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IntroductionThe persistence of Acinetobacter baumannii in the contaminated environment is sustained by tolerance to biocides and ability to growth as biofilm. The aim of the study was to analyze the susceptibility of A. baumannii biofilms to chlorhexidine (CHX) and benzalkonium (BZK) biocides and the ability of natural monomeric stilbenoid resveratrol (RV) to modulate the phenomenon.MethodsBiofilm formation and preformed biofilm were tested by Crystal violet and tetrazolium salt reduction assay, respectively. Analysis of efflux pump (EP) expression during biofilm growth was performed by Real-time RT-PCR assays.ResultsCHX and BZK at ¼ and ½ MICs alone or in combination inhibited biofilm growth of A. baumannii ATCC 19606, 4190, and 3909 strains. RV at 32 mg/L and CHX and BZK at ¼ or ½ MICs showed a synergistic effect and completely inhibited biofilm formation in all A. baumannii strains. Similarly, RV at 32 mg/L and CHX and BZK at ½ MIC significantly inhibited air-liquid biofilm formation of A. baumannii ATCC 19606, 4190 and 3909 strains. The inactivation of AdeB and AdeJ RND EPs in A. baumannii ATCC19606 increased the susceptibility to CHX and BZK alone or in the presence of 32 mg/L RV. Concordantly, carbonyl cyanide m-chlorophenylhydrazine (CCCP) increased the susceptibility to CHX, BZK and RV and dose-dependently inhibited biofilm formation in A. baumannii ATCC 19606, 4190 and 3909 strains. RV at 32 mg/L inhibited basal and CHX-induced EP genes expression, while increased EP gene expression in the presence of BZK during A. baumannii ATCC19606 biofilm growth. In addition, CHX and BZK alone or in combination dose-dependently reduced preformed biofilm of all A. baumannii strains. The combination of RV with CHX and BZK additively decreased minimal biofilm eradicating concentrations in A. baumannii strains.ConclusionThese results demonstrate that: (i) CHX and BZK alone or in the presence of RV inhibit biofilm growth and preformed biofilm in A. baumannii; (ii) tolerance to CHX and BZK during biofilm growth is dependent on the activation of AdeB and AdeJ EPs; and (iii) the inhibitory effect of RV on biofilm growth is mediated by the inhibition of EP genes expression in A. baumannii.

BackgroundAlzheimer’s and other neurodegenerative forms of dementia affect 8 million Europeans. Assistive technologies are suggested to reduce the burden of care and improve the quality of life of person living with dementia. Nonetheless, the acceptance and attitudes toward technological interventions pose challenges not only for people living with dementia and caregivers but also for healthcare workers. This review specifically aims to investigate how these key groups perceive and accept technology in European dementia care settings.MethodsThis systematic review was conducted to identify studies, published between 2013 and 2023, that examined the acceptance and attitude of assistive technologies in Alzheimer’s and other dementia European settings, following the PRISMA guidelines. Rayyan AI was used for data extraction, and bias was assessed using the Mixed Methods Appraisal Tool.ResultsAmong the 1,202 identified articles, 13 met the inclusion criteria, revealing a prevailing positivity toward technological interventions in dementia care. Nonetheless, several barriers to adoption, including technological unfamiliarity, and specific dementia-related symptoms that complicate usage were identified. They also unveiled varying attitudes, influenced by factors such as familiarity with technologies, perceived usefulness, and the broader context of the COVID-19 pandemic which accelerated telemedicine and digital solution acceptance during restricted mobility and social distancing.ConclusionUnderstanding attitudes toward technology in dementia care is crucial as it influences the adoption and utilization of tech-based interventions, impacting symptom management and quality of life. Addressing these attitudes through tailored interventions and education can enhance well-being and quality of life for people living with dementia, caregivers, and healthcare professionals.

