Publications by authors named "Paola Borella"

34 Publications

virucidal efficacy of a dry steam disinfection system against Human Coronavirus, Human Influenza Virus, and Echovirus.

J Occup Environ Hyg 2021 Oct 20:1-6. Epub 2021 Oct 20.

Department of Surgery Medicine Dentistry and Morphological Sciences with an Interest in Transplant Oncology, University of Modena and Reggio Emilia, Modena, Italy.

This study was aimed to assess the efficacy of dry steam in inactivating Human Coronavirus OC43 (HCoV-OC43) as surrogate of SARS-CoV-2, Human Influenza Virus A/H1N1/WSN/33 and Echovirus 7 on stainless steel, polypropylene, and cotton. The virus models were chosen on the basis of their transmission route and environmental resistance. Tests were carried out under a laminar flow cabinet, where two panels of each material were contaminated with a viral suspension. The inocula were left to dry and then the virus on untreated panel (control) was collected by swabbing in order to determine the initial titer. The other panel was treated using a professional vacuum cleaner equipped with a dry steam generator. Dry steam is generated in a boiler where tap water is heated up to 155 °C at 5.5 bar pressure and then during the passage along the flexible hose the temperature decreases to a value between 100 °C and 110 °C at the output. The dry steam was applied for four sec with a window wiper on metal and plastic panels or a brush covered by a microfiber cap on cotton, simulating the steam application during routine cleaning. After the treatment, infectious virus possibly remained on the surface was collected following the same swabbing procedure applied for controls. HCoV-OC43 and Echovirus 7 were titrated by end-point method on HCT-8 line cells and Vero cells, respectively, while Human Influenza Virus was quantified by plaque reduction assay on MDCK cells. Dry steam resulted effective against the three viruses on all tested materials, achieving a mean Log reduction factor ≥4 in viral titer of treated samples compared with controls according to UNI EN 14476:2019. Thus, dry steam may be proposed as an ease to use, effective, fast, and nontoxic alternative to chemicals for surface disinfection without damaging materials. Therefore, this device could be employed not only in healthcare facilities but also in occupational, domestic, and community settings, with advantages for environment and human health.
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http://dx.doi.org/10.1080/15459624.2021.1989442DOI Listing
October 2021

Seroprevalence of anti-SARS-CoV-2 antibodies in the Northern Italy population before the COVID-19 second wave.

Int J Occup Med Environ Health 2021 Aug 27. Epub 2021 Aug 27.

University of Modena and Reggio Emilia, Modena, Italy (Department of Biomedical, Metabolic and Neural Sciences).

Objectives: The COVID-19 pandemic is due to SARS-CoV-2 coronavirus infections. It swept across the world in the spring of 2020, and so far it has caused a huge number of hospitalizations and deaths. In the present study, the authors investigated serum anti-SARS-CoV-2 antibody prevalence in the period of June 1-September 25, 2020, in 7561 subjects in Modena, Northern Italy.

Material And Methods: The study population included 5454 workers referred to testing by their companies, and 2107 residents in the Modena area who accessed testing through self-referral.

Results: The authors found the overall seroprevalence to be 4.7% (95% confidence interval [CI] 4.2-5.2%), which was higher in women (5.4%, 95% CI: 4.5-6.2%) than in men (4.3%, 95% CI: 3.7-4.9%), and in the oldest age groups (7.3%, 95% CI: 5.2-9.3% for persons aged 60-69 years, and 11.8%, 95% CI: 8.6-15.1%, for persons aged ≥70 years). Among the occupational categories, the highest seroprevalence was found in healthcare workers (8.8%, 95% CI: 7.0-10.5%), dealers and vehicle repairers (5.2%, 95% CI: 2.9-7.6%), and workers in the sports sector (4.0%, 95% CI: 1.8-6.1%), while there was little or no such evidence for those employed in sectors such as transport and storage, accommodation and restaurant services, and the school system.

Conclusions: These results have allowed, for the first time, to assess population seroprevalence in this area of Italy severely hit by the epidemic, while at the same time identifying the subgroups at a higher risk of exposure to SARS-CoV-2.
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http://dx.doi.org/10.13075/ijomeh.1896.01826DOI Listing
August 2021

Frequency of Anti-SARS-CoV-2 Antibodies in Various Occupational Sectors in an Industrialized Area of Northern Italy from May to October 2020.

Int J Environ Res Public Health 2021 07 27;18(15). Epub 2021 Jul 27.

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.

