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.

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 fluoroedenite 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.

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.

Objectives. Adverse effects of waste management represent a public health issue. Mortality meta-analysis in Italian National Priority Contaminated Sites (NPCSs) with industrial waste landfills or illegal dumps is presented. Methods. 24 NPCSs include industrial waste landfills or illegal dumps. Class 1 (10 NPCSs with industrial waste landfills) and Class 2 (14 NPCSs with illegal dumps) were categorized. Random-effects model meta-analyses of Standardized Mortality Ratios non-adjusted (SMRs) and adjusted for Deprivation (DI-SMRs) computed for each CS (1995-2002) were performed for overall 24 NPCSs and the two classes. The North-Southern gradient was considered. Results. 24 CSs pooled-SMRs are significantly increased in both genders for cancer of liver (men: SMR = 1.13; women: SMR = 1.18), bladder (men: SMR = 1.06; women: SMR = 1.11), and for cirrhosis (men: SMR = 1.09; women: SMR = 1.13). In Class 2 the increase is confirmed in both genders for liver and bladder cancers and for cirrhosis and in men only for lung cancer. Congenital anomalies and adverse perinatal conditions are not increased. Conclusion. The results are consistent with the hypothesis of adverse health effects of non-adequately managed hazardous waste. Causal interpretation is not allowed, but the meta-analytic approach provides more confidence in the findings.

INTRODUCTION. The incidence of cancer among residents in sites contaminated by pollutants with a possible health impact is not adequately studied. In Italy, SENTIERI Project (Epidemiological study of residents in National Priority Contaminated Sites, NPCSs) was implemented to study major health outcomes for residents in 44 NPCSs. METHODS. The Italian Association of Cancer Registries (AIRTUM) records cancer incidence in 23 NPCSs. For each NPCSs, the incidence of all malignant cancers combined and 35 cancer sites (coded according to ICD-10), was analysed (1996-2005). The observed cases were compared to the expected based on age (5-year period,18 classes), gender, calendar period (1996-2000; 2001-2005), geographical area (North-Centre and Centre-South) and cancer sites specific rates. Standardized Incidence Ratios (SIR) with 90% Confidence Intervals were computed. RESULTS. In both genders an excess was observed for overall cancer incidence (9% in men and 7% in women) as well as for specific cancer sites (colon and rectum, liver, gallbladder, pancreas, lung, skin melanoma, bladder and Non Hodgkin lymphoma). Deficits were observed for gastric cancer in both genders, chronic lymphoid leukemia (men), malignant thyroid neoplasms, corpus uteri and connective and soft-tissue tumours and sarcomas (women). DISCUSSION. This report is, to our knowledge, the first one on cancer risk of residents in NPCSs. The study, although not aiming to estimate the cancer burden attributable to the environment as compared to occupation or life-style, supports the credibility of an etiologic role of environmental exposures in contaminated sites. Ongoing analyses focus on the interpretation of risk factors for excesses of specific cancer types overall and in specific NPCSs in relation to the presence of carcinogenic pollutants.

INTRODUCTION. The objective of this chapter is to study the health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy), in terms of mortality and hospitalization. The diseases which international scientific literature indicates as associated with asbestos exposure were taken into consideration: mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis testis, malignant neoplasm of larynx, malignant neoplasm of trachea, bronchus and lung, malignant neoplasm of ovary, pneumoconiosis; moreover, in order to describe the health profile of the study population, large groups of diseases were taken into consideration. MATERIAL AND METHODS. Current data (available in the Data Bases of the Unit of Statistics of ISS) regarding mortality and hospitalization were analyzed. Standardized Mortality Ratios, Standardized Hospitalization Ratios and Age-standardized Death Rates were calculated. The demographic background of the population residing in Biancavilla was also outlined. Conclusions. Our findings support the etiologic role of fibres with fluoro-edenitic composition in the occurrence of the above mentioned diseases, already observed in other studies.

Subsequently to the observation of a localized excess of mortality from malignant pleural neoplasms in the town of Biancavilla (Sicily), previously unknown amphibolic fibres with fluoro-edenitic composition were detected as naturally occurring soil contaminants. Less then two years after the initial report, ISS provided a set of public health recommendations that were complied by regional and local institutions. The recognition of Biancavilla as a National Priority Contaminated Site in 2002 opened the way to clean-up interventions. An up-dating of epidemiological studies, exposure assessment investigations and in vivo and in vitro mechanistic studies on fluoro-edenite fibres is provided in this issue. Scientific evidence can provide a sound foundation to public health action and environmental remediation. Finally, it is now necessary to properly tune the response of the health system to the community needs in terms of diagnostic procedures and medical treatment.

