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  • Andrea Ranzi1

  1. ARPA, Modena
Andrea Ranzi -

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Ricerca del 20 ottobre 2010

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Criteri di esclusione degli articoli:
• Articoli su riviste italiane
• Articoli su E&P
• Editoriali
• Review narrative
Stringa di ricerca: ((pollution OR pollutants) OR (climate change)) AND (Italy) AND (epidemiology OR health effects)
Limits Activated: Publication Date from 2010/01/01 to 2010/09/17

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Stafoggia M, Forastiere F, Faustini A, Biggeri A, Bisanti L, Cadum E, Cernigliaro A, Mallone S, Pandolfi P, Serinelli M, Tessari R, Vigotti MA, Perucci CA; EpiAir Group. Susceptibility factors to ozone-related mortality: a population-based case-crossover analysis. Am J Respir Crit Care Med. 2010 Aug 1;182(3):376-84.
Abstract
RATIONALE: Acute effects of ozone on mortality have been extensively documented in clinical and epidemiological research. However, only a few studies have focused on subgroups of the population especially vulnerable to these effects.
OBJECTIVES: To estimate the association between exposure to ozone and cause-specific mortality, and to evaluate whether individual sociodemographic characteristics or chronic conditions confer greater susceptibility to the adverse effects of ozone.
METHODS: A case-crossover analysis was conducted in 10 Italian cities. Data on mortality were collected for the period 2001 to 2005 (April-September) for 127,860 deceased subjects. Information was retrieved on cause of death, sociodemographic characteristics, chronic conditions from previous hospital admissions, and location of death. Daily ozone concentrations were collected from background fixed monitors.
MEASUREMENTS AND MAIN RESULTS: We estimated a 1.5% (95% confidence interval [CI], 0.9-2.1) increase in total mortality for a 10 microg/m(3) increase in ozone (8-h, lag 0-5). The effect lasted several days for total, cardiac and respiratory mortality (lag 0-5), and it was delayed for cerebrovascular deaths (lag 3-5). In the subgroup analysis, the effect was more pronounced in people older than 85 years of age (3.5%; 95% CI, 2.4-4.6) than in 35- to 64-year-old subjects (0.8%; 95% CI, -0.8 to 2.5), in women (2.2%; 95% CI, 1.4-3.1) than in men (0.8%; 95% CI, -0.1 to 1.8), and for out-of-hospital deaths (2.1%; 95% CI, 1.0-3.2), especially among patients with diabetes (5.5%; 95% CI, 1.4-9.8).
CONCLUSIONS: A greater vulnerability of elderly people and women was indicated; subjects who died at home and had diabetes emerged as especially affected.

Commento a cura di Andrea Ranzi
L’analisi presentata ha riguardato gli effetti dell’inquinamento da ozono sulla mortalità in soggetti adulti (>35 anni), deceduti tra il 2001 e il 2005 nelle 10 città coinvolte nel progetto CCM EpiAir. L’articolo ci mostra l’eterogeneità degli effetti dell’ozono sulla mortalità, che colpiscono in maggiore misura gli anziani, le donne e i diabetici adulti. L’editoriale che commenta l’articolo, oltre a rimarcare l’importanza dell’effetto differenziale dell’inquinamento atmosferico sulla popolazione, evidenzia come i livelli di ozono registrati nelle 10 città italiane siano al di sotto degli standard EPA e, aggiungo, al di sotto dei limiti normativi italiani per la media mobile su 8 ore (DLgs 183/04) e prossimi alle linee guida OMS sulla qualità dell’aria (2005), sottolineando nuovamente il problema della definizione di limiti normativi a tutela della salute in situazioni di relazione dose risposta senza soglia.

2. Simoni M, Annesi-Maesano I, Sigsgaard T, Norback D, Wieslander G, Nystad W, Canciani M, Sestini P, Viegi G. School air quality related to dry cough, rhinitis and nasal patency in children. Eur Respir J. 2010 Apr;35(4):742-9.