Abstract Background Overuse of pesticides is a major worldwide problem for the environment and human health. Atrazine (ATR) is a synthetic triazine herbicide that is typically used to manage crops and although it was banned many years ago, it was detected frequently with a high persistence in the aquatic environments. This study assesses the human and environment health risks, temporal patterns and spatial distribution of ATR and its degradation products (DPs) in the Sele River estuary within the Southern European context.. It specifically investigates their occurrence in the water dissolved phase (WDP), suspended particulate matter (SPM), and sediment. Results Sampling was conducted across 10 sites throughout the year’s four seasons. Amounts of ATR and its DPs detected ranged from 20.1 to 96.5 ng L−1 in WDP, from 5.4 to 60.2 ng L−1 in SPM, and from 4.7 to 19.8 ng g−1 in sediment samples, signifying some pollution levels. Spatial distribution mechanisms revealed a southward movement of ATR and its DPs pollution from the Sele River mouth, intensifying during the rainy season. In this study area, a risk evaluation was also carried out. No sample contained ATR or its DPs in concentrations above the recommended limits, which pose a Non-carcinogenic and Carcinogenic risk. The environmental risk was low. Additionally, the determined Incremental lifetime cancer risk (ILCR) value was within the allowable range. Conclusion Despite its long-standing prohibition, this study investigate ATR levels in the water and sediments of Sele River in Southern Europe. Beyond simply delineating the pollution status of Sele River, this research delineates its ecological repercussions on the Thyrrenian Sea, providing essential data for norms and laws related to water contamination. Graphical Abstract

Background: We aim to provide up-to-date real-world evidence on the persistence, adherence, healthcare resource utilization, and costs of multiple sclerosis (MS) by comparing ocrelizumab to other disease-modifying treatments (DMTs) and within different DMT sequences. Methods: We included 3371 people with MS who first received or switched DMT prescriptions from January 2018 to December 2022; they were identified through hospital discharge records, drug prescriptions, and exemption codes from the Campania Region (South Italy). We calculated persistence (time from the first prescription to discontinuation or switching to another DMT), adherence (proportion of days covered (PDC)), DMT costs, and MS hospital admissions and related costs. Results: The most frequently prescribed DMT was dimethyl fumarate (n = 815; age 38.90 ± 11.91 years; 69.5% females), followed by ocrelizumab (n = 682; age 46.46 ± 11.29 years; 56.3%); 28.8% of the patients treated with ocrelizumab were naïve to DMTs. Using ocrelizumab as a statistical reference, the risk of discontinuation was higher for other highly active (HR = 6.32; 95%CI = 3.16, 12.63; p < 0.01) and low-/medium-efficacy DMTs (HR = 10.10; 95%CI = 5.10, 19.77; p < 0.01); adherence was lower for other highly active DMTs (Coeff = −0.07; 95%CI = −0.10, −0.04; p < 0.01) and low-/medium-efficacy DMTs (Coeff = −0.16; 95%CI = −0.19, −0.14; p < 0.01). monthly DMT costs were higher for other highly active DMTs (Coeff = 77.45; 95%CI = 29.36, 125.53; p < 0.01) but lower for low-/medium-efficacy DMTs (Coeff = −772.31; 95%CI = −816.95, −727.66; p < 0.01). The hospital admissions and related costs of MS were similar between ocrelizumab, other highly active DMTs, and other low-/medium-efficacy DMTs, and with ocrelizumab as the first-line DMT after other highly active DMTs and after low-/medium-efficacy DMTs, which was possibly due to the low number of observations. Conclusions: From 2018 to 2022, ocrelizumab was among the most frequently prescribed DMTs, with 28.8% prescriptions to incident MS patients, confirming its relevance in clinical practice. Ocrelizumab was associated with the highest persistence and adherence, pointing towards its favorable benefit–risk profile. The costs of ocrelizumab were lower than those of other highly active DMTs.