INTRODUCTION. Amphibolic fibres with fluoro-edenitic composition characterize Biancavilla soil, including the major quarry from which building materials have been extensively extracted. These fibres induce mesothelioma in experimental animals and their in vitro biological action is similar to that of crocidolite. MATERIALS AND METHODS. Malignant mesothelioma case series and incidence were examined to evaluate the disease burden on Biancavilla inhabitants. RESULTS. The incidence of pleural mesothelioma in Biancavilla is steadily higher than in the Sicilian Region, risk estimates are more elevated in women than in men, the most affected age class is constituted by subjects aged less than 50. DISCUSSION AND CONCLUSIONS. Environmental exposure to fibres with fluoro-edenitic composition appears to be causally related to the elevated mesothelioma occurrence in Biancavilla. In this frame, environmental clean-up is the main goal to be pursued in public health terms. A contribution of scientific research to public health decision making with respect to priority setting for environmental clean-up can derive from some further selected epidemiological investigations.

INTRODUCTION: A neighbourhood of the city of Ferrara (Italy) was built over an area polluted with chlorinated organic compounds. A residential cohort study was performed to assess the health profile of the population living in the polluted area. METHODS: The residential history of 3475 subjects who had lived in the East quadrant neighbourhood in the period 1994-2010 was constructed. Mortality for the period 19942010 and cancer incidence for the years 1994-2007 were studied. Standardised mortality ratios (SMR) for 2632 subjects and standardised incidence ratios (SIR) for 2578 subjects who had lived for at least 5 years in the area under study were calculated. Indicators were calculated for males and females combined, using the population of Ferrara as reference population. RESULTS: The health profile of the population of the East quadrant neighbourhood, defined using mortality indicators for major groups of causes, is essentially similar to that of the city of Ferrara. Increased mortality rates for lung cancer (SMR 131, 90% CI 94-178) and incidence rates for some cancer sites, including liver (SIR 135, 90% CI 67-243) were observed, albeit on the basis of few cases and with wide confidence intervals. DISCUSSION: The likelihood of observing significant increases in risk is reduced by the sizes of the cohorts and the short follow-up period, but some findings nonetheless suggest that, as a precautionary measure, the cohort study should be continued in parallel with measures for the reclamation of the site and that this study should take the form of epidemiological surveillance.

Notwithstanding a major body of evidence on the carcinogenicity of all asbestos fibres and a general consensus of the scientific community on the health impact of this agent, asbestos is still produced and used in a large number of countries, thus determining further harm for future generations. Prevention of asbestos-related disease requires international cooperation, transfer of know-how and dissemination of successful procedures in order to contrast asbestos exposure in the frame of a global environmental health approach.

INTRODUCTION: Spatial distribution of mortality from pleural mesothelioma (which in the ICD-10 Revision has a specific code: C45.0) in Italy for the period 2003-2009 is described. Previous mortality studies at national level employed the topographic code "Malignant neoplasms of pleura", because of unavailability of a specific code in ICD-9 Revision for pleural mesothelioma. METHODS: Standardized mortality ratios were computed for all municipalities, using each regional population as reference; for municipalities in Regions with rate higher than the national rate, the latter has been used as reference. SMRs were computed specifically also for each Italian Polluted Sites "of national concern for environmental remediation" (IPS) with asbestos exposure sources, composed by one or more municipalities, using regional rate as reference. Spatial Scan Statistics procedure, using SatScan software, was applied in cluster analysis: the country was divided into geographic macro-areas and the relative risks (RR) express the ratio of risk within the cluster to the risk of the macro-area outside the cluster. Clusters with p-value < 0.10 were selected. RESULTS: The national standardized annual mortality rate was 1.7 cases per 100 000. Several areas with evident burden of asbestos-related disease were detected. Significant clusters were found in correspondence to asbestos-cement industries (e.g. Casale Monferrato, women: RR = 28.7), shipyards (e.g. Trieste, men: RR = 4.8), petrochemical industries (e.g. Priolo, men: RR = 6.9) and a stone quarry contaminated by fluoro-edenite fibres (Biancavilla, women: RR = 25.9). Some of the increased clusters correspond to IPS. CONCLUSIONS: The results may contribute to detect asbestos exposure and to set priorites for environmental remediation.

