Aerosol source apportionment uncertainty linked to the choice of input chemical components.

For a Positive Matrix Factorization (PMF) aerosol source apportionment (SA) studies there is no standard procedure to select the most appropriate chemical components to be included in the input dataset for a given site typology, nor specific recommendations in this direction. However, these choices are crucial for the final SA outputs not only in terms of number of sources identified but also, and consequently, in the source contributions estimates. In fact, PMF tends to reproduce most of PM mass measured independently and introduced as a total variable in the input data, regardless of the percentage of PM mass which has been chemically characterized, so that the lack of some specific source tracers (e.g. levoglucosan) can potentially affect the results of the whole source apportionment study. The present study elaborates further on the same concept, evaluating quantitatively the impact of lacking specific sources' tracers on the whole source apportionment, both in terms of identified sources and source contributions. This work aims to provide first recommendations on the most suitable and critical components to be included in PMF analyses in order to reduce PMF output uncertainty as much as possible, and better represent the most commons PM sources observed in many sites in Western countries. To this aim, we performed three sensitivity analyses on three different datasets across EU, including extended sets of organic tracers, in order to cover different types of urban conditions (Mediterranean, Continental, and Alpine), source types, and PM fractions. Our findings reveal that the vehicle exhaust source resulted to be less sensitive to the choice of analytes, although source contributions estimates can deviate significantly up to 44 %. On the other hand, for the detection of the non-exhaust one is clearly necessary to analyze specific inorganic elements. The choice of not analysing non-polar organics likely causes the loss of separation of exhaust and non-exhaust factors, thus obtaining a unique road traffic source, which provokes a significant bias of total contribution. Levoglucosan was, in most cases, crucial to identify biomass burning contributions in Milan and in Barcelona, in spite of the presence of PAHs in Barcelona, while for the case of Grenoble, even discarding levoglucosan, the presence of PAHs allowed identifying the BB factor. Modifying the rest of analytes provoke a systematic underestimation of biomass burning source contributions. SIA factors resulted to be generally overestimated with respect to the base case analysis, also in the case that ions were not included in the PMF analysis. Trace elements were crucial to identify shipping emissions (V and Ni) and industrial sources (Pb, Ni, Br, Zn, Mn, Cd and As). When changing the rest of input variables, the uncertainty was narrow for shipping but large for industrial processes. Major and trace elements were also crucial to identify the mineral/soil factor at all cities. Biogenic SOA and Anthropogenic SOA factors were sensitive to the presence of their molecular tracers, since the availability of OC alone is unable to separate a SOA factor. Arabitol and sorbitol were crucial to detecting fungal spores while odd number of higher alkanes (C27 to C31) for plant debris.

The need for European harmonization of Nutrivigilance in a public health perspective: a comprehensive review.

According to the European Union regulation, some countries have established a pre-market notification system for food supplements while others have not. As this regulation is unfulfilled, a notified and marketed food supplement ingredient in one country may be forbidden in another. Even though food supplements shall not be placed on the market if unsafe, some products may still expose the consumers to risks. The risk is increased by easier access due to worldwide dissemination fostered by the internet and free movement of goods in the European Union. The Rapid Alert System for Food and Feed and the Emerging Risks Exchange Network are described. To date, the European Union legislation does not include a provision to establish a dedicated vigilance system for food supplements (Nutrivigilance). Six European Union countries have nevertheless set up national systems, which are presented. The present lack of European Union data collection harmonization, does not allow easy cooperation between countries. This article advocates for creating a coordinated European Nutrivigilance System to detect and scrutinize adverse effects of food supplements. This, to help in directing science-based risk assessments and reinforce the science-based decision of policy makers to improve public health safety.

The impact of prophylactic treatment on post-traumatic epilepsy after severe traumatic brain injury.