The results of a voluntary screening campaign for the presence of anti-SARS-CoV-2 serum antibodies are presented, performed on workers in the highly industrialized province of Modena in northern Italy in the period 18 May-5 October 2020. The employment activities of the subjects that tested positive for anti-SARS-CoV-2 IgM and/or IgG antibodies were determined and classified using the International Standard Industrial Classification of All Economic Activities (ISIC). The distribution across different sectors was compared to the proportion of workers employed in the same sectors in the province of Modena as a whole. Workers with anti-SARS-CoV-2 serum antibodies were mainly employed in manufacturing (60%), trade (12%), transportation (9%), scientific and technical activities (5%), and arts, entertainment and recreation activities (4.5%). Within the manufacturing sector, a cluster of workers with positive serological tests was observed in the meat processing sector, confirming recent data showing a possible increased risk of SARS-CoV-2 infection in these workers.
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http://dx.doi.org/10.3390/ijerph18157948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345498PMC
July 2021

Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy.

Int J Environ Res Public Health 2021 03 20;18(6). Epub 2021 Mar 20.

Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy.

Children obesity is a serious public health issue. This study aimed to investigate physical/sedentary activities of first-year primary schools children in Modena, and their association with overweight/obesity and dietary habits of children and family characteristics to identify the risk factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anonymous questionnaire administered to parents, as well as family characteristics and weight/height of child and parents. Logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of which 72 without anthropometric data were excluded. Three out of four children spent in physical activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated to physical/sedentary activities. Our results suggest the need of interventions to increase time for physical activity and to promote a responsible use of digital media involving the entire families to reach all parents regardless of their education and nationality with a possible relapse on other family members.
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http://dx.doi.org/10.3390/ijerph18063221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003752PMC
March 2021

Safety and Effectiveness of Monochloramine Treatment for Disinfecting Hospital Water Networks.

Int J Environ Res Public Health 2020 08 22;17(17). Epub 2020 Aug 22.

Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.

The formation of potentially carcinogenic N-nitrosamines, associated with monochloramine, requires further research due to the growing interest in using this biocide for the secondary disinfection of water in public and private buildings. The aim of our study was to evaluate the possible formation of N-nitrosamines and other toxic disinfection by-products (DBPs) in hospital hot water networks treated with monochloramine. The effectiveness of this biocide in controlling spp. contamination was also verified. For this purpose, four different monochloramine-treated networks, in terms of the duration of treatment and method of biocide injection, were investigated. Untreated hot water, municipal cold water and, limited to N-nitrosamines analysis, hot water treated with chlorine dioxide were analyzed for comparison. spp. contamination was successfully controlled without any formation of N-nitrosamines. No nitrification or formation of the regulated DBPs, such as chlorites and trihalomethanes, occurred in monochloramine-treated water networks. However, a stable formulation of hypochlorite, its frequent replacement with a fresh product, and the routine monitoring of free ammonia are recommended to ensure a proper disinfection. Our study confirms that monochloramine may be proposed as an effective and safe strategy for the continuous disinfection of building plumbing systems, preventing vulnerable individuals from being exposed to legionellae and dangerous DBPs.
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http://dx.doi.org/10.3390/ijerph17176116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503937PMC
August 2020

[The Health Examination Survey at regional level: the Emilia-Romagna Region (Northern Italy) example].

Epidemiol Prev 2020 Jan-Feb;44(1):40-47

Dipartimento di malattie cardiovascolari, endocrino-metaboliche e dell'invecchiamento, Istituto superiore di sanità, Roma.

Objectives: to assess time trend of lifestyles, cardiovascular risk factors, and prevalence of high-risk conditions in random samples of the general adult population residing in Emilia-Romagna, examined in two cross-sectional surveys conducted within the Epidemiological Cardiovascular Observatory (OEC 1998-2002) and the Epidemiological Cardiovascular Observatory/Health Examination Survey (OEC/HES 2008-2012).

Design: cross-sectional surveys conducted on random samples of general adult population stratified by gender and age group in some municipalities of Emilia-Romagna.

Settings And Participants: in Emilia-Romagna, 341 males and 354 females were examined in 1998-2002 and 307 males and 300 females were examined in 2008-2012.

Main Outcome Measures: cardiovascular risk factors, high risk conditions, and proportion of population following healthy lifestyles recommendations.

Results: in the second survey, prevalence of hypercholesterolemia and mean values of total and LDL cholesterol were higher. Less than 30% of the sample consumes adequate quantities of vegetables and fish; cheeses, sausages, and sweets are overconsumed, as a higher cholesterol intake.

