Evaluation of the Risk of African Swine Fever Virus Transmission at the Interface between Feral and Domestic Pigs in Lombardy, with a View to Establishing Preventive Measures for Domestic Pigs.

African swine fever (ASF) continues to spread worldwide, and has reached multiple countries across Asia, the Caribbean, Europe, and the Pacific, representing a serious economic burden threatening pig health and welfare, as well as food security. The disease affects domestic pigs and wild boar, and in several European countries the disease is endemic in wild boars. The lack of vaccines or effective treatments highlights the importance of effective control measures used to keep domestic and feral pigs separated to prevent the spread of the virus. However, the study of the livestock-wildlife interface is quite complex and has many aspects to consider, including the uncertainty of wild-boar population data. In this study, we determined the risk of spread of the ASF virus at the interface between domestic pigs and wild boars using indicators that can indirectly indicate the presence of wild boars in order to target specific control measures in the highest risk areas. The results of the study were compared with those obtained by Pittiglio, in which the population data for wild boars was estimated using a geostatistical method and similar results were obtained. However, the present study used specific information relating to the wild-boar population and this allowed us to use fewer variables.

Semi-Quantitative Risk Assessment of African Swine Fever Virus Introduction in Outdoor Pig Farms.

In a previous study, a semi-quantitative risk assessment was developed to rank pig holdings in terms of likelihood of introducing African swine fever virus (ASFV) by assessing their compliance with biosecurity and exposure to geographical risk factors. The method was initially developed for confined pig holdings, but given that ASF is endemic in wild boar of several countries, we modified the approach to make it suitable for free-range farms as well. In the current study, a total of 41 outdoor pig farms were assessed in an area where exposure to wild boar was generally high (density from 2.3 to 10.3 wild boar per Km2). As expected, non-compliance with biosecurity measures was frequent in outdoor farms, and the frequency of non-compliance indicated that the absence of adequate separation of pigs from the external environment was the major weakness in the farms assessed. In 46.3% of them, there was no fence or, if present, it was not adequate to avoid contact with wild boar. However, the approach adopted proved to be suitable for identifying intervention priorities to mitigate the risk of ASFV spread in free-range pig herds and for identifying the weaknesses of individual farms, as recommended by EFSA in 2021, which suggests implementing tools to improve biosecurity by favoring higher-risk farms.

Semi-quantitative risk assessment of African swine fever virus introduction in pig farms.

A semi-quantitative risk assessment was developed to classify pig farms in terms of the probability of introduction of African swine fever virus (ASFV). Following on-farm data collection via a specific checklist, we applied a modified failure mode and effect analysis (FMEA) to calculate the risk priority codes (RPC's), indicating increasing risk levels ranging from 1 to 5. The importance of biosecurity measures was attributed by experts. To consider geographic risk factors, we classified pig farms based on local density of farmed pigs, and on the estimated wild boar population density. The combination of RPC's with geographical risk factors resulted into a final ranking of pig farms in terms of the risk of ASFV introduction. Furthermore, the estimation of frequency and levels of non-compliance with biosecurity measures was used to identify weak points in risk prevention at farm level. The outcome of the risk assessment was affected by choices in assigning non-compliance scores and importance to specific components of biosecurity. The method was applied in 60 commercial farms in major pig production areas in Italy. Furthermore, we applied a reduced version of our checklist in 12 non-commercial/small commercial (≤20 pigs) farms in the northern Apennines. In commercial farms, highest RPC's were obtained for biosecurity measures associated with personnel practices and farm buildings/planimetry. Intervention should be addressed to training of personnel on biosecurity and ASF, to avoid contacts with other pig herds, and to improve practices in the entrance into the farm. Sharing trucks with other farms, and loading/unloading of pigs were other weak points. Fencing was classified as insufficient in 70% of the commercial farms. Among these farms, breeding units were characterised by the lowest risk of ASFV introduction (although differences among median ranks were not statistically significant: P-value = 0.07; Kruskal-Wallis test), and increasing herd size was not significantly correlated with a higher risk (Kendall's τ = -0.13; P-value = 0.14). Density of farmed pig was greatest in the main pig production area in northern Italy. Conversely, exposure to wild boars was greatest for non-commercial/small commercial farms on the Apennines, which were also characterised by non-compliance with critical biosecurity measures.

