Publications by authors named "Carmela Protano"

64 Publications

Assessing Undergraduates' Perception of Risks Related to Body Art in Italy: The SUPeRBA Multicenter Cross-Sectional Study.

Int J Environ Res Public Health 2021 Sep 1;18(17). Epub 2021 Sep 1.

Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", 80133 Naples, Italy.

Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0-11 for tattooing, 0-14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father's education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.
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http://dx.doi.org/10.3390/ijerph18179233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431427PMC
September 2021

Adverse effects related to tattoos in the community setting: a systematic review.

J Epidemiol Community Health 2021 Oct 12;75(10):1023-1028. Epub 2021 Jul 12.

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

Background: Tattoos were historically associated with deviant behaviours or religious and other social purposes, but in the last decades, they have gained increasing popularity and have become a mainstream. The aim of this systematic review is to assess the literature evidence about decorative tattoos complications, considering both infective and non-infective risks.

Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched the following electronic bibliographic databases: PubMed, Scopus and Web of Science (science and social science citation index).

Results: The literature search resulted in 6473 studies. A total of 207 full articles were considered potentially relevant and were reviewed independently by researchers. After full-text evaluation, 152 of 207 articles were excluded, as they did not meet selection criteria. The remaining 55 studies were included in the systematic review and their quality assessment was performed. Ten studies reported microbiological complications, 37 reported non-microbiological effects and eight reported either microbiological and non-microbiological complications.

Conclusions: Several well-known and uncommon risks are associated with tattooing and tattoo after-care. Public health authorities could take into account health education programmes for tattooists and customers in order to prevent health complications in people with tattoos.

Prospero Registration Number: CRD42020177972.
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http://dx.doi.org/10.1136/jech-2021-216874DOI Listing
October 2021

Exergames in Childhood Obesity Treatment: A Systematic Review.

Int J Environ Res Public Health 2021 05 6;18(9). Epub 2021 May 6.

Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", 80133 Naples, Italy.

In the last decade, active video games (exergames) have been proposed in obesity prevention and treatment as a potential tool to increase physical activity. This review was aimed to assess the possible role of exergames in reducing weight-related outcomes among overweight/obese children and/or adolescents. The databases PubMed, Scopus, Web of Science and SPORTDiscus were interrogated to detect controlled studies involving healthy overweight/obese children and adolescents in interventions based exclusively on exergames. Out of a total of 648 articles found, 10 met the inclusion criteria and were included in the review. The included studies differ for duration, setting and type of intervention, frequency of active game sessions, and outcomes considered. Seven out of ten studies reported better outcomes in children/adolescents involved in the interventions, with significant differences between groups in four, while three studies found better outcomes in control groups. These results suggest a possible positive effect of active video games on weight-related outcomes in obese children and adolescents. However, further research is still needed to define if they can be effectively used in childhood obesity treatment and which may be the most effective approach. The potentiality of the new digital media in this field should be explored.
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http://dx.doi.org/10.3390/ijerph18094938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124431PMC
May 2021

Determination of 40 Elements in Powdered Infant Formulas and Related Risk Assessment.

Int J Environ Res Public Health 2021 05 11;18(10). Epub 2021 May 11.

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185 Rome, Italy.

The aim of the study was to analyze all powdered infant formulas authorized and commercialized in Italy at the time of the study to measure the concentrations of 40 elements, and to estimate the infants' intake of some toxic heavy metals for assessing possible related health risks. For this purpose, an optimized multi-element method was used through inductively coupled plasma mass spectrometry. Be, B, Al, Zr, Nb, Sb, Te, W, V, Cr and As concentrations were
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http://dx.doi.org/10.3390/ijerph18105073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150698PMC
May 2021

Environmental status of an Italian site highly polluted by illegal dumping of industrial wastes: The situation 15 years after the judicial intervention.

Sci Total Environ 2021 03 16;762:144100. Epub 2020 Dec 16.

Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64B, 44121 Ferrara, FE, Italy. Electronic address:

In 2008 the Italian government classified the Bussi sul Tirino area (Central Italy) as Site of National Interest destined to remediation which, unfortunately, has not yet begun. The decision followed >20 years of illegal dumping of industrial wastes, lasting from 1984 to 2005, that generated the biggest illegal toxic waste disposal site in Europe. The contamination profile of the site was mainly characterized by PCDD/Fs, PCBs, PAHs, chlorinated solvents, Hg, and Pb. Due to the health concern of the population and local authorities, an extensive monitoring and biomonitoring campaign was carried out in 2017-2018, checking the site-specific pollutants in local food (free-range hens' eggs, milk from grazing sheep and goats, wild edible mushrooms, and drinking water), environmental (air and freshwaters) and biological (human urine) matrices. A total of 314 samples were processed, obtaining 3217 analytical data that were compared with regulatory limits, when available, and values reported by international literature. The sum PCDD/Fs and DL-PCBs ranged from 0.24 to 3.6 pg TEQ g fat, and from 0.46 to 8.3 pg TEQ g fat, respectively in milk in eggs, in line with the maximum levels established by CE Regulations except for an egg sample. As regards PAHs, all our results were lower than the literature data, as well as for Hg and Pb. Outdoor air showed levels of chlorinated solvents ranging from
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http://dx.doi.org/10.1016/j.scitotenv.2020.144100DOI Listing
March 2021

Urinary Mercury Levels and Predictors of Exposure among a Group of Italian Children.

