Ambiente
Ricerca bibliografica periodo 15 ottobre 2010 – 17 gennaio 2011
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1 Menichini F, Mudu P. Drug consumption and air pollution: an overview. Pharmacoepidemiol Drug Saf. 2010 Dec;19(12):1300-15. doi: 10.1002/pds.2033. Epub 2010 Oct 6.
Faculty of Pharmacy and Nutrition and Health Sciences, Department of Pharmaceutical Sciences, University of Calabria, Arcavacata di Rende, Italy. federica.menichini@unical.it
Abstract
PURPOSE: Acute respiratory symptoms are among the health effects of air pollution exposure. Studies over the past decades have linked respiratory drug use (consumption or sales) with changes in air pollution conditions.
METHODS: Twenty-one studies were analyzed to discuss whether increased levels of air pollution are associated with the use of medications for respiratory diseases.
RESULTS: Epidemiological studies agree that variation in the drug use is related to air pollution exposure. In panel studies, although asthmatics are more sensitive to air pollution effects, the increase in drug use was comparable and similar to non-asthmatics. Ecological studies confirm a significant association in respiratory drug sales depending on the selected lags (that is the time elapsing between air pollution measurement and the resulting drug use). The results of a meta-analysis of two ecological studies showed an increase in risk for increase in daily mean concentration of some pollutant (10 µg m(-3) ). For Black Smoke RR=1.007 (95% CI 1.004-1.011) for lag 1, and RR=1.008 (95% CI 1.005-1.010) for lag 8. For Nitrogen dioxide, RR=1.008 (95% CI 1.005-1.012) for lag 8 and for Sulfur dioxide, RR=1.005 (95% CI 1.001-1.010) for lag 9.
CONCLUSIONS: The analysis of drug use provides useful data for the evaluation of risks which derive from exposure to air pollution. More studies are needed to measure the effects of air pollution on respiratory medication use. Lags of up to 14 days have to be considered and the pollutants to be considered should include particulate matter and ozone.
Abstract
PURPOSE: Acute respiratory symptoms are among the health effects of air pollution exposure. Studies over the past decades have linked respiratory drug use (consumption or sales) with changes in air pollution conditions.
METHODS: Twenty-one studies were analyzed to discuss whether increased levels of air pollution are associated with the use of medications for respiratory diseases.
RESULTS: Epidemiological studies agree that variation in the drug use is related to air pollution exposure. In panel studies, although asthmatics are more sensitive to air pollution effects, the increase in drug use was comparable and similar to non-asthmatics. Ecological studies confirm a significant association in respiratory drug sales depending on the selected lags (that is the time elapsing between air pollution measurement and the resulting drug use). The results of a meta-analysis of two ecological studies showed an increase in risk for increase in daily mean concentration of some pollutant (10 µg m(-3) ). For Black Smoke RR=1.007 (95% CI 1.004-1.011) for lag 1, and RR=1.008 (95% CI 1.005-1.010) for lag 8. For Nitrogen dioxide, RR=1.008 (95% CI 1.005-1.012) for lag 8 and for Sulfur dioxide, RR=1.005 (95% CI 1.001-1.010) for lag 9.
CONCLUSIONS: The analysis of drug use provides useful data for the evaluation of risks which derive from exposure to air pollution. More studies are needed to measure the effects of air pollution on respiratory medication use. Lags of up to 14 days have to be considered and the pollutants to be considered should include particulate matter and ozone.
Breve commento a cura di Andrea Ranzi
Il lavoro di Menichini e Mudu tratta un argomento di grande interesse: la possibilità di un utilizzo a fini epidemiologici di un archivio sanitario elettronico corrente, quale il consumo di farmaci. Gli archivi elettronici che derivano da normative nazionali o regionali, pur nei loro limiti di precisione diagnostica dovuti alle finalità di tipo amministrativo, possono rappresentare potenziali fonti informative di sicuro interesse per l’epidemiologia, soprattutto se integrate ad altri archivi di natura diversa. Questo argomento è già stato più volte trattato all’interno della rivista, che ha anche dedicato un supplemento ad hoc all’esperienza fatta da un gruppo di lavoro AIE sul tema. Il presente lavoro cerca i possibili legami fra il consumo di farmaci per problemi respiratori acuti e l’inquinamento atmosferico attraverso un analisi di lavori di letteratura e una meta-analisi sui soli due studi ecologici comparabili, a dimostrazione della grande eterogeneità nell’approccio a questi tipo di indagini. In discussione gli autori affermano che, a dispetto delle differenze nel disegno di studio e nelle metodologie di analisi, la consistenza dei risultati porta a pensare di poter utilizzare, con le dovute cautele, questo tipo di informazioni come indicatore di salute degli effetti a breve termine dell’inquinamento atmosferico. Pur nelle difficoltà anche qui riscontrate, la prospettiva di un possibile utilizzo di questi archivi come strumento di valutazione di impatto e di sorveglianza sembra di sicuro interesse.
