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  • Andrea Ranzi1

  1. ARPA, Modena
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Ricerca bibliografica periodo 1 febbraio 2011 – 1 aprile 2011

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Database: Pubmed/MEDline
Stringa:
((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
Criteri di esclusione degli articoli: Articoli su riviste italiane, Articoli su E&P, Editoriali e Review narrative

CLICCA sul titolo di ogni articolo PER LEGGERE L'ABSTRACT.

1. Ranzi A, Fano V, Erspamer L, Lauriola P, Perucci CA, Forastiere F. Mortality and morbidity among people living close to incinerators: a cohort study based on dispersion modeling for exposure assessment. Environ Health. 2011 Mar 24;10:22.
Abstract
BACKGROUND: Several studies have been conducted on the possible health effects for people living close to incinerators and well-conducted reviews are available. Nevertheless, several uncertainties limit the overall interpretation of the findings. We evaluated the health effects of emissions from two incinerators in a pilot cohort study.
METHODS: The study area was defined as the 3.5 km radius around two incinerators located near Forli (Italy). People who were residents in 1/1/1990, or subsequently became residents up to 31/12/2003, were enrolled in a longitudinal study (31,347 individuals). All the addresses were geocoded. Follow-up continued until 31/12/2003 by linking the mortality register, cancer registry and hospital admissions databases. Atmospheric Dispersion Model System (ADMS) software was used for exposure assessment; modelled concentration maps of heavy metals (annual average) were considered the indicators of exposure to atmospheric pollution from the incinerators, while concentration maps of nitrogen dioxide (NO2) were considered for exposure to other pollution sources. Age and area-based socioeconomic status adjusted rate ratios and 95% Confidence Intervals were estimated with Poisson regression, using the lowest exposure category to heavy metals as reference.
RESULTS: The mortality and morbidity experience of the whole cohort did not differ from the regional population. In the internal analysis, no association between pollution exposure from the incinerators and all-cause and cause-specific mortality outcomes was observed in men, with the exception of colon cancer. Exposure to the incinerators was associated with cancer mortality among women, in particular for all cancer sites (RR for the highest exposure level=1.47, 95% CI: 1.09, 1.99), stomach, colon, liver and breast cancer. No clear trend was detected for cancer incidence. No association was found for hospitalizations related to major diseases. NO2 levels, as a proxy from other pollution sources (traffic in particular), did not exert an important confounding role.
CONCLUSIONS: No increased risk of mortality and morbidity was found in the entire area. The internal analysis of the cohort based on dispersion modeling found excesses of mortality for some cancer types in the highest exposure categories, especially in women, The interpretation of the findings is limited given the pilot nature of the study.

Breve commento a cura di Fabrizio Bianchi
Studio di mortalità e ospedalizzazione di una coorte di residenti intorno a due inceneritori localizzati a Forlì (località Coriano), con follow up 1.1.1990-31.12.2003 ed esposizione individuale attribuita in conformità al modello di dispersione di metalli pesanti e di NOx. Mentre gli indicatori di mortalità e di morbosità dei residenti nell’area intorno agli impianti non sono risultati significativamente diversi dai dati della popolazione regionale, all’interno dell’area sono emerse alcune differenze statisticamente significative tra una delle tre sub-aree definite maggiormente esposte e la sub-area di riferimento: tumore del colon-retto tra gli uomini e totale dei tumori, tumori di stomaco, colon e mammella tra le donne. I dati di ospedalizzazione e di incidenza di tumori non mostrano eccessi significativi, fatta eccezione per il colon-retto tra le donne.
Per alcune cause di interesse per il tipo di esposizione (inceneritori) le stime sono instabili a causa dei numeri ridotti di eventi, tuttavia alcuni eccessi emersi possono essere considerati come segnali di interesse in fase di estensione del follow up (es. mortalità per linfoma non-hodgkin e mieloma tra le donne, incidenza sarcoma dei tessuti molli tra le donne).
Il lavoro offre importanti risultati e diversi elementi da tenere in considerazione, soprattutto per una comunicazione equilibrata: gli eccessi all’interno dell’area di studio sono emersi non sempre per le categorie più esposte e non hanno mostrato andamenti crescenti, gli eccessi di mortalità emersi in particolare a carico delle donne riguardano cause ad eziologia multifattoriale, elementi che avrebbero potuto rafforzare le associazioni di rischio descritte.
Infine, gli eccessi emersi dai confronti interni a fronte di assenza di differenze nei confronti interno-esterno suggeriscono domande più che risposte: qual è il ruolo dell’esposizione ai valori bassi di iso-concentrazione degli inquinanti? l’area interna di riferimento è particolarmente “sana”? la diluizione di valori interni di rischio elevato con valori di rischio ridotto portano a valori medi non difformi dall’esterno? Il lavoro di Ranzi e collaboratori è senz’altro un punto di snodo in epidemiologia ambientale, poiché usando un disegno avanzato (coorte con definizione dell’esposizione individuale con modello di dispersione di inquinanti) cresce la validità e l’attendibilità dei risultati ma anche la sfida per ulteriori sviluppi.

