The power of Posidonia oceanica meadows to retain microplastics and the consequences on associated macrofaunal benthic communities.

In the coastal environment, a large amount of microplastics (MPs) can accumulate in the sediments of seagrass beds. However, the potential impact these pollutants have on seagrasses and associated organisms is currently unknown. In this study, we investigated the differences in MPs abundance and composition (i.e., shape, colour and polymer type) in marine sediments collected at different depths (-5 m, -15 m, -20 m) at two sites characterized by the presence of Posidonia oceanica meadows and at one unvegetated site. In the vegetated sites, sediment samples were collected respectively above and below the upper and lower limits of the meadow (-5 m and -20 m), out of the P. oceanica meadow, and in the central portion of the meadow (-15 m). By focusing on the central part of the meadow, we investigated if the structural features (i.e. shoots density and leaf surface) can affect the amount of MPs retained within the underlying sediment and if these, in turn, can affect the associated benthic communities. Results showed that the number of MPs retained by P. oceanica meadows was higher than that found at the unvegetated site, showing also a different composition. In particular, at vegetated sites, we observed that MPs particles were more abundant within the meadow (at - 15 m), compared to the other depths, on unvegetated sediment, with a dominance of transparent fragments of polypropylene (PP). We observed that MPs entrapment by P. oceanica was accentuated by the higher shoots density, while the seagrass leaf surface did not appear to have any effect. Both the abundance and richness of macrofauna associated with P. oceanica rhizomes appear to be negatively influenced by the MPs abundance in the sediment. Overall, this study increases knowledge of the potential risks of MPs accumulation in important coastal habitats such as the Posidonia oceanica meadows.

Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor (USCOM).

We aimed to establish reference ranges for USCOM parameters in preterm infants, determine factors that affect cardiac output, and evaluate the measurement repeatability. This retro-prospective study was performed at Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. We included infants below 32 weeks of gestational age (GA) and/or 1500 g of birth weight (BW). We excluded infants with congenital heart diseases or hemodynamic instability. Measurements were performed at 3 ± 1, 7 ± 2, and 14 ± 2 postnatal days. We analyzed 204 measurements from 92 patients (median GA = 30.57 weeks, BW = 1360 g). The mean (SD) cardiac output (CO) was 278 (55) ml/min/kg, cardiac index (CI) was 3.1 (0.5) L/min/m2, and systemic vascular resistance (SVRI) was 1292 (294) d*s*cm-5/m2. CO presented a negative correlation with postmenstrual age (PMA), while SVRI presented a positive correlation with PMA. The repeatability coefficient was 31 ml/kg/min (12%).  Conclusion: This is the first study describing reference values for USCOM parameters in hemodynamically stable preterm infants and factors affecting their variability. Further studies to investigate the usefulness of USCOM for the longitudinal assessment of patients at risk for cardiovascular instability or monitoring the response to therapies are warranted. What is Known: • The ultrasonic cardiac output monitoring (USCOM) has been widely used on adult and pediatric patients and reference ranges for cardiac output (CO) by USCOM have been established in term infants. What is New: • We established reference values for USCOM parameters in very preterm and very-low-birth-weight infants; the reference ranges for CO by USCOM in the study population were 198-405 ml/kg/min. • CO normalized by body weight presented a significant negative correlation with postmenstrual age (PMA); systemic vascular resistance index presented a significant positive correlation with PMA.

Developing a Strategy for COVID-19 Control Among Hard-to-Reach Migrant Communities: The Experience of Roma 2 Local Health Authority.

Roma 2 Local Health Authority (ASL) developed a strategy to control the COVID-19 epidemic in Hard-to-reach (HTR) migrant communities, addressing both the containment of clusters in informal settlements and access to COVID-19 vaccination. The strategy was based on a strong collaboration of different services across the ASL and with Non-Governmental Organizations (NGOs). NGOs were involved in the active surveillance, reporting of COVID-19 suspected cases to the ASL and information to the communities. Health interventions (e.g., COVID-19 tests, contact tracing, vaccination) were offered in outreach in HTR communities' life places. From April 2020 to February 2021, 15 outbreaks were controlled, for a total of over 4,500 persons reached, and 265 COVID-19 cases identified. From July to November 2021, vaccinations were offered in outreach or with dedicated sessions, reaching 1,398 people. This intervention model may lay the foundations for the design of public health strategies, not only aimed at HTR populations.

