Smoking while driving and public support for car smoking bans in Italy.

OBJECTIVE: To analyse the prevalence and correlates of smoking in cars as well as attitudes towards the extension of smoking bans in private vehicles among Italian adults. METHODS: We used data from two surveys conducted in 2011 and 2012 on an overall sample of 6167 individuals representative of the Italian population aged ≥15 years. RESULTS: The prevalence of smoking while driving was 65.5% among adult smokers. There was a negative trend with age and a positive one with education level. Smoking while driving was more prevalent among men, heavy smokers and smokers who believe there is little or no increased risk of accidents from smoking while driving. Among smokers who smoke while driving, 20.9% smoke in cars carrying children. Overall, 79.6% of Italians (88.2% non-smokers and 48.8% current smokers) support a ban on smoking in cars, and 92.5% (95.0% non-smokers and 83.5% current smokers) support such a ban in cars carrying children. CONCLUSIONS: Despite the high percentage of smokers who smoke in private vehicles, the majority of the Italian population (including smokers) support the introduction of a smoking ban in cars, particularly in cars carrying children. Smoke-free laws should therefore be extended to private vehicles, particularly if they are carrying children. Moreover, warning labels on cigarette packages should include information on the increased risk of accidents when smoking while driving. Mass media campaigns should also consider targeting this topic.

IMU-based human activity recognition and payload classification for low-back exoskeletons.

Nowadays, work-related musculoskeletal disorders have a drastic impact on a large part of the world population. In particular, low-back pain counts as the leading cause of absence from work in the industrial sector. Robotic exoskeletons have great potential to improve industrial workers' health and life quality. Nonetheless, current solutions are often limited by sub-optimal control systems. Due to the dynamic environment in which they are used, failure to adapt to the wearer and the task may be limiting exoskeleton adoption in occupational scenarios. In this scope, we present a deep-learning-based approach exploiting inertial sensors to provide industrial exoskeletons with human activity recognition and adaptive payload compensation. Inertial measurement units are easily wearable or embeddable in any industrial exoskeleton. We exploited Long-Short Term Memory networks both to perform human activity recognition and to classify the weight of lifted objects up to 15 kg. We found a median F1 score of [Formula: see text] (activity recognition) and [Formula: see text] (payload estimation) with subject-specific models trained and tested on 12 (6M-6F) young healthy volunteers. We also succeeded in evaluating the applicability of this approach with an in-lab real-time test in a simulated target scenario. These high-level algorithms may be useful to fully exploit the potential of powered exoskeletons to achieve symbiotic human-robot interaction.

Chemical characterization and source apportionment of fine and coarse particulate matter inside the refectory of Santa Maria Delle Grazie Church, home of Leonardo Da Vinci's "Last Supper".

The association between exposure to indoor particulate matter (PM) and damage to cultural assets has been of primary relevance to museum conservators. PM-induced damage to the "Last Supper" painting, one of Leonardo da Vinci's most famous artworks, has been a major concern, given the location of this masterpiece inside a refectory in the city center of Milan, one of Europe's most polluted cities. To assess this risk, a one-year sampling campaign was conducted at indoor and outdoor sites of the painting's location, where time-integrated fine and coarse PM (PM(2.5) and PM(2.5-10)) samples were simultaneously collected. Findings showed that PM(2.5) and PM(2.5-10) concentrations were reduced indoors by 88 and 94% on a yearly average basis, respectively. This large reduction is mainly attributed to the efficacy of the deployed ventilation system in removing particles. Furthermore, PM(2.5) dominated indoor particle levels, with organic matter as the most abundant species. Next, the chemical mass balance model was applied to apportion primary and secondary sources to monthly indoor fine organic carbon (OC) and PM mass. Results revealed that gasoline vehicles, urban soil, and wood-smoke only contributed to an annual average of 11.2 ± 3.7% of OC mass. Tracers for these major sources had minimal infiltration factors. On the other hand, fatty acids and squalane had high indoor-to-outdoor concentration ratios with fatty acids showing a good correlation with indoor OC, implying a common indoor source.