2. Signorino G, Pasetto R, Gatto E, Mucciardi M, La Rocca M, Mudu P. Gravity models to classify commuting vs. resident workers. An application to the analysis of residential risk in a contaminated area. Int J Health Geogr. 2011 Jan 27;10:11.
Department of Economics, Statistics, Mathematics and Sociology, University of Messina, Via Tommaso Cannizzaro 278, Messina, Italy.

Abstract
BACKGROUND: The analysis of risk for the population residing and/or working in contaminated areas raises the topic of commuting. In fact, especially in contaminated areas, commuting groups are likely to be subject to lower exposure than residents. Only very recently environmental epidemiology has started considering the role of commuting as a differential source of exposure in contaminated areas. In order to improve the categorization of groups, this paper applies a gravitational model to the analysis of residential risk for workers in the Gela petrochemical complex, which began life in the early 60s in the municipality of Gela (Sicily, Italy) and is the main source of industrial pollution in the local area. RESULTS: A logistic regression model is implemented to measure the capacity of Gela "central location" to attract commuting flows from other sites. Drawing from gravity models, the proposed methodology: a) defines the probability of finding commuters from municipalities outside Gela as a function of the origin's "economic mass" and of its distance from each destination; b) establishes "commuting thresholds" relative to the origin's mass. The analysis includes 367 out of the 390 Sicilian municipalities. Results are applied to define "commuters" and "residents" within the cohort of petrochemical workers. The study population is composed of 5,627 workers. Different categories of residence in Gela are compared calculating Mortality Rate Ratios for lung cancer through a Poisson regression model, controlling for age and calendar period. The mobility model correctly classifies almost 90% of observations. Its application to the mortality analysis confirms a major risk for lung cancer associated with residence in Gela. CONCLUSIONS: Commuting is a critical aspect of the health-environment relationship in contaminated areas. The proposed methodology can be replicated to different contexts when residential information is lacking or unreliable; however, a careful consideration of the territorial characteristics ("insularity" and its impact on transportation time and costs, in our case) is suggested when specifying the area of application for the mobility analysis.

Breve commento a cura di Andrea Ranzi
L’articolo propone una metodologia, basata su un modello probabilistico, per la classificazione di una popolazione di lavoratori di un impianto petrolchimico in due categorie: residenti e pendolari. L’obiettivo finale è una migliore caratterizzazione della popolazione esposta ad inquinanti ambientali, quando l’esposizione è definita su base geografica e le informazioni sulla storia residenziale sono assenti o parziali.
La mobilità della popolazione rappresenta un aspetto molto importante negli studi di epidemiologia ambientale per una migliore caratterizzazione dell’esposizione delle popolazioni oggetto di indagine. La proposizione di metodi quantitativi, come il presente, per la ricostruzione dell’informazione relativa alla storia residenziale e alla mobilità rappresentano importanti contributi per valutare al meglio l’esposizione della popolazione e il carico di incertezza che tali stime si portano dietro.