Epidemiological Features of the Highly Pathogenic Avian Influenza Virus H5N1 in a Densely Populated Area of Lombardy (Italy) during the Epidemic Season 2021-2022.

In the last two years, there have been three major epidemic seasons in the territory of the European Union and the HPAI epizootic in 2021-2022 is the most severe in recent history. In Italy, the disease was introduced to dense poultry areas with serious economic consequences for the entire sector. In Lombardy, the analysis of the risk factors was carried out, also taking into account the density of domestic birds. In the most affected areas, 66.7% of the outbreaks occurred in the areas with the highest poultry density and the likelihood of an outbreak occurring increased with an increase in the density of birds per km2. In cells 10 × 10 km with a density greater than 10,000 birds/km2, the probability of outbreak occurrence was over 66.7%. The provinces involved in the last epidemic were the same involved in previous epidemics and, given the risk factors present in the area, it is plausible that the risk remains high also for future epidemic seasons. Therefore, to avoid the repetition of similar events, certain control measures shall be strengthened and vaccination considered as a complementary tool for the control of HPAI virus in risk areas.

Analysis of Bee Population Decline in Lombardy during the Period 2014-2016 and Identification of High-Risk Areas.

The first events of bee decline in Italy were reported during 1999. Since then, population decline has frequently been reported in Lombardy. In this study, the association between bee decline and the type of land surrounding the apiary was evaluated. A risk map was developed to identify areas with the highest risk of decline. Apiaries in Lombardy were selected from the national beekeeping database (BDA). The study period was from 2014 to 2016. Apiaries were deemed "declined" if they reported at least one event of decline or tested positive for plant protection products; apiaries were "not declined" if they did not report any events of bee decline during the study period. Out of 14,188 apiaries extracted from the BDA, 80 were considered declined. The probability of an apiary being declined increases by 10% in orchards and by 2% in arable land for each additional km2 of land occupied by these crops. The study showed an association between bee decline and the type of territory surrounding the apiaries, and the areas at the greatest risk of decline in Lombardy were identified. This information can be used by Veterinary Services as a predictive parameter for planning prevention and control activities.

[Analysis of pigs' movement to Lombardy (Northern Italy) to assess the potential risk of pathogens introduction into this region and to plan mitigation measures]. / Analisi delle movimentazioni di suini in entrata in Lombardia al fine di valutare il potenziale rischio di introduzione di patogeni nella regione e pianificare misure di controllo.

OBJECTIVES: to analyse the trade flow of pigs to Lombardy (Northern Italy) to single out the farms more involved in animal movements to identify the holdings and areas most exposed to the risk of introducing pathogens into the region and to plan proper mitigation measures. Indeed, the movement of live animals and of the means of transport is one of the main risk factors in the spread of diseases and this is particularly relevant in areas with high stocking density. DESIGN: statistical analysis on movements of pigs entering Lombardy was carried out. Data on pigs' movements and farm characteristics were collected from the National and Regional databases. Social Network Analysis (SNA) was used to analyse the flows of pigs to Lombardy, to identify the holdings and geographical areas that are central in the trading network and that could have a role in the introduction of swine pathogens into the region. SETTING AND PARTICIPANTS: data on pigs' movements introduced into Lombardy in 2016 were analysed. Lombardy is a region of Northern Italy with intensive livestock husbandry. The pig sector is of particular economic relevance also in view of the processing industry, suited to the production of high quality pork products. Annually about 1.8 million pigs are introduced into the region also to satisfy the request of the processing industry for the production of pork products. MAIN OUTCOME MEASURES: in this study, the farms that buy pigs from outside the region were identified as well as the territories where the largest number of pigs are introduced. The analysis was carried out also considering certain factors related to the movement of animals, which can be relevant for the transmission of pathogens, such as number of commercial partners, number of exchanged animals, and number of shipments. RESULTS: in 2016, 1,782,568 pigs were introduced into Lombardy; by using SNA, it was possible to highlight a complex trade network of pigs, mainly involving the Northern regions. Indeed, the pigs were mostly purchased from Emilia Romagna (33.4%), followed by Veneto and Piedmont. These regions have been the most closely analysed in this study. SNA was also used to identify Lombardy territories (provinces and municipalities) which, based on the number of introduced pigs, are potentially most exposed to the introduction of pathogens from outside the region. Mantua and Brescia provinces resulted the most exposed area. CONCLUSIONS: Italy is one of most important European producers of pigs and about 50% of national pig assets is present in Lombardy; furthermore, about 1.8 million pigs are introduced yearly into the region. Currently, the region is free from the main diseases of pigs and the introduction of an epidemic disease into the pig population could adversely affect the entire productive sector. For this reason, an analysis of the movements of pigs entering the region was carried out to identify the areas (provinces, municipalities) and holdings most exposed to the risk of introduction of pathogens. This information is relevant for the veterinary authorities to plan appropriate control activities (official controls, surveillance, biosecurity, and vaccination, where possible) in order to enhance disease prevention and promote early detection.

