Greenhouse investigation on the phytoremediation potential of pioneer tree Pinus halepensis Mill. in abandoned mine site.

Tailings and mine dumps are often pollutant sources that pose serious environmental threats to surrounding areas. The use of pioneer vascular plants to extract or stabilize metals is considered among the more effective mine tailing reclamation techniques. The study aimed at evaluating the phytoremediation potential of Pinus halepensis in abandoned mine-tailing (SW-Sardinia, Italy). Plant ability to tolerate high Zn, Pb, and Cd concentration and their accumulation in roots and aerial parts were assessed at greenhouse conditions. Experiments were performed on 45 seedlings planted in different substrates (mine-tailings, mine-tailings compost-amended, and reference) and on 15 seedlings grown spontaneously in the contaminated mine site investigated with their own substrates. The phytostabilization potential of plant was evaluated through biological accumulation and translocation indexes together with plant survival and biometric parameters. The outcomes showed the adaptability of P. halepensis to grow and survive in contaminated substrates. Compost addition did not improve plant survival and growth, however, it enhanced total carbon and nitrogen contents of soil, restricted metal bioavailability, and accumulation in plant aerial parts. These findings highlight that P. halepensis may be considered for phytostabilization given the great potential to limit Zn, Pb, and Cd toxicity in plant tissues by applying compost amendment in metal contaminated mine sites.

The novelty of this study is the selection of Pinus halepensis Mill. as a proper tree species for long-term phytoremediation of multi-heavy metal mine tailing sites. This plant species not only had adaptation to the Mediterranean climate and could tolerate high temperatures and high metal concentrations, but also showed high survival and growth percentage of its roots and epigean organs in highly contaminated mine tailing. Pinus halepensis could limit metal accumulation and toxicity in the aerial part of the plant with the addition of compost amendment. This study demonstrates that compost can enhance soil properties and modify metal bioavailability. The outcomes can be beneficial for the phytostabilization project and restoration of similar Mediterranean mine sites.

Investigating metal pollution in the food chain surrounding a lead-zinc mine (Northwestern Iran); an evaluation of health risks to humans and animals.

The current study aims to evaluate the health risk of heavy metals for humans and animals in the Angouran mining complex (northwest of Iran). Twenty-five plant species and their corresponding soils (natural soils) were collected along with mine tailings samples. The carcinogenic and non-carcinogenic risks of heavy metals (Zn, Pb, Cd, Cr, and Co) for humans using the hazard quotient (HQ) and hazard index (HI) were evaluated. Moreover, the health risk caused by forage feeding to grazing ruminants (cow and sheep) and the risk associated with animal products consumption by humans in the soil-plant-animal transfer system were assessed. The value of HI in natural soils (rangeland use) was less than one (HI < 1), while regarding tailings, the HQ via oral ingestion and the HI were greater than one (HI & HQ > 1). The range of total carcinogenesis risk in natural soils exceeded the target risk (Risk < 10-6) and for tailings, it showed the probability of cancer risk, 1 person per 3636 populations, which is much higher than the acceptable or tolerable range (10-4 < Risk < 10-6). Regarding the animal health risk, the content of Pb and Cd in most of the animal organs was higher than the control values. In turn, dietary exposure to Pb and Cd is worrying for residents due to exceeding the provisional tolerable weekly intake (PTWI). This comprehensive study suggests the necessity of risk assessment of mining sites in Iran and immediate control measures to diminish pollutants.

Perspectives for phytoremediation capability of native plants growing on Angouran Pb-Zn mining complex in northwest of Iran.

Phytoremediation is a cost-effective, environmentally-friendly and emerging remediation technology that treats polluted areas using plants, having the potential to restore ecosystems and make compromised areas useable again, therefore returning a resource to community use. In the present work a study was conducted on the contamination of soil by heavy metals (Zn, Pb, Cr, Cd, and Co) in the mining area of Angouran (northwestern Iran) and on their uptake by 25 native species present in the mining district, in order to evaluate their potential use in phytoremediation interventions. Plant and soils from three sites around the mine were sampled and characterized, and metals accumulation and translocation were evaluated. Principal Component Analysis (PCA) and Cluster Analysis (CA) were applied to study the behavior of species in the accumulation and translocation of the elements in their tissues. The contents of Zn, Pb, Cr, Cd, and Co in the studied plants were, respectively, 31.77-723.05, 7.78-233.25, 1.77-21.57, 0.04-7.92, and 0.15-9.97 mg/kg. Among the 25 species, 13 plants showed translocation factor greater than one (TF > 1) for Zn, 14 for Pb, 3 for Cr, 10 for Co, and 6 for Cd. Marrubium cuneatum having an accumulation factor greater than one (AF > 1) for Zn and bioconcentration factor greater than one (BCF >1) for Cd can be considered as an accumulator and stabilizer for Zn and Cd, respectively. Also, the highest value of Pb (233.25 mg/kg) and Cr (21.57 mg/kg) were found in the shoot of this plant. Psathyrostachys fragilis with BCF >1 for Co and maximum Pb accumulation in the root can be used as a stabilizer plant for Pb and Co-contaminated soils. Besides, Stipa arabica and Verbascum speciosum, with TF > 1 and rather high AF, could be considered suitable species for removing Zn and Pb through phytoextraction. This research showed that some native species in the study area have considerable potential for developing phytoremediation strategies.

