Survey of domestic accidents in the elderly in the Province of Genoa (northern Italy).

INTRODUCTION: Accidents in the home are a major public health issue in most industrialised countries, as they are a frequent cause of injury and death. Moreover, since a considerable portion of such accidents involve elderly people, it is important to assess their social impact in this population. In Italy, the available data indicate that well over 3 million people per year suffer accidents in the home, and that this number is rising. The aim of the present study was to evaluate the number, characteristics and causes of domestic accidents among the elderly. MATERIALS AND METHODS: The study population was made up of subjects of both sexes aged between 65 and 92 years admitted to first aid units and emergency departments of hospitals in Genoa. The investigation was conducted by means of an ad hoc questionnaire designed to record the circumstances of the accident, the functional capacity of the subject involved, any risky behaviour enacted and the safety profile of the subject's home. RESULTS: The study enrolled 111 voluntary participants: 62 women and 49 men. At the time of the accident, subjects were engaged in the following activities: housework (36.9%) "rest" (14.5%), ablutions (10%), gardening (9%), leisure activities (8.1%), eating and drinking (2.7%). The most common injuries were bruises (39.6%), followed by fractures (23.4%) and cuts (23.4%); the frequency of other, some time more severe injures (burns, poisoning, asphyxia, crush injuries, etc.) was,fortunately, very low. Anyway, taking into account their consequences, their surveillance and prevention is very important. Most subjects were deemed to be in good health and, in 76% of cases, the safety profile of their houses proved to be satisfactory. DISCUSSION AND CONCLUSIONS: The data collected during this survey are in line with those yielded by national and international studies. They show that the elderly are very vulnerable to domestic accidents and that, even in the event of only slight injury, the management of elderly victims requires a strong organisational commitment on the part of relatives and considerable financial resources for healthcare services. Falling proved to be the main cause of injury. Clearly, efforts to reduce the cost of accidents in the home should aim to implement preventive intervention among elderly people, since the elderly population is destined to grow as a result of increasing life expectancy. In particular, preventive action should focus on reducing the incidence of falls by eliminating risk-related structural features in domestic settings as far as possible and by raising public awareness of the problem through health education campaigns.

Surface disinfection: evaluation of the efficacy of a nebulization system spraying hydrogen peroxide.

INTRODUCTION: The study assessed the efficacy of a system of nebulization of a hydrogen peroxide-based solution for surface disinfection. METHODS: Different concentrations (1, 2 and 4 ml/m3) of the same disinfectant solution (active principle: hydrogen peroxide) were nebulized inside a 50 m3 experimental environment. Sampling was carried out on both horizontal and vertical surfaces, and the total bacterial load at 37 degrees C was determined by means of direct contact with Rodac plates. The disinfection efficacy of the system was evaluated by comparing the total bacterial load measured on the surfaces before and after treatment. Statistical analysis was performed by means of Stata/SE9 software. RESULTS: The percentage reduction in the mean bacterial load on horizontal surfaces as a result of treatment at concentrations of 1, 2 and 4 ml/m3 proved to be 54.9%, 70.9% and 86.9%, respectively. With regard to vertical surfaces, the percentage reduction was 100% in all experimental conditions. DISCUSSION AND CONCLUSIONS: The system tested proved to be efficacious in disinfecting surfaces inside environments of 50 m3 in volume. It could therefore be used to disinfect surfaces in hospital and community settings. In healthcare facilities, disinfection by means of nebulization systems could help to reduce the risk of spreading nosocomial infections.

Response of CFU-GM to increasing doses of rhGM-CSF in patients with aplastic anemia.

The aim of this study was to test whether large amounts of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) are capable of promoting the growth of hemopoietic progenitors from patients with marrow failure. For this purpose 0.1, 100, 1000, 10,000 and 20,000 ng/ml of rhGM-CSF were added to 10(5) light-density (adherent cell-depleted) bone marrow cells from 9 normal controls and from 52 patients with aplastic anemia, 25 cases of which were transfusion-dependent (Tx-D) aplastic anemia (AA) and 27 of which were transfusion-independent (Tx-I) aplastic anemia (AA). A dose-dependent increase of granulocyte-macrophage colony-forming units (CFU-GM) was observed in healthy donors, from 81 to 247 colonies at 0.1 and 1000 ng/ml of rhGM-CSF, with a plateau thereafter. Tx-I AA patients showed the best increase of CFU-GM in response to colony-stimulating factor, from 0.1 to 32.7 mean colonies at 0.1 and 20,000 ng/ml of rhGM-CSF, and the increment was greater when compared to controls. The ratio of CFU-GM grown from these patients and controls was 1:810 at 0.1 ng/ml of rhGM-CSF and 1:7.9 at 20,000 ng/ml. Eleven patients were studied at diagnosis; there was no in vitro response to rhGM-CSF (0 and 1.8 mean colonies/10(5) cells at 0.1 and 10,000 ng/ml). Overall, Tx-D AA patients showed minimal increments of CFU-GM growth at very high doses of rhGM-CSF. Two suggestions come from this study: 1) maturation of CFU-GM from recovering AA patients appears to require larger doses of GM-CSF than normal controls, and 2) very high doses of rhGM-CSF have little or no effect on CFU-GM growth in AA patients. This may be relevant for clinical studies designed to improve hemopoiesis in patients with marrow failure.