Clinical efficacy of Lactobacillus reuteri-containing lozenges in the supportive therapy of generalized periodontitis stage III and IV, grade C: 1-year results of a double-blind randomized placebo-controlled pilot study.

OBJECTIVE: The aim of this 12-month mono-centre double-blind randomized placebo-controlled clinical study was to evaluate the efficacy of Lactobacillus reuteri-containing lozenges during the supportive therapy of generalized periodontitis stage III and IV, grade C (GPIII-IVC) patients. MATERIAL AND METHODS: Twenty treated GPIII-IVC patients were randomly divided into 2 groups. The test group received two 3-month-long administrations of L. reuteri (2 lozenges/day after brushing) with a 3-month washout period, while the control one received a placebo. Outcome measures were tooth survival, complications and adverse events, change in probing pockets depth (PPD), change in probing attachment level (PAL), presence of bleeding on probing (BOP) and patient's evaluation of treatment. Measurements were collected at 3, 6, 9 and 12 months. RESULTS: At 1 year, no dropout, tooth loss, complications or adverse event were recorded. Mean PPD and mean PAL and percentages of sites with BOP were statistically improved (p < 0.05) compared with baseline in both groups, while more PPD reduction at all time points (p < 0.05) and more PAL gain at 6 months and more BOP reduction at 6 and 9 months were found in the probiotic group (p < 0.05). CONCLUSIONS: Within the limitation of the study, the use of L. reuteri probiotics lozenges improved some clinical outcomes in treated GPIII-IVC patients during maintenance therapy. Studies with a larger number of patients are needed to confirm these data. CLINICAL RELEVANCE: The use of L. reuteri probiotic lozenges could be considered as an adjunct in the maintenance therapy of GPIII-IVC patients.

Periodontitis Stage III-IV, Grade C and Correlated Factors: A Histomorphometric Study.

BACKGROUND: Periodontitis is a disease that leads to serious functional and esthetic dysfunctions. Periodontitis exists in different forms, and its etiology is related to multiple component causes. Two key processes involved in the evolution of this pathology are angiogenesis and inflammatory infiltrate. The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage III-IV, grade C periodontitis (GPIII-IVC), which is a particular form of periodontitis. METHODS: Eighteen subjects with GPIII-IVC were enrolled in this study. The percentage of inflammatory cells and the vascular area were measured and evaluated in relation to each periodontal disease-associated factor. RESULTS: Females showed a significant increase in the percentage of inflammatory cells compared to males (6.29% vs. 2.28%, p-value = 0.020) and it was higher in non-smokers than in smokers (4.56% vs. 3.14%, p-value = 0.048). Young patients showed a significant increase in vascular area percentage compared to older patients (0.60% vs. 0.46%, p-value = 0.0006) and this percentage was also higher in non-smokers compared to smokers (0.41% vs. 0.55%, p-value = 0.0008). The vascular area was also more than halved in subjects with residual plaque on tooth surfaces (0.74% vs. 0.36%, p-value = 0.0005). CONCLUSIONS: These results suggested that even if these factors are commonly related to the worsening of periodontal status, some of them (pus and periodontal probing depth (PPD)) do not affect the inflammatory and vascular patterns.

