• Andrea Ranzi1

  1. Arpa, Modena

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Ricerca bibliografica periodo dal 16 giugno – 30 agosto 2013

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Stringa: (pollution[Title/Abstract] OR pollutant[Title/Abstract] OR pollutants[Title/Abstract] OR climate change[Title/Abstract] ) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2013/06/16"[PDAT] : "2013/08/30"[PDAT])
1. Raaschou-Nielsen O, Andersen ZJ, Beelen R, Samoli E, Stafoggia M, Weinmayr G, Hoffmann B, Fischer P, Nieuwenhuijsen MJ, Brunekreef B, Xun WW,Katsouyanni K, Dimakopoulou K, Sommar J, Forsberg B, Modig L, Oudin A, Oftedal B, Schwarze PE, Nafstad P, De Faire U, Pedersen NL, Ostenson CG,Fratiglioni L, Penell J, Korek M, Pershagen G, Eriksen KT, Sørensen M, Tjønneland A, Ellermann T, Eeftens M, Peeters PH, Meliefste K, Wang M, Bueno-de-Mesquita B, Key TJ, de Hoogh K, Concin H, Nagel G, Vilier A, Grioni S, Krogh V, Tsai MY, Ricceri F, Sacerdote C, Galassi C, Migliore E, Ranzi A, Cesaroni G,Badaloni C, Forastiere F, Tamayo I, Amiano P, Dorronsoro M, Trichopoulou A, Bamia C, Vineis P, Hoek G Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol. 2013 Aug;14(9):813-22. doi: 10.1016/S1470-2045(13)70279-1. Epub 2013 Jul 10.
Danish Cancer Society Research Center, Copenhagen, Denmark. Electronic address:

Abstract Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations. This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 μm (PM10), less than 2•5 μm (PM2•5), and between 2•5 and 10 μm (PMcoarse), soot (PM2•5absorbance), nitrogen oxides, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses. The 312 944 cohort members contributed 4 013 131 person-years at risk. During follow-up (mean 12•8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically significant association between risk for lung cancer and PM10 (hazard ratio [HR] 1•22 [95% CI 1•03-1•45] per 10 μg/m(3)). For PM2•5 the HR was 1•18 (0•96-1•46) per 5 μg/m(3). The same increments of PM10 and PM2•5 were associated with HRs for adenocarcinomas of the lung of 1•51 (1•10-2•08) and 1•55 (1•05-2•29), respectively. An increase in road traffic of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1•09 (0•99-1•21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1•01 [0•95-1•07] per 20 μg/m(3)) or traffic intensity on the nearest street (HR 1•00 [0•97-1•04] per 5000 vehicles per day).

Breve commento a cura di Andrea Ranzi
Il progetto ESCAPE (European Study of Cohorts for Air Pollution Effects), finanziato dall’Unione Europea nell’ambito del VII Programma Quadro e coordinato dall’Università di Utrecht (Olanda) con la collaborazione con diversi partner europei, ha come obiettivo la valutazione degli effetti sulla salute dovuti ad esposizioni di lungo periodo agli inquinanti atmosferici in diverse realtà europee. Sono state considerate coorti già esistenti, e grande sforzo è stato fatto all’interno del progetto, per migliorare la valutazione dell’esposizione residenziale dei soggetti delle diverse coorti, attraverso un approccio omogeneo e l’uso di modelli di regressione lineare (LUR), che migliorassero il classico approccio di attribuzione omogenea dell’esposizione media della città di residenza a tutti gli abitanti, catturando invece l’eterogeneità intra-urbana dell’esposizione all’inquinamento. Il presente lavoro riporta uno dei primi risultati di meta-analisi di 17 delle coorti coinvolte, per un totale di oltre 310.000 persone adulte residenti in nove paesi europei (in Italia sono state coinvolte oltre 30.000 soggetti residenti a Torino, Roma e Varese). Lo studio ha evidenziato un aumento di rischio di sviluppare un tumore al polmone all’aumentare dell’esposizione a particolato (PM10 e PM25). Il fatto rilevante è che le analisi siano state corrette per stili di vita e abitudini al fumo, e che questi rischi siano più elevati per l’adenocarcinoma, che è il solo tipo di tumore polmonare che si sviluppa anche in un numero sostanziale di non fumatori. I commenti a questo articolo sono stati numerosi sulla stampa specialistica e non, sotto riporto qualche link:

2. Baccini M, Kosatsky T, Biggeri A. Impact of Summer Heat on Urban Population Mortality in Europe during the 1990s: An Evaluation of Years of Life Lost Adjusted for Harvesting. PLoS One. 2013 Jul 22;8(7):e69638. doi: 10.1371/journal.pone.0069638. Print 2013.
Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy ; Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy.