2 Di Novi C. The influence of traffic-related pollution on individuals' life-style: results from the BRFSS. Health Econ. 2010 Nov;19(11):1318-44.
University of Eastern Piedmont, Polis-Public Policy and Choice, Alessandria, Italy. dinovi@econ.unito.it
Abstract
This paper employs the Behavioral Risk Factor Surveillance System (2001) data in conjunction with the Environmental Protection Agency's Air Quality System data to investigate how air pollution caused by motor vehicle emissions affects the likelihood of good health and the amount of health investments. Models are estimated using three different measures of overall health: a measure of self-assessed health and two health outcome indicators (asthma and blood pressure). A multivariate probit approach is used to estimate recursive systems of equations for self-assessed health, health outcomes and life-styles. The most interesting result concerns the influence of pollution on health-improving life-style choices: only if traffic pollution is in the 'satisfactory range' (AQI level at or below 100), individuals will have incentive to invest in health.
Abstract
This paper employs the Behavioral Risk Factor Surveillance System (2001) data in conjunction with the Environmental Protection Agency's Air Quality System data to investigate how air pollution caused by motor vehicle emissions affects the likelihood of good health and the amount of health investments. Models are estimated using three different measures of overall health: a measure of self-assessed health and two health outcome indicators (asthma and blood pressure). A multivariate probit approach is used to estimate recursive systems of equations for self-assessed health, health outcomes and life-styles. The most interesting result concerns the influence of pollution on health-improving life-style choices: only if traffic pollution is in the 'satisfactory range' (AQI level at or below 100), individuals will have incentive to invest in health.
Breve commento a cura di Andrea Ranzi
Ho scelto di commentare questo articolo per portare un esempio di valutazione dell’impatto dell’inquinamento atmosferico attraverso un indicatore, per me, non consueto. Il lavoro di Di Novi analizza infatti l’influenza dell’inquinamento da traffico sugli stili di vita, e in particolare sull’attitudine agli investimenti sanitari da parte dei singoli individui. Partendo da equazioni di letteratura, propone una modifica alle stesse, basate sul concetto che vi sia un livello di inquinamento “ottimale†in funzione della resa degli investimenti in salute, creando quindi una relazione a forma di U rovesciata tra le due variabili. Al di sotto del livello ottimale, un aumento di inquinamento porta a un maggiore investimento finalizzato alla protezione della propria salute. Ma al di sopra di questo livello ottimale, un aumento dell’inquinamento porta gli individui ad investire meno in salute, in quanto richiede un costo troppo alto per contrastare gli effetti dell’inquinamento. Questo articolo porta un buon esempio, ritengo, di come si debba sempre più utilizzare un approccio multidisciplinare (e indicatori di diversa natura, non solo strettamente legati ad eventi sanitari avversi) per valutare gli impatti dell’inquinamento atmosferico sulla salute della popolazione.
3 Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study. Floud S, Vigna-Taglianti F, Hansell A, Blangiardo M, Houthuijs D, Breugelmans O, Cadum E, Babisch W, Selander J, Pershagen G, Antoniotti MC, Pisani S, Dimakopoulou K, Haralabidis AS, Velonakis V, Jarup L; on behalf of the HYENA study team. Occup Environ Med. 2010 Nov 16.
MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Abstract
Objectives Studies on the health effects of aircraft and road traffic noise exposure suggest excess risks of hypertension, cardiovascular disease and the use of sedatives and hypnotics. Our aim was to assess the use of medication in relation to noise from aircraft and road traffic.
Methods This cross-sectional study measured the use of prescribed antihypertensives, antacids, anxiolytics, hypnotics, antidepressants and antasthmatics in 4,861 persons living near seven airports in six European countries (UK, Germany, the Netherlands, Sweden, Italy, and Greece). Exposure was assessed using models with 1dB resolution (5dB for UK road traffic noise) and spatial resolution of 250×250m for aircraft and 10×10m for road traffic noise. Data were analysed using multilevel logistic regression, adjusting for potential confounders.
