Publications by authors named "Angelo Solimini"

29 Publications

  • Page 1 of 1

Real-life use of tocilizumab with or without corticosteroid in hospitalized patients with moderate-to-severe COVID-19 pneumonia: A retrospective cohort study.

PLoS One 2021 10;16(9):e0257376. Epub 2021 Sep 10.

Department of Public Health and Infectious Diseases, Policlinico Umberto 1st Hospital, Sapienza University of Rome, Rome, Italy.

Objective: To evaluate the effectiveness of Tocilizumab (with or without corticosteroids) in a real-life context among moderate-to-severe COVID-19 patients hospitalized at the Infectious Diseases ward of two hospitals in Lazio region, Italy, during the first wave of SARS-CoV-2 pandemic.

Method: We conducted a retrospective cohort study among moderate-to-severe COVID-19 pneumonia to assess the influence of tocilizumab (with or without corticosteroids) on: 1) primary composite outcome: risk for death/invasive mechanical ventilation/ICU-transfer at 14 days from hospital admission; 2) secondary outcome: COVID-related death only. Both outcomes were also assessed at 28 days and restricted to baseline more severe cases. We also evaluated the safety of tocilizumab.

Results: Overall, 412 patients were recruited, being affected by mild (6.8%), moderate (66.3%) or severe (26.9%) COVID-19 at baseline. The median participant' age was 63 years, 56.5% were men, the sum of comorbidities was 1.34 (±1.44), and the median time from symptom onset to hospital admission was 7 [3-10] days. Patients were subdivided in 4 treatment groups: standard of care (SoC) only (n = 172), SoC plus corticosteroid (n = 65), SoC plus tocilizumab (n = 50), SoC plus tocilizumab and corticosteroid (n = 125). Twenty-six (6.3%) patients underwent intubation, and 37 (9%) COVID-related deaths were recorded. After adjusting for several factors, multivariate analysis showed that tocilizumab (with or without corticosteroids) was associated to improved primary and secondary outcomes at 14 days, and at 28-days only when tocilizumab administered without corticosteroid. Among more severe cases the protective effect of tocilizumab (± corticosteroids) was observed at both time-points. No safety concerns were recorded.

Conclusion: Although contrasting results from randomized clinical trials to date, in our experience tocilizumab was a safe and efficacious therapeutic option for patients with moderate-to-severe COVID-19 pneumonia. Its efficacy was improved by the concomitant administration of corticosteroids in patients affected by severe-COVID-19 pneumonia at baseline.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257376PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432821PMC
September 2021

Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis.

Eur J Prev Cardiol 2020 Nov 12. Epub 2020 Nov 12.

Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden.

Aims: We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy.

Methods And Results: Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013-2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0-5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines.

Conclusion: PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.
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http://dx.doi.org/10.1093/eurjpc/zwaa084DOI Listing
November 2020

A cohort study on long-term exposure to air pollution and incidence of liver cirrhosis.

Environ Epidemiol 2020 Aug 4;4(4):e109. Epub 2020 Aug 4.

Department of Epidemiology of Lazio Regional Health Service, Rome, Italy.

Cirrhosis is an advanced liver disease affecting millions of people worldwide, involving high healthcare costs. Despite experimental evidence suggesting a possible role of airborne pollutants in liver diseases, epidemiological studies are lacking. We aimed at investigating the association between exposure to air pollutants and incidence of cirrhosis in a large population-based cohort in Rome.

Methods: We used an administrative cohort established from the 2001 census. We included all adults of 30 years of age or older who were free of cirrhosis, resulting in a study population of over 1.2 million subjects. Follow-up of the subjects ended on 31 December 2015. We ascertained incident cases of cirrhosis from regional mortality and hospital discharge registries using a validated algorithm. We assessed exposure of the subjects to PM, PM coarse, PM, PM absorbance, NO, NOx, and PM metal components at their residential address using Land Use Regression models. We used Cox regression models, adjusted for relevant covariates, to estimate the association between air pollution exposure and cirrhosis incidence.

Results: We observed 10,111 incident cases of cirrhosis, with a crude incidence rate of 67 × 100,000 person-years. Long-term exposure to all pollutants tested was significantly associated with cirrhosis, e.g., PM (hazard ratios [HR], 1.05; 95% confidence interval [CI], 1.01-1.09, per 10 µg/m increments), PM coarse (HR, 1.11; 95% CI, 1.05-1.17, per 10 µg/m increments), PM (HR, 1.08; 95% CI, 1.03-1.13, per 5 µg/m increments), and NO (HR, 1.03; 95% CI, 1.02-1.05, per 10 µg/m increments). The associations were robust in secondary analyses.

Conclusions: Our findings suggest a possible contribution of air pollution to the development of cirrhosis.
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http://dx.doi.org/10.1097/EE9.0000000000000109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941789PMC
August 2020

A global association between Covid-19 cases and airborne particulate matter at regional level.

Sci Rep 2021 03 18;11(1):6256. Epub 2021 Mar 18.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.