[Geocoding one million of addresses using API: a semiautomatic multistep procedure]. / Geocodificare un milione di indirizzi mediante l'utilizzo di API: una procedura semiautomatica a più step.

OBJECTIVES: to geocode all residence addresses from Lazio Health Information System in order to obtain a geographical regional database. DESIGN: a semiautomatic and multistep geocoding procedure using several tools and software. SETTING AND PARTICIPANTS: all residence addresses of resident population of Lazio Region (Central Italy) in 2020. MAIN OUTCOME MEASURES: geographic coordinates at residence addresses and accuracy level of geocoding procedure for more than 1 million of addresses. RESULTS: the 99% of residence addresses in the Lazio Region have been geocoded thanks to the purposed procedure; almost 94% of the addresses have been geocoded with a good level of accuracy (more than 56% at civic number level). In the province of Rome, the percentage of addresses geocoded with a good level of accuracy is higher (97.1%), while in the province of Rieti and Frosinone is lower (82.7% and 84.2%, respectively). CONCLUSIONS: this method is useful to obtain accurate geographic coordinates of residences of the entire regional population. This database will be useful for several epidemiological studies in the Region.

Dark fermentative volatile fatty acids production from food waste: A review of the potential central role in waste biorefineries.

Volatile fatty acids (VFAs) are high-value chemicals that are increasingly demanded worldwide. Biological production via food waste (FW) dark fermentation (DF) is a promising option to achieve the sustainability and environmental benefits typical of biobased chemicals and concurrently manage large amounts of residues. DF has a great potential to play a central role in waste biorefineries due to its ability to hydrolyze and convert complex organic substrates into VFAs that can be used as building blocks for bioproducts, chemicals and fuels. Several challenges must be faced for full-scale implementation, including process optimization to achieve high and stable yields, the development of efficient techniques for selective recovery and the cost-effectiveness of the whole process. This review aims to critically discuss and statistically analyze the existing relationships between process performance and the main variables of concern. Moreover, opportunities, current challenges and perspectives of a FW-based and fermentation-centred biorefinery layout are discussed.

A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Three Relevant Diseases of the Digestive and Genitourinary System: Inflammatory Bowel Diseases, Celiac Disease, and Chronic Kidney Disease.

OBJECTIVES: to identify and describe all Inflammatory Bowel Disease (IBD), Celiac Disease (CD), and Chronic Kidney Disease (CKD) case-identification algorithms by means of Italian Healthcare Administrative Databases (HADs), through a review of papers published in the past 10 years. METHODS: this study is part of a project that systematically reviewed case-identification algorithms for 18 acute and chronic conditions by means of HADs in Italy. PubMed was searched for original articles, published between 2007 and 2017, in Italian or English. The search string consisted of a combination of free text and MeSH terms with a common part that focused on HADs and a disease-specific part. All identified papers were screened by two independent reviewers; exclusion criteria were the following: no details of algorithms reported, algorithm not developed in the Italian context, exclusive use of data from the death certificate register, or from general practitioner or pediatrician databases. Pertinent papers were classified according to the objective for which the algorithm had been used, and only articles that used algorithms for primary objectives (I disease occurrence, II population/cohort selection, III outcome identification) were considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, followback periods, and age ranges applied by the algorithms have been reported. Further information on specific objective(s), accuracy measures, sensitivity analyses and the contribution of each HAD, have also been recorded. RESULTS: the search string led to the identification of 98 articles for IBD, 42 articles for CD, and 390 for CKD. By screening the references, one paper for IBD was added. Finally, this led to 5, 9, and 8 pertinent papers respectively for IBD, CD, and CKD. Considering the papers on IBD and CD, specific age selections were applied to focus on children and young adult populations. When a selection on age was applied for CKD, instead, it mostly considered individuals aged more than 18 years. Three algorithms for IBD, 4 for CD, and 5 for CKD were extracted from papers and characterized. Drug prescription databases were used for both IBD and CKD algorithms, whereas the hospital discharge database and co-payment exemption database were used for IBD and CD. Pathology records and specialist visit databases were also used for CD and CKD, respectively. For each disease only one algorithm applied criteria for the exclusion of prevalent cases. External validation was performed only for Crohn's disease among IBDs, in one algorithm. CONCLUSIONS: the results of this review indicate that case identification for IBD and CD from routinely collected data can be considered feasible and can be used to perform different kinds of epidemiological studies. The same is not true for CKD, which requires further efforts, mainly to improve the detection of early stage patients.

