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Biomonitoring studies:Bioaccumulation of Polychlorinated Biphenyls and Heavy Metal
No full textIntroduction In 1990, the Italian Ministry of the Environment declared a 276-km 2 area - which includes the municipalities of Gela, Niscemi and Butera - a high-risk area (see Chapter 1). Gela, a coastal city located in the south of Sicily, had a population of 77 145 people in 2008 (54 774 in 1961). In 2008, the municipalities of Niscemi (332 m above sea level) and Butera (402 m above sea level) had 26 541 and 5063 inhabitants, respectively. In 2000, on the basis of the documented presence of soil contamination or hazardous waste, 51 km 2 of Gela (corresponding to private, industrial, public and marine areas) were designated a site of national concern (see "Introduction" in Chapter 6). In this area, extremely high levels of toxic, persistent and bioaccumulating chemical pollutants have been detected in soil, surface and groundwater, as well as in marine water and sediments (Musmeci et al., 2009). In the last decade, descriptive epidemiological studies have provided evidence of highly significant adverse health outcomes (see Chapter 5). Prior to the analytical epidemiological study described in the present chapter, the data produced by industry, to characterize chemical substances measured in soil, surface water and groundwater in the national sites of concern, were evaluated by an ad hoc multidisciplinary group (Musmeci et al., 2009). Although data on environmental matrices and health outcomes are available for the area of national concern, these data are scattered and lack organization. Considering the data available on polluting chemicals, and taking into account their toxic properties, the multidisciplinary group produced a list of chemicals defined as index substances. This list represents a priority set for environment and health assessments(Musmeci et al., 2009). The human biomonitoring study described in the present chapter aims to improve the knowledge of exposure of the residents of the municipalities of Gela, Niscemi and Butera to selected pollutants. The study surveyed the development of a communication plan: dissemination of information, contacts with local communities, meetings, training activities and the involvement of stakeholders. The study started in 2008, and its results were presented publicly in July 2009. This chapter will show the results of a human biomonitoring study, called Studio Epidemiologico Biomonitoraggio Area Gela(SEBIOMAG), in the Gela area. The chapter contains four sections: 1.background information on environment and health data; 2.material and methods for investigating several metals and organochlorinated compounds; 3.results of metals detected in urine and blood and organochlorinated compounds detected in plasma; and 4.discussion
Thyroid hormone and heart failure: from myocardialprotection to systemic regulation
Get PDFHeart failure (HF) is an intriguing model of chronic disease. It starts as an organ disorder developing, in its progression, into a systemic disease in which the dysfunction of other organs plays a relevant clinical and prognostic impact. Furthermore, continuous activation of systemic pathways plays a role in disease progression, switching their effect from protective to harmful. In this combination of organ dysfunction and systemic derangement, thyroid hormone (TH) have an important regulative impact from cardiovascular to systemic level and from molecular/cellular processes to clinical setting. Whether it is accepted to include TH and thyroid stimulating hormone assessment in the clinical HF course, the next challenge will be to ascertain the benefit of TH replacement therapy in HF patients, taking into consideration the type of hormone to administer, dosage and treatment schedule
MDEForge: an Extensible Web-Based Modeling Platform
No full textModel-Driven Engineering (MDE) refers to the systematic use of models as first class entities throughout the software development life cycle. Over the last few years, many MDE technologies have been conceived for developing domain specific modeling languages, and for supporting a wide range of model management activities. However, existing modeling platforms neglect a number of important features that if missed reduce the acceptance and the relevance of MDE in industrial contexts, e.g., the possibility to search and reuse already developed modeling artifacts, and to adopt model management tools as a service. In this paper we propose MDEForge a novel extensible Web-based modeling platform specifically conceived to foster a community-based modeling repository, which underpins the development, analysis and reuse of modeling artifacts. Moreover, it enables the adoption of model management tools as software-as-a-service that can be remotely used without overwhelming the users with intricate and error-prone installation and configuration procedures
A decision support system for real-time stress detection during virtual reality exposure
