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Ramos-Bonilla JP, Giraldo M, Marsili D, Pasetto R, Terracini B, Mazzeo A, Magnani C, Comba P, Lysaniuk B, Cely-García MF, Ascoli V. An Approach to Overcome the Limitations of Surveillance of Asbestos Related Diseases in Low- and Middle-Income Countries: What We Learned from the Sibaté Study in Colombia. Ann Glob Health 2023; 89:64. [PMID: 37810608 PMCID: PMC10558025 DOI: 10.5334/aogh.4166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The asbestos industry began its operations in Colombia in 1942 with the establishment of an asbestos-cement facility in Sibaté, located in the Department of Cundinamarca. Despite extensive asbestos use and production in Colombia, the country lacks a reliable epidemiological surveillance system to monitor the health effects of asbestos exposure. The Colombian health information system, known as SISPRO, did not report mesothelioma cases diagnosed in the municipality, posing a significant challenge in understanding the health impacts of asbestos exposure on the population of Sibaté. Methods To address this issue, an active surveillance strategy was implemented in Sibaté. This strategy involved conducting door-to-door health and socioeconomic structured interviews to identify Asbestos-Related Diseases (ARDs). Validation strategies included a thorough review of medical records by a panel of physicians, and the findings were communicated to local, regional, and national authorities, as well as the general population. Results The active surveillance strategy successfully identified a mesothelioma cluster in Sibaté, revealing the inadequacy of the existing health information system in monitoring asbestos-related diseases. The discovery of this cluster underscores the critical importance of implementing active surveillance strategies in Colombia, where governmental institutions and resources are often limited. Conclusion The findings of this study emphasize the urgent need for Colombia to establish a reliable epidemiological surveillance system for asbestos-related diseases (ARDs). Active surveillance strategies can play a crucial role in identifying mesothelioma clusters and enhancing our understanding of the health effects of asbestos exposure in low- and middle-income countries.
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Affiliation(s)
| | - Margarita Giraldo
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá, Colombia
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, ISS, Rome, IT
- WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, IT
| | - Roberto Pasetto
- Department of Environment and Health, Istituto Superiore di Sanità, ISS, Rome, IT
- WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, IT
| | - Benedetto Terracini
- Collegium Ramazzini, Bologna, IT
- Unit of Cancer Epidemiology, University of Torino and CPO-Piemonte, Torino, IT
| | - Agata Mazzeo
- Department of History and Cultures, University of Bologna, Bologna, IT
| | - Corrado Magnani
- Collegium Ramazzini, Bologna, IT
- Department of Translational Medicine, University of Eastern Piedmont, Novara, IT
| | | | | | | | - Valeria Ascoli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, IT
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Bruno C, Di Stefano R, Ricceri V, La Rosa M, Cernigliaro A, Ciranni P, Di Maria G, Mandrioli D, Zona A, Comba P, Scondotto S. Fluoro-edenite non-neoplastic diseases in Biancavilla (Sicily, Italy): pleural plaques and/or pneumoconiosis? Ann Ist Super Sanita 2023; 59:187-193. [PMID: 37712235 DOI: 10.4415/ann_23_03_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND A mesothelioma cluster in Biancavilla (Sicily, Italy), drew attention to fluoro-edenite, a fibre classified by International Agency for Research on Cancer as carcinogenic to humans. Significant excesses in mortality and morbidity were observed for respiratory diseases and a significant excess of pneumoconiosis hospitalizations was reported. OBJECTIVE Aim of this study is to assess the characters of the lung damage in Biancavilla residents hospitalized with pneumoconiosis or asbestosis diagnoses. METHODOLOGY Medical records, available radiographs and computed tomography scans were collected. The obtained imaging was reviewed by a panel of three specialists and focused on pleural and parenchymal abnormalities. Cases with an ILO-BIT or ICOERD score equal or greater than 2 were considered positive for a pneumoconiosis-like damage, cases with a score lower than 2 or insufficient quality of imaging were considered inconclusive. If no pneumoconiotic aspects were present the cases were classified as negative. RESULTS Out of 38 cases, diagnostic imaging for 25 cases were found. Ten cases out of 25 showed asbestosis-like features, nine subjects were considered negative. In six patients' results were inconclusive. CONCLUSIONS Asbestosis-like features were substantiated in Biancavilla residents without known occupational exposure to asbestos. Further studies to estimate population respiratory health are required. Experimental studies on the fibrogenic potential of fluoro-edenite are needed.
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Affiliation(s)
- Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | | | - Vincenzo Ricceri
- Divisione di Radiologia, Ospedale Maria Santissima Addolorata di Biancavilla, Azienda Provinciale Sanitaria, Catania, Italy
| | - Mauro La Rosa
- Divisione di Radiologia, Ospedale Maria Santissima Addolorata di Biancavilla, Azienda Provinciale Sanitaria, Catania, Italy
| | - Achille Cernigliaro
- Unità Operativa Complessa di Patologia Clinica, Dipartimento di Scienze Radiologiche e Servizi, Ospedale Sant'Antonio Abate, Azienda Sanitaria Provinciale, Trapani, Italy
| | - Paolo Ciranni
- Dipartimento per le Attività Sanitarie e Osservatorio Epidemiologico, Assessorato della Salute, Regione Siciliana, Palermo, Italy
| | - Giuseppe Di Maria
- Dipartimento di Medicina Interna, Università di Catania, Catania, Italy
| | | | - Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Salvatore Scondotto
- Dipartimento per le Attività Sanitarie e Osservatorio Epidemiologico, Assessorato della Salute, Regione Siciliana, Palermo, Italy
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Magnani C, Mensi C, Binazzi A, Marsili D, Grosso F, Ramos-Bonilla JP, Ferrante D, Migliore E, Mirabelli D, Terracini B, Consonni D, Degiovanni D, Lia M, Cely-García MF, Giraldo M, Lysaniuk B, Comba P, Marinaccio A. The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos. Int J Environ Res Public Health 2023; 20:ijerph20020936. [PMID: 36673690 PMCID: PMC9858856 DOI: 10.3390/ijerph20020936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023]
Abstract
Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.
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Affiliation(s)
- Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, ISS (Italian National Institute of Health), 00161 Rome, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Juan Pablo Ramos-Bonilla
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Benedetto Terracini
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Michela Lia
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | | | - Margarita Giraldo
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Pietro Comba
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Alessandro Marinaccio
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
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Fazzo L, Manno V, Iavarone I, Minelli G, De Santis M, Beccaloni E, Scaini F, Miotto E, Airoma D, Comba P. The health impact of hazardous waste landfills and illegal dumps contaminated sites: An epidemiological study at ecological level in Italian Region. Front Public Health 2023; 11:996960. [PMID: 36923045 PMCID: PMC10010672 DOI: 10.3389/fpubh.2023.996960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 03/03/2023] Open
Abstract
Background and aim The implementation of idoneous management of hazardous waste, in contrast to illegal practices, is one of the environment and health priorities of the WHO. The aim of the present study, based on a collaborative agreement between the Italian National Health Institute and a Prosecution Office located in Naples North, was to evaluate the health effects of illegal landfills and burning of urban and hazardous waste in the territory of the Prosecution Office. Methods The municipalities included in the study territory were investigated with respect to the regional population. Regression analyses were performed in the study area between four classes of an environmental municipal indicator of waste risk (MRI) previously defined, computing the relative risks (RRs) in 2-4 MRI classes, with respect to the first MRI class (the least impacted). The prevalence of reproductive outcomes and cause-specific mortality and hospitalization were analyzed in the general population and in the 0-19-year-old population using SAS software. Results An increase of mortality and hospitalization risk in both the genders of the whole area, with respect to regional population, were found for overall all cancer cases, cancer of the stomach, the liver, the lung and the kidney, and ischemic heart diseases. An increase of mortality for leukemias in the 0-19-year-old population and in hospitalization risk for certain conditions originating in the perinatal period were observed. Correlation between MRI and the risk of mortality from breast tumors in women (MRI class 2: RR = 1.06; MRI class 3: RR = 1.15; MRI class 4: RR = 1.11) and between MRI and the risk of hospitalization from testis tumors (MRI class 2: RR = 1.25; MRI class 3: RR = 1.31; MRI class 4: RR = 1.32) were found. The hospitalization risk from breast tumors and asthma exceeded significantly in both genders of three and four MRI classes. Among the 0-19-year-old population, correlation between MRI and hospitalization from leukemias (MRI class 2: RR = 1.48; MRI class 3: RR = 1.60; MRI class 4: RR = 1.41) and between MRI and the prevalence of preterm birth (MRI class 2: RR = 1.17; MRI class 3: RR = 1.08; MRI class 4: RR = 1.25) were found. Conclusion A correlation between health outcomes and the environmental pressure by uncontrolled waste sites was found. Notwithstanding the limitation of the study, the results promote implementing the actions of environmental remediation and the prosecution of illegal practices.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Eleonora Beccaloni
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Scaini
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Edoardo Miotto
- Department of Medicine, University of Udine, Udine, Italy
| | - Domenico Airoma
- Avellino Prosecution Office, Former North Naples Prosecution Office, Avellino, Italy
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Comba P, Pasetto R. Health in contaminated sites: the contribution of epidemiological surveillance to the detection of causal links. Commentary. Ann Ist Super Sanita 2022; 58:223-226. [PMID: 36511192 DOI: 10.4415/ann_22_04_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The search for cause-effect relationships is a central aspect of epidemiological surveillance programs applied to populations living close to contaminated sites. Here are described needs for assessing causality in using different epidemiological study designs in association with the aim of promoting environmental public health, where uncertainties should be considered under a precautionary driven approach.
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Affiliation(s)
- Pietro Comba
- Dipartimento Ambiente Salute Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Pasetto
- Dipartimento Ambiente Salute Istituto Superiore di Sanità, Rome, Italy
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6
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Girardi P, Barbiero F, Baccini M, Comba P, Pirastu R, Mastrangelo G, Ballarin MN, Biggeri A, Fedeli U. Mortality for Lung Cancer among PVC Baggers Employed in the Vinyl Chloride Industry. Int J Environ Res Public Health 2022; 19:ijerph19106246. [PMID: 35627783 PMCID: PMC9141742 DOI: 10.3390/ijerph19106246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Vinyl-chloride monomer (VCM) is classified as a known carcinogen of the liver; for lung cancer, some results suggest a potential association with polyvinyl chloride (PVC) dust. We evaluated the relationship between lung cancer mortality and exposure as PVC baggers in a cohort of workers involved in VCM production and polymerization in Porto Marghera (Venice, Italy) considering both employment status and smoking habits. The workers were studied between 1973 and 2017. A subset of them (848 over 1658) was interviewed in the 2000s to collect information about smoking habits and alcohol consumption. Missing values were imputed by the Multivariate Imputation by Chained Equations (MICE) algorithm. We calculated standardized mortality ratios (SMR) and 95% confidence intervals (95% CIs) using regional reference rates by task (never, ever, and exclusively baggers) and by smoking habits. Mortality rate ratios (MRR), adjusted for age, calendar time, time since first exposure, and smoking habits, were obtained via Poisson regression using Rubin’s rule to combine results from imputed datasets calculating the fraction of information due to non-response. Lung cancer mortality was lower than the regional reference in the whole cohort (lung cancer SMR = 0.92; 95% CI 0.75–1.11). PVC baggers showed a 50% increase in lung cancer mortality compared to regional rates (SMR = 1.48; 95% CI 0.82–2.68). In the cohort analyses, a doubled risk of lung cancer mortality among PVC baggers was confirmed after adjustment for smoking and time-dependent covariates (MRR = 1.99, 95% CI 1.04–3.81). Exposure to PVC dust resulting from activity as bagger in a polymerization PVC plant was associated with an increase in lung cancer mortality risk after adjustment for smoking habits.
