Gastrointestinal infections are an important Public Health problem. International institutions suggest supporting traditional epidemiologic surveillance with syndromic surveillance, including the use of drug sales data monitoring. This review aims to investigate the usefulness of drug sales data as a tool for gastrointestinal infections surveillance by addressing the question “could drug sales data be a complementary contribution to traditional epidemiological GI infections surveillance?”. The bibliographic search was carried out in December 2025 using a specific string across 4 scientific literature databases (PubMed, Embase, CINAHL, Cochrane Library), according to PRISMA guidelines. Out of 5.905 publications screened, 15 met the inclusion criteria and were included in the review. The selected studies were published between 1983 and 2021, mostly conducted in Europe. Despite the wide variety of study designs, 73

Particulate matter (PM), mainly PM0.5, represents a significant concern for human health, particularly relating to lung homeostasis, and more research is required to ascertain its tissue tropism and the molecular pathways involved. In this study, we first focus on classical in vitro toxicological endpoints (cytotoxicity and cell growth) in human bronchial and alveolar epithelial cell lines mimicking the two pulmonary target tissues. Air samples were collected in five Italian cities (Brescia, Lecce, Perugia, Pisa, Turin) during winter and spring. To better decipher the PM0.5 effects on pulmonary cells, a further winter sampling was performed in Brescia, and studies were extended to assess tumour promotion, oxidative stress, and the activity of Matrix metalloproteases (MMP). The results confirmed that the effect of air pollution is linked to the seasons (winter is usually more cytotoxic than spring) and is correlated with the peculiar characteristics of the cities studied (meteoclimatic conditions, economic/anthropogenic activities). Alveolar cells were often less sensitive than bronchial cells. All PM samples from Brescia inhibited intercellular communication mediated by gap junctions (GJIC), increased the total content in glutathione, and decreased the reduced form of glutathione, whereas the Reactive Oxygen Species (ROS) content was almost constant. Long-term treatments at higher doses of PM decreased MMP2 and MMP9 activity. Taken together, the results confirmed that PM is cytotoxic and can potentially act as tumour promoters, but the mechanisms involved in oxidative stress and lung homeostasis are dose- and time-dependent and quite complex.

COVID-19 pandemic led to the adoption of a different working approach: "The remote working." Evidence about the association of remote working with stress outcomes and life quality is lacking. This systematic review provides an overview of the effects of COVID-19 pandemic on remote-workers' stress and life quality. We conducted systematic literature searches in databases including Pubmed, Scopus and Web of science, from September 2020 to September 2023. Screening of titles, abstracts, and full texts were performed according to the Preferred Reporting Item for Systematic Review and Meta-analyses. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The review highlighted possible predictors (work-family conflict or a condition of social isolation) associated with improvement or worsening of quality of life and stress. The results highlighted the association between stress and family difficulties (beta: -0.02, P-value <0.05), isolation during the first (beta: -0.22, P-value <0.05) and second pandemic waves (beta: -0.40, P-value <0.05) or due to the advancing age of workers (beta:0.19, P-value <0.05) and (beta: -0.05, P-value <0.05), furthermore some job categories presented greater stress such as teachers (16.94 +/- 5.46). Conversely, remote working positively affected life quality, enhancing factors such as creativity (Average Variance Extracted, AVE: 0.41, R2: 0.17) and self-efficacy (AVE: 0.60, R2: 0.36). Future research should focus more on the relationship between work and family and on interventions that counteract social isolation.

The present study was aimed at investigating DNA damage, micronuclei frequency and meta-nuclear alterations in buccal cells of workers involved in pigment-grade TiO2 production (15 exposed and 20 not-exposed). We also assessed associations of genotoxicity biomarkers with oxidative stress/inflammatory biomarkers in urine and exhaled breath condensate (EBC), as well as possible associations between biomarkers and reported respiratory symptoms. In spite of compliance with TiO2 Occupational Exposure Limits, results showed increased direct/oxidative DNA damage and micronuclei frequency in exposed workers. Genotoxicity parameters were associated with oxidative stress/inflammation biomarkers in urine and EBC, thus confirming that TiO2 exposure can affect the oxidative balance. Workers with higher genotoxic/oxidative stress biomarkers levels reported early respiratory symptoms suggesting that molecular alterations can be predictive of early health dysfunctions. These findings suggest the need to assess early health impairment in health surveillance programs and to address properly safety issues in workplaces where TiO2 is handled.