AIM: To assess the incidence of late post-traumatic epilepsy (PTE) in patients with very severe traumatic brain injury (TBI) who either received or did not receive anti-epileptic prophylactic treatment. METHODS: Two populations were studied: 55 patients retrospectively and 82 subjects prospectively. RESULTS: Ten patients (18%) in the first population showed late PTE. Although the incidence was lower in patients who did not receive prophylactic treatment, the difference between the treated and the non-treated group was not statistically significant. Sixty-nine patients in the second group (84%) had prophylactic treatment. Twenty-seven patients (39%) suffered from late PTE during the 2-year follow-up period and 17 of them (63%) showed EEG epileptic abnormalities. No patient who did not receive preventive therapy suffered from late PTE during the observation period. CONCLUSIONS: Due to the negative cognitive effects of anti-epileptic drugs, the preliminary results are of considerable interest for the rehabilitation of patients with very severe TBI.

Determinants of acquiring hepatitis A virus disease in a large Italian region in endemic and epidemic periods.

Viral hepatitis A is endemic in Puglia region (southeast Italy). Over the last 13 years, annual incidence rates have ranged from 4 to 138 per 100,000 inhabitants and periodical regional epidemics have been described. Between 1 January 1996 and 31 December 1997 over 11,000 cases of hepatitis A were reported accounting for an annual incidence rate over 130/100,000. To identify exposures during the epidemics, a case-control study was performed in two different rounds and since 1997, an enhanced surveillance system has permitted the monitoring of exposures of subsequent cases. Raw seafood consumption was identified as the major risk factor for hepatitis A. Adjusted odds ratio and 95% confidence intervals for this exposure from the first round of the case-control study was 38.6 (12.2-122.4) and for the second round for consumption of raw mussels it was 30.7 (16.0-52.0). Hepatitis A epidemiology in Puglia is consistent with an endemic situation sustained by locally contaminated seafood consumed raw and by the recurrence of large epidemics, where size is influenced by the accumulation of susceptible subjects in the population.

[Early effects of cigarette smoking in hypertensive and normotensive subjects. An ambulatory blood pressure and thermographic study]. / Effetti del fumo di sigaretta sulla circolazione periferica. Rilievi termografici e pressori.

BACKGROUND: Among the acute effects of cigarette smoking there are an increase in the arterial blood pressure and a decrease in skin temperature. The aim of this study is to evaluate whether these effects are more evident in hypertensive subjects (HTS) than in normotensive (NTS) ones. METHODS: A monitored Ambulatory Blood Pressure method, an Agema 880 Thermograph and a Surgitron thermal stimulator have been employed. Ten NTS males and 10 HTS, age paired (50-60 years, mean 57.8), were examined. Area of interest, the volar face of the fingertips. The pressural and thermographic tests were performed with patients staying in a proper room for 2 h, smoking consecutively 4 cigarettes, one every 14 min. The tests were made at 0 time (baseline), after smoking each cigarette and, finally, 60' after the beginning of the last one. RESULTS: A rise in blood pressure and a fall in skin thermal gradients both in HTS and in NTS was seen since the first cigarette, and these values, more evidently in hypertensive subjects, were appeared progressively increased along with the other 3 cigarettes. CONCLUSIONS: These results confirm the damage of smoking on peripheral blood vessels verified and also the cumulative effect of smoking more cigarettes. The similar increased percentage of ABP and telethermography (TT) values in these tests lead us to consider TT as a routinary method for the evaluation of a more general vascular damage provoked by cigarette smoking. Also, the immediate visual thermal effect (=thermal amputation) after smoking is very useful in smoking educative programs.

Free radical scavenger activity of rutosides.