A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Three Relevant Diseases of the Nervous System: Parkinson's Disease, Multiple Sclerosis, and Epilepsy.

BACKGROUND: Parkinson's Disease (PD), Multiple Sclerosis (MS), and Epilepsy are three highly impactful health conditions affecting the nervous system. PD, MS, and epilepsy cases can be identified by means of Healthcare Administrative Databases (HADs) to estimate the occurrence of these diseases, to better monitor the adherence to treatments, and to evaluate patients' outcomes. Nevertheless, the absence of a validated and standardized approach makes it hard to quantify case misclassification. OBJECTIVES: to identify and describe all PD, MS, and epilepsy case-identification algorithms by means of Italian HADs, through the review of papers published in the past 10 years. METHODS: this study is part of a project that systematically reviewed case-identification algorithms for 18 acute and chronic conditions by means of HADs in Italy. PubMed was searched for original articles, published between 2007 and 2017, in Italian or English. The search string consisted of a combination of free text and MeSH terms with a common part that focused on HADs and a disease-specific part. All identified papers were screened by two independent reviewers. Pertinent papers were classified according to the objective for which the algorithm had been used, and only articles that used algorithms for primary objectives (I disease occurrence; II population/cohort selection; III outcome identification) were considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, follow-back periods, and age ranges applied by the algorithms have been reported. Further information on specific objective(s), accuracy measures, sensitivity analyses and the contribution of each HAD, have also been recorded. RESULTS: the search strategy led to the identification of 70 papers for PD, 154 for MS, and 100 for epilepsy, of which 3 papers for PD, 6 for MS, and 5 for epilepsy were considered pertinent. Most articles were published in the last three years (2014-2017) and focused on a region-wide setting. Out of all pertinent articles, 3 original algorithms for PD, 4 for MS, and 4 for epilepsy were identified. The Drug Prescription Database (DPD) and Hospital Discharge record Database (HDD) were used by almost all PD, MS, and epilepsy case-identification algorithms. The Exemption from healthcare Co-payment Database (ECD) was used by all PD and MS case-identification algorithms, while only 1 epilepsy case-identification algorithm used this source. All epilepsy case-identification algorithms were based on at least a combination of electroencephalogram (EEG) and drug prescriptions. An external validation had been performed by 2 papers for MS, 2 for epilepsy, and only 1 for PD. CONCLUSION: the results of our review highlighted the scarce use of HADs for the identification of cases affected by neurological diseases in Italy. While PD and MS algorithms are not so heterogeneous, epilepsy case-identification algorithms have increased in complexity over time. Further validations are needed to better understand the specific characteristics of these algorithms.

A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Two Relevant Diseases of the Respiratory System: Asthma and Chronic Obstructive Pulmonary Disease.