Abstract
Controls for indoor air quality (IAQ) in schools are not usually performed throughout Europe. The aim of this study was to assess the effects of IAQ on respiratory health of schoolchildren living in Norway, Sweden, Denmark, France and Italy. In the cross-sectional European Union-funded HESE (Health Effects of School Environment) Study, particulate matter with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)) and CO(2) levels in a day of normal activity (full classroom) were related to wheezing, dry cough at night and rhinitis in 654 children (10 yrs) and to acoustic rhinometry in 193 children. Schoolchildren exposed to PM(10) >50 microg x m( -3) and CO(2) >1,000 ppm (standards for good IAQ) were 78% and 66%, respectively. All disorders were more prevalent in children from poorly ventilated classrooms. Schoolchildren exposed to CO(2) levels >1,000 ppm showed a significantly higher risk for dry cough (OR 2.99, 95% CI 1.65-5.44) and rhinitis (OR 2.07, 95% CI 1.14-3.73). By two-level (child, classroom) hierarchical analyses, CO(2) was significantly associated with dry cough (OR 1.06, 95% CI 1.00-1.13 per 100 ppm increment) and rhinitis (OR 1.06, 95% CI 1.00-1.11). Nasal patency was significantly lower in schoolchildren exposed to PM( 10) >50 microg x m(-3) than in those exposed to lower levels. A poor IAQ is frequent in European classrooms; it is related to respiratory disturbances and affects nasal patency.

Commento a cura di Andrea Ranzi
L’articolo presenta i risultati di uno studio pilota sulla relazione fra qualità dell’aria all’interno degli edifici scolastici e effetti sulla salute respiratoria nei bambini. Si tratta di una indagine multicentro, all’interno del progetto europeo HESE (Health Effects of School Environment), condotta su 21 scuole di 5 paesi diversi. I risultati, pur con le limitazioni di uno studio pilota, evidenziano la necessità di incrementare le misure di inquinamento indoor e la conseguente valutazione degli effetti della qualità dell’aria entro gli edifici sulla salute umana, specialmente in popolazioni suscettibili.

3. Cesaroni G, Badaloni C, Romano V, Donato E, Perucci CA, Forastiere F. Socioeconomic position and health status of people who live near busy roads: the Rome Longitudinal Study (RoLS). Environ Health. 2010 Jul 21;9:41.
Abstract
BACKGROUND: Subjects living close to high traffic roads (HTR) are more likely to suffer from air-pollution related morbidity and mortality. The issue has large public health consequences but few studies have described the main socio-demographic characteristics of people exposed to traffic.
OBJECTIVES: To characterise a large cohort of residents in Rome according to different measures of traffic exposure, socioeconomic position (SEP), and baseline health status.
METHODS: Residents of Rome in October 2001 were selected. Individual and area-based SEP indices were available. GIS was used to obtain traffic indicators at residential addresses: distance from HTR (> = 10,000 vehicles/day), length of HTR, average daily traffic count, and traffic density within 150 meters of home. Hospitalisations in the 5-year period before enrolment were used to characterise health status. Logistic and linear regression analyses estimated the association between traffic exposure and socio-demographic characteristics.
RESULTS: We selected 1,898,898 subjects with complete SEP information and GIS traffic indicators. A total of 320,913 individuals (17%) lived within 50 meters of an HTR, and 14% lived between 50 and 100 meters. These proportions were higher among 75+ year-old subjects. Overall, all traffic indicators were directly associated with SEP, with people living in high or medium SEP areas or with a university degree more likely to be exposed to traffic than people living in low SEP areas or with a low level of education. However, an effect modification by area of residence within the city was seen and the association between traffic and SEP was reversed in the city centre.
CONCLUSIONS: A large section of the population is exposed to traffic in Rome. Elderly people and those living in areas of high and medium SEP tend to be more exposed. These findings are related to the historical stratification of the population within the city according to age and socioeconomic status.
4. D'Ippoliti D, Michelozzi P, Marino C, de'Donato F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramón M, Paldy A, Atkinson R, Kovats S, Bisanti L, Schneider A, Lefranc A, Iñiguez C, Perucci CA. The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health. 2010 Jul 16;9:37.
Abstract
BACKGROUND: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.
METHODS: Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated.
RESULTS: The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions.
CONCLUSIONS: Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.
5. Michelozzi P, de' Donato FK, Bargagli AM, D'Ippoliti D, De Sario M, Marino C, Schifano P, Cappai G, Leone M, Kirchmayer U, Ventura M, di Gennaro M, Leonardi M, Oleari F, De Martino A, Perucci CA. Surveillance of summer mortality and preparedness to reduce the health impact of heat waves in Italy. Int J Environ Res Public Health. 2010 May;7(5):2256-73.
