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Environment and health We are too slow in health protection actions from air pollution; this is the premise of Legambiente' s annual report Mal'aria di città 2023. This report highlights how air pollution is decreasing too slowly, putting the health of Italian citizens at risk with critical issues for some cities related to the days of exceeding the daily limit for PM10. Considering that attention should also be put to the level of other pollutants like such as those of PM2.5 and NO2. WHO has reported recent scientific evidence on the limits of concentrations not to be exceeded, and the European Air Quality Directive proposes downward limits (20 μg/mc) that should be complied with from January 2030 and that are to be considered an intermediate step from the WHO indications (15μg/mc). So there are 7 years to comply, but despite the mitigation actions put in place and tangible emission reductions, there has been no steady decline in air pollutant concentrations in virtually any city; in fact, the average rate of reduction in concentrations nationwide is only 2% for PM10 and 3% for NO2, too slow to reach the target set by the European directive for 2030. Polluted air is still being breathed for too long. As in previous issues, the main articles published in the monitored journals are summarized here, among which numerous are precisely those related to air pollution. All articles and editorials deemed worthy of attention are listed divided by topic, with a brief commentary. This issue is based on systematic monitoring of the publications of November and December 2022.

Environment and health Amid uncertainties, doubts, and lack of courage, COP 27 ended by postponing many decisions to COP 28 next year. Positive is the decision to create a fund that will be made operative by COP28 on Losses and Damages for island states, the most fragile and vulnerable in the face of climate change. Also positive is the appointment of the first youth delegate of the COP chairmanship. In contrast, the goal of mobilizing $100 billion annually for climate finance was not met, and there was no breakthrough on exiting fossil fuels. Only 33 out of 200 states then submitted plans to implement national temperature reduction commitments. The text on human rights in climate change was deleted entirely, the only positive note being the recognition of the right to a healthy, clean and sustainable environment. Little or nothing has been done on biodiversity. That said, we have no choice but to do prevention with daily actions such as those represented by the flyer attached to this issue of Environment&Health News. These actions represent our contribution to system change and mitigation and adaptation processes. As in previous issues, the main articles published in the monitored journals are summarized here, among which numerous are precisely those related to air pollution. All articles and editorials deemed worthy of attention are listed divided by topic, with a brief commentary. This issue is based on systematic monitoring of the September and October 2022 publications. comment.

Introduction: Very few studies have been published on the clinical history and contagiousness of not hospitalized Covid-19 pediatric patients. Therefore, to get deeper in this topic, between October 2020 and March 2021, we carried out an observational study in the pediatric primary care setting in Italy. Methods: The study enrolled patients with Covid-19 disease (cases); patients with suspicious symptoms but negative swab; close contacts of Covid-19 cases. The follow-up was 28 days for patients with Covid-19 disease, 14 days for the other subjects enrolled. Results: 1947 patients aged 0-13 were enrolled: 465 with Covid-19 disease; 549 with suspicious symptoms but negative swab; 933 close contacts of Covid-19 cases. 130 subjects with Covid-19 were asymptomatic at the time of diagnosis. Among the others, in children aged 0-2 the most frequent symptom was rhinitis (41%) followed by fever (38%) and cough (31%). In children aged 3-13 the most frequent symptom was headache (30%) followed by rhinitis (23%), asthenia (18%), fever (16%), cough (11%). No symptoms alone were sufficient to induce or rule out the suspicion of the Covid-19 disease diagnosis. A multiple logistic regression analysis, conducted for the purpose, allowed to build a score capable of inducing disease suspicion in patients older than 2 years of age, based on: fever, rash, rhinitis, headache and asthenia. Conclusions: This study compared subjects with SARS-CoV-2 infection with unaffected subjects with similar symptoms and confirmed that it is impossible to clinically distinguish Covid-19 from other similar respiratory diseases in pediatric age. The obtained score, potentially useful and valid during the study period, could not be applied in other epidemiological scenarios.

Environment and health The greatest will the impact of technology on our life be, the greatest will our need for nature be. This is what emerges from this bimonthly review. Some articles put in evidence the importance of soil remediations for the health of people living near polluted sites. Others articles underline children's vulnerability to the heavy metals present in street dust or the risks of pesticides for pregnant women and future offspring. Other articles emphasize the importance of environmental education to increase awareness both in children and teenagers and how activities in natural environments can help cognitive development as well as physical and mental health. Finally, it is highlighted how much work still needs to do be done to train health workers on mitigation and adaptation actions to the impacts of climate change we are experiencing. A part of this work is also up to us pediatricians, and this is one of the tasks of this review. This issue summarizes the main articles published in the monitored journals. All articles and editorials deemed worthy of attention are listed divided by topic, with a concise comment. This number is based on the systematic review of the May and June 2022 publications.