Abstract BACKGROUND: Efforts to prevent and respond to heat-related illness would benefit by quantifying the impact of summer heat on acute population mortality. We estimated years of life lost due to heat in 14 European cities during the 1990s accounting for harvesting. METHODS: We combined the number of deaths attributable to heat estimated by the PHEWE project with life expectancy derived from population life tables. The degree of harvesting was quantified by comparing the cumulative effect of heat up to lagged day 30 with the immediate effect of heat, by geographical region and age. Next, an evaluation of years of life lost adjusted for harvesting was obtained. RESULTS: Without accounting for harvesting, we estimated more than 23,000 years of life lost per year, 55% of which was among individuals younger than 75. When 30 day mortality displacement was taken into account, the overall impact reduced on average by 75%. Harvesting was more pronounced in North-continental cities than in Mediterranean cities and was stronger among young people than among elderly. CONCLUSIONS: High ambient temperatures during summer were responsible for many deaths in European cities during the 1990s, but a large percentage of these deaths likely involved frail persons whose demise was only briefly hastened by heat exposure. Differences in harvesting across regions and classes of age could reflect different proportions of frail individuals in the population or could be indicative of heterogeneous dynamics underlying the entry and exit of individuals from the high-risk pool which is subject to mortality displacement.

3. Leone M, D'Ippoliti D, De Sario M, Analitis A, Menne B, Katsouyanni K, De' Donato FK, Basagana X, Salah AB, Casimiro E, Dörtbudak Z, Iñiguez C, Peretz C, Wolf T, Michelozzi P. A time series study on the effects of heat on mortality and evaluation of heterogeneity into European and Eastern-Southern Mediterranean cities: results of EU CIRCE project. Environ Health. 2013 Jul 3;12:55. doi: 10.1186/1476-069X-12-55.
Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53 00198, Rome, Italy.

Abstract BACKGROUND: The Mediterranean region is particularly vulnerable to the effect of summer temperature.Within the CIRCE project this time-series study aims to quantify for the first time the effect of summer temperature in Eastern-Southern Mediterranean cities and compared it with European cities around the Mediterranean basin, evaluating city characteristics that explain between-city heterogeneity. METHODS: The city-specific effect of maximum apparent temperature (Tappmax) was assessed by Generalized Estimation Equations, assuming a linear threshold model. Then, city-specific estimates were included in a random effect meta-regression analysis to investigate the effect modification by several city characteristics. RESULTS: Heterogeneity in the temperature-mortality relationship was observed among cities. Thresholds recorded higher values in the warmest cities of Tunis (35.5°C) and Tel-Aviv (32.8°C) while the effect of Tappmax above threshold was greater in the European cities. In Eastern-Southern Mediterranean cities a higher effect was observed among younger age groups (0-14 in Tunis and 15-64 in Tel-Aviv and Istanbul) in contrast with the European cities where the elderly population was more vulnerable. Climate conditions explained most of the observed heterogeneity and among socio-demographic and economic characteristics only health expenditure and unemployment rate were identified as effect modifiers. CONCLUSIONS: The high vulnerability observed in the young populations in Eastern-Southern Mediterranean cities represent a major public health problem. Considering the large political and economic changes occurring in this region as well future temperature increase due to climate change, it is important to strengthen research and public health efforts in these Mediterranean countries.

4. Buonanno G, Marks GB, Morawska L. Health effects of daily airborne particle dose in children: direct association between personal dose and respiratory health effects. Environ Pollut. 2013 Sep;180:246-50. doi: 10.1016/j.envpol.2013.05.039. Epub 2013 Jun 19.
Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy.