Results We found marked differences between countries in the effect of aircraft noise on antihypertensive use; for night-time aircraft noise, a 10dB increase in exposure was associated with ORs of 1.34 (95% CI 1.14 to1.57) for the UK and 1.19 (1.02 to 1.38) for the Netherlands but no significant associations were found for other countries. For day-time aircraft noise, excess risks were found for the UK (OR 1.35; CI: 1.13 to 1.60) but a risk deficit for Italy (OR 0.82; CI: 0.71 to 0.96). There was an excess risk of taking anxiolytic medication in relation to aircraft noise (OR 1.28; CI: 1.04 to 1.57 for daytime and OR 1.27; CI: 1.01 to 1.59 for night-time) which held across countries. We also found an association between exposure to 24hr road traffic noise and the use of antacids by men (OR 1.39; CI 1.11 to 1.74).
Conclusion Our results suggest an effect of aircraft noise on the use of antihypertensive medication, but this effect did not hold for all countries. Results were more consistent across countries for the increased use of anxiolytics in relation to aircraft noise.
Abstract
Objectives Studies on the health effects of aircraft and road traffic noise exposure suggest excess risks of hypertension, cardiovascular disease and the use of sedatives and hypnotics. Our aim was to assess the use of medication in relation to noise from aircraft and road traffic.
Methods This cross-sectional study measured the use of prescribed antihypertensives, antacids, anxiolytics, hypnotics, antidepressants and antasthmatics in 4,861 persons living near seven airports in six European countries (UK, Germany, the Netherlands, Sweden, Italy, and Greece). Exposure was assessed using models with 1dB resolution (5dB for UK road traffic noise) and spatial resolution of 250×250m for aircraft and 10×10m for road traffic noise. Data were analysed using multilevel logistic regression, adjusting for potential confounders.
Results We found marked differences between countries in the effect of aircraft noise on antihypertensive use; for night-time aircraft noise, a 10dB increase in exposure was associated with ORs of 1.34 (95% CI 1.14 to1.57) for the UK and 1.19 (1.02 to 1.38) for the Netherlands but no significant associations were found for other countries. For day-time aircraft noise, excess risks were found for the UK (OR 1.35; CI: 1.13 to 1.60) but a risk deficit for Italy (OR 0.82; CI: 0.71 to 0.96). There was an excess risk of taking anxiolytic medication in relation to aircraft noise (OR 1.28; CI: 1.04 to 1.57 for daytime and OR 1.27; CI: 1.01 to 1.59 for night-time) which held across countries. We also found an association between exposure to 24hr road traffic noise and the use of antacids by men (OR 1.39; CI 1.11 to 1.74).
Conclusion Our results suggest an effect of aircraft noise on the use of antihypertensive medication, but this effect did not hold for all countries. Results were more consistent across countries for the increased use of anxiolytics in relation to aircraft noise.
4 Faustini A, Stafoggia M, Berti G, Bisanti L, Chiusolo M, Cernigliaro A, Mallone S, Primerano R, Scarnato C, Simonato L, Vigotti MA, Forastiere F; on behalf of the EPIAIR collaborative Group. The relationship between ambient particulate matter and respiratory mortality: a multi-city study in Italy. Eur Respir J. 2011 Jan 13. [Epub ahead of print]
Regional Health Service of Lazio Rome Italy.
Abstract
The association of air pollutants with natural and respiratory mortality has been consistently reported. However, several aspects of the relationship between particles with an aerodynamic diameter of less than 10 micrometers (PM10) and respiratory mortality require further investigation. To assess the PM10 - respiratory mortality association in Italy and to examine potentially susceptible groups. All natural (n. 276,205) and respiratory deaths (n. 19,629) occurring among 35-plus-year-olds in ten northern, central and southern Italian cities in 2001-2005 were selected. Data for 10-micron particulate matter, nitrogen dioxide and ozone were obtained. A time-stratified case-crossover analysis was carried out. Different cumulative lags were selected to analyse immediate, delayed, prolonged and best-time effects of air pollution. The shape of the exposure-response relationship was analysed. Age, gender, chronic conditions and death site were investigated as potential effect modifiers. We found a 2.29% (IC95%=1.03; 3.58) increase in respiratory mortality at 0-3 lags. The increase in respiratory mortality was higher in summer (7.57%). The exposure-response curve had a linear shape without any threshold. Gender and chronic diseases modified the relationship between particulate matter and respiratory mortality. The effect of particulate on respiratory mortality was stronger and more persistent than that on natural mortality. Females and chronic disease sufferers were more likely to die of a respiratory disease caused by air pollution than males and healthy people.