OBJECTIVES: to identify and describe all asthma and Chronic Obstructive Pulmonary Disease (COPD) case-identification algorithms by means of Italian Healthcare Administrative Databases (HADs), through the review of papers published in the past 10 years. METHODS: this study is part of a project that systematically reviewed case-identification algorithms for 18 acute and chronic conditions by means of HADs in Italy. PubMed was searched for original articles, published between 2007 and 2017, in Italian or English. The search string consisted of a combination of free text and MeSH terms with a common part that focused on HADs and a disease-specific part. All identified papers were screened by two independent reviewers; exclusion criteria were the following: no description of reported algorithms, algorithm developed outside of the Italian context, exclusive use of death certificates, pathology register, general practitioner or pediatrician data. Pertinent papers were classified according to the objective for which the algorithm had been used, and only articles that used algorithms for primary objectives (I disease occurrence; II population/cohort selection; III outcome identification) were considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, follow-back periods, and age ranges applied by the algorithms have been reported. Further information on specific objective(s), accuracy measures, sensitivity analyses and the contribution of each HAD, have also been recorded. RESULTS: the search string led to the identification of 98 and 147 papers, respectively for asthma and COPD. By screening the references, 2 papers for asthma and 7 for COPD were added. At the end of the screening process, 14 pertinent papers were identified for asthma and 31 for COPD. Half of these used healthcare data covering a time period between 2008 and 2014. More than 75% considered the age range 6-17 for asthma and >=45 for COPD. About one-third of the articles used algorithms to estimate the occurrence of these diseases. Fourteen algorithms for asthma and 16 for COPD were extracted from the papers and characterized. The Drug Prescription Database (DPD) was used by almost all asthma case-identification algorithms, while only 7 COPD algorithms used this data source. The spectrum of active ingredients was strongly overlapping between the two diseases, with different combinations of drugs and administration routes, as well as specific number of prescriptions, follow-back years, and age ranges. Age class and chronic treatment were the main disease-specific traits that emerged from the algorithms. Three external validation processes have been performed for asthma and three for COPD. High accuracy levels have been found for asthma. COPD sensitivity analyses were unsatisfactory, while a high specificity was found for algorithms based on hospital discharge records. CONCLUSION: elements from the review on the use of healthcare administrative databases represent a useful tool to decide which algorithm to adopt, based on the algorithm's individual requirements, limits, and accuracy, taking into account the specific research objective.

A Systematic Review of Case-Identification Algorithms for 18 Conditions Based on Italian Healthcare Administrative Databases: A Study Protocol.

BACKGROUND: there has been a long-standing, consistent use worldwide of Healthcare Administrative Databases (HADs) for epidemiological purposes, especially to identify acute and chronic health conditions. These databases are able to reflect health-related conditions at a population level through disease-specific case-identification algorithms that combine information coded in multiple HADs. In Italy, in the past 10 years, HAD-based case-identification algorithms have experienced a constant increase, with a significant extension of the spectrum of identifiable diseases. Besides estimating incidence and/or prevalence of diseases, these algorithms have been used to enroll cohorts, monitor quality of care, assess the effect of environmental exposure, and identify health outcomes in analytic studies. Despite the rapid increase in the use of case-identification algorithms, information on their accuracy and misclassification rate is currently unavailable for most conditions. OBJECTIVES: to define a protocol to systematically review algorithms used in Italy in the past 10 years for the identification of several chronic and acute diseases, providing an accessible overview to future users in the Italian and international context. METHODS: PubMed will be searched for original research articles, published between 2007 and 2017, in Italian or English. The search string consists of a combination of free text and MeSH terms with a common part on HADs and a disease-specific part. All identified papers will be screened for eligibility by two independent reviewers. All articles that used/defined an algorithm for the identification of each disease of interest using Italian HADs will be included. Algorithms with exclusive use of death certificates, pathology register, general practitioner or pediatrician data will be excluded. Pertinent papers will be classified according to the objective for which the algorithm was used, and only articles that used algorithms with "primary objectives" (I disease occurrence; II population/cohort selection; III outcome identification) will be considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, follow-back periods, and age ranges applied by the algorithms will be collected. Further information on specific accuracy measures from external validations, sensitivity analyses, and the contribution of each source will be recorded. This protocol will be applied for 16 different systematic reviews concerning eighteen diseases (Hypothyroidism, Hyperthyroidism, Diabetes mellitus, Type 1 diabetes mellitus, Acute myocardial infarction, Ischemic heart disease, Stroke, Hypertension, Heart failure, Congenital heart anomalies, Parkinson's disease, Multiple sclerosis, Epilepsy, Chronic obstructive pulmonary disease, Asthma, Inflammatory bowel disease, Celiac disease, Chronic kidney failure). CONCLUSION: this protocol defines a standardized approach to extensively examine and compare all experiences of case identification algorithms in Italy, on the 18 abovementioned diseases. The methodology proposed may be applied to other systematic reviews concerning diseases not included in this project, as well as other settings, including international ones. Considering the increasing availability of healthcare data, developing standard criteria to describe and update characteristics of published algorithms would be of great use to enhance awareness in the choice of algorithms and provide a greater comparability of results.

[Validation of algorithms for the identification of subjects with chronic disease using health information systems]. / Validazione di algoritmi per l'identificazione di persone con patologia cronica attraverso i dati dei sistemi informativi.

