 minutes of contact at 640 mg/l concentration. As regards Poliovirus 2 a good linear trend was highlighted between titrations and times at all the concentrations in shorter times at pH acid. The complete viral activity absence was obtained with 640 mg/l concentration after 30 minutes at pH acid. The HAV seems to own a higher resistance than Poliovirus 2 and Poliovirus 1 too.

Biological markers in non-small cell lung cancer. Retrospective study of 10 year follow-up after surgery

BACKGROUND

The biological markers in non-small cell lung cancer (NSCLC) have been widely studied and encouraging results have shown that products of some oncogenes and other molecular markers can predict the aggressiveness of the disease and the outcome of the patients.

METHODS

To verify the reliability of these prognostic markers we have studied retrospectively the expression of c-erbB-2 and 67Ki (growth regulation), p53 (cell cycle regulation and apoptosis), bcl-2 (apoptosis) and CD31 and CD34 (angiogenesis) in 78 patients operated on for NSCLC with curative intent between January 1987 and December 1988 and followed up for 10 years. For the determination of the biological markers we have used the ABC (Avidin-Biotin-Peroxidase complex) immunohistochemical method. The Cox regression model was used for the univariate and multivariate analysis.

RESULTS

Nineteen patients (24%) were alive after 10 years and 59 (76%) died. The univariate analysis of the relationship between the 10-year survival and the expression of the markers was significant only for p53 (p=0.0097). Stratifying the patients according to the 3 histological subtypes (squamous cell carcinoma, adenocarcinoma and large cell undifferentiated carcinoma) the correlation between markers and survival pointed out that the only significant one was p53 (p=0.0459) in adenocarcinoma. In the same way considering the stages p53 was significant in stage IIIa (p=0.0357). The multivariate analysis emphasized that p53 was the only significant marker with respect to the 10-year survival (p=0.0091). Examining the histological groups significant was only p53 in adenocarcinoma (p=0.0192) and in large cell undifferentiated carcinomas (p=0.0290). This marker is also significant in pathological stage II (p=0.0271) and IIIa (p=0.0402). Apart from histology and staging the 10-year survival was 33% for p53 negative versus 10% for p53 positive. In patients with adenocarcinoma the 10-year survival was 40% for p53 negative and 6% for p53 positive.

CONCLUSIONS

In conclusion our results emphasize the importance of p53 as a prognostic factor in 10-year survival in patients with adenocarcinoma and in stage II and IIIa.

[Selective percutaneous thermorhizotomy in the surgical treatment of facial pain: personal considerations in light of 180 patients treated]

The purpose of this paper is to report the experience of the authors regarding the treatment of the primitive and secondary facial pains by Percutaneous Selective Thermorhizotomy (P.S.T.), 180 patients having been treated in the period of two years. The immediate postoperative control has obtained 156 good results (86,6%), 10 medium results (5,5%) and 14 (7,7%) unsuccessful. The failure of the P.S.T. in the treatment of the post-zosterian neuralgias, in the atypical and in the vascular pains is stated. The P.S.T. appears resolutive in the "tic doloreux" and secondary painful syndromes. A far follow up was performed (4 months-2 years) on 94 patients and a good result was kept at 64,2% among all of them. The shortage of the postoperative not expected collateral effect is also stated. The causes of unsuccessful and poor results (mistaking in the choice of the patient or tecnical mistaking) are discussed. It is finally suggested a careful personal value of the patient candidated to operation, in order to reduce the poor results and therefore improve the successful ones.