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) have well-known adverse effects, and numerous studies have shown inappropriate behaviors regarding their use. The primary aim of this study was to analyze the knowledge, attitudes, and behaviors regarding the use of NSAIDs simultaneously in one of the largest and most populated areas of Italy, Naples.MethodsFrom 2021 December 14th to 2022 January 4th, a cross-sectional survey study was conducted among community centers, working places, and universities using a snowball sampling method. For inclusion in the study, the participants were required to be at least 18 years old and residents in the metropolitan area of Naples. Three multiple linear regression analysis (MLRA) models were developed by including variables that could potentially be associated with the following outcomes of interest: knowledge (Model I), attitudes (Model II), and behavior (Model III) regarding the use of NSAIDs.ResultsData were acquired from 1,012 questionnaires administered to subjects evenly divided by gender with an average age of 36.8 years and revealed that only 7.9% of the participants self-admittedly did not take NSAIDs, while approximately half the participants (50%) admitted to occasionally using them. The results showed a statistically significant correlation between attitudes regarding the appropriate use of NSAIDs and less knowledge. The regression analyses indicated that behaviors regarding the appropriate use of NSAIDs were statistically significant in younger respondents, non-smokers, and those without children. These interesting results showed that behaviors regarding the appropriate use of NSAIDs were significantly higher among respondents with less knowledge and more positive attitudes.ConclusionAccording to the collected data and statistical analysis results, it is possible to identify factors that can greatly affect inappropriate behaviors regarding the use of NSAIDs and establish targeted prevention programs.

Introduction: Vaccines are the most cost-effective and straightforward intervention against severe infectious diseases. However, in Europe and in Italy, paediatric vaccination coverage for certain vaccines remains suboptimal, with considerable regional differences in Italy. Vaccine coverage varies significantly due to socio-economic and organisational factors. Aim of this study was to assess the influence of the Deprivation Index, the density of General Practitioners and General Paediatricians per inhabitants on the coverage of both mandatory and non-mandatory paediatric vaccinations across local health authorities and health districts in the Campania Region for birth cohorts from 2001 to 2015. Materials and methods: Population-based, ecological time series analysis focusing on the Campania Region, most populous region in the south of Italy. Vaccination coverage data were extracted from the regional immunization database, whilst information on the Deprivation Index and number of primary care doctors and primary care paediatricians per local health district were extracted from public health records. Univariate descriptive statistics were employed to describe study characteristics, as appropriate, whilst and mixed-effect linear regression models were employed to assess the associations between variables of interest and vaccination coverage. Results: Overall vaccination coverage has generally increased, except for the MMR vaccine, which showed coverage fluctuations. An increase in the Deprivation Index, indicative of less favourable socio-economic conditions, was associated with decreased vaccination coverage in the 24-month age group for some mandatory vaccines (DTaP: Coef −0.97, 95% CI −1.77 | −0.17; Poliomyelitis: Coef −0.98, 95% CI −1.78 | −0.17; Hepatitis B: Coef −0.90, 95% CI −1.71 | −0.10). Moreover, areas with a greater density of General Paediatricians per inhabitants saw increased coverage for Haemophilus influenzae type b in the 6-year age group (Coef 9.78, 95% CI 1.00 | 18.56). Conclusions: It is necessary to target public health policies to address vaccination inequalities. These efforts should include expanding vaccination campaigns, enhancing catch-up programs, and increase resource allocation in primary care settings to facilitate the role of General Practitioners and Paediatricians in fostering awareness and adherence.

Despite the extensive use of recycled polyethylene terephthalate (rPET) in food contact materials (FCMs), research on the presence of heavy metals (HMs) and rare earth elements (REEs) during various recycling stages (e.g., flakes, granules, and preforms) remains limited. This study aimed to address these gaps by validating a rapid and sensitive analytical method to quantify 26 HMs and 4 REEs in PET and rPET matrices. An ICP-MS method was validated per EURACHEM guidelines, assessing linearity, limits of detection (LOD), limits of quantification (LOQ), accuracy, and repeatability. The method was employed for initial screening of HMs and REEs classified as non-intentionally added substances (NIASs) in PET and rPET samples. The findings showed high accuracy and reliability, with recovery rates between 80% and 120%. Analysis revealed varying concentrations of HMs and REEs, with the highest levels in 100% rPET preforms, notably Zn, Cu, and Al among HMs, and La among REEs. The study identified critical contamination points during the recycling process, highlighting the need for targeted interventions. This research provides a crucial analytical framework for assessing HMs and REEs in PET and rPET, ensuring FCM safety compliance and supporting efforts to enhance rPET product safety, promoting public health protection and advancing the circular economy.