BACKGROUND: The O-(beta-hydroxyethyl)-rutosides (HRs) are a standard mixture of flavonoid-derivatives that have a clinico-pharmacological activity on peripheral circulation, particularly on the endothelial cells of veins and lymphatics. Flavonoids are believed to prevent the oxidative damage derived from radical oxidative species (ROS), like hydroxyl radicals (HO.) and hypochlorite (-OCl). The aim of the study was to investigate the stability and capability of HRs in toto and of their single components (7-mo-nohydroxy ethyl rutoside; 7,4'-dihydroxyethyl rutoside; 7,3',4'-trihydroxyethyl rutoside and the 7,5,3',4'-tetrahydroxyethyl rutoside) of scavenging ROS and other radicals generated by different oxidative systems, and also their anti-lipoperoxidative activity at mM concentrations (1.0-10.0 mM). METHODS: The following oxidative systems have been employed: Fenton reaction for the hydro-xylation of l-tyrosine to l-DOPA and the peroxidation of arachidonic acid; photo-Fenton type reaction for the oxidation of toluene in the aqueous UV irradiated TiO2 system; the azocompound 2.2'-azobis(2, 4-dimethylvaleronitrile (AMVN) to produce peroxy radicals and the daily autoxidation of arachidonic acid. Analyses were performed by HPLC, HPLC-MS, GC-MS, and spectrophotometry. RESULTS: At 5.0 mM concentration, HRs produced the following inhibitions: 63+/-5% of the overall formation of cresols, benzaldehyde, benzyl alcohol, and biphenyl induced by photo-Fenton reaction; 91.6+/-5% and 59+/-8% of the synthesis of l-DOPA induced by HO. generated by Fenton reaction; 45+/-7% and 52+/-6% of the oxidation of arachidonic acid induced by Fenton reaction and AMVN; 60+/-4% of the autoxidation of arachidonic acid. These effects were strictly concentration dependent. CONCLUSIONS: At mM concentrations, HRs display a significant antilipoperoxidative activity due to their notable scanvenging activity against HO.; moreover these actions are concentration-dependent.

Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors?

OBJECTIVES: The aim of this study was to evaluate whether the transmission of hepatitis C virus (HCV) between spouses occurs through sexual contact or through other types of exposure. METHODS: We consecutively enrolled 311 chronic HCV carriers and their spouses. The spouses underwent HCV blood testing. Exposure to parenteral risk factors was compared between couples of which both partners were HCV positive and couples with one positive partner. In couples with both partners positive, qualitative detection of serum HCV RNA and genotyping were performed. RESULTS: The prevalence among spouses was 10.3% (32/311). The mean age was higher for HCV-positive spouses (57.7 vs 49.6 yr for HCV-negative spouses; p < 0.01). The prevalence among spouses increased with the duration of marriage, whereas no difference was found in relation to the clinical status of the index case. The 32 HCV-positive spouses reported parenteral exposure (blood transfusion, drug use, and use of multiple-use glass syringes inside or outside the family) more often than the 279 HCV-negative spouses (84.4% vs 26.2%; odds ratio [OR], adjusted for age by multiple logistic regression analysis, 12.4; 95% CI = 4.5-34.0). The percentage of couples sharing glass syringes was significantly higher among those with both partners infected (65.6% vs 12.9%; OR = 12.9; 95% CI = 5.4-31.4). Qualitative serum HCV RNA was determined in 22 couples with both partners infected; in 13 of them, both partners were HCV RNA positive, whereas in the remaining nine, only one partner was positive. In eight of the 13 couples with both partners HCV RNA positive, the same genotype was found for both partners. CONCLUSIONS: The findings that the same genotype was detected for both partners in relatively few couples, and that a history of parenteral exposure was an independent predictor of HCV positivity, suggest that the risk of sexual transmission is low. The sharing of glass syringes may have played an important role in transmission between spouses.

Niflumic acid and cutaneous reactions in children.

In a case control study of adverse drug reactions in children, the odds ratio of developing a serious mucocutaneous event among users of niflumic acid, adjusted for concomitant use of all other drugs, was 4.9 (95% CI 1.9 to 12.8). Given the availability of safer analgesics and antipyretics, there is no indication, in our opinion, that requires the prescription of substances which bear an increased risk.

[Effects of socio-environmental factors on neurocognitive performance in premature or low-birth weight preschoolers]. / Effetti dei fattori socio-ambientali sugli esiti neurocognitivi in età prescolare dei bambini con prematurità o basso peso alla nascita.