3 Occup Environ Med. 2010 Dec 16. Saharan dust and daily mortality in Emilia-Romagna (Italy). Zauli Sajani S, Miglio R, Bonasoni P, Cristofanelli P, Marinoni A, Sartini C, Goldoni CA, De Girolamo G, Lauriola P.
Abstract
Objective: To investigate the association between Saharan dust outbreaks and natural, cardiovascular and respiratory mortality.
Methods: A case-crossover design was adopted to assess the effects of Saharan dust days (SDD) on mortality in the Emilia-Romagna region of Italy. The population under study consisted of residents in the six main towns of the central-western part of the region who died between August 2002 and December 2006. The association of Saharan dust outbreaks and PM(10) concentration with mortality was estimated using conditional logistic regression, adjusted for apparent temperature, holidays, summer population decrease, flu epidemic weeks and heat wave days. The role of the interaction term between PM(10) and SDD was analysed to test for effect modification induced by SDD on the PM(10)-mortality concentration-response function. Separate estimates were undertaken for hot and cold seasons.
Results: We found some evidence of increased respiratory mortality for people aged 75 or older on SDD. Respiratory mortality increased by 22.0% (95% CI 4.0% to 43.1%) on the SDD in the whole year model and by 33.9% (8.4% to 65.4%) in the hot season model. Effects substantially attenuated for natural and cardiovascular mortality with ORs of 1.042 (95% CI 0.992 to 1.095) and 1.043 (95% CI 0.969 to 1.122), respectively.
Conclusions: Our findings suggest an association between respiratory mortality in the elderly and Saharan dust outbreaks. We found no evidence of an effect modification of dust events on the concentration-response relationship between PM(10) and daily deaths. Further work should be carried out to clarify the mechanism of action.

Breve commento a cura di Andrea Ranzi
Quest’articolo presenta i risultati di uno studio condotto in Emilia Romagna sugli effetti delle polveri sahariane sulla salute. Vi è la conferma di alcuni risultati di letteratura, con un ulteriore suggestione di un aumento della mortalità respiratoria per gli anziani nei giorni di presenza di queste polveri. Oltre alla rilevanza scientifica, legata anche all’evidenza di effetti in aree ben lontane dalla fonte di emissione (deserto del Sahara), l’articolo ha potenziali implicazioni di carattere politico-decisionale, come sottolineato anche dal commento di Laura Perez e Nino Kunzli, presente nello stesso numero della rivista. Infatti la recente legislazione europea permette di non considerare il contributo cosiddetto "naturale" al PM10 (tra cui rientrano le polveri sahariane) nel computo dei superamenti dei limiti giornalieri. Questo aspetto pone in luce ancora una volta il noto problema dell’integrazione tra evidenze scientifiche e il loro utilizzo nelle decisioni politiche.

