Profile of common prostate cancer risk variants in an unscreened Romanian population.

To find sequence variants affecting prostate cancer (PCA) susceptibility in an unscreened Romanian population we use a genome-wide association study (GWAS). The study population included 990 unrelated pathologically confirmed PCA cases and 1034 male controls. DNA was genotyped using Illumina SNP arrays, and 24.295.558 variants were imputed using the 1000 Genomes data set. An association test was performed between the imputed markers and PCA. A systematic literature review for variants associated with PCA risk identified 115 unique variants that were tested in the Romanian sample set. Thirty of the previously reported SNPs replicated (P-value < 0.05), with the strongest associations observed at: 8q24.21, 11q13.3, 6q25.3, 5p15.33, 22q13.2, 17q12 and 3q13.2. The replicated variants showing the most significant association in Romania are rs1016343 at 8q24.21 (P = 2.2 × 10-4 ), rs7929962 at 11q13.3 (P = 2.7 × 10-4 ) and rs9364554 at 6q25.2 (P = 4.7 × 10-4 ). None of the variants tested in the Romanian GWAS reached genome-wide significance (P-value <5 × 10-8 ) but 807 markers had P-values <1 × 10-4 . Here, we report the results of the first GWAS of PCA performed in a Romanian population. Our study provides evidence that a substantial fraction of previously validated PCA variants associate with risk in this unscreened Romanian population.

Identification of Lynch syndrome risk variants in the Romanian population.

Two familial forms of colorectal cancer (CRC), Lynch syndrome (LS) and familial adenomatous polyposis (FAP), are caused by rare mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2) and the genes APC and MUTYH, respectively. No information is available on the presence of high-risk CRC mutations in the Romanian population. We performed whole-genome sequencing of 61 Romanian CRC cases with a family history of cancer and/or early onset of disease, focusing the analysis on candidate variants in the LS and FAP genes. The frequencies of all candidate variants were assessed in a cohort of 688 CRC cases and 4567 controls. Immunohistochemical (IHC) staining for MLH1, MSH2, MSH6, and PMS2 was performed on tumour tissue. We identified 11 candidate variants in 11 cases; six variants in MLH1, one in MSH6, one in PMS2, and three in APC. Combining information on the predicted impact of the variants on the proteins, IHC results and previous reports, we found three novel pathogenic variants (MLH1:p.Lys84ThrfsTer4, MLH1:p.Ala586CysfsTer7, PMS2:p.Arg211ThrfsTer38), and two novel variants that are unlikely to be pathogenic. Also, we confirmed three previously published pathogenic LS variants and suggest to reclassify a previously reported variant of uncertain significance to pathogenic (MLH1:c.1559-1G>C).

Ecological and human exposure assessment to PBDEs in Adige River.

The interest for environmental issues and the concern resulting from the potential exposure to contaminants were the starting point to develop methodologies in order to evaluate the consequences that those might have over both the environment and human health. Considering the feature of POPs, including PBDEs, such as bioaccumulation, biomagnification, long-range transport and adverse effects even long time after exposure, risk assessment of POPs requires specific approaches and tools. In this particular context, the MERLIN-Expo tool was used to assess the aquatic environmental exposure of Adige River to PBDEs and the accumulation of PBDEs in humans through the consumption of possible contaminated local aquatic food. The aquatic food web models provided as output of the deterministic simulation the time trend of concentrations for twenty years of BDE-47 and total PBDEs, expressed using the physico-chemical properties of BDE-47, in aquatic organisms of the food web of Adige River. For BDE-47, the highest accumulated concentrations were detected for two benthic species: Thymallus thymallus and Squalius cephalus whereas the lowest concentrations were obtained for the pelagic specie Salmo trutta marmoratus. The trend obtained for the total PBDEs, calculated using the physico-chemical properties of BDE-47, follows the one of BDE-47. For human exposure, different BDE-47 and total PBDEs concentration trends between children, adolescent, adults and elderly were observed, probably correlated with the human intake of fish products in the daily diet and the ability to metabolize these contaminants. In detail, for the adolescents, adults and elderly a continuous accumulation of the target contaminants during the simulation's years was observed, whereas for children a plateau at the end of the simulation period was perceived.

