Suchergebnisse

Abstract Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure–response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. Results: We obtained 2005–2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0–23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. Discussion: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures.

L'igiene ospedaliera in Italia ha una lunga e solida storia che però richiede una necessaria riflessione per poter restare al passo con quelle che sono le innovazioni e gli sviluppi dei sistemi sanitari anche connessi a quelle che sono le attività dell'Unione Europea. A livello europeo infatti esistono diverse tradizioni nazionali che riguardo l'igiene ospedaliera e per questo motivo l'European Centre for Disease Prevention and Control (ECDC) ha adottato il termine "controllo delle infezioni e igiene ospedaliera" per poter così includere tutti i professionisti sanitari dei singoli Paesi. La nostra proposta è sia quella di modificare il termine di "igiene ospedaliera" in "igiene delle organizzazioni sanitarie" per poter focalizzare l'attenzione anche ai numerosi livelli di cura non ospedalieri, sia di adottare la seguente definizione: "tutte le attività volte a garantire, in modo appropriato, scientificamente valido ed efficiente, l'assistenza in un ambiente sicuro, confortevole e salubre per i pazienti, i caregiver e gli operatori sanitari". L'igiene ospedaliera ed i suoi professionisti sono un pilastro necessario per garantire la qualità e la sicurezza dell'assistenza sanitaria in Italia. ; Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.