Severely preterm neonates (gestational age < or = 32 weeks) and/or very low birth weight (VLBW, with weight at birth < or = 1500 g) are 2% of all newborns, with a rising incidence due to the increase of multiple gestations and of pregnancies at advanced age. These neonates may be affected by severe neurological pathologies (6-10% of cases), but they often have minor disabilities (such as distractibility, hyperactivity, learning and social competence disabilities, deficit of motor development) difficult to be early diagnosed, and frequently recognized only at pre-school or school age. A review of the current knowledge about the effects of potential risk factors responsible for deficits of neurocognitive development in pre-school age and for postnatal distress of mothers, and their inter-correlations, is reported.

Is seborrhoeic dermatitis a clinical marker of HIV disease?

The Authors have conducted a cohort study on a group of subjects HIV positive, asymptomatic, (group A, according to CDC criteria) who presented Seborrhoeic dermatitis (SD), to evaluate if this cutaneous finding could be considered a marker of the HIV disease. Previously the Authors had shown that healthy subjects affected by SD showed at blood level an imbalance in the ratio of PL-PUFA (fundamental components of cell walls) to the antioxidants Vitamin E (Vit E) and gluthathion peroxidase (GSH-Px); furthermore the Authors reported SD as being constantly present in AIDS patients, in which they found more severe biochemical changes. On these bases they enrolled 72 HIV positive individuals that presented at STD-AIDS Unit of the S Gallicano Institute in the years 1994-1995 and followed them, until the 1998. They were all asymptomatic and were divided at the beginning in two subgroups, respectively with and without SD. Records were made regularly of their clinical, laboratory and biochemical data. The results highlighted the fact that SD-HIV positive individuals had severe biochemical alterations and a worse clinical evolution (higher incidence of opportunistic events). These data confirm on the hand the SD as a cutaneous marker of HIV disease not only, but also its presence could indicate the possibility of a worse progression of the disease. Finally the Authors suggest the possibility of a dietary pharmacological treatment, associated, or not, with antiretroviral therapy, to the aim to improve cell membrane defences and thereby cell immunity itself.

Surgical procedures as a major risk factor for chronic hepatitis C virus infection in Italy: evidence from a case-control study.

OBJECTIVES: The study was carried out to evaluate the risk factors associated with chronic hepatitis C virus (HCV) infection. METHODS: This case-control study used multiple logistic regression analysis to determine risk factors associated with HCV infection. Study participants were followed at 10 liver or gastroenterologic units and included 294 subjects with chronic HCV infection and 295 age and sex matched anti-HCV-negative controls. RESULTS: The use of glass syringes and surgical procedures was reported by as many as 77.6% and 73.8% of cases, respectively; blood transfusion was recorded in nearly a quarter of cases; 10.2% of cases, but none of the controls, reported past or current intravenous drug use. Multiple logistic regression analysis showed that blood transfusion, being the sexual partner of an intravenous drug user, and surgery all were independent predictors of the likelihood of HCV infection. CONCLUSIONS: These findings indicate that, besides the well-known sources of infection, such as blood transfusion and intravenous drug use, surgical procedures may play an important role in the spread of HCV infection in Italy. Given that a large proportion of the general population undergoes surgery, a rational and relatively inexpensive policy for the prevention of HCV infection must focus on implementing efficient procedures for the sterilization of instruments and the use of disposable materials in surgical units.

Suspected adverse drug events requiring emergency department visits or hospital admissions.

OBJECTIVE: To analyse the contribution of adverse drug events (ADEs) to the overall number of referrals or visits at an emergency department, to determine the proportion of more severe episodes requiring hospital admission and to characterize the different causes of drug-related visits or admissions. METHODS: A 1-year prospective collection of data on visits performed at an emergency department. All visits, observed during 1 week every month, were analyzed in order to identify suspected ADEs. The effects of age and sex on the frequency of ADE-related visits and admissions were evaluated. All patients hospitalized because of an ADE were followed up in order to collect information about progress and outcome of the events, which were also assessed in terms of avoidability. RESULTS: Among the 5497 patients who visited the Emergency Department over 1 year, 235 (4.3%) experienced an ADE, 45 of these (19.1%) were subsequently hospitalized, among whom there were five deaths. Dose-related therapeutic failures were the main causes of drug-related admissions (55.6%), whereas adverse drug reactions caused the most frequent drug-related visits to the Emergency Department (63.8%). Although the frequency of drug-drug interactions leading to a visit to the Emergency Department was small (3.8%), this type of event was more severe, because most of these patients were hospitalized. No age/sex effect was observed in the proportion of ADE-related hospital admissions. Twenty-five (1.4% of the total admissions) of the 45 ADE-related admissions were evaluated as preventable, contributing by more than 61% of the overall length of hospital stay. CONCLUSION: The high proportion of drug therapeutic failures leading to an admission highlights the need for public education, particularly to prevent non-compliance.

