Active breaks: a strategy to counteract sedentary behaviors for Health Promoting Schools. A discussion on their implementation in Italy.

Abstract: School Active Breaks are short bouts of physical activity (5-15 minutes) conducted by appropriately trained teachers and delivered during or between curricular lessons. They are a good strategy to counteract sedentary behaviors, and a growing body of evidence shows that they can represent also a tool to promote and improve health, school wellbeing and academic achievements. On 19 February 2022, the Working Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health organized an Awareness Day on the effectiveness, usefulness and feasibility of School Active Breaks, opened to teachers, educators, school leaders, pediatricians, personnel from Departments of Prevention and Public Health and Health Policy-makers. During the event, the testimonies about the experiences already carried out in Italy showed that School Active Breaks are an effective intervention that each school can easily include in its educational offer and apply in any context.

Molecular Diagnosis of Emmonsia-Like Fungi Occurring in Wild Animals.

Using specific primers based on the ribosomal operon, positive DNA amplification was obtained from lungs of 11/215 tested small burrowing animals, both terrestrial and aquatic, and including frozen (n = 4) and formalin-fixed paraffin-embedded (n = 7) samples. The main species detected in Europe in mice, otters and river rats was Emmonsia crescens. Two strains from otters and weasels were Blastomyces parvus. Two Australian wombats revealed the presence of a hitherto unknown species of the geophilic genus Emmonsiellopsis.

Perinatal outcome in pregnant women with cancer: are there any effects of chemotherapy?

Cancer is the leading cause of death in women of reproductive age. During the last decades and especially in developed countries, the incidence of cancer is increasing dramatically, with an incidence of 1 in 1,000 pregnancies. This is mostly related to delay of pregnancy into the late reproductive years. The aim of this study was to investigate the outcome of pregnancy in women with diagnosis of cancer; in particular, neonatal morbidity and mortality, after in utero exposure to chemotherapy, were evaluated. A total of 59 singletons and one twin pregnancy complicated by cancer were followed at our tertiary centre over the last 15 years. A different treatment, based on surgery and/or chemotherapy in pregnancy or delayed to the postpartum period, was employed. There were 59 live births (97%), one foetal loss and one stillbirth at 28 weeks. The congenital malformation rate was 5% (n = 3). The rate of preterm birth was 83%. The mean birthweight and mean birthweight percentile were 2,098 g (740-3930) and 46 (7-93), respectively; 32% of neonates were small for gestational age (SGA). Dividing the population into treated or untreated with chemotherapy, the rate of SGA was not statistically significant different between the two groups. Our results showed that chemotherapy administered during the second trimester or later did not influence intrauterine foetal growth, but the high prevalence of SGA neonates in the two groups, exposed or not exposed to chemotherapy, suggests an influence of maternal cancer per se on foetal growth.

Epidemiology of Huntington disease: first post-HTT gene analysis of prevalence in Italy.

Huntington disease (HD) prevalence shows geographic variability and has been recently updated by taking into account the mutation diagnostic test. In Italy, the last epidemiological estimation was reported well before the HTT gene discovery and the availability of the corresponding genetic test. It reported a prevalence of affected subjects ranging between 2.3 and 4.8/100,000 in some restricted areas of Northern Italy. We have performed a service-based epidemiological analysis in a very restricted geographic area named Molise, where our institutions currently operate and represent the only point of reference for rare neuropsychiatric diseases. The estimated prevalence rate found was 10.85/100,000 (95% confidence interval (CI): 7.20-14.50), remarkably higher than that previously described before the gene test analysis was available, and expected to an increase of an additional 17% by 2030, because of Italian population aging. According to our analysis, we estimate that about 6500 subjects are currently affected by HD in Italy, and that this number will further increase in the next decades because of population aging, variable phenotype penetrance and improved life expectancy.

Retrospective space-time analysis methods to support West Nile virus surveillance activities.

The steep increase in human West Nile virus (WNV) infections in 2011-2012 in north-eastern Italy prompted a refinement of the surveillance plan. Data from the 2010-2012 surveillance activities on mosquitoes, equines, and humans were analysed through Bernoulli space-time scan statistics, to detect the presence of recurrent WNV infection hotspots. Linear models were fit to detect the possible relationships between WNV occurrence in humans and its activity in mosquitoes. Clusters were detected for all of the hosts, defining a limited area on which to focus surveillance and promptly identify WNV reactivation. Positive relationships were identified between WNV in humans and in mosquitoes; although it was not possible to define precise spatial and temporal scales at which entomological surveillance could predict the increasing risk of human infections. This stresses the necessity to improve entomological surveillance by increasing both the density of trapping sites and the frequency of captures.