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Affiliation(s)
- Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, 30172 Venice, Italy;
| | - Fabiano Barbiero
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Michela Baccini
- Department of Statistics, Computer Science, Applications, University of Florence, 50134 Florence, Italy;
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Roma, Italy;
| | - Roberta Pirastu
- Department of Biology and Biotechnology “Charles Darwin”, Sapienza Rome University, 00185 Roma, Italy;
| | - Giuseppe Mastrangelo
- Section of Occupational Medicine, Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, 35128 Padova, Italy;
| | | | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35132 Padova, Italy
- Correspondence: ; Tel.: +39-049-877-8251
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7
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Fazzo L, Binazzi A, Ferrante D, Minelli G, Consonni D, Bauleo L, Bruno C, Bugani M, De Santis M, Iavarone I, Magnani C, Romeo E, Zona A, Alessi M, Comba P, Marinaccio A. Burden of Mortality from Asbestos-Related Diseases in Italy. Int J Environ Res Public Health 2021; 18:10012. [PMID: 34639316 PMCID: PMC8508095 DOI: 10.3390/ijerph181910012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Lisa Bauleo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Marcella Bugani
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Elisa Romeo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Mariano Alessi
- Department of Prevention, Ministry of Health, 00100 Roma, Italy;
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
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Barone Adesi F, Bruno C, Calisti R, Chellini E, Comba P, Consonni D, Fazzo L, Fedeli U, Forastiere F, Magnani C, Marinaccio A, Merler E, Mirabelli D, Ricci P, Terracini B. [Effects of Asbestos on Human Health. Document of the Italian Epidemiological Association (AIE)]. Epidemiol Prev 2021; 44:327-338. [PMID: 33506658 DOI: 10.19191/ep20.5-6.a001.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES the Italian Epidemiological Association (AIE) intends to formulate assessments and recommendations on the most relevant and critical aspects in the preparation, conduct, and interpretation of epidemiological investigations on the health effects of exposure to asbestos and asbestos-like fibres. DESIGN, SETTING, AND PARTICIPANTS the document was prepared by a working group of AIE associates, with a broad curriculum of epidemiological investigations, starting from the evaluation of scientific evidence, and was subsequently evaluated by the AIE governing body. RESULTS the topics covered included: • consumption and presence of asbestos; • association between asbestos exposure and disease; • epidemiological surveillance of asbestos related diseases in Italy; • risk function for asbestos related diseases; • increased risk and anticipation of the disease; • interaction between asbestos and other carcinogens; • diagnosis in epidemiological studies; • assessment of exposure to asbestos; • epidemiological evidence on asbestos related diseases. CONCLUSIONS the document ends with a summary of the conclusions of scientific research shared by AIE, with reflection on the methodology to be followed for the application at individual level of the results of epidemiological studies, and the proposal of themes on which to direct research.
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Affiliation(s)
| | - Caterina Bruno
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Roberto Calisti
- Servizio prevenzione e sicurezza negli ambienti di lavoro - epidemiologia occupazionale, ASUR MARCHE, Civitanova Marche (MC)
| | - Elisabetta Chellini
- SS epidemiologia dell'ambiente e del lavoro, Istituto per lo studio, la prevenzione e la rete oncologica (ISPRO), Firenze
| | - Pietro Comba
- già Direttore, Reparto di epidemiologia ambientale e sociale, Dipartimento ambiente e salute, Istituto superiore di sanità
| | - Dario Consonni
- UO epidemiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Ugo Fedeli
- Servizio epidemiologico regionale e registri - Azienda Zero, Regione del Veneto
| | | | - Corrado Magnani
- Dipartimento di medicina traslazionale, Università del Piemonte Orientale, Novara;
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Enzo Merler
- Registro regionale veneto dei casi di mesotelioma, Padova (ora in pensione)
| | - Dario Mirabelli
- Epidemiologia dei tumori, CPO Piemonte e Università di Torino (ora in pensione)
| | - Paolo Ricci
- UOC osservatorio epidemiologico, ATS della Val Padana, Mantova
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Barbieri PG, Finotto L, Belli S, Festa R, Comba P. [Death certification of pleural malignant mesothelioma from the Italian National Institute of Statistics: a comparison on 269 clinical diagnosis confirmed at autopsy (1997-2016)]. Epidemiol Prev 2021; 45:149-154. [PMID: 34212695 DOI: 10.19191/ep21.3.p149.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the agreement between pleural malignant mesothelioma diagnosis in life, with diagnoses confirmed at autopsy, and the certification of the cause of death in the form of the Italian National Institute of Statistics (Istat). DESIGN comparison between autopsic cases and cases from Istat. SETTING AND PARTICIPANTS two series of autopsy diagnoses of pleural malignant mesothelioma placed from 1997 to 2016; 185 in shipyard workers and 90 in Brescia province inhabitants, for whom the Istat death form was acquired for 180 and 89 subjects, respectively. RESULTS the general agreement between pleural malignant mesothelioma clinical diagnosis in life and death certification was about 91% for the first group and 92% for the second one. In the first group, the age at diagnosis does not affect the accuracy of the death certification, which instead increased over time to become total in the period 2010-2016. CONCLUSIONS the study suggests that the agreement between pleural malignant mesothelioma clinical diagnosis and certification of the cause of death appears to be very high.
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Affiliation(s)
- Pietro Gino Barbieri
- Medico del lavoro, già Servizio PSAL, ASL e Registro mesoteliomi della provincia di Brescia;
| | - Luigi Finotto
- SOC prevenzione e sicurezza ambienti di lavoro, ASS 2 "Isontina", Monfalcone
| | - Stefano Belli
- già Reparto di epidemiologia ambientale, Dipartimento di ambiente e prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberto Festa
- già Servizio prevenzione e sicurezza ambienti di lavoro, ASL Brescia
| | - Pietro Comba
- Già Direttore, Reparto di epidemiologia ambientale e sociale, Dipartimento ambiente e salute, Istituto superiore di sanità
- fellow del Collegium Ramazzini
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Fazzo L, Minelli G, Bruno C, Comba P, Conti S, De Santis M, Zona A, Binazzi A, Magnani C, Marinaccio A, Iavarone I. Early mortality from malignant mesothelioma in Italy as a proxy of environmental exposure to asbestos in children. Ann Ist Super Sanita 2020; 56:478-486. [PMID: 33346174 DOI: 10.4415/ann_20_04_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant mesothelioma (MM) is a rare neoplasm caused by asbestos. Mortality from MM in ≤50 years old people, considering the long latency, is likely related to asbestos exposure in childhood. Mortality from MM (C45, ICD10 code) is described among ≤50 years (ys) old people in Italy, in 2003-2016. National and regional Standardized Rates (SRs) were computed by age-class. The North-South trend of regional SRs, increasing in >50ys age-class, showed a flat cline in ≤50ys old people. Municipal Standardized Mortality Ratios (SMRs) were computed, with respect to regional figures, for ≤50 ys old population. In Italy, 487 people ≤50 ys old died from MM, in 2003-2016 (2.5% of all MM deaths), corresponding to 35/year. The highest SMRs were observed in Northern Regions, the most industrialized areas. Exceeding SMRs were found in 10 municipalities where former asbestos-cement plants, shipyards, and a quarry contaminated by fluoro-edenite fibres were present. Early mortality from MM, proxy of childhood environmental asbestos exposure, deserves particular concern.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Servizio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Bruno
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - Retired
| | - Susanna Conti
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - Retired
| | - Marco De Santis
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Amerigo Zona
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Binazzi
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Alessandro Marinaccio
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Ivano Iavarone
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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Lysaniuk B, Cely-García MF, Mazzeo A, Marsili D, Pasetto R, Comba P, Ramos-Bonilla JP. Where are the landfilled zones? Use of historical geographic information and local spatial knowledge to determine the location of underground asbestos contamination in Sibaté (Colombia). Environ Res 2020; 191:110182. [PMID: 32971078 DOI: 10.1016/j.envres.2020.110182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 09/03/2020] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Sibaté is a municipality located in the central region of Colombia, where the first asbestos-cement facility of the country has been in operation since 1942. Both a malignant pleural mesothelioma cluster and landfilled zones with the presence of an underground friable asbestos layer have been identified in Sibaté. There is still limited knowledge regarding the history of the construction of landfilled zones, and what kinds of materials were deposited. The current study aims to improve our understanding of the history and characteristics of the landfilled zones present in Sibaté. METHODS Two participatory workshops with inhabitants of Sibaté were conducted to determine when the landfilled zones were built and their location. Information collected in participatory workshops was crossed with both topographic maps and aerial photographs, giving special attention to zones within the urban area of the municipality that in the past were inundated with water from El Muña Reservoir. An opportunistic soil sampling campaign was conducted in suspected landfilled zones that had not been previously sampled, during the replacement of pipelines of the drainage system ordered by the municipality. RESULTS The analysis of historical topographic maps, combined with the interpretation of aerial photographs, confirmed the disposal of residues in areas that were previously inundated with water from El Muña Reservoir, creating landfilled zones in the urban area of Sibaté. On top of these landfilled zones, a football stadium and a football field with an athletic track were built. The location of landfilled zones identified using geographic analysis was similar to the location identified analyzing maps constructed by inhabitants of Sibaté in participatory workshops. The four soil samples collected during an opportunistic sampling campaign confirmed the presence in new locations of the underground friable asbestos layer discovered in previous studies. DISCUSSION Based on the extension of the landfilled zones, the presence of friable asbestos in these areas, and the close proximity to a school and residential dwellings, there could have been major dispersion events of asbestos fibers in the urban area of Sibaté during the disposal of residue materials and the construction of the landfilled zones. Thus, important asbestos exposures may have occurred among residents of Sibaté, which is aggravated by the fact that during those years, more than 50% of the population of Sibaté was 25 years old or younger. Although the results of the current study improved our understanding of the processes and chronology associated with the landfilled zones, the uncertainty regarding their exact location remains significant. It is important to continue investigating the adverse health effects resulting from this potential asbestos exposure source.
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Affiliation(s)
| | - María Fernanda Cely-García
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Agata Mazzeo
- Department of History and Cultures, University of Bologna, Bologna, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy; WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Pasetto
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy; WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dr. Pietro Comba recently retired from the Istituto Superiore di Sanità, Rome, Italy
| | - Juan Pablo Ramos-Bonilla
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia.