Evidences of an association between air pollution and Covid-19 infections are mixed and inconclusive. We conducted an ecological analysis at regional scale of long-term exposure to air-borne particle matter and spread of Covid-19 cases during the first wave of epidemics. Global air pollution and climate data were calculated from satellite earth observation data assimilated into numerical models at 10 km resolution. Main outcome was defined as the cumulative number of cases of Covid-19 in the 14 days following the date when > 10 cumulative cases were reported. Negative binomial mixed effect models were applied to estimate the associations between the outcome and long-term exposure to air pollution at the regional level (PM, PM), after adjusting for relevant regional and country level covariates and spatial correlation. In total we collected 237,749 Covid-19 cases from 730 regions, 63 countries and 5 continents at May 30, 2020. A 10 μg/m increase of pollution level was associated with 8.1% (95% CI 5.4%, 10.5%) and 11.5% (95% CI 7.8%, 14.9%) increases in the number of cases in a 14 days window, for PM and PM respectively. We found an association between Covid-19 cases and air pollution suggestive of a possible causal link among particulate matter levels and incidence of COVID-19.
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http://dx.doi.org/10.1038/s41598-021-85751-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973572PMC
March 2021

Differential induction of type I and III interferon genes in the upper respiratory tract of patients with coronavirus disease 2019 (COVID-19).

Virus Res 2021 04 5;295:198283. Epub 2021 Jan 5.

Laboratory of Virology, Department of Molecular Medicine, Sapienza University, Affiliated to Istituto Pasteur Italia, Rome 00185, Italy; Microbiology and Virology Unit, Hospital "Policlinico Umberto I", Sapienza University, Rome 00185, Italy.

The natural course of type I and III interferon (IFN) response in the respiratory tract of COVID-19 patients needs to be better defined. We showed that type I/III IFNs, IFN-regulatory factor 7 (IRF7), and IFN stimulated genes (ISGs), are highly expressed in the oropharyngeal cells of SARS-CoV-2 positive patients compared to healthy controls. Notably, the subgroup of critically-ill patients that required invasive mechanical ventilation had a general decrease in expression of IFN/ISG genes. Heterogeneous patterns of IFN-I/III response in the respiratory tract of COVID-19 patients may be associated to COVID-19 severity.
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http://dx.doi.org/10.1016/j.virusres.2020.198283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834390PMC
April 2021

Effect of Urban Wastewater Discharge on the Abundance of Antibiotic Resistance Genes and Antibiotic-Resistant in Two Italian Rivers.

Int J Environ Res Public Health 2020 09 18;17(18). Epub 2020 Sep 18.

Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Piazza A. Moro 5, 00185 Rome, Italy.

Background: Wastewater treatment plants (WWTPs) are microbial factories aimed to reduce the amount of nutrients and pathogenic microorganisms in the treated wastewater before its discharge into the environment. We studied the impact of urban WWTP effluents on the abundance of antibiotic resistance genes (ARGs) and antibiotic-resistant (AR-) in the last stretch of two rivers (Arrone and Tiber) in Central Italy that differ in size and flow volume.

Methods: Water samples were collected in three seasons upstream and downstream of the WWTP, at the WWTP outlet, and at sea sites near the river mouth, and analyzed for the abundance of ARGs by qPCR and AR- using cultivation followed by disk diffusion assays.

Results: For all studied genes (, , , , , and ), absolute concentrations were significantly higher in the Tiber than in the Arrone at all sampling sites, despite their collection date, but the prevalence of target ARGs within bacterial communities in both rivers was similar. The absolute concentrations of most ARGs were also generally higher in the WWTP effluent with median levels between log 4 and log 6 copies per ml but did not show differences along the studied stretches of rivers. Statistically significant site effect was found for phenotypic resistance to tetracycline and ciprofloxacin in the Arrone but not in the Tiber.

Conclusions: In both rivers, diffuse or point pollution sources other than the studied WWTP effluents may account for the observed resistance pattern, although the Arrone appears as more sensitive to the wastewater impact considering its lower flow volume.
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http://dx.doi.org/10.3390/ijerph17186813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557954PMC
September 2020

Spatial modes for transmission of chikungunya virus during a large chikungunya outbreak in Italy: a modeling analysis.

BMC Med 2020 08 7;18(1):226. Epub 2020 Aug 7.

Center for Information Technology, Fondazione Bruno Kessler, Trento, Italy.

Background: The spatial spread of many mosquito-borne diseases occurs by focal spread at the scale of a few hundred meters and over longer distances due to human mobility. The relative contributions of different spatial scales for transmission of chikungunya virus require definition to improve outbreak vector control recommendations.

Methods: We analyzed data from a large chikungunya outbreak mediated by the mosquito Aedes albopictus in the Lazio region, Italy, consisting of 414 reported human cases between June and November 2017. Using dates of symptom onset, geographic coordinates of residence, and information from epidemiological questionnaires, we reconstructed transmission chains related to that outbreak.

