Exposure to phthalates, potential endocrine disruptors, in an infant cohort in Modena, Italy

Abstract   Phthalates are pollutants ubiquitous in the environment. Human exposure to phthalates and their endocrine disrupting effects have been widely studied. Therefore, the European Union forbids phthalates in toys, cosmetic and kitchenware manufacturing. However, phthalate metabolites can still be found in human biological matrices. The purpose of this study is to investigate phthalate exposure over time in a group of Italian healthy newborns. In a prospective cohort study, we enlisted 187 women who gave birth in the University Hospital of Modena, Italy, between January 2019 and May 2020. Urine samples from women after delivery and from their infants at birth, 3 and 6 months were collected and 8 metabolites of 6 phthalates were analysed. Descriptive statistics were calculated and preliminary correlation coefficients tests were performed. Monoethylphthalate (MEP) was always detectable in urine samples. MEP, monomethylphthalate and diethylhexylphthalate metabolites showed an increasing trend over time, while monobutylphthalate and monobenzylphthalate showed decreasing levels over time. Associations between levels of phthalates metabolites in mother and infant pairs at birth were found for a few metabolites, while metabolites in infant samples at 3 and 6 months appeared often significantly associated. Infants’ phthalate exposure in Modena is still high and prolonged over time, even to those more toxic and strictly regulated. As phthalates presence in indoor environment can be a risk factor especially for the most fragile groups of population, such as children, public Health campaigns addressing childbearing age women should stress about the risk posed by these substances and how to avoid their exposure. Moreover, regulatory actions and a stricter legislation should be considered. Key messages • In Italy infant exposure to phthalates, including those strictly forbidden, appears still high and continuous over time. • Public heath intervention and stricter regulatory actions should be considered.

Dementia is a major cause of disability and dependency among older people worldwide. Eco-bio-psychosocially supportive design can significantly reduce agitation and depression while improving mobility and daily activities. For this we need to include dementia patients as experts while understanding the neurological changes and functional impairments associated with the progression of the disease over time. How can we support dementia patients to participate? What tools/processes can we use to involve them in the design process? The aim of this project was to map and evaluate co-design methods for dementia and neurodiversity, in order to create an eco-bio-psychosocially supportive environment. Mixed methods were used comprising a systematic literature review on co-design  techniques for spaces for dementia, three workshops: a 3-day  one with seven early career researchers translating patient  involving methodologies to the dementia context, a round  table Patient and Public Involvement and Engagement with six  service providers and stakeholders cross three countries and a cross-sectoral international day conference with four academics, four early career researchers and eight stakeholders and a series of co-design workshops for dementia and neurodiversity, which were then classified according to applicability so as to generate co-production methods for living environments for dementia. This transdisciplinary project highlighted the challenges of participatory design in the context of dementia built environment. The importance of the topic was highlighted by clinicians and staff but there are still significant limitations in terms of research and methodologies. The workshops outcome was an inclusive code of conduct for participatory design and research for dementia patients, which will help to improve home and care environments for people with dementia. The framework involved aspects such as time, space, equipment in relation to people involved (carers, patients, proxies).

Key messages:
The project created a framework to support dementia patients' involvement for built environment decision making that considers aspects such as time, space and equipment to foster communication.
The framework described the phases and the tools/methods in order to build trust and enable fluidity to accommodate dementia patients' needs.
Phthalates are pollutants ubiquitous in the environment. Human exposure to phthalates and their endocrine disrupting effects have been widely studied. Therefore, the European Union forbids phthalates in toys, cosmetic and kitchenware manufacturing. However, phthalate metabolites can still be found in human biological matrices. The purpose of this study is to investigate phthalate exposure over time in a group of Italian healthy newborns. In a prospective cohort study, we enlisted 187 women who gave birth in the University Hospital of Modena, Italy, between January 2019 and May 2020. Urine samples from women after delivery and from their infants at birth, 3 and 6 months were collected and 8 metabolites of 6 phthalates were analysed. Descriptive statistics were calculated and preliminary correlation coefficients tests were performed. Monoethylphthalate (MEP) was always detectable in urine samples. MEP, monomethylphthalate and diethylhexylphthalate metabolites showed an increasing trend over time, while monobutylphthalate and monobenzylphthalate showed decreasing levels over time. Associations between levels of phthalates metabolites in mother and infant pairs at birth were found for a few metabolites, while metabolites in infant samples at 3 and 6 months appeared often significantly associated. Infants' phthalate exposure in Modena is still high and prolonged over time, even to those more toxic and strictly regulated. As phthalates presence in indoor environment can be a risk factor especially for the most fragile groups of population, such as children, public Health campaigns

Background:
Plenty of literature reported the applicability and usefulness of telemedicine and teleassistance (TMTA) services in the management of diabetes and other chronic conditions. Specifically, TMTA proved to be effective for conditions that require radical lifestyle modifications, tailored pharmacological interventions, and periodic monitoring of clinical health status. The purpose of this study is to investigate the individual and contextual determinants of the perceived quality (PQ) of the telemedicine and teleassistance (TMTA) services and the willingness to continue (WC) with them among patients with diabetes using TMTA during the COVID-19 pandemic in one large region of Italy (Emilia-Romagna).

Methods:
A structured survey was administered to patients with type 1 and 2 diabetes who used TMTA services during the first wave of the COVID-19 pandemic. The questionnaire was comprised of questions on TMTA service experience and participants' socio-demographic characteristics. Multiple regression models investigated the independent factors associated with PQ (score 1-100) and WC (yes/no).

Conclusions:
Our study identified several determinants of PQ and WC. These socio-demographic and patient-perception related factors should be considered in the implementation of care pathways integrating in-person visits with TMTA services. Key messages: Socio-demographic factors play a crucial role in TMTA acceptance and should be taken into due consideration when implementing health pathways integrating in-person visits with TMTA services.
Health workers should always try to improve patients' selfmanagement skills and should always make patients feel supported. This is also true in the digital health era.
Abstract citation ID: ckac129.570 Specchio-COVID19: a digital cohort study to improve public involvement in epidemiological research

Background:
To manage the sanitary crisis and rapidly assess the seroprevalence of anti-SARS-CoV-2 antibodies in the canton of Geneva, we invited previous participants of an annual health survey of the general population to a first serological test. As the pandemic progressed, it become clear that there would be a significant longer impact on health and wellbeing of population. Moreover, there was a need to assess the adherence of the population regarding COVID-19 prevention measures, over time, as well as to provide scientific knowledge about antibodies dynamics and protection from new infections. For all these reasons, a long-term follow-up has been settled via the dedicated digital platform Specchio-COVID19 and on-line questionnaires and repeated serological tests.

Methods:
Several measures were designed to maintain high retention and involvement, including regular electronic newsletters with links to a ''News'' webpage, a ''Research'' webpage for dissemination of publications and the organization of webinars specifically dedicated to participants. A specific email address and a dedicated hotline were set up so that participants can get in touch with the Specchio-COVID19 team.

Conclusions:
Our digital cohort facilitates participants' involvement, allowing participation from remote locations, organizing webinar, promoting news and scientific information via newsletters and specific webpages and enabling interaction between researchers and participants. Key messages: When designing the Specchio-COVID19 digital cohort, the purpose was not only to collect data. But to establish a reciprocal exchange of information between researchers and participants, fostering long-term involvement and health empowerment.