Abstract
The association of air pollutants with natural and respiratory mortality has been consistently reported. However, several aspects of the relationship between particles with an aerodynamic diameter of less than 10 micrometers (PM10) and respiratory mortality require further investigation. To assess the PM10 - respiratory mortality association in Italy and to examine potentially susceptible groups. All natural (n. 276,205) and respiratory deaths (n. 19,629) occurring among 35-plus-year-olds in ten northern, central and southern Italian cities in 2001-2005 were selected. Data for 10-micron particulate matter, nitrogen dioxide and ozone were obtained. A time-stratified case-crossover analysis was carried out. Different cumulative lags were selected to analyse immediate, delayed, prolonged and best-time effects of air pollution. The shape of the exposure-response relationship was analysed. Age, gender, chronic conditions and death site were investigated as potential effect modifiers. We found a 2.29% (IC95%=1.03; 3.58) increase in respiratory mortality at 0-3 lags. The increase in respiratory mortality was higher in summer (7.57%). The exposure-response curve had a linear shape without any threshold. Gender and chronic diseases modified the relationship between particulate matter and respiratory mortality. The effect of particulate on respiratory mortality was stronger and more persistent than that on natural mortality. Females and chronic disease sufferers were more likely to die of a respiratory disease caused by air pollution than males and healthy people.
5 Rusconi F, Catelan D, Accetta G, Peluso M, Pistelli R, Barbone F, Di Felice E, Munnia A, Murgia P, Paladini L, Serci A, Biggeri A. Asthma Symptoms, Lung Function, and Markers of Oxidative Stress and Inflammation in Children Exposed to Oil Refinery Pollution. J Asthma. 2010 Dec 29. [Epub ahead of print]
Unit of Epidemiology, "Anna Meyer" Children's University Hospital, Florence, Italy.
Abstract
Objectives. Little is known about the effects of exposure to petroleum refinery emissions on respiratory health in children. We evaluated lung function and markers of inflammation and oxidative stress in children and adolescents with and without asthma or wheezing symptoms living in a petrochemical polluted area (Sarroch, Sardinia) versus a reference area (Burcei).
Methods. Parents of 275/300 6- to 14-year-old children living in Sarroch and parents of 214/323 children living in Burcei answered a questionnaire on respiratory symptoms and risk factors. Measurements of forced expiratory volume after 1 second (FEV(1)) and of forced expiratory flow rates at 25-75% of vital capacity (FEF(25-75)) were available in 27 and 23 asthma/wheezing-positive subjects and in 7 and 54 asthma/wheezing-negative subjects in Sarroch and in Burcei, respectively; for fractional exhaled nitric oxide (FE(NO)) corresponding figures were 27 and 24 and 8 and 55 in Sarroch and in Burcei, respectively. Malondialdehyde-deoxyguanosine (MDA-dG) adduct levels in nasal mucosa were measured in 12- to 14-year-old adolescents (8 and 14 asthma/wheezing-positive and 20 and 28 asthma/wheezing-negative subjects in Sarroch and in Burcei, respectively). Air pollutants were assessed during 3 weeks, starting 1 week before lung function,FE(NO), and MDA-dG measurements. Generalized linear models were used to estimate the effect of the area of residence adjusting for confounders.
Results. Weekly average concentrations of sulfur dioxide were 6.9-61.6μg/m(3) in Sarroch versus 0.3-7.6μg/m(3) in the rural area of Burcei; of nitrogen dioxide, 5.2-28.7μg/m(3) versus 1.7-5.3μg/m(3); and of benzene, 1.8-9.0μg/m(3) versus 1.3-1.5μg/m(3),respectively. Children living in Sarroch versus children living in the reference area showed an increase in wheezing symptoms {adjusted prevalence ratio=1.70 [90%confidence interval (CI)=1.01; 2.86]}; a decrease in lung function [variation in FEV(1)=-10.3% (90% CI=-15.0; -6.0%) and in FEF(25-75)=-12.9% (90% CI=-20.7; -4.3%)]; an increase in bronchial inflammation [variation in FE(NO)=+35% (90% CI=11.7; 80.1%)]; and an increase in MDA-dG adducts of +83% (90% CI=22.9; 174.1%).