Results: Focal spread (within 1 km) accounted for 54.9% of all cases, 15.8% were transmitted at a local scale (1-15 km) and the remaining 29.3% were exported from the main areas of chikungunya circulation in Lazio to longer distances such as Rome and other geographical areas. Seventy percent of focal infections (corresponding to 38% of the total 414 cases) were transmitted within a distance of 200 m (the buffer distance adopted by the national guidelines for insecticide spraying). Two main epidemic clusters were identified, with a radius expanding at a rate of 300-600 m per month. The majority of exported cases resulted in either sporadic or no further transmission in the region.

Conclusions: Evidence suggest that human mobility contributes to seeding a relevant number of secondary cases and new foci of transmission over several kilometers. Reactive vector control based on current guidelines might allow a significant number of secondary clusters in untreated areas, especially if the outbreak is not detected early. Existing policies and guidelines for control during outbreaks should recommend the prioritization of preventive measures in neighboring territories with known mobility flows to the main areas of transmission.
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http://dx.doi.org/10.1186/s12916-020-01674-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412829PMC
August 2020

A comparative analysis of the 2007 and 2017 Italian chikungunya outbreaks and implication for public health response.

PLoS Negl Trop Dis 2020 06 11;14(6):e0008159. Epub 2020 Jun 11.

Dipartimento di Sanitá Pubblica e Malattie Infettive, Sapienza University of Rome, Rome, Italy.

Key Results: Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8-6 (2007) and 1.5-2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low.

Major Conclusions: Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks.
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http://dx.doi.org/10.1371/journal.pntd.0008159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289343PMC
June 2020

Knowledge, Attitude and Practices towards the Tiger Mosquito Aedes Albopictus. A Questionnaire Based Survey in Lazio Region (Italy) before the 2017 Chikungunya Outbreak.

Int J Environ Res Public Health 2020 06 3;17(11). Epub 2020 Jun 3.

Department of Public Health & Infectious Diseases, University of Roma "La Sapienza", 00185 Rome, Italy.

The invasion of has played a major role in the resurgence of mosquito-borne diseases in Italy, generating the two largest chikungunya outbreaks in Europe (2007, 2017). Knowledge, attitude and practice (KAP) are important in order to prevent -borne disease transmission, yet so far they have not been assessed. To this scope we used multivariate logistic regression to investigate KAP of citizen-to- ecology and transmitted diseases. Data were collated by a structured questionnaire (18 questions) in 2016. Participants were selected in the Lazio region from members of native populations and two resident communities (RC) originating from the Indian subcontinent where -transmitted diseases are endemic. Results showed that compared to Italians, RC respondents had a higher knowledge and concern of -transmitted diseases (Odds Ratio = 2.61 (95%CI: 1.03-6.05); OR = 3.13 (2.15-4.65)) as well as their life cycles (OR = 2.49 (1.75-3.56); OR = 9.04 (6.22-13.66)). In contrast, they perceived a lower nuisance due to the presence of (OR = 0.2 (0.13-0.32); OR = 0.55 (0.38-0.78). These findings suggest that citizens in the Lazio region are not prepared to face a potential outbreak of arboviruses and further efforts should be made to increase knowledge, awareness and best practices.
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http://dx.doi.org/10.3390/ijerph17113960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312532PMC
June 2020

Short-term exposure to PM and risk of venous thromboembolism: A case-crossover study.

Thromb Res 2020 06 13;190:52-57. Epub 2020 Mar 13.

Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy.

Background: Short-term exposure to air pollution increases the risk of cardiovascular mortality and morbidity but little evidence is available on pollution effects on venous thromboembolism (VTE), a common vascular disease.

Methods: We conducted a case-crossover analysis of all urgent hospitalizations for deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients >35 years during the period 2006 to 2017 in Rome (Italy). We examined whether 1) short-term exposure to particulate matter with aerodynamic diameter <2.5 μg (PM) increases the risk of hospitalization for DVT or PE, and 2) if the associations are modified by the period of the year (warm and cold seasons), sex, age and comorbidity.

Results: We found that short-term exposure to PM was associated with an increase of PE hospitalization risk of during the warm season (April to September) of 19.6% (95% confidence intervals: 8.3, 31%) per 10 μg/m, while no statistically significant effects were displayed during the cold season or the whole year or for DVT hospitalizations. The effect of PM remained significant (%change: 21.3; 95%CI: 5.4, 39.5) after adjustment for nitrogen dioxide (NO) co-exposure (a marker of traffic sources) and when limiting to primary diagnosis of PE (%change: 19.1; 95%CI: 4.2, 36.1). Age, sex and comorbid conditions did not modify the association.

Conclusions: Our results suggested a positive association between short-term exposure to PM and pulmonary embolism during the warm period of the year while no evidence emerged for deep vein thrombosis.
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http://dx.doi.org/10.1016/j.thromres.2020.03.008DOI Listing
June 2020

Frequency of virulence and antibiotic resistance genes in Escherichia coli isolates in two rivers of central Italy.

Ann Ig 2020 May-Jun;32(3):322-324

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.