OBJECTIVES: to test the validity of algorithms to identify diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and hypothyroidism from routinely collected health data using information from self-reported diagnosis and laboratory or functional test. SETTING AND PARTICIPANTS: clinical or self-reported diagnosis from three surveys conducted in Lazio Region (Central Italy) between year 2010 and 2014 were assumed as gold standard and compared to the results of the algorithms application to administrative data. MAIN OUTCOME MEASURES: prevalence resulted from administrative data and from information available in the surveys were compared. Sensitivity, specificity, positive predictive value, and positive likelihood ratio of algorithms with respect to self-reported diagnosis, laboratory or functional test, assumed as gold standards, were calculated. RESULTS: we analyzed data of 7,318 subjects (1,545 for diabetes, 1,783 for COPD, 2,448 for hypertension, and 1,542 for hypothyroidism). For hypertension and hypothyroidism, we observed a higher prevalence from laboratory or functional test compared to self-reported diagnosis (54.5% vs. 44.9% and 7.5% vs. 1.5%). Sensitivity of administrative data with respect to self-reported diagnosis resulted 90.9%, 38.5%, 88.3%, and 47.8%, respectively, for diabetes, COPD, hypertension, and hypothyroidism. Respectively, specificity was 97.4%, 91.7%, 84.8% and 91.8%; positive predictive value was 70,9%, 38.1%, 82.6% and 8.1%. All values of positive likelihood ratio resulted moderate (about 5), with exception of the diabetes algorithm and the disease-specific payment exemptions register for hypertension (respectively 35.5 and 17.4). CONCLUSION: hypertension and hypothyroidism resulted markedly underdiagnosed from self-reported data. Case identification algorithms are highly specific, allowing their utilization for selection of cohort of subject affected by chronic diseases. The sub-optimal sensitivity observed for COPD and hypothyroidism could limit the utilization of the algorithms for prevalence estimation.

Adherence to Long-Acting Bronchodilators After Discharge for COPD: How Much of the Geographic Variation is Attributable to the Hospital of Discharge and How Much to the Primary Care Providers?

In moderate-severe chronic obstructive pulmonary disease (COPD), long-acting bronchodilators (LBs) are recommended to improve the quality of life. The aims of this study were to measure adherence to LBs after discharge for COPD, identify determinants of adherence, and compare amounts of variation attributable to hospitals of discharge and primary care providers, i.e. local health districts (LHDs) and general practitioners (GPs). This cohort study was based on the Lazio region population, Italy. Patients discharged in 2007-2011 for COPD were followed up for 2 years. Adherence was defined as a medication possession ratio >80%. Cross-classified models were performed to analyse variation. Variances were expressed as median odds ratios (MORs). An MOR of 1.00 stands for no variation, a large MOR indicates considerable variation. We enrolled 13,178 patients. About 29% of patients were adherent to LBs. Adherence was higher for patients discharged from pneumology wards and for patients with GPs working in group practice. A relevant variation between LHDs (MOR = 1.21, p = 0.001) and GPs (MOR = 1.28, p = 0.035) was detected. When introducing the hospital of discharge in the model, the MOR related to LHDs decreased to 1.05 (p = 0.345), MOR related to GPs dropped to 1.22 (p = 0.086), whereas MOR associated with hospitals of discharge was 1.38 (p < 0.001). Treatments with proven benefit for COPD were underused. Moreover, a relevant geographic variation was observed. This heterogeneity raises equity concerns in access to optimal care. The reduction of variability among LHDs and GPs after entering the hospital level proved that differences we observe in primary care partially 'reflect' the clinical approach of hospitals of discharge.

[Socioeconomic position and appropriate antiplatelet therapy after percutaneous coronary intervention: a population-based cohort study in Rome (Lazio Region, Central Italy)]. / Posizione socioeconomica e aderenza alla terapia antiaggregante post angioplastica coronarica: uno studio epidemiologico a Roma.