No full textVirtual Reality (VR) is increasingly being used in combination with psycho-physiological measures to improve assessment of distress in mental health research and therapy. However, the analysis and interpretation of multiple physiological measures is time consuming and requires specific skills, which are not available to most clinicians. To address this issue, we designed and developed a Decision Support System (DSS) for automatic classification of stress levels during exposure to VR environments. The DSS integrates different biosensor data (ECG, breathing rate, EEG) and behavioral data (body gestures correlated with stress), following a training process in which self-rated and clinical-rated stress levels are used as ground truth. Detected stress events for each VR session are reported to the therapist as an aggregated value (ranging from 0 to 1) and graphically displayed on a diagram accessible by the therapist through a web-based interface
Lo screening della disfunzione ventricolare sinistra sistolica asintomatica in un campione di popolazione ad alto rischio cardiovascolare in Lombardia: lo studio DAVID-Berg
Get PDFBackground. Prevalence of asymptomatic left ventricular systolic dysfunction (ALVSD) increases with age and cardiovascular (CV) risk exposure. Early diagnosis and treatment allow reducing heart failure and fatal and non-fatal event rates. Data on ALVSD prevalence in Italy are still scarce and ALVSD remains commonly under-diagnosed in primary care, where diagnostic facilities are limited. Among subjects at high CV risk in primary care, we assessed the prevalence of ALVSD and the relative predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the Framingham Heart Failure Risk Score (FHFRS). Conclusions. In subjects at high CV risk in primary care, prevalence of ALVSD is 5.3%; for diagnosis NT-proBNP adds predictive value to the FHFRS and is equivalent to the combination of FHFRS and ECG. Because of its practical advantages, NT-proBNP might be routinely used for ALVSD screening in primary care
Progetto S.E.N.T.I.E.R.I.- Mortalit?, incidenza oncologica e ricoveri ospedalieri. Razionale e Obiettivi
No full textThe Istituto Superiore di Sanit? (National Institute of Health-ISS), in partnership with a network of Italian national and regional scientific institutions, initiated the SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites-NPCSs), the objectives, methods and initial results of which were published by Epidemiologia & Prevenzione in 2010 and 2011. In the course of 2013, some of the SENTIERI Project findings were published in international scientific journals, and the ?SENTIERI approach? was among those sanctioned by theWorld Health Organization to conduct an initial description of the health status of residents of contaminated sites. The present Report, set up jointly by ISS and the Italian Network of Cancer Registries (AIRTUM), as anticipated in the 2011 Report, aims to provide, for each of the 18 National Priority Contaminated Sites included in the SENTIERI Project where the Italian Association of Cancer Registries is active, a mortality update to 2010, analyses of cancer incidence (1996-2005 in 17 NPCSs) and of hospital discharges, (2005-2010), as is explained in detail in Chapter 2, pertaining to the project\u27s materials and methods. The results of the analyses for each NPCS are presented in Chapter 3, while Chapter 4 includes a critical appraisal, a discussion of the methodological approach and a series of concluding remarks. The second section of the Report takes an in-depth look at important issues of public health and scientific research in contaminated sites. This Report represents an important step towards implementing a permanent epidemiological surveillance system in Italy\u27s contaminated sites, the ultimate goal of the SENTIERI Project.L\u27Istituto superiore di sanit? (ISS), in collaborazione con una rete di istituzioni scientifiche italiane operanti a livello nazionale e regionale, ha ideato lo Studio Epidemiologico Nazionale dei Territori e Insediamenti Esposti a Rischio da Inquinamento (Progetto SENTIERI) i cui obiettivi,metodi e primi risultati sono stati pubblicati da Epidemiologia & Prevenzione nel 2010-2011. Nel corso del 2013 alcuni risultati del Progetto SENTIERI sono stati pubblicati nella letteratura scientifica internazionale, e contestualmente l\u27?approccio SENTIERI? ? stato incluso fra quelli ritenuti validi dall\u27Organizzazione mondiale della sanit? (OMS) per condurre una prima caratterizzazione dello stato di salute delle popolazioni residenti nei siti contaminati. Il presente Rapporto, frutto di una collaborazione scientifica fra ISS e Associazione italiana dei registri tumori(AIRTUM) gi? prevista come sviluppo nel precedente rapporto del 2011, ha come obiettivo quello di fornire, per i 18 siti di interesse nazionale inclusi nel Progetto SENTIERI e serviti da Registri tumori: un\u27estensione dello studio di mortalit?, aggiornata al 2010; l\u27analisi dell\u27incidenza oncologica relativa al periodo 1996-2005; una prima analisi dei dati di ospedalizzazione relativi al periodo 2005-2010, come dettagliatamente illustrato nel capitolo 2 del presente Rapporto relativo aimateriali emetodi del progetto. La presentazione dei risultati dello studio ? riportata nel capitolo 3, mentre il capitolo 4 contiene un commento critico, una discussione delle caratteristiche metodologiche e una serie di considerazioni conclusive. Nella seconda sezione del rapporto sono presentati approfondimenti su questioni di rilievo in termini di sanit? pubblica e di ricerca scientifica. Questo Rapporto rappresenta una tappa significativa del processo di costruzione di quel sistema permanente di sorveglianza epidemiologica nei siti contaminati italiani che costituisce la finalit? del Progetto SENTIERI
A hybrid cardiovascular simulator as test bench for VAD autoregulation control.
