Istituto Superiore Di Sanita Research Articles

Alcohol, youth and sport: recommendation and good practice examples from the FYFA European project.

Focus on Youth Football and Alcohol (FYFA) is a European project (EC, 3rd Health Program, HP-PJ-2016) involving research institutions from Belgium, Finland, Italy, Poland, Slovenia and the UK. The Istituto Superiore di Sanità (ISS), was the project leader of Work Package 5: "Review of national policies and practice in six Member States related to alcohol, young people, sport, marketing and football." The aim of WP5 was to determine the status quo of the policies and practices to reduce heavy episodic drinking related to young people, alcohol and sport at national level. This work investigates knowledge, attitudes and perceptions of experts from sport settings and from the prevention area giving insights on the perceived obstacles and facilitators, whenever available, to promote strategies to reduce alcohol related harm in youth within sport contexts. The presented work describes laws, regulations and attitudes. Furthermore, the results help identifying areas requiring development, highlighting examples of good practices. It emerges that prevention of alcohol-related harm to youth is important within sport settings and should be a priority for all FYFA countries. Despite the presence of regulations, there is a low level of knowledge and enforcement at national level and in the sport contexts; and there is the need of cooperation across organizations to implement alcohol policies for youth within sport settings. More efforts and resources are needed to overcome the main obstacles for effective implementation of alcohol policies, such as regulations on advertising and sponsorship, and alcohol selling, serving and consumption for young players. It is necessary to implement information strategies, prevention initiatives, training programs and to support the dialogue between sporting and prevention settings.

How can we manage the COVID-19 infodemics? A case study targeted to health workers in Italy.

The Istituto Superiore di Sanità (ISS) has been asked for rapid technical and scientific advice to the State and Regions during Sars-CoV-2 pandemic preparedness. An ad hoc Working Group on Scientific Literature updates (WG SL) was set up at ISS (March-May 2020) to screen pre-prints and peer reviewed papers from arXiv, medRxiv, bioRxiv, and Pubmed to provide a real time knowledge and empirical evidence addressed to health-workers. The WG SL screened a total of 4,568 pre-prints and 15,590 peer reviewed papers, delivered as daily summary report of pre-print selection for ISS President activity in the National Scientific Technical Committee framework and a weekly open access publication (COVID Contents) on peer-reviewed papers of interest for health professionals, monitored by a satisfaction questionnaire. Promoting heath literacy, with a cross-cutting approach is a powerful heritage of Public Health Institutes and a proven effective non pharmacological intervention.

Correlation between flu and Wikipedia's pages visualization.

Introduction:This study aimed to assess if the frequency of the Italian general public searches for influenza, using the Wikipedia web-page, are aligned with Istituto Superiore di Sanità (ISS) influenza cases.Materials and Methods:The reported cases of flu were selected from October 2015 to May 2019. Wikipedia Trends was used to assess how many times a specific page was read by users; data were extracted as daily data and aggregated on a weekly basis. The following data were extracted: number of weekly views by users from the October 2015 to May 2019 of the pages: Influenza, Febbre and Tosse (Flu, Fever and Cough, in English). Cross-correlation results are obtained as product-moment correlations between the two times series.Results:Regarding the database with weekly data, temporal correlation was observed between the bulletin of ISS and Wikipedia search trends. The strongest correlation was at a lag of 0 for number of cases and Flu (r=0.7571), Fever and Cough (r=0.7501). The strongest correlation was at a lag of -1 for Fever and Cough (r=0.7501). The strongest correlation was at a lag of 1 for number of cases and Flu (r=0.7559), Fever and Cough (r=0.7501).Conclusions:A possible future application for programming and management interventions of Public Health is proposed.

The TOP-IMPLART project

A new proton therapy center is planned to be built in Rome, Italy. The project, named TOP-IMPLART, is developed by three institutions, ENEA (Agenzia Nazionale per le Nuove tecnologie, l’Energia e lo Sviluppo Economico Sostenibile - Italian national agency for new technologies, energy and sustainable economic development), ISS (Istituto Superiore di Sanita, Italian National Institute of Health) and IFO-IRE (Istituto Fisioterapico Ospedaliero - Istituto Regina Elena, Regina Elena, National Cancer Institute in Rome). The project is centered on a medium-energy proton accelerator designed as a sequence of linear accelerators. Two phases of construction are foreseen: the first (funded by the Italian Regione Lazio for 11 M€ spread over four years) with a maximum energy of 150 MeV and the second one up to 230 MeV. The segment up to 150 MeV is under construction and will be tested at the ENEA Research Center in Frascati before the transfer to IFO that is the clinical user. The basic concepts of the design are described here.