Abstract
Since 2004, the Italian Department for Civil Protection and the Ministry of Health have implemented a national program for the prevention of heat-health effects during summer, which to-date includes 34 major cities and 93% of the residents aged 65 years and over. The Italian program represents an important example of an integrated approach to prevent the impact of heat on health, comprising Heat Health Watch Warning Systems, a mortality surveillance system and prevention activities targeted to susceptible subgroups. City-specific warning systems are based on the relationship between temperature and mortality and serve as basis for the modulation of prevention measures. Local prevention activities, based on the guidelines defined by the Ministry of Health, are constructed around the infrastructures and services available. A key component of the prevention program is the identification of susceptible individuals and the active surveillance by General Practitioners, medical personnel and social workers. The mortality surveillance system enables the timely estimation of the impact of heat, and heat waves, on mortality during summer as well as to the evaluation of warning systems and prevention programs. Considering future predictions of climate change, the implementation of effective prevention programs, targeted to high risk subjects, become a priority in the public health agenda.
6. Belleudi V, Faustini A, Stafoggia M, Cattani G, Marconi A, Perucci CA, Forastiere F. Impact of fine and ultrafine particles on emergency hospital admissions for cardiac and respiratory diseases. Epidemiology. 2010 May;21(3):414-23.
Abstract
BACKGROUND: Little is known about the short-term effects of ultrafine particles.
METHODS: We evaluated the effect of particulate matter with an aerodynamic diameter or=35 years hospitalized for acute coronary syndrome, heart failure, lower respiratory tract infections, and chronic obstructive pulmonary disease (COPD). Information was available for factors indicating vulnerability, such as age and previous admissions for COPD. Particulate matter data were collected daily at one central fixed monitor. A case-crossover analysis was performed using a time-stratified approach. We estimated percent increases in risk per 14 microg/m PM10, per 10 microg/m PM2.5, and per 9392 particles/mL.
RESULTS: An immediate impact (lag 0) of PM2.5 on hospitalizations for acute coronary syndrome (2.3% [95% confidence interval = 0.5% to 4.2%]) and heart failure (2.4% [0.3% to 4.5%]) was found, whereas the effect on lower respiratory tract infections (2.8% [0.5% to 5.2%]) was delayed (lag 2). Particle number concentration showed an association only with admissions for heart failure (lag 0-5; 2.4% [0.2% to 4.7%]) and COPD (lag 0; 1.6% [0.0% to 3.2%]). The effects were generally stronger in the elderly and during winter. There was no clear effect modification with previous COPD.
CONCLUSIONS: We found sizeable acute health effects of fine and ultrafine particles. Although differential reliability in exposure assessment, in particular of ultrafine particles, precludes a firm conclusion, the study indicates that particulate matter of different sizes tends to have diverse outcomes, with dissimilar latency between exposure and health response.
7. Merlo DF, Stagi E, Fontana V, Consonni D, Gozza C, Garrone E, Bertazzi PA, Pesatori AC. A historical mortality study among bus drivers and bus maintenance workers exposed to urban air pollutants in the city of Genoa, Italy. Occup Environ Med. 2010 Sep;67(9):611-9.
Abstract
OBJECTIVE: A historical mortality cohort study was conducted in Genoa, Italy among public transport workers ever employed between 1949 and 1980, to estimate overall and cause-specific mortality from January 1970 to December 2005 and to examine associations between exposure to urban air pollutants and overall and cause-specific mortality.
METHODS: Causes of death for 9267 males (6510 bus drivers, 2073 maintenance workers and 601 white collar workers) were coded according to ICD-9. Standardised mortality ratios (SMRs) and 95% CIs were computed by applying Italian and regional male death rates to person-years of observation for the entire cohort and following stratification by longest held job title and length of and time since first employment using the Poisson regression model.
RESULTS: There were 2916 deaths and 230,009 person-years of observation; 17 subjects were lost to follow-up. SMRs for all causes, diseases of the circulatory, respiratory, digestive and genitourinary systems, and for accidents were lower than expected. SMRs (95% CI) were increased for lung cancer (1.16, 1.05 to 1.28), non-Hodgkin's lymphoma (1.23, 0.85 to 1.78), Hodgkin's lymphoma (2.14, 1.19 to 3.87) and diabetes mellitus (1.16, 1.05 to 1.28). The SMR for leukaemia was 0.77 (0.51 to 1.16). Hodgkin's lymphoma mortality was significantly increased among bus drivers (1.62, 1.37 to 5.04). Lung cancer risk was significantly increased among all workers after 30 years' employment and among maintenance workers.