[Smoking in car: monitoring pollution of particulate matter, of organic volatile compounds and of carbon monoxide. The effect of opening the driver's window]. / Fumare in macchina: l'inquinamento da polveri, da composti organici volatili e da monossido di carbonio. L'effetto dell'apertura del finestrino.

OBJECTIVE: to identify the most suitable marker for monitoring ETS inside a moving car, and to verify the efficacy of window opening to reduce ETS pollution inside the car. DESIGN: experimental pilot study. SSETTING AND PARTICIPANTS: monitoring of ETS markers in a moving car. MAIN OUTCOMES MEASURES: we used real time analyzers to measure: n particulate matter as mass (mug/m3, PM1, PM2.5, PM10); n suspended particle number (total number of particles sized >0.3 e >0.4 mum; n the number of particles with aerodynamic size between 0.3-0.4 mum in diameter; n total volatile organic compounds (TVOC); n carbon monoxide (CO). The recordings were carried out inside a car moving on the road at the speed of 50 km/h, with controlled conditions of temperature and relative humidity. RESULTS: after lighting a cigarette, with driver's window closed, the levels of all the pollutants increased dramatically, with peaks of 700 mug/m3 for PM2.5 and PM10, and of over 600,000 particles/ liter, while TVOC reached values up to 6,000 mug/m3 and CO up to 6 ppm. When a cigarette was lit with the window 1/4 open, excess pollution was promptly recorded, although with less intensity. With the window completely open, PM, TVOC and CO concentrations were hardly measurable as compared to background levels. On the contrary, particle number increased dramatically up to over 300,000/liter, mostly due to the submicrometric particle fraction in the range 0.3-0.4 mum. CONCLUSION: smoking just a cigarette inside a car represents an extremely high exposure to ETS. Partially opening the window is useless to prevent the accumulation of pollutants. Complete window opening is helpful to remove coarse PM and volatile pollutants, but is ineffective against submicrometer particles. Measuring particle number seems to be the best way to assess ETS pollution inside a car.

[Observed smoking in car: results of a study of the Regional Health Prevention Service of Veneto, Northern Italy]. / La prevalenza dell'abitudine a fumare in automobile: i risultati dello studio osservazionale in Veneto.

OBJECTIVE: to estimate the prevalence of smokers inside cars or duty vehicles and the presence of children exposed to second hand smoke on board, in the NHS districts of Veneto Region. DESIGN: an observational study was carried out by the technicians of the Prevention department from October 1st to October 17th 2008. The observers had to record sex of the driver and of the passengers, their presumed ages, verify if drivers or passengers were smoking, and if there were any children on board. SETTING AND PARTICIPANTS: 19 Local Health Authorities (90,5%) out of 21 in the Veneto region. MAIN OUTCOMES MEASURES: percentage of crossings monitored out of the total scheduled. RESULTS: a total of 5,928 cars were examined at the crossings, males accounted for 61,4% of the drivers. Smoking overall by at least one person in the car was reported in 409 cases (6.9%, 12% among commercial vehicles), the driver alone was smoking in 87.3% of the cases, whereas only the passenger smoking represented 8.3% of the cases. Both the driver and passenger smoking were 4.4% of the observations. Children were present as passengers in 762 cars (12.9%); there were people smoking with children on board in 7 cars (0.9%). CONCLUSION: in spite of the efforts to limit the dangers of second hand smoke, smoking in car is still a common behaviour, and represents a serious risk both for both, adults and children. Focusing in research projects could help the Department of Prevention of the Local Health Authorities to increase their activities and involvement in the research field.

Inhaled steroid/tobacco smoke particle interactions: a new light on steroid resistance.