Abstract Air pollution is a widespread health problem associated with respiratory symptoms. Continuous exposure monitoring was performed to estimate alveolar and tracheobronchial dose, measured as deposited surface area, for 103 children and to evaluate the long-term effects of exposure to airborne particles through spirometry, skin prick tests and measurement of exhaled nitric oxide (eNO). The mean daily alveolar deposited surface area dose received by children was 1.35 × 10(3) mm(2). The lowest and highest particle number concentrations were found during sleeping and eating time. A significant negative association was found between changes in pulmonary function tests and individual dose estimates. Significant differences were found for asthmatics, children with allergic rhinitis and sensitive to allergens compared to healthy subjects for eNO. Variation is a child's activity over time appeared to have a strong impact on respiratory outcomes, which indicates that personal monitoring is vital for assessing the expected health effects of exposure to particles.

5. Stafoggia M, Samoli E, Alessandrini E, Cadum E, Ostro B, Berti G, Faustini A, Jacquemin B, Linares C, Pascal M, Randi G, Ranzi A, Stivanello E, Forastiere F; MED-PARTICLES Study Group. Short-term Associations between Fine and Coarse Particulate Matter and Hospitalizations in Southern Europe: Results from the MED-PARTICLES Project. Environ Health Perspect. 2013 Jun 18. [Epub ahead of print]
Department of Epidemiology of the Lazio Region Health Service, Rome, Italy.

Abstract BACKGROUND: Evidence on the short-term effects of fine and coarse particles on morbidity in Europe is scarce and inconsistent. OBJECTIVES: To estimate the association between daily concentrations of fine and coarse particles with hospitalizations for cardiovascular and respiratory conditions in 8 Southern European cities, within the MED-PARTICLES project. METHODS: City-specific Poisson models were fitted to estimate associations of daily concentrations of particulate matter with aerodynamic diameter < 2.5 μm (PM2.5), 10 (PM10) and their difference (PM2.5-10), with daily counts of emergency hospitalizations for cardiovascular and respiratory diseases. Pooled estimates were derived from random-effects meta-analysis and the robustness of results to co-pollutant exposure adjustment and model specification was evaluated. Pooled concentration-response curves were estimated using a meta-smoothing approach. RESULTS: We found significant associations between all PM fractions and cardiovascular admissions. Increases of 10-μg/m(3) in PM2.5, 6.3-μg/m(3) in PM2.5-10 and 14.4-μg/m(3) in PM10 (lag 0-1 days) were associated with increases in cardiovascular admissions of 0.51% (95% CI: 0.12, 0.90%), 0.46% (95% CI: 0.10, 0.82%) and 0.53% (95% CI: 0.06, 1.00%), respectively. Stronger associations were estimated for respiratory hospitalizations, ranging from 1.15% (95% CI: 0.21, 2.11%) for PM10 to 1.36% (95% CI: 0.23, 2.49) for PM2.5 (lag 0-5 days). CONCLUSIONS: PM2.5 and PM2.5-10 were positively associated with cardiovascular and respiratory admissions in 8 Mediterranean cities. Information on the short-term effects of different PM fractions on morbidity in Southern Europe will be useful to inform European policies on air quality standards.

Breve commento a cura di Andrea Ranzi
Il progetto MED-PARTICLES (Particles size and composition in Mediterranean countries: geographical variability and short-term health effects), finanziato all’interno del programma LIFE Environment, ha valutato gli effetti a breve termine dell’esposizione a particolato in 10 città dell’area Mediterranea (Milano, Torino, Bologna, Parma, Reggio Emilia, Modena, Roma, Marsiglia, Madrid e Barcellona). Il progetto si chiuderà il 31 agosto di quest’anno e questo primo lavoro ha studiato le associazioni fra mortalità e polveri fini e coarse (PM2.5 e PM2.5-10). I risultati depongono per un ruolo più consistente delle polveri fini, e mostrano associazioni più alte nel periodo estivo, aspetto già evidenziato in precedenti lavori. Le abitudini di vita legate al clima favorevole, il traffico, gli aspetti relativi alla formazione del particolato secondario, la presenza di componenti nel particolato legate a incendi incontrollati o a trasporto di polveri sahariane, rendono peculiare la composizione delle polveri in queste aree, e sono alla base delle possibili interpretazioni dei risultati.