Climate change significantly contributes to water scarcity in various regions worldwide. While wastewater reuse is a crucial strategy for mitigating water scarcity, it also carries potential risks for human health due to the presence of pathogenic and antibiotic resistant bacteria (ARB). Antibiotic resistance represents a Public Health concern and, according to the global action plan on antimicrobial resistance, wastewater role in selecting and spreading ARB must be monitored. Our aim was to assess the occurrence of ARB, antibiotic resistance genes (ARGs), and potential pathogenic bacteria throughout a wastewater treatment plant (WWTP) designed for water reuse. Furthermore, we aimed to evaluate potential association between ARB and ARGs with antibiotics and heavy metals. The results obtained revealed the presence of ARB, ARGs and pathogenic bacteria at every stage of the WWTP. Notably, the most prevalent ARB and ARG were sulfamethoxazole-resistant bacteria (up to 7.20 log CFU mL-1) and sulII gene (up to 5.91 log gene copies mL-1), respectively. The dominant pathogenic bacteria included Arcobacter, Flavobacterium and Aeromonas. Although the abundance of these elements significantly decreased during treatment (influent vs. effluent, p < 0.05), they were still present in the effluent designated for reuse. Additionally, significant correlations were observed between heavy metal concentrations (copper, nickel and selenium) and antibiotic resistance elements (ampicillin-resistant bacteria, tetracycline-resistant bacteria, ARB total abundance and sulII) (p < 0.05). These results underscore the importance of monitoring the role of WWTP in spreading antibiotic resistance, in line with the One Health approach. Additionally, our findings suggest the need of interventions to reduce human health risks associated with the reuse of wastewater for agricultural purposes.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

The microbiological quality assessment of drinking water (DW) and drinking water sources (DWSs) is based on the detection of indicator microorganisms (IMs). However, the relationship between IMs and pathogens has been questioned, as pathogens have been detected even in the absence of IMs, and vice versa. Therefore, the aim of this review was to evaluate the reliability of IMs by analysing the correlation between the presence of IMs and pathogens in water. This review focused on studies that reported statistical analyses of the relationship between traditional and alternative IMs and enteric pathogens in DWSs (groundwater, surface water, and rainwater) and in DW. Additionally, the main DW guidelines and regulations, along with a focus on the application of Quantitative Microbial Risk Assessment (QMRA), were also reported. The overall analysis of publications revealed a controversial correlation, characterised by high spatiotemporal variability, indicating the impossibility of identifying a reliable IM for any specific pathogen or water type. The association was also influenced by numerous factors, such as intrinsic characteristics of microorganisms, seasonal variations, sample number, water sample volume, and the detection method used. In conclusion, the detection of IMs should be considered complementary to, rather than a substitute for, the detection of pathogens.