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http://dx.doi.org/10.7416/ai.2020.235DOI Listing
August 2021

The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014-June 2015.

Epidemiol Infect 2019 01;147:e103

Department of Public Health and Infectious Diseases,Faculty of Medicine and Pharmacy,'Sapienza' University of Rome,Rome,Italy.

In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epidemiology of the EVD outbreak during July 2014-June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44-2.50; P < 0.01) and those attending funeral (OR 1.02; 95% CI 1.01-1.04; P < 0.01). EVD cases from Kunike chiefdom had a lower odds of death (OR 0.22; 95% CI 0.08-0.44; P < 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23-4.57; P < 0.05). Only 25.1% of alerts were generated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice during funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness.
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http://dx.doi.org/10.1017/S0950268819000177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518516PMC
January 2019

Estimating the risk of Dengue, Chikungunya and Zika outbreaks in a large European city.

Sci Rep 2018 11 6;8(1):16435. Epub 2018 Nov 6.

Department of Public Health and Infectious Diseases, Universita' La Sapienza, Rome, Italy.

Outbreaks of arbovirus infections vectored by invasive Aedes albopictus have already occurred and are predicted to become increasingly frequent in Southern Europe. We present a probabilistic model to assess risk of arbovirus outbreaks based on incident cases worldwide, on the probability of arrival of infected travelers, and on the abundance of the vector species. Our results show a significant risk of Chikungunya outbreak in Rome from mid June to October in simulations with high human biting rates (i.e. when ≥50% of the population is bitten every day). The outbreak risk is predicted to be highest for Chikungunya and null for Zika. Simulated increase of incident cases in selected endemic countries has no major impact on the outbreak risk. The model correctly estimated the number of imported cases and can be easily adapted to other urban areas where Ae. albopictus is the only potential vector present.
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http://dx.doi.org/10.1038/s41598-018-34664-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219586PMC
November 2018

Association between PM10, PM2.5, NO2, O3 and self-reported diabetes in Italy: A cross-sectional, ecological study.

PLoS One 2018 17;13(1):e0191112. Epub 2018 Jan 17.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Introduction: Air pollution represents a serious threat to health on a global scale, being responsible for a large portion of the global burden of disease from environmental factors. Current evidence about the association between air pollution exposure and Diabetes Mellitus (DM) is still controversial. We aimed to evaluate the association between area-level ambient air pollution and self-reported DM in a large population sample in Italy.

Materials And Methods: We extracted information about self-reported and physician diagnosed DM, risk factors and socio-economic status from 12 surveys conducted nationwide between 1999 and 2013. We obtained annual averaged air pollution levels for the years 2003, 2005, 2007 and 2010 from the AMS-MINNI national integrated model, which simulates the dispersion and transformation of pollutants. The original maps, with a resolution of 4 x 4 km2, were normalized and aggregated at the municipality class of each Italian region, in order to match the survey data. We fit logistic regression models with a hierarchical structure to estimate the relationship between PM10, PM2.5, NO2 and O3 four-years mean levels and the risk of being affected by DM.

Results: We included 376,157 individuals aged more than 45 years. There were 39,969 cases of DM, with an average regional prevalence of 9.8% and a positive geographical North-to-South gradient, opposite to that of pollutants' concentrations. For each 10 μg/m3 increase, the resulting ORs were 1.04 (95% CI 1.01-1.07) for PM10, 1.04 (95% CI 1.02-1.07) for PM2.5, 1.03 (95% CI 1.01-1.05) for NO2 and 1.06 (95% CI 1.01-1.11) for O3, after accounting for relevant individual risk factors. The associations were robust to adjustment for other pollutants in two-pollutant models tested (ozone plus each other pollutant).

Conclusions: We observed a significant positive association between each examined pollutant and prevalent DM. Risk estimates were consistent with current evidence, and robust to sensitivity analysis. Our study adds evidence about the effects of air pollution on diabetes and suggests a possible role of ozone as an independent factor associated with the development of DM. Such relationship is of great interest for public health and deserves further investigation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191112PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771616PMC
February 2018

Transmission dynamics of the ongoing chikungunya outbreak in Central Italy: from coastal areas to the metropolitan city of Rome, summer 2017.

Euro Surveill 2017 Nov;22(44)

Center for Information Technology, Fondazione Bruno Kessler, Trento, Italy.

A large chikungunya outbreak is ongoing in Italy, with a main cluster in the Anzio coastal municipality. With preliminary epidemiological data, and a transmission model using mosquito abundance and biting rates, we estimated the basic reproduction number R at 2.07 (95% credible interval: 1.47-2.59) and the first case importation between 21 May and 18 June 2017. Outbreak risk was higher in coastal/rural sites than urban ones. Novel transmission foci could occur up to mid-November.
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http://dx.doi.org/10.2807/1560-7917.ES.2017.22.44.17-00685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710132PMC
November 2017

Association between Air Pollution and Emergency Room Visits for Atrial Fibrillation.