Conclusions: increased in total and LDL cholesterol are partly due to the reach diet, as suggested by nutrient consumption. Appropriate preventive actions for the improvement of the lifestyles and lipid profile in the general population are recommended.
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http://dx.doi.org/10.19191/EP20.1.P040.016DOI Listing
December 2020

Characterisation of Microbial Community Associated with Different Disinfection Treatments in Hospital hot Water Networks.

Int J Environ Res Public Health 2020 03 24;17(6). Epub 2020 Mar 24.

Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy.

Many disinfection treatments can be adopted for controlling opportunistic pathogens in hospital water networks in order to reduce infection risk for immunocompromised patients. Each method has limits and strengths and it could determine modifications on bacterial community. The aim of our investigation was to study under real-life conditions the microbial community associated with different chemical (monochloramine, hydrogen peroxide, chlorine dioxide) and non-chemical (hyperthermia) treatments, continuously applied since many years in four hot water networks of the same hospital. Municipal cold water, untreated secondary, and treated hot water were analysed for microbiome characterization by 16S amplicon sequencing. Cold waters had a common microbial profile at genera level. The hot water bacterial profiles differed according to treatment. Our results confirm the effectiveness of disinfection strategies in our hospital for controlling potential pathogens such as , as the investigated genera containing opportunistic pathogens were absent or had relative abundances ≤1%, except for non-tuberculous mycobacteria, , and . Monitoring the microbial complexity of healthcare water networks through 16S amplicon sequencing is an innovative and effective approach useful for Public Health purpose in order to verify possible modifications of microbiota associated with disinfection treatments.
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http://dx.doi.org/10.3390/ijerph17062158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7143765PMC
March 2020

The relevance of molecular genotyping to allocate cases in a suspected outbreak of Legionella pneumonia in patients with prolonged immunosuppressive therapy.

Int J Infect Dis 2020 Feb 7;91:174-176. Epub 2019 Nov 7.

Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy.

Three cases of pneumonia caused by Legionella pneumophila serogroup 1 (Lp1) in immunosuppressed patients with repeated hospitalization were suspected as a healthcare-associated cluster. The environmental investigation did not reveal the presence of legionellae in the hospital patient rooms. Water samples collected from the homes of two patients were also negative for Legionella spp. In the absence of environmental strains potentially involved in the infections, we proceeded to genotype environmental Lp1 strains isolated in the hospital during routine water sampling during the decade 2009-2019 and recovered after long-term storage at -20°C. These 'historical' strains exhibited a high grade of similarity and stability over time, regardless of the disinfection systems. The different molecular profiles shown among the clinical and environmental strains excluded a nosocomial outbreak. The study suggests that the application of molecular typing may be a useful tool to discriminate hospital vs community-acquired cases, mostly for severely immunosuppressed patients in whom the symptomatology could be insidious and the incubation period could be prolonged. Moreover, the genotyping allowed us to exclude any link between the cases.
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http://dx.doi.org/10.1016/j.ijid.2019.11.002DOI Listing
February 2020

Risk Factors for Overweight and Obesity in Children Attending the First Year of Primary Schools in Modena, Italy.

J Community Health 2020 04;45(2):301-309

Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy.

Over the last four decades, childhood overweight/obesity has dramatically increased, becoming a significant public health concern. The main aims of this study were to investigate the prevalence of overweight/obesity among first-year primary schools children in Modena and to identify the associated risk factors. Data were collected on the socio-demographic characteristics of family and weight, height, dietary habits and sedentary behaviours of the children, and on the parents' perception of their child's weight status, through an anonymous questionnaire administered to parents. The questionnaires were delivered by 660 out of 890 (74.2%) families, and after excluding those without anthropometric data, 588 children were included in the study. The prevalence of overweight/obesity among the children was 25.2%, significantly lower in children born to parents with a high education, and higher among children born to foreign parents and overweight/obese mothers. The multivariable analysis showed that the children most likely to become overweight/obese were those who skipped breakfast (OR 2.3, 95%CI 1.3-4.2) and/or mid-morning snacks (OR 3.2, 95%CI 1.5-6.5). Breakfast consumption was positively associated with higher parental education levels, whereas skipping mid-morning snacks is more frequent among children born to foreign parents and overweight/obese mothers. Moreover, 84.7% of the parents of overweight/obese children underestimated their child's weight status. One in four 6-7 year-old children is already overweight or obese. Childhood overweight/obesity is significantly associated with unhealthy lifestyles and family lifestyle. It is therefore essential to implement public health intervention programs aimed at both parents and children, in order to promote healthy lifestyles in early childhood.
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http://dx.doi.org/10.1007/s10900-019-00741-7DOI Listing
April 2020

Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward.

