Antonio Arnese

Vaccination against hepatitis b virus: are Italian medical students sufficiently protected after the public vaccination programme?

BackgroundThe development of a vaccine against hepatitis B virus (HBV) has been a major achievement in terms of prevention of HBV infection. For the present study, we analysed the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities.MethodsA cross-sectional study of undergraduate and postgraduate students attending the Medical School of the Second University of Naples was conducted between September 2012 and December 2014. HBV serum markers were determined and multivariate logistic regression analysis was used to identify factors associated with the level of long-term immunogenicity.ResultsOf the 2,932 subjects evaluated, only 33 (1.1 %) declared no history of vaccination. All vaccinated subjects were HBsAg/anti-HBc negative, 459 of which had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., dental hygienists, nursing, paediatric nursing, radiography and midwifery) than a medical school (at either undergraduate or postgraduate level) and more likely to have been vaccinated in infancy.ConclusionThe results of this study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful to identify small numbers of unvaccinated subjects or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations.

Microbiological quality of drinking water from dispensers in Italy

BackgroundWater coolers are popular in office buildings and commercial stores and the quality of this source of drinking water has the potential to cause waterborne outbreaks, especially in sensitive and immunocompromised subjects. The aim of this study was to determine the quality of water plumbed in coolers from commercial stores in comparison with tap water in Italy.MethodsFor each sample, microbial parameters and chemical indicators of contamination were evaluated and information about the date of installation, time since last ordinary and extraordinary maintenance of water coolers was collected.ResultsIn all samples the chemical parameters (nitrite, ammonium, free active chlorine residual) did not exceed the reference values of the drinking water regulation; the pH value in 86.8% samples of the carbonated waters was lower than the reference limit. The microbiological results indicated that the bacteria count at 22°C and 37°C was higher than the required values in 71% and 81% for the non-carbonated water and in 86% and 88% for the carbonated one, respectively. Enterococcus spp. and Escherichia coli were not detected in any of the water samples. Pseudomonas aeruginosa was found in only one sample of the tap water and in 28.9% and 23.7% of the non-carbonated and carbonated water samples, respectively. No statistically significant differences in bacterial counts at 22°C and 37°C have been found between the non-carbonated and carbonated water from the sampled coolers in relation with the time since the last filter was substituted. The bacteriological quality of tap water was superior to that of non-carbonated and carbonated water from coolers.ConclusionThe results emphasize the importance of adopting appropriate routinely monitoring system in order to prevent or to diminish the chances of contamination of this water source.

Survey of lead, cadmium, mercury and arsenic in seafood purchased in Campania, Italy

Lead, cadmium, mercury and arsenic were surveyed in fresh catch, farmed and frozen marine fish, cephalopods and mussels marketed in Campania (Italy), and the populations weekly intake from seafood was assessed. A total of 162 specimens of fish and cephalopods and 30 pools of mussels were analyzed. Pb levels in fresh catch species ranged between <20 and 689 ng/g; in farmed from <20 to 438 ng/g and in frozen from <20 to 541 ng/g. Cd values ranged in fresh catch seafood from <0.8 to 19.8 ng/g; in farmed from <0.8 to 42.3 ng/g; in frozen from <0.8 to 93.1. Hg levels ranged 8–339 ng/g in wild seafood; <5–226 ng/g in farmed and <5–313 ng/g in frozen. In fresh catch seafood, As values ranged <10–231 ng/g; in farmed from 12–310 ng/g and in frozen 12–272 ng/g. Cd and Hg concentrations were below the EU limits in all species; two samples of farmed European seabass and two frozen samples exceeded EU limits for Pb. The median weekly dietary intake could affect the provisional tolerable weekly intake (PTWI) of Pb by 2% (range 0.5–16.5%), Cd PTWI by 0.9% (range 0.1–8.0%), Hg PTWI by 9.6% (range 0.6–41.0%) and the As PTWI by 3.6% (range 0.4–12.5%). Considering the upper values in the ranges, seafood represents a non-negligible contribution to Pb weekly intake (16.5%), but mainly to the weekly intake of Hg (41.0%) for high seafood consumers and those consuming the most contaminated species.