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Fazzo L, Cernigliaro A, De Santis M, Quattrone G, Bruno C, Zona A, Tumino R, Cascone G, Scondotto S, Comba P. Occupational cohort study of asbestos-cement workers in a contaminated site in Sicily (Italy). Epidemiol Prev 2020; 44:137-144. [PMID: 32631013 DOI: 10.19191/ep20.2-3.p137.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to analyse the asbestos-related diseases risk among the former workers of Sacelit asbestos-cement plant, operating in San Filippo del Mela (Sicily: 1958- 1993). DESIGN cohort study. SETTING AND PARTICIPANTS 228 subjects were employed in Sacelit from 1958 to 1993. Due to the available observation periods, the analyses of the different outcomes were performed for the subjects alive at the beginning of the respective follow up periods: mortality (1986-2018) was analysed for 204 subjects (177 men, 27 women), hospitalization (2001-2016) for 164 workers (139 men, 25 women) and the incidence of mesothelioma (1998-2016) was estimated for 178 subjects (153 men, 25 women). MAIN OUTCOMES MEASURES mortality (Standardized Mortality Ratio: SMR) and hospitalization (Standardized Hospitalization Ratio: SHR) from specific diseases were analysed. Incidence (Standardized Incidence Ratio: SIR) of mesothelioma cases was detected, also. SMR (1986-2014), SHR (2001-2016) and SIR (1998-2016), with 95% Confidence Intervals, were computed with respect to the regional rates, with STATA11. RESULTS in the men cohort, mortality from lung (17 cases, SMR 2.83) and pleural cancers (5 cases, SMR 30) and from asbestosis (15 cases, SMR 1,930) was in excess. The risk of hospitalization was in excess, in both genders, from lung cancer (men: 6 cases, SHR 4.1; women: 2 cases, SHR 8.6) and asbestosis (men: 17 cases, SHR 1,304; women: 6 cases, SHR 2,455). The incidence of mesothelioma was in excess in men (5 cases, SIR 23.9); no female cases of mesothelioma were observed. CONCLUSIONS a high occurrence of asbestos-related diseases in the cohort, particularly among men, was observed. The excess of hospitalization from asbestosis and lung cancer was highlighted also in women. The prosecution of the on-going health surveillance plan is particularly appropriated.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy);
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | | | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Provincial Health Unit, Ragusa (Italy)
| | | | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
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Benedetti M, Fazzo L, Guarda L, Gatti L, Comba P, Ricci P. Residential proximity to an industrial incinerator and risk of soft-tissue sarcoma, 1999-2014. Epidemiol Prev 2020; 44:128-136. [PMID: 32631012 DOI: 10.19191/ep20.2-3.p128.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND exposure to dioxins has been associated with an increased risk of soft-tissue sarcoma (STS). In a study relating to 1989-1998, a significant excess of STS was found in the population living within a 2-kilometre radius of an industrial incinerator located inside a Mantua industrial site. In the years 1974-1991, the incinerator burned hazardous chlorine-containing waste that resulted in the emission of dioxins. After 1991, it was exclusively fed with organic synthetic products not containing chlorine. OBJECTIVES the aim of this case-control study was to estimate the STS risk, for 1999-2014, in the population living in four Mantua districts located in the proximity of the industrial incinerator, compared to subjects resident in the remaining parts of Mantua province, regarded as non-exposed. METHODS the cases analysed were subjects with a first-incident diagnosis of STS between 1999 and 2014 resident at diagnosis in Mantua Province. Cases were selected using the 2013 criteria from the WHO classification. Cases of Kaposi sarcoma, PEComas and STS occurring in a previously irradiated field were excluded. For each case of soft-tissue sarcoma, four controls were randomly selected from all individuals resident in Mantua Province included in the Regional Health Service database in the years of incidence of each case (calendar year), and individually matched for gender and year of birth. Residential and occupational history (for employment in an oil refinery, and petrochemical and chemical plants) was reconstructed for all study subjects (cases and controls) since 1961. Subjects were considered exposed if they had lived in the four Mantua districts most affected by the incinerator emissions, on the basis of an atmospheric dispersion model and a dioxins biomonitoring survey. Four analyses were performed according to variously defined residential time windows. Odds ratios and corresponding 95% confidence intervals (95%CI) were calculated using conditional regression models adjusted for occupational history. RESULTS 391 cases (203 males and 188 females) and 1,564 controls were included. The number of exposed cases and controls in the four analyses were 8 and 55, 8 and 60, 15 and 68, and 15 and 73, respectively. An increased STS risk was not observed in any of the analyses. CONCLUSIONS in this study, no increased risk of STS was observed in subjects who had lived, in the study's time window, in the Mantua districts most affected by the incinerator emissions. The most likely interpretation of the present finding is a real STS risk reduction for subjects resident in the most recent decades in the Mantua districts most affected by the incinerator emissions, due to the cessation of burning chlorine-containing waste in the incinerator, development of some remediation plans, and implementation of new industrial procedures.
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Affiliation(s)
- Marta Benedetti
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy);
| | - Lucia Fazzo
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy)
| | - Linda Guarda
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
| | - Luciana Gatti
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
| | - Pietro Comba
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy)
| | - Paolo Ricci
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
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Rossi S, Vanacore N, Comba P. Multiple chemical sensitivity: pursuit of a scientific consensus, need for a public health response. Commentary. Ann Ist Super Sanita 2020; 55:319-322. [PMID: 31850857 DOI: 10.4415/ann_19_04_03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
On the international scene, Multiple Chemical Sensitivity (MCS) is defined, by several experts, as a multisystem syndrome that develops following chronic exposures to low doses of common chemical contaminants. Its general characteristics are, however, the object of conflicting opinions and a source of debate and research aimed at the appropriate nosological and therapeutic frameworks. In the face of a potentially debilitating trend, both in the occupational and in the economical and social sphere, the scientific community has not so far found an agreement. This problem leads patients and their associations to periodically claim some requests. The syndrome is also taken into consideration at a political level, especially due to the close connection with the problems related to environmental pollution and to decision making in the field of control and prevention. For these reasons we believe that an appropriate widespread surveillance network for MCS should be set up in Italy, capable of intercepting possible cases, analyzing them at a multidisciplinary level, and following their evolution.
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Affiliation(s)
- Sabrina Rossi
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Nicola Vanacore
- Centro Nazionale Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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Ramos-Bonilla JP, Marsili D, Comba P. Epidemiological research as a driver of prevention: the Sibaté study. Commentary. Ann Ist Super Sanita 2020; 56:6-9. [PMID: 32242530 DOI: 10.4415/ann_20_01_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although asbestos exposure and risks can be prevented, only five countries in Latin America have banned asbestos, including Colombia. Beginning in 2011, a collaboration between the Istituto Superiore di Sanità in Italy and Universidad de los Andes in Colombia was established, bringing together relevant expertise aiming to improve our understanding of the asbestos problem. An important result of this collaboration was a recently published study conducted in Sibaté, Colombia, a municipality where an asbestos-cement facility has operated since 1942. The evidence collected suggests the presence of a mesothelioma cluster in Sibaté. Landfilled zones with an underground layer of friable asbestos were also discovered in the urban area of the municipality. The importance of this type of collaboration can go beyond understanding the impact of asbestos at the local level, which is crucial, and may also contribute in solving unanswered questions of the problem in countries that banned asbestos decades ago.
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Affiliation(s)
- Juan Pablo Ramos-Bonilla
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de los Andes, Bogotá, Colombia
| | - Daniela Marsili
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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Zona A, Iavarone I, Buzzoni C, Conti S, Santoro M, Fazzo L, Pasetto R, Pirastu R, Bruno C, Ancona C, Bianchi F, Forastiere F, Manno V, Minelli G, Minerba A, Minichilli F, Stoppa G, Pierini A, Ricci P, Scondotto S, Bisceglia L, Cernigliaro A, Ranzi A, Comba P. [SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report]. Epidemiol Prev 2020; 43:1-208. [PMID: 31295974 DOI: 10.19191/ep19.2-3.s1.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES This volume provides an update of the health status of the populations living in the National Priority Contaminated Sites (NPCSs) included in the SENTIERI Project. This update is part of an epidemiological surveillance programme carried out in NPCSs, promoted by the Italian Ministry of Health as a further step of a project started in 2006, when the health status of residents in contaminated sites was first addressed within the National Strategic Program "Environment and Health". The Report focuses on five health outcomes: mortality, cancer incidence, hospital discharges, congenital anomalies, and children, adolescents and young adults' health. A key element of SENTIERI project is the a priori evaluation of the epidemiological evidence of a causal association between the considered cause of disease and the exposure. When an a priori evidence is identified, it is given a greater importance in the comment of the study findings. METHODS The present update of the SENTIERI Project concerns 45 NPCSs including in all 319 Italian Municipalities (out of over 8,000 Municipalities), with an overall population of 5,900,000 inhabitants at the 2011 Italian Census. Standardized Mortality Ratios (SMRs) and Standardized Hospitalization Ratios (SHRs), referring to a time window of 2006-2013, were computed for all the 45 NPCSs, using as a reference the corresponding mortality and hospitalization rates of the Regions where each NCPS is located. Standardized Incidence Ratios (SIRs) were computed by the Italian Association of Cancer Registries (AIRTUM) for the 22 NPCSs served by a Cancer Registry. AIRTUM covers about 56% of Italy, with partly different time-windows. SIRs have been estimated using as reference population the 4 macroareas in which Italy is divided (North-West, North-East, Centre, South). Prevalence of congenital anomalies was computed for 15 NPCSs. RESULTS An all-cause excess of 5,267 and 6,725 deaths was observed, respectively, in men and women; the cancer death excess was of 3,375 in men and 1,910 in women. It was estimated an excess of cancer incidence of 1,220 case in men and 1,425 in women over a five-year time window. With regard to the diseases with an a priori environmental aetiological validity, an excess for malignant mesothelioma, lung, colon, and gastric cancer, and for non-malignant respiratory diseases was observed. Cancer excess mainly affected NPCSs with presence of chemical and petrochemical plants, oil refineries, and dumping hazardous wastes. An excess of non-malignant respiratory disease was also detected in NPCSs in which steel industries and thermoelectric plants were present. An excess of mesothelioma was observed in NPCSs characterized by presence of asbestos and fluoro-edenite; it was also observed where the presence of asbestos was not reported in the legislative national decrees which define the NPCS areas. It is worth noting that, even if the presence of asbestos is not reported in many NPCSs legislative decrees, petrochemical plants and steel industries, for instance, are often characterized by the presence of a large amount of this mineral that, in the past, was extensively used as an insulating material. For the first time, the present Report includes a focus on the health status of children and adolescents (1,160,000 subjects, aged 0-19 years), and young adults (660,000 subjects, aged 20-29 years). Among infants (0-1 year), an excess of 7,000 hospitalizations was observed, 2,000 of which due to conditions of perinatal origin. In the age class 0-14, an excess of 22,000 hospitalizations for all causes was observed; 4,000 of them were due to acute respiratory diseases, and 2,000 to asthma. Data on cancer incidence for subjects aged 0-24 years were derived from general population cancer registries for twenty NPCSs, and from children cancer registries (age group: 0-19 years) for six NPCSs; 666 cases where diagnosed in the age group 0-24 years, corresponding to an excess of 9%. The main contributions to this excess are from soft tissue sarcomas in children (aged 0-14 years), acute myeloid leukaemia in children (aged 0-14 years) and in the age group 0-29 years, non-Hodgkin lymphoma and testicular cancer in young adults (aged 20-29 years). In seven out of 15 NPCSs, an excess prevalence rate of overall congenital anomalies at birth was observed. Congenital anomalies excesses included the following sites: genital organs, heart, limbs, nervous system, digestive system, and urinary system. CONCLUSIONS The main findings of SENTIERI Project have been the detection of excesses for the diseases which showed an a priori epidemiological evidence of a causal association with the environmental exposures specific for each considered NPCS. These observations are valuable within public health, because they contribute to priority health promotion activities. Looking ahead, the health benefits of an improved environmental quality might be appreciated in terms of reduction of the occurrence of adverse health effects attributable to each Site major pollutant agents. Due to the methodological approach of the present study, it was not possible to adjust for several confounding factors reported to be risk factors for the studied diseases (e.g., smoking, alcohol consumption, obesity). Even if excesses of mortality, hospitalization, cancer incidence, and prevalence of congenital anomalies were found in several NPCSs, the study design and the multifactorial aetiology of the considered diseases do not permit, for all of them, to draw conclusions in terms of causal links with environmental contamination. Moreover, it must be taken into consideration that economic factors and the availability of health services may also play a relevant role in a diseases outcome. A few observations regarding some methodological limitations of SENTIERI Project should be made. There is not a uniform environmental characterisation of the studied NPCSs in term of quality and detection of the pollutants, because this information is present in different databases which at present are not adequately connected. Moreover, the recognition of a contaminated site as a National Priority Site is based on soil and groundwater pollution, and the available information on air quality is currently sparse and not homogenous. Another limitation, in term of statistical power, is the small population size of many NPCSs and the low frequency of several health outcomes. A special caution must be paid in data interpretation when considering the correspondence between the contaminated areas and the municipality boundaries, as they do not always coincide perfectly: in some cases, a small municipality with a large industrial site, while in other settings only a part of the municipality is exposed to the sources of pollution. Furthermore, all available health information systems are currently accessible at municipality level. The real breakthrough is essentially comprised of the development and fostering of a networking system involving all local health authorities and regional environmental protection agencies operating in the areas under study. The possibility to integrate the geographic approach of SENTIERI Project with a set of ad hoc analytic epidemiological investigations, such as residential cohort studies, case control studies, children health surveys, biomonitoring surveys, and with socioepidemiological studies, might greatly contribute to the identification of health priorities for environmental remediation activities. Finally, as discussed in the last section of the report, there is a need to adopt, in each NPCS, a two-way oriented communication plan involving public health authorities, scientific community, and resident population, taking into account that the history, the cultural frame and the network of relationships specific of each local context play a major role in the risk perception perspective.