Since many waterborne diseases are caused by human pathogenic viruses,virus monitor-ing of drinking water(DW)and DW sources is crucial for public health.Therefore,the aim of this review was to describe the occurrence of human pathogenic viruses in DW and DW sources;the occurrence of two viruses proposed as novel indicators of human faecal con-tamination(Pepper mild mottle virus and Tobacco mosaic virus)was also reported.This research was focused on articles that assessed viral occurrence using molecular methods in the sur-face water used for DW production(SW-D),groundwater used for DW production(GW-D),DW and bottled-DW(BW).A total of 1544 studies published in the last 10 years were anal-ysed,and 79 were ultimately included.In considering the detection methods,filtration is the most common concentration technique,while quantitative polymerase chain reaction is the most common quantification technique.Regarding virus occurrence in SW-D,GW-D,and DW,high percentages of positive samples were reported for adenovirus,polyomavirus and Pepper mild mottle virus.Viral genomes were frequently detected in SW-D and rarely in GW-D,suggesting that GW-D may be a safe DW source.Viral genomes were also detected in DW,posing a possible threat to human health.The lowest percentages of positive sam-ples were found in Europe,while the highest were found in Asia and South America.Only three articles assessed viral occurrence in BW.This review highlights the lack of method standardization and the need for legislation updates.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Among particulate matter composing paints, titanium dioxide (TiO2) forms about 20% of the final suspension. Although TiO2 is broadly used in many applications, TiO2 powders represent an established respiratory hazard for workers with long-term exposure. In 35 workers of a paints production plant (15 exposed and 20 not exposed), we assessed pro-inflammatory cytokines (IL-1β, TNF-α, IL-10, IL-17), surfactant protein D (SP-D) and Krebs von den Lungen-6 glycoprotein (KL-6) in exhaled breath condensate (EBC). In urine samples, we measured 8-isoprostane (Isop) and Malondialdehyde (MDA) as biomarkers of oxidative stress, and Titanium (Ti-U) as a biomarker of exposure. Health status, habits and occupational history were recorded. Airborne respirable dusts and Ti were quantified. Particle number concentration and average diameter (nm) were detected by a NanoTracer™ monitoring device. Ti was measurable in filters collected at the respiratory breathing zone (0.11–0.44 µg/m3 8-h TWA). IL-1β and IL-10 values were significantly higher in exposed workers, whereas SP-D was significantly lower (p < 0.001). KL-6 was significantly higher in workers than in controls (p < 0.01). MDA levels were significantly increased in exposed workers and were positively correlated with Ti-U. Exposure to TiO2 in paint production is associated with the subtle alterations of lung pathobiology. These findings suggest the need for an integrated approach relying on both personal exposure and biomarker assessment to improve the hazard characterisation in occupational settings.

This study investigates the antibiotic resistance fate in the urban water cycle, evaluating the dynamics of antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) in three different full-scale wastewater treatment plants (WWTPs) and two drinking water treatment plants (DWTPs) located in the same geographical area (North-West of Italy). ARB (tetracycline-, ampicillin-, and sulfonamide-resistant bacteria) were quantified by plate counting and the abundances of selected ARGs (i.e., tetA, blaTEM, and sulII) and intI1 gene were measured using quantitative real-time PCR (qPCR). Higher concentrations of ARB and ARGs were observed in the WWTPs with respect to the DWTPs identifying the WWTP as hotspot for the spread of antibiotic resistances. Although a significant reduction of ARB and ARGs was observed in WWTPs and DWTPs after the treatment, none of the detected ARB or ARGs was completely removed in drinking water. The stability of the antibiotic-resistant rates between inlet and outlet associated with the reduction of relative ARG abundances underlined that both the treatments (WWTs and DWTs) did not apply any selective pressure. The overall results highlighted the importance to investigate the antibiotic resistance dynamics in aquatic ecosystems involved in urban water cycle integrating the information obtained by culture-dependent method with the culture-independent one and the need to monitor the presence of ARB and ARGs mainly in drinking water that represents a potential route of transmission to human.

Orthorexia nervosa (ON) is defined as the excessive attention on healthy eating, and studies especially focused on food quality ON prevalence in university students can be extremely variable. The objective of this study is to investigate whether there was a difference in ON risk between health-scientific, economic-humanistic, sport sciences and dietetics and nutrition students, and to evaluate if lifestyle-related ON risk factors (dieting, physical activity, drugs and supplements use) could have an impact in different ways in determining ON risk among students attending these four programs. Participants were recruited at the University of Pavia and received a two-section questionnaire including demographic and lifestyle information and the ORTO-15 questionnaire. A total of 671 students (54% F e 46% M) completed the questionnaire (median age 21.00 (IQR 20.00–23.00), median BMI 21.77 kg/m2 (IQR 20.06–23.66 kg/m2)). The 31.2% had ORTO-15 test scores < 35, and were considered at risk of having ON. No differences were found in ON risk among the students attending the four university courses. Dieting was confirmed as the major ON risk factor for health-scientific, economic-humanistic and sport sciences students. The type of sport practiced was an important determinant of ON risk only for the economic-humanistic course, while supplements use was statistically different between sport sciences students with or without ON. Our findings may suggest that lifestyle-related risk factors of orthorexia can differ among the students of distinct university courses, but these results need to be supported by further longitudinal and prospective studies.