BACKGROUND: Inhaled steroid resistance is an obstacle to asthma control in asthmatic smokers. The reasons of this phenomenon are not yet entirely understood. Interaction of drug particles with environmental tobacco smoke (ETS) could change the aerodynamic profile of the drug through the particle coagulation phenomenon. Aim of the present study was to examine whether steroid particles interact with smoke when delivered in the presence of ETS. METHODS: Beclomethasone-hydrofluoralkane (BDP-HFA) pMDI particle profile was studied after a single actuation delivered in ambient air or in the presence of ETS in an experimental chamber using a light scattering Optical Particle Counter capable of measuring the concentrations of particle sized 0.3-1.0, 1.1-2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, and > 5.1 microm in diameter with a sampling time of one second. The number of drug particles delivered after a single actuation was measured as the difference between total particle number after drug delivery and background particle number. Two groups of experiments were carried out at different ambient background particle concentrations. Two-tail Student's t-test was used for statistical analysis. RESULTS: When delivered in ambient air, over 90% of BDP-HFA particles were found in the 0.3-1.0 microm size class, while particles sized 1.1-2.0 microm and 2.1-3.0 represented less than 6.6% and 2.8% of total particles, respectively. However, when delivered in the presence of ETS, drug particle profile was modified, with an impressive decrease of 0.3-1.0 microm particles, the most represented particles resulting those sized 1.1-2.0 microm (over 66.6% of total particles), and 2.1-3.0 microm particles accounting up to 31% of total particles. CONCLUSION: Our data suggest that particle interaction between inhaled BDP-HFA pMDI and ETS takes place in the first few seconds after drug delivery, with a decrease in smaller particles and a concurrent increase of larger particles. The resulting changes in aerosol particle profile might modify regional drug deposition with potential detriment to drug efficacy, and represent a new element of steroid resistance in smokers. Although the present study does not provide any functional or clinical assessment, it might be useful to advise smokers and non smokers with obstructive lung disease such as asthma or COPD, to avoid to act inhaled drugs in the presence of ETS in order to obtain the best therapeutic effect.

Efficacy of pins and diplomas as a reward for long-term smoking cessation.

AIMS AND BACKGROUND: Since 2004, the Antismoking Center of the National Cancer Institute of Milan has rewarded those who have been ex-smokers for longer than a year with a "former smoker" pin and a diploma. We investigated firstly whether these rewards contributed to maintain smoking withdrawal, secondly, which one of these was more appreciated and why, and thirdly, how they may have influenced the ex-smokers' perception of smoking and how this was reflected on those surrounding them (i.e., ex-smokers' personal and/or interpersonal areas). METHODS: A multiple-choice questionnaire was developed to investigate how much the rewards were appreciated and their effectiveness in maintaining smoking cessation. Moreover, smokers and non-smokers were asked about the impact of the pin. The questionnaire was completed on the phone by the last 100 ex-smokers who entered the pin and diploma program. RESULTS: All subjects appreciated the rewards, but only a few of them considered them as an aid to maintain long-term smoking cessation. Those who preferred the diploma stated that it represented a contribution to their self-esteem, an official recognition of being an ex-smoker, besides being something to show with pride to others. Those who preferred the pin principally stated it allowed them to be an example to other smokers. Most of the subjects reported that they wore the pin in several circumstances, raising interest and admiration. CONCLUSIONS: Rewarding ex-smokers one year after smoking cessation with a small prize may be a useful practice to improve the doctor-patient relationship, which is vital to maintain smoking cessation, and to boost the awareness of the availability of aids to reach this objective.

[The effects of the traffic restriction fee (Ecopass) in the center of Milan on urban pollution with particulate matter: the results of a pilot study]. / L'effetto del provvedimento di restrizione del traffico nel centro di Milano (Ecopass) sull'inquinamento urbano da polveri: i risultati di uno studio pilota.

