Investigation of organic impurity and its occurrence in industrial waste salt produced by physicochemical process

Industrial waste salt is classified as hazardous waste to the environment. The organic impurity and its occurrence in industrial waste salt affect the salt resource utilization. In this paper, composition quantitative analysis, XRD, TG-DSC, SEM/FIB-SEM coupled with EDS, FTIR, XPS and GC-Ms were chosen to investigate the organic impurity and its occurrence in industrial waste salt. The organic impurities owe small proportion (1.77%) in the specimen and exhibit weak thermal stability within the temperature of 600°C. A clear definition of organic impurity, including 11 kinds of organic compounds, including aldehyde, benzene and its derivatives etc., were detected in the industrial waste salt. These organic impurities, owing (C-O/C-O-C, C-OH/C = O, C–C/CH_x/C = C etc.)-containing function group substance, are mainly distributed both on the surface and inside of the salt particles. Meanwhile, the organic substance may combine with metal cations (Ni²⁺, Mg²⁺, Cu²⁺ etc.) through functional groups, such as hydroxide, carbonyl etc., which increases its stability in the industrial waste salt. These findings provide comprehensive information for the resource utilization of industrial waste salt from chemical industry etc.

The release of contaminants from steel slags and natural aggregates: Evaluation of toxicity and genotoxicity

Steel slags (SS) are the major waste produced by iron and steel industry. Slags may be reused as recycled materials, instead of natural aggregates (NA), to reduce the final disposal in a landfill and the exploitation of raw materials. However, the reuse of SS may generate a potential release of toxic compounds for the environment and humans. The purpose of this study was to evaluate the toxicity and genotoxicity of SS, in comparison with NA, by using an integrated chemical-biological approach to enable their safe reuse in engineering applications. Leaching solutions from samples were obtained by using short-term leaching tests (CEN EN 12457-2, 2004) usually adopted for the evaluation of waste recovery and final disposal. Chemical analyses of leachates were performed according to the Italian legislation on waste recovery (Ministerial Decree 186/2006). The leaching solutions were assayed by using toxicity test on Daphnia magna. Moreover, mutagenicity/genotoxicity tests on Salmonella typhimurium, Allium cepa, and human leucocytes and fibroblasts were carried out. The releases of pollutants from all samples were within the limits of the Italian legislation for waste recovery. Despite the effects that SS and NA could have on different cells, in terms of toxicity and genotoxicity, globally, SS do not seem to be any more hazardous than NA. This ecotoxicological assessment, never studied before, is important for promoting further studies that may support the decision-making process regarding the use of such types of materials.

Adverse health effects for populations living near waste incinerators with special attention to hazardous waste incinerators. A review of the scientific literature

Incinerators of municipal, hazardous and medical wastes are sources of emissions of toxic pollutants, being polychlorinated dibenzo-p-dioxins and dibenzofurans, as well as a number of heavy metals of special concern. Moreover, waste incineration also generates ashes that must be properly disposed. In all countries, waste management is currently being an issue of tremendous importance. While the treatment and disposal of municipal solid waste (MSW) is a problem in the entire world, in industrialized countries, the management of hazardous waste (HW) is an additional issue of important concern. While the available scientific information on the environmental impact and the health risks of MSWIs is quite considerable, that related with the potential adverse health effects for the populations living near HWIs is much more reduced. In this paper, we have reviewed the information on health effects-including the incidence of cancer and cancer mortality-for the people residing in the vicinity of HWIs. For a better understanding of the problem, some studies on cancer and other adverse health effects near MSWIs have been also reviewed. Special attention has been paid to the HWI of Constantí (Catalonia, Spain) on which the most complete information among all HWIs in the entire world is available. In our conclusions, a series of important issues/questions are raised: is really safe the limit value of 0.1 ng TEQ/Nm³ for PCDD/Fs to protect human health? Where are the evidences on this? On the other hand, to date, risk assessment studies have been only focused on certain substances; heavy metals and PCDD/Fs. Studies have not included those chemicals that are not routinely analyzed, being even some of them probably unknown right now. Moreover, what about potential interactions among chemicals in order to estimate the carcinogenic and non-carcinogenic risks for the population living near incinerators? Complete epidemiological studies are clearly necessary.

Environmental Justice: the Economics of Race, Place, and Pollution

The grassroots movement that placed environmental justice issues on the national stage around 1980 was soon followed up by research documenting the correlation between pollution and race and poverty. This work has established inequitable exposure to nuisances as a stylized fact of social science. In this paper, we review the environmental justice literature, especially where it intersects with work by economists. First we consider the literature documenting evidence of disproportionate exposure. We particularly consider the implications of modeling choices about spatial relationships between polluters and residents, and about conditioning variables. Next, we evaluate the theory and evidence for four possible mechanisms that may lie behind the patterns seen: disproportionate siting on the firm side, “coming to the nuisance” on the household side, market-like coordination of the two, and discriminatory politics and/or enforcement. We argue that further research is needed to understand how much weight to give each mechanism. Finally, we discuss some policy options.

A new strategy to control the proliferation of microorganisms in solid hospital waste and the diffusion of nosocomial infections

A possible tool to reduce nosocomial infections is to identify unknown sources of contamination and then to provide a measure for controlling the related infections. In this study, solid hospital waste was considered a potential source of contamination, and a strategy to reduce the potential risk of pathogen contamination was tested. This paper describes a novel technique for waste management in healthcare settings with a view to facilitating infection prevention and control. We explored the innovative use of sodium dichloroisocyanurate (NaDCC) by investigating the microbicidal activity of chlorine, which derives from the hydrolysis of NaDCC mediated by humidity, and by testing its effect on the inhibition of microorganism growth. NaDCC was inserted in a solid hospital waste bin containing also Lauria-Bertani agar plates, with different dilutions of a known titre of three different microorganisms, namely Escherichia coli, Staphylococcus aureus and Aspergillus brasiliensis. The plates were incubated in the container with or without the antimicrobial agent (control, CNT) at room temperature for 5 days. The number of colony-forming units (CFUs) present on each plate was then counted. Microorganisms capable of proliferating in the CNT waste bin were not able to grow in the presence of NaDCC. Furthermore, the molecular chlorine which developed and was released in the waste bin under the experimental conditions (T=20°C, t=5 days) was quantified using iodometric titration. NaDCC hydrolysis, mediated by humidity, has a strong and long-lasting microbicide effect. The proliferation of tested bacteria and fungi is totally inhibited. These results demonstrate the effectiveness of NaDCC in controlling and/or inhibiting microbial proliferation and support its possible use in the treatment of hospital waste to control the spread of nosocomial contamination.