Int J Environ Res Public Health 2020 12 10;17(24). Epub 2020 Dec 10.

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185 Rome, Italy.

Urinary mercury (Hg) levels are suitable to assess long-term exposure to both elemental and inorganic Hg. In this study, the urinary Hg levels of 250 children (aged 6-11 years) from three areas with different anthropogenic impacts in the Rieti province, central Italy, were assessed. The Hg concentrations were in the range of 0.04-2.18 µg L with a geometric mean equal to 0.18 µg L [95% confidence interval (CI), 0.17-0.20 µg L] or 0.21 µg g creatinine (95% CI, 0.19-0.23 µg g creatinine), and a reference value calculated as 95th percentile of 0.53 µg L (95% CI, 0.44-0.73 µg L) or 0.55 µg g creatinine (95% CI, 0.50-0.83 µg g creatinine). In all cases, urinary Hg data were below the HBM-I values (7 µg L or 5 µg g creatinine) established for urine, while the 95th percentile was above the German Human Biomonitoring Commission's RV95 (0.4 µg L) set for children without amalgam fillings. A significant correlation ( < 0.05) was found between creatinine-corrected results and residence area, with higher urinary Hg levels in children living in the industrial area. Multiple linear regression analysis showed that creatinine was the main predictor of urinary Hg.
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http://dx.doi.org/10.3390/ijerph17249225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763174PMC
December 2020

Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic.

Int J Environ Res Public Health 2020 08 25;17(17). Epub 2020 Aug 25.

Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy.

: From March to May 2020, lockdown measures were adopted in Italy to contain the epidemic of the novel Coronavirus. People were forced to restrict their movement and social contacts, therefore having a higher risk of inactivity. This study, carried out among Italian undergraduates, explored their sedentary and physical activities (PA) during the lockdown with respect to their previous habits. : An electronic questionnaire was administered once to students attending three Italian universities after the end of lockdown. : A total of 1430 students (mean age 22.9 ± 3.5 years, 65.5% females) completed the questionnaire. All the sedentary behaviors increased significantly, and all the physical activities decreased significantly during the lockdown. Time spent using electronic devices showed the highest increase (+52.4 min/day), and walking the greatest decrease (-365.5 min/week). Being younger than 22 years old, female, and previously active, attending the universities of Naples and Rome and having at least one graduate parent were associated with the achievement of recommended levels of PA even during the lockdown. : This study highlights the reduction of PA among Italian undergraduates in the course of home-confinement due to the CoViD-19 pandemic. The practice of adequate PA during the lockdown was mainly associated with the previous adoption of an active lifestyle. Promoting active lifestyles during the non-pandemic period may have had positive effects also in case of lockdown.
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http://dx.doi.org/10.3390/ijerph17176171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504707PMC
August 2020

Comparative Indoor Pollution from Glo, Iqos, and Juul, Using Traditional Combustion Cigarettes as Benchmark: Evidence from the Randomized SUR-VAPES AIR Trial.

Int J Environ Res Public Health 2020 08 19;17(17). Epub 2020 Aug 19.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are appealing alternatives to combustion cigarettes. Limited between- and within-device comparative data are available on MRP. We aimed at comparing indoor particulate matter (PM) emissions measured in a randomized trial enforcing standardized smoking sessions, testing different devices and flavors of MRP, using traditional combustion cigarettes (TCC) as benchmark. Overall, MRP yielded significantly lower levels of indoor PM in comparison to TCC (with median PM levels during smoking for MRP < 100 μg/m, and for TCC > 1000 μg/m). Despite this, significant differences among MRP were found, with Iqos appearing associated with a significantly lower burden of emissions for all the monitored fractions of PM, including total PM (all < 0.05). Precisely, during use, PM ≤1 µm (PM) emissions were 28 (16; 28) μg/m for Glo, 25 (15; 57) μg/m for Iqos, and 73 (15; 559) μg/m for Juul ( < 0.001 for Glo vs. Iqos, < 0.001 for Glo vs. Juul, and = 0.045 for Iqos vs. Juul). Exploratory within-MRP analyses suggested significant differences between flavors, favoring, for instance, Ultramarine for Glo, Bronze for Iqos, and Mango for Juul, even if results varied substantially according to individual smoker. In conclusion, leading MRP have significantly less intense and persistent effects on indoor pollution in comparison to TCC. Yet, when focusing solely on MRP, between-product and between-flavor differences appear, with quantitative estimates suggesting lower polluting effects with Iqos. These results, if confirmed externally, could be used to individualize product and flavor choice to minimize the untoward effects of EVC and HNBC on indoor pollution.
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http://dx.doi.org/10.3390/ijerph17176029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504617PMC
August 2020

A Cross-Sectional Study on Benzene Exposure in Pediatric Age and Parental Smoking Habits at Home.