BMJ Open 2019 05 27;9(5):e026259. Epub 2019 May 27.

Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.

Objective: Medication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including a (BPMH) compared with a standard medication history in patients admitted to an internal medicine ward.

Design: Prospective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model.

Setting: Internal medicine ward in a secondary care hospital in Southern Switzerland.

Participants: The first 100 consecutive patients admitted in an internal medicine ward.

Primary And Secondary Outcome Measures: Medication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified.

Results: The median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model.

Conclusion: Even in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.
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http://dx.doi.org/10.1136/bmjopen-2018-026259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538074PMC
May 2019

An Innovative Mobile Health System to Improve and Standardize Antenatal Care Among Underserved Communities: A Feasibility Study in an Italian Hosting Center for Asylum Seekers.

J Immigr Minor Health 2018 Oct;20(5):1128-1136

Department of Obstetrics and Gynaecology, Geneva University Hospitals, Geneva, Switzerland.

Innovative migrant-friendly tools are needed to assist health personnel manage the high number of pregnancies within reception centers. This study tests functionality and acceptability of a new mHealth system in providing antenatal care amongst migrants. The study, carried out between 2014 and 2016, involved 150 pregnant women residing in the largest European migrant reception center in Sicily. A ticket tracking system assessed the system's functionality and a questionnaire assessed women's acceptability. The system facilitated the collection of clinical data, enabling the creation of electronic patient records and identifying 10% of pregnancies as high-risk. The application's digital format increased health providers' adherence to antenatal-care recommendations, while the graphic interface facilitated women's engagement and retention of the health education modules. The study recorded a 91.9% patient satisfaction rate. The system was efficient in providing comprehensive and high-quality antenatal care amongst migrants, facilitating the continuity of care for a population undergoing frequent relocations.
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http://dx.doi.org/10.1007/s10903-017-0669-2DOI Listing
October 2018

Trace elements in starter infant formula: dietary intake and safety assessment.

Environ Sci Pollut Res Int 2018 Jan 28;25(3):2035-2044. Epub 2016 Dec 28.

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41125, Modena, Italy.

The aim of this study was to investigate the concentrations of five essential (Fe, Mn, Zn, Cu and Se) and four non-essential/toxic elements (Cr, Cd, Ni and Pb) in 35 different starter infant formulas (0-6 months) sold in Italy. In addition, a safety assessment of these trace elements was carried out, by comparing the estimated daily intake (EDI) with the adequate intake (AI) and the provisional tolerable daily intake (PTDI), with a view to provide information on the metal distribution patterns and health risk to infants arising from the consumption of these products. The concentrations were determined by using inductively coupled plasma mass spectrometry after microwave digestion. The concentrations expressed in geometric mean ± geometric standard deviation of Fe (6.17 ± 1.61 mg/L), Zn (6.21 ± 1.31 mg/L), Cu (416.4 ± 1.21 μg/L), Mn (121.5 ± 1.85 μg/L) and Se (13.27 ± 1.67 μg/L) were within legal limits. In spite of this, the mean EDIs of Fe (4.81 mg/day) and Mn (94.75 μg/day) were many times higher than the recommended AI, especially for Mn. Chromium, Ni, Cd and Pb concentrations were not detectable in 11, 37, 57 and 66% of the samples, respectively. Considering the overall sample, the GM ± GSD of these elements were 4.80 ± 5.35 μg/L for Cr, 1.02 ± 11.65 μg/L for Ni, 0.21 ± 14.83 μg/L for Cd and 0.14 ± 17.13 μg/L for Pb. The mean EDIs were far below the respective PTDI. When the safety assessment was based on the 75° percentile level of each elements, all EDIs remained well below the PTDI, with the exception of Cd, whose EDI approached (74.7%), albeit remaining below the PTDI. In conclusion, our results and the increased awareness on the potential risks of excessive Mn and Fe for infants support that an urgent scientific-based definition of the appropriated levels of fortification in formulas is required. Moreover, regular monitoring of all the stages of production of infant formulas is essential in order to limit toxic metal contamination.
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http://dx.doi.org/10.1007/s11356-016-8290-9DOI Listing
January 2018

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures.

Appl Environ Microbiol 2016 05 2;82(10):2959-2965. Epub 2016 May 2.

University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neurosciences, Section of Public Health, Modena, Italy.