The exposure to water with cigarette residue changes the anti-predator response in female Swiss albino mice

Recent studies have shown that cigarette consumption affects much more than human health. Smoked cigarette butt (SCB) disposal into the environment can bring little-known negative biological consequences to mammals, since it contains many organic and inorganic toxic chemical constituents. Thus, we aim at assessing whether the ingestion of water with leached SCB for 60 days by female Swiss mice changes their defensive behavioral response to potential predators (cats and snakes). We worked with the following groups of animals: control (pollutant-free water), water with environmental concentration of SCB (1.9 μg/L of nicotine), and concentration 1000 times higher (EC1000×). Our data show that the treatments did not cause locomotor, visual, auditory, and olfactory deficit in the animals. However, we observed that the animals exposed to the pollutants did not present behavioral differences in the test session with or without the snake. On the other hand, animals in all groups showed defensive behavior when the test was conducted with the cat in the apparatus. However, female mice presented weaker response than the control. Thus, our data point towards the potential neurotoxic damage caused to mice who have ingested water with SCB residues, even at low concentrations.

Hazardous waste and health impact: a systematic review of the scientific literature

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.

Assessing the impact of hazardous waste on children's health: The exposome paradigm

Assessment of the health impacts related to hazardous waste is a major scientific challenge with multiple societal implications. Most studies related to associations between hazardous waste and public health do not provide established of mechanistic links between environmental exposure and disease burden, resulting in ineffective waste management options. The exposome concept comes to overhaul the nature vs. nurture paradigm and embraces a world of dynamic interactions between environmental exposures, endogenous exposures and genetic expression in humans. In this context, the exposome paradigm provides a novel tool for holistic hazardous waste management. Waste streams and the related contamination of environmental media are not viewed in isolation, but rather as components of the expotype, the vector of exposures an individual is exposed to over time. Thus, a multi-route and multi-pathway exposure estimation can be performed setting a realistic basis for integrated health risk assessment. Waste management practices are thus assessed not only regarding their technological edge and efficacy but also their effects on human health at the individual and community level, considering intra-subject variability in the affected population. The effectiveness of the exposome approach is demonstrated in the case of Athens, the capital of Greece, where the health effects associated to long term and short term exposure to two major waste management facilities (landfill and plastic recycling) are presented. Using the exposome analysis tools, we confirmed that proximity to a landfill is critical for children neurodevelopment. However, this effect is significantly modified by parameters such as parental education level, socioeconomic status and nutrition. Proximity to a plastics recycling plant does not pose significant threats under normal operating conditions; yet, in the case of an accidental fire, release of persistent carcinogenic compounds (dioxins and furans) even for a short period results in increased lifelong risk, especially for breast feeding neonates.

PCDD/F contamination on surface soil in the vicinity of a hazardous waste incinerator: is it possible a different trend?

This study is the first to investigate the contamination of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) on surface soils in the vicinity of the first hazardous waste incinerator of Turkey. In the study, 24 soil samples were taken from a 1625-m-radius circle whose center is the stack of the incinerator. This process was repeated 1 year later. Since the acquired average PCDD/F concentrations of the two sampling campaigns (0.05 and 0.02 ng WHO-toxic equivalent (TEQ)/kg) were meaningfully low compared to the related literatures, a new sampling campaign was carried out to control this inconsistency, but this time in a foreign laboratory (0.56 ng WHO-TEQ/kg). In the same period, eight gas samples were taken from the stack under different operational conditions of the facility. According to the evaluations of the findings, the geographical-meteorological data of the study area and the specific operational conditions of the facility corroborate the concentrations of the first and the second soil samplings rather than the third one. The major underlying reason for the inconsistency of the soil concentrations may be the fact that the data analysis procedures used by the laboratories are different. The author suggests a hypothesis which argues that the soils in the vicinity of a hazardous waste incinerator may have significantly lower concentration levels than in related literatures.

Human exposure to environmental pollutants after a tire landfill fire in Spain: Health risks

In May 2016, a fire occurred in one of the largest landfills in Europe (Seseña, Toledo, Spain), where 70,000-90,000tons of tires had been illegally accumulated for >15years. Because of the proximity of population nuclei and the duration of the episode (>20days), we conducted a preliminary human health risk assessment study just after the tire fire. Samples of air and soil were collected in 3 areas surrounding the landfill (El Quiñón, at only 500m, and Seseña Nuevo and Seseña Viejo, both at 4km), as well as in background sites. In addition, samples of crops (barley, wheat, cabbage and lettuce) were also obtained from local farmers. The concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs) and a number of trace elements (As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Sb, Sn, Tl, and V) were analyzed in all the samples. The concentrations of all the target pollutants, excepting PAHs, were relatively similar at the different sampling zones, irrespective of the distance to the landfill. In turn, a significant increase of PAHs was noted near the tire landfill, with air levels up to 6-times higher than those found at 4km (134 vs. 19.5-22.7ng/m³). Similarly, PAH concentrations in lettuce were relatively higher than those typically found in monitoring programs of food safety. Because of the increase of airborne PAHs, cancer risks due to exposure to environmental pollutants for the population living at El Quiñón, near the landfill, were between 3- and 5-times higher than those estimated for the inhabitants of Seseña. After this preliminary study, further investigations, focused only on PAHs, but more extensive in terms of number of samples, should be conducted to assure that PAHs have been progressively degraded through time.