Int J Environ Res Public Health 2020 07 29;17(15). Epub 2020 Jul 29.

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185 Rome, Italy.

After the introduction of the smoke-free legislation, household smoking has become the major source of environmental tobacco smoke (ETS) exposure for children. In our previous research, we found a strong association between urinary unmodified benzene (u-UB) levels and passive smoking exposure related to the home smoking policies (HSP). The aim of the study is to further investigate the impacts of several factors on ETS-exposure in childhood by using u-UB as tobacco-related carcinogen biomarker of exposure. Two cross-sectional studies were performed on the same target population of our previous research, in summer and winter season of the years 2017 and 2018, respectively. A questionnaire and a head space-solid phase micro-extraction/gas chromatography-mass spectrometry (HS-SPME/GC-MS) analytical method were used as investigative procedures. The improvement found in smoking habits, when compared to our previous surveys, reduced the levels of u-UB in children. However, significant differences related to the high number of smokers and smoked cigarettes, in total and at home, still persist. These differences are more relevant in the winter season. Finally, the only effective way for making homes completely smokefree is to develop public health policies for encouraging people to quit or drastically reduce smoking.
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http://dx.doi.org/10.3390/ijerph17155469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432498PMC
July 2020

How Do Combustion and Non-Combustion Products Used Outdoors Affect Outdoor and Indoor Particulate Matter Levels? A Field Evaluation Near the Entrance of an Italian University Library.

Int J Environ Res Public Health 2020 07 18;17(14). Epub 2020 Jul 18.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

Particulate Matter (PM) is a well-known health risk factor and pollutes both outdoor and indoor air. Using PM as an air pollution indicator, the aims were to assess outdoor and indoor air pollution due to combustion and/or non-combustion products used outdoors and to compare the PM levels emitted by different products. PM with an aerodynamic diameter ≤10, 4, 2.5 and 1 µm (PM, PM, PM, PM) was simultaneously measured in two areas, respectively, indoors (with smoking ban) and outdoors (where people commonly smoke) of a university library during the morning and the afternoon of two weekdays. Both combustion and non-combustion products determined a relevant worsening of outdoor air quality, with the highest PM levels achieved when a single traditional cigarette (9920 µg m), a single e-cigarette (9810 µg m) and three simultaneous traditional cigarettes (8700 µg m) were smoked. An increase of indoor PM levels was found during outdoor smoking/vaping sessions, persisting also after the end of sessions. The results highlighted the need for a revision of smoke-free laws, especially for outdoor areas, to include non-combustion products. In addition, it is essential to make society aware of the dangers of smoking outdoors by implementing health promotion interventions.
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http://dx.doi.org/10.3390/ijerph17145200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400601PMC
July 2020

High spatial resolution analysis of polybrominated diphenyl ethers (PBDEs) using transplanted lichen Evernia prunastri: A case study in central Italy.

Sci Total Environ 2020 Nov 29;742:140590. Epub 2020 Jun 29.

Department of Public Health and Infectious Diseases, University of Rome La Sapienza, P.le Aldo Moro, 5, 00185 Rome, Italy. Electronic address:

The ability of transplanted lichen Evernia (E.) prunastri (L.) to act as a high spatial biomonitoring tool for 14 polybrominated diphenyl ethers (PBDEs) was evaluated at 23 monitoring sites in a very polluted area in central Italy. The selected area is characterized by the presence of numerous emission sources, such as waste-to-energy plant, steel plant, vehicular traffic, and domestic heating. Transplanted E. prunastri proved to be a useful tool to biomonitor PBDEs, due to its ability to bioaccumulate individual congeners in varying concentrations in relation to the strength of the emission sources present over the territory. PBDEs levels widely ranged from 132 to 24,237 ng kg dry weight, according to the sources of emission located around the monitoring sites. The highest concentrations were detected at the sites close to the municipal solid waste incinerator, steel plant, and high busy roads, confirming their important role as PBDEs emissions sources.
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http://dx.doi.org/10.1016/j.scitotenv.2020.140590DOI Listing
November 2020

Impact of Electronic Alternatives to Tobacco Cigarettes on Indoor Air Particular Matter Levels.

Int J Environ Res Public Health 2020 04 24;17(8). Epub 2020 Apr 24.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

An aerosol study was carried out in a test room measuring particulate matter (PM) with an aerodynamic diameter smaller than 10, 4, 2.5 and 1 µm (PM, PM, PM, PM) before and during the use of electronic alternatives to tobacco cigarettes (EATC) IQOS, GLO, JUUL, with different kinds of sticks/pods, as well as during the smoking of a conventional tobacco cigarette. The aerosol was mainly in the PM size range (>95%). All studied EATCs caused lower indoor PM concentrations than conventional tobacco cigarettes. Nevertheless, they determined a worsening of indoor-PM concentration that ranged from very mild for JUUL-depending on the pod used-to considerably severe for IQOS and GLO. Median values ranged from 11.00 (Iqos3 and Juul2) to 337.5 µg m (Iqos4). The high variability of particle loadings was attributed both to the type of stick/pod used and to the different way of smoking of volunteers who smoked/vaped during the experiments. Moreover, during vaping IQOS and GLO indoor PM concentrations reach levels by far higher than outdoor concentrations that range from 14 to 21 µg m, especially during the exhalation of the smoke. From these results emerge an urgent need of a legislative regulation limiting the use of such devices in public places.
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http://dx.doi.org/10.3390/ijerph17082947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254302PMC
April 2020

Biomonitoring of Mercury in Hair among a Group of Eritreans (Africa).