Migrants' mental health recovery in Italian reception facilities.

BACKGROUND: Forced migration leaves deep marks on the psychological well-being of migrants, with post-traumatic stress disorder (PTSD) and other psychological conditions being prevalent among them. While research has clarified the extent to which pre-migration trauma is a predictor of mental health outcomes, the role of post-migration stressors in the settlement environment are yet to be fully characterized. METHODS: We monitored mental health of a cohort of 100 asylum-seekers during their 14-day COVID-19-related quarantine in reception facilities in Rome, Italy, through the administration of six questionnaires (a demographic survey, the WHO-5 well-being index, the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the Harvard Trauma Questionnaire, the Trauma and Loss Spectrum-Self Report, and the LiMEs-Italian version). Through the combination of statistical analysis and supervised learning, we studied the impact of the first contact with the reception system on asylum-seekers' mental health and sought for possible risk and shielding factors for PTSD. RESULTS: We find that sheltering in refugee centers has a positive impact on migrants' mental health; asylum-seekers with PTSD reported more traumatic events and personality characteristics related to loss and trauma; life events are predictors of PTSD in asylum-seekers. CONCLUSIONS: We identify past traumatic experiences as predictors of PTSD, and establish the positive role the immediate post-migration environment can play on migrants' psychological well-being. We recommend for host countries to implement reception models that provide effective protection and integration of asylum-seekers, similar to those in the Italian system.

Traumatic experiences before and during migration can impact the psychological well-being of migrants. This can result in post-traumatic stress disorder (PTSD), a disorder in which prior experience of traumatic events can lead to severe anxiety. We asked migrants to fill in questionnaires about their well-being during a 14-day quarantine in reception facilities in Rome, Italy. We evaluated whether the migrants had symptoms of PTSD and the impact of the quarantine on their mental health. We found that migrants who had experienced past traumatic events were more likely to have PTSD, and that staying in a safe and welcoming place in Italy helped improve their mental wellbeing. These findings underline the importance of designing suitable policies to support migrants' mental health when they arrive in host countries.

Experimental Analysis of Hot-Mix Asphalt (HMA) Mixtures with Reclaimed Asphalt Pavement (RAP) in Railway Sub-Ballast.

Environmental safeguards promote innovative construction technologies for sustainable pavements. On these premises, this study investigated four hot mix asphalt (HMA) mixtures-i.e., A, B, C, and D-for the railway sub-ballast layer with 0%, 10%, 20%, and 30% reclaimed asphalt pavement (RAP) by total aggregate mass and a rejuvenator additive, varying the bitumen content between 3.5% and 5.0%. Both Marshall and gyratory compactor design methods have been performed, matching the stability, indirect tensile strength, and volumetric properties of each mixture. Dynamic stiffness and fatigue resistance tests provided mechanical performances. Laboratory results highlighted that the RAP and the rejuvenator additive increase the mechanical properties of the mixtures. In addition, the comparative analysis of production costs revealed up to 20% savings as the RAP content increased, and the life cycle impact analysis (LCIA) proved a reduction of the environmental impacts (up to 2% for resource use-fossils, up to 7% for climate change, and up to 13% for water use). The experimental results confirm that HMA containing RAP has mechanical performances higher than the reference mixture with only virgin raw materials. These findings could contribute to waste management and reduce the environmental and economic costs, since the use of RAP in the sub-ballast is not, so far, provided in the Italian specifications for railway construction.

Transcript-Targeted Therapy Based on RNA Interference and Antisense Oligonucleotides: Current Applications and Novel Molecular Targets.