Evaluation of the selenium content of the traditional Italian diet

Food samples and ready-made meals from the traditional Italian-type diet were analysed for selenium content. The average Se content varied in food samples from 7 micrograms/kg w/w (fresh fruit) to 226 micrograms/kg w/w (fish). The highest average contents were obtained in the animal products and in legumes. Among ready-made foods the animal derived dishes were the richest in Se, representing 78% of the estimated total daily dietary intake of Se. The average daily dietary intake of selenium for Italian people is estimated to be 50.9 +/- 29.8 micrograms Se/day when results obtained on complete meals are used, while it is 45.0 +/- 30.8 micrograms Se/day when results on foods and statistical data on consumption are used.

Organochlorine pesticide residues in fish from southern Italian rivers

Extensive use of pesticides in agricultural and municipal fields contributed all over the world to an effective increase of production and to a limitation of the vector injuries to health. However the large quantities of synthetic chemical products employed to achieve these purposes have resulted in an extended environmental pollution, especially worrying about the organochlorine insecticides that are very persistent and suspected of carcinogenicity. For these reasons, this group of pesticides has been banned or strongly restricted in many countries including Italy, where just Lindane and Endosulfan are now allowed in agriculture, representing only 7% of the annual use of synthetic pesticides. In order to control the amount of contamination of surface water from organochlorine pesticides, some surveys were carried out in northern and central Italy, but information regarding situation in southern Italy is not available. The purpose of this study was to evaluate the occurrence and the magnitude of chlorinated pesticide aquatic pollution in southern Italy by the analysis of some permanent freshwater fish species.

Prevalence of Latent Tuberculosis Infection and Associated Risk Factors Among 1557 Nursing Students in a Context of Low Endemicity

Introduction: The risk of tuberculosis (TBC) in nurses is related to its incidence in the general population. Nursing students involved in clinical training could be exposed to occupational risks similar to those of healthcare workers (HCWs). To better understand the epidemiology of nosocomial TBC among nurses in a context of low endemicity, we recruited a cohort of young nursing trainees at the Second University of Naples. Methods: A screening programme for LTBI in nursing students was conducted between January 2012 and December 2013, at the Second University of Naples, with clinical evaluations, tuberculin skin test (TST) and, in positive TST student, the interferon-g release assays (IGRA). Putative risk factors for LTBI were assessed by a standardized questionnaire. Results: 1577 nursing students attending the Second University of Naples have been submitted to screening programme for TBC. 1575 have performed TST as first level test and 2 Quantiferon test (QFT). 19 students were TST positive and continued the diagnostic workup practicing QFT, that was positive in 1 student. Of the 2 subjects that have practiced QFT as first level test only 1 was positive. In 2 students positive to QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. Conclusion: The prevalence of LTBI among nursing students in our study resulted very low. In countries with a low incidence of TBC, the screening programs of healthcare students can be useful for the early identification and treatment of the sporadic cases of LTBI.

Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country

BackgroundHealthcare workers (HCWs) are at higher risk than the general population of contracting tuberculosis (TB). Moreover, although subjects with latent TB infection (LTBI) are asymptomatic and are not infectious, they may eventually develop active disease. Thus, a fundamental tool of TB control programs for HCWs is the screening and treatment of LTBI.MethodsFrom January 2014 to January 2015, hospital personnel at Azienda Ospedaliera Universitaria, Naples, Italy, were screened for TB. To this end, a tuberculin skin test (TST) was administered as an initial examination, unless when contraindicated, in which case the QuantiFERON® TB-Gold (QFT) assay was performed. Moreover, QFT was carried out on all TST-positive cases to confirm the initial result.ResultsOf 628 personnel asked to participate, 28 (4.5%) denied consent, 533 were administered TST as the baseline examination, and 67 were tested only with QFT. In the TST group, 73 (13.2%) individuals were found positive, 418 (78.4%) were negative, and 42 (7.9%) were absent for the reading window; QFT confirmed the result in 39 (53.4%) TST-positive individuals. In the QFT-only group, 44 (65.7%) individuals were found positive. All TST- and/or QFT-positive subjects were referred for chest X-ray and examination by an infectious diseases specialist. None were found to have active TB, and were thus diagnosed with LTBI.ConclusionsAlthough Italy is a low-incidence country regarding TB, our findings suggest that the prevalence of LTBI in HCWs may be relatively high. As a result, active screening for TB and LTBI is needed for these workers.