Int J Environ Res Public Health 2017 06 20;14(6). Epub 2017 Jun 20.

Department of Epidemiology, Lazio Regional Health Service, ASL Rome 1, 00147 Rome, Italy.

Despite the large prevalence in the population, possible factors responsible for the induction of atrial fibrillation (AF) events in susceptible individuals remain incompletely understood. We investigated the association between air pollution levels and emergency department admissions for AF in Rome. We conducted a 14 years' time-series study to evaluate the association between the daily levels of air pollution (particulate matter, PM and PM, and nitrogen dioxide, NO₂) and the daily count of emergency accesses for AF (ICD-9 code: 427.31). We applied an over-dispersed conditional Poisson model to analyze the associations at different lags after controlling for time, influenza epidemics, holiday periods, temperature, and relative humidity. Additionally, we evaluated bi-pollutant models by including the other pollutant and the influence of several effect modifiers such as personal characteristics and pre-existing medical conditions. In the period of study, 79,892 individuals were admitted to the emergency departments of Rome hospitals because of AF (on average, 15.6 patients per day: min = 1, max = 36). Air pollution levels were associated with increased AF emergency visits within 24 h of exposure. Effect estimates ranged between 1.4% (0.7-2.3) for a 10 µg/m³ increase of PM to 3% (1.4-4.7) for a 10 µg/m³ increase of PM at lag 0-1 day. Those effects were higher in patients ≥75 years for all pollutants, male patients for PM, and female patients for NO₂. The presence of previous cardiovascular conditions, but not other effect modifiers, increase the pollution effects by 5-8% depending on the lag. This study found evidence that air pollution is associated with AF emergency visits in the short term.
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http://dx.doi.org/10.3390/ijerph14060661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486347PMC
June 2017

Is swimming in recreational water associated with the occurrence of respiratory illness? A systematic review and meta-analysis.

J Water Health 2016 Aug;14(4):590-9

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy E-mail: Giuseppe La Torre Accademia Romana di Sanità Pubblica, Via Giovanni Nicotera 29, Rome 00195, Italy.

This study represents the first systematic review and meta-analysis conducted to assess the association between swimming in recreational water and the occurrence of respiratory illness. Most studies focus their attention on gastrointestinal illnesses occurring after exposure to microbial polluted water. Fourteen independent studies that included 50,117 patients with significant heterogeneity (I(2) = 95.3%) were reviewed. The meta-analysis reports that people exposed to recreational water (swimmers/bathers) present a higher risk of respiratory illness compared to non-swimmers/non-bathers [relative risk (RR) = 1.63 (confidence interval at 95% [95% CI]: 1.34-1.98)]. This percentage increases if adjusted RR by age and gender [RR = 2.24 (95% CI: 1.81-2.78)] are considered. A clear association between swimming in recreational water and the occurrence of respiratory illness was found. The surveillance of water quality monitoring systems is crucial not only for gastrointestinal illness, but also for respiratory ones.
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http://dx.doi.org/10.2166/wh.2016.266DOI Listing
August 2016

Spatial and Temporal Hot Spots of Aedes albopictus Abundance inside and outside a South European Metropolitan Area.

PLoS Negl Trop Dis 2016 06 22;10(6):e0004758. Epub 2016 Jun 22.

Dipartimento di Sanità Pubblica e Malattie Infettive, Università di Roma "Sapienza", Piazzale Aldo Moro 5, Rome, Italy.

Aedes albopictus is a tropical invasive species which in the last decades spread worldwide, also colonizing temperate regions of Europe and US, where it has become a public health concern due to its ability to transmit exotic arboviruses, as well as severe nuisance problems due to its aggressive daytime outdoor biting behaviour. While several studies have been carried out in order to predict the potential limits of the species expansions based on eco-climatic parameters, few studies have so far focused on the specific effects of these variables in shaping its micro-geographic abundance and dynamics. The present study investigated eco-climatic factors affecting Ae. albopictus abundance and dynamics in metropolitan and sub-urban/rural sites in Rome (Italy), which was colonized in 1997 and is nowadays one of the most infested metropolitan areas in Southern Europe. To this aim, longitudinal adult monitoring was carried out along a 70 km-transect across and beyond the most urbanized and densely populated metropolitan area. Two fine scale spatiotemporal datasets (one with reference to a 20m circular buffer around sticky traps used to collect mosquitoes and the second to a 300m circular buffer within each sampling site) were exploited to analyze the effect of climatic and socio-environmental variables on Ae. albopictus abundance and dynamics along the transect. Results showed an association between highly anthropized habitats and high adult abundance both in metropolitan and sub-urban/rural areas, with "small green islands" corresponding to hot spots of abundance in the metropolitan areas only, and a bimodal seasonal dynamics with a second peak of abundance in autumn, due to heavy rains occurring in the preceding weeks in association with permissive temperatures. The results provide useful indications to prioritize public mosquito control measures in temperate urban areas where nuisance, human-mosquito contact and risk of local arbovirus transmission are likely higher, and highlight potential public health risks also after the summer months typically associated with high mosquito densities.
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http://dx.doi.org/10.1371/journal.pntd.0004758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917172PMC
June 2016

Meat intake and non-Hodgkin lymphoma: a meta-analysis of observational studies.