First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry).

Objective: Neonatal Lupus (NL) is a rare syndrome caused by placental transfer of maternal anti-SSA/Ro and anti-La/SSB autoantibodies to the fetus. The rarity of this condition requires the establishment of multidisciplinary registries in order to improve our knowledge. Method: Inclusion criteria in this retrospective study were the maternal confirmed positivity for anti-SSA/Ro and/or anti-SSB/La antibodies, and the presence of II or III degree congenital heart block (CHB) in utero or neonatal period (up to 27 days after birth). Result: Eighty-nine cases of CHB were observed in 85 women with 88 pregnancies that occurred between 1969 and 2017. CHB was mostly detected in utero (84 cases, 94.2%), while five cases were observed in the neonatal period. A permanent pacemaker was implanted in 51 of 73 children born alive (69.8), whereas global mortality rate was 25.8% (23 cases): 16 in utero, five perinatal, and two during childhood. By univariate analysis, factors associated with fetal death were pleural effusion (p = 0.005, OR > 100; CI 95% 2.88->100 and hydrops (p = 0.003, OR = 14.09; CI 95% 2.01-122). Fluorinated steroids (FS) were administered in 71.4% pregnancies, and its use was not associated with better survival. Some centers treated all cases with fluorinated steroids and some centers did not treat any case. CHB was initially incomplete in 24 fetuses, and of them five cases of II degree block reverted to a lower degree block after treatments. Recurrence rate in subsequent pregnancies was 17.6% (3 out of 17). A prophylactic treatment was introduced in 10 of these 16 subsequent (58.8%) pregnancies, mostly with FS or high dose intravenous immunoglobulins. Conclusion: This is the first report from the Italian Registry of neonatal lupus/CHB. The live birth rate was nearly 80%, with nearly two thirds of the children requiring the implantation of a pacemaker. The management of fetuses diagnosed with CHB was heterogeneous across Italian Centers. The registry at present is mainly rheumatological, but involvement of pediatric cardiologists and gynecologists is planned.

Health-related quality of life varies in different respiratory disorders: a multi-case control population based study.

BACKGROUND AND OBJECTIVE: Health-related quality of life (HRQL) in respiratory diseases has been generally investigated in clinical settings, focusing on a single disorder. In this study on a general population sample, we assessed the relationship between HRQL and several respiratory diseases studied simultaneously (COPD, current (CA) and past (PA) asthma, allergic (AR) and non-allergic (NAR) rhinitis and chronic bronchitis (CB). METHODS: Controls (n = 328) and cases of NAR (n = 95), AR (n = 163), CB (n = 48), CA (n = 224), PA (n = 126) and COPD (n = 28) were recruited in the centre of Verona in the frame of the Italian multi-case control GEIRD (Gene Environment Interactions in Respiratory Diseases) study; HRQL was measured through the SF-36 questionnaire. The relationships between HRQL (in terms of Physical (PCS) and Mental Component Scores (MCS)), respiratory diseases, and covariates were evaluated. RESULTS: With respect to controls, the adjusted PCS median score was worse in subjects suffering from current asthma (- 1.7; 95%CI:-2.8;-0.6), CB (- 3.8; 95%CI:-5.7;-1.9), and COPD (- 5.6; 95%CI:-8.1;-3.1). MCS was worse in current asthmatics (- 2.2; 95%CI:-4.1;-0.3), CB (- 5.5; 95%CI:-8.7;-2.2), and COPD cases (- 4.6; 95%CI:-8.8;-0.5) as well. CONCLUSIONS: To our knowledge, this is the first study in the general population that analyzed HRQL performing a simultaneous comparison of HRLQ in several respiratory disorders. We found that subjects suffering from COPD, CA, and CB had the poorest HRQL. Clinicians should carefully consider the possible impact of respiratory disorders as CB and not only that of CA and COPD.

Maternal functional hemodynamics in uncomplicated twin pregnancies: A longitudinal study using impedance cardiography.