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Affiliation(s)
- Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma;
| | - Ivano Iavarone
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carlotta Buzzoni
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Susanna Conti
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Michele Santoro
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberto Pasetto
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberta Pirastu
- Dipartimento di Biologia e Biotecnologie Charles Darwin, Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carla Ancona
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Fabrizio Bianchi
- Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Francesco Forastiere
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Valerio Manno
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Giada Minelli
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Aldo Minerba
- Struttura Complessa Statistica ed Epidemiologia, ASL Taranto
| | - Fabrizio Minichilli
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Giorgia Stoppa
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Anna Pierini
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, ATS Val Padana, Mantova
| | - Salvatore Scondotto
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Lucia Bisceglia
- Agenzia Regionale Strategica per la Salute e il Sociale, Regione Puglia, Bari
| | - Achille Cernigliaro
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Andrea Ranzi
- Direzione Tecnica, Centro Tematico Regionale Ambiente Salute, ARPAE Emilia-Romagna, Modena
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
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Magoni M, Donato F, Apostoli P, Rossi G, Comba P, Fazzo L, Speziani F, Leonardi L, Orizio G, Scarcella C, Anastasia A, Tucci A. Serum levels of polychlorinated biphenyls and risk of non-Hodgkin lymphoma: A hospital-based case-control study. Chemosphere 2019; 235:969-975. [PMID: 31561313 DOI: 10.1016/j.chemosphere.2019.06.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/06/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
Polychlorinated biphenyls (PCB) have been classified by the International Agency for Research on Cancer (IARC) in Group 1 as carcinogenic to human, based on sufficient evidence in humans of an increased risk of cutaneous malignant melanoma and limited evidence for non-Hodgkin lymphoma (NHL). However present findings on the association of PCB exposure and NHL are still controversial. This study examined the relationship between PCB serum levels and risk of NHL in a Northern Italy area (Brescia province), where a chemical factory produced PCBs from 1938 to 1984, causing human contamination. A case-control study of 215 NHL patients and 215 control subjects was conducted. Cases and controls were assayed for serum levels of 33 PCB congeners. No associations were found between risk of NHL and serum levels of total PCBs (OR = 0.51; 95% CI: 0.25-1.04 for highest vs lowest quartile) or specific PCB congeners. The study confirmed a strong association of NHL with HCV infection (OR = 3.60; 95% CI: 1.30-10.02). This case-control study does not support the hypothesis of an association between current serum levels of PCBs and NHL development in the general population.
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Affiliation(s)
- Michele Magoni
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy
| | - Pietro Apostoli
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy
| | - Giuseppe Rossi
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Lucia Leonardi
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Grazia Orizio
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | | | - Antonella Anastasia
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Alessandra Tucci
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
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Ramos-Bonilla JP, Cely-García MF, Giraldo M, Comba P, Terracini B, Pasetto R, Marsili D, Ascoli V, Lysaniuk B, Rodríguez MC, Mazzeo A, Panqueva RDPL, Baldión M, Cañón D, García-Herreros LG, Pinzón B, Hernández LJ, Silva YA. An asbestos contaminated town in the vicinity of an asbestos-cement facility: The case study of Sibaté, Colombia. Environ Res 2019; 176:108464. [PMID: 31229775 DOI: 10.1016/j.envres.2019.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 05/16/2023]
Abstract
INTRODUCTION The asbestos industry began operations in Colombia in 1942, with an asbestos-cement facility located in the municipality of Sibaté. In recent years residents from Sibaté have been complaining about what they consider is an unusually large number of people diagnosed with asbestos-related diseases in the town. A study to analyze the situation of Sibaté started in 2015, to verify if the number of asbestos related diseases being diagnosed were higher than expected, and to identify potential asbestos exposure sources in the town. METHODS A health and socioeconomic survey was implemented door-to-door to identify potential asbestos-related diseases. Several self-reported mesothelioma cases were identified, and for confirmation purposes, copies of the medical record with the histopathology report were obtained. A panel of six physicians analyzed the medical records. Information of validated cases was used to estimate the male and female age-adjusted incidence rate for Sibaté. Based on reports of the existence of potential asbestos-contaminated landfills, topographic maps, a digital elevation model, and current satellite images were crossed using a geographic information system to identify potential landfilled areas, and soils samples were collected in some of these areas. RESULTS A total of 355 surveys were completed, and 29 self-reported mesothelioma cases were identified. Twenty-five of these cases have been persons who had lived at some moment of their lives in Sibaté. It was possible to obtain copies of the medical diagnosis for 17 cases. Of these, the panel of physicians classified 15 cases as certain pleural mesothelioma, one as probable, and one as not mesothelioma. Based on this information, the estimated age-adjusted incidence rate of mesothelioma in Sibaté was 3.1 × 105 persons-year for males and 1.6 × 105 persons-year for females. These rates are high in comparison to those reported in other cities, regions, and countries of the world. Using geographic information systems, landfilled zones in the urban area of Sibaté were identified, on top of which a school and different sports facilities were built. The analysis of four soil samples collected in landfilled zones, confirmed the existence of an underground layer of friable and non-friable asbestos. CONCLUSION The collected evidence suggests the presence of a malignant pleural mesothelioma cluster in Sibaté.
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Affiliation(s)
- Juan Pablo Ramos-Bonilla
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia.
| | - María Fernanda Cely-García
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Margarita Giraldo
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy; WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | | | - Roberto Pasetto
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy; WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy; WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | | | - María Camila Rodríguez
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Agata Mazzeo
- Department of History and Cultures, University of Bologna, Bologna, Italy
| | - Rocio Del Pilar López Panqueva
- Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Associate Clinical Professor, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Margarita Baldión
- Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Associate Clinical Professor, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Diana Cañón
- Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Associate Clinical Professor, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | | | - Bibiana Pinzón
- Diagnostic Imaging Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Yordi Alejandro Silva
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Bogotá, Colombia
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Marsili D, Canepa A, Mossone N, Comba P. Environmental Health Education for Asbestos-Contaminated Communities in Italy: The Casale Monferrato Case Study. Ann Glob Health 2019; 85:84. [PMID: 31225962 PMCID: PMC6634471 DOI: 10.5334/aogh.2491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Environmental health education contributes towards increasing awareness of communities to prevent exposure to hazardous substances. Casale Monferrato, the operating site for the Eternit asbestos-cement factory from 1907 to 1986, is a prioritized asbestos-contaminated site for remediation in Italy. The area is prone to severe asbestos-related diseases. About 50 cases of mesothelioma are diagnosed in Casale Monferrato annually; mesothelioma has been shown to be caused by occupational, environmental and domestic asbestos exposure. OBJECTIVES The goal of this paper is to analyze the Casale Monferrato case study in terms of youth engagement in environmental health education initiatives on asbestos risk and health impact. The paper aims at underlining the lessons learned in order to share the success of this initiative with other communities living in asbestos-contaminated sites in different countries. METHODS Peer education methodology has been used through the Asbestos Classroom to involve teachers, students and other local stakeholders in training activities, in selection of the contents for educational materials and interactive tools, as well as in choosing the presentation process for the aforementioned knowledge sharing instruments. FINDINGS From November 2014 to June 2018, 185 high school students and teachers were trained through the Asbestos Classroom. Through December 2018, they trained 3,241 classroom visitors. The Classroom relies on an inclusive participative process in which young people play a key role in the network of relationships within their community. CONCLUSIONS The paper corroborates the importance of engaging the educational system in communication efforts aimed at fostering collective awareness on environmental risk and health-related impacts for communities living in industrially contaminated sites. Considering the global dimension of the asbestos contamination and disease burden, this experience might be of relevance both in countries that banned asbestos and in those where asbestos is not yet prohibited.
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Affiliation(s)
- Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, IT
- WHO Collaborating Centre on Environmental Health in Contaminated Sites, IT
| | - Adriana Canepa
- Cesare Balbo High School of the Network “ScuoleInsieme”, Casale Monferrato, IT
| | - Nicola Mossone
- Cesare Balbo High School of the Network “ScuoleInsieme”, Casale Monferrato, IT
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, IT
- WHO Collaborating Centre on Environmental Health in Contaminated Sites, IT
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Marques MM, Berrington de Gonzalez A, Beland FA, Browne P, Demers PA, Lachenmeier DW, Bahadori T, Barupal DK, Belpoggi F, Comba P, Dai M, Daniels RD, Ferreccio C, Grigoriev OA, Hong YC, Hoover RN, Kanno J, Kogevinas M, Lasfargues G, Malekzadeh R, Masten S, Newton R, Norat T, Pappas JJ, Queiroz Moreira C, Rodríguez T, Rodríguez-Guzmán J, Sewram V, Zeise L, Benbrahim-Tallaa L, Bouvard V, Cree IA, El Ghissassi F, Girschik J, Grosse Y, Hall AL, Turner MC, Straif K, Korenjak M, McCormack V, Müller K, Schüz J, Zavadil J, Schubauer-Berigan MK, Guyton KZ. Advisory Group recommendations on priorities for the IARC Monographs. Lancet Oncol 2019; 20:763-764. [DOI: 10.1016/s1470-2045(19)30246-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zona A, Fazzo L, Minelli G, De Santis M, Bruno C, Conti S, Comba P. Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources. Cancer Epidemiol 2019; 60:162-167. [PMID: 31030080 DOI: 10.1016/j.canep.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study is part of a national plan of epidemiological surveillance of malignant mesothelioma (MM) mortality in Italy. The paper shows the results of malignant peritoneal mesothelioma (MPeM) mortality study in Italian Regions and municipalities. METHODS National Bureau of Statistics data for MPeM municipal mortality (ICD-10, Code C45.1) were analyzed in the time-window 2003-2014: mortality standardized rates (reference Italian population, census 2011), temporal trends of the annual national rates, Standardized Mortality Ratios and a municipal clustering analysis were performed. RESULTS 747 deaths for MPeM were recorded (0.10/100,000): 464 in men (0.14/100,000) and in 283 women (0.07/100,000). No significant MPeM mortality temporal trend was found. Seventeen municipalities showed excesses of mortality for MPeM in at least one gender and/or overall population. Four clusters in male population, and one in women were identified. CONCLUSIONS The study identifies some areas where remediation activities and/or health care actions may be warranted.
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Affiliation(s)
- A Zona
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - L Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - G Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - M De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - C Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - S Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - P Comba
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
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Pasetto R, Zona A, Fazzo L, Binazzi A, Bruno C, Pirastu R, Comba P, Marinaccio A. Proportion of mesothelioma attributable to living in industrially contaminated areas in
Italy. Scand J Work Environ Health 2019; 45:444-449. [DOI: 10.5271/sjweh.3809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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23
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Gianicolo EAL, Mangia C, Cervino M, Bruni A, Portaluri M, Comba P, Pirastu R, Biggeri A, Vigotti M, Blettner M. Long-term effect of arsenic exposure: Results from an occupational cohort study. Am J Ind Med 2019; 62:145-155. [PMID: 30609098 DOI: 10.1002/ajim.22939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 1976 in Manfredonia (Italy), arsenic was released into the atmosphere due to an accident in a petrochemical plant. We aimed to analyze the mortality of workers involved in the factory for the site cleaning activities. METHODS The cohort consisted of 1467 workers grouped into contract, fertilizer, and plastic workers. The outcome of interest was mortality for specific causes. Standardized mortality ratios (SMR) and 95% confidence intervals (95%CI) were computed. RESULTS For all workers and all causes of death combined, the SMR was less than 1.0. Mortality ratios were increased for malignant neoplasms of the pleura, bone and melanoma of the skin. Contract workers, the group mostly exposed to arsenic, showed statistically significant SMRs for several malignancies, in particular for lung cancer (SMR = 1.26; 95%CI: 1.05-1.54). CONCLUSIONS Overall, the results reported here on mortality among persons occupationally exposed to arsenic are consistent with the literature and biologically plausible.