4. Nuvolone D, Maggiore RD, Maio S, Fresco R, Baldacci S, Carrozzi L, Pistelli F, Viegi G. Geographical information system and environmental epidemiology: a cross-sectional spatial analysis of the effects of traffic-related air pollution on population respiratory health. Environ Health. 2011 Mar 1;10:12.
Epidemiology Unit, Regional Agency of Public Health of Tuscany (ARS), Via Pietro Dazzi 1, I-50141 Florence, Italy. daniela.nuvolone@asf.toscana.it.
Abstract
BACKGROUND: Traffic-related air pollution is a potential risk factor for human respiratory health. A Geographical Information System (GIS) approach was used to examine whether distance from a main road (the Tosco-Romagnola road) affected respiratory health status.
METHODS: We used data collected during an epidemiological survey performed in the Pisa-Cascina area (central Italy) in the period 1991-93. A total of 2841 subjects participated in the survey and filled out a standardized questionnaire on health status, socio-demographic information, and personal habits. A variable proportion of subjects performed lung function and allergy tests. Highly exposed subjects were defined as those living within 100 m of the main road, moderately exposed as those living between 100 and 250 m from the road, and unexposed as those living between 250 and 800 m from the road. Statistical analyses were conducted to compare the risks for respiratory symptoms and diseases between exposed and unexposed. All analyses were stratified by gender.
RESULTS: The study comprised 2062 subjects: mean age was 45.9 years for men and 48.9 years for women. Compared to subjects living between 250 m and 800 m from the main road, subjects living within 100 m of the main road had increased adjusted risks for persistent wheeze (OR = 1.76, 95% CI = 1.08-2.87), COPD diagnosis (OR = 1.80, 95% CI = 1.03-3.08), and reduced FEV1/FVC ratio (OR = 2.07, 95% CI = 1.11-3.87) among males, and for dyspnea (OR = 1.61, 95% CI = 1.13-2.27), positivity to skin prick test (OR = 1.83, 95% CI = 1.11-3.00), asthma diagnosis (OR = 1.68, 95% CI = 0.97-2.88) and attacks of shortness of breath with wheeze (OR = 1.67, 95% CI = 0.98-2.84) among females.
CONCLUSION: This study points out the potential effects of traffic-related air pollution on respiratory health status, including lung function impairment. It also highlights the added value of GIS in environmental health research.
5. Maifredi G, Donato F, Magoni M, Orizio G, Gelatti U, Maiolino P, Zani C, Vassallo F, Scarcella C. Polychlorinated biphenyls and non-Hodgkin's lymphoma: a case-control study in Northern Italy. Environ Res. 2011 Feb;111(2):254-9. Epub 2011 Jan 15.
Institute of Hygiene, Epidemiology and Public Health, Department of Experimental and Applied Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
Abstract
BACKGROUND: Polychlorinated biphenyls (PCBs) have been hypothesized to increase the risk of non-Hodgkin lymphoma (NHL), although conclusive evidence is still lacking. High levels of PCBs were found in soil in some areas close to a PCB-producing factory in Brescia, North Italy. We conducted a population-based case-control study among residents of the town to investigate the possible association between PCB pollution and NHL in this area.
METHODS: We included both incident and deceased NHL cases, and a random sample of the town residents as controls, frequency matched to cases as regards age and gender. Exposure to PCBs was estimated on the basis of the lifetime residential history of cases and controls in four different areas of the town-A, B and C (polluted areas) and D (control area).
RESULTS: A total of 495 cases (287 incident cases) and 1467 controls were enrolled. Positive associations were found between NHL and having resided for at least 10 years in the area A, the most polluted area (odds ratio, OR=1.8; p=0.02) and for having resided in any of the polluted areas considered together (A+B+C) (OR=1.4; p=0.08). However, no associations were evident for having resided 20 years or longer in the polluted areas or when analyzing the association with each subject's main residence in his/her lifetime.
CONCLUSION: This study provides some evidence for an association between PCB exposure and NHL, though results should be considered with caution in the absence of individual biological measures of exposure.
6. Santangelo A, Albani S, Beretta M, Cappello A, Mamazza G, Pavano S, Testaì M, Tomarchio M, Zuccaro C, Maugeri D. Aging and environmental factors: an estimation of the health state of the elderly population residing in industrialized vs. rural areas. Arch Gerontol Geriatr. 2011 Mar-Apr;52(2):181-4. Epub 2010 Apr 18.