Validation of a Nomogram to Predict Long Term Outcomes After Curative Surgery for Gastric Cancer in an Italian Cohort of Patients.

AIM OF THE STUDY: Nomograms have been proposed to assess prognosis following curative surgery for gastric cancer. The objective of the current study was to evaluate the performance of the Gastric Cancer Collaborative Group nomograms developed in 2014 by Kim et al., using a cohort of patients from a 10-year single institution experience in gastric cancer management. PATIENTS AND METHODS: We retrospectively reviewed patients who underwent curative-intent surgery for histologically confirmed gastric cancer at First Surgical Clinic of Padua University Hospital (Italy) from January 2010 to May 2020. Univariable and multivariable Cox proportional hazard models were employed to assess the effect of the variables of interest on mortality and recurrence. Multivariable analysis was performed by considering the variables included in the Gastric Cancer Collaborative Group nomograms in order to validate them. The performance of the nomograms was evaluated using Harrell's C-index and calibration plots. RESULTS: Overall, 168 patients were included, with a median follow-up of 20.1 months. On multivariable analysis, tumor location, lymph node ratio, and pathological T stage were associated with recurrence; age, tumor location, lymph node ratio, and pT stage were associated with OS (overall survival). The nomograms had good discriminatory capability to classify both OS (C-index: 0.75) and DFS (disease-free survival) (C-index 0.72). The corrected C-Index for DFS based on the AJCC staging system revealed better prediction (C-Index 0.75), while the corrected C-Index for OS had worse discrimination ability compared with the current nomogram (C-Index 0.72). CONCLUSIONS: The Gastric Cancer Collaborative Group nomograms demonstrated good performances in terms of prediction of both OS and DFS on external validation. The two nomograms are easy to apply, and variables included are widely available to most facilities.

Few Italian drug users undergo HIV testing.

We estimated the proportion of drug users at treatment centres in Italy who had undergone HIV testing and the correlates of testing. Of the 1,917 drug injectors, 37.4% had been tested in the current year; of the 665 non-injectors, 28% had been tested. Among injectors, testing was associated with: being older than 35, foreign nationality, residing in central Italy, drug use for over 2 years, and having undergone both pharmacological and psychological treatment. Among non-injectors, an association was found for foreign nationality and not having been treated at other facilities. The results stress the need to facilitate access to testing.

West Nile virus circulation in Veneto region in 2008-2009.

West Nile virus (WNV) was detected in Italy, in late summer 2008 in horses and birds in the Po valley. As a consequence, an intense WNV surveillance was implemented in that area involving Emilia-Romagna, Veneto and Lombardy. This paper presents the results of the September 2008-November 2009 surveillance on equines, mosquitoes, wild birds, dogs and cattle in Veneto. WNV was detected in equines and dogs, and, to a lesser extent in cattle and wild birds. Simultaneous circulation of Usutu virus was detected by testing wild birds found dead. Usutu virus but not WNV was also found in mosquitoes monitored during 2009. Equine practices monitoring allowed the definition of an area of WNV circulation and the 2008-2009 westward and northward spread of the infection. Although a relatively low number of human cases and a low virus circulation in vectors and birds detected in Veneto region could be considered favourable conditions for a limited risk of human exposure, it remains difficult to predict the possible evolution of the epidemiological situation.

The central role of Italy in the spatial spread of USUTU virus in Europe.

USUTU virus (USUV) is an arbovirus maintained in the environment through a bird-mosquito enzootic cycle. Previous surveillance plans highlighted the endemicity of USUV in North-eastern Italy. In this work, we sequenced 138 new USUV full genomes from mosquito pools (Culex pipiens) and wild birds collected in North-eastern Italy and we investigated the evolutionary processes (phylogenetic analysis, selection pressure and evolutionary time-scale analysis) and spatial spread of USUV strains circulating in the European context and in Italy, with a particular focus on North-eastern Italy. Our results confirmed the circulation of viruses belonging to four different lineages in Italy (EU1, EU2, EU3 and EU4), with the newly sequenced viruses from the North-eastern regions, Veneto and Friuli Venezia Giulia, belonging to the EU2 lineage and clustering into two different sub-lineages, EU2-A and EU2-B. Specific mutations characterize each European lineage and geographic location seem to have shaped their phylogenetic structure. By investigating the spatial spread in Europe, we were able to show that Italy acted mainly as donor of USUV to neighbouring countries. At a national level, we identified two geographical clusters mainly circulating in Northern and North-western Italy, spreading both northward and southward. Our analyses provide important information on the spatial and evolutionary dynamics of USUTU virus that can help to improve surveillance plans and control strategies for this virus of increasing concern for human health.

