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Medicina
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Risk Assessment and Risk Management of Toxic Pollutants: A One...
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Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 29176

Special Issue Editor

Dr. Alberto Mantovani

grade E-Mail Website
Guest Editor
Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, viale Regina Elena, Roma, Italy
Interests: food; nutrition and health; environment and health; transdisciplinary collaboration approaches

Special Issue Information

Dear Colleagues,

The recognition of public health risks due to chemical substances is established in industrialized countries, and substantial regulations are in place. Undoubted progress is being made, but pollutants remain in the environment notwithstanding regulations, and significant knowledge gaps exist, such as: a One Health framework linking environment, food chains, and human health; risk assessment and risk analysis in the new scenarios of emerging countries; and health risk prevention in uncertainty-laden situations such as emerging risks.

This Issue aims to provide an overview of interdisciplinary case studies on the assessment and management of public health risks from substances, with a special attention toward One Health approaches and emerging data-poor issues.

The recent history of the prevention of health risks from toxicants faces a series of emerging problems (endocrine disruption, nanotoxicology, mixtures, etc.) that call for new transdisciplinary approaches and paradigms in order to feed science into public health policies.

Cutting-edge issues include the use of mechanistic research into risk assessment, transdisciplinary One Health strategies, and the scientific assessment of uncertainties.

Papers with an interdisciplinary character (from molecular to risk assessment, from environment to health, from science to policy), with a special focus on emerging scenarios and countries, are especially welcome.

Dr. Alberto Mantovani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • food, nutrition and health
  • environment and health
  • transdisciplinary collaboration approaches

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Published Papers (7 papers)