[The characteristics of the use and the levels of diffusion of nonconventional medicine]. / Caratteristiche d'uso e livelli di diffusione della medicina non convenzionale.

The national trends of the utilisation of non conventional therapies suggest that an increasing number of patients employ remedies that are outside the mainstream of what has been defined as conventional western medicine. The extent to which these practices have clinical efficacy according to biomedical criteria is a matter of ongoing debate. It may be that independent of any such efficacy, the attraction of alternative medicine is related to the power of its underline shared beliefs and cultural assumptions. The fundamental premises are an advocacy of nature, vitalism, "science" and spirituality. For patients, who choose alternative medicine, the most important reason to abandon conventional therapies could be to move from the sterile "high-tech" realm of official medicine to a more intimate "high-touch" intervention offered by non-physicians.

Ketorolac use in outpatients and gastrointestinal hospitalization: a comparison with other non-steroidal anti-inflammatory drugs in Italy.

OBJECTIVE: To compare the risk of hospitalization for gastroduodenal ulcer associated with the use of ketorolac and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A cohort and a nested case-control study were carried out. All residents in the region of Umbria (Italy), aged 35-84 years, who had been given at least one NSAID prescription in 1993 and 1994 were identified. Exposure to drugs was ascertained through a drug prescription database. We estimated rate ratios of hospitalization for gastroduodenal ulcer with or without complications in the current, recent or past period according to exposure to different NSAIDs. RESULTS: Rate ratio estimates, adjusted for age and sex, were 2.8 for any current NSAID and 1.4 for any recent NSAID. The highest rate ratios of lesions of any severity for current NSAID use were observed for piroxicam (RR: 4.6) and ketorolac (RR: 3.4). For gastrointestinal haemorrhage or perforation the highest rate ratios were those for ketorolac (RR: 5.9) and piroxicam (RR: 4.8). Rate ratio estimates did not change after adjustment for concomitant use of gastrotoxic drugs, use of gastroprotective agents not associated with NSAIDs and prior use of NSAIDs. CONCLUSION: Our study demonstrates the need to adhere to the restrictions relating to the indications and duration of use of ketorolac. At present piroxicam represents a greater public health concern since it is confirmed to be among the most gastrotoxic NSAIDs and is one of the most commonly prescribed NSAIDs in Italy.

Hepatitis C virus infection in family setting.

To evaluate risk factors associated with intrafamiliar transmission of hepatitis C virus (HCV), 113 hepatitis C virus index subjects with chronic HCV infection and their 267 family contacts were studied from January 1994 to October 1995. Overall, 16 family contacts (6%) were positive for anti-HCV by ELISA II generation. The prevalence was 11.3% in spouses and 2.9% in other relatives (odds ratios: 4.2; 95% CI: 1.4-12.6). Spouses who had been married to the index cases longer than 20 years had a 7.5-fold risk (95% CI: 1.0-336.3) of HCV seropositivity as compared to those married less than 20 years. In univariate analysis HCV seropositivity was associated with surgical intervention, use of glass syringes and hospitalization. The results of multivariate logistic analysis showed that any parenteral exposure (odds ratios: 3.8; 95% CI: 1.2-12.8) and sexual contact with an anti-HCV index case (odds ratios: 3.0; 95% CI: 1.0-9.4) were both independent predictors of HCV seropositivity among household contacts of HCV positive index cases. These findings indicate that sexual contact and any parenteral exposure both play an independent role in the spread of HCV infection in the family setting.

Drug use and acute leukemia.