OBJECTIVES: to evaluate the association between socioeconomic position (SEP) and adherence to appropriate antiplatelet therapy (AAT) after percutaneous coronary intervention (PCI) in the year following the discharge. DESIGN: according to scientific guidelines, AAT for PCI patients consists of Clopidogrel for a minimum of 1 month and ideally up to 12 months after discharge, and with Acetylsalicylic Acid (ASA) indefinitely. For each patient, drug claims over a 1-year period after discharge were retrieved from Regional Drug Dispense Registry. Drug use was measured with Proportion of Days Covered (PDC). PDC was computed dividing the total number of dispensed Defined Daily Dose by each patient's follow-up time. Dual antiplatelet therapy with PDC ≥75% and single therapy based on Clopidogrel with PDC ≥75% were considered as AAT. We used a composite area-based index of socioeconomic position by census block of residence built using the 2001 census of Rome, assuming 5 levels (from 1 =High SEP to 5 =Low SEP). SETTING AND PARTICIPANTS: study population of 5,901 patients resident in Rome, who underwent their first PCI during 2006-2007 were selected from the Hospital Information System. MAIN OUTCOME MEASURES: proportions of patients treated with AAT by SEP was measured for the overall year and by semester. The association between SEP and adherence to AAT was estimated through logistic regression models adjusting for factors selected by a stepwise procedure (gender, age, comorbidities, discharged from cardiology or coronary care unit, new user of antiplatelet drugs). RESULTS: 76% of the study population were men, 96% were aged more than 44 years, and 63% belonged to medium-low SEP. In the 1-year follow-up, the proportion of patients adherent to appropriate antiplatelet therapy was 65%; SEP was associated with AAT (OR high vs. low SEP 1.26; 95%CI 1.05-1.51; p trend =0.002). CONCLUSIONS: during the year after discharge, adherence to AAT of PCI patients was unsatisfactory and it decreased overtime more in medium-low SEP patients than in high SEP patients. Strategies to improve adherence to AAT among patients who underwent PCI need to be identified taking into account the multifactorial nature of poor medication adherence, and in particular patients' socioeconomic position.

[Mortality and morbidity among municipal waste workers in Rome: a cohort study]. / Studio di coorte della mortalità e morbosità dei lavoratori addetti alla raccolta, il trasporto e lo smaltimento dei rifiuti urbani a Roma.

INTRODUCTION: The adverse health effects associated with waste treatment processes are of great concern as large population groups and workers may be exposed to refuse-derived toxic substances. The main effects are respiratory and gastrointestinal infections, reduced lung function, irritations, allergic reactions, and injuries. OBJECTIVE: To evaluate morbidity and mortality among a cohort of municipal waste workers in Rome. METHODS: All 6839 workers (18.6% women) involved in waste collection, transportation and landfill disposal employed since 01/01/1994, with a minimum period of employment of five years were enrolled and with follow-up until 31/12/2009. The assessment of vital status was carried out through linkages with information systems (municipality records, mortality and hospital information systems), and through contacts with municipalities of residence. Gender specific standardized mortality (SMR) and hospitalization (SHR) ratios were calculated, using regional population mortality (and hospitalization) rates. RESULTS: Overall, in this cohort workers had the same mortality as the population of the Region. Hospitalizations for natural causes were significantly higher than expected among workers involved in transportation (SHR = 1.25, 95% CI = 1.13-1.38) and in waste collection (SHR(men) = 1.14, 95% CI = 1.07-1.22; SHR(women) = 1.65, 95% CI = 1.47-1.84). Among women there was an excess of hospitalizations for respiratory diseases (SHR = 1.95, 95% CI = 1.33-2.77), for digestive system disorders (SHR = 1.37, 95% CI = 1.03-1.79) and for injuries and intoxications (SHR = 2.28, 95% CI = 1.69-2. 99). CONCLUSIONS: The study did not find any increased mortality among the workers of either sexes. Female workers deserve further surveillance mainly due to an increased risk of trauma and respiratory and gastrointestinal disorders.

Chelate facilitated phytoextraction of Pb, Cd, and Zn from a lead-zinc mine contaminated soil by three accumulator plants.

This study aims to evaluate the enhancement of phytoextraction of heavy metals (Pb, Cd, and Zn) by species Marrubium cuneatum, Stipa arabica, and Verbascum speciosum, through EDTA amendment. Assisted phytoextraction pot experiments were performed at different EDTA dosages (0, 1, 3, and 5 mmol kg-1 soil). The DTPA-extractable metal content increased in the presence of EDTA, followed by their contents in the tissues of all three studied species. Resulting from oxidative stress, the activity of antioxidant enzymes such as glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase (CAT) increased when the chelating agent was added. EDTA in higher doses partially decreased chlorophyll concentration, and 5 mmol kg-1 of that reduced the biomass of the studied species. The bioconcentration factor (BCF) for Cd was notably high in all studied plants and considerably elevated for Zn and Pb with the addition of EDTA in M. cuneatum and S. arabica (BCF > 1), whilst an accumulation factor greater than one (AF > 1) was found for Cd in all species and for Pb in the case of S. arabica. In general, the results demonstrated that EDTA can be an effective amendment for phytoextraction of Cd, Zn, and Pb by M. cuneatum, V. speciosum and S. arabica in contaminated soils.