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Research

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12 pages, 1594 KiB  
Article
Role and Tasks of the Occupational Physician during the COVID-19 Pandemic
by Lorenzo Spagnolo, Luigi Vimercati, Antonio Caputi, Marcello Benevento, Luigi De Maria, Davide Ferorelli and Biagio Solarino
Medicina 2021, 57(5), 479; https://doi.org/10.3390/medicina57050479 - 12 May 2021
Cited by 19 | Viewed by 3190
Abstract
Background and Objectives: The first clusters of SARS-CoV-2 infection were identified in an occupational setting, and to date, a significant portion of the cases may result from occupational exposure; thus, COVID-19 should also be considered a new occupational risk that both directly and [...] Read more.
Background and Objectives: The first clusters of SARS-CoV-2 infection were identified in an occupational setting, and to date, a significant portion of the cases may result from occupational exposure; thus, COVID-19 should also be considered a new occupational risk that both directly and indirectly impacts the health of workers. Given the significance of occupational-exposure-related infections and deaths, this study aims to assess the roles and tasks of occupational physicians (OPs) in countering the spread of the infection. Indeed, despite the OP’s centrality in risk management in the workplace, its activity in the current epidemic context has rarely been mentioned. Materials and Methods: Three different databases (PubMed, Google Scholar, and Embase) were questioned using the main keywords “COVID-19” and “SARS-CoV-2” that were crossed, according to different needs, with the terms “occupational medicine”, “occupational physician”, “workplace”, and “risk assessment” using, when possible, the MeSH database research. Additionally, a systematic research of the regulatory changes of workplaces health surveillance was performed on reference sites of international, European, and Italian authorities. Results: Fundamental tasks and duties of OPs in the current COVID-19 outbreak are highlighted by examining their clinical activity and technical action. A risk assessment and management workflow is proposed, and medico-legal implications in case of infection at work are also discussed in the light of recent regulatory changes that clearly attribute to OPs an important role in safeguarding public health. Conclusion: The proposed approach can provide new instruments to contrast the spread of the infection as part of a comprehensive system response to the current pandemic, for which OPs are called to assume full responsibility. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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24 pages, 11513 KiB  
Article
Toxicological Risk Analysis in Data-Poor Countries: A Narrative Approach to Feed an “Awareness Raising—Community Empowerment” Vortex
by Chiara Frazzoli
Medicina 2020, 56(11), 629; https://doi.org/10.3390/medicina56110629 - 20 Nov 2020
Cited by 8 | Viewed by 7733
Abstract
Background and objectives: With globalization of culture and products, choices and behaviors associated with the unawareness of toxicological risk factors result in human and environmental toxic exposures along with health disparities. Toxic exposures are risk factors for malnutrition and diseases, impairing the [...] Read more.
Background and objectives: With globalization of culture and products, choices and behaviors associated with the unawareness of toxicological risk factors result in human and environmental toxic exposures along with health disparities. Toxic exposures are risk factors for malnutrition and diseases, impairing the chances of being healthy and having a healthy adulthood for current and next generation(s). Increasing research funds, infrastructures, analytical data and risk assessment is a reality well worth attention in sub-Saharan Africa. These countries are still unprotected nowadays and are particularly exposed and data-poor in respect to risk factors (e.g., neurotoxicants, immunotoxicants and endocrine disruptors). This paper presents how—based on scientific literature—low-resource countries may achieve more with less. As one of the world’s most important emerging markets, Africa can, and should, assess the benefits and risks of modernity versus tradition and ask for safe and quality products at affordable prices while producing safe and nutritious foods. Materials and Methods: Exempla and experiences of risk analysis based on participant observation in field anthropological research, consumer safaris and reportages in the field of food safety, environmental health and consumer products are discussed in terms of “narrative prevention” and its power to highlight previously unrecognized/overlooked real-life risk scenarios. Knowledge return initiatives are discussed in light of their power to feed awareness raising, informed choice and empowerment of communities. Results: In some cases, data exist but remain too sparse, unknown or underused; in other cases, the information is totally neglected. When there is international scientific evidence, a diagnostic risk assessment is feasible. Despite significant resource constraints, properly science-driven targeted reportages in data-poor countries can bridge the gaps between international scientific knowledge and the implementation of relevant findings in an “awareness-empowerment vortex”. When a clear message promoting healthy choices and behaviors is given, African communities are ready to respond. Conclusions: Poor skills are an avoidable consequence of low national income. Narrative prevention does not replace scientific research but stimulates scientific research and toxicological risk analysis during the ongoing risk transition in Africa. While African populations increasingly aspire to improve life expectancy in health, increasing exposure to such new health risk factors in sub-Saharan Africa needs top-down choices for diseases prevention, One Health, as well as public awareness and empowerment towards everyday habits and health protective choices. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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9 pages, 779 KiB  
Article
Development and Improvement of an Effective Method for Air and Surfaces Disinfection with Ozone Gas as a Decontaminating Agent
by Giuseppina Moccia, Francesco De Caro, Concetta Pironti, Giovanni Boccia, Mario Capunzo, Anna Borrelli and Oriana Motta
Medicina 2020, 56(11), 578; https://doi.org/10.3390/medicina56110578 - 30 Oct 2020
Cited by 26 | Viewed by 3441
Abstract
Background and objectives: Ozone has been one of the most investigated and discussed sanitization methods. This paper reports a procedure to sanitize air hospital environments, in particular chirurgical surgery rooms that require high levels of disinfection. The purpose of this work was the [...] Read more.
Background and objectives: Ozone has been one of the most investigated and discussed sanitization methods. This paper reports a procedure to sanitize air hospital environments, in particular chirurgical surgery rooms that require high levels of disinfection. The purpose of this work was the development and implementation of a cleansing and sanitizing procedure for critical clinical settings with ozone, to prevent hospital infections by the elimination of all toxic and harmful microorganisms in the air, and ensure safe use for operators and patients. Materials and Methods: The protocol for the study involved a structured selection of a representative environment of healthcare structures such as high, medium, and low-risk settings in air and examples of hospital furniture. Results: The concentration of ozone was measured during sanitization treatment and the estimation of the total microbial count in the air and on different surfaces before and after the sanitization operations was performed. The results demonstrated a significant reduction in the microbial count that always fell below the threshold value. Conclusions: Currently, there are no air treatment strategies available for inactivating airborne organisms during hospital outbreaks, which is most probably due to the lack of approved protocols. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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Review