Medical Waste Disposal Method Selection Based on a Hierarchical Decision Model with Intuitionistic Fuzzy Relations

Although medical waste usually accounts for a small fraction of urban municipal waste, its proper disposal has been a challenging issue as it often contains infectious, radioactive, or hazardous waste. This article proposes a two-level hierarchical multicriteria decision model to address medical waste disposal method selection (MWDMS), where disposal methods are assessed against different criteria as intuitionistic fuzzy preference relations and criteria weights are furnished as real values. This paper first introduces new operations for a special class of intuitionistic fuzzy values, whose membership and non-membership information is cross ratio based ]0, 1[-values. New score and accuracy functions are defined in order to develop a comparison approach for ]0, 1[-valued intuitionistic fuzzy numbers. A weighted geometric operator is then put forward to aggregate a collection of ]0, 1[-valued intuitionistic fuzzy values. Similar to Saaty’s 1–9 scale, this paper proposes a cross-ratio-based bipolar 0.1–0.9 scale to characterize pairwise comparison results. Subsequently, a two-level hierarchical structure is formulated to handle multicriteria decision problems with intuitionistic preference relations. Finally, the proposed decision framework is applied to MWDMS to illustrate its feasibility and effectiveness.

COSMOS-rice technology abrogates the biotoxic effects of municipal solid waste incinerator residues

Fly ashes generated by municipal solid waste incinerator (MSWI) are classified as hazardous waste and usually landfilled. For the sustainable reuse of these materials is necessary to reduce the resulting impact on human health and environment. The COSMOS-rice technology has been recently proposed for the treatment of fly ashes mixed with rice husk ash, to obtain a low-cost composite material with significant performances. Here, aquatic biotoxicity assays, including daphnidae and zebrafish embryo-based tests, were used to assess the biosafety efficacy of this technology. Exposure to lixiviated MSWI fly ash caused dose-dependent biotoxic effects on daphnidae and zebrafish embryos with alterations of embryonic development, teratogenous defects and apoptotic events. On the contrary, no biotoxic effects were observed in daphnidae and zebrafish embryos exposed to lixiviated COSMOS-rice material. Accordingly, whole-mount in situ hybridization analysis of the expression of various tissue-specific genes in zebrafish embryos provided genetic evidence about the ability of COSMOS-rice stabilization process to minimize the biotoxic effects of MSWI fly ash. These results demonstrate at the biological level that the newly developed COSMOS-rice technology is an efficient and cost-effective method to process MSWI fly ash, producing a biologically safe and reusable material.

Combustion of hazardous biological waste derived from the fermentation of antibiotics using TG-FTIR and Py-GC/MS techniques

The combustion characteristics for three kinds of antibiotics residue (AR) materials were investigated by TG-FTIR and Py-GC/MS technique. The TG results indicated that AR combustion involved three stages, and correlation between the H/C atomic ratio of the raw materials and peak temperature of weight loss for the second stage was obtained. The FTIR spectra identified evolving gaseous products as CO2, CH4, HCNO, NH3, HCN, and NO. An AR material with a low H/C ratio promoted the formation of CO2 and HCN, but suppressed the yields of NH3 and CH4. The Py-GC/MS results suggested that abundant volatiles can be produced, including alkenes, benzene, phenols, furans, acid, and heterocyclic-N, nitrile-N and amine-N compounds, and confirmed the FTIR absorption characteristics in the low temperature range. A possible pathway for the AR combustion was also tentatively presented.

Assessment of the distribution, sources and potential ecological risk of heavy metals in the dry surface sediment of Aibi Lake in northwest China

The distribution, sources and potential ecological risk of heavy metals in the sediment of lakes in eastern China and other areas of the world that have undergone rapid economic development have been widely researched by scholars. However, this is not true for heavy metals in the sediment of rump lakes in the arid regions of China and world-wide. Because of this, we chose Aibi Lake to serve as a typical rump lake in an oasis in an arid area in northwest China for our study. Sediment samples were collected from the lake and then the quantities of the heavy metals Pb, Ni, Cd, Cu, Zn, Hg and Cr were measured. Then using a variety of statistical methods, we analyzed the distribution, sources, pollution status and the potential ecological risk of these metals. The results show that: (1) The amounts of the seven heavy metals all fell within the Second Soil National Standard, but the average and maximum values were all higher than the background values of Xinjiang in northwest China. (2) Multivariate statistical analysis determined that the Cd, Pb, Hg and Zn in the sediment were mainly derived from man-sources, and Cu, Ni, and Cr were mainly from the natural geological background. (3) Enrichment factor analysis and the geo-accumulation index evaluation method show that Cd, Hg and Pb in the surface sediment of the Aibi Lake were at low and partial pollution levels, while Zn, Cr, Ni and Cu were at no and low pollution levels. (4) Calculation of the potential ecological hazards index found that, among the seven tested heavy metals, Cd, Hg and Pb were the main potential ecological risk factors, and the contribution of each was 42.6%, 28.6%, and 24.0%, respectively. Cd is the main potential ecological risk factor, followed by Hg and Pb. This work revealed that recent economic development of the Aibi Lake Basin has negatively influenced the accumulation of heavy metals in the sediments of the lake, and, therefore, we should pay increasing attention to this problem and take effective measures to protect the ecology of the Aibi Lake Basin. This work can provide a scientific basis for an early warning of heavy metal pollution and for protection of the environment. Furthermore, it can serve as a reference when creating policies for the economic development in Aibi Lake Basin and environmental protection of rump lakes in arid regions of northwest China and other areas of the world.

Environmental pollution from illegal waste disposal and health effects: a review on the "triangle of death"

The term “triangle of death” was used for the first time by Senior and Mazza in the journal The Lancet Oncology referring to the eastern area of the Campania Region (Southern Italy) which has one of the worst records of illegal waste dumping practices. In the past decades, many studies have focused on the potential of illegal waste disposal to cause adverse effects on human health in this area. The great heterogeneity in the findings, and the bias in media communication has generated great healthcare doubts, anxieties and alarm. This paper addresses a review of the up-to-date literature on the “triangle of death”, bringing together the available information on the occurrence and severity of health effects related to illegal waste disposal. The Scopus database was searched using the search terms “waste”, “Campania”, “Naples”, “triangle of death” and “human biomonitoring”. Despite the methodological and sampling heterogeneity between the studies, this review examines the evidence from published data concerning cancer incidence, childhood mortality and birth defects, so that the current situation, knowledge gaps and research priorities can be established. The review aims to provide a contribution to the scientific community, and to respond to the concerns of the general population.