Pesticides water decontamination in oxygen-limited conditions.

This study was undertaken to develop a laboratory bioreactor, with a functioning principle similar with that of biobed systems but working in oxygen-limited conditions, suitable for decontaminating wastewater mixtures with pesticides. The system is composed by two cylindrical plastic containers. The first one, where the pesticides solution is collected, is open, whereas the second one, where the biomass is disposed, is closed. The pesticides solution was pumped at the biomass surface and subsequently recollected and disposed in the first container. Four pesticides with different physical-chemical characteristics were tested. The results obtained showed a relatively good capacity of the developed prototype to decontaminate waste water containing the mixture of pesticides. The time of the experiment, the number of cycles that the solution made in the system and the environmental temperature have a significantly influence for the decontamination of acetochlor and chlorpyrifos whereas for the decontamination of terbuthylazine and metalaxyl no significant influence was observed. Even if the present prototype could represent a valid solution to manage the water pesticides residues in a farm and to increase the confidence of bystanders and residents, the practical difficulties when replacing the biomass could represent a limit of the system.

Glyphosate, glufosinate ammonium, and AMPA occurrences and sources in groundwater of hilly vineyards.

Glyphosate [N-(phosphonomethyl) glycine] and glufosinate ammonium [ammonium dl-homoalanin-4-(methyl) phosphinate] are broad-spectrum, nonselective, post-emergence herbicides extensively used in various applications for weed control in both agricultural and non-crop areas. Aminomethylphosphonic acid (AMPA) is the major degradation product of glyphosate found in plants, water, and soil. Due to glyphosate's presumed low mobility, its monitoring in European water was limited. Recently both glyphosate and AMPA have been detected in several groundwater samples in Europe, U.S, Canada, Argentina, and China. Understanding the sources of these substances in water, especially in groundwater used for drinking, becomes a priority. In the present work the occurrences and the main drives of glyphosate, AMPA, and glufosinate ammonium in the groundwater of hilly vineyards located in the North-West of Italy were evaluated. Groundwater monitoring results showed frequent detection and concentrations above EQSGW for glyphosate and AMPA, while glufosinate ammonium was never detected. More frequent occurrences and higher concentrations were detected in the samples collected from wells located in the farmyards, most of them being used for irrigation and/or preparation of PPPs mixtures. Indeed, AMPA was the only compound detected in one groundwater well used for drinking, at values bellow EQSGw/DWQS. Such monitoring results were not expected as the modelling estimations under local pedoclimatic conditions indicated no risk of leaching to groundwater. However, the modelling performance and output may have been influenced by the non-consideration of important specific processes. Integrating monitoring and modelling results with information concerning the agricultural practices adopted and the wells use and location, possible contamination drivers were identified. These include the non-agricultural use of glyphosate in the farmyard, the point source contamination of wells and the possible transport with the subsurface lateral inflow of water from up-hill vineyard. This study strengthens the position of SETAC EMAG-Pest GW group concerning the necessity of spatial and temporal contextualisation of groundwater monitoring for a better understanding of its contamination drivers by PPPs.

A Holistic Approach of Personality Traits in Medical Students: An Integrative Review.

Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person's surroundings in the setting of incompatible traits and characteristics. It is true that 'one must be born' for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients' safety. Empathy contributes to effective patient-physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence-the capacity to respond to one's own and others' emotions-was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students' personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.

The WaterProtect governance guide: Experiences from seven agricultural and drinking water production catchments across Europe.