INTRODUCTION: Longitudinal studies of maternal hemodynamics in twin pregnancy are scarce and preload reserve in twin pregnancies has not been studied. Thus, we aimed to investigate serial changes in maternal systemic hemodynamics from the first to third trimester, and cardiovascular response to passive leg raising to evaluate preload reserve using impedance cardiography in a cohort of uncomplicated twin pregnancies. MATERIAL AND METHODS: This was a prospective longitudinal study of 50 twin pregnancies. Maternal hemodynamics was assessed at baseline and 120 seconds after passive leg raising using impedance cardiography, at five time points during gestation. Women were excluded from the analysis if there were pregnancy complications or fewer than three of five planned assessments were available. RESULTS: Data from 37 uncomplicated twin pregnancies were available for analysis. Mean arterial pressure slightly decreased until 17 weeks' gestation, then increased. Systemic vascular resistance was constant in the first half of pregnancy before rising steadily thereafter, whereas the cardiac output increased from the first trimester, peaked by the end of the second trimester and then decreased in the third trimester. The change in stroke volume and cardiac output following passive leg raising during pregnancy ranged from -2.2% to 1.6% and from -3.7% to 3.2%, respectively. Although passive leg raising caused no significant changes in systemic vascular resistance, cardiac output or heart rate, mean arterial pressure decreased in the first and second trimesters. CONCLUSIONS: In uncomplicated twin pregnancies, maternal cardiovascular adaptation is evident from the first trimester. Twin pregnancies show a reduced preload reserve in the second half of gestation.

Longitudinal reference ranges for serial measurements of myocardial performance index (MPI) by conventional and pulsed-wave tissue Doppler in monochorionic diamniotic twins at 17 to 26 weeks of gestation.

OBJECTIVE: To describe the longitudinal changes of fetal myocardial performance index (MPI) measured by conventional Doppler (MPI) and by pulsed-wave tissue Doppler (MPI') based on a prospective cohort of uncomplicated monochorionic diamniotic twin. METHOD: Single-center observational study. We measured MPI and MPI' in the right and left ventricles 3 times between 17 and 26 weeks of gestation. Second-degree fractional polynomials were built to obtain the best fitting curves in relation to gestational age (weeks) for each parameter. Gestational age-specific reference values were estimated by using two-level hierarchical models. RESULTS: Eighty-three uncomplicated monochorionic pregnancies were included in our study with a total of 249 observations. Fetal cardiac function was measured as MPI RV and LV, MPI' RV and LV at a mean gestational age of 18+3 (range 17+1 to 19+2 ), 22+3 (21+1 to 23+5 ), and 24+3 (22+6 to 26+2 ) weeks. The reference ranges for MPI LV, MPI RV, MPI' LV, and MPI' RV at 17 to 26 weeks were constructed and conditional percentiles calculated. CONCLUSION: The present study provides additional data on fetal cardiac function in uncomplicated monochorionic diamniotic twin gestations, describing the evolution of MPI and MPI' in both ventricles in uncomplicated monochorionic diamniotic pregnancies.

Imported malaria in northern Italy: epidemiology and clinical features observed over 18 years in the Teaching Hospital of Brescia.

BACKGROUND: Even though malaria incidence is decreasing worldwide, travel-related cases reported in Europe have remained stable in recent years. In Italy, incidence had increased in the 1990s, reaching a peak in 1999; a slow decline was then reported over the subsequent decade. To our knowledge, few published data are available on imported malaria in Italy since 2010. In this article we aimed to analyse trends in imported malaria in the teaching hospital of Brescia, northern Italy, over the last 18 years. METHODS: All malaria cases diagnosed from 1999 to 2016 in Spedali Civili Hospital, Brescia, were retrospectively identified. Demographic, clinical and travel-related data were described. RESULTS: A total of 1200 cases of imported malaria were diagnosed in Brescia during the study period. Among them, 225 were children. A trend of increasing paediatric cases was identified over the study period, while cases in adults were stable. Most cases were diagnosed between August and October. Patients were most likely exposed in sub-Saharan Africa (87.2%). The main reported travel reason was travelling to visit friends and relatives (66.0%). A significantly higher risk of severe malaria was observed in non-immune patients and children visiting friend and relatives (P < 0.001 and P = 0.006, respectively). CONCLUSIONS: Our study reveals a relatively stable incidence in imported malaria cases with a peak during the summertime. A large and increasing paediatric burden of disease was identified. Imported malaria requires attention since in Italy a potential reappearance of autochthonous Plasmodium vivax malaria transmission cannot be excluded. Preventive action and physician awareness should be especially directed to children visiting friends and relatives in endemic countries and to non-immune patients since they both represent high-risk groups for severe malaria.