Physical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study was to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and nonculturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine, and hydrogen peroxide. The temperature levels and biocide concentrations that proved to give reliable results were analyzed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for 6 months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide, and hyperthermia. Different selections of Legionella spp. were observed, as networks treated with chlorine-based disinfectants were contaminated mainly by Legionella pneumophila serogroup 1, hyperthermia was associated with serogroups 2 to 14, and hydrogen peroxide treatment was associated mainly with non-pneumophila species. NC cells were detected only in heat-treated waters, and also when the temperature was approximately 60°C. The corrosion rates of the coupons were within a satisfactory limit for water networks, but the morphologies differed. We confirm here that chemical disinfection controls Legionella colonization more effectively than hyperthermia does. Monochloramine was the most effective treatment, while hydrogen peroxide may be a promising alternative to chlorine-based disinfectants due to its ability to select for other, less virulent or nonpathogenic species.
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http://dx.doi.org/10.1128/AEM.03873-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959080PMC
May 2016

Aetiology, source and prevention of waterborne healthcare-associated infections: a review.

J Med Microbiol 2014 Oct 7;63(Pt 10):1247-1259. Epub 2014 Aug 7.

Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.

The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.
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http://dx.doi.org/10.1099/jmm.0.075713-0DOI Listing
October 2014

Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks.

J Water Health 2013 Dec;11(4):738-47

Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail:

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pre-treatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l(-1) and chlorine dioxide between 0.50 and 0.70 mg l(-1) were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution systems.
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http://dx.doi.org/10.2166/wh.2013.079DOI Listing
December 2013

Selenium neurotoxicity in humans: bridging laboratory and epidemiologic studies.

Toxicol Lett 2014 Oct 22;230(2):295-303. Epub 2013 Nov 22.

Neurology and Toxicology Service and Unit, Shaare Zedek Medical Center, Jerusalem, Israel.

Selenium is a metalloid of considerable interest in the human from both a toxicological and a nutritional perspective, with a very narrow safe range of intake. Acute selenium intoxication is followed by adverse effects on the nervous system with special clinical relevance, while the neurotoxicity of long-term overexposure is less characterized and recognized. We aimed to address this issue from a public health perspective, focusing on both laboratory studies and the few epidemiologic human studies available, with emphasis on their methodological strengths and limitations. The frequently overlooked differences in toxicity and biological activity of selenium compounds are also outlined. In addition to lethargy, dizziness, motor weakness and paresthesias, an excess risk of amyotrophic lateral sclerosis is the effect on the nervous system which has been more consistently associated with chronic low-level selenium overexposure, particularly to its inorganic compounds. Additional research efforts are needed to better elucidate the neurotoxic effects exerted by selenium overexposure.
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http://dx.doi.org/10.1016/j.toxlet.2013.11.016DOI Listing
October 2014

A culture-proven case of community-acquired legionella pneumonia apparently classified as nosocomial: diagnostic and public health implications.

Case Rep Med 2013 11;2013:303712. Epub 2013 Feb 11.

Department of Clinical, Diagnostic and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the oncology ward were negative, notably the patient's room and the oxygen bubbler, and the revision of the case history induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires' disease has major clinical, legal, and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2-10-day incubation period.
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http://dx.doi.org/10.1155/2013/303712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582109PMC
March 2013

[Hand hygiene of medical and nursing students during clinica rotations: a pilot study on knowledge, attitudes and impact on bacterial contamination].

Assist Inferm Ric 2012 Jul-Sep;31(3):123-30

Dipartimento di Scienze di Sanitá Pubblica, Università degli Studi di Mondena e Reggio Emilia.

Unlabelled: Hand hygiene in nursing and medical students during training: a pilot study on knowledge, practices and impact on bacterial contamination.

Introduction: Despite exhaustive guidelines on hand hygiene (HH), compliance in health care professionals is reported to be low. In order to improve adherence with HH, interventions on students' education should be effective.

Aim: To describe the knowledge, behavior and hand hygiene (HH) practices in nursing and medical students. The results of the pilot study are presented.

Methods: A questionnaire designed to investigate knowledge on HH and its practical implementation was administered to a sample of 50 nursing and 50 medical students. Data collected were associated with hand contamination measured at the beginning and at the end of the training shift.

Results: All nursing students performed HH with a significantly higher frequency compared to medical students. At the end of training, total bacterial counts were significantly reduced in both groups, but more in nursing students. Total bacterial count increased in absence of hygienic practices and the most effective procedure was the alternate use of conventional hand washing and alcohol-based hands rubs. The knowledge of both groups was adequate, although some differences were observed.