Ensuring air quality in operating rooms is crucial for the health and safety of healthcare professionals and patients. This study, focused on 141 operating theatres in the Campania Region from 2015 to 2022, highlights the importance of air monitoring in operating rooms. Microclimatic parameters, air exchanges, thermal comfort indices, air pressure differences, and anesthetic gas concentrations were measured using standardized procedures. Results indicate that 19% of microclimatic checks exceeded acceptable limits, with significant non-compliance in air velocity (0.01–0.04 m/s, mean 0.03 m/s) and air changes (1–14 h−1, mean 6 h−1). Additionally, levels of anesthetic gases such as nitrous oxide (54.7–197.31 ppm, mean 142.92 ppm) and sevoflurane (2.05–19.45 ppm, mean 5.90 ppm) frequently exceeded recommended exposure limits, raising health concerns. These findings underscore the importance of rigorously adhering to environmental standards and continuously monitoring for optimal conditions in operating rooms. The study also stresses the necessity of ongoing education and training for healthcare personnel on preventive measures to reduce risks. In conclusion, maintaining optimal environmental conditions not only safeguards the comfort and safety of healthcare professionals and patients, but also improves team productivity and clinical outcomes. The study advocates for regularly updating national guidelines and rigorously enforcing safety protocols in healthcare facilities.

Background: COVID-19 pandemic represented a unique stressful event that affected the physical health and psychological well-being (PWB) of individuals and communities. Monitoring PWB is essential not only to clarify the burden on mental health effects but also to define targeted psychological-supporting measures. This cross-sectional study evaluated the PWB of Italian firefighters during the pandemic. Methods: Firefighters recruited during the pandemic period filled out a self-administered questionnaire, the Psychological General Well-Being Index, during the health surveillance medical examination. This tool is usually used to assess the global PWB and explores six subdomains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. The influencing roles of age, gender, working activities, COVID-19, and pandemic restrictive measures were also explored. Results: A total of 742 firefighters completed the survey. The aggregate median PWB global score was in the “no distress” range (94.3 ± 10.3), which was higher than that observed in studies conducted using the same tool in the Italian general population during the same pandemic period. Similar findings were observed in the specific subdomains, thus suggesting that the investigated population was in good PWB condition. Interestingly, significantly better outcomes were detected in the younger firefighters. Conclusion: Our data showed a satisfactory PWB situation in firefighters that could be related to different professional factors such as work organization and mental and physical training. In particular, our results would suggest the hypothesis that in firefighters, maintaining a minimum/moderate level of physical activity (consisting of even just going to work) might have a profoundly positive impact on psychological health and well-being.

IntroductionDespite proven efficacy, HPV vaccination coverage is still suboptimal. Factors influencing vaccination uptake are education attainment, socio-economic position, and knowledge about HPV. This study aimed to assess HPV vaccination uptake and its correlates among medical students and identify logistic-organizational barriers, knowledge, and attitudes with regard towards HPV vaccination to improve current public health vaccination strategies. Medical students, with their acquired biological knowledge, were selected as a low-risk groups for HPV vaccination uptake. This cross-sectional study was conducted using a validated questionnaire.MethodsStudents in their the first 3 years of study students were preferentially invited. Eventually, the invitation was extended to every medical student. Logistic multivariable regression was used to assess determinants of HPV vaccination uptake. Additional analysis explored determinants of knowledge of and attitude toward HPV vaccination. Finally, a sensitive analysis was conducted to further assess the effect of knowledge and attitude on the HPV vaccination rate.ResultsA total of 882 medical students participated, with 74.5% enrolled in the first 3 years of their training. HPV vaccination uptake was 55.5%, ranging from 78.5% for females to 16.5% for males. Male sex and increasing age were consistently associated with a lower vaccination uptake (males sex: OR 0.03, CI 0.02–0.05; age: OR 0.77, CI 0.68–0.88), whereasilst progress in their academic career was associated with a to higher likelihood of being vaccinated (6th year: OR 3.45, CI 1.24–9.57). These associations were confirmed when considering the knowledge of and attitude towards HPV. Additionally also, an active outreach from healthcare institutions was associated with a higher likelihood of receiving HPV vaccination (OR 1.70, CI 1.09–2.65.ConclusionHPV vaccination in medical students was higher than in the general population; however, it was still suboptimal. An active and up-to-date call strategy and extending the free-of-charge offer are essential measures for to improvinge vaccination uptake. The findings support the need to improve public health strategies and increase awareness and knowledge ofregarding HPV vaccination.