Int J Environ Res Public Health 2020 03 15;17(6). Epub 2020 Mar 15.

Department of Chemistry, Sapienza University, Piazzale Aldo Moro 5, I-00185 Rome, Italy.

Small-scale or artisanal mining, using gold-mercury amalgamation to extract gold from ore, is a significant source of exposure for the workers and nearby populations. Few studies on hair mercury (Hg) have been conducted in Africa despite the fact that Africa has several gold deposits. No studies have been conducted in Eritrea that is one of the emerging gold producing countries in Africa. The aim of the study was to assess the Hg concentration in hair samples ( = 120) of a population living in Asmara, capital of Eritrea, and to evaluate the influence of some factors on the Hg levels in hair. Information on age, height, weight, occupation, smoking and fish consumption of participants were collected via questionnaire. Hair Hg concentration was significantly higher among women compared to men ( < 0.001) and among women preparing spicy products in Medeber market compared to those who did other jobs ( = 0.010). These results highlight the need for routine biomonitoring surveys and for health promotion campaigns devoted to local decision makers and workers.
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http://dx.doi.org/10.3390/ijerph17061911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7143335PMC
March 2020

Profiling the Acute Effects of Modified Risk Products: Evidence from the SUR-VAPES (Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking) Cluster Study.

Curr Atheroscler Rep 2020 02 7;22(2). Epub 2020 Feb 7.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy.

Purpose Of Review: Modified risk products (MRP) are promoted as a safer alternative to traditional combustion cigarettes (TCC) in chronic smokers. Evidence for their lower hazardous profile is building, despite several controversies. Yet, it is unclear whether individual responses to MRP differ among consumers. We hypothesized that different clusters of subjects exist in terms of acute effects of MRP.

Recent Findings: Pooling data from a total of 60 individuals, cluster analysis identified at least three clusters (labelled 1 to 3) of subjects with different electronic vaping cigarettes (EVC) effects and at least two clusters (labelled 4 to 5) of subjects with different heat-not-burn cigarettes (HNBC) effects. Specifically, oxidative stress, platelet aggregation, and endothelial dysfunction after EVC were significantly different cluster-wise (all p < 0.05), and oxidative stress and platelet aggregation after HNBC were significantly different (all p < 0.05). In particular, subjects belonging to Cluster 1 appeared to have less detrimental responses to EVC usage than subjects in Cluster 2 and 3, as shown by non-significant changes in flow-mediated dilation (FMD) and less marked increase in Nox2-derived peptide (NOX). Conversely, those assigned to Cluster 3 had the worst reaction in terms of changes in FMD, NOX, and P-selectin. Furthermore, individuals belonging to Cluster 4 responded unfavorably to both HNBC and EVC, whereas those in Cluster 5 interestingly showed less adverse results after using HNBC than EVC. Results for main analyses were consistent employing different clusters, tests, and bootstrap. Individual responses to MRP differ and smokers aiming at using EVC or HNBC as a risk reduction strategy should consider trying different MRP aiming at finding the one which is less detrimental, with subjects resembling those in Cluster 1 preferably using EVC and those resembling Cluster 5 preferably using HNBC.
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http://dx.doi.org/10.1007/s11883-020-0824-4DOI Listing
February 2020

A Cross-Sectional Study on Prevalence and Predictors of Burnout among a Sample of Pharmacists Employed in Pharmacies in Central Italy.

Biomed Res Int 2019 24;2019:8590430. Epub 2019 Dec 24.

Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", P.le Aldo Moro 5, 00185 Rome, Italy.

Burnout is defined as an occupational phenomenon linked to chronic workplace stress that has not been successfully managed and included among the factors influencing health status or contact with health services. Although several studies were performed for assessing this phenomenon, there is a lack of data on the prevalence of burnout and associated predictors, due to different definitions of the syndrome and heterogeneity of assessment methods. One of the well-known evidences on burnout is related to the highest risk professions, which include policemen, firemen, teachers, psychologists, medical students, nurses, physicians, and other health professionals, such as pharmacists. . The aims of the present study were to (1) assess the occurrence of burnout syndrome among a sample of pharmacists employed in public and private pharmacies located in Rome province (Latium Region; central Italy); (2) evaluate the role of some potential predictors for the development of the syndrome. . A questionnaire elaborated ad hoc was administered online to 2,000 members of the Association of Professional Pharmacists of Rome and its province and employed in public or private pharmacies. The questionnaire included the 14-item Shirom-Melamed Burnout Measure (SMBM) tool and questions on demographic characteristics and working conditions. . Physical exhaustion was the burnout dimension with the highest score; besides, approximately 11% of the studied pharmacists were categorized as having clinically relevant burnout levels (≥4.40). Several of the investigated variables significantly influenced the single burnout dimensions at the univariate analyses; multivariate analyses demonstrated that alcohol consumption and workplace location have a significant independent role on the overall SMBM index, while working time significantly influences clinically relevant burnout level. . The results revealed that pharmacists are at risk of burnout, and thus, it is necessary to perform specific preventive intervention for managing this occupational threat.
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http://dx.doi.org/10.1155/2019/8590430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944955PMC
July 2020

Occupational Exposure Assessment of Major and Trace Elements in Human Scalp Hair Among a Group of Eritrean Workers.