Background Wastewater reuse represents a promising alternative source of water supply considering the water scarcity related to climate change. However, if not adequately treated, wastewater represents a source of microbiological health risk. The purpose of this work was to investigate the role of wastewater treatment on microbiological contamination by evaluating the possible risks associated with wastewater effluent reuse, taking into account new EU legislation (2020/741) on minimum requirements for water reuse. E. coli that produce Shiga toxins (STEC) and thermotolerant Campylobacter were monitored using an enrichment step associated with specific PCR, while Salmonella spp. and Legionella were detected with both cultural and molecular methods (PCR and q-PCR, respectively). Culture method was also used for the enumeration of different microbial indicators. The bacteria detection was compared in different wastewater plants with membrane bioreactor (MBR) system or with disinfection step with chlorine dioxide (ClO2). Moreover a comparison between molecular and culture methods was discussed. Results The results obtained showed good abatement performance for WWTPs equipped with MBR. The high concentrations of E. coli (range between 0.88 and 5.21 Log MPN/100 mL) and contamination by Salmonella spp. in effluent disinfected with ClO2 (17% of samples) showed the need to control the quality of this effluent. In addition, despite the absence of Legionella spp. with the culture method required by EU regulation, high concentrations of Legionella spp. (range between 2 and 7 log GU/L) and the presence of Leg. pneumophila with qPCR (15% of samples) highlight the need to carry out further investigations for reuse associated with aerosol formation (e.g. spray irrigation in agriculture). Conclusions The results obtained underline that the MBR technology can be suitable for wastewater reuse applications allowing to achieve the requirement proposed by the new European legislation. More attention should be given to wastewater reuse of effluents treated with ClO2. The use of the molecular methods for pathogens detection in wastewater could allow a more precautionary risks estimation associated with reuse. The overall results highlight that an evaluation of the effectiveness of the wastewater treatments is required for the prevention of a possible risk to public health.

Administration of questionnaires to assess the diffusion of disordered eating behaviours via the web is becoming common today. The aim of this study is to assess whether two different approaches of administering a test to assess traits of eating disorders (EDs), orthorexia nervosa (ON) and muscle dysmorphia (MD) by email recruitment and online completion (web-based survey—WBS) and by in person recruitment and paper-and-pencil completion (paper-based survey—PBS), gives different results. During 2 consecutive academic years, a self-reported questionnaire consisting of questions about personal characteristics and three tests for the evaluation of ON (ORTO-15), MD (MDDI-ITA), and EDs (EAT-26) were administered to two groups of undergraduates, respectively, as a WBS and a PBS. The WBS response rate was 6.7% (N = 137), and the PBS response rate was 86.5% (N = 372). The WBS group showed a statistically significant higher prevalence of students with eating disordered behaviours (21.2% vs 5.4%) and registered a higher mean score on the EAT-26 test (13.5 ± 11.1 vs 6.0 ± 8.0); no differences between the two groups emerged for ON and MD prevalence and test scores. Moreover, in the WBS group, the number of students with one or more tests with test scores above the cut-off values was significantly higher (46.0% vs 32.3%). The choice of the approach to administer a questionnaire to assess the diffusion of EDs and related issues must take into account all the factors that can result in selection bias and that can affect the reliability of the results. Level V, descriptive cross-sectional survey.

One source of water contamination is the release of wastewater that has not undergone efficient treatment. The aim of this study was to evaluate the reduction obtained with sodium hypochlorite (NaClO), UV and peracetic acid disinfection treatment of Salmonella spp., pathogenic Campylobacter, STEC and bacterial indicators in three full-scale municipal wastewater plants. A general reduction in Salmonella was observed after disinfection, but these bacteria were detected in one UV-treated sample (culture method) and in 33%, 50% and 17% of samples collected after NaClO, UV and PAA disinfection treatments, respectively (PCR method). A better reduction was also observed under NaClO disinfection for the microbial indicators. Independent of the disinfection treatment, E. coli O157:H7 was not detected in the disinfected samples, whereas some samples treated with UV and PAA showed the presence of the stx1 gene. No reduction in the presence of stx2 genes was verified for any of the disinfection treatments. Campylobacter was not detected in any of the analysed samples. The overall results highlight a better reduction in microbiological parameters with a NaClO disinfection treatment in a full-scale municipal wastewater plant compared with UV and PAA. However, the results indicate that a complete and specific monitoring program is necessary to prevent a possible risk to public health.