Conclusions. Data from this small study are consistent with the role of environmental pollutants on lung function and inflammation.
Abstract
Objectives. Little is known about the effects of exposure to petroleum refinery emissions on respiratory health in children. We evaluated lung function and markers of inflammation and oxidative stress in children and adolescents with and without asthma or wheezing symptoms living in a petrochemical polluted area (Sarroch, Sardinia) versus a reference area (Burcei).
Methods. Parents of 275/300 6- to 14-year-old children living in Sarroch and parents of 214/323 children living in Burcei answered a questionnaire on respiratory symptoms and risk factors. Measurements of forced expiratory volume after 1 second (FEV(1)) and of forced expiratory flow rates at 25-75% of vital capacity (FEF(25-75)) were available in 27 and 23 asthma/wheezing-positive subjects and in 7 and 54 asthma/wheezing-negative subjects in Sarroch and in Burcei, respectively; for fractional exhaled nitric oxide (FE(NO)) corresponding figures were 27 and 24 and 8 and 55 in Sarroch and in Burcei, respectively. Malondialdehyde-deoxyguanosine (MDA-dG) adduct levels in nasal mucosa were measured in 12- to 14-year-old adolescents (8 and 14 asthma/wheezing-positive and 20 and 28 asthma/wheezing-negative subjects in Sarroch and in Burcei, respectively). Air pollutants were assessed during 3 weeks, starting 1 week before lung function,FE(NO), and MDA-dG measurements. Generalized linear models were used to estimate the effect of the area of residence adjusting for confounders.
Results. Weekly average concentrations of sulfur dioxide were 6.9-61.6μg/m(3) in Sarroch versus 0.3-7.6μg/m(3) in the rural area of Burcei; of nitrogen dioxide, 5.2-28.7μg/m(3) versus 1.7-5.3μg/m(3); and of benzene, 1.8-9.0μg/m(3) versus 1.3-1.5μg/m(3),respectively. Children living in Sarroch versus children living in the reference area showed an increase in wheezing symptoms {adjusted prevalence ratio=1.70 [90%confidence interval (CI)=1.01; 2.86]}; a decrease in lung function [variation in FEV(1)=-10.3% (90% CI=-15.0; -6.0%) and in FEF(25-75)=-12.9% (90% CI=-20.7; -4.3%)]; an increase in bronchial inflammation [variation in FE(NO)=+35% (90% CI=11.7; 80.1%)]; and an increase in MDA-dG adducts of +83% (90% CI=22.9; 174.1%).
Conclusions. Data from this small study are consistent with the role of environmental pollutants on lung function and inflammation.
6 Calogero AE, La Vignera S, Condorelli R, Perdichizzi A, Valenti D, Asero P, Carbone U, Boggia B, De Rosa N, Lombardi G, D'Agata R, Vicari E, De Rosa M. Environmental car exhaust pollution damages human sperm chromatin and DNA. J Endocrinol Invest. 2010 Oct 15. [Epub ahead of print]
Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Biomedical Sciences, University of Catania, Catania, Italy. acaloger@unict.it.
Abstract
Objective: The adverse role of traffic pollutants on male fertility is well known. Aim of this study was to evaluate their effects on sperm chromatin/DNA integrity.
Methods: To accomplish this, 36 men working at motorway tollgates and 32 unexposed healthy men (controls) were enrolled. All of them were interviewed about their lifestyle. Hormone, semen samples and environmental and biological markers of pollution were evaluated. Sperm chromatin and DNA integrity were evaluated by flow cytometry following propidium iodide staining and TUNEL assay, respectively.
Results: LH, FSH and testosterone serum levels were within the normal range in tollgate workers. Sperm concentration, total sperm count, total and progressive motility, and normal forms were significantly lower in these men compared to controls. Motorway tollgate workers had a significantly higher percentage of spermatozoa with damaged chromatin and DNA fragmentation, a late sign of apoptosis, compared to controls. A significant direct correlation was found between spermatozoa with damaged chromatin or fragmented DNA and the length of occupational exposure, suggesting a time-dependent relationship.