Cancer Causes Control 2016 May 13;27(5):595-606. Epub 2016 Apr 13.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazza A. Moro 5, 00185, Rome, Italy.

Purpose: High intake of meat has been inconsistently associated with increased risk of non-Hodgkin lymphoma (NHL). We carried out a meta-analysis to summarize the evidence of published observational studies reporting association between red meat and processed meat intake and NHL risk.

Methods: Analytical studies reporting relative risks with 95 % confidence intervals (95 % CI) for the association between intake of red and/or processed meat and NHL or major histological subtypes were eligible. We conducted random-effects meta-analysis comparing lowest and highest intake categories and dose-response meta-analysis when risk estimates and intake levels were available for more than three exposure classes.

Results: Fourteen studies (four cohort and ten case-control) were included in the meta-analysis, involving a total of 10,121 NHL cases. The overall relative risks of NHL for the highest versus the lowest category of consumption were 1.14 (95 % CI 1.03, 1.26) for red meat and 1.06 (95 % CI 0.98, 1.15) for processed meat. Significant associations were present when the analysis was restricted to case-control studies but not when restricted to cohort studies. No significant associations were found for major NHL etiological subtypes. Dose-response meta-analysis could be based only on eight studies that provided sufficient data, and compared to no meat consumption, the overall NHL relative risk increased nonlinearly with increased daily intake of red meat.

Conclusion: The observed positive association between red meat consumption and NHL is mainly supported by the effect estimates coming from case-control studies and is affected by multiple sources of heterogeneity. This meta-analysis provided mixed and inconclusive evidences on the supposed relationship between red and processed meat consumption and NHL.
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http://dx.doi.org/10.1007/s10552-016-0745-2DOI Listing
May 2016

Benthic macroinvertebrates in lake ecological assessment: A review of methods, intercalibration and practical recommendations.

Sci Total Environ 2016 Feb 12;543(Pt A):123-134. Epub 2015 Nov 12.

Bioforum GmbH, Sudetenstr. 34, 73230 Kirchheim/Teck, Germany.

Legislation in Europe has been adopted to determine and improve the ecological integrity of inland and coastal waters. Assessment is based on four biotic groups, including benthic macroinvertebrate communities. For lakes, benthic invertebrates have been recognized as one of the most difficult organism groups to use in ecological assessment, and hitherto their use in ecological assessment has been limited. In this study, we review and intercalibrate 13 benthic invertebrate-based tools across Europe. These assessment tools address different human impacts: acidification (3 methods), eutrophication (3 methods), morphological alterations (2 methods), and a combination of the last two (5 methods). For intercalibration, the methods were grouped into four intercalibration groups, according to the habitat sampled and putative pressure. Boundaries of the 'good ecological status' were compared and harmonized using direct or indirect comparison approaches. To enable indirect comparison of the methods, three common pressure indices and two common biological multimetric indices were developed for larger geographical areas. Additionally, we identified the best-performing methods based on their responsiveness to different human impacts. Based on these experiences, we provide practical recommendations for the development and harmonization of benthic invertebrate assessment methods in lakes and similar habitats.
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http://dx.doi.org/10.1016/j.scitotenv.2015.11.021DOI Listing
February 2016

Ecological correlation between diabetes hospitalizations and fine particulate matter in Italian provinces.

BMC Public Health 2015 Jul 25;15:708. Epub 2015 Jul 25.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.

Background: Exposure to particulate matter has been associated with increased risk of cardiovascular and respiratory diseases. We evaluated the ecological correlation between standardized hospital discharges with diabetes in Italian provinces and fine particulate matter (PM2.5) adjusting for common risk factors, socioeconomic factors and differences in hospitalization appropriateness.

Methods: We used cross sectional data aggregated at the province level and available from official institutional databases for years 2008-2010. Covariates included prevalence of adult overweight, obese, smokers, physically inactive, education and income (as average gross domestic product per person, GDP). We reduced the number of covariates to a smaller number of factors for the subsequent statistical model by extracting meaningful components using principal component analysis (PCA). Log-linear multiple regression analysis was used to model diabetes hospital discharges with PCA components and PM2.5 levels and hospitalization appropriateness for men and women.

Results: The first PCA components for both men and women were characterized by larger loadings of risk factors (obesity, overweight, physical inactivity, cigarette smoking) and lower socioeconomic factors (educational level and mean GDP). Diabetes hospitalization increases with the first PCA component and decreases with the index of hospitalization appropriateness. In fully adjusted models, diabetes hospitalizations increase with increasing annual PM2.5 concentrations, with a rise of 3.5 % (1.3 %-5.6 %) for men and of 4.0 % (1.5 %-6.4 %) for women per unit of PM2.5 increase.