HIV Evolution: A Quantification of the Effects Due to Age and to Medical Progress

This paper offers an analysis of HIV/AIDS dynamics, defined by CD4 levels and Viral load, carried out from a macroscopic point of view by means of a general stochastic model. The model focuses on the patient's age as a relevant factor to forecast the transitions among the different levels of seriousness of the disease and simultaneously on the chronological time. The third model considers the two previous features simultaneously. In this way it is possible to quantify the medical scientific progresses due to the advances in the treatment of the HIV. The analyses have been performed through non-homogeneous semi-Markov processes. These models have been implemented by using real data provided by ISS (Istituto Superiore di Sanita, Rome, Italy). They refer to 2159 subjects enrolled in Italian public structures from September 1983 to January 2006. The relevant results include also the survival analysis of the infected patients. The computed conditional probabilities show the different responses of the subjects depending on their ages and the elapsing of time.

TRICHINELLA MURRELLI IN SCAVENGING MAMMALS FROM SOUTH-CENTRAL WISCONSIN, USA

Tissues and serum from 59 raccoons (Procyon lotor), 42 coyotes (Canis latrans), and seven Striped Skunks (Mephitis mephitis) collected in Dane and Iowa Counties, Wisconsin, USA, between October 2005 and March 2006 were microscopically and serologically examined for the presence of Trichinella spp. Encapsulated larvae were found on compression slides prepared from tongue tissues from a few animals. Complete tissue digestion of tongues revealed that 19% of the raccoons, 26% of the coyotes, and none of the seven skunks tested were infected with Trichinella spp. Cats were subsequently experimentally infected by feeding them the raccoon tissues containing muscle larvae, and muscle larvae isolated from the collected tongues were experimentally transmitted to mice. Multiplex polymerase chain reaction analysis of the isolated muscle larvae demonstrated two distinct bands migrating at 127 base pairs (bp) and 316 bp in all samples, which together are diagnostic for Trichinella murrelli; the isolates were assigned Istituto Superiore di Sanita (ISS) codes ISS1656 through ISS1667, and ISS1708 through ISS1710 by the International Trichinella Reference Centre. These findings extend the geographic range of T. murrelli into Wisconsin, USA.

Tropical Disease Follows Mosquitoes to Europe

EPIDEMIOLOGY For years, medical entomologists have worried that the astonishing ascent of the Asian tiger mosquito ( Aedes albopictus ) might bring not only nasty bites but also new public health surprises. After all, the mosquito is a known vector for more than 20 viral diseases. They were right. This summer, the mosquito, which has become firmly established in southern Europe, has infected almost 200 people in Italy with chikungunya, a painful viral disease. It's the first known example of chikungunya transmission outside the tropics—and it's making scientists wonder whether A. albopictus has the potential to touch off much larger outbreaks in Europe and the United States. Chikungunya is rarely fatal but can cause severe fevers, headaches, fatigue, nausea, and muscle and joint pains. People started falling ill in Castiglione di Cervia and Castiglione di Ravenna—two villages separated by a river in the province of Ravenna—in early July, says Antonio Cassone of the Istituto Superiore di Sanita (ISS), a national government lab in Rome. But most patients' symptoms were mild and resembled those of other diseases, such as the Toscana virus, so health officials didn't notice for a while. Samples reached ISS on 27 August, and the virus was identified the next day. Epidemiological detective work suggests that the index patient was a man who traveled to one of the villages and became sick there, after having been infected in India. Isolation and sequencing of the virus are under way to confirm that theory, Cassone says. One patient, an 83-year-old man with severe preexisting medical problems, has died. Chikungunya sickened more than one-third of the almost 800,000 inhabitants of La Reunion, a French island in the Indian Ocean, in 2005 and 2006 ( Science , 24 February 2006, p. [1085][1]). India suffered an explosive outbreak in 2006 with more than 1.25 million cases, although some believe the real toll is much higher. Several European countries had seen “imported” cases of chikungunya lately, but local transmission in Europe has never been observed before. “It's fascinating,” says entomologist Paul Reiter of the Pasteur Institute in Paris. A daytime biter, A. albopictus originated in Southeast Asia and has made impressive strides across the globe in the past 2 decades. It was first found in the United States in secondhand tires imported from Asia in Houston, Texas, in 1985; today, it has spread to more than 20 southern and eastern states. In Europe, the mosquito has appeared in Mediterranean countries from Greece to Spain and as far north as the Netherlands. Its eggs often hitch a ride with plants shipped in water containers, such as the popular Lucky bamboo. ![Figure][2] Six-legged stowaway. Aedes albopictus frequently travels in shipments of plants such as Lucky bamboo. CREDITS (TOP TO BOTTOM): TIM ROBERTS/GETTY IMAGES; GETTY IMAGES It's too early to tell whether chikungunya now has a permanent foothold in Europe. New cases have slowed to a trickle, says Cassone, in part because the mosquito population is dwindling as temperatures drop. A critical question is whether infected mosquitoes can survive the winter or pass on the virus to their offspring via their eggs, says Reiter. “If they can, we might see a rip-roaring epidemic next year,” he says. Even if they can't, any newly imported case could kick off an outbreak in the future. There are no drugs or vaccines against chikungunya, but the outbreak at La Reunion triggered renewed interest in an old vaccine candidate developed in the 1980s by a U.S. Army lab in Fort Detrick, Maryland. Scientists at three French government institutions are now working on that vaccine, and new clinical trials might begin before the end of 2008, says epidemiologist Antoine Flahault, who chaired a French task force on chikungunya last year. [1]: /lookup/doi/10.1126/science.311.5764.1085a [2]: pending:yes