The historical hill-site zone of Prosecco's wine production was recognised as a UNESCO World Heritage Site. This area is part of the province of Treviso, an area where in recent years many lands have been occupied by the viticulture to produce this type of wine, due to a growing demand of prosecco, especially on international markets. Currently viticulture occupies 31% of the total agricultural area of the province. This is determining an important alteration of the landscape of the area, with serious loss of biodiversity. Even more, this intensive cultivation requires the use of many pesticides (in 2018, 4,622 tons were sold, equivalent to more than 36 kg per hectare of arable land), that are harmful to the health of the population. They can cause acute effects by inhalation or contact during the treatment of the vines, and chronic effects for the continuous intake of small doses through contaminated waters. To safeguard the environment and health, two actions are needed: to reduce the use of pesticides by promoting organic production; to restore biodiversity by promoting other crops besides the vineyards. Our hope is that belonging to the UNESCO heritage world list favours these actions.

Environment and health news This issue of Ambiente e salute news comes out shortly after two significant events: the COP26 which took place in Glasgow in November 2021 with media coverage inversely proportional to the results, and a support initiative, Ride for Their Lives initiative which led pediatricians and international health workers on bicycles from London to Glasgow to reiterate that individual behaviors are also indispensable to protect our planet for the future of our children, and that it is necessary for the medical profession to mobilize much more in this direction. This concept was reiterated once again by the authors and readers of the bmj, as seen in this statement: https://blogs.bmj.com/bmj/2021/10/24/we-must-protect-our-planet-for-our-childrens-future/. Our alleged powerlessness in the face of the complexity of climate change can be overcome through awareness of what we know and what we can put into practice, and this belief also supports this column: https://blogs.bmj.com/bmj/2021/10/24/the-climate-crisis-how-do-we-show-we-care/. As in the previous issues, we summarize here briefly the main articles published in the monitored journals, among which numerous are precisely those relating to climate change and air pollution. This issue is based on the systematic review of the September and October 2021 publications.

Environment and health news The column on the environment edited by the group of Pediatricians for a Possible World of the Pediatric Cultural Association opens in this issue with the summary of an important WHO document on risks related to electronic waste landfills. As in the previous issues, the main articles published in the monitored journals are then summarized. All articles and editorials deemed worthy of attention are listed divided by topic, with a concise comment. Among the many we point out an important study on the health effects of climate changes. This number is based on the systematic review of the May-June 2021 publications.

Environment and health news This issue of the heading on the environment comes out shortly from the publication of the new WHO Guidelines on Air Quality that have further reiterated the danger of air pollutants even at very low concentrations. This important document was accompanied by an article signed by 40 international associations of doctors, scientists and patients in which serious responses to this problem are asked by politics, which we invite you to read in full. As in the previous issues, the main articles published in the monitored journals are summarized here, many of which are precisely those relating to air pollution. All articles and editorials considered worthy of attention are listed by topic, with a summary comment. This number is based on the systematic review of the July and August 2021 publications.

The goal of this study was to evaluate the effectiveness of nebulized beclomethasone in preventing the recurrence of viral wheezing. METHODS: The study was designed as a randomized, double-blind, placebo-controlled trial. Outpatient children aged 1 to 5 years with at least 1 episode of viral wheezing in the last 12 months, presenting to any of 40 Italian pediatricians for an upper respiratory tract infection, were randomly allocated to receive beclomethasone 400 mg or placebo twice daily for 10 days. Medications were administered through a nebulizer. A clinical evaluation was performed by the pediatrician at the start and end of the treatment period. A subjective evaluation of symptoms and efficacy of treatment was performed by the parents. The primary endpoint was the incidence of viral wheezing diagnosed by the pediatricians during the 10-day treatment period. RESULTS: A total of 525 children were enrolled in the study, 521 of whom were visited at the end of the treatment period. Wheezing was diagnosed by the pediatricians in 47 children (9.0% (95% confi- dence interval: 6.7 to 11.3)), with no statistically significant differences between treatment groups (beclomethasone versus placebo relative risk: 0.61 (95% confidence interval: 0.35 to 1.08)).The treatment was considered helpful by 63% of parents (64% in the beclomethasone group vs 61% in the placebo group). In all, 46% of children still had infection symptoms at the end of the treatment period, with no differ- ences between groups. CONCLUSIONS: The findings from this study confirm that inhaled ste- roids are not effective in preventing recurrence of viral wheezing. Moreover, no benefits were found in reducing symptoms of respiratory tract infections. Pediatrics 2014;133:e505-e512 ABBREVIATIONS CI—confidence interval RCT—randomized controlled trial RR—relative risk URTI—upper respiratory tract infection Dr Clavenna conceptualized and designed the study, and drafted the initial manuscript; Drs Sequi and Cartabia conducted the statistical analyses, and reviewed and revised the manuscript; Drs Borghi and Fortinguerra were involved in the data management and reviewed and revised the manuscript; and Dr Bonati contributed to defining the protocol, supervised the study, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

Background An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately. Methods Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive. Results Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy. Conclusions Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.