Conclusion: This study showed that car exhaust exposure has a sperm genotoxic effect on human spermatozoa. This may be of relevant importance not only for the reproductive performance of the men exposed, but also for the offspring health.
Abstract
Objective: The adverse role of traffic pollutants on male fertility is well known. Aim of this study was to evaluate their effects on sperm chromatin/DNA integrity.
Methods: To accomplish this, 36 men working at motorway tollgates and 32 unexposed healthy men (controls) were enrolled. All of them were interviewed about their lifestyle. Hormone, semen samples and environmental and biological markers of pollution were evaluated. Sperm chromatin and DNA integrity were evaluated by flow cytometry following propidium iodide staining and TUNEL assay, respectively.
Results: LH, FSH and testosterone serum levels were within the normal range in tollgate workers. Sperm concentration, total sperm count, total and progressive motility, and normal forms were significantly lower in these men compared to controls. Motorway tollgate workers had a significantly higher percentage of spermatozoa with damaged chromatin and DNA fragmentation, a late sign of apoptosis, compared to controls. A significant direct correlation was found between spermatozoa with damaged chromatin or fragmented DNA and the length of occupational exposure, suggesting a time-dependent relationship.
Conclusion: This study showed that car exhaust exposure has a sperm genotoxic effect on human spermatozoa. This may be of relevant importance not only for the reproductive performance of the men exposed, but also for the offspring health.
7 Cannavò S, Ferraù F, Ragonese M, Curtò L, Torre ML, Magistri M, Marchese A, Alibrandi A, Trimarchi F. Increased prevalence of acromegaly in a highly polluted area. Eur J Endocrinol. 2010 Oct;163(4):509-13. Epub 2010 Jul 9.
Section of Endocrinology, Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
Abstract
OBJECTIVE: Despite the contribution of national registries and population-based reports, data concerning the epidemiology of acromegaly is scanty. In addition, the role of the environmental context has not been investigated.
DESIGN: Epidemiology of acromegaly was studied in the province of Messina (Sicily, Italy), focusing on the influence of environmental factors.
METHODS: Four zones, characterized by different degrees of exposition to environmental toxins due to industrial pollution, were identified in the province: area A (76,338 inhabitants), area B (287,328 inhabitants), area C (243,381 inhabitants), and area D (47,554 inhabitants) at low, middle-low, middle, and high industrial density respectively. We identified all acromegalics who were born and resided in the province of Messina, among patients either referred to our endocrine unit or referred elsewhere but recorded in the archives of the provincial healthcare agency.
RESULTS: In the province of Messina, we found 64 patients (2 in area A, 24 in area B, 28 in area C, and 10 in area D). Macroadenomas were 60%, the male/female ratio was 1, and mean age at diagnosis (±s.e.m.) was 45.4±1.6 years. Overall, prevalence was 97 c.p.m. in the province (26 c.p.m. in area A, 84 c.p.m. in area B, 115 c.p.m. in area C, and 210 c.p.m. in area D). Risk ratio (RR), calculated in every area assuming area A as a reference, showed an increased risk of developing acromegaly in people residing in area D (RR=8.03; P<0.0014).
Conclusion: This study confirms the prevalence of acromegaly reported recently.The increased risk of developing this disease in area D suggests that the pathogenetic role of environmental context needs to be better evaluated.
Abstract
OBJECTIVE: Despite the contribution of national registries and population-based reports, data concerning the epidemiology of acromegaly is scanty. In addition, the role of the environmental context has not been investigated.
DESIGN: Epidemiology of acromegaly was studied in the province of Messina (Sicily, Italy), focusing on the influence of environmental factors.
METHODS: Four zones, characterized by different degrees of exposition to environmental toxins due to industrial pollution, were identified in the province: area A (76,338 inhabitants), area B (287,328 inhabitants), area C (243,381 inhabitants), and area D (47,554 inhabitants) at low, middle-low, middle, and high industrial density respectively. We identified all acromegalics who were born and resided in the province of Messina, among patients either referred to our endocrine unit or referred elsewhere but recorded in the archives of the provincial healthcare agency.
RESULTS: In the province of Messina, we found 64 patients (2 in area A, 24 in area B, 28 in area C, and 10 in area D). Macroadenomas were 60%, the male/female ratio was 1, and mean age at diagnosis (±s.e.m.) was 45.4±1.6 years. Overall, prevalence was 97 c.p.m. in the province (26 c.p.m. in area A, 84 c.p.m. in area B, 115 c.p.m. in area C, and 210 c.p.m. in area D). Risk ratio (RR), calculated in every area assuming area A as a reference, showed an increased risk of developing acromegaly in people residing in area D (RR=8.03; P<0.0014).