BACKGROUND: the city of Milan introduced a traffic charging zone in city center in January 2008, named Ecopass. AIM OF THE STUDY: to compare PM1, PM2,5 and PM10 levels in and outside the restricted area before and after the enforcement of the charging scheme. METHODS: PM1, PM2,5 and PM10 exposures were measured by means of pre-calibrated portable laser-operated particle analyzers. PM10 data from the ARPA official monitoring stations were also evaluated. RESULTS: during a walking trip from Piazza Loreto (outside) to Piazza Duomo (inside Ecopass zone) and back, mean (SD) PM1, PM2,5 and PM10 were 31 (6), 68 (24) and 93 (37) microg/m3 inside the Ecopass zone, and 32 (6), 70 (37), 98 (48) microg/m3 in the outer area, respectively (not significant, ns). In another trip walking from Piazza Buonarroti to Piazza Duomo and back, PM1, PM2,5 and PM10 levels were 56 (2), 183 (14) and 245 (28) microg/m3 inside the Ecopass zone, and 58 (3), 197 (13) and 247 (24) microg/m3 in the outer area, respectively (ns). In the measurements taken from a car moving in three ring belts--one inside the restricted zone, and two outer radial orbitals--PM1, PM2,5 and PM10 levels were found 41 (1), 110 (8) and 148 (16) microg/m3 inside the Ecopass area, 42 (3), 116 (14) and 152 (28) microg/m3 along the middle belt, and 39 (4), 102 (15) and 127 (23) microg/m3 along the greater Milan orbital ("Tangenziale"), respectively (ns). Mean (SD) PM10 levels from ARPA in the two months before the enforcement were 71.2 (32.6) and 74.8 (38.4) microg/m3, in the Ecopass zone and outside, respectively while after the enforcement were 67.3 (36.4) and 70.9 (38.3) microg/m3 of PM10, respectively (ns). CONCLUSIONS: no signficant improvement in air quality was observed after the enforcement of the Ecopass charging zone in Milan. In spite of their limitations, the present data confirm that small scale reductions in particle emissions are not sufficient to reach the goal of an improvement in air quality. Large scale, coordinated interventions on an inter-regional basis are envisioned.

Residual tobacco smoke: measurement of its washout time in the lung and of its contribution to environmental tobacco smoke.

BACKGROUND: Tobacco smoking entails inhaling millions of fine particles with each puff, and it is intuitive that after smoking a cigarette it will take a certain time to washout residual tobacco smoke (RTS) from the lungs with subsequent breaths. OBJECTIVES: To study the washout time of 0.3-1.0 microm particles after the last puff in 10 volunteer smokers by using equipment capable of measuring particle concentration in real time in the exhaled air. RESULT: Mean (standard deviation (SD)) lung RTS washout time was 58.6 (23.6) s, range 18-90 s, and corresponded to 8.7 (4.6) subsequent breathings. The contribution of individual and overall RTS to indoor pollution was calculated by subtracting incremental background particle concentration from room concentration after 10 consecutive re-entries of smokers after the last puff into a room of 33.2 m3, with an air exchange rate per hour in the range of 0.2-0.4. Mean (SD) individual RTS contribution consisted of 1402 (1490) million particles (range 51-3611 million), whereas RTS increased room 0.3-1.0 microm particle concentration from a baseline of 22,283 particles/l to a final room concentration of 341,956 particles/l, corresponding to a total increase in particulate matter (2.5) from a background of 0.56 up to 3.32 microg/m3. CONCLUSION: These data reveal a definite although marginal, role of RTS as a source of hidden indoor pollution. Further studies are needed to understand the relevance of this contribution in smoke-free premises in terms of risk exposure; however, waiting for about 2 min before re-entry after the last puff would be enough to avoid an unwanted additional exposure for non-smokers.

[A comparison between indoor air quality before and after the implementation of the smoking ban in public places in Italy]. / Un confronto tra la qualità dell'aria nei luoghi pubblici prima e dopo l'introduzione della legge sull fumo passivo in Italia.