Incidence of soft tissue sarcomas in an Italian area affected by illegal waste dumping sites

The aim of the present study was to investigate the possible association between occurrence of soft tissue sarcomas (STS) and residence in an Italian area affected by illegal practices of dumping and setting fire to both hazardous and solid urban wastes. Standardized incidence ratios (SIRs) were computed separately for STS and some specific STS subtypes. The analysis was performed for the total population and for specific age groups, namely, children, adolescents, and adults. In adults, no significant increase in STS was found other than for gastrointestinal stromal tumors in males. A nonsignificant increase in incidence of STS was observed for male children and female adolescents. The results of the present study do not allow conclusions for a causal association. In the absence of previous epidemiological studies on this issue, further investigations are needed.

Hazard property classification of waste according to the recent propositions of the EC using different methods

Hazard classification of waste is a necessity, but the hazard properties (named "H" and soon "HP") are still not all defined in a practical and operational manner at EU level. Following discussion of subsequent draft proposals from the Commission there is still no final decision. Methods to implement the proposals have recently been proposed: tests methods for physical risks, test batteries for aquatic and terrestrial ecotoxicity, an analytical package for exhaustive determination of organic substances and mineral elements, surrogate methods for the speciation of mineral elements in mineral substances in waste, and calculation methods for human toxicity and ecotoxicity with M factors. In this paper the different proposed methods have been applied to a large assortment of solid and liquid wastes (>100). Data for 45 wastes - documented with extensive chemical analysis and flammability test - were assessed in terms of the different HP criteria and results were compared to LoW for lack of an independent classification. For most waste streams the classification matches with the designation provided in the LoW. This indicates that the criteria used by LoW are similar to the HP limit values. This data set showed HP 14 'Ecotoxic chronic' is the most discriminating HP. All wastes classified as acute ecotoxic are also chronic ecotoxic and the assessment of acute ecotoxicity separately is therefore not needed. The high number of HP 14 classified wastes is due to the very low limit values when stringent M factors are applied to total concentrations (worst case method). With M factor set to 1 the classification method is not sufficiently discriminating between hazardous and non-hazardous materials. The second most frequent hazard is HP 7 'Carcinogenic'. The third most frequent hazard is HP 10 'Toxic for reproduction' and the fourth most frequent hazard is HP 4 "Irritant - skin irritation and eye damage". In a stepwise approach, it seems relevant to assess HP 14 first, then, if the waste is not classified as hazardous, to assess subsequently HP 7, HP 10 and HP 4, and then if still not classified as hazardous, to assess the remaining properties. The elements triggering the HP 14 classification in order of importance are Zn, Cu, Pb, Cr, Cd and Hg. Progress in the speciation of Zn and Cu is essential for HP 14. Organics were quantified by the proposed method (AFNOR XP X30-489) and need no speciation. Organics can contribute significantly to intrinsic toxicity in many waste materials, but they are only of minor importance for the assessment of HP 14 as the metal concentrations are the main HP 14 classifiers. Organic compounds are however responsible for other toxicological characteristics (hormone disturbance, genotoxicity, reprotoxicity…) and shall be taken into account when the waste is not HP 14 classified.

Human exposure to metals: levels in autopsy tissues of individuals living near a hazardous waste incinerator

The concentrations of a number of metals were determined in the brain, bone, kidney, liver, and lung of 20 autopsied subjects who had lived, at least 10 years, in the neighborhood of a hazardous waste incinerator (HWI) in Tarragona (Catalonia, Spain). Results were compared with those obtained in 1998 (baseline survey) and previous surveys (2003 and 2007). Arsenic, Be, Ni, Tl, and V showed concentrations below the corresponding detection limits in all tissues. Cadmium showed the highest levels in the kidney, with a mean value of 21.15 μg/g. However, Cd was found below the detection limit in the brain and bone. Chromium showed similar concentrations in the kidney, brain, and lung (range of mean values, 0.57-0.66 μg/g) and higher in the bone (1.38 μg/g). In turn, Hg was below the detection limit in all tissues with the exception of the kidney, where the mean concentration was 0.15 μg/g (range, <0.05-0.58 μg/g). On the other hand, Mn could be detected in all tissues showing the highest levels in the liver and kidney (1.45 and 1.09 μg/g, respectively). Moreover, Pb showed the highest concentrations in bone (mean, 1.39 μg/g; range, <0.025-4.88 μg/g). Finally, Sn could be detected only in some tissue samples, reaching the highest values in the bone (0.17 μg/g). The current metal levels in human tissues from individuals living near the HWI of Tarragona are comparable and of a similar magnitude to previously reported results corresponding to general populations, as well as those of our previous surveys.

[SENTIERI Project: rationale and objectives]

The Istituto Superiore di Sanità (National Institute of Health-ISS), in partnership with a network of Italian national and regional scientific institutions, initiated the SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites-NPCSs), the objectives, methods and initial results of which were published by Epidemiologia & Prevenzione in 2010 and 2011. In the course of 2013, some of the SENTIERI Project findings were published in international scientific journals, and the "SENTIERI approach" was among those sanctioned by the World Health Organization to conduct an initial description of the health status of residents of contaminated sites. The present Report, set up jointly by ISS and the Italian Network of Cancer Registries (AIRTUM), as anticipated in the 2011 Report, aims to provide, for each of the 18 National Priority Contaminated Sites included in the SENTIERI Project where the Italian Association of Cancer Registries is active, a mortality update to 2010, analyses of cancer incidence (1996-2005 in 17 NPCSs) and of hospital discharges (2005-2010), as is explained in detail in Chapter 2, pertaining to the project's materials and methods. The results of the analyses for each NPCS are presented in Chapter 3, while Chapter 4 includes a critical appraisal, a discussion of the methodological approach and a series of concluding remarks. The second section of the Report takes an in-depth look at important issues of public health and scientific research in contaminated sites. This Report represents an important step towards implementing a permanent epidemiological surveillance system in Italy's contaminated sites, the ultimate goal of the SENTIERI Project.