Biol Trace Elem Res 2020 Sep 2;197(1):89-100. Epub 2019 Dec 2.

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

The aim of the study was to evaluate occupational exposure to 40 elements among a group of Eritrean adults employed at the Medeber metal market by analysing human scalp hair samples and by investigating the role of some predictors (gender, age, and body mass index-BMI) on their levels. Scalp hair samples were collected from 60 subjects (32 subjects working at the Medeber metal market and 28 subjects not working at Medeber and not employed in other industrial or artisanal activities) and were analysed through inductively coupled plasma mass spectrometry to determine the contents of 40 major and trace elements. Information on participants was collected via questionnaire. Significant differences were found in the hair levels of certain elements between subjects working at the Medeber metal market and subjects not exposed. In particular, working at the Medeber metal market increased hair levels of Be, B, Cu, Zn, Mo, Cd, Sb, Tl, Pb, and Fe from 25 to 100%, while reduced Na, K, and Rb levels from 30 to 50%. With multivariate adjustment for age, gender, and BMI, the results confirm that working at Medeber significantly increased the hair levels of Cu, Zn, Sb, Pb, and Fe. This finding reveals the need for more accurate and routine biomonitoring surveys and the necessity of health promotion campaigns both for local decision-makers and workers to increase health promotion and safety in this workplace.
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http://dx.doi.org/10.1007/s12011-019-01988-wDOI Listing
September 2020

Further Insights on Predictors of Environmental Tobacco Smoke Exposure during the Pediatric Age.

Int J Environ Res Public Health 2019 10 23;16(21). Epub 2019 Oct 23.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the "worst case" is represented by both parents who smoke. More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke.
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http://dx.doi.org/10.3390/ijerph16214062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861986PMC
October 2019

Air quality assessment in different environmental scenarios by the determination of typical heavy metals and Persistent Organic Pollutants in native lichen Xanthoria parietina.

Environ Pollut 2019 Nov 7;254(Pt A):113013. Epub 2019 Aug 7.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, p.le Aldo Moro 5, I-00185 Rome, Italy. Electronic address:

The study was aimed to evaluate the ability of native lichen Xanthoria (X.) parietina to biomonitor and bioaccumulate some heavy metals (As, Cd, Co, Cr, Ni, Pb), PAHs, PCDDs, PCDFs, PCBs and PBDEs and to evaluate the use of the native X. parietina as a multi-tracer tool for scenarios characterized by different anthropogenic pressures. Samples of native X. parietina were collected in six different sites (two green, two residential and two industrial areas, respectively) and analyzed for the target compounds. The results show that X. parietina was a useful tool for the biomonitoring of air quality in the selected areas, and was able to bioaccumulate all the studied metals and POPs. In particular, the total concentrations dry weight (dw) ranged between 8.1 and 103.4 mg kg for metals, from 113 × 10 to 183 × 10 ng kg for PAHs, from 868 to 7685 ng kg for PCBs, from 14.3 to 113.8 ng kg for PCDDs/Fs (∑TEq = 0.9-7.1), and from 194 to 554 ng kg for PBDEs. Besides, in general, the levels of analytes recovered in the different samples of lichen show an increasing trend from green to industrial sites, especially for PCBs (mean values equal to 1218, 4253 and 7192 ng kg respectively for green, residential and industrial areas). The statistical approach, based on Pearson's correlation and principal component analysis tests, showed that one of the industrial sites was well-separated from the others, that resulted grouped due to some similarities.
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http://dx.doi.org/10.1016/j.envpol.2019.113013DOI Listing
November 2019

A prophylactic multi-strain probiotic treatment to reduce the absorption of toxic elements: In-vitro study and biomonitoring of breast milk and infant stools.

Environ Int 2019 09 3;130:104818. Epub 2019 Jul 3.