Epidemiology and risk factors for dermatophytoses in rabbit farms.

While dermatophytoses of several animal species have been extensively investigated, information on their occurrence and epidemiology in rabbits is limited. We carried out a study from October 2006 to February 2007 of 23 rabbit farms in Apulia and Basilicata regions (southern Italy) in order to investigate the occurrence and risk factors associated with dermatophytoses in breeding rabbits. Dermatophytes were isolated from 86.9% (20/23) of the farms and from 51.8% (420/810) of the animals sampled. Trichophyton mentagrophytes (47.9%) and Microsporum canis (3.2%) were isolated from diseased (71.7%) and healthy (48.4%) animals as well from the surrounding environment (7.5%). The occurrence of lesions, the age of rabbits, and farm management (e.g., temperature, humidity and methods and frequency of disinfection practices) were identified as the most significant risk factors (P < 0.05) for the occurrence of dermatophytes. Animals in fattening and finishing stages were the most frequently infected (i.e., 58.2 and 61.6% respectively). Dermatophyte prevalence was significantly (P < 0.05) higher in areas with higher temperature (>20°C) and relative humidity ranging from 62-65%. The results of the present investigation suggest that zoonotic dermathophytes are present in rabbit farms and highlight the importance of correct management procedures for the control of the infections.

The feasibility of developing a risk assessment for the impact of climate change on the emergence of Crimean-Congo haemorrhagic fever in livestock in Europe: a review.

Crimean-Congo haemorrhagic fever virus (CCHFV) is one of the most widespread of all medically important arboviruses with ticks of the Hyalomma spp. serving as the main vectors. Infection of livestock by CCHFV serves as a route of exposure to humans, as a reservoir of disease and as a route of importation. This study discusses the pathways and data requirements for a qualitative risk assessment for the emergence of CCHFV in livestock in Europe. A risk map approach is proposed based on layers that include the potential routes of release (e.g. by migrating birds carrying infected ticks) together with the main components for exposure, namely the distributions of the tick vectors, the small vertebrate host reservoirs and the livestock. A layer on landscape fragmentation serves as a surrogate for proximity of livestock to the tick cycle. Although the impact of climate change on the emergence of CCHF is not clear, comparing the distribution of risk factors in each layer currently with those predicted in the 2080s with climate change can be used to speculate how potential high-risk areas may shift. According to the risk pathway, transstadial and/or transovarial transmission in the tick vector are crucial for CCHFV spread. Vector competence and tick vector switching, however, remain critical factors for CCHFV colonization of new regions in Europe. The species of migratory bird is also an important consideration in the release assessment with greater abundance and biodiversity of ground-dwelling birds in southern Europe than in northern Europe.

Seasonal dynamics of the brown dog tick, Rhipicephalus sanguineus, on a confined dog population in Italy.

This study evaluated the seasonal dynamics of Rhipicephalus sanguineus (Latreille) (Acari: Ixodidae) on naturally infested dogs in a private shelter in southern Italy. From March to May 2008, 39 autochthonous mixed-breed young dogs and 10 beagles were enrolled in the study. From March 2008 until March 2009, every 21 +/- 2 days, 11 body sites of each dog were checked for ticks. At each follow-up, the number of ticks, their developmental stage, sex and location on the dog's body were recorded. Adult ticks were found throughout the year, but immatures were absent in January and February. The adult tick population increased from July to August, whereas the load of immatures increased in early July and peaked in September, which suggests that R. sanguineus develops one generation per year in this area. The mean number of immature ticks per infested dog was higher than that of adults from March to October 2008. Ears, interdigital areas and armpits were the most frequent attachment sites of adult ticks. At the last follow-up, a total of 2266 ticks were collected and identified as R. sanguineus. The results suggest that R. sanguineus develops one generation per year in the study area, but that it infests dogs in all seasons. This information should be taken into account when planning control programmes against this tick species and the pathogens it transmits.

Influence of gastrointestinal trichostrongylidosis on ram fertility.

A study on the influence of gastrointestinal trichostrongyles on ram fertility was performed. Two groups of semen donor rams (Sarda breed) were utilized; one was experimentally infected with Haemonchus contortus, Trichostrongylus colubriformis and Teladorsagia circumcincta and the other was used as a control group. In all animals, coprological, haematological and reproductive parameters were studied. The results suggest that the parasites had a limited effect with some changes in phosphorus, cholesterol and chlorine levels. In our experience the parasitic burden produced no significant change on ram fertility.