The development of novel target therapies based on the use of RNA interference (RNAi) and antisense oligonucleotides (ASOs) is growing in an exponential way, challenging the chance for the treatment of the genetic diseases and cancer by hitting selectively targeted RNA in a sequence-dependent manner. Multiple opportunities are taking shape, able to remove defective protein by silencing RNA (e.g., Inclisiran targets mRNA of protein PCSK9, permitting a longer half-life of LDL receptors in heterozygous familial hypercholesteremia), by arresting mRNA translation (i.e., Fomivirsen that binds to UL123-RNA and blocks the translation into IE2 protein in CMV-retinitis), or by reactivating modified functional protein (e.g., Eteplirsen able to restore a functional shorter dystrophin by skipping the exon 51 in Duchenne muscular dystrophy) or a not very functional protein. In this last case, the use of ASOs permits modifying the expression of specific proteins by modulating splicing of specific pre-RNAs (e.g., Nusinersen acts on the splicing of exon 7 in SMN2 mRNA normally not expressed; it is used for spinal muscular atrophy) or by downregulation of transcript levels (e.g., Inotersen acts on the transthryretin mRNA to reduce its expression; it is prescribed for the treatment of hereditary transthyretin amyloidosis) in order to restore the biochemical/physiological condition and ameliorate quality of life. In the era of precision medicine, recently, an experimental splice-modulating antisense oligonucleotide, Milasen, was designed and used to treat an 8-year-old girl affected by a rare, fatal, progressive form of neurodegenerative disease leading to death during adolescence. In this review, we summarize the main transcriptional therapeutic drugs approved to date for the treatment of genetic diseases by principal regulatory government agencies and recent clinical trials aimed at the treatment of cancer. Their mechanism of action, chemical structure, administration, and biomedical performance are predominantly discussed.

Global health education for medical students in Italy.

BACKGROUND: Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools. METHODS: An online survey was carried out using a questionnaire administered to a network of interested individuals with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score. RESULTS: A total of 61 responses were received from affiliates of 33 out of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points was related to the nature of "elective" courses, which were not mandatory in the curricula. Enrollees tended to be students genuinely interested in GH issues. Some community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels. CONCLUSIONS: GHE has spreading in Italy in line with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to include GH in the mandatory curricula of medical schools and other health faculties.

Long-term impact of Global Health educational experiences in Rome: an attempt of measurement.

BACKGROUND: Global health education (GHE) is spreading in Europe and in other parts of the world. Since 2008, Sapienza University of Rome has offered activities to medical and other health profession students related to global health (GH), which is grounded in the theory of social determinants of health and inspired by social justice. The educational activities included elective courses as well as community and service-learning experiences, referred to as GH gyms. This study attempts to measure the long-term impact of these educational experiences, especially to demonstrate their influence on the perceived social responsibility of future health professionals. METHODS: A questionnaire was elaborated and tested on a small sample of participants. It was sent to participants by e-mail. Quantitative results were analysed through descriptive statistics and qualitative answers were carefully read and classified. RESULTS: A total of 758 students from different faculties took part to the educational experiences. Only 488 e-mail addresses were available. One hundred and five (21.5%) questionnaires were returned. Participation in GH gyms was perceived to have had a higher influence on future professional and personal choices, when compared to participation in elective GH courses. CONCLUSIONS: The study shows that consideration of health and social issues related with inequities in health and the use of interactive teaching methodologies had important effects on social responsibility of a large number of students. As there could be a selection bias among respondents, more research is needed to understand the impact of GH educational experiences. The inclusion of global health education in health and social curricula and the use of interactive methodologies with a correct evaluation of results are the indications that emerge from this research, together with the necessity of a strong involvement of students, professors and the whole academic reality.

Medical education: an Italian contribution to the discussion on global health education.

BACKGROUND: In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE's point of view on Medical Education. METHODS: To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members. RESULTS: INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document. CONCLUSIONS: The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice.

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach.

OBJECTIVE: The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. METHODS: In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. RESULTS: At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. CONCLUSIONS: On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Cost-effectiveness of switching from trivalent to quadrivalent inactivated influenza vaccines for the at-risk population in Italy.

Seasonal influenza is caused by two subtypes of influenza A and two lineages of influenza B. Although trivalent influenza vaccines (TIVs) contain both circulating A strains, they contain only a single B-lineage strain. This can lead to mismatches between the vaccine and predominant circulating B lineages, a concern especially for at-risk populations. Quadrivalent influenza vaccines (QIVs) containing a strain from both B lineages have been developed to improve protection against influenza. Here, we used a cost-utility model to examine whether switching from TIV to QIV would be cost-effective for the at-risk population in Italy. Costs were estimated from the payer and societal perspectives. The discount rate for outcomes was 3.0%. Univariate and probabilistic sensitivity analyses were performed to examine the effects of variations in parameters. Switching from TIV to QIV in Italy was estimated to increase quality-adjusted life-years (QALYs) and produce cost savings, including €1.6 million for hospitalization and approximately €2 million in productivity. The incremental cost-effectiveness ratio was €23,426 per QALY from a payer perspective and €21,096 per QALY from a societal perspective. Switching to QIV was most cost-effective for individuals ≥ 65 years of age (€19,170 per QALY). Probabilistic sensitivity analysis showed that the switching from TIV to QIV would be cost-effective for > 91% of simulation at a maximum willingness-to-pay threshold of €40,000 per QALY gained. Although the model did not take herd protection into account, it predicted that the switch from TIV to QIV would be cost-effective for the at-risk population in Italy.