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

Potential exposure to toxic elements initially occurs during gestation and after birth via breast milk, which is the principal source of nutrients for infants during the first months of life. In this study, we evaluated whether maternal oral supplementation with a multi-strain probiotic product can protect infants from exposure to arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) via breast milk. In-vitro studies of the bacterial strains present in this probiotic product showed a high bacterial tolerance for As, Cd, Hg, and Pb, and good binding capacity for Cd, Hg, and Pb (72%, 81%, and 64%, respectively) within 1 h of contact. We evaluated concentrations (5 mg L for Cd and Pb, and 2 mg L for Hg) that largely exceeded the provisional tolerable weekly intake of these toxic elements via food or water applicable for human consumption. Changes in the levels of these elements in breast milk and newborn stools were evaluated in the control (orally supplemented with placebo) and experimental (orally supplemented with probiotic) groups at birth (t0), 15 days (t15), and 30 days (t30) after delivery. Elemental analysis of breast milk did not show significant differences between the control and experimental groups at different stages of lactation; however, stool samples obtained from newborns of mothers supplemented with the probiotic product showed that Cd levels were significantly reduced (by 26%) at t15 compared with the levels of the controls. Our data did not show an association between concentration of toxic elements in breast milk and that in newborn stools. Indeed, the concentration of Cd, Hg, and Pb in breast milk decreased during the lactation period, whereas the levels of these elements in newborn stools were stable over time. Although our in-vitro data indicate that the consortium of these probiotic strains can absorb toxic compounds, this study was limited by its small sample size and potential uncontrolled confounding effects, such as maternal diet and lifestyle. Therefore, we could not confirm whether prophylactic use of this probiotic product can reduce the absorption of toxic elements. The risk assessment in the studied population evidenced a margin of exposure (MOE) of 1, or between 1 and 10 for Pb, and lower than 50 for As. This poses a potential risk for breastfed infants, indicating that interventions aimed to avoid breastfeeding-related health risks remain a major challenge in public health.
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http://dx.doi.org/10.1016/j.envint.2019.05.012DOI Listing
September 2019

Evaluation of the Submicron Particles Distribution Between Mountain and Urban Site: Contribution of the Transportation for Defining Environmental and Human Health Issues.

Int J Environ Res Public Health 2019 04 14;16(8). Epub 2019 Apr 14.

Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, via De Sanctis, I-86100 Campobasso, Italy.

Transportation is one of the main causes of atmospheric pollution, especially in downtown big cities. Researchers usually point their attention to gaseous and/or particulate matter pollutants. This paper investigated the role of submicron particles, particularly the fraction ranging between 5-560 nm, in aerosol chemistry for identifying the contribution of autovehicular traffic and investigating the doses deposited in the human respiratory tract. Measurements carried out by two Fast Mobility Particle Sizer (FMPS, TSI) analyzers were simultaneously performed at two different sampling sites (an urban and a mountain site) during workdays and weekends in July. The total particle number (2-2.5 times higher in the urban site), the aerosol size distribution (different modes during the day), and the ultrafine/non-ultrafine particle ratios (ranging between 2-4 times between two sites) were investigated and discussed in relationship to the high autovehicular traffic in Rome and the almost null anthropogenic emissions at the mountain site, as well as the differing contributions of both to the "fresh nucleation" and to "aged aerosol". Furthermore, the regional cumulative number doses deposited in the human respiratory tract were studied for both sites: The difference between the urban/mountain site was very high (up to 15 fold), confirming the pollutant role of transportation.
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http://dx.doi.org/10.3390/ijerph16081339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517916PMC
April 2019

Where Do Ultrafine Particles and Nano-Sized Particles Come From?

J Alzheimers Dis 2019 ;68(4):1371-1390

Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, Campobasso, Italy.

This paper presents an overview of the literature studies on the sources of ultrafine particles (UFPs), nanomaterials (NMs), and nanoparticles (NPs) occurring in indoor (occupational and residential) and outdoor environments. Information on the relevant emission factors, particle concentrations, size, and compositions is provided, and health relevance of UFPs and NPs is discussed. Particular attention is focused on the fraction of particles that upon inhalation deposit on the olfactory bulb, because these particles can possibly translocate to brain and their possible role in neurodegenerative diseases is an important issue emerging in the recent literature.
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http://dx.doi.org/10.3233/JAD-181266DOI Listing
August 2020

Cancer Mortality Trend in Central Italy: Focus on A "Low Rate of Land Use" Area from 1982 to 2011.

Int J Environ Res Public Health 2019 02 21;16(4). Epub 2019 Feb 21.

Laboratory of Experimental Medicine and Environmental Pathology, Rieti University Hub "Sabina Universitas", 02100 Rieti, Italy.

The aim of the present study was to estimate total cancer mortality trends from 1982 to 2011 in a "low rate of land use" province of the Latium region (Rieti, central Italy) characterized by a low degree of urbanization, a high prevalence of elderly, and a low number of births. Mortality data of the studied period, provided by the Italian National Institute of Statistics, were used for calculating standardized cancer mortality rates. Trends in mortality were analyzed using Joinpoint regression analysis. Results showed that total standardized cancer mortality rates decreased in the monitored area over the study period. A comparison with other provinces of the same region evidenced that the studied province presented the lowest cancer mortality. The three systems/apparatuses affected by cancer that mainly influenced cancer mortality in the monitored province were the trachea-bronchus-lung, colorectal-anus, and stomach. These findings could be attributed to the implement of preventive initiatives performed in the early 2000s, to healthier environmental scenario, and to lower levels of carcinogenic pollutants in air, water, and soil matrices. Thus, our results indicate that the studied area could be considered a "healthy" benchmark for studies in oncological diseases.
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http://dx.doi.org/10.3390/ijerph16040628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406941PMC
February 2019

Evidences of copper nanoparticle exposure in indoor environments: Long-term assessment, high-resolution field emission scanning electron microscopy evaluation, in silico respiratory dosimetry study and possible health implications.