Conclusions: At the beginning of their course, nursing students are educated to correct practices that implement during practical training. Medical students receive information on HH later in their education and pay less attention to these aspects, also due to the limited number of physical contacts with patients. Thus, the contents on HH should be anticipated before the start of the training activity.
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http://dx.doi.org/10.1702/1176.13038DOI Listing
January 2013

Control of Legionella contamination in a hospital water distribution system by monochloramine.

Am J Infect Control 2012 Apr 8;40(3):279-81. Epub 2011 Jul 8.

Department of Public Health Sciences, University of Modena and Reggio Emilia, Italy.

Background: We report the results of 1-year application of monochloramine to control Legionella pneumophila contamination in a hospital hot water distribution system.

Methods: In the main building of the hospital, a device continuously distributing monochloramine was installed. Legionella pneumophila and Pseudomonas spp contamination was followed in comparison with 2 other water networks in the same building using chlorine dioxide.

Results: Monochloramine significantly reduced the number of contaminated sites compared with baseline (from 97.0% to 13.3%, respectively), chlorine dioxide device I (from 100% to 56.7%, respectively), and device II (from 100% to 60.8%, respectively). No positive sample exceeded 10(4) colony-forming units/L versus 59.4% at baseline.

Conclusion: Monochloramine could represent a good alternative to chlorine dioxide in controlling legionellae contamination in public and private buildings.
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http://dx.doi.org/10.1016/j.ajic.2011.03.008DOI Listing
April 2012

Parameters predictive of Legionella contamination in hot water systems: association with trace elements and heterotrophic plate counts.

Water Res 2011 Mar 20;45(6):2315-21. Epub 2011 Jan 20.

Department of Public Health Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy.

The contamination of hot water samples with Legionella spp. was studied in relation to temperature, total hardness, trace element concentrations (iron, zinc, manganese, and copper) and heterotrophic plate counts (HPC) at both 22 and 37 °C. Factor analysis and receiver operating characteristic (ROC) curves were used to establish the cut-off of water parameters as predictors for Legionella contamination. Legionella spp. was isolated in 194 out of 408 samples (47.5%), with Legionella pneumophila being the most common (92.8%). After multiple logistic regression analysis, the risk for legionellae colonisation was positively associated with Mn levels >6 μg l(-1), HPC at 22 °C >27 CFU l(-1), and negatively with temperature >55 °C and Cu levels >50 μg l(-1). Multiple regression analysis revealed that Legionella spp. counts were positively associated with Mn, HPC at 37 °C and Zn and negatively associated with temperature. Only 1 out of the 97 samples (1%) having a Mn concentration, an HPC at 22 °C and an HPC at 37 °C below the respective median values exhibited a Legionella spp. concentration exceeding 10(4) CFU l(-1)vs. 41 out of the 89 samples (46.1%) with the three parameters above the medians. Our results show a qualitative and quantitative relationship between Legionella spp., the Mn concentration and heterotrophic plate counts in hot water samples from different buildings, suggesting that these parameters should be included in a water safety plan. The role of manganese in biofilm formation and its possible involvement in the mechanisms favouring Legionella survival and growth in water niches should be investigated further.
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http://dx.doi.org/10.1016/j.watres.2011.01.009DOI Listing
March 2011

Extremely low frequency-magnetic fields (ELF-EMF) occupational exposure and natural killer activity in peripheral blood lymphocytes.

Sci Total Environ 2009 Jan 19;407(3):1218-23. Epub 2008 Sep 19.

Chair of Occupational Medicine, Department of Public Health Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41100, Modena (MO), Italy.

Extremely Low Frequency-Magnetic Fields (ELF-MF) are possible carcinogens to humans and some data suggest that they can act as promoters or progressors. Since NK cells play a major role in the control of cancer development, an adverse effect on ELF-MF on NK function has been hypothesized. We examined NK activity in 52 workers exposed to different levels of ELF-MF in various activities. Individual exposure was monitored during 3 complete work-shifts using personal dosimeters. Environmental exposure was also monitored. ELF-MF levels in the workers were expressed as Time-Weighted Average (TWA) values. NK activity was measured in peripheral blood lymphocytes (PBL). In the whole group the median occupational TWA was 0.21 microT. According to the TWA levels, workers were classified as low exposed (26 subjects, TWA < or =0.2 microT) and higher exposed workers (26 subjects; TWA >0.2 microT). In higher exposed workers, we observed a trend to reduce NK activity compared to low exposed, but the difference was not significant. Then we selected a subgroup of highest exposed workers (12 subjects; TWA >1 microT); no difference was observed between low and highest exposed subjects in the main personal variables. Considering both E:T ratios from 12:1 to 50:1 and Lytic Units, a significant reduction in NK activity was observed in the highest exposed workers compared to the low exposed. Multivariate analysis showed a significant negative correlation between exposure and LU, while no correlation was evidenced with other personal characteristics. ELF-MF are considered possible carcinogens, and existing data suggest that they can act as promoters. Due to the role of NK activity in host defence against cancer, the results obtained in this study in workers exposed to ELF-MF levels exceeding 1 microT are in agreement with this hypothesis, and support the need for further investigation in this field.
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http://dx.doi.org/10.1016/j.scitotenv.2008.08.012DOI Listing
January 2009