Long-term marrow culture in patients with aplastic anemia compared with marrow transplant recipients and normal controls.

UNLABELLED: Patients with severe aplastic anemia (SAA; n = 46) were studied in long-term bone marrow culture (LTBMC) systems and compared with allogeneic marrow transplant (BMT) recipients (n = 16) (within 30 days following BMT) and normal control patients (n = 12). SAA patients were divided in two groups: transfusion-dependent (Tx-D) SAA patients (group A; n = 15) and transfusion-independent (Tx-I) patients after treatment with antilymphocyte globulin (group B; n = 31). Cultures were analyzed at three levels: stromal layer (SL) formation (score: 0, no SL; 1, half confluent SL; and 2, confluent SL), number of nucleated cells in suspension, and growth of CFU-GM colonies. SL formation was rapid and complete in SAA patients, groups A and B (mean score on day 14: 1.3 and 1.4), similar to controls (mean score on day 14: 1.3), whereas an impairment of SL formation was seen in BMT recipients (mean score on day 14: 1.0). The number of nucleated cells in suspension increased significantly on day 7 of culture in controls (7.6-fold), significantly more than in BMT and SAA patients, and declined thereafter. Colony formation was also significantly increased on day 7 in Tx-I SAA patients, BMT recipients, and normal controls (4-, 5-, and 16-fold, respectively), lasting respectively 2, 3, and 4 weeks. Increments of colony formation were also obtained in Tx-D SAA patients, but in the first week of culture only. IN CONCLUSION: 1) a significant impairment of SL formation was seen in BMT recipients, but not in SAA patients; 2) a significant increment of granulocyte-macrophage colony-forming units (CFU-GM) growth can be obtained in patients with marrow failure early after starting long-term culture; 3) the number of CFU-GM grown in these culture conditions from Tx-I SAA patients parallels the number of progenitors from early post-BMT recipients; and 4) progenitor cells from Tx-D SAA patients are not only reduced in numbers, but also exhibit a poor ability to survive in LTBMC.

Circadian reduction of chromium in the gastric environment.

Samples of gastric juice from variously treated subjects efficiently reduced hexavalent chromium and decreased its mutagenicity. Chromium reduction was due to thermostable components of gastric secretions and was favoured by the acidity of the intragastric environment. The circadian monitoring of pH and of chromium reduction, as assessed by colorimetric analysis at hourly intervals, showed a basal activity (less than 10 micrograms/ml gastric juice) during the night and interdigestive periods, and peaks (tens of micrograms/ml) during the 3-4-h periods after each meal. Assays in the Ames reversion test confirmed that the decrease in mutagenicity of sodium dichromate produced by gastric juice was significantly enhanced after meals. This physiological mechanism is expected to provide an important protective barrier against the oral toxicity of this metal, and may explain its lack of oral carcinogenicity.

Genotoxic activity and potency of 135 compounds in the Ames reversion test and in a bacterial DNA-repair test.

Compounds of various chemical classes were comparatively assayed in the Ames reversion test with his- S. typhimurium strains TA1535, TA157 , TA1538, TA98, TA100, and, in part, TA97 , and in a DNA-repair test with trp- E. coli strains WP2 (repair-proficient), WP67 (uvrA- polA-) and CM871 (uvrA- recA- lexA-). A liquid micromethod procedure for the assessment of the minimal inhibitory concentration (MIC) of test compounds, using the same reagents as the Ames test, was set up and calibrated in its technical details. Other techniques (spot test and treat-and-plate method) were applied to a number of compounds in order to obtain more complete information on their DNA-damaging activity in E. coli. From a qualitative standpoint, the results obtained in the reversion test and in the DNA-repair test (liquid micromethod) were overlapping for 96 (59 positive and 37 negative) out of 135 compounds (71.1%). There was disagreement for 39 compounds (28.9%), 9 of which were positive only in the reversion test (8 requiring metabolic activation and 5 genotoxic in the treat-and-plate method). 30 compounds were positive only in the lethality test, showing a direct DNA-damaging activity, which in half of the cases was completely eliminated by S9 mix. Although the experimental protocol intentionally included several compounds already reported as nonmutagenic carcinogens or as noncarcinogenic mutagens, the overall accuracy was 64.5% for the reversion test and 72.4% for the DNA-repair test, as evaluated for 75 compounds classified according to their carcinogenic activity. Quantitation of results was obtained in the Ames test by relating the net number of revertants to nmoles of compound and in the DNA-repair test by means of a formula relating the difference and ratio of MICs in repair-proficient and -deficient bacteria to nmoles of compound. Following these criteria, the genotoxic potency varied over a 4.5 X 10(7)-fold range among compounds positive in the reversion test and over a 6 X 10(9)-fold range among compounds damaging E. coli DNA. The genotoxic potencies in the two bacterial systems were correlated within the majority of the chemical classes under scrutiny.