Department of Surgery, University of Catania, Cannizzaro Hospital, Via Messina 829, 95129 Catania, Italy.
Abstract
The possibilities have already been discussed that the environment of the living beings may influence the aging process, by causing alterations of the homeostatic capacities to such an extent that definitive pathologies will come into being. Therefore, the aim of the present study was at estimating the effective impact of the environmental pollution on the health state of the subjects residing in highly industrialized areas. For this purpose, we compared 2 populations over the age of 56 years, one from the industrialized areas and the other of agricultural character. The health indicator we utilized was the rate of hospitalization calculated for the main geriatric pathologies. It has been observed that among the residents of highly polluted areas, the hospitalizations were more frequent for the screened pathologies. This finding could be an indicator of an interference of the environmental pollution with the physiological process of aging. One can also suspect that for the cardiovascular pathologies also the factor of physical fatigue being more prevalent in the rural population might play an important role in the high occurrence of this type of diseases. On the basis of these findings we intend to emphasize that the sanitary programs of a given territory should consider in the development and application of a sanitary service the intrinsic characteristics of the given area, when designing the possibly most adequate health care service.
7 Farina F, Sancini G, Mantecca P, Gallinotti D, Camatini M, Palestini P. The acute toxic effects of particulate matter in mouse lung are related to size and season of collection. Toxicol Lett. 2011 May 10;202(3):209-17. Epub 2011 Mar 1.
SourceDepartment of Experimental Medicine, POLARIS Research Center, University of Milano-Bicocca, 48 via Cadore, Monza 20052, Italy.
Abstract
The toxicity of size-fractionated particulate matter (PM10 and PM2.5) collected in Milano during two different seasons (summer and winter) has been evaluated in vivo. The focus is on time related (3h, 24h and 1 week) lung response following a single intratracheal aerosolization in BALB/c mice. The bronchoalveolar lavage fluid (BALf) and the lung parenchyma were screened for different markers of inflammation and cytotoxicity. Histology and immunohistochemistry were performed on excised fixed lungs to assess the effects produced by the different PM fractions. All the analyzed inflammatory markers (PMNs percentage, TNF-α, Hsp70 in the BALf, HO-1 in lung parenchyma), increased after summer PM10 administration; on the contrary winter PM10 and PM2.5 specifically increased the amount of the Cyp1B1, a protein putatively involved in the induction of pro-carcinogenic effect. Moreover, we detected an intensification of LDH activity in the BALf after the administration of winter PM10 and PM2.5, potentially related to an in progress necrotic process while after summer PM10 and PM2.5 administration, the initiation of the caspase cascade suggested a cytotoxic effect sustained by apoptosis. Our results evidenced the toxicity mechanisms elicited by size fractionated PM samples, collected in winter and summer seasons, which differs for dimensions, chemical and microbiological composition. PM10 has been indicated to elicit above all a pro-inflammatory response, linked to its specific biological components, while PM2.5 is supposed to be more harmful due to its smaller dimension and the ability to distribute into the lung alveolar districts. We hypothesized that adverse health effects observed after a single dose of winter PM2.5 is at least partly caused by specific winter PM components, i.e. PAH and transitional metals.
8 Campo L, Cattaneo A, Consonni D, Scibetta L, Costamagna P, Cavallo DM, Bertazzi PA, Fustinoni S. Urinary methyl tert-butyl ether and benzene as biomarkers of exposure to urban traffic. Environ Int. 2011 Feb;37(2):404-11. Epub 2010 Dec 4.
Abstract
Methyl tert-butyl ether (MTBE) and benzene are added to gasoline to improve the combustion process and are found in the urban environment as a consequence of vehicular traffic. Herein we evaluate urinary MTBE (MTBE-U) and benzene (BEN-U) as biomarkers of exposure to urban traffic. Milan urban policemen (130 total) were investigated in May, July, October, and December for a total of 171 work shifts. Personal exposure to airborne benzene and carbon monoxide (CO), and atmospheric data, were measured during the work shift, while personal characteristics were collected by a questionnaire. A time/activity diary was completed by each subject during the work shift. Spot urine samples were obtained for the