Metal phytostabilization by mastic shrub (Pistacia lentiscus L.) and its root-associated bacteria in different habitats of Sardinian abandoned mining areas (Italy).

Pistacia lentiscus L. is an excluder metallophyte proposed for the revegetation and phytostabilization of metal-contaminated sites in the Mediterranean area. The present study aims at evaluating the linking between bacterial communities and plants spontaneously growing in ecosystems chronically impacted by mining activities. Environmental properties and metal accumulation into hypogeal and epigeal tissues were analyzed in wild plants of two contrasting habitats with extreme metal contamination (> 2300 mg/kg for Zn, > 1100 mg/kg for Pb, > 10 mg/kg for Cd). The community structures of rhizospheric and root endophytic bacteria were fingerprinted by terminal restriction fragment length polymorphism of the 16S rRNA gene. The wild shrubs efficiently restrict the accumulation of the three major contaminants to the epigeal tissues in the two habitats under study (249 ± 68 mg/kg dw for Zn, 43 ± 21 mg/kg dw for Pb, and 1.4 ± 0.5 mg/kg dw for Cd). Evidence was provided that the combined but not individual effect of environmental conditions (moisture, inorganic carbon, pH) and proportion between Zn and Cd in the mine substrate play a role in structuring rhizosphere bacterial communities. The observed changes in community structures of root endophytes were found to be strongly associated with Pb level in roots and substrate properties (inorganic carbon and Zn/Cd ratio). Overall, our study highlights the importance of the analysis of multifactorial interactions among mine substrate, plant, and microbes for understanding how the environmental context affects phytoremediation under real conditions.

[Evaluation of the indirect impact of the Sars-CoV-2 epidemic on primary and ambulatory care processes using synthetic quality measures and graphic representations.] / Valutazione dell'impatto indiretto dell'epidemia da Sars-CoV-2 sui processi assistenziali del territorio attraverso rappresentazioni sintetiche della qualità delle cure.

INTRODUCTION: A concise representation of different primary and ambulatory care quality indicators can be very useful for quickly understanding the data and defining appropriate intervention strategies. The objectives of this study are to implement a graphical representation based on the TreeMap, a tool capable of summarizing results from heterogeneous indicators, with different measurement scales and thresholds, and take advantage of TreeMap's potential to measure the indirect impact of the Sars-CoV-2 epidemic on primary and ambulatory care processes. METHODS: Seven healthcare areas were considered each defined by a set of different indicators representative of the area. A discrete score ranging from 1 (very high quality) to 5 (very low quality) was assigned to the value of each indicator, based on the level of adherence to evidence-based recommendations. Finally, the score of each healthcare area is obtained as the weighted average of the scores of the representative indicators. The TreeMap is calculated for each Local health authority (Lha) of the Lazio Region. In order to assess the impact of the epidemic, a comparison was made between the results observed in 2019 and those observed in 2020. RESULTS: As an example, the results of one of the 10 Lhas of the Lazio Region have been reported. Compared to 2019, in 2020 there was an improvement in primary and ambulatory healthcare regarding all of the evaluated areas, with the exception of the metabolic area which remained stable. "Avoidable" hospitalizations have decreased, such as those for heart failure, Copd and diabetes. The incidence of cardio-cerebrovascular events following myocardial infarction or ischemic stroke has decreased, and inappropriate visits to emergency room have reduced. Furthermore, after decades of overprescribing, the use of drugs with a high risk of inappropriateness, such as antibiotics and aerosolized corticosteroids, has significantly decreased. DISCUSSION: The TreeMap has proven to be a valid tool for evaluating the quality of primary care, summarizing evidence from different and heterogeneous indicators. The improvements in quality levels observed in 2020, compared to 2019, should be interpreted with extreme caution because they could represent a paradox generated by the indirect effects of the Sars-CoV-2 epidemic. If, in the case of the epidemic, the distorting factors can be easily identified, in different and more ordinary evaluative analyses the "research for the causes" could be much more complex.

Short-term effects of air pollution in a cohort of patients with chronic obstructive pulmonary disease.