CONCLUSIONS: The study failed to show any increased risk for leukaemias. The increased mortality from Hodgkin's lymphoma and lung cancer may be associated with long-term exposure to urban air pollution.
8. Sajani SZ, Hänninen O, Marchesi S, Lauriola P. Comparison of different exposure settings in a case-crossover study on air pollution and daily mortality: counterintuitive results. J Expo Sci Environ Epidemiol. 2010 Jun 23.
Abstract
Because of practical problems associated with measurement of personal exposures to air pollutants in larger populations, almost all epidemiological studies assign exposures based on fixed-site ambient air monitoring stations. In the presence of multiple monitoring stations at different locations, the selection of them may affect the observed epidemiological concentration-response (C-R) relationships. In this paper, we quantify these impacts in an observational ecologic case-crossover study of air pollution and mortality. The associations of daily concentrations of PM(10), O(3), and NO(2) with daily all-cause non-violent mortality were investigated using conditional logistic regression to estimate percent increase in the risk of dying for an increase of 10 mug/m(3) in the previous day air pollutant concentrations (lag 1). The study area covers the six main cities in the central-western part of Emilia-Romagna region (population of 1.1 million). We used four approaches to assign exposure to air pollutants for each individual considered in the study: nearest background station; city average of all stations available; average of all stations in a macro-area covering three cities and average of all six cities in the study area (50 x 150 km(2)). Odds ratios generally increased enlarging the spatial dimension of the exposure definition and were highest for six city-average exposure definition. The effect is especially evident for PM(10), and similar for NO(2), whereas for ozone, we did not find any change in the C-R estimates. Within a geographically homogeneous region, the spatial aggregation of monitoring station data leads to higher and more robust risk estimates for PM(10) and NO(2), even if monitor-to-monitor correlations showed a light decrease with distance. We suggest that the larger aggregation improves the representativity of the exposure estimates by decreasing exposure misclassification, which is more profound when using individual stations vs regional averages.Journal of Exposure Science and Environmental Epidemiology advance online publication, 23 June 2010; doi:10.1038/jes.2010.27.
9. Barbato DL, Tomei G, Tomei F, Sancini A. Traffic air pollution and oxidatively generated DNA damage: can urinary 8-oxo-7,8-dihydro-2-deoxiguanosine be considered a good biomarker? A meta-analysis. Biomarkers. 2010 Sep;15(6):538-45.
Abstract
Oxidative stress is one of the mechanisms through which traffic-related air pollution causes adverse effects on human health. The urinary excretion of 8-oxo-7,8-dihydro-2-deoxyguanosine (8oxodG) has often been used as a biomarker to evaluate the effect of air pollution on subjects occupationally exposed. We used a meta-analysis to evaluate the effect of traffic air pollution on urinary 8oxodG levels in healthy workers. We observed higher urinary 8oxodG levels in non-smoking exposed subjects compared with smokers. This difference was clearer when an HPLC assay was used. These results show that urinary 8oxodG can be used as a biomarker to evaluate the pro-oxidant effects of vehicle exhaust emissions on DNA in exposed workers.
10. Sancini A, Fioravanti M, Ciarrocca M, Palermo P, Fiaschetti M, Schifano MP, Tomei G, Tomei F. Pulmonary nodules in workers exposed to urban stressor. Environ Res. 2010 Jul;110(5):519-25. Epub 2010 Apr 28.