determination of MTBE-U and BEN-U. Median personal exposure to CO and airborne benzene were 3.3 mg/m(3) and 9.6 μg/m(3), respectively; median urinary levels in end-of-shift (ES) samples were 147 ng/L (MTBE-U) and 207 ng/L (BEN-U). The time spent on traffic duty at crossing was about 40% of work time. Multiple linear regression models, taking into account within-subject correlations, were applied to investigate the role of urban pollution, atmospheric conditions, job variables and personal characteristics on the level of biomarkers. MTBE-U was influenced by the month of sampling and positively correlated to the time spent in traffic guarding, CO exposure and atmospheric pressure, while negatively correlated to wind speed (R(2) for total model 0.63, P<0.001). BEN-U was influenced by the month and smoking habit, and positively correlated to urinary creatinine; moreover, an interaction between CO and smoking was found (R(2)=0.62, P<0.001). These results suggest that MTBE-U is a reliable marker for assessing urban traffic exposure, while BEN-U is determined mainly by personal characteristics.
9. Sarigiannis DA, Karakitsios SP, Gotti A, Liakos IL, Katsoyiannis A. Exposure to major volatile organic compounds and carbonyls in European indoor environments and associated health risk. Environ Int. 2011 May;37(4):743-65. Epub 2011 Feb 26.
Abstract
This paper summarizes recent data on the occurrence of major organic compounds (benzene, toluene, xylenes, styrene, acetaldehyde, formaldehyde, naphthalene, limonene, α-pinene and ammonia, classified by the European Commission's INDEX strategy report as the priority pollutants to be regulated) and evaluates accordingly cancer and non-cancer risks posed by indoor exposure in dwellings and public buildings in European Union (EU) countries. The review process indicated that significant differences in indoor air quality exist within and among the countries where data were available, indicating corresponding differences in sources and emission strength of airborne chemicals, identified or not. Conservative exposure limits were not exceeded for non-carcinogenic effects, except for formaldehyde; for carcinogenic agents the estimated risks were up to three orders of magnitude higher than the one (10(-6)) proposed as acceptable by risk management bodies. However, the risk assessment evaluation process faces crucial difficulties, either due to the relative paucity of indoor air quality measurements in many EU countries, or by the lack of sampling consistency in the already existing studies, indicating the need for additional measurements of indoor air quality following a harmonized sampling and analytical protocol. Additionally, uncertainties embodied in the cancer potency factors and exposure limit values impose further difficulties in substance prioritization and risk management.
10. Baderna D, Maggioni S, Boriani E, Gemma S, Molteni M, Lombardo A, Colombo A, Bordonali S, Rotella G, Lodi M, Benfenati E. A combined approach to investigate the toxicity of an industrial landfill's leachate: Chemical analyses, risk assessment and in vitro assays. Environ Res. 2011 May;111(4):603-13. Epub 2011 Feb 12.
Abstract
Solid wastes constitute an important and emerging problem. Landfills are still one of the most common ways to manage waste disposal. The risk assessment of pollutants from landfills is becoming a major environmental issue in Europe, due to the large number of sites and to the importance of groundwater protection. Furthermore, there is lack of knowledge for the environmental, ecotoxicological and toxicological characteristics of most contaminants contained into landfill leacheates. Understanding leachate composition and creating an integrated strategy for risk assessment are currently needed to correctly face the landfill issues and to make projections on the long-term impacts of a landfill, with particular attention to the estimation of possible adverse effects on human health and ecosystem. In the present study, we propose an integrated strategy to evaluate the toxicity of the leachate using chemical analyses, risk assessment guidelines and in vitro assays using the hepatoma HepG2 cells as a model. The approach was applied on a real case study: an industrial waste landfill in northern Italy for which data on the presence of leachate contaminants are available from the last 11 years. Results from our ecological risk models suggest important toxic effects on freshwater fish and small rodents, mainly due to ammonia and inorganic constituents. Our results from in vitro data show an inhibition of cell proliferation by leachate at low doses and cytotoxic effect at high doses after 48h of exposure.