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20 pages, 919 KiB  
Review
Toxic Metals and Non-Communicable Diseases in HIV Population: A Systematic Review
by Opeyemi M. Folorunso, Chiara Frazzoli, Ifeyinwa Chijioke-Nwauche, Beatrice Bocca and Orish E. Orisakwe
Medicina 2021, 57(5), 492; https://doi.org/10.3390/medicina57050492 - 13 May 2021
Cited by 6 | Viewed by 3393
Abstract
Background and Objectives: HIV has been a serious global health concern since its discovery, with about 37.9 million people living with HIV worldwide as of 2018. Sub-Saharan Africa (SSA) accounts for 68% of the infection and contributed 74% of the 1.5 million deaths [...] Read more.
Background and Objectives: HIV has been a serious global health concern since its discovery, with about 37.9 million people living with HIV worldwide as of 2018. Sub-Saharan Africa (SSA) accounts for 68% of the infection and contributed 74% of the 1.5 million deaths in 2013 despite having only 12% of the total world population residing in the region. This systematic review has attempted to determine the association between heavy metal toxicity and the occurrence of non-communicable diseases in the HIV/AIDS population. Materials and Methods: Three databases were systematically searched: PubMed, Scopus, and Google Scholar for studies written in English and published between 1 April 2000 and 12 April 2020. Studies were excluded if the main outcomes were not measured or did not meet the inclusion criteria. Results: All the six included studies are cross-sectional in design, and therefore were evaluated using the STROBE checklist. The data extraction was done using an extraction table; the ratio of female to male participants included in the study was 1.09:1. Qualitative analysis was used due to the heterogeneity in the heavy metal biomarkers and the outcome measured by the included studies. Two studies compared the concentration of heavy metals in HIV-positive and HIV-negative participants while one compared the levels between HAART-naïve and HAART-treated participants, and three determined the association between heavy metal toxicity and non-communicable diseases (liver fibrosis, anaemia, and reproductive parameters, respectively) in HIV-positive patients. Conclusions: Blood lead, cadmium, and mercury levels were higher in HIV-seropositive than -seronegative subjects, whereas serum zinc level was lower in HIV-seropositive than -seronegative subjects, but the causal association between heavy metals and non-communicable diseases in HIV subjects is largely unknown. Interdisciplinary research between nutrition, toxicology, and human health is envisaged for primary and secondary prevention and treatment. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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8 pages, 308 KiB  
Review
Immuno-Hormonal, Genetic and Metabolic Profiling of Newborns as a Basis for the Life-Long OneHealth Medical Record: A Scoping Review
by Alekandra Fucic, Alberto Mantovani and Gavin W. ten Tusscher
Medicina 2021, 57(4), 382; https://doi.org/10.3390/medicina57040382 - 15 Apr 2021
Cited by 1 | Viewed by 2699
Abstract
Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare. Personal medical records are only partially unified by hospital or general practitioner informatics systems, but only for citizens with long-term permanent [...] Read more.
Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare. Personal medical records are only partially unified by hospital or general practitioner informatics systems, but only for citizens with long-term permanent residence. Otherwise, insight into the medical history of patients greatly depends on their medical archive and memory. Additionally, occupational exposure records are not combined with clinical or general practitioner records. Environmental exposure starts preconceptionally and continues during pregnancy by transplacental exposure. Antenatal exposure is partially dependent on parental lifestyle, residence and occupation. Newborn screening (NBS) is currently being performed in developed countries and includes testing for rare genetic, hormone-related, and metabolic conditions. Transplacental exposure to substances such as endocrine disruptors, air pollutants and drugs may have life-long health consequences. However, despite the recognised impact of transplacental exposure on the increased risk of metabolic syndrome, neurobehavioral disorders as well as immunodisturbances including allergy and infertility, not a single test within NBS is geared toward detecting biomarkers of exposure (xenobiotics or their metabolites, nutrients) or effect such as oestradiol, testosterone and cytokines, known for being associated with various health risks and disturbed by transplacental xenobiotic exposures. The outcomes of ongoing exposome projects might be exploited to this purpose. Developing and using a OneHealth Medical Record (OneHealthMR) may allow the incorporated chip to harvest information from different sources, with high integration added value for health prevention and care: environmental exposures, occupational health records as well as diagnostics of chronic diseases, allergies and medication usages, from birth and throughout life. Such a concept may present legal and ethical issues pertaining to personal data protection, requiring no significant investments and exploits available technologies and algorithms, putting emphasis on the prevention and integration of environmental exposure and health data. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