Although collaborative, multi-level and adaptive governance is put forward as the right approach to manage water resources, it remains a challenge for local water managers to engage with multiple understandings and perspectives and to move towards more transdisciplinary approaches in water governance. In this research, we address this need by proposing a practical guide for water governance assessment and improvement, existing of three successive steps, i.e. (1) an assessment of water governance, (2) the implementation of a multi-actor process and (3) an evaluation of achievements. This guide is tested in the seven action labs of the WaterProtect project, which have in common that they are drinking water catchments suffering from agricultural pollution throughout Europe. By implementing the guide in the different action labs, we find that water managers appreciated the integrated approach of the guide, helping them in the efficient organization of the water governance process while taking into account the human dimension. Furthermore action lab leaders evaluated the governance guide as being hands-on and practical, allowing them to redirect and open up the governance process. Despite this, they welcomed the presence of a facilitator, who boosted the local action lab leaders' confidence and motivation to put things into motion. Looking at the results, we find that over the different action labs a lot of progress has been made towards intermediary goals, however that an improvement of the water quality cannot be expected in the short time frame of a project. We therefore recommend improving the design of the guide with insights from transition management, which will allow local water managers to better address change at different time-scale levels.

Medical Students' Personalities: A Critical Factor for Doctor-Patient Communication.

The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = -0.2037, p = 0.0263; r = -0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = -0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279; r = 0.20, p = 0.0245). Medical students' creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.

Multi-actor approach and engagement strategy to promote the adoption of best management practices and a sustainable use of pesticides for groundwater quality improvement in hilly vineyards.

The adoption of pesticide mitigation measures and innovation at farm level, are seen as a drivers to reach the sustainable water policy objectives. With the aim to prevent the pesticide pressure of hilly vineyards on groundwater contamination, a stepwise approach in Tidone Valley was applied using different consultation mechanisms and involvement strategies throughout the overall process. Face to face meetings, direct surveys, participatory monitoring and planning of several activities aiming to inform, educate, improve skills, change of individual behaviour or raise awareness, or even initiatives to build institutional trust or support for new investment in innovation are some examples. These activities allowed us to involve key actors of water use and governance (such as farmers, advisors, representatives of drinking water management, farmer's associations, Winemaking cooperatives, local Health Authority), and to have a deeper knowledge of the context agricultural practices, of farmer's knowledge and skills concerning factors influencing water contamination and also to promote the most suitable Best Management Practices aimed at limiting the pesticide occurrence in groundwater. Indeed, the surveys results highlighted that the majority of the farms are small (64% of vineyards <10 ha), that most of the farmers (62%) are not aware of the current legislation on water, even if 64% of them declare to participate regularly to training courses for the prevention of water contamination and that there is a low to moderate level of adoption of Best Practices able to prevent contamination by pesticides. At the end of the overall process, it can be stated that the multi-actor approach and engagement strategy adopted were successful in improving attitudes to more sustainable practices. This is supported also by the monitoring data that show in 2019 a decrease by 44% of pesticides occurrences and a fall by 68% of values above EQSgw if compared with the period 2017-2018.

Influence of nitrogen-based fertilization on nitrates occurrence in groundwater of hilly vineyards.

Nitrogen losses from intensive agricultural production may end up as high nitrate (NO3-) concentrations in groundwater, with a long-term impact on groundwater quality. The main objective of this study was to evaluate the impact of fertilization practices used for grape cultivation on groundwater quality of Tidone Valley, northwest of Italy, following an integrated socio-hydrogeological approach that consists on (i) the involvement of 175 farmers in the description of agricultural and fertilization practices, using a survey of ad hoc questionnaires, (ii) the evaluation of NO3- occurrence in groundwater and (iii) the identification of NO3- sources through isotopic and hydrochemical analysis. In this area, as for certain particular Apennines shallow aquifers, groundwater is of reduced interest due to its limited storage capacity and there are insufficient wells currently monitored by the local Environmental Agency (ARPAE) to evaluate the impact of agricultural fertilization on existing local aquifers. Farmers' questionnaires results highlighted an extensive use of inorganic nitrogen fertilization and a tendency of farmers to follow their own experience for fertilization. Chemical analyses revealed high variability of major and trace elements concentrations isotope data. NO3- concentrations were significantly higher in deeper wells with respects to shallow wells. Isotopic results indicated that groundwater NO3- origin is inorganic, in agreement with the land use and the declared viticultural practices. Comparing groundwater NO3- occurrence from the studied area with values of entire Emilia-Romagna Region, only 7.7% of groundwater samples showed values above the EQS. (50 mg NO3-/L) between Nov 2017 and Sept 2018, while in the entire region 11.5% of groundwater samples showed values above the EQS in the same period. Considering that the vineyards surface in the studied area represents almost 75% of the entire regional vineyard surface, the obtained results suggest a low to moderate impact of viticulture on NO3-concentration of regional groundwater.