Sci Total Environ 2019 Feb 6;653:1192-1203. Epub 2018 Nov 6.

Department of Chemistry, Sapienza University, P.le Aldo Moro 5, I-00185 Rome, Italy.

A variety of appliances operated by brush electric motors, widely used in indoor environments, emit nanoparticles (NPs). Due to electric arc discharge during the operation of such motors, some NPs contain copper (Cu). Their dimensions are the same of those found in brain tissue samples by other authors who speculated their possible translocation to brain through olfactory bulb. Cu has been reported to play an important role in the etiopathogenesis of Alzheimer's disease. Thus, the present study was performed to 1. estimate by means of Multiple-Path Particle Dosimetry model the doses of NPs released by electric appliances that can potentially deposit on the olfactory bulb; 2. investigate the morphology and the composition of particles emitted by some electric appliances daily used in indoor environments; 3. monitor for a long time period the Cu contamination of indoor environments due to this kind of appliances. About 10-10 NPs deposit on the olfactory bulb during the operation (1.5-6 min) of such appliances, with a major contribution due to 10-20 nm NPs. HR-FESEM characterization confirmed the presence of such NPs, that were observed both as individual particles (20-40 nm) and aggregated to form particles in the μm sizes range. XEDS microanalysis revealed the presence of Cu together with other elements. Relevant daily contamination of indoor environments due to these appliances has been confirmed by monitoring throughout a year the Cu content of PM samples collected both indoor and outdoor private dwellings. Cu was present in great part as an insoluble form. This means that, following protracted exposure, Cu NPs of such origin may undergo tissue accumulation. This is cause of concern because general population is chronically exposed to such Cu nanoparticles in indoor environments and in view of the role assigned to Cu in the development of neurological disorders.
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http://dx.doi.org/10.1016/j.scitotenv.2018.11.044DOI Listing
February 2019

Optimization and validation of a fast digestion method for the determination of major and trace elements in breast milk by ICP-MS.

Anal Chim Acta 2018 Dec 18;1040:49-62. Epub 2018 Jul 18.

Department of Chemistry, Sapienza University, Piazzale Aldo Moro 5, I-00185 Rome, Italy.

Breast milk guarantees all the nutrients required by infants during their first few months of life and remains the most important food source for their health and growth. However, the mother may transfer potentially toxic chemicals to the suckling infant through breastfeeding. The aim of this study was to optimize and validate a fast method for the determination of a total content of 34 elements (Al, As, B, Ba, Be, Bi, Ca, Cd, Co, Cr, Cs, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, P, Pb, Rb, Sb, Se, Si, Sn, Sr, Te, Ti, Tl, U, V, and Zn) in liquid and lyophilized breast milk. The samples were subjected to HNO:HO (2:1) digestion in an open vessel heated in a water bath (WBD; 80 °C) and subsequently analysed by quadrupole inductively coupled plasma mass spectrometry equipped with a collision-reaction interface. The performance of the proposed method was evaluated in terms of selectivity, detection and quantification limits, linearity, accuracy, and robustness by using standard reference materials and filed samples of breast milk. Compared to microwave-assisted acid digestion, the proposed open vessel digestion allows a significant reduction in treatment time and sample manipulation, while maintaining a similar analytical performance. Masses of 0.5 g of breast milk were efficiently digested with the WBD treatment allowing a residual carbon content lower than 60 mg L and a residual acidity lower than 0.87 mol L in final digested samples. Thus, it shows great potential for application to routine analysis. The method provides satisfactory detection limits and good performance (trueness and recovery percentages 80-111%; coefficient of variation <10%; and relative repeatability <15%) and allows a high sample throughput for multi-elemental determination in human biomonitoring studies.
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http://dx.doi.org/10.1016/j.aca.2018.07.037DOI Listing
December 2018

Environmental Electronic Vape Exposure from Four Different Generations of Electronic Cigarettes: Airborne Particulate Matter Levels.

Int J Environ Res Public Health 2018 10 3;15(10). Epub 2018 Oct 3.

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

Electronic cigarettes (e-cigs) were introduced into the market in 2006 and their technological features have evolved substantially over time. Currently, there are four different generations of e-cigs that are broadly considered less harmful than the use of combusted tobacco products although passive exposure to aerosols often occurs in public spaces and indoor environments. The study aim was to evaluate the levels of airborne particulate matter (PM) emitted during the use of all the four generations of e-cigs, testing different use modalities. PM, PM₄, PM and PM₁ were measured through a Dusttrak ™ II Aerosol Monitor, for a total of 20 independent experiments. All tested e-cigs devices produced PM during their use, and PM was almost made of PM₁ size fraction. In addition, we observed a progressive increase in PM emission from the first to the fourth generation, and an upward trend of PM₁ emitted by the fourth generation e-cig with an increase in the operating power. The results showed that, whatever the model adopted, passive vaping does occur. This finding supports the need for legislative interventions to regulate the e-cigs use in public places and other enclosed environments, in order to protect the health of any subject who is potentially exposed.
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http://dx.doi.org/10.3390/ijerph15102172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210766PMC
October 2018

Ultrafine particles in domestic environments: Regional doses deposited in the human respiratory system.