OBJECTIVE: To monitor indoor air quality index in a few Italian hospitality industry venues before and after the implementation of the smoking ban in January 2005. DESIGN: Indoor PM2.5 measurements were carried out in four Milan restaurants during evening hours in the period January-February 2004, and again in January-February 2005, with concurrent outdoor PM2.5 monitoring. The measures were recorded with a portable laser-operated aerosol analyzer with a sampling time of 2 minutes, calibrated by comparison with gravimetric method RESULTS: PM2.5 ranged between 187+/-52 and 709+/-180 mg/m3, and between 24+/-10 e 141+/-28 mg/m3 (p <0.0001) in the years 2004 and 2005, respectively. After the 2005 smoking ban, overall indoor fine particle pollution decreased by values in the range from 81 to 96%. CONCLUSIONS: Within the limits of a small sample, the study showed a good compliance with the smoking ban in the hospitality industry which resulted in a remarkable improvement in air quality index. Smoking ban thus appears to achieve the aims of protecting people from exposure to an unwanted dangerous pollutant such as environmental tobacco smoke.

[Survey among GP's about their smoking habits, opinions and behaviours in smoking prevention in Lombardy (Northern Italy)]. / Indagine conoscitiva sulle abitudini al fumo, le opinioni e l'attività di prevenzione del tabagismo tra i medici di medicina generale della Lombardia.

OBJECTIVE: to analyze smoking habits, opinions on smoking, curriculum and smoking prevention activities carried out by general practitioners in the Lombardy Region (Northern Italy). DESIGN AND PARTICIPANTS: between 2000 and 2002 a questionnaire about tobacco smoke retrieved from the European Project "GPs Empowerment" has been sent to 5348 general practitioners in the Lombardy Region. The questionnaire focuses on the difference of opinions and activity between smoking and non-smoking physicians. We analyzed 3571 questionnaires voluntarily filled. RESULTS: The prevalence of smokers among the general practitioners in the Lombardy Region was 22.3% (CI95% 21-24%), (M: 24.2%, CI 95% 22-26% and F: 17.8%, CI 95% 15-20%). Physicians could play a role in the prevention of tobacco: 98.7% (CI 95% 98-99%) agree about the effectiveness of counseling but only 65.6% (CI95% 64-67%) regularly counsel their patients about smoking-related diseases and quitting. In this paper, we estimated that 963% (CI95% 96-97%) non smoking GPs consider counseling useful for their patients vs 92.6% (CI 95% 91-94%) of smoking physicians (p <0. 001); GPs who think to represent a model for people are more frequent among non smokers (97.5%, CI95% 97-98% vs 89.3%, CI 95% 87-91%;p <0.001). Those who discuss with their patients about tobacco addiction and cessation are 68.9% (CI95% 67-71%) among non smokers vs 53.4% (CI 95% 50-54%) among smokers (p <0.001). Finally 67% (CI 95 % 65-69%) interviewed physicians lacked a specific training in smoking prevention. Among them, 87.4%(CI 95% 86-89%) would attend the courses. CONCLUSION: this finding could be useful for planning or enhancing activities aimed at improving preventive and cessation methods.

Early detection of chronic obstructive pulmonary disease (COPD): the role of spirometry as a diagnostic tool in primary care.

Chronic obstructive pulmonary disease (COPD) is common and often undiagnosed in its early stages, especially in smokers, who are also most at risk. Patients can develop severe or very severe disease before they consult a physician. It is therefore important to identify patients at-risk of COPD and check their lung function regularly since early stage disease is often asymptomatic or mistaken for asthma. Primary care physicians are often the first health care providers to encounter patients with COPD in the early stages, and their role in early detection and treatment process is pivotal. Spirometry is a cheap, simple and reliable method for the early detection and monitoring of COPD patients, and for establishing a differential diagnosis. Spirometry gives immediate results and communicating the results to smokers has been shown to motivate them to quit. Early diagnosis and appropriate therapy can positively influence disease course, slowing progression, relieving symptoms and reducing the incidence of acute 'flares', or exacerbations.