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy.

BACKGROUND: In Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11. METHODS: A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered. CONCLUSION: The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective. RESULTS: Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.

Conflict of interest between professional medical societies and industry: a cross-sectional study of Italian medical societies' websites.

OBJECTIVE: To describe how Italian medical societies interact with pharmaceutical and medical device industries through an analysis of the information available on their websites. DESIGN: Cross sectional study. SETTING: Italy. PARTICIPANTS: 154 medical societies registered with the Italian Federation of Medical-Scientific Societies. MAIN OUTCOME MEASURES: Indicators of industry sponsorship (presence of industry sponsorship in the programme of the last medical societies' annual conference; presence of manufacturers' logos on the homepage; presence of industry sponsorship of satellite symposia during the last annual conference). RESULTS: 131 Italian medical societies were considered. Of these, 4.6% had an ethical code covering relationships with industry on their websites, while 45.6% had a statute that mentioned the issue of conflict of interest and 6.1% published the annual financial report. With regard to industry sponsorship, 64.9% received private sponsorship for their last conference, 29.0% had manufacturers' logos on their webpage, while 35.9% had industry-sponsored satellite symposia at their last conference. The presence of an ethical code on the societies' websites was associated with both an increased risk of industry sponsorship of the last conference (relative risk (RR) 1.22, 95% CIs 1.01 to 1.48 after adjustment) and of conferences and/or satellite symposia (RR 1.22, 95% CIs 1.02 to 1.48 after adjustment) but not with the presence of manufacturers' logos on the websites (RR 1.79, 95% CIs 0.66 to 4.82 after adjustment). No association was observed with the other indicators of governance and transparency. CONCLUSIONS: This survey shows that industry sponsorship of Italian medical societies' conferences is common, while the presence of a structured regulatory system is not. Disclosure of the amount of industry funding to medical societies is scarce. The level of transparency therefore needs to be improved and the whole relationship between medical societies and industry should be further disciplined in order to avoid any potential for conflict of interest.

Concurrent environmental stressors and jellyfish stings impair caged European sea bass (Dicentrarchus labrax) physiological performances.

The increasing frequency of jellyfish outbreaks in coastal areas has led to multiple ecological and socio-economic issues, including mass mortalities of farmed fish. We investigated the sensitivity of the European sea bass (Dicentrarchus labrax), a widely cultured fish in the Mediterranean Sea, to the combined stressors of temperature, hypoxia and stings from the jellyfish Pelagia noctiluca, through measurement of oxygen consumption rates (MO2), critical oxygen levels (PO2crit), and histological analysis of tissue damage. Higher levels of MO2, PO2crit and gill damage in treated fish demonstrated that the synergy of environmental and biotic stressors dramatically impair farmed fish metabolic performances and increase their health vulnerability. As a corollary, in the current scenario of ocean warming, these findings suggest that the combined effects of recurrent hypoxic events and jellyfish blooms in coastal areas might also threaten wild fish populations.

Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome.

BACKGROUND: In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers. METHODS: Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup. RESULTS: Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis. CONCLUSION: The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia

Intendendo la salute come un diritto umano fondamentale che non si esaurisce alla dimensione biologica ma si estende a quella sociale, economica e politica, gli autori, dopo aver descritto brevemente le politiche che a livello europeo sono state emanate per tutelare la salute dei migranti, analizzano l’esperienza italiana alla luce delle direttive internazionali. L’Italia rappresenta infatti un caso particolare ed avanzato di tutela della salute dei migranti; la sua politica sanitaria decisamente inclusiva riconosce parità di diritti e doveri ai cittadini regolarmente presenti ed ammette ampie possibilità di protezione ed assistenza anche per gli immigrati privi di permesso di soggiorno. Tuttavia, anche in un contesto avanzato come quello italiano, è necessaria un’evoluzione da un approccio di tipo assistenzialistico ad uno più ampio di promozione della salute attraverso politiche di natura intersettoriale, alla luce della teoria dei determinanti sociali di salute. Affrontare la tematica della salute del popolo migrante rappresenta un’occasione per rendere i servizi sanitari in particolare e le politiche migratorie in generale più attente ad ogni persona, alla sua storia e al contesto nel quale essa vive.(AU)

Understanding health as a fundamental human right, not limited only to the biological dimension, but including the social, economic, and political ones, the authors, after briefly describing the politics enacted at the European level to protect migrant health, analyzethe Italian experience in the light of international guidelines. Italy is, in fact, a specific and advanced case of migrant health protection; it’s very inclusive health policy recognizesthe equality in rights and responsibilities of legal citizens and offers protection and assistance to immigrants without legal authorization to reside in the country. However, even in an advanced context such as the Italian, it is important to transition from an assistance-based approach to a broader one of health promotion through intersectoral policies in light of the theory of the social determinants of health. Addressing the issue of migrant health represents an opportunity for the health services and, in general, for migration policies to become more focused on each person, his/her history, and the context in which he/she lives in.(AU)

[Correlation between legal protection of the environment and health]. / Correlazione tra tutela giuridica dell'ambiente e della salute.

Health promotion is a priority of our time and planning and the evaluation of health and hygiene should be directed towards strategies to improve the well-being and lifestyles of the community. At the legislative level in Italy, the Ministry of Health, was established in 1958 with the task of providing for the collective health of the whole nation and in 1978, with Law 833, the National Health Service (NHS) was created which secured assistance and healthcare to all Italian citizens. The most important component of the entire health system is the Local Health Unit (USL) which has responsibility for prevention, treatment and rehabilitation, and highlights the importance of safeguarding the health, hygiene and safely at home and at work and the "hygiene of urban settlements and communities", ie environmental protection. One of the reasons for the delays in the promotion of environmental protection initiatives in Italy is to be found in the referendums of 1993, including the one which removed the tasks regarding environmental controls from the NHS. The temporary skills gap in the environmental field was filled with the 'National Agency for Environmental Protection (ANPA), which later became the Agency for Environmental Protection and Technical Services (APAT), and the regional level, the Regional Agencies Environmental Protection Agency (ARPA). Law 61/21 January 1994 joined the ARPA to the National Institute for Environmental Research and Protection (ISPRA). It is now necessary to implement a program that takes account of the damage caused to the environment and consequently the individual, which is totally committed the combination of the environment and human health and not, as in the recent past, as two distinct entities. In this sense, it is of fundamental importance the role of prevention departments to promote the organization networking and of individual companies' and individuals' skills, in fact. The integration of planning processes, environmental monitoring intiatives and health planning are an inescapable element necessary to produce positive effects on public health.

Use of carbon fiber cages for treatment of cervical myeloradiculopathies.

BACKGROUND: Different types of intersomatic fixation systems are available for use in the treatment of cervical disc pathologies. In this paper, we report our experience using carbon fiber cages (Brantigan I/F cage, De Puy Acromed, Raynham, MA; Mikai distrib.) for acute and chronic cervical disc pathologies. METHODS: Between 1997 and 2001, 97 patients underwent surgical treatment for cervical disc pathologies. Follow-up ranged from 1 to 60 months. In all cases a microdiscectomy according to Caspar was performed; anterior stabilization was performed in cases with evidence of instability and in post-traumatic disc herniations. RESULTS: A total number of 119 carbon fiber cages, ranging in height from 4 to 8 mm, were employed as well as 10 anterior plates with screws. The type of material used to fill the cages was homologous bone (50.5%), heterologous bone (22.3%), hydroxyapatite (21.1%), and autologous bone (6%). In all cases, follow-up radiograms performed after at least 6 months demonstrated bone fusion. None of the patients had either spontaneous displacement of the implant or symptoms from nerve compression. CONCLUSIONS: These preliminary results suggest that anterior cervical fusion with carbon fiber cages are valid to restore intervertebral disc height and to promote bone fusion with low complications rate.