A multi-actor, participatory approach to identify policy and technical barriers to better farming practices that protect our drinking water sources.

Despite an improvement of water quality across Europe there are many pollution hotspots for both nitrates and PPPs, mainly due to agricultural activities. The BMPs and MMs to reduce pollution from agriculture are well known, and there are policy instruments in place to ensure drinking water standards, but the current approach has not been efficient enough. Within the H2020 Water Protect project the premise was that there is a need for a multi-actor, participatory approach to tackle the issue from a new angle, and to assess why the uptake of known BMPs and MMs was not better among farmers. Seven "Action Labs" were selected that represent major physical, socio-economical, cultural and farming settings across Europe. A methodology of multi-actor engagement was chosen but with different approaches due to the local context. Initially the level of farmers' awareness about water quality issues was matched to the observed uptake rates of BMPs and MMs. In a second survey barriers hindering the uptake of measures were identified. The first survey revealed a low general awareness on the potential pollution to drinking water sources. Despite this, between 24% to 88% of the surveyed farmers per Action Lab were already voluntarily adopting one quarter of the selected BMPs and MMs. The second survey demonstrated the need to address organisational, legislative, sociological and technical barriers. The lack of coordination between different institutional bodies promoting measures and the financial incentives needed to invest and operate these often-costly measures need to be considered. The multi-actor, participatory approach with its improved awareness and collaboration made it possible to identify the crucial factors for improvement - to build a social acceptance among all actors and communicate the issues and solutions from the start.

Collection of human and environmental data on pesticide use in Europe and Argentina: Field study protocol for the SPRINT project.

Current farm systems rely on the use of Plant Protection Products (PPP) to secure high productivity and control threats to the quality of the crops. However, PPP use may have considerable impacts on human health and the environment. A study protocol is presented aiming to determine the occurrence and levels of PPP residues in plants (crops), animals (livestock), humans and other non-target species (ecosystem representatives) for exposure modelling and impact assessment. To achieve this, we designed a cross-sectional study to compare conventional and organic farm systems across Europe. Environmental and biological samples were/are being/will be collected during the 2021 growing season, at 10 case study sites in Europe covering a range of climate zones and crops. An additional study site in Argentina will inform the impact of PPP use on growing soybean which is an important European protein-source in animal feed. We will study the impact of PPP mixtures using an integrated risk assessment methodology. The fate of PPP in environmental media (soil, water and air) and in the homes of farmers will be monitored. This will be complemented by biomonitoring to estimate PPP uptake by humans and farm animals (cow, goat, sheep and chicken), and by collection of samples from non-target species (earthworms, fish, aquatic and terrestrial macroinvertebrates, bats, and farm cats). We will use data on PPP residues in environmental and biological matrices to estimate exposures by modelling. These exposure estimates together with health and toxicity data will be used to predict the impact of PPP use on environment, plant, animal and human health. The outcome of this study will then be integrated with socio-economic information leading to an overall assessment used to identify transition pathways towards more sustainable plant protection and inform decision makers, practitioners and other stakeholders regarding farming practices and land use policy.