14 pages, 902 KiB  
Review
Assessing Environmental Factors within the One Health Approach
by Sarah Humboldt-Dachroeden and Alberto Mantovani
Medicina 2021, 57(3), 240; https://doi.org/10.3390/medicina57030240 - 5 Mar 2021
Cited by 20 | Viewed by 5474
Abstract
Background: One Health is a comprehensive and multisectoral approach to assess and examine the health of animals, humans and the environment. However, while the One Health approach gains increasing momentum, its practical application meets hindrances. This paper investigates the environmental pillar of the [...] Read more.
Background: One Health is a comprehensive and multisectoral approach to assess and examine the health of animals, humans and the environment. However, while the One Health approach gains increasing momentum, its practical application meets hindrances. This paper investigates the environmental pillar of the One Health approach, using two case studies to highlight the integration of environmental considerations. The first case study pertains to the Danish monitoring and surveillance programme for antimicrobial resistance, DANMAP. The second case illustrates the occurrence of aflatoxin M1 (AFM1) in milk in dairy-producing ruminants in Italian regions. Method: A scientific literature search was conducted in PubMed and Web of Science to locate articles informing the two cases. Grey literature was gathered to describe the cases as well as their contexts. Results: 19 articles and 10 reports were reviewed and informed the two cases. The cases show how the environmental component influences the apparent impacts for human and animal health. The DANMAP highlights the two approaches One Health and farm to fork. The literature provides information on the comprehensiveness of the DANMAP, but highlights some shortcomings in terms of environmental considerations. The AFM1 case, the milk metabolite of the carcinogenic mycotoxin aflatoxin B1, shows that dairy products are heavily impacted by changes of the climate as well as by economic drivers. Conclusions: The two cases show that environmental conditions directly influence the onset and diffusion of hazardous factors. Climate change, treatment of soils, water and standards in slaughterhouses as well as farms can have a great impact on the health of animals, humans and the environment. Hence, it is important to include environmental considerations, for example, via engaging environmental experts and sharing data. Further case studies will help to better define the roles of environment in One Health scenarios. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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14 pages, 335 KiB  
Review
Multifactorial Rare Diseases: Can Uncertainty Analysis Bring Added Value to the Search for Risk Factors and Etiopathogenesis?
by Domenica Taruscio and Alberto Mantovani
Medicina 2021, 57(2), 119; https://doi.org/10.3390/medicina57020119 - 28 Jan 2021
Cited by 7 | Viewed by 2261
Abstract
Uncertainty analysis is the process of identifying limitations in knowledge and evaluating their implications for scientific conclusions. Uncertainty analysis is a stable component of risk assessment and is increasingly used in decision making on complex health issues. Uncertainties should be identified in a [...] Read more.
Uncertainty analysis is the process of identifying limitations in knowledge and evaluating their implications for scientific conclusions. Uncertainty analysis is a stable component of risk assessment and is increasingly used in decision making on complex health issues. Uncertainties should be identified in a structured way and prioritized according to their likely impact on the outcome of scientific conclusions. Uncertainty is inherent to the rare diseases (RD) area, where research and healthcare have to cope with knowledge gaps due to the rarity of the conditions; yet a systematic approach toward uncertainties is not usually undertaken. The uncertainty issue is particularly relevant to multifactorial RD, whose etiopathogenesis involves environmental factors and genetic predisposition. Three case studies are presented: the newly recognized acute multisystem inflammatory syndrome in children and adolescents associated with SARS-CoV-2 infection; the assessment of risk factors for neural tube defects; and the genotype–phenotype correlation in familial Mediterranean fever. Each case study proposes the initial identification of the main epistemic and sampling uncertainties and their impacts. Uncertainty analysis in RD may present aspects similar to those encountered when conducting risk assessment in data-poor scenarios; therefore, approaches such as expert knowledge elicitation may be considered. The RD community has a main strength in managing uncertainty, as it proactively develops stakeholder involvement, data sharing and open science. The open science approaches can be profitably integrated by structured uncertainty analysis, especially when dealing with multifactorial RD involving environmental and genetic risk factors. Full article
(This article belongs to the Special Issue Risk Assessment and Risk Management of Toxic Pollutants: A One Health Prespective)
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