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Affiliation(s)
- Emilio Antonio L. Gianicolo
- Italian National Research Council; Institute of Clinical Physiology; Lecce Italy
- University of Mainz; Institute of medical Biostatistics, Epidemiology and Informatics; Mainz Germany
| | - Cristina Mangia
- Italian National Research Council; Institute of Atmospheric Sciences and Climate; Lecce Italy
| | - Marco Cervino
- Italian National Research Council; Institute of Atmospheric Sciences and Climate; Bologna Italy
| | - Antonella Bruni
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale; Taranto Italy
| | | | - Pietro Comba
- Department of Environment and Health; Istituto Superiore di Sanità; Rome Italy
| | | | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications; University of Florence; Florence Italy
- Epidemiologia e Prevenzione Social Enterprise; Torino Italy
| | - Mariangela Vigotti
- Italian National Research Council; Institute of Clinical Physiology; Lecce Italy
| | - Maria Blettner
- University of Mainz; Institute of medical Biostatistics, Epidemiology and Informatics; Mainz Germany
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24
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Fedeli U, Girardi P, Gardiman G, Zara D, Scoizzato L, Ballarin MN, Baccini M, Pirastu R, Comba P, Mastrangelo G. Mortality from liver angiosarcoma, hepatocellular carcinoma, and cirrhosis among vinyl chloride workers. Am J Ind Med 2019; 62:14-20. [PMID: 30474170 DOI: 10.1002/ajim.22922] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Occupational exposure to vinyl chloride monomer (VCM) has been established as a cause of hepatocellular carcinoma (HCC) and liver angiosarcoma (ASL). However, some controversy remains due to conflicting results on liver cirrhosis, and to evidence on HCC based on few confirmed cases. The aim of the study is to clarify the association between VCM exposure and mortality from liver diseases. METHODS In a cohort of 1658 workers involved in VCM production and polymerization, Poisson regression was adopted to estimate rate ratios (RR) across categories of VCM exposure for mortality due to ASL (n = 9), HCC (n = 31) confirmed by histological/clinical records, and the combination of deaths from liver cirrhosis and from liver cancer with clinical/histological evidence of cirrhosis (n = 63). RESULTS Cumulative VCM exposure was associated with study outcomes; RRs in the highest compared to the lowest exposure category were: ASL 91.1 (95%Confidence Interval 16.8-497), HCC 5.52 (2.03-15.0), liver cirrhosis 2.60 (1.19-5.67). CONCLUSIONS The risk of death from liver cirrhosis, as well as from HCC in the largest available series of confirmed cases, increased with VCM exposure.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological DepartmentVeneto RegionItaly
| | | | | | - Davide Zara
- Occupational Health ServiceLocal Health Unit 3VeniceItaly
| | - Luca Scoizzato
- Occupational Health ServiceLocal Health Unit 3VeniceItaly
| | | | - Michela Baccini
- Department of Statistics, Informatics, ApplicationsUniversity of FlorenceFirenzeItaly
| | - Roberta Pirastu
- Department of Biology and BiotechnologiesSapienza UniversityRomeItaly
| | - Pietro Comba
- Department of Environment and HealthIstituto Superiore di SanitàRomeItaly
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
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Marsili D, Magnani C, Canepa A, Bruno C, Luberto F, Caputo A, Fazzo L, Zona A, Comba P. Communication and health education in communities experiencing asbestos risk and health impacts in Italy. Ann Ist Super Sanita 2019; 55:70-79. [PMID: 30968841 DOI: 10.4415/ann_19_01_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Numerous municipalities in Italy currently experience asbestos health impact, in particular excesses of pleural mesothelioma incidence and mortality. This paper presents an integrated analysis of epidemiological studies and communication actions in affected municipalities to highlight how communication has been implemented depending on health impact evidence and involvement of local stakeholders. METHODOLOGY Four case studies are identified concerning industrial and natural sources of asbestos exposure having different diseases burden. This integrated analysis benefited from multidisciplinary skills. DISCUSSION Evidence of different stakeholders engagement is presented to emphasize their role in the communication process. Similarities and differences among case studies allowed us to identify lessons-learned to be transferred in other asbestos contaminated sites. CONCLUSIONS The adoption of communication strategies and practices, since the very early evidence of asbestos health impact, represents a relevant contribution for epidemiological and health surveillance, particularly for those communities where asbestos health impact has only been recently reported.
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Affiliation(s)
- Daniela Marsili
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale e CPO Piemonte, Novara, Italy
| | - Adriana Canepa
- Istituto di Istruzione Superiore "Cesare Balbo" della rete ScuoleInsieme, Casale Monferrato, Alessandria, Italy
| | - Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Ferdinando Luberto
- Servizio di Epidemiologia e Comunicazione, AUSL e IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
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Comba P, Marsili D. Towards integration of epidemiological and social sciences approaches in the study of communities affected by asbestos exposure. Preface. Ann Ist Super Sanita 2019; 55:68-69. [PMID: 30968840 DOI: 10.4415/ann_19_01_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Daniela Marsili
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
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Comba P, D'Angelo M, Fazzo L, Magnani C, Marinaccio A, Mirabelli D, Terracini B. Mesothelioma in Italy: the Casale Monferrato model to a national epidemiological surveillance system. Ann Ist Super Sanita 2018; 54:139-148. [PMID: 29916419 DOI: 10.4415/ann_18_02_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of the present paper is to review the origin and development of the epidemiology of mesothelioma in Italy, starting with the detection and investigation of the major outbreak of the disease observed in Casale Monferrato, Piedmont Region. Over the last four decades, mortality among the cohort of ex-Eternit workers has been measured at three points in time. More recently, population based case-control studies in the area of Casale Monferrato have provided new light on the dose-response curve of the relationship between asbestos exposure and mesotheliomas. The publication of the first Casale Monferrato study had a major impact in the country and contributed to the decision of the Italian Parliament to ban the use of asbestos. The experience of Casale Monferrato represents a lesson in several terms, from the epidemiological surveillance to the health care of the victims and the relationship between epidemiologists, victims, their relatives and residents in contaminated areas.
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Affiliation(s)
- Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo D'Angelo
- Centro Sanitario Amianto Piemonte, Casale Monferrato (Alessandria), Italy
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Translazionale, Università del Piemonte Orientale, Novara, Italy
| | - Alessandro Marinaccio
- Dipartimento di Epidemiologia e Igiene, Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
| | - Dario Mirabelli
- Epidemiologia dei Tumori, CPO-Piemonte e Università di Torino, Turin, Italy
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Uccelli R, Mastrantonio M, Altavista P, Caiaffa E, Cattani G, Belli S, Comba P. Female lung cancer mortality and long-term exposure to particulate matter in Italy. Eur J Public Health 2018; 27:178-183. [PMID: 28177487 DOI: 10.1093/eurpub/ckw203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Raffaella Uccelli
- Territorial and Production Systems Sustainability Department, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Marina Mastrantonio
- Territorial and Production Systems Sustainability Department, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Pierluigi Altavista
- Territorial and Production Systems Sustainability Department, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Emanuela Caiaffa
- Energy Technologies Department, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Giorgio Cattani
- State of the Environment and Environmental Metrology Department, Italian National Institute for Environmental Protection and Research (ISPRA), Rome, Italy
| | - Stefano Belli
- Dipartimento Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità (ISS), Rome, Italy
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Scarnato C, Rambaldi R, Mancini G, Olanda S, Spagnolo MR, Previati E, Parmeggiani V, Minisci S, Comba P, Pirastu R. [Mortality study update of workers exposed to vinyl chloride in plants located in Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy)]. Epidemiol Prev 2018; 41:271-278. [PMID: 29119762 DOI: 10.19191/ep17.5-6.p271.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES to update the mortality study of subjects exposed to vinyl chloride in the phases of synthesis of the monomer and polymerization in the plants of Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy). DESIGN both for the whole cohort and for the two plants, standardized mortality ratios (SMRs), with 95% confidence intervals (95%CI), were calculated for different death causes, then stratified by duration and latency, periods of the beginning of work and cumulative exposure (ppm-years). SETTING AND PARTICIPANTS the cohort includes 1,540 subjects (469 in Ferrara hired from 1953 to 1999; 1,071 in Ravenna hired from 1959 to 2000), with at least six months of work. RESULTS by the end of the follow-up (31.12.2013), 348 deaths occurred. Overall observed mortality, contrasted to that expected based on Emilia-Romagna Region mortality rates, appeared to be lower than expected in the whole cohort (348 cases, SMR: 0.85; 95%CI 0.77-0.95) and in Ravenna (173 cases, SMR: 0.71; 95%CI 0.61-0.83). Mortality for all neoplasms was in excess in Ferrara (79 cases, SMR: 1.27; 95%CI 1.02-1.58), but lower than expected in Ravenna (83 cases, SMR: 0.80; 95%CI 0.64-0.99). An excess in mortality was observed in the whole cohort (16 cases, SMR: 1.74; 95%CI 1.07-2.85) and in Ferrara for liver cancer (7 cases, SMR: 2.12; 95%CI 1.02-4.46), and only in Ferrara for respiratory tract cancer (30 cases, SMR: 1.45; 95%CI 1.02-2.07) and larynx cancer (4 cases, SMR: 3.35; 95%CI 1.26-8.92). In the whole cohort, SMR for liver cancer was in excess since a cumulative exposure of 5,000 ppm-year and 12 cases belong to the job title of autoclave workers (12 cases, SMR 4.6; 95%CI 2.6-8.0), duration of work higher than 20 years (8 cases, SMR 2.4; 95%CI 1.2-4.9), and latency higher than 40 years (7 cases, SMR 2.5; 95%CI 1.2-5.2). The excess in mortality for lung cancer is statistically significant for and with cumulative exposure higher than 7,330 ppm-years (6 cases, SMR 3.2 95%CI 1.4-7.0). There are not excesses among subjects hired after 1971. CONCLUSIONS the study findings confirm and expand the ones of previous studies. It was not possible to apply a best evidence approach to the study of liver cancer, and consequently it is not possible to distinguish between hepatic angiosarcoma and hepatocellular carcinoma. The evidence of a causal link between vinyl chloride exposure and liver cancer is anyhow confirmed. The causal link between vinyl chloride exposure and lung cancer must be further investigated.
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Affiliation(s)
| | | | | | - Sandra Olanda
- Dipartimento di sanità pubblica, Azienda USL di Ravenna
| | | | | | | | - Salvatore Minisci
- Insegnamento di sicurezza sui luoghi di lavoro, Università di Ferrara
| | - Pietro Comba
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.,Dipartimento di biologia animale e dell'uomo, Università "Sapienza", Roma
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Fazzo L, Minelli G, De Santis M, Bruno C, Zona A, Conti S, Comba P. Epidemiological surveillance of mesothelioma mortality in Italy. Cancer Epidemiol 2018; 55:184-191. [PMID: 29990795 DOI: 10.1016/j.canep.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/31/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Malignant mesothelioma (MM) is causally linked to asbestos exposure with an estimated etiological fraction of 80% or more. METHODS Standardized rates of all mesothelioma (C45, ICD-10) and malignant pleural mesothelioma (C45.0, ICD-10) mortality in Italy were computed at national and regional levels, for the period 2003-2014. Standardized Mortality Ratios (SMRs, with 95% Confidence Intervals) were calculated for each of the 8047 Italian municipalities, for both diseases, with respect to Regional figures. A geographical clustering analysis at municipal level was performed, applying SatScan methods. RESULTS In Italy, 16,086 persons (about 1,340/year) died for MM, in analysed period. National Standardized rates of MM mortality are 3.65/100,000 in men and 1.09/100,000 in women, with an increasing annual trend, among male population. The highest rates were found in men from Northern Regions. Significant clusters (p < 0.10) were found corresponding to areas that hosted major asbestos-cement plants, naval shipyards, petrochemical plants and refineries. Furthermore, excesses were found corresponding to chemical and textile industries; the latter involving, particularly, female population. Excesses were found also in areas near the chrysotile mine of Balangero, and in Biancavilla, a town with a stone quarry contaminated by fluoro-edenitic fibres; an excess of MM mortality was observed among male population living in a minor island where a Navy shipyard is located. CONCLUSIONS Mortality for mesothelioma in Italy is still increasing, twenty-six years after the asbestos ban. Epidemiological surveillance of mesothelioma mortality allows to detect the temporal trend of the disease and highlights previously unknown or underestimated sources of asbestos exposure.