First evaluation of pesticides occurrence in groundwater of Tidone Valley, an area with intensive viticulture.

Agricultural practice often involves an intensive and incorrect use of pesticides and fertilizers. These chemicals can leach through the soil profile and contaminate groundwater, including drinking water. For this reason, an effective groundwater monitoring is strongly advisable. The aim of this study was to investigate the groundwater contamination by plant protection products (PPPs) on a hilly area situated in the Tidone Valley, North-West of Italy, a region characterized by an intensive viticulture production. This area is not included in the national groundwater monitoring plan and therefore scarce information is available regarding the quality of groundwater, even though the local Environmental Agency previously revealed the occurrence of PPPs at values higher than the Environmental Quality Standard downstream this area. Hence, a monitoring wells network was developed following an upstream-downstream criterion, a list of pesticides to be monitored, based on a multi-actor approach, and an analytical method for PPPs detection and quantification. The analytical approach involved solid phase extraction followed by High-Performance Liquid Chromatography tandem mass spectrometry. The results of three monitoring campaigns revealed the occurrence of seven PPPs at a level higher than EQS for groundwater (0.1 µg/L) in 30% of the wells. The main pesticides detected were Chlorantraniliprole, Dimethomorph, Fluopicolide, Metalaxyl-M, Penconazole, and Tetraconazole, all commonly used in viticulture, together with S-metolachlor, authorized for cereal cropping. Statistical analysis revealed a significant influence of the sampling time, slope of the soil surrounding the wells, wells depth and wells location on the concentration of five PPPs. Therefore, the results obtained show that the improper use of PPPs for grapevine cultivation may cause groundwater contamination and suggest the need for a deeper analysis of territorial reality, including hydrology studies and farmer behavior and for an urgent introduction of best management practices and mitigation measures to promote a sustainable use of PPPs in viticulture.

Evaluation of groundwater contamination sources by plant protection products in hilly vineyards of Northern Italy.

In Europe, 25% of groundwater has poor chemical status. One of the main stressors is agriculture, with nitrates and plant protection products (PPPs) causing failure in 18% and 6.5%, respectively, of groundwater bodies (by area). EU legislation for the placement of the PPPs on the market is one of the most stringent in the world. However, recent monitoring studies in hilly vineyards of Tidone Valley, north-west of Italy, show presence of PPPs used for grapevine cultivation in 15 out of 26 groundwater wells monitored, at values above the Environment Quality Standard (EQS) for groundwater (0.1 µg/L). However, no information about the contamination sources are available. Therefore, the objective of the present work is to evaluate the groundwater contamination sources by PPPs, in a small catchment with intensive viticulture, by collecting and integrating monitoring data, sub-surface water movement data and territorial characteristics. The results show that in wells used for PPP's mixture preparation and sprayer washing located at the top of hilly vineyards, with low slope and no water movement in the surrounding soil, the contamination is most likely from point sources. On the contrary, for wells located in a fenced area at the bottom of the hill, far away from vineyards and being used for drinking water production, the contamination is most likely from diffuse sources. Our results were used to raise awareness on groundwater contamination from PPPs among farmers in the study area; moreover a waterproof platform for sprayers washing, equipped with wastewater recovery and disposal system, able to avoid point-source contamination, was implemented in a local demonstration farm. Several demonstration activities were then organised with the farmers of the entire Valley in order to show its functionality and promote its diffuse use.

Adsorption of chlorpyrifos, penconazole and metalaxyl from aqueous solution by modified clays.