Evaluation of the poultry red mite, Dermanyssus gallinae (Acari: Dermanyssidae) susceptibility to some acaricides in field populations from Italy.

Red mite field populations from seven naturally infested Italian caged laying poultry farms were investigated for their susceptibility to acaricide formulations available on the market, containing amitraz, carbaryl and permethrin. A minimum of 3,000 mites of all stages were collected from each farm and were tested with five acaricide concentrations (5, 10, 20, 50, 100%) plus an untreated control (0%). Field red mite populations were found to be tolerant even with the highest concentrations with carbaryl and permethrin for six (86%) and three (42%) of the investigated farms, respectively (P < 0.05). Furthermore, six (86%) of the investigated farms showed a red mite population susceptible to amitraz at any concentration. Out of the seven field populations tested with amitraz, one population is becoming less tolerant whereas another was the most tolerant to carbaryl and permethrin at any concentration. Data show that the lack of effectiveness of some acaricides is spreading in Europe and call for the adoption of alternative management strategies to avoid development of resistance.

Disability management: the application of preventive measures, health promotion and case management in Italy.

BACKGROUND: Disability Management can be defined as a practice to improve workers' health and to reduce the impact and costs of disability. The aim of the study was to estimate the diffusion of DM in Italian companies. METHODS: A survey was conducted using a questionnaire, the Worksite Disability Management Audit. The questionnaire was structured into five parts addressing the following domains: 1) characteristics of the company; 2) health promotion activities; 3) preventive measures; 4) case management; 5) disability management. We selected public and private companies and collected information by direct interview. RESULTS: Twenty companies entered the survey. Twelve Companies (60%) indicated that health promotion programs and sensibilisation campaigns are usually carried out. The presence of an individual who provided workplace safety indications and materials was stated by 19 companies (95%). Periodical medical examinations are carried out by 19 companies (95%); 16 (80%) have an evaluation process for ergonomics concerns. Risk assessment and analysis are performed by all companies and the security procedures and policies are updated at least once in a year in 40% of cases. Health status monitoring of injured workers is performed in eight (40%) of the companies, while Disability Management is present as a whole in only three companies. CONCLUSIONS: This survey highlights that Disability Management is not undertaken in most companies and that, where applied, there is still confusion and disorganization about ways to promote health and manage workers' illness and disability. Hence, there is still the need to promote an all-inclusive evaluation and management of workers' safety, illness and disabilities.

[Proportion of drug users in treatment who have never undergone serological testing for HIV, HBV and HCV and correlates of failure to undergo testing: Italy, 2005-2007]. / Proporzione di tossicodipendenti in trattamento che non hanno mai eseguito i test sierologici per HIV, HBV e HCV e fattori correlati alla mancata esecuzione: Italia, 2005-2007.

In Italy, although the most recent guidelines stress the importance of screening for the human immunodeficiency virus (HIV) and the hepatitis B and C viruses (HBV and HCV) those subjects considered to be at high risk (e.g., injecting drug users), not all drug users being treated at public drug dependency centres are regularly tested for these infections. The results of the present study show that 7.2%, 13.0%, and 7.4% of injecting drug users seeking treatment at public drug dependency centres are not tested for, respectively, HIV, HBV and HCV infections and while corresponding figures for drug users who do not inject drugs are 20.3%, 25.1% and 16.2%. The failure to undergo testing among injectors was associated with a shorter history of drug use and with drug centres in central or southern Italy; these associations were also found among non-injectors, with the addition of low level of education. The results stress the importance of facilitating access to testing, of providing the drug dependency centres with the necessary resources for taking blood samples at the centres themselves, of making access to (and performance of) testing uniform throughout the country, and of removing obstacles that can lead to the drug user's refusal to undergo testing.

[Frequency and determinants of inter-hospital transfers in the Local Health Unit of Frosinone, Italy in the years 1997-2005]. / Valutazione della frequenza e dei determinanti dei trasferimenti interospedalieri nella Azienda Sanitaria Locale di Frosinone nel periodo 1997-2005.