OBJECTIVE: To study the occurrence of acute leukemia in relation to preceding use of drugs a case-control study has been carried out in Rome, Italy. PATIENTS AND METHODS: Two hundred and two patients (age >15 years) with a diagnosis of acute leukemia during the period July 1992-June 1994 were enrolled. For each patient, 10 controls matched by age and gender were randomly drawn from the source population. Through the individual beneficiary code the information relevant to the drugs received within the National Health Service during the period January 1989-December 1992 was retrieved. The use of drugs was considered etiologically related to leukemia if the prescription occurred before the 12 months preceding the diagnosis. Exposure was categorized as 'any use' (at least one prescription during the etiologic period), 'high use' (duration of use greater than the median in the control group) and, for NSAIDs, 'very high use' (duration of use greater than 180 days). RESULTS: Among drugs suspected to cause leukemia, users of high doses of chloramphenicol presented an OR of 1.8 (95% CI: 0.6-5.3). Among other categories of drugs with an increase in the ORs, though not statistically significant, we found tricyclic antidepressants (OR=1.7; 0.8-3.4) and oral contraceptives (OR=1.8; 0.8-4.0). No excess risk was observed for users of calcium-channel blockers (OR=0.9; 0.5-1.7). Use of very high doses of NSAIDs appeared to decrease the occurrence of acute leukemia (OR=0.4; 0.1-1.5). CONCLUSION: Even with several limitations, this study provides an initial frame of reference for the potential causal role of drugs in acute leukemia.

Prevalence, risk factors, and genotype distribution of hepatitis C virus infection in the general population: a community-based survey in southern Italy.

In 1996 the prevalence, risk factors, and genotype distribution of hepatitis C virus (HCV) infection were assessed in the general population of a town in southern Italy. The sample was selected from the census by a systematic 1:4 sampling procedure. The participation rate was 96.6%. Among the 1,352 subjects enrolled, 195 (14.4%) tested reactive to antibody to HCV (anti-HCV) with enzyme immunoassay (EIA 3). When further tested with recombinant immunoblot assay (RIBA 3), 170 subjects (87.2%) tested positive, 23 subjects (11.8%) had indeterminate results, and 2 subjects (1%) tested negative. Thus, the overall anti-HCV EIA-positive RIBA-confirmed prevalence was 12.6% (170 of 1,352 subjects) and increased from 1.3% in subjects younger than 30 years to 33.1% in those > or =60 years of age. This latter age group accounted for 72.3% of all anti-HCV-positive subjects. Females tested positive more frequently than males (14.1% vs. 10.5%; P < .05). Alanine transaminase (ALT) concentrations were abnormal in only 4.1% (7/170) of anti-HCV EIA-positive RIBA-confirmed subjects. This suggests that ALT screening is not useful in the detection of anti-HCV-positive subjects in a general population. The results of multiple logistic regression analysis showed that an age of less than 45 years, the use of glass syringes, and dental therapy were all independent predictors of anti-HCV positivity. HCV RNA was detected by polymerase chain reaction in 75.9% of the 195 anti-HCV EIA-positive subjects: in 84.7% (144/170) of the RIBA-confirmed subjects; in 17.4% (4/23) tested as RIBA indeterminate; and in neither of the two subjects who tested RIBA negative. HCV type 1b was detected in 75 subjects (50.7%), type 2b in 1 subject (0.7%), type 2c in 66 subjects (44.6%), type 3a in 4 subjects (2.7%), and type 4 in two subjects (1.3%). These figures differ from those of Italian patients with chronic liver disease in whom genotype 2 is more rare. None of the individuals was infected with more than one genotype. The distribution of the two most common HCV viral types (1b and 2c) was not statistically different in terms of mean age, sex, or risk factors and suggests that they may have had a parallel spread in this community. These findings provide one of the highest overall anti-HCV prevalence rates in a general population with a likely cohort effect, i.e., decreased risk of infection along generations. These observations may indicate an epidemic or focus of hepatitis C that occurred several years earlier. The majority of anti-HCV-positive subjects in the oldest age group and with no clinical evidence suggests that HCV infection is a very prolonged and indolent disease.