BACKGROUND: Although damage to the respiratory system from air pollutants has been recognized, research on susceptibility to air pollution in patients with chronic obstructive respiratory disease (COPD) has produced contradictory results. We studied the short-term effects of particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and ozone (O3) on cardiac and respiratory mortality in a COPD cohort. We assessed age, sex, and previous diseases as effect modifiers. METHODS: Using hospital data (1998-2009) and pharmaceutical data (2005-2009), we enrolled 145,681 COPD subjects, aged 35+ years and residents of Rome, and followed them from 2005 to 2009. A comparison group of people without COPD (1,710,557 subjects) was also studied. We analyzed deaths due to all natural causes (International Classification of Diseases - Ninth Revision codes 1-799). Statistical analyses were carried out using Poisson regression and a case-crossover approach. RESULTS: PM10, PM2.5, and NO2 (0- to 5-day lag) were associated with daily mortality, with stronger effects in people with COPD. The mortality associated with PM10 (per interquartile range [IQR] = 16 µg/m) was five times more in COPD patients (3.5% [95% confidence interval = -0.1% to 7.2%]) than in other subjects (0.7% [-0.8% to 2.2%]). Effects on respiratory mortality among COPD subjects were particularly elevated from PM2.5 (IQR = 11 µg/m) (11.6% [2.0% to 22.2%]) and NO2 (IQR = 24 µg/m) (19.6% [3.5% to 38.2%]). Older age, male sex, preexisting heart conduction disorders, and cerebrovascular diseases were associated with stronger effects in COPD subjects. CONCLUSIONS: COPD patients are more susceptible to air pollutants, especially PM10 and NO2. These results suggest a need for more protective air pollution standards for susceptible groups.

A cascade biorefinery for grape marc: Recovery of materials and energy through thermochemical and biochemical processes.

The agro-industrial sector makes a high contribution to greenhouse gas emissions; therefore, proper waste management is crucial to reduce the carbon footprint of the food chain. Hydrothermal carbonization (HTC) is a promising and flexible thermochemical process for converting organic materials into energy and added-value products that can be used in different applications. In this work, grape marc residues before and after an extraction process for recovering polyphenols were hydrothermally treated at 220 °C for 1 h. The resulting hydrochar and process water were investigated to test an innovative cascade approach aimed at a multiple product and energy recovery based on the integration of HTC with anaerobic digestion. The results show that this biorefinery approach applied to grape marc could allow to diversify and integrate its potential valorisation options. The produced hydrochars possess an increased fixed carbon content compared to the feedstock (up to +70 %) and, therefore, can be used in soil, immobilizing carbon in a stable form and partially replacing peat in growing media (up to 5 % in case of hydrochar from grape marc after extraction), saving the consumption of this natural substrate. In addition, energy can be recovered from both hydrochar by combustion and from process water through anaerobic digestion to produce biogas. Hydrochars show good properties as solid fuel similar to lignite, with an energy content of around 27 MJ kg-1 (+30 % compared to the feedstock). The anaerobic digestion of the process water allowed obtaining up to 137 mL of biomethane per gram of fed COD. Finally, while HTC process waters are suitable for biological treatment, attention must be paid to the presence of inhibiting compounds that induce acute toxic effects in aerobic conditions. The proposed approach is consistent with the principles of circular economy and could increase the overall sustainability and resilience of the agro-industrial sector.

Incidence of SARS-CoV-2 Infection and Related Mortality by Education Level during Three Phases of the 2020 Pandemic: A Population-Based Cohort Study in Rome.

Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, with particular attention to changes in socioeconomic inequalities over time. A cohort of 1,538,231 residents in Rome on 1 January 2020, aged 35+, followed from 1 March to 31 December 2020, were considered. Cumulative incidence and mortality rates by education were estimated. Multivariable log-binomial and Cox regression models were used to investigate educational disparities in the incidence of SARS-CoV-2 infection and mortality during the entire study period and in three phases of the pandemic. During 2020, there were 47,736 incident cases and 2281 deaths. The association between education and the incidence of infection changed over time. Till May 2020, low- and medium-educated individuals had a lower risk of infection than that of the highly educated. However, there was no evidence of an association between education and the incidence of SARS-CoV-2 infection during the summer. Lastly, low-educated adults had a 25% higher risk of infection from September to December than that of the highly educated. Similarly, there was substantial evidence of educational inequalities in mortality within 30 days of the onset of infection in the last term of 2020. In Rome, social inequalities in COVID-19 appeared in the last term of 2020, and they strengthen the need for monitoring inequalities emerging from this pandemic.