Prevalence of alcohol use disorders among under- and post-graduate healthcare students in Italy

A cross-sectional study was carried out on 641 medical students, 359 students attending a degree course in the healthcare professions, and 500 resident physicians, all undergoing health surveillance at the ambulatory of the Division of Occupational Medicine, Second University of Naples, Italy. 76.1% of the participants drank alcohol, with 85.5% of medical students, 77.4% of resident physicians, and 63% of healthcare-professions students reporting regular alcohol use. In the whole sample, the mean Audit-C score was 1.6 for men and 1.1 for women; only 5.5% of men and 7.1% of women had a hazardous alcohol consumption with an Audit-C score of respectively ≥4 and ≥3. Multivariate regression modeling revealed that regular alcohol use was more likely in individuals who were men, were younger, had a lower body-mass index, were active smokers, were habitual coffee drinkers, and who were resident physicians or medical students rather than healthcare-professions students. This finding identifies a need to assess alcohol use in medical-profession workers in order to identify risky behavior early on and to carry out rapidly effective preventive and curative interventions.

Prevalence and associated risk factors of latent tuberculosis infection among undergraduate and postgraduate dental students: A retrospective study

ABSTRACT To estimate the prevalence of latent tuberculosis (TB) infection (LTBI) in Italian dental students exposed to the same occupational risks as dental health care personnel and to evaluate potential risk factors, a cross-sectional study was conducted on undergraduate and postgraduate students. After clinical evaluation, students were given a tuberculin skin test; in those found positive, an interferon-γ release assay (IGRA) was conducted. Of the 281 students enrolled, 10 were only TST positive; 8 were TST or/and IGRA positive. We found that participants testing positive at TST and/or IGRA, a group in which the risk of false LTBI positives is minimal, were older and had been studying longer. Although the prevalence of LTBI among dental students in our study was low, a risk of acquiring a work-related infection exists even in a country with a low incidence of TB. Thus, dental students should be screened to catch LTBI early on.

Evaluation of airborne respirable particulate matter and polycyclic aromatic hydrocarbon exposure of asphalt workers

Introduction : Assessment of exposure to the airborne respirable particles (PM10) and polycyclic aromatic hydrocarbons (PAHs) of asphalt manufacturing and road paving workers in the Campania region (Italy). Materials and Methods : A study was carried out during 2006 and involved 5 firms producing and employing bitumen in road paving activities. The workers studied were categorized on the basis of their job as workers in bitumen manufacturing, in road paving and in workers not exposed at bitumen fume considered like controls. Results : In the manufacturing plants the average concentrations of airborne PM10 were 1125±445 ig/m3 in the HMA manufacturing workers’ areas; 314±81 ig/m3 in the process surveyors’ cabins and 92±27 ig/m3 in the controls’ areas (administrative offices). Within the breathing zones of the worker, the average PAHs levels in air were as follows: 367±198 ng/m3 for HMA manufacturing workers; 348±172 ng/m3 for process surveyors; 21±2 ng/m3 for the controls. At the road paving sites the average airborne PM10 levels were 1435±325 ig/m3 for roller operators; 1610±356 ig/m3 for paver operators; 319±108 ig/m for the controls (traffic controllers). PAHs in the breathing zones were 1220±694 ng/m3 for the paver operators; 1360±575 ng/m3 for the roller operators’ and 139±135 ng/m3 for the traffic controllers’. The results show that the more consistent hazard for asphalt workers’ health is derived from exposure to airborne PM10 both in exposed and in non-exposed (controls) workers.