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Affiliation(s)
- Lucia Fazzo
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Marco De Santis
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Caterina Bruno
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Amerigo Zona
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Susanna Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Pietro Comba
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
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31
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Caputo A, De Santis M, Manno V, Cauzillo G, Bruni BM, Palumbo L, Conti S, Comba P. [Health impact of asbestos fibres naturally occurring in Mount Pollino area (Basilicata Region, Southern Italy)]. Epidemiol Prev 2018; 42:142-150. [PMID: 29774711 DOI: 10.19191/ep18.2.p142.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to estimate the health impact of asbestos fibres naturally occurring in Mount Pollino area (Basilicata Region, Southern Italy). DESIGN geographic mortality, hospitalization, and incidence study. Setting and participant s: population resident in 12 Municipalities of Mount Pollino area with naturally occurring asbestos fibres. MAIN OUTCOME MEASURES standardized mortality ratio (SMR) and standardized hospitalization rate (SHR) for asbestos-related diseases; standardized incidence ratio (SIR) for mesotheliomas. Result s: in the area of Mount Pollino, where asbestos fibres naturally occur, especially in the sub-area in which fibres are close to dwellings and settlements, it was observed: • a significant excess of mesothelioma incidence (SIR: 208; CI95% 111-355; 13 observed); • a non-significant excess of hospitalization for malignant pleural neoplasms (SHR: 176; CI95% 93-335; 9 observed); • a significant excess for mortality and hospitalization for pneumoconiosis (SMR: 534; CI95% 345-824; 20 observed - SHR: 245; CI95% 149-405; 15 observed); • a significant excess for hospitalization (SHR: 852; CI95% 290-2,506; 3 observed) for asbestosis. CONCLUSION it is necessary to continue environmental monitoring and environmental remediation in the area with higher asbestos exposure. It is suggested to implement a permanent process of epidemiological surveillance in this same area. A communication plan with local administrators, general practitioners, school teachers, media, and the resident population at large should be realized.
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Affiliation(s)
| | - Marco De Santis
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Valerio Manno
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Gabriella Cauzillo
- Centro operativo Registro nazionale mesoteliomi, Regione Basilicata, Potenza
| | | | - Lorenzo Palumbo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Susanna Conti
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Pietro Comba
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
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Vermeulen R, Saberi Hosnijeh F, Bodinier B, Portengen L, Liquet B, Garrido-Manriquez J, Lokhorst H, Bergdahl IA, Kyrtopoulos SA, Johansson AS, Georgiadis P, Melin B, Palli D, Krogh V, Panico S, Sacerdote C, Tumino R, Vineis P, Castagné R, Chadeau-Hyam M, Botsivali M, Chatziioannou A, Valavanis I, Kleinjans JCS, de Kok TMCM, Keun HC, Athersuch TJ, Kelly R, Lenner P, Hallmans G, Stephanou EG, Myridakis A, Kogevinas M, Fazzo L, De Santis M, Comba P, Bendinelli B, Kiviranta H, Rantakokko P, Airaksinen R, Ruokojarvi P, Gilthorpe M, Fleming S, Fleming T, Tu YK, Lundh T, Chien KL, Chen WJ, Lee WC, Kate Hsiao C, Kuo PH, Hung H, Liao SF. Pre-diagnostic blood immune markers, incidence and progression of B-cell lymphoma and multiple myeloma: Univariate and functionally informed multivariate analyses. Int J Cancer 2018; 143:1335-1347. [PMID: 29667176 PMCID: PMC6100111 DOI: 10.1002/ijc.31536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Recent prospective studies have shown that dysregulation of the immune system may precede the development of B‐cell lymphomas (BCL) in immunocompetent individuals. However, to date, the studies were restricted to a few immune markers, which were considered separately. Using a nested case–control study within two European prospective cohorts, we measured plasma levels of 28 immune markers in samples collected a median of 6 years before diagnosis (range 2.01–15.97) in 268 incident cases of BCL (including multiple myeloma [MM]) and matched controls. Linear mixed models and partial least square analyses were used to analyze the association between levels of immune marker and the incidence of BCL and its main histological subtypes and to investigate potential biomarkers predictive of the time to diagnosis. Linear mixed model analyses identified associations linking lower levels of fibroblast growth factor‐2 (FGF‐2 p = 7.2 × 10−4) and transforming growth factor alpha (TGF‐α, p = 6.5 × 10−5) and BCL incidence. Analyses stratified by histological subtypes identified inverse associations for MM subtype including FGF‐2 (p = 7.8 × 10−7), TGF‐α (p = 4.08 × 10−5), fractalkine (p = 1.12 × 10−3), monocyte chemotactic protein‐3 (p = 1.36 × 10−4), macrophage inflammatory protein 1‐alpha (p = 4.6 × 10−4) and vascular endothelial growth factor (p = 4.23 × 10−5). Our results also provided marginal support for already reported associations between chemokines and diffuse large BCL (DLBCL) and cytokines and chronic lymphocytic leukemia (CLL). Case‐only analyses showed that Granulocyte‐macrophage colony stimulating factor levels were consistently higher closer to diagnosis, which provides further evidence of its role in tumor progression. In conclusion, our study suggests a role of growth‐factors in the incidence of MM and of chemokine and cytokine regulation in DLBCL and CLL. What's new? B‐cell lymphomas (BCL) are frequent in immunocompromised individuals, but most BCL cases are thought to occur as a consequence of minor immune perturbations in otherwise immunocompetent individuals. Here the authors prospectively examined a panel of immune markers in the blood from 268 patients afflicted with BCL and paired controls. The data uncover a functional role for growth factors (i.e. FGF‐2, TGF‐alpha) in the incidence and progression of multiple myeloma, a BCL subtype, and underscore the importance of chemokine and cytokine regulation in diffuse large B‐cell lymphoma and chronic lymphocytic leukemia.
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Affiliation(s)
- Roel Vermeulen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Fatemeh Saberi Hosnijeh
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara Bodinier
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Lützen Portengen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Benoît Liquet
- Laboratoire de Mathématiques et de leurs Applications, Université de Pau et des Pays de l'Adour, UMR CNRS, Pau, France.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia
| | - Javiera Garrido-Manriquez
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Henk Lokhorst
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingvar A Bergdahl
- Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | | | - Panagiotis Georgiadis
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Domenico Palli
- The Institute for Cancer Research and Prevention, Florence, Italy
| | - Vittorio Krogh
- Fondazione IRCCS-Instituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Frederico II, Naples, Italy
| | - Carlotta Sacerdote
- Piedmont Reference Centre for Epidemiology and Cancer Prevention (CPO Piemonte), Turin, Italy
| | - Rosario Tumino
- Cancer registry and Histopathology Unit, Azienda Ospedaliera 'Civile-M.P.Arezzo', Ragusa, Italy
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,HuGeF Foundation, Torino, Italy
| | - Raphaële Castagné
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,INSERM, UMR1027, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Marc Chadeau-Hyam
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | | - Maria Botsivali
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Aristotelis Chatziioannou
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Ioannis Valavanis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Jos C S Kleinjans
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Theo M C M de Kok
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Hector C Keun
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Institute of Reproductive and Developmental Biology (IRDB), Hammersmith Hospital, London, United Kingdom
| | - Toby J Athersuch
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rachel Kelly
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Per Lenner
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Goran Hallmans
- Nutrition Research, Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | | | - Antonis Myridakis
- Environmental Chemical Processes Laboratory, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Yu-Kang Tu
- University of Leeds, Leeds, United Kingdom
| | | | | | - Wei J Chen
- National Taiwan University, Taipei, Taiwan
| | | | | | | | - Hung Hung
- National Taiwan University, Taipei, Taiwan
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Ascoli V, Belli S, Carnovale-Scalzo C, Corzani F, Facciolo F, Lopergolo M, Nardi F, Pasetto R, Comba P. Malignant Mesothelioma in Rome and Latium Region, 1993-2001. Tumori 2018; 89:377-81. [PMID: 14606638 DOI: 10.1177/030089160308900405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Epidemiological studies on malignant mesothelioma have provided evidence on the etiologic role of occupational asbestos exposure and, to some extent, domestic and residential exposures. Less attention has been given to the occurrence of mesothelioma in urban areas where large quantities of asbestos have been employed in the past. The purpose of the study was to investigate the occurrence of mesothelioma in patients living in the urban area of Rome and in other parts of the Latium Region and the patterns of asbestos exposure. Methods and study design A pathology-based, malignant mesothelioma archive operating in Rome, Italy, was the source of cases. Included in the survey were cases resident in Latium and diagnosed in the period January 1, 1993, through December 31, 2001. Information on asbestos exposure was derived from interviews to the patient or his/her next of kin and from available medical records. Results The case series included: 114 males and 53 females; total, 167. Information on asbestos exposure was available for 138 cases (83%). Occupational exposure was ascertained or suspected for 33% of cases resident in Rome and 63% of those resident in other municipalities of Latium. Sex ratio was 1.6 in Rome and 3.3 in Latium. Conclusions The high prevalence of women among mesothelioma cases and lower proportion of occupational exposure in Rome versus the other municipalities of Latium suggest a possible role of environmental asbestos exposure in the urban area.
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Affiliation(s)
- Valeria Ascoli
- Anatomia Patologica, Dipartimento di Medicina Sperimentale e Patologia, Università La Sapienza, Roma, Italy.
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Ascoli V, Scalzo CC, Facciolo F, Martelli M, Manente L, Comba P, Bruno C, Nardi F. Malignant Mesothelioma in Rome, Italy 1980-1995. A Retrospective Study of 79 Patients. Tumori 2018; 82:526-32. [PMID: 9061058 DOI: 10.1177/030089169608200603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim and background To evaluate the characteristics of a case-series of 79 malignant mesothelioma patients collected from the main teaching hospital of Rome, Italy, and other local clinics of Latium Region and to assess the role of asbestos exposure, since previous studies on the occurrence of the disease in this area were lacking. Methods The study included cytohistologically diagnosed malignant mesothelioma (71 pleural, 7 peritoneal, and 1 testicular tunica vaginalis) detected or referred for consultation during the period 1980-1995. Information regarding occupational and/or nonoccupational exposures was derived from clinical records and interviews, when available. Results Patients were resident in Rome and other towns of Latium; a few were from other parts of central and southern Italy. Exposure to asbestos was assessed for 45.5% of patients, another 45.5% had unknown exposure, and for the remaining 9% such information was lacking. Occupational exposure occurred in 53% of men for whom information was available and nonoccupational exposure occurred in 20% of women. The study identified two clusters of cases from an asbestos-cement plant and a facility where asbestos was ubiquitous. Furthermore, most exposed subjects reported occupations in the construction industry, which is particularly active in the Latium Region; others were railroad workers, naval mechanics and navy personnel, bakers, explosive workers and car mechanics. A few patients reported indoor exposure to asbestos at home and/or in the workplace. Conclusions The study confirmed that mesothelioma risk is present in several job titles of the construction industry, and it is no longer confined to workers employed in the manufacture or application of asbestos products. The occurrence of malignant mesothelioma in patients with unexpected occupational and nonoccupational exposures indicates the need for further investigation on previously underestimated exposures.