Abstract
By multilayer spiral low-dose computed tomography (LD-CT) of the chest this study assesses the early detection of lung lesions on a sample of 100 traffic policemen of a big Italian city professionally exposed to urban pollutants and 100 controls non-occupationally exposed to urban pollutants matched by sex, age, length of service and cigarette smoking habit. Exposure to urban pollutants in traffic policemen was characterized using the annual average concentrations of PM(10), NO2 and benzene in the period 1998-2008 measured by fixed monitoring stations located in different areas of the city. A significant and increasing number of suspicious lung nodules with diameters between 5 and 10 mm was observed: in traffic policemen (including smokers and non-smokers) vs. controls (including smokers and non-smokers); in total smokers (including traffic policemen and controls) vs. total non-smokers (traffic policemen and controls); in smoker traffic policemen vs. smoker controls and vs. non-smoker traffic policemen; in non-smoker traffic policemen vs. non-smoker controls. The RR of finding cases with at least one lung nodule with diameters between 5 and 10mm in traffic policemen (including smokers and non-smokers) compared to controls (including smokers and non-smokers) is 1.94 (CI 1.13-3.31); in total smokers vs. non-smokers the RR is 1.96 (CI 1.20-3.19). The comparison between the interaction exposure and smoking shows an increase in smoker traffic policemen than in smoker controls (RR=2.14; CI 1.02-4.52). The RR for smoker traffic policemen was higher than in non-smoker traffic policemen (RR=2.09; CI 1.19-3.66). The results of our study show that: (1) while smoker workers have a higher risk for developing solid suspicious lung nodules, the simple routinely exposure to urban pollutants is unable to produce the same kind of increased risk; (2) the interaction of smoking and exposure to urban pollutants greatly increases the risk for the development of solid suspicious lung nodules. In conclusion, the use of chest LD-CT in workers at risk helps identify suspicious solid lung nodules at early stage.
11. Ariano R, Canonica GW, Passalacqua G. Possible role of climate changes in variations in pollen seasons and allergic sensitizations during 27 years. Ann Allergy Asthma Immunol. 2010 Mar;104(3):215-22.
Abstract
BACKGROUND: Climate changes may affect the quality and amount of airborne allergenic pollens. The direct assessment of such an effect requires long observation periods and a restricted geographic area.
OBJECTIVE: To assess variations in pollens and allergic sensitizations across 27 years in relation to climate change in a specific region.
METHODS: We recorded pollen counts, season durations, and prevalences of sensitizations for 5 major pollens (birch, cypress, olive, grass, and Parietaria) in western Liguria between 1981 and 2007. Pollen counts were performed using a Hirst-type trap, and sensitizations were assessed by means of skin prick testing. Meteorologic data for the same period included average temperatures, direct radiation, humidity, number of sunny days, and rainfall.
RESULTS: There was a progressive increase in the duration of the pollen seasons for Parietaria (+85 days), olive (+18 days), and cypress (+18 days), with an overall advance of their start dates. For Parietaria, there was an advance of 2 months in 2006 vs 1981. Also, the total pollen load progressively increased for the considered species (approximately 25% on average) except for grasses. Percentages of patients sensitized to the pollens increased throughout the years, whereas the percentage of individuals sensitized to house dust mite remained stable. These behaviors paralleled the constant increase in direct radiation, temperature, and number of days with a temperature greater than 30 degrees C.
CONCLUSION: The progressive climate changes, with increased temperatures, may modify the global pollen load and affect the rate of allergic sensitization across long periods.
12. Martuzzi M, Mitis F, Forastiere F. Inequalities, inequities, environmental justice in waste management and health. Eur J Public Health. 2010 Feb;20(1):21-6.
Abstract
BACKGROUND: The scientific evidence on the health effects of waste-related exposure is not conclusive. Differential exposure to waste by socio-economic status (SES) is often documented, but the interplay between environmental and social factors, crucial for policy making, is not well known. This review aims at investigating the role of health inequalities and inequities in waste management.
METHODS: Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA.
RESULTS: Available data provide consistent indications that waste facilities are often disproportionally more located in areas with more deprived residents, or from ethnical minorities. This applies to waste incinerators, landfills, hazardous waste sites, legal and illegal. In studies considering health effects (mainly from Europe), risks are estimated with standardization for SES. Such standardization almost always decreases risk estimates for several cancers and reproductive outcomes. However, effect modification is not investigated in these studies.
CONCLUSIONS: The patterns of association between waste-related environmental pressures and SES suggest that some of the observed inequalities in exposure and health represent a case of environmental injustice as they are the result of social processes and may be prevented, at least partly. Disentangling the possible health effects remains difficult, due to limitations in the methodology. It seems important to investigate if disadvantaged people are more vulnerable, i.e. risks differ in different social groups living in the same area. Notwithstanding these open questions, public health officers and decision makers should identify waste management policies to minimize their potential health impacts and their unequal distribution.