Guidelines into practice: An international pilot study of "Asthma Crystal Byte".

INTRODUCTION: Decision support software offers an opportunity to improve the care of patients with asthma by linking individual management decisions to guidelines. METHOD: A guidelines based software package linked to a large database and incorporating a morbidity predictive function was developed in the United Kingdom. Clinicians from several European countries volunteered to evaluate the package in their own clinical environment. RESULTS: The package was run during consultations with patients in the UK, Portugal, Switzerland and Italy. Clinicians agreed on a need for local translations, local drug choices and guidelines to be developed. An emphasis on allergy, immunology and smoking cessation advice in asthma care in some countries highlighted a need to adapt country specific versions. CONCLUSIONS: This International pilot study demonstrated that clinicians can learn from each other and work together around a common theme of implementing guidelines using decision support software.

[Real-time measurement of indoor particulate matter originating from environmental tobacco smoke: a pilot study]. / La misurazione in tempo reale del particolato fine prodotto da fumo di sigaretta negli ambienti indoor: risultati di uno studio pilota.

Short-term measurement of suspended particulate matter has been recently made possible since the release of laser-operating portable instruments. Data of a pilot study of field evaluation of environmental tobacco smoke (ETS) with a portable instrument are reported. We analysed the concentrations of total suspended particle (TSP) and of the fine particles PM10, PM7, PM2.5 and PM1 released indoor from a single cigarette, and their levels inside smoking- and non-smoking-areas of a restaurant. The results indicate that ETS creates high level indoor particulate pollution, with concentrations of PM10 exceeding air quality standards. This kind of field evaluation could allow a more careful assessing of short-term exposure to ETS and its relevance to public health.

[Active and passive smoking: two sides of the same medal]. / Fumo attivo e fumo passivo: due facce della stessa medaglia.

The authors underline the similarities between active and passive smoking under many features, i.e. chemical and physical composition, the kind of health risks, the anti-educational impact on the youth. The special character of passive smoking is also discussed, such as its multiplicative exposure effect on the population, and the hazard to high-risk people like children, pregnant women, and respiratory and cardiovascular patients.

Antismoking centers in Milan's communal pharmacies: analysis of the 2010-2011 campaign.

AIMS AND BACKGROUND: According to recent assessments from the Italian Istituto Superiore della Sanità, information and assistance to smokers are still far from satisfactory. We evaluated the impact of a new smoking cessation service located in pharmacies. Smokers' individual characteristics were also considered. MATERIAL AND METHODS: A 1-year pilot study was carried out from October 2010 to September 2011. Five pharmacies in Milan were selected. A psychologist with experience in smoking cessation was present in each pharmacy one afternoon per week, and pharmacists were trained by a team from the Antismoking Center of the Fondazione IRCCS Istituto Nazionale dei Tumori. Each pharmacy was equipped with informative material, carbon monoxide analyzers, and motivational and nicotine dependence questionnaires, in addition to a clinical briefcase. Counseling sessions were also arranged upon request. RESULTS: In the first 12 months of activity, 216 persons asked for a consultation. The sample, aged 15-79 years, reported the following median values: 30 pack/years, 14 ppm CO, and a Fagerström Test of Nicotine Dependence score of 5. More than one-third of the sample (40.3%) had one pathology and 25% had more than one. In some cases (15.7%), people just wanted information about what the service offered. For those who tried to quit, smoking cessation rates were 33.3% at 3 months, 28% at 6 months, and 24.6% at 1 year. Three kinds of pharmacologic therapies were suggested to smokers: nicotine replacement therapy (75.5%), varenicline (17.5%), and bupropion (7%). CONCLUSIONS: The results show that an accessible and free smoking cessation service is considered useful by smokers as demonstrated by the large number of requests compared with other smoking centers in Italy. Increased involvement of pharmacists in supporting smoking cessation makes this a promising initiative for the near future.