6. Marcon A, Pesce G, Girardi P, Marchetti P, Blengio G, de Zolt Sappadina S, Falcone S, Frapporti G, Predicatori F, de Marco R. Association between PM10 concentrations and school absences in proximity of a cement plant in northern Italy. Int J Hyg Environ Health. 2013 Aug 7. pii: S1438-4639(13)00110-7. doi: 10.1016/j.ijheh.2013.07.016. [Epub ahead of print]
Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy. Electronic address:

Abstract Dusts are one of the main air pollutants emitted during cement manufacturing. A substantial part of these are breathable particles that are less than 10μm in diameter (PM10), which represent a potential threat for the health of the exposed population. This study aimed at evaluating the short-termeffects of PM10 concentrations on the health of children, aged 6-14 years, who attended the schools in Fumane (Italy), in proximity (1.2km) to a large cement plant. School absenteeism was used as a proxy indicator of child morbidity. Time series of daily school absences and PM10 concentrations were collected for 3 school-years from 2007 to 2010 (541 school-days, 462 children on average). The associations between PM10 concentrations and school absence rates in the same day (lag0) and in the following 4 days (lag1 to lag4) were evaluated using generalised additive models, smoothed for medium/long term trends and adjusted for day of the week, influenza outbreaks, daily temperature and rain precipitations. The average concentration of PM10 in the period was 34 (range: 4-183) μg/m3. An average 10μg/m3 increase of PM10 concentration in the previous days (lag0-4) was associated with a statistically significant 2.5% (95%CI: 1.1-4.0%) increase in the rate of school absences. The highest increase in the absence rates (2.4%; 95%CI: 1.2-3.5%) was found 2 days after exposure (lag2). These findings provide epidemiological evidence of the acute health effects of PM10 in areas with annual concentrations that are lower than the legal European Union limit of 40μg/m3, and support the need to establish more restrictive legislative standards.

7. Porta D, Fantini F, De Felip E, Blasetti F, Abballe A, Dell'Orco V, Fano V, Ingelido AM, Narduzzi S, Forastiere F. A biomonitoring study on blood levels of beta-hexachlorocyclohexane among people living close to an industrial area. Environ Health. 2013 Jul 16;12:57. doi: 10.1186/1476-069X-12-57.
Department of Epidemiology, Lazio Regional Health Service- ASL RME, Rome, Italy.

Abstract BACKGROUND: A chemical plant manufacturing pesticides has been operating since the 1950's in the Sacco River Valley (Central Italy). In 2005, high beta-hexachlorocyclohexane (Beta-HCH) concentrations were found in milk of cows raised and fed near the river. We report the results of a biomonitoring study conducted in this region to evaluate the body burden of Beta-HCH and to identify the determinants of the human contamination. METHODS: We defined four residential areas by their distance from the chemical plant and the river, and selected a stratified random sample of 626 people aged 25-64 years. We evaluated the association, in terms of the geometric mean ratio (GMR), between several potential determinants and Beta-HCH serum concentrations using multivariate linear regression analysis. RESULTS: Two hundred forty-six serum samples were analysed to assess Beta-HCH levels (mean concentration: 99 ng/g lipid; Standard Deviation: 121; Geometric Mean: 60.6; Geometric Standard Deviation: 2.65). We found a strong association between Beta-HCH and living in the area close to the river (GMR: 2.00; 95%CI: 1.36-2.94). Beta-HCH levels were also associated with age, level of education, use of private wells and consumption of local food. CONCLUSIONS: The results suggest that people living close to the river may have been contaminated by Beta-HCH, most likely through water from private wells and privately grown food. A programme of epidemiological and clinical surveillance is on-going on this population.

8. Pirastu R, Pasetto R, Zona A, Ancona C, Iavarone I, Martuzzi M, Comba P. The health profile of populations living in contaminated sites: SENTIERI approach. J Environ Public Health. 2013;2013:939267. doi: 10.1155/2013/939267. Epub 2013 Jun 18.
Department of Biology and Biotechnologies Charles Darwin, Sapienza University of Rome, Piazzale Aldo Moro, 5-00185 Rome, Italy.