No full textAim: Continuous flow ventricular assists device (VAD) drew the attention to VAD speed control development and testing. Aim of this work is to demonstrate the effectiveness of a hybrid (hydro-numerical) simulator (HCS) as a test bench for VAD autoregulation control. Methods: The HCS is a computational cardiovascular model in which the left atrium and ascending aorta are connected in real time with the hydraulic part (impedance transformers). This permits to physically connect a Circulite Synergy? Micropump and to reproduce the HCS-VAD interaction in real time. The resulting inlet and outlet VAD pressures and VAD flow are sent to the ARU as inputs. This latter is a FPGA-based control unit allowing to adjust VAD speed remotely via Bluetooth or to automatically control VAD speed in order to keep VAD flow constant. Results: HCS was used to reproduce an ischemic cardiomyopathy, the ARU was tested activating the VAD from 20000 to 26000 rpm via Bluetooth. Secondly, the ARU flow control was activated to 2 l/min and tested on the HCS reproducing ischemic cardiomyopathy, systemic hypertension and then hypotension. This caused a change of VAD afterload (74-94-49 mmHg) inducing ARU to automatically change VAD speed (25000-26000-24200 rpm). Conclusions: The HCS, thanks to the connection to a real VAD and the reproduction of different pathologies, is a valid tool for testing different VAD speed control algorithms. Acknowledgments: The work was supported by the SensorART (N. 248763) project
The Hypotensive and bradycardic effects of mouth opening: evidence in an animal model.
Get PDFObjective Previous studies in normotensive anesthetized rats (Lapi Arch.Ital.Biol 151:11-23,2013) showed that peripheral stimulation of the trigeminal nerve induced by submaximal mouth opening (mandibular extension, ME) caused prolonged (at least 80min) bradycardia, hypotension and cerebral hemodynamic changes (pial arterioles showed a characteristic response pattern consisting in a significant constriction during ME followed by a dilatation for the entire remaining observation time). Design and method In this study we assessed the in vivo effects of ME on HR, MABP and pial microcirculation in hypertensive rats. Experiments were performed in male Wistar rats weighing 250-300g (n = 8). Hypertension was induced by intraperitoneal daily injection of dexamethasone (0.03mg/kg/day) for 10 days. ME was obtained by inserting an ad hoc developed retractor between the dental arches. HR and MABP were recorded by ECG and a catheter placed in the left femoral artery and measured by a computer-assisted system. Pial arterioles were observed through a closed cranial window implanted above the left parietal cortex and visualized by an in vivo fluorescence microscopy technique to assess vessel diameter changes before (baseline), during 10min ME and thereafter until 160min. Arteriolar diameters were measured with a computer-assisted method (MIP Image program, frame by frame). Results In sham-treated (no ME) hypertensive rats (n=3) HR, MABP and pial microcirculation did not change during whole observation period. Hypertensive rats subjected to ME (n=5) showed a significant decrease of HR and MABP. HR declined by 42bpm, (p<0.01) starting from 60 min after ME up to 160min, while MABP by 18mmHg (p<0.05) starting from 20min after ME up to 100min, compared with baseline. Pial arterioles exhibited a biphasic response: the arteriolar diameter decreased by 2.94μm (p<0.05) during ME, afterwards it significantly increased by 3.46μm (p<0.01) starting from 20min after ME; this vasodilatation lasted for the whole observation period. Conclusions Our results suggest that ME is able to exert profound and prolonged regulatory effects on systemic arterial blood pressure and pial arteriolar tone in hypertensive rats
Prevalence and prenatal ultrasound detection of clubfoot in a non-selected population: an analysis of 549 931 births in Tuscany
Get PDFObjective: To evaluate the prevalence and prenatal ultrasound detection of clubfoot in Tuscany during a period of 20 years. Methods: This is a descriptive analysis on data from the Tuscan register of congenital defects, covering a 20-year period from 1992 to 2011. The Tuscan registry of congenital defects is a population-based register for the epidemiologic surveillance of congenital anomalies. The study included all cases of pre- or postnatally diagnosed clubfoot (isolated clubfoot and cases associated with other congenital defects). Overall prevalence and pre-natal detection rates were calculated. Results: Among the 549 931 deliveries recorded in Tuscany between 1992 and 2011, 858 cases of clubfoot were registered, with a prevalence of 1.56/1000. Seventy-eight percent of cases were isolated. The detection rate was higher when the defect was associated with other anomalies compared to isolated forms. Over the study period, there was a substantial improvement in the prenatal detection of clubfoot (from 11 to 31% overall). For isolated forms, detection rate improved from 4 to 16%, and for cases associated with other congenital defects, it increased from 43 to 73%. Conclusion: Prevalence of clubfoot in Tuscany is 1.56 per 1000 births, in agreement with the incidence reported in epidemiological studies in Europe. Prenatal detection of clubfoot improved over time. The detection rate was higher in cases associated with other anomalies
Assessment of health risks of policies
Get PDFThe assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessmentwith special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.