Proposal of a Model for Prevention and Treatment of Congenital Toxoplasmosis

Die richtige Vorgehensweise bei der Prävention und Behandlung angeborener Toxoplasmose ist immer noch umstritten, und es gibt noch keinen Konsens in Bezug auf pränatale Untersuchungen und diagnostische Tests. Tritt diese Infektion während einer Schwangerschaft auf, ist eine multidisziplinäre Herangehensweise erforderlich. Heutzutage werden akkurate diagnostische Tests sowie die landesweite Erhebung von epidemiologischen Daten zu dieser Infektion benötigt, um ein richtiges und Kosten sparendes Protokoll für Diagnose, Behandlung und Nachsorge zu entwickeln. Wir berichten hier über unsere Erfahrungen mit einem regionalen, multidisziplinären Modell für die pränatale Diagnose von Toxoplasmose. Das Modell wurde gemäß den Nationalen Richtlinien des Istituto Superiore di Sanitá (ISS) entwickelt.

Mycobacterium tuberculosisDrug Resistance, Abkhazia

To the Editor: Drug-resistant tuberculosis (TB) has been identified as a major problem in the former Soviet Union, and was recently surveyed in the Aral Sea regions of Dashoguz (Turkmenistan) and Karakalpakstan (Uzbekistan) (1). However, few data are available for the Caucasian region and published reports have focused mainly on prisons (2,3). We report a drug resistance survey for first- and second-line anti-TB drugs conducted in Abkhazia, a Caucasian region of 8,600 km2 with approximately 250,000 inhabitants, at the western end of Georgia on the Black Sea. The collapse of the Soviet Union lead to disruption of TB control activities in all Eastern bloc regions (4). In Abkhazia, the shortage and poor quality of drugs, self-medication, and poor adherence to the therapy became even more evident during the war with Georgia in 1993 and the international embargo that followed. A TB program based on the World Health Organization/International Union against Tuberculosis and Lung Disease (WHO/IUATLD) recommendations was initiated in Abkhazia with the support of Medecins Sans Frontieres (MSF) in 1999. In 2000, monitoring of drug resistance was started for new cases and previously treated case-patients. The study was performed in collaboration with the Guliripchi TB Hospital, MSF, and the Istituto Superiore di Sanita (ISS), a WHO/IUATLD Supranational Reference Laboratory for anti-TB drug resistance. Sputa were collected from all patients attending Guliripchi TB Hospital in Sukhumi, the capital of Abkhazia, from September 2000 to April 2004. Patients were either referred by their practitioners or came spontaneously because TB was suspected. Diagnosis, treatment, and hospitalization were provided free. Samples were treated as previously described (5). Of 489 sputa collected from individual patients, 447 were culture positive (246 from new case-patients and 201 from previously treated case-patients) and 42 were culture negative; of these, >90% showed a negative, doubtful, or 1+ smear result. Susceptibility to first-line (streptomycin, isoniazid, rifampin, and ethambutol) and second-line (kanamycin, ethionamide, capreomycin, cycloserine, p-aminosalicylic acid, and ofloxacin) drugs was determined by the proportion method on Middlebrook 7H10 agar. The critical concentrations used were streptomycin, 2 µg/mL; isoniazid, 0.2 µg/mL; rifampin, 1 µg/mL; ethambutol, 5 µg/mL; kanamycin, 5 µg/mL; ethionamide, 5 µg/mL; capreomycin, 10 µg/mL; p-aminosalicylic acid, 2 µg/mL; and ofloxacin, 2 µg/mL (6–8). Cycloserine was used at a concentration of 30 µg/mL (9). If a strain was resistant to >1 first-line drugs, the susceptibility to all second-line drugs was determined. Data on resistance to the first- and second-line drugs are given in the Table. The strains isolated from 35.8% of the new cases and 57.2% of the previously treated case-patients were resistant to >1 first-line drugs. The highest monoresistance was seen for isoniazid