Environ Int 2018 09 2;118:134-145. Epub 2018 Jun 2.

Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, via F. De Sanctis, I-86100 Campobasso, Italy; Institute of Ecotoxicology & Environmental Sciences, In-700156 Kolkata, India. Electronic address:

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http://dx.doi.org/10.1016/j.envint.2018.05.049DOI Listing
September 2018

Reference Intervals for Urinary Cotinine Levels and the Influence of Sampling Time and Other Predictors on Its Excretion Among Italian Schoolchildren.

Int J Environ Res Public Health 2018 04 21;15(4). Epub 2018 Apr 21.

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

(1) Background: Environmental Tobacco Smoke (ETS) exposure remains a public health problem worldwide. The aims are to establish urinary (u-) cotinine reference values for healthy Italian children, to evaluate the role of the sampling time and of other factors on children's u-cotinine excretion. (2) Methods: A cross-sectional study was performed on 330 children. Information on participants was gathered by a questionnaire and u-cotinine was determined in two samples for each child, collected during the evening and the next morning. (3) Results: Reference intervals (as the 2.5th and 97.5th percentiles of the distribution) in evening and morning samples were respectively equal to 0.98⁻4.29 and 0.91⁻4.50 µg L (ETS unexposed) and 1.39⁻16.34 and 1.49⁻20.95 µg L (ETS exposed). No statistical differences were recovered between median values found in evening and morning samples, both in ETS unexposed and exposed. Significant predictors of u-cotinine excretions were ponderal status according to body mass index of children (β = 0.202; -value = 0.041 for evening samples; β = 0.169; -value = 0.039 for morning samples) and paternal educational level ( = -0.258; -value = 0.010; for evening samples; β = -0.013; -value = 0.003 for morning samples). (4) Conclusions: The results evidenced the need of further studies for assessing the role of confounding factors on ETS exposure, and the necessity of educational interventions on smokers for rising their awareness about ETS.
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http://dx.doi.org/10.3390/ijerph15040817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923859PMC
April 2018

Metagenomic analysis of bacterial community in a travertine depositing hot spring.

New Microbiol 2018 Apr 2;41(2):126-135. Epub 2018 Mar 2.

Laboratory of Epidemiology and Biotechnologies, University of Rome "Foro Italico", Rome, Italy.

Several factors influence bacteria biodiversity in hot springs. The impact of biotic and abiotic pathways on travertine deposition plays a key role in microbial ecology and in the final composition of the waterborne microbiota. The metabolism of some bacterial groups such as photoautotrophs or lithoautotrophs influences water chemistry, favoring carbonate precipitation processes. The role of microbial mats in mineral precipitation processes is not fully clarified. For the first time, a comprehensive metagenomic analysis has been undertaken in the historical Bullicame hot spring. Bacterial biodiversity was characterized and biomineralization activities were assigned to different genera. A higher biodiversity in mat samples compared to water samples was observed: Shannon index of 3.34 and 0.86, respectively. Based on the functional assignment of each Operational Taxonomic Unit, the bacteria involved in biologically- induced mineralization are prevalent in mat and released in the water. According to the principle that each geothermal water specimen has distinctive physic-chemical characteristics, our results suggest new interacting bio-actions within these ecosystems. The saturation index and the chemical composition, as the high concentration of sulfur species and HCO3, can be linked to create a selective environment where pioneer communities are able to live and shape the ecosystem.
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April 2018

Urinary reference ranges and exposure profile for lithium among an Italian paediatric population.

Sci Total Environ 2018 Apr 29;619-620:58-64. Epub 2017 Nov 29.

Department of Public Health and Infectious Diseases, P.le Aldo Moro 5, 00185, Sapienza University, Rome, Italy. Electronic address:

The aims of the present study were to establish reference values useful in monitoring Lithium (Li) treatment and to trace environmental Li exposure profiles in paediatric age. A cross-sectional study was conducted on a group of healthy Italian children aged 5-11. Data on possible predictors were assessed through a questionnaire, and Li levels in morning and evening urinary samples were determined by ICP-MS technique. The reference intervals for the evening and morning samples were respectively 3.8-51.9μgL or 5.6-60.6μgg creatinine and 4.8-71.7μgL or 4.8-73.2μgg creatinine. Urinary Li levels showed a significantly inverse correlation with age and a positive correlation with urinary creatinine in both the evening and morning samples. No other studied variables influenced Li urinary excretion. These results, obtained using a readily available matrix as urine, can be useful for both environmental research and Li treatment monitoring.
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http://dx.doi.org/10.1016/j.scitotenv.2017.11.090DOI Listing
April 2018
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