Abstract SENTIERI project (Epidemiological Study of Residents in Italian Contaminated Sites) studied mortality in the sites of national interest for environmental remediation (National Priority Contaminated Sites-NPCSs). SENTIERI described mortality of residents in NPCSSs, and it specifically focused on causes of death for which environmental exposure is suspected or ascertained to play an etiologic role. The epidemiological evidence of the causal association was classified a priori into one of these three categories: Sufficient (S), Limited (L), and Inadequate (I). Mortality in the period 1995-2002 was studied for 63 single or grouped causes at the municipal level by computing: crude rate, standardized rate, standardized mortality ratios (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as references for SMR calculations and 90% CI accompanied SMR values. The deprivation index was constructed using 2001 national census variables for the following socioeconomic domains: education, unemployment, dwelling ownership, and overcrowding. SENTIERI results will allow the priorities setting in remediation intervention so as to prevent adverse health effects from environmental exposure. This paper's objective is to present the rationale, methods, advantages, and limitations underlying SENTIERI project and to describe data and resources required to apply a similar approach in other countries.

9. Lombardo D, Ciancio N, Campisi R, Di Maria A, Bivona L, Poletti V, Mistretta A, Biggeri A, Di Maria G. A retrospective study on acute health effects due to volcanic ash exposure during the eruption of Mount Etna (Sicily) in 2002. Multidiscip Respir Med. 2013 Aug 7;8(1):51. doi: 10.1186/2049-6958-8-51.
Pulmonology Unit, A,O,U, Policlinico-Vittorio Emanuele, Catania, Italy.

Abstract BACKGROUND: Mount Etna, located in the eastern part of Sicily (Italy), is the highest and most active volcano in Europe. During the sustained eruption that occurred in October-November 2002 huge amounts of volcanic ash fell on a densely populated area south-east of Mount Etna in Catania province. The volcanic ash fall caused extensive damage to infrastructure utilities and distress in the exposed population. This retrospective study evaluates whether or not there was an association between ash fall and acute health effects in exposed local communities. METHODS: We collected the number and type of visits to the emergency department (ED) for diseases that could be related to volcanic ash exposure in public hospitals of the Province of Catania between October 20 and November 7, 2002. We compared the magnitude of differences in ED visits between the ash exposure period in 2002 and the same period of the previous year 2001. RESULTS: We observed a significant increase of ED visits for acute respiratory and cardiovascular diseases, and ocular disturbances during the ash exposure time period. CONCLUSIONS: There was a positive association between exposure to volcanic ash from the 2002 eruption of Mount Etna and acute health effects in the Catania residents. This study documents the need for public health preparedness and response initiatives to protect nearby populations from exposure to ash fall from future eruptions of Mount Etna.

10. Baderna D, Colombo A, Amodei G, Cantù S, Teoldi F, Cambria F, Rotella G, Natolino F, Lodi M, Benfenati E. Chemical-based risk assessment and in vitro models of human health effects induced by organic pollutants in soils from the Olona valley. Sci Total Environ. 2013 Jul 13;463-464C:790-801. doi: 10.1016/j.scitotenv.2013.06.088. [Epub ahead of print]
Laboratory of Environmental Chemistry and Toxicology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address:

Abstract Risk assessment of soils is usually based on chemical measurements and assuming accidental soil ingestion and evaluating induced toxic and carcinogenic effects. Recently biological tools have been coupled to chemical-based risk assessment since they integrate the biological effects of all xenobiotics in soils. We employed integrated monitoring of soils based on chemical analyses, risk assessment and in vitro models in the highly urbanized semirural area of the Olona Valley in northern Italy. Chemical characterization of the soils indicated low levels of toxic and carcinogenic pollutants such as PAHs, PCDD/Fs, PCBs and HCB and human risk assessment did not give any significant alerts. HepG2 and BALB/c 3T3 cells were used as a model for the human liver and as a tool for the evaluation of carcinogenic potential. Cells were treated with soil extractable organic matters (EOMs) and the MTS assay, LDH release and morphological transformation were selected as endpoints for toxicity and carcinogenicity. Soil EOMs induced dose-dependent inhibition of cell growth at low doses and cytotoxicity after exposure to higher doses. This might be the result of block of cell cycle progression to repair DNA damage caused by oxidative stress; if this DNA damage cannot be repaired, cells die. No significant inductions of foci were recorded after exposure to EOMs. These results indicate that, although the extracts contain compounds with proven carcinogenic potential, the levels of these pollutants in the analyzed soils were too low to induce carcinogenesis in our experimental conditions. In this proposed case study, HepG2 cells were found an appropriate tool to assess the potential harm caused by the ingestion of contaminated soil as they were able to detect differences in the toxicity of soil EOMs. Moreover, the cell transformation assay strengthened the combined approach giving useful information on carcinogenic potential of mixtures.

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