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Affiliation(s)
- V Ascoli
- Dipartimento di Medicina Sperimentale e Patologia, Università La Sapienza, Rome, Italy
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Magoni M, Apostoli P, Donato F, Manganoni A, Comba P, Fazzo L, Speziani F, Leonardi L, Orizio G, Scarcella C, Calzavara Pinton P. Plasma levels of polychlorinated biphenyls and risk of cutaneous malignant melanoma: A hospital-based case-control study. Environ Int 2018; 113:20-25. [PMID: 29421403 DOI: 10.1016/j.envint.2018.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 05/20/2023]
Abstract
Polychlorinated biphenyls (PCB) have been classified by the International Agency for Research on Cancer (IARC) in Group 1 as carcinogenic to human, based on sufficient evidence in humans of an increased risk of cutaneous malignant melanoma (CMM), however few studies have been done in the general population. This study examined the relationship between PCB plasma levels and risk of CMM adjusting for sun sensitivity and sun exposure in a province of Northern Italy (Brescia), where a chemical factory produced PCBs from 1938 to 1984 causing human contamination. A case-control study of 205 CMM patients and 205 control subjects was conducted. Cases and controls were assayed for plasma levels of 33 PCB congeners. No associations was found between risk of CMM and plasma levels of total PCB (OR = 0.81; 95% CI: 0.34-1.96 for highest vs lowest quartile) or specific congeners. The study confirmed the association with light skin colour (OR = 3.00; 95% CI: 1.91-4.73), cumulative lifetime UV exposure (OR = 2.56; 95% CI: 1.35-4.85) and high level of education (OR = 1.45; 95% CI: 1.03-2.05). This case-control study does not support the hypothesis of an association between current plasma levels of PCBs and CMM development in the general population.
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Affiliation(s)
- Michele Magoni
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Pietro Apostoli
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy
| | - Ausilia Manganoni
- Section of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Lucia Leonardi
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Grazia Orizio
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
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Minelli G, Zona A, Cavariani F, Comba P, Pasetto R. Silicosis mortality in Italy: temporal trends 1990-2012 and spatial patterns 2000-2012. Ann Ist Super Sanita 2018; 53:275-282. [PMID: 29297856 DOI: 10.4415/ann_17_04_02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The objective of this contribution is to describe, for the first time, occurrence, temporal trends and spatial patterns of mortality from silicosis in Italy in recent decades. METHODS Mortality data on pneumoconiosis due to silica or silicates (ICD-9 code 502, ICD-10 code J62) were extracted from the Italian National Mortality Database. Temporal trends were analysed in the period 1990-2012; standardized rates per 100 000, spatial distribution, including cluster analysis, were computed for eleven years, i.e. 2000-2012 (2004-2005, data non available). RESULTS In the period 1990-2012, a general decline in mortality was found with a total decrease of 74% and an estimated three year percentage change of -7.72. 4590 deaths from silicosis were observed in eleven years, 98% of them among men. The average age at death was 79.8 years. The mean age standardized rate was 0.33 (95% CI: 0.32 to 0.34). The Regions of Aosta Valley, Abruzzo and Sardinia had the highest rates. The assessment of risk at municipality level showed a significant excess of risk in 804 out of 8057 municipalities. Clusters of municipalities with a risk higher than expected were 34, observed in 18 out of 21 Regions. CONCLUSIONS The study shows that mortality due to silicosis in Italy has steadily declined in the last decades, with differences among Regions. Clusters of municipalities with an excess of risk should be verified with Local Health Units in order to assess the need of targeted preventive actions.
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Affiliation(s)
- Giada Minelli
- Servizio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvio Cavariani
- Centro Regionale di Riferimento Amianto, Dipartimento di Prevenzione, ASL Viterbo, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Pasetto
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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Benedetti M, De Santis M, Manno V, Minerba S, Mincuzzi A, Morabito A, Panocchia N, Soggiu ME, Tanzarella A, Pastore T, Bossola M, Giua R, Leogrande S, Nocioni A, Conti S, Comba P. Spatial distribution of kidney disease in the contaminated site of Taranto (Italy). Am J Ind Med 2017; 60:1088-1099. [PMID: 29027241 DOI: 10.1002/ajim.22781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. METHODS Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. RESULT Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. CONCLUSION Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.
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Affiliation(s)
- Marta Benedetti
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Marco De Santis
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Valerio Manno
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Sante Minerba
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Antonella Mincuzzi
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Angela Morabito
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Nicola Panocchia
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Maria Eleonora Soggiu
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | | | - Tiziano Pastore
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Maurizio Bossola
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Roberto Giua
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Simona Leogrande
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | | | - Susanna Conti
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Pietro Comba
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
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Marsili D, Angelini A, Bruno C, Corfiati M, Marinaccio A, Silvestri S, Zona A, Comba P. Asbestos Ban in Italy: A Major Milestone, Not the Final Cut. Int J Environ Res Public Health 2017; 14:E1379. [PMID: 29137208 PMCID: PMC5708018 DOI: 10.3390/ijerph14111379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
Abstract
Background and history: Italy was the main asbestos producer and one of the greatest consumers in 20th century Europe until the asbestos ban was introduced in 1992. Asbestos exposure affected the population in a wide range of working environments, namely mining and marketing of asbestos, asbestos cement production, shipyards and textile industries. This also determined a widespread environmental asbestos exposure affecting the surrounding communities. Methods: To investigate the drivers and difficulties of the process leading to the asbestos ban and its subsequent implementation, we focused on stakeholder involvement, environmental health policies, capacity building and communication. Results: In the past three decades, stakeholder involvement has been instrumental in advancing the industrial asbestos replacement process, prevention and remediation interventions. Furthermore, involvement also contributed to the integration of environmental and health policies at national, regional and local levels, including capacity building and communication. In a global public health perspective, international scientific cooperation has been established with countries using and producing asbestos. Discussion and Conclusions: Key factors and lessons learnt in Italy from both successful and ineffective asbestos policies are described to support the relevant stakeholders in countries still using asbestos contributing to the termination of its use.
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Affiliation(s)
- Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Alessia Angelini
- Institute for Study and Prevention of Cancer, 50139 Florence, Italy.
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensation Authority (INAIL), 00143 Rome, Italy.
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensation Authority (INAIL), 00143 Rome, Italy.
| | - Stefano Silvestri
- Institute for Study and Prevention of Cancer, 50139 Florence, Italy.
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
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Fazzo L, Minichilli F, Santoro M, Ceccarini A, Della Seta M, Bianchi F, Comba P, Martuzzi M. Hazardous waste and health impact: a systematic review of the scientific literature. Environ Health 2017; 16:107. [PMID: 29020961 PMCID: PMC5637250 DOI: 10.1186/s12940-017-0311-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/26/2017] [Indexed: 05/07/2023]
Abstract
Waste is part of the agenda of the European Environment and Health Process and included among the topics of the Sixth Ministerial Conference on Environment and Health. Disposal and management of hazardous waste are worldwide challenges. We performed a systematic review to evaluate the evidence of the health impact of hazardous waste exposure, applying transparent and a priori defined methods. The following five steps, based on pre-defined systematic criteria, were applied. 1. Specify the research question, in terms of "Population-Exposure-Comparators-Outcomes" (PECO). POPULATION people living near hazardous waste sites; Exposure: exposure to hazardous waste; Comparators: all comparators; Outcomes: all diseases/health disorders. 2. Carry out the literature search, in Medline and EMBASE. 3. Select studies for inclusion: original epidemiological studies, published between 1999 and 2015, on populations residentially exposed to hazardous waste. 4. Assess the quality of selected studies, taking into account study design, exposure and outcome assessment, confounding control. 5. Rate the confidence in the body of evidence for each outcome taking into account the reliability of each study, the strength of the association and concordance of results.Fifty-seven papers of epidemiological investigations on the health status of populations living near hazardous waste sites were selected for the evidence evaluation. The association between 95 health outcomes (diseases and disorders) and residential exposure to hazardous waste sites was evaluated. Health effects of residential hazardous waste exposure, previously partially unrecognized, were highlighted. Sufficient evidence was found of association between exposure to oil industry waste that releases high concentrations of hydrogen sulphide and acute symptoms. The evidence of causal relationship with hazardous waste was defined as limited for: liver, bladder, breast and testis cancers, non-Hodgkin lymphoma, asthma, congenital anomalies overall and anomalies of the neural tube, urogenital, connective and musculoskeletal systems, low birth weight and pre-term birth; evidence was defined as inadequate for the other health outcomes. The results, although not conclusive, provide indications that more effective public health policies on hazardous waste management are urgently needed. International, national and local authorities should oppose and eliminate poor, outdated and illegal practices of waste disposal, including illegal transboundary trade, and increase support regulation and its enforcement.
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Affiliation(s)
- L. Fazzo
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - F. Minichilli
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - M. Santoro
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - A. Ceccarini
- Documentation Service, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - M. Della Seta
- Documentation Service, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - F. Bianchi
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - P. Comba
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - M. Martuzzi
- Centre for Environment and Health, World Health Organization - Regional Office for Europe, Platz der Vereinten Nationen 1, D-53113 Bonn, Germany
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Binazzi A, Marinaccio A, Corfiati M, Bruno C, Fazzo L, Pasetto R, Pirastu R, Biggeri A, Catelan D, Comba P, Zona A. Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites. Scand J Work Environ Health 2017; 43:550-559. [PMID: 28985440 DOI: 10.5271/sjweh.3676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.
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Affiliation(s)
- Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene. National Institute for Insurance against Accidents at Work (INAIL), Via Stefano Gradi 55, 00143 Rome, Italy.
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Gianicolo EAL, Bruni A, Mangia C, Cervino M, Portaluri M, Biggeri A, Pirastu R, Comba P, Vigotti MA, Blettner M, of O B. Auswirkungen von einer beruflichen akuten Arsenexposition: eine 39-Jahre Kohortenstudie in Manfredonia (Apulien, Italien). Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- EAL Gianicolo
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Uni Mainz, Mainz
- National Research Council, Istitute of Clinical Physiology, Lecce
| | - A Bruni
- National Research Council, Istitute of Clinical Physiology, Lecce
| | - C Mangia
- National Research Council, Istitute of Atmospheric Sciences and Climate, Lecce
| | - M Cervino
- National Research Council, Istitute of Atmospheric Sciences and Climate, Bologna
| | - M Portaluri
- General Hospital „Perrino“, Radiotherapy Department, Brindisi
| | - A Biggeri
- Epidemiologia e Prevenzione Giulio Maccacaro Social Enterprise, Torino
- University of Florence, Department of Statistics, Computer Science, Applications, Florence
| | | | - P Comba
- Istituto Superiore di Sanità, Dipartimento Ambiente e Salute, Rome
| | - MA Vigotti
- National Research Council, Istitute of Clinical Physiology, Lecce
- University of Pisa, Pisa
| | - M Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Uni Mainz, Mainz
| | - B of O
- „Manfredonia environment and health Committee“, Manfredonia
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Pasetto R, Zengarini N, Caranci N, De Santis M, Minichilli F, Santoro M, Pirastu R, Comba P. [Environmental justice in the epidemiological surveillance system of residents in Italian National Priority Contaminated Sites (SENTIERI Project)]. Epidemiol Prev 2017. [PMID: 28627155 DOI: 10.19191/ep17.2.p134.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES descriptive evaluation of distributional justice in the epidemiological surveillance system of populations residing in Italian National priority Contaminated Sites (NPCSs) of SENTIERI project. Analysis of the feasibility of monitoring different Environmental Justice dimensions in SENTIERI. DESIGN descriptive study and ecological meta-analysis. SETTING AN PARTICIPANTS: residents in 298 municipalities included in 44 NPCSs in SENTIERI. Description of their level of deprivation and mortality analysis by deprivation level in the first period evaluated in SENTIERI, years 1995-2002. MAIN OUTCOME MEASURES an index of multiple deprivation at municipality level DI-SENTIERI, built using 4 indicators based on variables from the Italian 2001 Census, was used to describe deprivation in communities living in NPCSs. The risk of mortality for all causes and all tumors in the pool of NPCSs municipalities by deprivation level was assessed using meta-Standardized Mortality Ratios (meta-SMRs). RESULTS sixty percent of municipalities (No. 179) in NPCSs belong to the two more deprived quintiles. The socioeconomic disadvantage of communities resident in NPCS has a North-South gradient: the proportion of municipalities belonging to the two more deprived quintiles is 29% in the North, 68% in the Centre, 92% in the South. Meta-SMRs for all causes in less deprived municipalities were 98 (90%CI 95-100) in men e 101 (90%CI 97-104) in women, the values for all cancers were 99 (90%CI 94-103) in men and 100 (90%CI 95-105) in women. The corresponding estimates in more deprived municipalities were, respectively in men and women, 103 (90%CI 101- 104) and 102 (90%CI 100-104) for all causes, 104 (90%CI 102-106) and 102 (90%CI 100-104) for all cancers. CONCLUSIONS residents in NPCSs are exposed to environmental stressors and are generally more deprived. The socioeconomic disadvantage is mostly affecting Central and Southern Italy populations. Furthermore, in these deprived communities the risk of mortality for all diseases and all cancers is higher. Populations living in NPCSs are affected by distributional injustice. To monitor the different dimensions of Environmental Justice, the DI-SENTIERI should be developed and other socioeconomic indicators implemented.