13. Iannuzzi A, Verga MC, Renis M, Schiavo A, Salvatore V, Santoriello C, Pazzano D, Licenziati MR, Polverino M. Air pollution and carotid arterial stiffness in children. Cardiol Young. 2010 Apr;20(2):186-90.
Abstract
BACKGROUND AND PURPOSE: Many studies unequivocally indicate that air pollution is directly linked to the adverse cardiovascular outcomes in the general population. No data are currently available on cardiovascular effects of exposure to trafficked roads in healthy children. Distance of the residence to a major road has been shown to be a useful proxy for long-term traffic exposure and seem to be more consistently associated with atherosclerosis than particulate matter 2.5. The aim of this study was to investigate a possible association between the distance to a major road and carotid arterial subclinical markers of atherosclerosis in a group of children in Italy.
METHODS: The participants consisted of 52 healthy children living in a small town of the Amalphitan Coast with only one highly trafficked road. All children underwent an ultrasound carotid arterial examination.
RESULTS: A statistically significant difference was found in carotid arterial stiffness between children living closer to the main street and other children, both those living between 330 and 730 metres from the main street and those living more than 750 metres from the main street. No significant differences were detectable in carotid arterial thickness and arterial blood pressure among the three groups of children.
CONCLUSION: This study provides evidence in support of an association of exposure to air pollution with early atherosclerotic markers in healthy children. Impaired vascular health in childhood and adolescence gives further substance to the hypothesis that traffic exhausts are relevant to cardiovascular diseases even early in life.
14. de Marco R, Accordini S, Antonicelli L, Bellia V, Bettin MD, Bombieri C, Bonifazi F, Bugiani M, Carosso A, Casali L, Cazzoletti L, Cerveri I, Corsico AG, Ferrari M, Fois AG, Lo Cascio V, Marcon A, Marinoni A, Olivieri M, Perbellini L, Pignatti P, Pirina P, Poli A, Rolla G, Trabetti E, Verlato G, Villani S, Zanolin ME; GEIRD Study Group. The Gene-Environment Interactions in Respiratory Diseases (GEIRD) Project. Int Arch Allergy Immunol. 2010;152(3):255-63.
Abstract
The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.
15. Eskenazi B, Warner M, Marks AR, Samuels S, Needham L, Brambilla P, Mocarelli P. Serum dioxin concentrations and time to pregnancy. Epidemiology. 2010 Mar;21(2):224-31.
Abstract
BACKGROUND: Pollution may play a role in population trends of declining semen quality and regional differences in time to pregnancy (TTP) in industrialized societies. Dioxins including 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) have been suspected. In 1976, an explosion near Seveso, Italy resulted in the highest TCDD exposure known in residential populations. Twenty years later, we conducted a retrospective cohort study, the Seveso Women's Health Study.
METHODS: Of 981 participants, 472 women attempted pregnancy after the explosion, and 278 delivered a livebirth not associated with contraceptive failure. Individual serum TCDD levels were measured from samples collected soon after the explosion and extrapolated to the conception attempt. We examined the relation of TCDD levels to time to pregnancy (parameterized as the monthly probability of conception within the first 12 months of trying) and to infertility (defined as conception after at least 12 months of trying). We modeled fecundability with discrete-time Cox proportional hazards regression, and we modeled fertility with logistic regression. We tested the sensitivity of the conclusions to differing definitions of eligibility and outcome.
RESULTS: Median TCDD level was 50 parts per trillion, median time to pregnancy was 2 months, and 17% reported taking 12 or more months to conceive. For every 10-fold increase in serum TCDD, we observed a 25% increase in time to pregnancy (adjusted-fecundability odds ratio = 0.75 [95% confidence interval (CI) = 0.60-0.95]) and about a doubling in odds of infertility (adjusted odds ratio = 1.9 [95% CI = 1.1-3.2]). Results were similar for extrapolated TCDD and sensitivity analyses.
CONCLUSIONS: We found dose-related increases in TTP and infertility associated with individual serum TCDD levels in the women from Seveso, Italy. These findings may have implications for fertility in industrialized areas.
16. Vidale S, Bonanomi A, Guidotti M, Arnaboldi M, Sterzi R. Air pollution positively correlates with daily stroke admission and in hospital mortality: a study in the urban area of Como, Italy. Neurol Sci. 2010 Apr;31(2):179-82. Epub 2010 Jan 30.