Effects of Domestic Storage and Thawing Practices on Salmonella in Poultry-Based Meat Preparations.

Among consumer food handling practices, time-temperature abuse has been reported as one of the most common contributory factors in salmonellosis outbreaks where the evidence is strong. The present study performed storage tests of burgers, sausages, and kebabs and investigated (i) the effect of refrigerator temperatures (4°C versus 8 or 12°C, which were the temperatures recorded in 33 and 3%, respectively, of domestic refrigerators in Italy), with or without prior temperature abuse (25°C for 2 h, simulating transport of meats from shop to home), and (ii) the impact of the thawing method (overnight in the refrigerator at 8°C versus on the kitchen countertop at 23°C) on the presence and numbers of Salmonella bacteria. Storage tests were carried out on naturally or artificially (Salmonella enterica serovar Typhimurium at ca. 10 CFU/g) contaminated products, while freezing-thawing tests were conducted only on artificially contaminated products (Salmonella Typhimurium at ca. 10, 100, and 1,000 CFU/g). The results from the artificially contaminated products showed significant (P < 0.05) growth of Salmonella Typhimurium at 12°C (i.e., from ca. 8 most probable number [MPN]/g to > 710 MPN/g) in kebabs after 7 and 10 days but more moderate growth in sausages (i.e., from ca. 14 MPN/g to a maximum of 96 MPN/g after 9 days of storage). Storage of naturally contaminated burgers or sausages (contamination at or below 1 MPN/g) at 4, 8, or 12°C and a short time of temperature abuse (2 h at 25°C) did not facilitate an increase in the presence and numbers of Salmonella bacteria. Thawing overnight in the refrigerator led to either a moderate reduction or no change of Salmonella Typhimurium numbers in burgers, sausages, and kebabs. Overall, this study showed that domestic storage and thawing practices can affect food safety and that time-temperature abuse can cause a substantial increase of Salmonella numbers in some types of poultry-based meat preparations, highlighting that efforts for the dissemination of consumer guidelines on the correct storage and handling of meats need to be continued.

Students' Consumption of Beverages and Snacks at School and Away from School: A Case Study in the North East of Italy.

In North-East Italy (the Veneto region), several public school nutrition policies have been developed to reduce the consumption of high-caloric snacks and beverages. However, little is known about whether the policies actually influence students' dietary behaviors. In order to address this point, a multi-center cross-sectional survey of 691 Italian students was conducted. Students completed the Beverage and Snack Questionnaire, which assesses the consumption of beverages and snacks at school and out of school. Three-level Poisson Models with random intercept with students (level 1 units) nested into classroom (level 2 units), and nested into schools (level 3 units), were used to examine the influence of the school setting vs. the out of school environment (independent variable) on students' consumption of sweet beverages, snacks, milk-based beverages, low-carbohydrate drinks, fruit, and vegetables (dependent variable) (p ≤ 0.05). The results showed a significantly higher consumption of sweet beverages, snacks, milk-based beverages, low-carbohydrate drinks, fruit, and vegetables out-of-the school, suggesting a school-protective association Thus, the policies aimed to limit or deny access to unhealthy foods in the school environment may play an important role in promoting more healthful dietary patterns for school children. Additional studies should be conducted to compare students' dietary behaviors between schools with nutrition policies to those without nutrition policies.

Survival of Salmonella Typhimurium in poultry-based meat preparations during grilling, frying and baking.