Community and rural hospitals rely to a greater extent on transferring acute patients to other settings which can provide the required definitive care. Using data on all hospital discharges of patients from the 11 acute care hospitals of the Frosinone Local Health Unit (7 of which were publicly run, and 4 were run by privates) over the period 1997-2005, a study was carried out to assess the frequency, time-trend and determinants of transfers. Between 1997 and 2005, 8,009 patients (1.3%) were transferred to acute care hospitals, while 2,499 (0.4%) were transferred to long-term and rehabilitation hospitals. The proportion of patients transferred to acute care hospitals increased over time, while that of patients transferred to long-term services was stable. Men, the elderly, those admitted in intensive care units and those with orthopaedic injuries, burns, traumas, drug abuse, mental illnesses, neurological and cardiovascular diseases were more likely to be transferred. Adjusting for other risk factors, the hospital of Ceccano had a higher frequency of transfers (8.7%) compared to the other hospitals, while privately administered hospitals showed a much lower percentage of inter-hospital transfers.

The containment of potential outbreaks triggered by imported Chikungunya cases in Italy: a cost utility epidemiological assessment of vector control measures.

The arrival of infected travelers from endemic regions can trigger sustained autochthonous transmission of mosquito-borne pathogens in Europe. In 2007 a Chikungunya outbreak was observed in central Italy, mostly affecting two villages characterised by a high density of Aedes albopictus. The outbreak was mitigated through intervention strategies reducing the mosquito abundance. Ten years later, in 2017, sustained Chikungunya transmission was documented in both central and southern Italy. The proposed analysis identifies suitable reactive measures for the containment and mitigation of future epidemics by combining epidemiological modeling with a health economic approach, considering different arrival times of imported infections and possible delays in the notification of cases. Obtained estimates suggest that, if the first notification will occur in the middle of the mosquito breeding season, the combination of larvicides, adulticides and breeding sites removal represents the optimal strategy. In particular, we found that interventions implemented in 2007 were cost-effective, with about 3200 prevented cases, 1450 DALYs averted and €13.5 M saved. Moreover, larvicides are proven to be more cost beneficial in early summer and warmer seasons, while adulticides should be preferred in autumn and colder seasons. Our results provide useful indications supporting urgent decision-making of public health authorities in response to emerging mosquito-borne epidemics.

Sero-epidemiological update on sheep toxoplasmosis in Sardinia, Italy.

In order to better understand the epidemiology of ovine toxoplasmosis in Sardinia, a serological survey was carried out on 22 flocks with no fertility problems. In total 1043 sera (9% of the 11,382 sheep raised in the flocks) were examined by means of a commercial ELISA kit. To verify the performance of ELISA test, 160 selected sera were tested again with a gold standard test (IFAT). Performance of the commercial ELISA kit was summarised in terms of Sensitivity (SE), Specificity (SP), positive and negative Likelihood Ratios (LR+; LR-). The overall seroprevalence with ELISA test was recorded as 51.3%. It was generally increasing according to age and was significantly lower in animals younger than one year (with the exception of < 1 month old lambs). This survey provided data on the current Toxoplasma gondii sheep seroprevalence in Sardinia, confirmed a still high parasite pressure and pointed out that consumption of raw or undercooked ovine meat can be considered a potential risk factor for humans.

A 2-yr Mosquito Survey Focusing on Aedes koreicus (Diptera: Culicidae) in Northern Italy and Implications for Adult Trapping.

Aedes koreicus (Edwards) is an invasive mosquito species, like Aedes albopictus (Skuse) and Aedes japonicus japonicus (Theobald), that has already colonized a large part of northeastern Italy and other European countries. Despite its rapid expansion, information about adult distribution and trapping is lacking. Here, we conducted a 2-yr longitudinal survey using adult traps to investigate the spatiotemporal distribution of Ae. koreicus and evaluated the effectiveness of three trapping devices in Latin square experiments conducted in an urban site and a forested site. The following three different traps were compared: a CO2-baited Biogents (BG) Sentinel trap, a CO2-baited Centers for Disease Control and Prevention light trap (CDC trap), and a grass infusion-baited gravid trap.In northern Italy, Ae. koreicus was collected from late April to early November, with peak of abundance observed in August. Aedes koreicus was more abundant in 2015 than in 2014 because of higher temperatures during summer. Unlike Ae. albopictus, the abundance of Ae. koreicus was not related to the altitude of the sampling locations in the range 241-660 m above sea level. The BG Sentinel and gravid traps collected significantly more Ae. koreicus than the CDC trap in the urban site, whereas there was no significant difference between the three traps in the forested site. In the urban site, the BG Sentinel trap and the gravid trap were the most effective for collecting Ae. albopictus and Culex pipiens L., respectively. In the forested site, Cx. pipiens was primarily collected by the CDC trap.