Abstract
Some current evidences suggest that stroke incidence and mortality may be higher in elevated air pollution areas. Our study examined the hypothesis of a correlation between air pollution level and ischemic stroke admission and in Hospital mortality in an urban population. Data on a total of 759 stroke admissions and 180 deaths have been obtained over a 4-year period (2000-2003). Five air ambient particles have been studied. A general additive model estimating Poisson distribution has been used, adding meteorological variables as covariates. NO(2) and PM(10) were significantly associated with admission and mortality (P value < 0.05) and with estimated RR of 1.039 (95% CI 1.066-1.013) and 1.078 (95% CI 1.104-1.052) for hospital admission at 2- and 4-day lags, respectively. In conclusion, this study suggests an association between short-term outdoor air pollution exposure and ischemic stroke admission and mortality.
17. Baccini M, Kosatsky T, Analitis A, Anderson HR, D'Ovidio M, Menne B, Michelozzi P, Biggeri A; the PHEWE Collaborative Group. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2010 Aug 9.
Abstract
Background High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. The impact of summer heat on mortality for 15 European cities during the 1990s was evaluated, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES). Methods A Monte Carlo approach was used to estimate the number of deaths attributable to heat for each city. These estimates rely on the results of a Bayesian random-effects meta-analysis that combines city-specific heat-mortality functions. Results The number of heat-attributable deaths per summer ranged from 0 in Dublin to 423 in Paris. The mean attributable fraction of deaths was around 2%. The highest impact was in three Mediterranean cities (Barcelona, Rome and Valencia) and in two continental cities (Paris and Budapest). The largest impact was on persons over 75 years; however, in some cities, important proportions of heat-attributable deaths were also found for younger adults. Heat-attributable deaths markedly increased under warming scenarios. The impact under SRES scenarios was slightly lower or comparable to the impact during the observed hottest year. Conclusions Current high summer ambient temperatures have an important impact on European population health. This impact is expected to increase in the future, according to the projected increase of mean ambient temperatures and frequency, intensity and duration of heat waves.
18. Serinelli M, Vigotti MA, Stafoggia M, Berti G, Bisanti L, Mallone S, Pacelli B, Tessari R, Forastiere F. Particulate matter and out-of-hospital coronary deaths in eight Italian cities. Occup Environ Med. 2010 May;67(5):301-6. Epub 2009 Oct 8.
Abstract
OBJECTIVES: We evaluated the association between PM(10) concentration and out-of-hospital coronary deaths in eight Italian cities during 1997-2004.
METHODS: 16 989 subjects aged >35 years who died out-of-hospital from coronary causes were studied and hospital admissions in the previous 2 years identified. We studied the effect of the mean of current and previous day PM(10) values (lag 0-1). A city-specific case-crossover analysis was applied using a time-stratified approach considering as confounders weather, holidays, influenza epidemics, and summer decrease in population. The pooled percentage increase (95% CI) in mortality per 10 microg/m(3) increase in PM(10) was estimated.
RESULTS: A statistically significant increase in out-of-hospital coronary deaths was related to a 10 microg/m(3) increase in PM(10): 1.46% (95% CI 0.50 to 2.43). Although no statistically significant effect modification by age was found, the effect was stronger among subjects aged >65 years (1.60%, 0.59 to 2.63), particularly those aged 65-74 (3.01%, 0.74 to 5.34). People in the lowest socio-economic category (3.34%, 1.28 to 5.45) had a stronger effect than those in the highest category. No clear effect modification was seen for gender, season or any specific comorbidity. An indication of negative effect modification was seen for previous admission for cardiac dysrhythmias. Subjects without hospital admissions in the previous 2 years were slightly more affected by PM(10) effects (1.91%, 0.28 to 3.47) than those with at least one previous hospital admission (1.44%, 0.09 to 2.82).
CONCLUSIONS: Our results show that short term exposure to PM(10) is associated with coronary mortality especially among the elderly and socio-economically disadvantaged. No clear effect modification by previous hospitalisations was detected except for cardiac dysrhythmias, possibly due to protective treatment.
19. Federico M, Pirani M, Rashid I, Caranci N, Cirilli C. Cancer incidence in people with residential exposure to a municipal waste incinerator: an ecological study in Modena (Italy), 1991-2005. Waste Manag. 2010 Jul;30(7):1362-70.