The burden of food-borne diseases still represents a threat to public health; in 2012, the domestic setting accounted for 57.6% of strong-evidence EU food-borne Salmonella outbreaks. Next to cross-contamination, inadequate cooking procedure is considered as one of the most important factors contributing to food-borne illness. The few studies which have assessed the effect of domestic cooking on the presence and numbers of pathogens in different types of meat have shown that consumer-style cooking methods can allow bacteria to survive and that the probability of eating home-cooked poultry meat that still contains surviving bacteria after heating is higher than previously assumed. Thus, the main purpose of this study was to reproduce and assess the effect of several types of cooking treatments (according to label instructions and not following label instructions) on the presence and numbers of Salmonella Typhimurium DT 104 artificially inoculated in five types of poultry-based meat preparations (burgers, sausages, ready-to-cook-kebabs, quail roulades and extruded roulades) that are likely to be contaminated by Salmonella. Three contamination levels (10 cfu/g; 100 cfu/g and 1000 cfu/g) and three cooking techniques (grilling, frying and baking) were applied. Cooking treatments performed according to label instructions eliminated Salmonella Typhimurium (absence per 25g) for contamination levels of 10 and 100 cfu/g but not for contamination levels of 1000 cfu/g. After improper cooking, 26 out of 78 samples were Salmonella-positive, and 23 out of these 26 samples were artificially contaminated with bacterial loads between 100 and 1000 cfu/g. Nine out of 26 samples provided quantifiable results with a minimum level of 1.4MPN/g in kebabs (initial inoculum level: 100 cfu/g) after grilling and a maximum level of 170MPN/g recorded in sausages (initial inoculum level: 1000 cfu/g) after grilling. Kebabs were the most common Salmonella-positive meat product after cooking, followed by sausages, burgers and extruded roulades; in relation to the type of cooking treatment applied, Salmonella Typhimurium was detected mostly after frying. Thus, following label instructions mostly, but not always, produced safe cooked poultry-based meat preparations, while the application of inadequate cooking treatments was not able to assure complete elimination of Salmonella from the products even with a low contamination level (10cfu/g). Consequently, there is a need to develop guidelines for producers and consumers and promote a multidisciplinary educational campaign in order to provide information on safe cooking and time-temperature combinations able to maintain the organoleptic qualities of meat.

Food safety and hygiene lessons in the primary school: implications for risk-reduction behaviors.

OBJECTIVE: This study describes an effective educational program to improve children's knowledge about characteristics of microorganisms and food contamination, and their personal hygiene behaviors. MATERIALS AND METHODS: Between November 2011 and March 2012, a health campaign, targeted at fifth-grade students of 12 public primary compulsory schools, was conceived. Participants were divided into two classes, a theoretical class and a practical class based on two different teaching approaches. To address children's knowledge and behaviors on the program topics and to monitor the effectiveness of the health campaign on changing pre-existent concepts and habits, pre- and post-intervention questionnaires were administered both to students and parents. Poisson and binomial mixed models were performed. RESULTS: Two hundred forty-nine children were enrolled. Results show an overall improvement in children's knowledge both for the practical and theoretical classes (incident risk ratios [IRRs]: 1.2, 95% confidence interval (CI) 1.1-1.2, p<0.001 and 1.1, 95% CI 1.0-1.1, p<0.001, post- versus pre-intervention). The same effect was observed for children's behavior, comparing post- versus pre-intervention for both groups (IRRs were 3.4, 95% CI 2.2-5.2, p<0.001 and 3.2 95% CI 1.9-5.5, p<0.001). CONCLUSION AND APPLICATIONS: The methodology described in this article might be usefully adopted to conduct food safety classes, contributing to the amelioration of children's awareness on food related risks and leading to significant benefit for primary prevention.

Mild asthma and chronic bronchitis seem to influence functional exercise capacity: a multi-case control study.