Effect of bacterial interference on biofilm development by Legionella pneumophila.

Curr Microbiol 2008 Dec 4;57(6):532-6. Epub 2008 Sep 4.

Department of Biomedical Science, University of Modena and Reggio Emilia, Via Campi 287, Modena 41100, Italy.

In the ecology of Legionella pneumophila a crucial role may be played by its relationship with the natural flora; thus we investigated the interactions between Legionella and other aquatic bacteria, particularly within biofilms. Among 80 aquatic bacteria screened for the production of bacteriocin-like substances (BLSs), 66.2% of them were active against L. pneumophila. The possible effect of some of these aquatic bacteria on the development and stability of L. pneumophila biofilms was studied. Pseudomonas fluorescens, the best BLS producer, showed the greatest negative effect on biofilm formation and strongly enhanced the detachment of Legionella. Pseudomonas aeruginosa, Burkholderia cepacia, Pseudomonas putida, Aeromonas hydrophila, and Stenotrophomonas maltophilia, although producing BLSs at different levels, were less active in the biofilm experiments. Acinetobacter lwoffii did not produce any antagonistic compound and was the only one able to strongly enhance L. pneumophila biofilm. Our results highlight that BLS production may contribute to determining the fate of L. pneumophila within ecological niches. The interactions observed in this study are important features of L. pneumophila ecology, which knowledge may lead to more effective measures to control the persistence of the germ in the environment.
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http://dx.doi.org/10.1007/s00284-008-9237-2DOI Listing
December 2008

Selenium interactions with essential and toxic elements in egg yolk from commercial and fortified eggs.

J Trace Elem Med Biol 2008 5;22(3):234-41. Epub 2008 Jun 5.

Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena, Italy.

The main objective of this work was to evaluate the interaction between selenium concentration in both commercial and Se-enriched eggs and other essential/toxic elements (Ca, Mg, Fe, Zn, Pb, and Cd), taking into account a possible synergic action of iodine. Commercial eggs were purchased from several sale points or directly from the producers (farmyard eggs). Fortified eggs were obtained by supplementing chickenfeed for 6 weeks with Se as sodium selenite (1.0 microg/g Se) or Se plus iodine (1.0 microg/g Se+3.7 microg/g I). Se in experimental egg yolks significantly increased over the basic value by 39% in the Se group and 61% in the Se+I group, suggesting that I addition may enhance Se absorption. Levels of Se in commercial yolks were identical in free-range, barn or battery eggs, but significantly lower in farmyard and higher in organic eggs where the Se content approximated that found in Se fortified eggs. A significant reduction in Cd was observed in Se+I treated yolks compared to both control and Se alone diet, thus suggesting a high sensitivity of Cd to the detoxifying effect of Se combined with I. Furthermore, Se+I supplementation was associated with a significant Zn reduction, a finding which needs clarification to avoid attempts to maximize one component affecting the levels of other essential elements.
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http://dx.doi.org/10.1016/j.jtemb.2008.03.004DOI Listing
February 2009

Influence of aquatic microorganisms on Legionella pneumophila survival.

New Microbiol 2007 Jul;30(3):247-51

Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

The ability of aquatic bacteria Pseudomonas fluorescens SSD (Ps-D) and Pseudomonas putida SSC (Ps-C) to support the persistence of Legionella pneumophila (Lp-1) in an artificial water microcosm was investigated for 42 day, at two different incubation temperatures. At 4 degrees C, individually suspended Lp-1 was no longer detectable just after 24 hours, while in co-cultures with Pseudomonas, Lp1 showed a better survival capability. At 30 degrees C, Lp-1 alone displayed high survival rates over the entire period of observation. When Lp-1 was inoculated with Ps-C and Ps-D, its count showed a marked decrease, followed by a gradual and costant decline.
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July 2007

Epidemiological investigation on a suggestive case of Legionella pneumonia and public health implications.