Abstract
We conducted a retrospective ecological study to assess cancer incidence during the period 1991-2005 in proximity of a municipal waste incinerator (MWI) in Modena (Italy). We identified three bands of increasing distance from the MWI, up to a radius of 5 km and used the residence as surrogate marker of the exposure. Residential history for Modena's population was reconstructed and residents were associated to the most appropriate census unit. Age-standardized incidence ratios (ASR) and standardized incidence ratios (SIR) were estimated for all cancers and selected sites. Variations in cancer incidence were investigated using space and space-time scan statistic. Deprivation index was taken into account as potential confounding factor. During the 15-year study period, 16,443 new cases of cancer were diagnosed among residents in Modena. The space-time clustering test identified three significant clusters but their shapes were not associable to the MWI exposition. The purely spatial analysis not showed statistically significant clusters. The SIR computed for all cancers and selected sites did not show any excess of risk in the area closest to the plant. Higher SIR for leukaemia was found in the second band from MWI (2-3.5 km) for females (SIR, age and DI adjusted: 1.35, 95%CI: 1.01-1.79) and for both sexes (SIR, age and DI adjusted: 1.28, 95%CI: 1.03-1.57), but not a spatial trend was observed, thus excluding a possible link with MWI. In conclusion, bearing in mind the intrinsic limits of the study, the results suggest that there is no detectable increase of cancer risk for people living in proximity to the Modena MWI.
20. Canova C, Torresan S, Simonato L, Scapellato ML, Tessari R, Visentin A, Lotti M, Maestrelli P. Carbon monoxide pollution is associated with decreased lung function in asthmatic adults. Eur Respir J. 2010 Feb;35(2):266-72. Epub 2009 Aug 13.
Abstract
The aim of the present study was to test the effects of exposure to air pollutants on lung function. A panel of 19 adult asthmatics living in Padua (Italy) was followed for five 30-day periods during 2 yrs consecutively (1,492 morning and 1,434 evening measures analysed). Peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV(1)) were measured using a pocket electronic meter. Daily levels of air pollutants and meteorological variables were collected at outdoor city monitoring sites. Significant inverse associations were observed between morning and evening PEF and carbon monoxide level (p = 0.01-0.03), without clear differences between lags (0-3 days). An increment of 1 mg.m(-3) CO was associated with a PEF variation ranging -2.6- -2.8%. All effect estimates on PEF for CO remained significant and even increased after controlling for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen dioxide and sulphur dioxide in single and multi-pollutant models. A similar trend was observed for FEV(1), but the associations were nonsignificant. A nonsignificant inverse relationship between evening PEF and SO(2) was also detected. PEF and FEV(1) were not related to PM(10) and NO(2) concentrations. The present results indicate that, in this panel of adult asthmatics, the worsening of lung function is associated with exposure to gaseous pollutants and occurs at levels of CO and SO(2) lower than current European standards.
21. Lippi G, Franchini M, Montagnana M, Filippozzi L, Favaloro EJ, Guidi GC. Relationship between 24-h air pollution, emergency department admission and diagnosis of acute coronary syndrome. J Thromb Thrombolysis. 2010 May;29(4):381-6.
Abstract
Current available evidence suggests that air pollution, especially particulate matter < 10 mum in aerodynamic diameter (PM10), has acute and chronic effects on health. We aimed to evaluate the epidemiological association between 24-h PM10 levels and acute coronary syndrome (ACS). We analyzed the number of daily admissions at the emergency unit (ED) of patients with suspected ACS, and the number of daily diagnosis of ACS in the same local ED according to the 24-h PM10, over a nearly 3-month period. 209 out of the 1,688 patients admitted to the ED with a clinical suspicion of ACS had a definitive diagnosis of ACS. Whereas the mean number of ED admissions for suspected ACS did not differ significantly according to the 24-h levels of PM10 (18 +/- 1 vs. 17 +/- 1; P = 0.13), the mean number of diagnoses of ACS was 26% higher when the 24-h levels of PM10 were >50 microg/m(3) (2.4 +/- 0.2 vs. 1.9 +/- 0.2; P = 0.03). A statistically significant association was also observed between 24-h PM10 levels and daily number of ACS diagnoses (r = 0.26; P < 0.001), but not between 24-h PM10 levels and daily ED accesses for suspected ACS (r = 0.12; P = 0.24). Taken together, these results support the existence of an epidemiologic association between air pollution and acute cardiovascular events.