Conclusion: This study confirms the prevalence of acromegaly reported recently.The increased risk of developing this disease in area D suggests that the pathogenetic role of environmental context needs to be better evaluated.
8 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 Jan 14. [Epub ahead of print]
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.
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.
9 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.
Department of Occupational and Environmental Health, Università degli Studi di Milano and Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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 3.3mg/m(3) and 9.6μg/m(3), respectively; median urinary levels in end-of-shift (ES) samples were 147ng/L (MTBE-U) and 207ng/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.
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 3.3mg/m(3) and 9.6μg/m(3), respectively; median urinary levels in end-of-shift (ES) samples were 147ng/L (MTBE-U) and 207ng/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.
10 Protano C, Guidotti M, Manini P, Petyx M, La Torre G, Vitali M. Benzene exposure in childhood: Role of living environments and assessment of available tools. Environ Int. 2010 Oct;36(7):779-87. Epub 2010 Jul 1.
Department of Public Health Sciences G. Sanarelli, P. le Aldo Moro 5, 00185, Sapienza University, Rome, Italy. carmela.protano@uniroma1.it
Abstract
Benzene is a widespread air pollutant and a well-known human carcinogen. Evidence is needed regarding benzene intake in the pediatric age group. We investigated the use of urinary (u) trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), and unmodified benzene (UB) for assessing exposure to low concentrations of environmental benzene and the role of living environment on benzene exposure in childhood. u-t,t-MA, u-SPMA, u-UB and u-cotinine were measured in urine samples of 243 Italian children (5-11 years) recruited in a cross-sectional study. Analytical results were compared with data obtained from questionnaires about participants' main potential exposure factors. u-UB, u-t,t-MA and u-SPMA concentrations were about 1.5-fold higher in children living in urban areas than in those in the rural group. Univariate analyses showed that u-UB was the only biomarker able to discriminate secondhand smoke (SHS) exposure in urban and rural children (medians=411.50 and 210.50 ng/L, respectively); these results were confirmed by the strong correlation between u-UB and u-cotinine in the SHS-exposed group and by multivariate analyses. A regression model on u-SPMA showed that the metabolite is related to residence area (p<0.001), SHS exposure (p=0.048) and gender (p=0.027). u-UB is the best marker of benzene exposure in children in the present study, and it can be used as a good carcinogen-derived biomarker of exposure to passive smoking, especially related to benzene, when urine sample is collected at the end of the day. In addition, it is important to highlight that SHS resulted the most important contributor to benzene exposure, underlining the need for an information campaign against passive smoking exposure.
Abstract
Benzene is a widespread air pollutant and a well-known human carcinogen. Evidence is needed regarding benzene intake in the pediatric age group. We investigated the use of urinary (u) trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), and unmodified benzene (UB) for assessing exposure to low concentrations of environmental benzene and the role of living environment on benzene exposure in childhood. u-t,t-MA, u-SPMA, u-UB and u-cotinine were measured in urine samples of 243 Italian children (5-11 years) recruited in a cross-sectional study. Analytical results were compared with data obtained from questionnaires about participants' main potential exposure factors. u-UB, u-t,t-MA and u-SPMA concentrations were about 1.5-fold higher in children living in urban areas than in those in the rural group. Univariate analyses showed that u-UB was the only biomarker able to discriminate secondhand smoke (SHS) exposure in urban and rural children (medians=411.50 and 210.50 ng/L, respectively); these results were confirmed by the strong correlation between u-UB and u-cotinine in the SHS-exposed group and by multivariate analyses. A regression model on u-SPMA showed that the metabolite is related to residence area (p<0.001), SHS exposure (p=0.048) and gender (p=0.027). u-UB is the best marker of benzene exposure in children in the present study, and it can be used as a good carcinogen-derived biomarker of exposure to passive smoking, especially related to benzene, when urine sample is collected at the end of the day. In addition, it is important to highlight that SHS resulted the most important contributor to benzene exposure, underlining the need for an information campaign against passive smoking exposure.