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Affiliation(s)
- Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma. .,WHO Collaborating centre for environmental health in contaminated sites, Istituto superiore di sanità, Roma
| | - Nicolás Zengarini
- Struttura complessa a direzione universitaria, Servizio sovrazonale di epidemiologia, ASL TO3 Grugliasco (TO)
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Marco De Santis
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Fabrizio Minichilli
- Unità di epidemiologia ambientale e registri di patologia, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Michele Santoro
- Unità di epidemiologia ambientale e registri di patologia, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Roberta Pirastu
- WHO Collaborating centre for environmental health in contaminated sites, Istituto superiore di sanità, Roma.,Dipartimento di biologia e biotecnologie Charles Darwin, Sapienza Università, Roma
| | - Pietro Comba
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating centre for environmental health in contaminated sites, Istituto superiore di sanità, Roma
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Affiliation(s)
- Pietro Comba
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Ivano Iavarone
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Pirastu
- WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy - Dipartimento di Biologia e Biotecnologie Charles Darwin, Sapienza Università di Roma, Rome, Italy
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Marsili D, Comba P, De Castro P. Environmental health literacy within the Italian Asbestos Project: experience in Italy and Latin American contexts. Commentary. Ann Ist Super Sanita 2017; 51:180-2. [PMID: 26428039 DOI: 10.4415/ann_15_03_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The adoption of multidisciplinary approaches to foster scientific research in public health and strengthen its impact on society is nowadays unavoidable. Environmental health literacy (EHL) may be defined as the ability to search for, understand, evaluate, and use environmental health information to promote the adoption of informed choices, the reduction of health risks, the improvement of quality of life and the protection of the environment. Both public health and environmental health literacy involve access to and dissemination of scientific information (including research findings), individual and collective decision-making and critical thinking. Specific experiences in environmental health literacy have been developed within the Italian National Asbestos Project (Progetto Amianto) in Latin American countries where the use of asbestos is still permitted, and in Italy where a specific effort in EHL has been dedicated to the risks caused by the presence of fluoro-edenite fibers in the town of Biancavilla (Sicily). Taking into account the different geographical and socio-economic contexts, both public health and environmental health literacy were addressed to a wide range of stakeholders, within and outside the health domain.
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Affiliation(s)
- Daniela Marsili
- Servizio Informatico, Documentazione, Biblioteca ed Attività Editoriali, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Paola De Castro
- Servizio Informatico, Documentazione, Biblioteca ed Attività Editoriali, Istituto Superiore di Sanità, Rome, Italy
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Bruno C, Bruni B, Scondotto S, Comba P. Prevention of disease caused by fluoro-edenite fibrous amphibole: the way forward. Ann Ist Super Sanita 2016; 51:90-2. [PMID: 26156176 DOI: 10.4415/ann_15_02_02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few months after the publication of the monographic section of Annali dell'Istituto Superiore di Sanità second issue of 2014 "Health impact of fibres with fluoro-edenitic composition", the carcinogenicity of fluoro-edenite was assessed by the International Agency for Research on Cancer (IARC) in the frame of Monograph 111. The IARC Working Group concluded that there is sufficient evidence in humans that exposure to fluoro-edenite fibrous amphibole causes mesothelioma, and sufficient evidence of carcinogenicity in experimental animals. Fluoro-edenite was allocated to Group 1 (the agent is carcinogenic to humans). Now, in view of the recent IARC evaluation, preventive action in Biancavilla requires an upgrade. First of all, environmental monitoring has to be further implemented. All operations of house cleaning should be performed employing wet tools, in order to avoid dust-raising. It is very important that environmental and biological monitoring be related to epidemiological surveillance. The recently approved act of the Sicilian Government concerning a plan of health interventions in Biancavilla will favour cooperation between national, regional and local health institutions with the common goal of improving the quality and appropriateness of diagnostic and therapeutics procedures offered by the health services.
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Affiliation(s)
- Caterina Bruno
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Biagio Bruni
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Salvatore Scondotto
- Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, Assessorato alla Sanità Regione Siciliana 
| | - Pietro Comba
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
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Pirastu R, Ranucci A, Consonni D, De Santis M, Bruno C, Conti S, Fazzo L, Iavarone I, Pasetto R, Zona A, Magnani C, Comba P. [Reference rates for cohort studies in Italy: an essential tool in occupational and residential cohort studies]. Med Lav 2016; 107:473-477. [PMID: 27976665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
The cohort study aims to test the hypothesis of an association between specific exposure/s and adverse health outcomes. The cohorts include the subjects who experience the exposure/s and are followed up over time to ascertain the health outcomes. This contribution presents the database for the analysis of mortality studies which is made available for public institutions carrying out cohort studies in Italy. The rates were computed from official mortality data from ISTAT. The database contains 141 causes or groups of causes for the years 1970-2012 ensuring correspondence with subsequent editions of ICD (International Classification of Diseases) VIII, IX and X.
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Fazzo L, Menegozzo S, Soggiu ME, De Santis M, Santoro M, Cozza V, Brangi A, Menegozzo M, Comba P. Mesothelioma incidence in the neighbourhood of an asbestos-cement plant located in a national priority contaminated site. Ann Ist Super Sanita 2016; 50:322-7. [PMID: 25522071 DOI: 10.4415/ann_14_04_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND An epidemic of asbestos-related disease is ongoing in most industrialized countries, mainly attributable to past occupational exposure but partly due to environmental exposure. In this perspective, the incidence of pleural mesothelioma close to a former asbestos-cement plant in a national contaminated site was estimated. METHODS The census-tracts interested by atmospheric dispersion of facilities in the contaminated site were identified. Two subareas with different estimated environmental asbestos impact were distinguished. An ecological study at micro-geographic level was performed. The standardized incidence ratios (SIR) for study area and the two subareas, in comparison with region and municipality were computed. The standardized incidence rate ratio (IRR) between the two subareas was computed. RESULTS Mesothelioma incidence in the study area was increased: 46 cases were observed with respect to 22.23 expected (SIR: 2.02). The increase was confirmed in analysis considering only the subjects without an occupationally exposure to asbestos: 19 cases among men (SIR = 2.48; 95% CI: 1.49-3.88); 11 case among women (SIR = 1.34; 95% CI: 0.67-2.40). The IRR between the two subareas is less than one in overall population considering all age-classes and of 3 fold (IRR = 3.14, 95% CI: 0.65-9.17) in the age-classes below 55 years. CONCLUSIONS The findings indicate an increased incidence of pleural mesothelioma in the neighbourhood of asbestos-cement plant, and a possible etiological contribution of asbestos environmental exposure in detected risks.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy.E-mail:
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De Castro P, Pasetto R, Marsili D, Comba P. Fostering public health awareness on risks in contaminated sites. Capacity building and dissemination of scientific evidence. Ann Ist Super Sanita 2016; 52:511-515. [PMID: 27999221 DOI: 10.4415/ann_16_04_09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The article focuses on the multidisciplinary nature of public health and the need to develop target oriented capacity building and dissemination plans taking into account both scientific evidence and the information needs of the different stakeholders. In particular, issues regarding stakeholders' involvement in epidemiological studies in contaminated sites, considering their different levels of awareness on risk characterization and management, are discussed. In a public health perspective, the main stakeholders in contaminated sites are researchers and public health officers, risk managers and policy makers, population residing in the contaminated areas, environmental associations, patient's organizations. The different components of a dissemination strategy addressed to different stakeholders are analyzed with the objective to create awareness and preparedness to facilitate management in contaminated sites, foster scientific knowledge and informed decisions to consolidate risk perception through science-driven information.
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Affiliation(s)
- Paola De Castro
- Settore Attività Editoriali, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Pasetto
- Dipartimento Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
| | - Daniela Marsili
- Dipartimento Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome, Italy
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Zona A, Fazzo L, Binazzi A, Bruno C, Corfiati M, Comba P, Conti S, Menegozzo S, Nicita C, Pasetto R, Pirastu R, Marinaccio A. [SENTIERI-ReNaM: Discussion and concluding remarks]. Epidemiol Prev 2016; 40:105-108. [PMID: 27825200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
SENTIERI-ReNaM Project analysed the incidence of malignant mesothelioma (MM) for the period 2000-2011 in 39 National Priority Contaminated Sites (NPCSs), and assessed the overall impact of mesothelioma in different types of NPCSs. In the study period, 2,683 incident cases of malignant mesothelioma were recorded: 1,998 males (74.5%), 685 females (25.5%). Excluding cases with non attributable exposure and those non interviewed, exposure was identified in 1,926 cases (70% of all cases): 1,541 males (occupational exposure: 1,414; environmental exposure: 82), 385 females (occupational exposure: 103; environmental exposure: 141). Women experienced mainly environmental and domestic exposures to asbestos. Standard Incidence Ratio (SIR) excesses were observed in men in 27 out of 39 NPCSs and defects in the remaining 12; in women, 20 NPCSs showed SIR excesses, defects in 15; in 4 NPCSs no MM cases occurred among female population. The highest rates were found in NPCSs with asbestos-cement plants (Broni and Casale Monferrato), respectively, 98 per 100,000 per year and 68.6 in men, 72.1 and 45.8 in women. Excluding these two sites, the highest incidence rates were found in the group with harbours and shipyards, where the rates were, respectively, 13.2 among men and 2.5 among women. The results of this report will be communicated to national and local institutions, as well as to NPCSs resident populations.
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Affiliation(s)
- Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Susanna Conti
- Ufficio di statistica, CNESPS, Istituto superiore di sanità, Roma
| | - Simona Menegozzo
- Istituto nazionale tumori, IRCCS "Fondazione G. Pascale", Napoli
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Comba P, Zona A, Pirastu R, Bruno C, Fazzo L, Pasetto R, Binazzi A, Corfiati M, Marinaccio A. [SENTIERI-ReNaM: Rationale and objectives]. Epidemiol Prev 2016; 40:13-15. [PMID: 27825196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of the SENTIERI-ReNaM Project is to analyse the incidence of mesothelioma in Italian National Priority Contaminated Sites (NPCSs) in order to estimate the health impact of asbestos on resident populations, disentangling the role of occupational and environmental exposures. SENTIERI Project has provided the relevant information on geographic and demographic structure of NPCSs and on existing sources of contamination. The Italian National Mesothelioma Registry (ReNaM), that covers the whole country through its Regional Operational Centres (CORs), has made available the procedures for estimating the incidence of mesothelioma in NPCSs and for assessing occupational and environmental asbestos exposure of the individual cases. The synergy between these two epidemiological surveillance systems lay also the ground for communication programmes with the affected communities.
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Affiliation(s)
- Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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