[SENTIERI Project: materials and methods]

The Report considers three health outcomes - mortality, cancer incidence and hospital discharges - studied using homogenous methods and using data from official sources, namely the National Institute of Statistics (Istat), Italian Network of Cancer Registries (AIRTUM) and the Health Ministry. The timeframes of observation are: 2003-2010 for mortality, 1996-2005 for cancer incidence and 2005-2010 for hospital discharges. The causes of death are those examined by the SENTIERI Project. Hospital discharges are analysed with reference to the main diagnosis. The study of cancer incidence applies to the sites selected by AIRTUM. Statistical parameters (SMR, Standardized Mortality Ratio; SIR, Standardized Incidence Ratio; SHR, Standardized Hospitalization Ratio) were computed with a 90% confidence interval; the estimators were adjusted for age and socioeconomic status.

Environmental and occupational exposure to chemicals and telomere length in human studies

Telomeres are complexes of tandem repeats of DNA (5'-TTAGGG-3') and protein that cap eukaryotic chromosomes and play a critical role in chromosome stability. Telomeres shorten with aging and this process can be accelerated by increased oxidative stress and episodes of inflammation. Evidence is rapidly growing that telomere length (TL) may be affected by environmental chemicals that have frequently been associated with chronic diseases. In this article, we review the published data on TL in relation to environmental and occupational exposure to several chemicals based on our own and others' studies. The environmental and occupational exposures associated with shorter TL include traffic-related air pollution (ie, particulate matter (PM), black carbon (BC), and benzene and toluene), polycyclic aromatic hydrocarbons (PAHs), N-nitrosamines, pesticides, lead, exposure in car mechanical workshops, and hazardous waste exposure. Arsenic, persistent organic pollutants (POPs) and short-term exposure to PM are associated with longer TL. We discuss the possible reasons for the differences in results, including time- and dose-related issues, study design, and possible mechanisms involved in telomere regulation. We also discuss the future directions and challenges for TL-related environmental and occupational health research, such as investigation of TL in subpopulations of blood leukocytes, and the study of genetic and epigenetic factors that may regulate telomere integrity using longitudinal designs.

Contaminated land: can acute exposure be a significant health risk? Two case studies and associated risk assessment methods

Contaminated land risk assessments generally focus on the chronic health risks, arising from long-term, low-level exposure to the contaminants, and a number of risk assessment tools are in routine use. Situations where significant acute risks might be present are not commonly encountered, and methods for risk assessment are less well established. We present two recent case studies from the northwest of England, the first an area of public open space, and the second an occupied school site, with the associated risk assessments.

Characterization and environmental risk assessment of heavy metals found in fly ashes from waste filter bags obtained from a Chinese steel plant

The environmental risk of exposure to six heavy metals (Cu, Pb, Zn, Cr, Ni, and Cd) found in fly ashes from waste filter bags obtained from a steel plant was estimated based on the mineralogical compositions, total concentrations and speciation of the metals in the fly ashes. The results indicated that the fly ashes mainly consisted of hematite, magnetite, cyanite, spinel, coesite and amorphous materials. The concentrations of Zn and Pb were much higher than that of other materials. After Zn and Pb, Ni was present in the highest concentration, followed by Cu, Cr and Cd. Each heavy metal was distributed differently in fly ashes. The levels of Zn, Cd and Pb in the active fraction were very high, and ranged from 64.83 to 81.96%, 34.48 to 82.4% and 6.92 to 79.65% respectively, while Cu, Cr and Ni were mainly present in the residual fraction. The risk assessment code (RAC) values of fly ashes showed that the Zn and Cd present in the H3 sample presented a very high risk, with RAC values greater than 50%. The Cu present in the H3 sample, Cd in the H2 sample and Zn in the H4 and H5 samples presented a high risk. The Pb present in the H2 sample, Cd in the H4 sample, Ni in the H1 and H5 samples, and Zn in the H1 sample presented a medium risk. A low risk was presented by the Cu present in the H1, H2, H4 and H5 samples, the Pb in the H1, H3 and H5 samples, the Cd in the H1 and H5 samples, and the Ni in the H2 sample. No risk was presented by Cr in any sample.

Adverse birth outcomes in the vicinity of industrial installations in Spain 2004-2008

Industrial activity is one of the main sources of ambient pollution in developed countries. However, research analyzing its effect on birth outcomes is inconclusive. We analyzed the association between proximity of mother's municipality of residence to industries from 24 different activity groups and risk of very (VPTB) and moderate (MPTB) preterm birth, very (VLBW) and moderate (MLBW) low birth weight, and small for gestational age (SGA) in Spain, 2004-2008. An ecological study was defined, and a "near vs. far" analysis (3.5 km threshold) was carried out using Hierarchical Bayesian models implemented via Integrated Nested Laplace Approximation. VPTB risk was higher for mothers living near pharmaceutical companies. Proximity to galvanization and hazardous waste management industries increased the risk of MPTB. Risk of VLBW was higher for mothers residing near pharmaceutical and non-hazardous or animal waste management industries. For MLBW many associations were found, being notable the proximity to mining, biocides and animal waste management plants. The strongest association for SGA was found with proximity to management animal waste plants. These results highlight the importance of further research on the relationship between proximity to industrial sites and the occurrence of adverse birth outcomes especially for the case of pharmaceutical and animal waste management activities.

[Actual problems of the impact of production and management of industrial waste on the environment and public health (review of literature)]

In the modern society the importance and applicability of the problem concerning the negative effect of production and consumption waste on the objects of the environment and the state sa people's health is related to their daily emergency, large tonnage, storage, and utilization. Wastes and places of their storage and waste burial constitute an toxicological and epidemiological risk. Chemical and biological contamination of solid waste is a threat to its penetration into the soil, air, groundwater and surface water bodies, vegetation, directly or indirectly, cause variations in health status of the population.