11 Olsson AC, Gustavsson P, Kromhout H, Peters S, Vermeulen R, Brüske I, Pesch B, Siemiatycki J, Pintos J, Brüning T, Cassidy A, Wichmann HE, Consonni D, Landi MT, Caporaso N, Plato N, Merletti F, Mirabelli D, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Lissowska J, Szeszenia-Dabrowska N, Zaridze D, Stücker I, Benhamou S, Bencko V, Foretova L, Janout V, Rudnai P, Fabianova E, Stanescu Dumitru R, Gross IM, Kendzia B, Forastiere F, Bueno-de-Mesquita B, Brennan P, Boffetta P, Straif K. Exposure to Diesel Motor Exhaust and Lung Cancer Risk in a Pooled Analysis from Case-Control Studies in Europe and Canada. Am J Respir Crit Care Med. 2010 Oct 29. [Epub ahead of print]
International Agency for Research on Cancer, Lyon, France; The Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Stockholm, 171 77, Sweden.
Abstract
RATIONALE: Diesel motor exhaust is classified by the International Agency for Research on Cancer as probably carcinogenic to humans. The epidemiological evidence is evaluated as limited because most studies lack adequate control for potential confounders and only few studies have reported on exposure-response relationships.
OBJECTIVE: Investigate lung cancer risk associated with occupational exposure to diesel motor exhaust, while controlling for potential confounders.
METHODS: The SYNERGY project pooled information on lifetime work histories and tobacco smoking from 13304 cases and 16282 controls from 11 case-control studies conducted in Europe and Canada. A general population job exposure matrix based on ISCO-68 occupational codes, assigning no, low or high exposure to diesel motor exhaust was applied to determine level of exposure.
MEASUREMENTS: Odds ratios (OR) of lung cancer and 95% confidence intervals (CI) were estimated by unconditional logistic regression, adjusted for age, sex, study, and ever employment in an occupation with established lung cancer risk, cigarette pack-years and time-since-quitting smoking.
MAIN RESULTS: Cumulative diesel exposure was associated with an increased lung cancer risk highest quartile vs. unexposed OR 1.31, 95% CI 1.19-1.43, and a significant exposure-response relationship, p-value <0.01. Corresponding effect estimates were similar in workers never employed in occupations with established lung cancer risk; and in women and never-smokers although not statistically significant.
CONCLUSIONS: Our results show a consistent association between occupational exposure to diesel motor exhaust and increased risk of lung cancer. This association is unlikely explained by bias or confounding, which we addressed by adjusted models and sub-group analyses.
Abstract
RATIONALE: Diesel motor exhaust is classified by the International Agency for Research on Cancer as probably carcinogenic to humans. The epidemiological evidence is evaluated as limited because most studies lack adequate control for potential confounders and only few studies have reported on exposure-response relationships.
OBJECTIVE: Investigate lung cancer risk associated with occupational exposure to diesel motor exhaust, while controlling for potential confounders.
METHODS: The SYNERGY project pooled information on lifetime work histories and tobacco smoking from 13304 cases and 16282 controls from 11 case-control studies conducted in Europe and Canada. A general population job exposure matrix based on ISCO-68 occupational codes, assigning no, low or high exposure to diesel motor exhaust was applied to determine level of exposure.
MEASUREMENTS: Odds ratios (OR) of lung cancer and 95% confidence intervals (CI) were estimated by unconditional logistic regression, adjusted for age, sex, study, and ever employment in an occupation with established lung cancer risk, cigarette pack-years and time-since-quitting smoking.
MAIN RESULTS: Cumulative diesel exposure was associated with an increased lung cancer risk highest quartile vs. unexposed OR 1.31, 95% CI 1.19-1.43, and a significant exposure-response relationship, p-value <0.01. Corresponding effect estimates were similar in workers never employed in occupations with established lung cancer risk; and in women and never-smokers although not statistically significant.
CONCLUSIONS: Our results show a consistent association between occupational exposure to diesel motor exhaust and increased risk of lung cancer. This association is unlikely explained by bias or confounding, which we addressed by adjusted models and sub-group analyses.
12 Baccini M, Kosatsky T, Analitis A, Anderson HR, D'Ovidio M, Menne B, Michelozzi P, Biggeri A; PHEWE Collaborative Group. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2011 Jan;65(1):64-70. Epub 2009 Oct 26.
Department of Statistics G. Parenti, University of Florence, Florence, Italy. baccini@ds.unifi.it
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.
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.