Conclusions: We found a significant ecological relationship between sex and age standardised hospital discharge with diabetes as principle diagnosis and mean annual PM2.5 concentrations in Italian provinces, once that covariates have been accounted for. The relationship was robust to different means of estimating PM2.5 exposure. A large portion of the variance of diabetes hospitalizations was linked to differences of hospital care appropriateness between Italian regions and this variable should routinely be included in ecological analyses of hospitalizations.
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http://dx.doi.org/10.1186/s12889-015-2018-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514955PMC
July 2015

Factors influencing persistence of Legionella pneumophila serogroup 1 in laboratory cocultures.

BMC Microbiol 2014 Oct 3;14:249. Epub 2014 Oct 3.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazza A, Moro 5, Rome, 00185, Italy.

Background: Risk for infections from Legionella pneumophila for immunocompromised individuals increases greatly when this species is present within the biofilm of the water distribution systems of hospitals or other health facilities. Multiplication and persistence of Legionella may dependent also upon planktonic growth in alternative to sessile growth. Here we compared the persistence of L. pneumophila serogroup 1 in experimental planktonic co-cultures subsided with iron, Pseudomonas aeruginosa and other non Legionella bacteria (quantified as Heterotrophic Plate Count, HPC at 37°C), isolated from drinking water sources of a large hospital.

Results: Concentrations of L. pneumophila showed a decreasing pattern with incubation time in all co-cultures, the degree of reduction depending on the experimental treatment. In co-cultures with added P. aeruginosa, no L. pneumophila was detectable already after 4 days of incubation. In contrast in co-cultures without P. aeruginosa, HPC but not iron were significant factors in explaining the pattern of L. pneumophila, although the HPC effect was different according to the incubation time (HPC x time interaction, p < 0.01).

Conclusions: Our results highlight the need of controlling for both HPC and metal constituents of the water systems of buildings used by individuals at particular risk to the effects of Legionella exposure.
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http://dx.doi.org/10.1186/s12866-014-0249-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195868PMC
October 2014

Microbiological safety of glasses dispensed at 3D movie theatres.

Eur J Public Health 2015 Feb 3;25(1):139-41. Epub 2014 Apr 3.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Recent popularity of three-dimensional movies raised some concern about microbiological safety of glasses dispensed into movie theatres. In this study, we analysed the level of microbiological contamination on them before and after use and between theatres adopting manual and automatic sanitation systems. The manual sanitation system was more effective in reducing the total mesophilic count levels compared with the automatic system (P < 0.05), but no differences were found for coagulase-positive staphylococci levels (P = 0.22). No differences were found for mould and yeast between before and after levels (P = 0.21) and between sanitation systems (P = 0.44). We conclude that more evidences are needed to support microbiological risk evaluation.
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http://dx.doi.org/10.1093/eurpub/cku019DOI Listing
February 2015

Temporal pattern of microbial indicators of ready-to-eat rocket salads during shelf life.

Ann Ist Super Sanita 2014 ;50(1):90-5

Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy. E-mail:

Introduction: From 2001-2009 there have been numerous community alerts and notifications about the rocket salad produced in Italy and distributed in Europe. Our study describes the evolution of the microbial quality of ready to eat rocket salad during shelf life among three different Italian producers.

Material And Methods: Total Mesophilic Count (TMC) and Escherichia coli (EC) count were measured in 248 samples. We used Wilcoxon test to compare the median values of TMC and EC counts and Kruskal Wallis test to compare the producers.

Results: The TMC and EC values differed among producers at the stages of raw material and in the finished product (Kruskall Wallis test, p < 0.05). The evolution of bacterial charges had significant differences among producers at expiration date (Wilcoxon test, p < 0.05). More than half of the samples (54.8%) exceed reference standard for TMC after 48 h from packaging.

Conclusion: Differences among producers may linked to the different minimal processing technologies adopted after harvesting.
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http://dx.doi.org/10.4415/ANN_14_01_13DOI Listing
April 2015

Are there side effects to watching 3D movies? A prospective crossover observational study on visually induced motion sickness.

PLoS One 2013 13;8(2):e56160. Epub 2013 Feb 13.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Background: The increasing popularity of commercial movies showing three dimensional (3D) images has raised concern about possible adverse side effects on viewers.

Methods And Findings: A prospective carryover observational study was designed to assess the effect of exposure (3D vs. 2D movie views) on self reported symptoms of visually induced motion sickness. The standardized Simulator Sickness Questionnaire (SSQ) was self administered on a convenience sample of 497 healthy adult volunteers before and after the vision of 2D and 3D movies. Viewers reporting some sickness (SSQ total score>15) were 54.8% of the total sample after the 3D movie compared to 14.1% of total sample after the 2D movie. Symptom intensity was 8.8 times higher than baseline after exposure to 3D movie (compared to the increase of 2 times the baseline after the 2D movie). Multivariate modeling of visually induced motion sickness as response variables pointed out the significant effects of exposure to 3D movie, history of car sickness and headache, after adjusting for gender, age, self reported anxiety level, attention to the movie and show time.