The Forum of the International HCH and Pesticides Association--a platform for international cooperation

The unsustainable life cycle management of pesticides in the last 60 years has created large pesticide stockpiles. The two major working areas of the International HCH and Pesticide Association (IHPA; www.ihpa.info ) address a part of these legacies and are shortly introduced here: (1) The assessment and support of the management of the worlds single largest POPs stockpile: the globally dumped 4 to 7 million tonnes hexachlorocyclohexane (HCH) wastes from lindane production, and (2) the support for the management of the obsolete pesticides legacy in Eastern Europe, the Caucasus and Central Asia (EECCA) countries of ~240,000 t, leaving these pesticides in unregulated storages without adequate safety control being a huge risk to the environment and human health. The integrative approach IHPA takes-promoting international cooperation and the exchange of knowledge and experiences-is shortly explained. IHPA has developed various supporting tools for its work: the IHPA web page and newsletter informing on the threats and challenges, but also on the progresses of managing pesticide stockpiles; the joint GIZ-PAN-IHPA exhibition on awareness of the pesticide stockpile challenge; and the 'International HCH and Pesticides Forum' as most important tool to progress the integrative work and mission of IHPA. Finally, a summary of the 11th International HCH and Pesticides Forum held in Gabala, Azerbaijan is given which brought together more than 120 scientists, policy-makers, non-governmental and international organisations, industry and students from more than 40 countries to progress the obsolete pesticides and hazardous chemical waste challenge in EECCA countries. The event finished with adoption of 'Gabala Declaration', which aims to mobilise efforts of all stakeholders for prevention and elimination of POPs, obsolete pesticides, and hazardous chemical waste in the region.

Forensic case of lead poisoning from a battery manufacturing company in Nakuru, Kenya

Acute sickness involving dairy cattle (n = 5) with a morbidity of 100% occurred in a farm in Nakuru, Kenya. A case study was undertaken with the objective of establishing the cause of the sickness. Samples of blood, soil and industrial waste contained high levels of lead. The symptoms, results of postmortem and history of the case were used to establish the diagnosis of acute lead poisoning. This is a forensic case in court between the owner of the animals and a lead recycling company that dumped the industrial waste that was associated with the poisoning. There could be many unreported cases of lead poisoning in Kenya areas with heavy industrial activities since data on of lead poisoning in Kenya is scanty.

The burden of disease from pediatric lead exposure at hazardous waste sites in 7 Asian countries

Identification and systematic assessment of hazardous wastes sites in low and middle-income countries has lagged. Hazardous waste problems are especially severe in lower income Asian countries where environmental regulations are non-existent, nonspecific or poorly enforced. In these countries extensive unregulated industrial development has created waste sites in densely populated urban areas. These sites appear to pose significant risks to public health, and especially to the health of children. To assess potential health risks from chemical contamination at hazardous waste sites in Asia, we assessed 679 sites. A total of 169 sites in 7 countries were classified as contaminated by lead. Eighty-two of these sites contained lead at levels high enough to produce elevated blood lead levels in surrounding populations. To estimate the burden of pediatric lead poisoning associated with exposure to lead in soil and water at these 82 lead-contaminated sites, we used standard toxicokinetic models that relate levels of lead in soil and water to blood lead levels in children. We calculated blood lead levels, and we quantified losses of intelligence (reductions in IQ scores) that were attributable to lead exposure at these sites. We found that 189,725 children in the 7 countries are at risk of diminished intelligence as a consequence of exposure to elevated levels of lead in water and soil at hazardous waste sites. Depending on choice of model, these decrements ranged from 4.94 to 14.96 IQ points. Given the restricted scope of this survey and the conservative estimation procedures employed, this number is almost certainly an underestimate of the full burden of disease. Exposure to toxic chemicals from hazardous waste sites is an important and heretofore insufficiently examined contributor to the Global Burden of Disease.

Cancer values of prevented fatalities (VPFs), one size does not fit all: the benefits of contaminated site cleanups in Italy

The authors conducted a survey based on conjoint choice experiments in Milan, Italy, about mortality risk reductions delivered by hypothetical private behaviors and public programs, and used it to estimate the value of a prevented fatality (VPF) when the cause of death is cancer. Their estimate of the VPF is 4.2 million Euros. The VPF is about C1 million larger when the risk reduction is delivered by a public program, but further analyses reveal that it is so only when the respondent believes that public programs are effective at reducing this particular type of mortality risk This estimate of the VPF is higher than generic European Union-wide figures recommended by the European Commission Directorate-General for Environment (DG Environment) for environmental policy analyses, and is comparable to other VPFs that are appropriate for Italy, hazardous waste regulations, and enforcement-based cleanup programs. The authors use their VPF to compute the benefits of addressing leaking landfills, illegal disposal of hazardous wastes, and poor hazardous waste management practices in the provinces of Naples and Caserta in southern Italy. The authors also examine the importance of the discount rates, since the mortality benefits of remediation begin in 20 yr and are assumed to continue over 30 yr.

Development of an eco-friendly method to convert life expired composite propellant into liquid fertilizer

Large quantity of composite propellants is produced as waste due to life expiry of missiles/rejection of propellant lots during manufacturing. The environmental protection agency does not allow the hazardous materials for open burning/open detonation. Therefore, a systematic study has been carried out to develop a method for the disposal of composite propellant into liquid fertilizer without affecting the environment. In this study, propellant compositions were digested in dilute nitric acid followed by neutralization with 5M KOH solution to get precipitated out aluminium as aluminium hydroxide and finally the obtained liquid was treated with orthophosphoric acid for further neutralization. The liquid fertilizer, thus, obtained was characterized for nitrate and phosphate content using ion chromatography while ICP-AES was used for the estimation of potassium, aluminium and other noxious metallic elements such as Pb, Cd, As, Cr, Cu, Ni and Zn. The analyses data indicate that liquid fertilizer is free from aluminium and noxious metallic elements while ratio of nitrogen, phosphorous and potassium are close to the Indian NPK value.

Can Chlorella pyrenoidosa be a bioindicator for hazardous solid waste detoxification?

Four kinds of solid waste residue (SWR, S1 to S4) from different stages in a sequential detoxification process were chosen. The biotoxicity of the leachates from S1 to S4 was tested by Chlorella pyrenoidosa. The growth inhibition, the chlorophyll a (chla) and chlorophyll b (chlb) concentrations, and the ultrastructural morphology of cells of C. pyrenoidosa were studied. It shows that the growth inhibition of C. pyrenoidosa significantly increased with increasing leachate concentration when exposed to the leachates from S1, S2, S3, and S4, respectively. It well reflects the toxicity difference of leachate from SWR at different treatment stages, namely S1>S2>S3>S4. Correspondingly, the chla and chlb concentrations of C. pyrenoidosa increased gradually as SWR was treated deeply. Leachate disrupted chlorophyll synthesis and inhibited cell growth. The changing of the ultrastructural morphology of cells under different leachate exposures, such as volume of chloroplasts and quantity of thylakoids reducing, confirmed the toxicity decrease of leachates from different stages. C. pyrenoidosa is a good bioindicator for hazardous solid waste detoxification. The EC(50) at difference scenarios also suggests that it was feasible to estimate ecological toxicity of leachates to C. pyrenoidosa after exposure times of 72h. C. pyrenoidosa can be introduced to evaluate the effect of hazardous solid waste disposal by biotoxicity assessment.