and streptomycin in both new and previously treated case-patients, while monoresistance to rifampin and ethambutol was low ( 1 second-line drugs. Table First-line and second line antituberculosis drug resistance in 447 Mycobacterium tuberculosis strains collected in Abkhazia from September 2000 to April 2004* Few data have been reported on drug resistance to first- and second-line drugs in the former Soviet Union and in the Caucasian region (1–4). Overall, in Abkhazia, monoresistance to isoniazid was higher than in Karakalpakstan and Dashoguz (1), while monoresistance to streptomycin was lower. MDR-TB in new and previously treated case-patients showed levels intermediate between these 2 regions. Resistance to kanamycin and ethionamide was 14.3% and 12.8%, respectively, while resistance to ofloxacin was low (1.5%). Fluoroquinolones have not been commonly used in Abkhazia and former regions of the Soviet Union. Currently, regimens for the treatment of MDR-TB in Abkhazia combine an intensive phase for a minimum of 6 months with at least 4 drugs to which the MTB strain is susceptible, including 1 parenteral agent and 1 fluoroquinolone (ofloxacin), followed by a continuation phase of at least 15 months with >3 drugs. This is the first survey reporting drug susceptibility data for MTB within the Caucasus. It indicates that the prevalence of MDR strains is similar to that in other central Asia regions (1). Our results are representative of the present situation in Abkhazia since sampling systematically covered all TB cases for the period examined. The Guliripchi TB Hospital of Sukhumi is the only TB treatment center in the region, and all cases were included in the study. Overall, our data show that second-line drug resistance is present in Abkhazia, particularly among cases with MDR, and suggest the adoption of strategies for access and correct use of second-line drugs (10).

Calibration of HCV Working Reagents for NAT Assays against the HCV International Standard

Abstract Background and Objectives: Five HCV RNA reference reagents, the Paul Ehrlich Institut (PEI) reference 75, the National Institute for Biological Standards and Control (NIBSC) reagent 96/586, the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service (CLB) Pelispy HCV RNA run control S2001, the Istituto Superiore di Sanita (ISS) reagent 0498 and the CBER panel member No. 1, were calibrated against the WHO International Standard, 96/790. Materials and Methods: The reference materials were calibrated in a collaborative study organised by NIBSC. Nineteen laboratories, using a range of qualitative and quantitative assays returned results. Results: The concentrations of the reagents were: 25,000 IU/ml for the PEI material, 710 IU/ml for the NIBSC material 96/586, 1,000 IU/ml for the CLB material, 1,700 IU/ml for the ISS material 0498 and 250 IU/ml for the CBER panel member No. 1. Conclusions: The calibration of these five reference reagents for HCV RNA nucleic acid amplification technology (NAT) assays enables them to be used for standardisation and validation of assays. Such calibrants are essential for meeting the requirements of the European Medicinal Evaluation Agency (EMEA) for the testing of plasma pools and donations for HCV RNA for the release of blood products and the PEI requirements for the release testing of erythrocyte and thrombocyte concentrates.

A primary exposure standard for X-rays in the (30÷150) keV range

The primary exposure standard for medium-energy X-rays of the Istituto Superiore di Sanita (ISS) is described with particular attention to some innovatory details. Methods for intercalibrating exposure standards from various national primary-standard laboratories are discussed. The results of a comparison between the ISS exposure standard and that of the Bureau International des Poids et Mesures performed in 1983 are presented.