Sorption of three pesticides (chlorpyrifos, metalaxyl and penconazole) has been measured on a commercial clay montmorillonite and on the same mineral modified with either of two cationic-surfactant micelles. Both micelle-clay complexes, commercial names Cloisite 20A and Cloisite 30B, showed a good capacity to sorb all three pesticides from water, whereas their sorption on the natural montmorillonite was not described by an isotherm. Modelling sorption on both micelle-clay complexes showed that the Freundlich sorption constant (K(F)) was higher for chlorpyrifos on Cloisite 20A (K(F) = 7.76) than on Cloisite 30B (K(F) = 5.91), whereas the sorption of metalaxyl was stronger on Cloisite 30B (K(F) = 1.07) than on Cloisite 20A (K(F) = 0.57). Moreover the micelle-clay complex Cloisite 20A also showed a good affinity for penconazole, the maximum quantity adsorbed (q(m)) of 6.33 mg g(-1) being 45% more than that on Cloisite 30B. Single-batch adsorption of each pesticide onto both micelle-clay complexes was studied using the Freundlich isotherm for chlorpyrifos and metalaxyl and the Langmuir isotherm for penconazole. The Cloisite 20A micelle-clay complex was predicted to require 23% less adsorbent to treat certain volumes of wastewater containing 30 mg L(-1) chlorpyrifos, 43% more to treat metalaxyl similarly and 57% less to treat penconazole compared with Cloisite 30B.

Combined ecotoxicological risk assessment in the frame of European authorization of pesticides.

Organisms are frequently exposed to mixtures of chemical contaminants in the environment, causing a potential "cocktail effect", or combined effect. The joint action of different molecules with similar or different modes of action could result in a potentially unlimited number of additives, synergistic or antagonistic combinations. Since the large number of contaminants makes it impossible to perform ecotoxicity tests for each potential mixture, a robust approach for prospective environmental risk assessment of chemical mixtures is needed. A number of recent publications by the European Commission and the authorities in charge prove the increasing interest that is spreading in the European community towards the topic of the assessment of chemical mixtures. The current EU regulation for Plant Protection Products authorization (Reg. 1107/2009 EC) explicitly requires the evaluation of the potential combined effects of active substances. We reviewed current methods and limitations of mixture assessment of pesticides (7 fungicides and 4 herbicides) through the analysis of the approaches adopted to investigate possible risks for different non-target organisms. The Concentration Addition (CA) approach was the most used approach to predict multiple toxicity to non-target organisms. The guidance for birds and mammals first introduced standard procedures to assess the multiple toxicity based on on CA concept. The recent aquatic EFSA guidance introduced some requirements to evaluate potential mixture toxicity, while the current guidance requirements for terrestrial organisms still lack clear indications on how to conduct the assessment. Moreover, new indications come from the draft guidance for the assessment of terrestrial plants and in-soil organisms. However, the approval and implementation of these new guidelines are still at a developmental stage. Some final considerations are drawn on the future possibilities to improve risk assessment procedures so as to identify harmful effects of pesticides mixtures on non-target organisms.

Communication skills in pediatrics - the relationship between pediatrician and child.

Interpersonal and communication skills are 2 essential qualities of every physician. These are separate and distinct parts of the professional character of every physician. In pediatrics these abilities present even a higher impact.We performed a survey-type prospective study based on questionnaires on 100 subjects, equally divided into 4 groups: 25 children, 25 pediatricians, 25 care-givers (parents, tutors, and relatives), and 25 health care staff, in a Tertiary Pediatric Clinic from Romania, between January 2017 and April 2017.We included 100 participants in our study, equally divided into 4 groups: pediatric patients, pediatricians, care-givers, and health care staff. The 1st group comprised 25 children diagnosed with different chronic conditions, presenting the age between 5 and 14 years. The male gender predominated among the children (57%). The lowest general average score for "Communication" section was encountered among pediatricians group, 3.8, while the other 3 groups presented the same average score for this section, that is, 4.6. The children and the health care staff offered the same average score for "Transparency," that is, 4.6, while the pediatricians offered a score of 4.5, and the care-givers of 4.7. The lowest average score for the item "Hospital environment" was given by the doctors, that is, 3.3, followed by care-givers with a score of 3.6, health care staff 3.7, and children with an average score of 3.8. All the 4 groups included in the study offered a general average of 4.9 out of 5 for the "Intercultural issues" section. The lowest average score for "Time management" section was offered by both children and pediatricians, that is, 4.1, while care-givers and health care staff had a slightly better perception regarding this item, offering 4.2 and 4.3, respectively.The opinion among the 4 groups included in the study was generally similar regarding the 5 items assessed by our questionnaires. Therefore, the main aspects that need to be improved in the health care system in downward order are the following: hospital environment, time management, communication, transparency, and intercultural issues.