Scand J Infect Dis 2006 ;38(8):725-8

Department of Public Health Sciences, University of Modena and Reggio E, Modena, Italy.

We report a case of Legionella pneumonia in a patient with psoriasis. The clinical strain had an identical PFGE pattern of 1 subtype of L. pneumophila serogroup 1 isolated at low concentration in a sporting club bath. Diagnostic, clinical and epidemiological aspects are discussed for their relevant public health implications.
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http://dx.doi.org/10.1080/00365540500488881DOI Listing
October 2006

Water ecology of Legionella and protozoan: environmental and public health perspectives.

Biotechnol Annu Rev 2005 ;11:355-80

Department of Hygiene and Microbiology, University of Modena and Reggio Emilia, Via Campi 287, 41100 Modena, Italy.

Ecological studies on Legionella spp. are essential to better understand their sources in the natural environments, the mechanism of their entry into man-made water systems and the factors enabling their survival and growth in aquatic habitats. Legionella spp. exhibits peculiar and multiple strategies to adapt to stressful environment conditions which normally impair other germ survival. These strategies include the ability to enter in a viable but non-cultivable (VBNC) state, to multiply intracellularly within a variety of protozoa, such as amoebae, to survive as free organisms within biofilms and to be enhanced/inhibited by the presence of other aquatic bacteria. The host-parasite interaction has been shown to be central in the pathogenesis and ecology of L. pneumophila. The bacterial-protozoan interaction contributes to the amplification of Legionella population in water systems, represents a shelter against unfavourable environmental conditions, acts as a reservoir of infection and contributes to virulence by priming the pathogen to infect human cells. Legionella is able to survive as free organism for long periods within biofilms which are widespread in man-made water systems. Biofilm provides shelter and nutrients, exhibits a remarkable resistance to biocide compounds and chlorination, thus representing ecological niches for legionella persistence in such environments. Further knowledge on biofilm-associated legionellae may lead to effective control measures to prevent legionellosis. Lastly, new perspectives in controlling legionella contamination can arise from investigations on aquatic bacteria able to inhibit legionella growth in natural and artificial water systems.
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http://dx.doi.org/10.1016/S1387-2656(05)11011-4DOI Listing
July 2006

Legionella contamination in hot water of Italian hotels.

Appl Environ Microbiol 2005 Oct;71(10):5805-13

Department of Hygiene and Microbiology, Via Campi, 287, I-41100 Modena, Italy.

A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of > or =10(3) CFU liter(-1), and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.
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http://dx.doi.org/10.1128/AEM.71.10.5805-5813.2005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1265926PMC
October 2005

Micro- and macromethod assays for the ecological study of Legionella pneumophila.

FEMS Microbiol Lett 2005 Nov 8;252(1):113-9. Epub 2005 Sep 8.

Department of Biomedical Science, University of Modena and Reggio Emilia, Modena, Italy.

The survival of a strain of Legionella pneumophila (Lp-1) inoculated in artificial water microcosms was investigated with and without an amoebal host and varying environmental conditions, such as biofilm formation, amount of nutrients and incubation temperature. The results obtained using short (micromethod) and long (macromethod) term methods showed that L. pneumophila Lp-1 dies rapidly at 4 degrees C in the "macromethod" assay. When the same temperature (4 degrees C) was applied to the "micromethod" assay, L. pneumophila Lp-1 survived for three weeks, although it progressively decreased. At an incubation temperature of 30 degrees C, the aquatic environment was more favourable and better survival emerged in the "macromethod"; in contrast, this favourable temperature condition did not improve the survival of L. pneumophila Lp-1 cultured with the "micromethod". The role of the protozoa Acanthamoeba polyphaga proved to be indispensable for legionella survival only when environmental conditions become unfavourable.
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http://dx.doi.org/10.1016/j.femsle.2005.08.040DOI Listing
November 2005

Legionella infection risk from domestic hot water.

Emerg Infect Dis 2004 Mar;10(3):457-64

Dipartamento di Scienze Igienistiche, Microbiologiche e Biostatistiche, University of Modena and Reggio E., Via Campi 287, I-41100 Modena, Italy.

We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of <100 microg/L and copper levels of >50 microg/L appeared to be protective against Legionella colonization [corrected]. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322798PMC
http://dx.doi.org/10.3201/eid1003.020707DOI Listing
March 2004
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