The role of ecotoxicology in the health impact assessment: an innovative ecosystem approach for the protection of human health in Italy

Background. The Health Impact Assessment (HIA) is a procedure with the aim to protect the populations exposed to the impacts deriving from the establishment or upgrading of large industrial enterprises, i.e. large combustion plants (>300 MWth). In Italy a guideline for the HIA procedure has been published in compliance with the 2014/52/EU Directive on the Environmental Impact Assessment (EIA) requirements.Italian HIA procedure. An ecotoxicological approach has been included for the first time in the HIA procedure with the aim to detect toxic effects caused by unknown not-monitored contaminants or mixtures in the ecosystem components affected by the potential emissions, discharges and releases of large industrial enterprises. Ecotoxicology plays an important bridge role between environment and human health in the scoping and monitoring step of the HIA procedure with a key function of early warning system and screening. The aim of this paper is to present the Italian experience in the first three years of the application of the new approach, proposing recommendations on specific case studies.Conclusion and future perspective. 80% of enterprises, that applied HIA, have delivered a robust, integrated and detailed documentation in relation to the ecotoxicological assessment, this positive feedback will generate environmental and human health benefits to the areas where the plants are established

Application of effect-based methods (EBMs) in a river basin: a preliminary study in Central Italy

Introduction. Effect-based methods (EBMs), i.e. in vitro and in vivo bioassays, represent innovative tools for the effect detection of environmental chemical pollutants on living organisms. The aim of this study was to evaluate the water quality of a river ecosystem implementing two in vivo bioassays on target freshwater animal species: the crustacean Daphnia magna and the small fish Danio rerio, also known as zebrafish. Materials and methods. The methods applied in this study, i.e. the Daphnia sp. Acute Immobilisation assay and the Fish Embryo Acute Toxicity (FET) test, are commonly used in water quality research and their application in short-term ecotoxicity detection is suggested by recent European projects. Two sampling sites were chosen in the urban part of the Tiber River in Rome, while a third one was chosen as a reference site in the Farfa River, a tributary upstream of the city. The sites in the Tiber River are potentially affected by different pollution sources, including urban and industrial wastewater discharges, the pesticide release, livestock waste products, and waste dumps. Results and discussion. The results of the study showed wide differences between the two applied bioassays. The FET test was generally more sensitive in detecting even low effects in all the water samples, but the strongest statistically results were observed with the D. magna Acute Immobilisation test. The results of this research confirm the effectiveness of EBMs in investigating and monitoring water chemical pollution, and stress the need for performing further studies, e.g. chemical analyses and other bioassays, to improve the knowledge of the health status of the Tiber River basin. Conclusions. Further results will aim to support the local authorities in adopting measures to reduce and to eliminate the sources of chemical pollution in the study area

Application of effect-based methods (EBMs) in a river basin: a preliminary study in Central Italy

Introduction. Effect-based methods (EBMs), i.e. in vitro and in vivo bioassays, represent innovative tools for the effect detection of environmental chemical pollutants on living organisms. The aim of this study was to evaluate the water quality of a river ecosystem implementing two in vivo bioassays on target freshwater animal species: the crustacean Daphnia magna and the small fish Danio rerio, also known as zebrafish.Materials and methods. The methods applied in this study, i.e. the Daphnia sp. Acute Immobilisation assay and the Fish Embryo Acute Toxicity (FET) test, are commonly used in water quality research and their application in short-term ecotoxicity detection is suggested by recent European projects. Two sampling sites were chosen in the urban part of the Tiber River in Rome, while a third one was chosen as a reference site in the Farfa River, a tributary upstream of the city. The sites in the Tiber River are potentially affected by different pollution sources, including urban and industrial wastewater discharges, the pesticide release, livestock waste products, and waste dumps.Results and discussion. The results of the study showed wide differences between the two applied bioassays. The FET test was generally more sensitive in detecting even low effects in all the water samples, but the strongest statistically results were observed with the D. magna Acute Immobilisation test. The results of this research confirm the effectiveness of EBMs in investigating and monitoring water chemical pollution, and stress the need for performing further studies, e.g. chemical analyses and other bioassays, to improve the knowledge of the health status of the Tiber River basin.Conclusions. Further results will aim to support the local authorities in adopting measures to reduce and to eliminate the sources of chemical pollution in the study area

Fish-Kills in the Urban Stretch of the Tiber River After a Flash-Storm: Investigative Monitoring with Effect-Based Methods, Targeted Chemical Analyses, and Fish Assemblage Examinations

In 2020 and 2021, fish-kills events occurred in the Tiber river in the city of Rome. These events, which caused the death of thousands of fish of different species (e.g., Barbus spp., Cyprinus carpio, Squalius spp.), were preceded the days before by severe flash-storms. Heavy rains in urban areas in recent years are linked to climate change and fish-kills events. With the aim to investigate the causes of these events, effect-based methods (EBMs) and targeted chemical analyses have been performed on a specific site of river Tiber in the center of the city. Additionally, examination and classification of the floating dead fishes have been performed. The chemical analysis performed on several groups of contaminants showed the presence of some pharmaceuticals, insecticides, and PFAS at up to ng/L. Results with the Fish Embryo Toxicity (FET) test confirmed lethal and sub-lethal effects, while acute effects were not detected with the Daphnia magna acute test. The fish-kills events probably can be generated by several factors as a consequence of an increasing human anthropization of the area with the contribution of different stressors together with chemical releases and emissions. This study shows that in multiple stressor scenarios characterized by heavy rainfall, droughts, and strong anthropogenic pressures, the application of EBMs, chemical analysis, and fish assemblage examinations can represent a useful support in the investigation of the causes of extensive fish-kills events

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update

PURPOSE To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for prevention of CIPN in addition to 14 primary trials related to treatment of established CIPN, are included in this update. RECOMMENDATIONS The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment. Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited

Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

<p>Abstract</p> <p>Background</p> <p>Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008.</p> <p>Methods</p> <p>Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes.</p> <p>Results</p> <p>Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes.</p> <p>Conclusions</p> <p>Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.</p