Abstract Over the past decade, several outbreaks of cryptosporidiosis have been reported in many EU countries in association with the consumption of contaminated drinking water, recreational waters, food consumption and contact with animals. The aim of this study was to evaluate the occurrence of Cryptosporidium oocysts in a drinking water treatment plant (DWTP) located in a rural area of northern Italy. Influent and effluent samples at the DWTP, together with tap water samples from a public fountain were collected for three years (2013-2016). All samples were analysed for the presence of Cryptosporidium spp. oocysts by the EPA Method 1623 based on immunomagnetic separation (IMS)/immunofluorescence assay (IFA), complemented by 4,6-diamidino-2-phenylindole (DAPI) staining. The detection has been implemented with a reverse transcriptase-PCR (RT-PCR) protocol to evaluate the oocyst viability. The results highlighted a high variability of oocyst concentrations in all samples (mean 4.3 - 5.8/100 L) and a high percentage variability of the DAPI-positive specimens (mean 48.2% - 40.3%). Conversely, RT-PCR did not reveal the presence of any viable C. parvum and C. hominis oocysts. A nested PCR targeting Cryptosporidium 18S ribosomal DNA was carried out in two water samples to deepen the understanding of the obtained results. This test revealed the presence of a particular Cryptosporidium genotype associated with wild animals in the river and in tap water. Although the recovered Cryptosporidium genotype is not a human pathogen, its presence demonstrates the existence of a potential pathogen Cryptosporidium spp. contamination risk. Moreover, these results underline the importance of considering unconventional (not bacterial) biological contaminations (protozoa) in water resources in rural areas, including those of developed countries. Key messages The supply source and the drinking water treatment plant examined represent a classic example of a system that requires continuous monitoring to guarantee population health. Cryptosporidium oocysts may still be a Public Health problem even in industrialized countries, especially in rural and mountain areas.

Abstract The global action plan on antimicrobial resistance reports the necessity to develop standards and guidance for the presence of antimicrobial agents in the environment, especially in wastewater, highlighting its possible role in the antibiotic resistance spreading. In addition, the New European One Health Action Plan against Antimicrobial Resistance underlines the need to support research into knowledge gaps on the release of resistant microorganisms into the environment and their dissemination. The aim of this study was to evaluate the presence of Antibiotic Resistance Bacteria (ARB) and Antibiotic Resistance Genes (ARG) in wastewater treatment plants (WWTPs). At this scope, untreated sewage and treated effluents of three different WWTPs (A, B and C) were sampled for one year. Sample dilutions were plated on R2Agar added/not-added with 4 different antibiotics (ampicillin 32mg/L; tetracycline 16 mg/L; chloramphenicol 32 mg/L; sulfamethoxazole 50,4 mg/L) to evaluate the percentage of antibiotic resistant bacteria and their WWTPs removal rate (%). DNA extraction on the filter used to concentrate the wastewater samples was performed to reveal the ARG presence; subsequently specific PCRs for ARG (blaTEM, tetA, sul II, sul III) were carried out. ARB were detected in all samples analysed. The highest antibiotic resistance percentage was revealed in the sewage (mean 21,7%±4,8) and effluent (mean 21,1%±3,0) of the three wastewater treatment plants for sulfamethoxazole. Moreover, sul II was the most present gene in the samples (81% of all samples, 89 % of sewages and 72% of effluents). The lower WWTPs removal was recovered in the plant B for the tetracycline (95, 7%). The results obtained underlines the need to monitor WWTP as critical hot spot for the antibiotic resistance spreading also considering the One Health approach. Furthermore, the results obtained could suggest interventions to reduce the spread of the antibiotic resistance in the integrated urban water cycle. Key messages The information obtained could provide usefulness information about the role of wastewater treatment plant in the antibiotic resistance spreading. The results could contribute to suggest the interventions targeted to reduce the antibiotic resistance phenomenon in the integrated urban water cycle.