[Experimental estimation of the hazard from combustion products of waste polymeric materials]

The object of the study was waste polymeric materials. Its aim was to reveal the hazard of their combustion. Conditions occurring in the combustion of waste polymeric materials were simulated; methods for chemical analysis were used; biotesting was performed. The study revealed a high hazard from combustion products of waste polymeric materials.

[SENTIERI Project: discussion and conclusions]

SENTIERI Project is the first comprehensive study of the health impact of residence in Italian polluted sites (IPSs). The present Chapter examines the main validity aspects of the present mortality investigation and the evaluation of causality of the observed associations; in addition, some recommendations for public health intervention and research priorities in epidemiological studies on environment and health are given. Exposure ascertainment is a key aspect when an ecological study design is adopted in environmental epidemiology, therefore any exposure potentially affecting the population at study should be described in detail. This is here discussed. SENTIERI is an ecological study, based on a priori hypotheses, in which each IPS's types of exposure were described with specific attention to human exposure. Though, when commenting the results, the problem of concurrent air pollution exposure and/or industrial activities implying occupational risk, if present in the IPSs, was taken into account. Socioeconomic status is a determinant of health and disease, therefore in SENTIERI the Standardized Mortality Ratios were computed both crude and adjusted for an ad hoc deprivation index. About 60% versus an expected 40% of IPSs residents are in the two most deprived quintiles of the index. This hints to a possible problem of environmental justice that should be taken into account when planning remediation intervention. The mortality results here presented are a first step in the epidemiological IPSs' characterization, and some developments have been made or planned. Firstly, a mortality analysis was performed combining mortality data in IPSs presenting similar pollution, i.e. asbestos, or industrial hazardous wastes or dumping sites; secondly, the mortality analysis will be extended beyond 2002, namely the year when ICD X started to be in use in Italy. In addition, disease prevalence will be investigated using hospital discharge records; cancer incidence and congenital anomalies incidence will be studied in IPSs in which a Cancer Register or a Congenital Anomalies Register are active. The above described activities will lead to a more valid estimate of the disease burden of IPSs residents, and allow to identify priorities of remediation activities. The method adopted in SENTIERI, specifically the ecological design and the use of mortality data at municipal level, in general does not grant the evaluation of the causal association between environmental exposure and adverse health effects. However, it allows etiological observations that make unacceptable the delay of remediation intervention.

[Methods for mortality analysis in SENTIERI Project]

The methods of mortality analysis in Italian polluted sites (IPS) are described. The study concerned 44 IPSs; each one included one or more municipalities. Mortality at municipality level was studied in the period 1995-2002, using the following indicators: crude rate, standardized rate, standardized mortality ratio (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as reference for indirect standardization. The deprivation index was constructed using the 2001 national census variables representing the following socioeconomic domains: education, unemployment, dwelling ownership, overcrowding. Mortality indicators were computed for 63 single or grouped causes. The results for all the 63 analysed causes of death are available for each IPS, and in this Chapter the results for each IPS for causes selected on the basis of a priori evidence of risk from local sources of environmental pollution are presented. The procedures and results of the evidence evaluation have been published in the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[Deprivation indices in small-area studies of environment and health in Italy]

The use of deprivation indices in small-area studies of environment and health is described, with particular reference to the Italian context. Deprivation indices can represent a proxy for individual deprivation and/or contextual deprivation. In Italy, deprivation indices have been constructed using Census variables. They are applied at census tract level in studies with a local basis; in national based studies, they can be used at municipality level. In SENTIERI Project (Mortality study of residents in Italian polluted sites) an ad hoc deprivation index at municipal level was used (DI SENTIERI). Its strength and weaknesses are discussed. In addition, suggestions about the use of socioeconomic indices in small area studies of environment and health are given. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project.

[Global burden of mortality in Italian polluted sites]

SENTIERI Project has assessed the overall mortality profile in all the IPSs combined, and performed IPS-specific analyses. The epidemiological evidence of the causal association between cause of death and exposure was classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8 for men (90%CI 114.4-117.2; 2 439 extra deaths) and 114.4 for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (men and women combined), an excess of 9 969 deaths is observed, with an average of around 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The distribution of the causes of deaths shows that the excesses are not evenly distributed: cancer mortality accounts for 30%of all deaths, but is 43.2%of the excess deaths (4 309 cases of 9 969). Conversely, the percentage of excesses in non cancer causes, 19%, is lower than their share of total mortality (42%). Consistently with previous studies, the results suggest that the health status of populations living in the IPSs is worse than what regional averages show. Compared to previous studies, the analysis of the causes selected in SENTIERI, on the basis of a priori Sufficient or Limited evidence of association with the environmental exposures, provides additional information on their role, though some limitations, due to methodology and data used, should be considered.

[The contribution of surveillance systems of occupational diseases and mesothelioma in environmental health studies]

National surveillance systems of occupational diseases may contribute to evaluate the work-related component of diseases investigated in SENTIERI Project. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The National Workers Compensation Authority (INAIL) archives all occupational diseases claims (more than 230 000 in the period 2000-2007) and is in charge of their compensation. The Italian National Mesothelioma Register (ReNaM) and the Sinonasal Cancer Register (ReNaTuNS) record high occupational etiological fraction neoplasms (i.e. mesothelioma and sinonasal cancers). The former has identified more than 10 000 mesothelioma cases until now, and covers almost the whole country; the latter is active only in three Italian regions, Piemonte, Lombardia and Toscana. The monitoring of cancer sites at lower occupational etiological fraction is based on a record-linkage procedure between population-based cancer registries and employment history data, available at the Italian National Institute for Social Security (INPS). Finally, the informative system Mal.Prof collects and classifies all the diseases possibly related to the work environment reported by the Prevention Services of the Local Health Units.