Relationships between metabolic deactivation of ICR compounds and their differential mutagenicity in bacteria and cultured mammalian cells.

Preparations of Chinese hamster ovary (CHO) cells decreased the genotoxicity of 3 ICR compounds (ICR 191, ICR 191-OH and ICR 170-OH), while they did not affect the genotoxicity of ICR 170 in the Salmonella reversion test nor in a DNA-repair test in E. coli. These data may contribute towards the explanation of the lack of activity of the two hydroxylated compounds in the CHO/HGPRT forward mutation system, as well as the different rank of mutagenicity of the two chloroethyl compounds in bacteria (ICR 191 greater than ICR 170), compared to cultured mammalian cells and in general to eukaryotic cells (ICR 170 greater than ICR 191).

[Multicentric survey on hygienic aspects in private dental practice]. / Indagine multicentrica sugli aspetti igienico-sanitari legati all'assistenza odontoiatrica privata.

The aim of this research was to evaluate the knowledge of cross-infection hazards in private dental practices, and their control procedures. The survey, carried out by questionnaire in 11 Italian cities, showed that dental personnel do not completely follow the main procedures for infection control. The interviewed subjects usually wear gloves (95.5%), masks (90.1%) and glasses (91.2%), less frequently caps (23.9%) and coats (54.9%). They use steam sterilizers (92.9%) and periodically check the effectiveness (80.6%). Regarding individuals protection, 20.5% is not vaccinated against HBV and only 55.2% of those previously vaccinated has checked their immunity. Moreover, the majority of subjects underestimate the infection hazards especially for air-transmitted diseases.

Detection of animal viruses in coastal seawater and sediments.

Animal viruses, predominantly enteroviruses, were detected in shallow water at bottom depths and in clastic marine sediments. Viruses accumulated in sandy and slimy deposits of the sea bottom near the shore and could be easily released into water by means of simple mechanical shaking.

Preliminary results of oral influenza vaccination with live attenuated viruses.

151 subjects, vaccinated by oral route with live influenza viruses attenuated in the USSR (bivalent A/England/42/72-B/Hong Kong/5/72 vaccine) and 66 non-vaccinated cohabitants have been studied. The vaccination did not cause any important side effect. The vaccine showed good immunizing activity: HI antibodies appeared in 91% of the subjects initially devoid of antibodies against A type and in 70% against B type. No viral diffusion occurred from the vaccinated to the cohabitants. During an A/Port Chalmers/1/73 epidemic the morbidity (3.3%) among the orally vaccinated patients turned out significantly lower than that among the non-vaccinated cohabitants (12.1%). The protection index was 72.6%.

Oral influenza vaccination with live attenuated viruses. 2. Protective efficacy during a type A(H3N2) epidemic.

151 subjects, orally immunized with live attenuated influenza virus of the Institute for Viral Preparations of Moscow (bivalent A(H3N2) England 72 and B vaccine) and 66 non vaccinated cohabitants were studied during an epidemic caused by strains similar to A/Port Chalmers/73. 5 cases of disease were virologically or serologically ascertained among the vaccinated (morbidity 3.3%) and 8 among the non-immunized cohabitants (12.1%). The difference turned out statistically significant. By comparing the incidence of the disease in the two groups the protection resulting from vaccination was 72.6%.

Oral influenza vaccination with live attenuated viruses. 1. Acceptability, immunogenicity and transmissibility.

151 subjects were vaccinated by oral route with live attenuated influenza virus vaccine, bivalent A and B, prepared in the U.S.S.R. Each subject received two vaccine doses with a 10-day interval. Vaccination did not bring about any important clinical manifestation and the incidende of the symptoms after vaccination was not significantly different in comparison with what observed in the non vaccinated cohabitants. The vaccine showed good immunizing activity: among the subjects who before vaccination, had a HI antibody titer lower than 1/16, 91% responded for A type, and 70% for B type. Several subjects with starting low antibody titers also responded to vaccination. Among the cohabitants of the vaccinated no influenza virus infections were serologically ascertained, thus showing that no transmission of the virus from the vaccinated to the cohabitants occurred.