Ecological status and sources of anthropogenic contaminants in mangroves of the Wouri River Estuary (Cameroon).

Mangroves are critically threatened by human activities, despite the important ecosystem functions and services they provide. Mangroves in Cameroon represent no exception to the worldwide trend of mangrove destruction, especially around Douala, on the Wouri river estuary. In two sites around Douala, we assessed the presence of sterols, PAHs, PCBs, DEHP, DDT and its metabolite p,p'-DDE and potentially toxic metals in sediment samples. As a proxy of ecological quality, we measured the diversity and abundance of macrobenthos assemblages. We detected p,p'-DDE contamination, with concentrations higher than 3µgkg(-1) in 16 out of 26 samples which were attributed to recent widespread use of DDT. The detection of sterols revealed faecal contamination. Significant sensitivity of the macrobenthos to contaminants was revealed, with possible implications on the overall mangrove vulnerability to climate change and on the provision of ecosystem services to local populations.

Potential for MERLIN-Expo, an advanced tool for higher tier exposure assessment, within the EU chemical legislative frameworks.

MERLIN-Expo merges and integrates advanced exposure assessment methodologies, allowing the building of complex scenarios involving several pollution sources and targets. The assessment of exposure and risks to human health from chemicals is of major concern for policy and ultimately benefits all citizens. The development and operational fusion of the advanced exposure assessment methodologies envisaged in the MERLIN-Expo tool will have a significant impact in the long term on several policies dealing with chemical safety management. There are more than 30 agencies in Europe related to exposure and risk evaluation of chemicals, which have an important role in implementing EU policies, having especially tasks of technical, scientific, operational and/or regulatory nature. The main purpose of the present paper is to introduce MERLIN-Expo and to highlight its potential for being effectively integrated within the group of tools available to assess the risk and exposure of chemicals for EU policy. The main results show that the tool is highly suitable for use in site-specific or local impact assessment, with minor modifications it can also be used for Plant Protection Products (PPPs), biocides and REACH, while major additions would be required for a comprehensive application in the field of consumer and worker exposure assessment.

PAHs content of sewage sludge in Europe and its use as soil fertilizer.

The European Commission has been planning limits for organic pollutants in sewage sludge for 14years; however no legislation has been implemented. This is mainly due to lack of data on sewage sludge contamination by organic pollutants, and possible negative effects to the environment. However, waste management has become an acute problem in many countries. Management options require extensive waste characterization, since many of them may contain compounds which could be harmful to the ecosystem, such as heavy metals, organic pollutants. The present study aims to show the true European position, regarding the polycyclic aromatic hydrocarbons (PAHs) content of sewage sludge, by comparing the Italian PAHs content with European Union countries, and at assessing the suitability of sewage sludge as soil fertilizer. The FOCUS Pearl model was used to estimate the concentration of benzo [a] pyrene (B(a)Pyr), the most toxic PAH in soil, and its exposure to organisms was then evaluated. The simulated B(a)Pyr and PAHs, expressed as B(a)Pyr, concentrations in soil were much lower than the B(a)Pyr's most conservative lowest observable effect concentration (LOEC) for soil organisms. Furthermore, the results obtained indicate that it is more appropriate to apply 5tha(-1) sewage sludge annually than 15tha(-1) triennially. Results suggest, the EU maximum recommended limit of 6mgkg(-)(1) PAHs in sewage sludge, should be conservative enough to avoid groundwater contamination and negative effects on soil organisms.