[The study of congenital anomalies in contaminated sites of interest for environmental remediation]

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPSs). A development of the Project is the investigation of adverse reproductive effects. This issue is of the utmost importance in the field of environmental epidemiology, both in analytical studies and in surveillance activity. An environmental factor can be at play either as a preconception mutagen (maternal or paternal exposure) or as a postconceptional teratogen. The US-Agency for Toxic Substances and Disease Registry (ATSDR) and the US-Environmental Protection Agency (USEPA), indicate as a priority the study of congenital anomalies (CA) and reproductive disorders. The choice of congenital anomalies to be included in the study is mainly based on the results of the evaluation of the epidemiological evidence completed for SENTIERI Project. The epidemiological knowledge on congenital anomalies in polluted sites is lacking, therefore main groups of CA will also be included for descriptive purposes. Data on CA are produced by seven registers located in Italy, either in regional or sub-regional areas, which are included in the National Committee of Congenital Malformations Registers hosted by the National Center for Rare Diseases at Istituto Superiore di Sanità. The study periods are: a) 1995-2002 (1996-2002 for the Region Campania), namely the same years as SENTIERI mortality study; b) for the years 2003-2008 different time windows will be chosen on the basis of data availability in single registers. Registers of CA are active in 16 out of 44 polluted sites included in SENTIERI, for a total of 119 municipalities. In each polluted site the number of expected cases for each CA will be estimated from the prevalence at birth of the same anomaly as from regional registers active in the polluted site at study. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to the Project.

[Mortality results in SENTIERI Project]

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPS). The epidemiological evidence of the causal association between causes of death and exposures was a priori classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). In these sites various environmental exposures are present. Asbestos (or asbestiform fibres as in Biancavilla) has been the motivation for defining six sites as IPSs (Balangero, Emarese, Casale Monferrato, Broni, Bari-Fibronit, Biancavilla). In five of these, increases in malignant neoplasm or pleura mortality are detected; in four of them, results are consistent in both genders. In six other sites (Pitelli, Massa Carrara, Aree del Litorale Vesuviano, Tito, "Aree industriali della Val Basento", Priolo), where other sources of environmental pollution in addition to asbestos are reported, mortality from malignant neoplasm of pleura is increased in both genders in Pitelli, Massa Carrara, Priolo, "Litorale vesuviano". In the time span 1995-2002, a total of 416 extra cases of malignant neoplasm of pleura are detected in the twelve asbestos-polluted sites. Asbestos and pleural neoplasm represent an unique case. Unlike mesothelioma, most causes of death analyzed in SENTIERI have multifactorial etiology; furthermore, in most IPSs multiple sources of different pollutants are present, sometimes concurrently with air pollution from urban areas: in these cases, drawing conclusions on the association between environmental exposures and specific health outcomes might be complicated. Notwithstanding these difficulties, in a number of cases an etiological role could be attributed to some environmental exposures. The attribution could be possible on the basis of increases observed in both genders and in different age classes, and the exclusion of a major role of occupational exposures was thus allowed. For example, a role of emissions from refineries and petrochemical plants was hypothesized for the observed increases in mortality from lung cancer and respiratory diseases in Gela and Porto Torres; a role of emissions from metal industries was suggested to explain increased mortality from respiratory diseases in Taranto and in Sulcis-Iglesiente-Guspinese. An etiological role of air pollution in the raise in congenital anomalies and perinatal disorders was suggested in Falconara Marittima, Massa-Carrara, Milazzo and Porto Torres. A causal role of heavy metals, PAH's and halogenated compounds was suspected for mortality from renal failure in Massa Carrara, Piombino, Orbetello, "Basso bacino del fiume Chienti" and Sulcis-Iglesiente-Guspinese. In Trento-Nord, Grado and Marano, and "Basso bacino del fiume Chienti" increases in neurological diseases, for which an etiological role of lead, mercury and organohalogenated solvents is possible, were reported. The increase for non-Hodgkin lymphomas in Brescia was associated with the widespread PCB pollution. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8% for men (90% IC 114.4-117.2; 2 439 extra deaths) and 114.4% for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (both men and women), an excess of 9 969 deaths is observed, with an average of about 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The procedures and results of the evidence evaluation are presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[SENTIERI Project: rationale and objectives]

SENTIERI Project (Mortality study of residents in Italian polluted sites) studied mortality of residents in the sites of national interest for environmental remediation (Italian polluted sites--IPSs). IPSs are in proximity of either active or dismissed industrial areas, near dumping sites of industrial and hazardous waste or incinerators. SENTIERI Project described and evaluated the mortality of the populations residing in IPSs and it specifically focused on causes of death for which environmental exposure is suspected or ascertained to play an etiologic role. The epidemiological evidence of the causal association was classified a priori into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The study results will allow the priorities setting in remediation intervention, so as to prevent adverse health effects from environmental exposure. At the time of 2001 Census, about 10%of Italian population resided in the 44 IPSs included in SENTIERI; the mortality analysis was carried out for the years 1995-2002 for 63 causes of death. The study results for the 44 IPSs are here commented and read on the basis the a priori evaluation of the epidemiological evidence in terms of strength of the causal association, and taking into account the limits of a geographic study design and its implied complexities. The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[Scientific collaboration between Istituto Superiore di Sanità and Italian Association of Cancer Registries for the study of cancer incidence in Italian polluted sites]

The collaborative study between Istituto superiore di sanità and Associazione italiana registri tumori (ISS-AIRTUM) aims at investigating cancer incidence in polluted sites for adults and for children (0-14 years) and adolescents (15-19 years) to comment the study results in the light of a set of a priori hypotheses. On the whole, 141 out of 298 municipalities included in SENTIERI Project are served by a Cancer Register participating to the AIRTUM network. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The time window of the study is the period 1996-2005. The number of expected cases in each polluted site will be estimated by applying incidence rates of the national pool of cancer registries and of the pool of the geographic macroarea in which each site is located: Northern, Central, Southern Italy and Islands. Cancer incidence in children and adolescents is one of the main priorities of international public health institutions, because of the need to protect childhood health from involuntary exposure to environmental risk factors. Standardized incidence ratios (SIRs) will be computed using expected figures derived from the national pool of cancer registries.