Conclusions: Seeing 3D movies can increase rating of symptoms of nausea, oculomotor and disorientation, especially in women with susceptible visual-vestibular system. Confirmatory studies which include examination of clinical signs on viewers are needed to pursue a conclusive evidence on the 3D vision effects on spectators.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056160PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572028PMC
August 2013

A survey of visually induced symptoms and associated factors in spectators of three dimensional stereoscopic movies.

BMC Public Health 2012 Sep 13;12:779. Epub 2012 Sep 13.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazza Aldo Moro, 5, 00185, Rome, Italy.

Background: The increasing popularity of commercial movies showing three dimensional (3D) computer generated images has raised concern about image safety and possible side effects on population health.This study aims to (1) quantify the occurrence of visually induced symptoms suffered by the spectators during and after viewing a commercial 3D movie and (2) to assess individual and environmental factors associated to those symptoms.

Methods: A cross-sectional survey was carried out using a paper based, self administered questionnaire. The questionnaire includes individual and movie characteristics and selected visually induced symptoms (tired eyes, double vision, headache, dizziness, nausea and palpitations). Symptoms were queried at 3 different times: during, right after and after 2 hours from the movie.

Results: We collected 953 questionnaires. In our sample, 539 (60.4%) individuals reported 1 or more symptoms during the movie, 392 (43.2%) right after and 139 (15.3%) at 2 hours from the movie. The most frequently reported symptoms were tired eyes (during the movie by 34.8%, right after by 24.0%, after 2 hours by 5.7% of individuals) and headache (during the movie by 13.7%, right after by 16.8%, after 2 hours by 8.3% of individuals). Individual history for frequent headache was associated with tired eyes (OR = 1.34, 95%CI = 1.01-1.79), double vision (OR = 1.96; 95%CI = 1.13-3.41), headache (OR = 2.09; 95%CI = 1.41-3.10) during the movie and of headache after the movie (OR = 1.64; 95%CI = 1.16-2.32). Individual susceptibility to car sickness, dizziness, anxiety level, movie show time, animation 3D movie were also associated to several other symptoms.

Conclusions: The high occurrence of visually induced symptoms resulting from this survey suggests the need of raising public awareness on possible discomfort that susceptible individuals may suffer during and after the vision of 3D movies.
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http://dx.doi.org/10.1186/1471-2458-12-779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490878PMC
September 2012

Evaluation of interleukin 28B single nucleotide polymorphisms in infants suffering from bronchiolitis.

Virus Res 2012 May 25;165(2):236-40. Epub 2012 Feb 25.

Department of Molecular Medicine, Laboratory of Virology, "Sapienza" University of Rome, Italy.

The genetic diversity of the host is believed to be the key of the diversity in the clinical presentation of bronchiolitis. The aim of this study was to determine whether the known rs12979860 and rs8099917 single nucleotide polymorphisms (SNPs) in interleukin (IL)28B region, influence clinical features and natural history of bronchiolitis. Both SNPs showed no significant association with the risk of hospitalization for respiratory syncytial virus (RSV), viral load, disease severity, and other clinical features of patients. Interestingly infants carrying IL28B rs12979860 TT genotype had lower age at hospital admission than that of infants carrying CC/CT genotypes. Overall our results indicate that both IL28B SNPs had no impact on the clinical course of bronchiolitis with the only exception of the IL28B rs12979860 SNP which increased the risk of hospitalization for bronchiolitis at early age.
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http://dx.doi.org/10.1016/j.virusres.2012.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114428PMC
May 2012

Diversity predicts stability and resource use efficiency in natural phytoplankton communities.

Proc Natl Acad Sci U S A 2008 Apr 28;105(13):5134-8. Epub 2008 Mar 28.

Norwegian Institute for Water Research, Gaustadalléen 21, 0349 Oslo, Norway.

The relationship between species diversity and ecosystem functioning has been debated for decades, especially in relation to the "macroscopic" realm (higher plants and metazoans). Although there is emerging consensus that diversity enhances productivity and stability in communities of higher organisms; however, we still do not know whether these relationships apply also for communities of unicellular organisms, such as phytoplankton, which contribute approximately 50% to the global primary production. We show here that phytoplankton resource use, and thus carbon fixation, is directly linked to the diversity of phytoplankton communities. Datasets from freshwater and brackish habitats show that diversity is the best predictor for resource use efficiency of phytoplankton communities across considerable environmental gradients. Furthermore, we show that the diversity requirement for stable ecosystem functioning scales with the nutrient level (total phosphorus), as evidenced by the opposing effects of diversity (negative) and resource level (positive) on the variability of both resource use and community composition. Our analyses of large-scale observational data are consistent with experimental and model studies demonstrating causal effects of microbial diversity on functional properties at the system level. Our findings point at potential linkages between eutrophication and pollution-mediated loss of phytoplankton diversity. Factors reducing phytoplankton diversity may have direct detrimental effects on the amount and predictability of aquatic primary production.
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http://dx.doi.org/10.1073/pnas.0708328105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278227PMC
April 2008
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