BACKGROUND: In the Genes Environment Interaction in Respiratory Diseases population-based multi-case control study, we investigated whether asthma, chronic bronchitis (CB) and rhinitis were associated with a reduced 6-minute walk distance (6MWD), and whether the 6MWD determinants were similar for subjects with/without respiratory diseases. METHODS: Cases of asthma (n = 360), CB (n = 120), rhinitis (n = 203) and controls (no respiratory diseases: n = 302) were recruited. The variation in the 6MWD across the groups was analyzed by ANCOVA, adjusting for gender, age, height, weight and comorbidity. The 6MWD determinants were studied by linear regression, and heterogeneity across the cases and controls was investigated. RESULTS: The 6MWD differed across cases and controls (p = 0.01). It was shorter for cases of asthma (-17.1, 95% CI -28.3 to -5.8 m) and CB (-20.7, 95% CI: -36.6 to -4.8 m) than for controls (604 ± 68 m on average), but not for cases of rhinitis. The negative association between age and the 6MWD was significant for cases of CB, but not for the other groups (p = 0.001). CONCLUSIONS: Even at the level of severity found in the general population, asthma and CB could influence the 6MWD, which seems to reflect the functional exercise level for daily physical activities. The negative association between ageing and the 6MWD was particularly strong in subjects with CB. Our report adds to the mounting evidence that CB is not a trivial condition, especially in the ageing adult population, and it supports the importance of monitoring functional capacity and of physical reconditioning in mild asthma.

The impact of diagnosed and undiagnosed current asthma in the general adult population.

BACKGROUND: Restrictive definitions of current asthma are used in epidemiological studies to achieve a highly specific classification of subjects. However, undiagnosed asthmatics should be taken into account to correctly evaluate the impact of the disease in the general population. METHODS: In an Italian multi-centre cross-sectional survey carried out in 1998-2000, 18,647 responders (20-44 years old) to a screening questionnaire were classified as having physician-diagnosed current asthma or current respiratory symptoms. Similarities in the risk factor profile and in the socioeconomic burden were considered suggestive of undiagnosed current asthma. RESULTS: In Italy, the prevalence of physician-diagnosed current asthma was 4.9% (95% CI 4.4-5.4), while that of 'asthma attacks and/or use of anti-asthmatic drugs in the past 12 months without a diagnosis of asthma' (ADWD) was 1.5% (95% CI 1.3-1.7). Allergic rhinitis was highly associated with diagnosed current asthma [relative risk ratio (RRR) 12.48; 95% CI 9.12-17.07; reference category: neither asthma during lifetime nor current respiratory symptoms] and with ADWD (RRR 8.42; 95% CI 6.33-11.19). Chronic cough/phlegm was homogeneously associated with all the respiratory conditions, and the strongest relationship was with ADWD (RRR 7.79; 95% CI 4.95-12.25). Subjects with ADWD and diagnosed current asthmatics were characterised by high and homogeneous percentages of individuals who reported productivity losses (19.0 and 15.1%) and hospitalisations (9.2 and 6.2%) because of respiratory problems in the past year. CONCLUSIONS: The impact of current asthma seems to be largely underestimated among Italian adults, since the individuals with ADWD may be undiagnosed current asthmatics.

Asthma in childhood reduces smoking initiation in subsequent teens among males.

BACKGROUND: The association between smoking habits and asthma is complex because subjects with asthma could avoid smoking, whereas smoking could increase asthma severity or incidence. PURPOSE: The relation between asthma in childhood (0-10 years) and smoking initiation in the second decade (11-20 years) was investigated using the database of the Italian Study on Asthma in Young Adults, performed in 1998-2000 on people aged 20-45 years. METHODS: The cumulative incidence of smoking initiation was compared among (1) subjects not reporting asthma attacks in the first 20 years of life (n = 17,384), (2) subjects reporting asthma onset in the first decade and no disease remission by the age of 20 years (n = 305), (3) subjects reporting asthma onset in the first decade and remission in the first and second decades (n = 573). RESULTS: Among men, the cumulative incidence of smoking onset was higher among nonasthmatics (49%) than among asthmatics (35.6%), and intermediate among asthmatics with disease remission (44.2%) (p = .001). These differences were larger in males born between 1953 and 1965, and tended to decrease in males born between 1966 and 1979: cumulative incidence of smoking onset decreased from 54.3% to 43.8% in nonasthmatics, whereas it remained stable in asthmatics (from 36.8% to 35%). Women, instead, had similar cumulative incidence of smoking initiation, irrespective of asthma onset or remission (p = .849). CONCLUSION: Asthma in childhood reduces smoking initiation during the subsequent teenage in men, but not in women. This protective effect tends to fade when asthma remission occurs. In the last decades, smoking initiation has decreased among nonasthmatic males, but not among asthmatic males.