INTRODUZIONE: Viene illustrata la distribuzione spaziale in Italia della mortalitá per mesotelioma pleurico (che nella decima revisione ICD ha un codice specifico: C45.0) per gli anni 2003-2009. Studi precedenti a livello nazionale avevano invece utilizzato il codice topografico "Tumori maligni della pleura", in assenza di un codice specifico in Nona Revisione ICD per il mesotelioma pleurico. METODI: I rapporti standardizzati di mortalitá (SMR) sono stati calcolati per tutti i comuni, utilizzando la popolazione regionale come riferimento; per i comuni in Regioni con un tasso maggiore di quello nazionale, é stato utilizzato quest'ultimo come riferimento. SMR sono stati calcolati anche specificatamente per i siti di interesse nazionale per le bonifiche (SIN) con sorgenti di esposizione ad amianto, composti da uno o piú comuni, rispetto al tasso regionale. Il software Spatial Scan Statistic SatScan é stato utilizzato per l'analisi dei cluster: il territorio nazionale é stato suddiviso in macro-aree regionali e i rischi relativi (RR) esprimono il rapporto del rischio all'interno del cluster rispetto al rischio del resto della macro-area. Cluster con un valore di p < 0,10 sono stati selezionati. RISULTATI: Il tasso standardizzato nazionale annuo é di 1,7 casi per 100 000. Cluster significativi sono stati trovati in corrispondenza di industrie del cemento-amianto (ad es. Casale Monferrato, donne: RR = 28,7), aree portuali (ad es. Trieste, uomini: RR = 4,8) e poli petrolchimici (ad es. Priolo, uomini: RR = 6,9); un cluster é stato identificato a Biancavilla (donne: RR = 25,9), dove é presente una cava di materiale contaminato da fluoro-edenite. Alcuni cluster significativi corrispondono a SIN. CONCLUSIONI: I risultati contribuiscono a identificare esposizioni ad amianto prioritarie per la bonifica ambientale.

The objective of this paper is to investigate mortality among 1247 male asbestos-cement workers employed in an asbestos-cement plant located in Naples. The cohort included 1247 men hired between 1950 and 1986. The follow-up began on January 1st 1965. The vital status and causes of death were ascertained up to December 31 2005. Cause-specific mortality rates of the Campania Region population were used as reference. Relative risks were estimated using Standardized Mortality Ratios (SMRs), and the confidence intervals were calculated at a 95% level (95% CI). A significant increase in mortality was observed for respiratory disease (81 deaths; SMR = 187; 95% CI = 149-233), particularly for pneumoconiosis (42 deaths; SMR = 13 313; 95% CI = 9595-17 996) of which 41 deaths for asbestosis (SMR = 43 385; 95% CI = 31 134-58 857), for pleural cancer (24 deaths; SMR = 2617; 95% CI = 1677-3893), for lung cancer (84 deaths; SMR=153; 95% CI = 122-189) and for peritoneal cancer (9 deaths; SMR = 1985; 95% CI = 908-3769). Non-significant increases were also observed for rectum cancer (6 deaths; SMR = 157; 95% CI = 58-342). In conclusion, consistently with other mortality studies on asbestos-cement workers performed in different countries, an increased mortality from asbestosis, lung cancer, pleural and peritoneal mesothelioma was detected in the present cohort.

Obiettivo del presente studio è descrivere la mortalità di una coorte di 1247 lavoratori della Eternit di Bagnoli (NA). è stato condotto uno studio di coorte, ristretto agli uomini, che ha incluso 1247 soggetti assunti a partire dal 1950 sino al 1986, con follow up iniziato nel 1965. Lo stato in vita e le cause di morte sono state accertate al 31/12/2005. La mortalità osservata è stata confrontata con quella attesa in base ai tassi di riferimento della popolazione campana. Sono stati calcolati i rapporti di mortalità standardizzati (SMR) per il periodo 1965-2005 ed i corrispondenti intervalli di confidenza al 95% (IC 95%). Un incremento significativo della mortalità è stato osservato per le malattie respiratorie (81 deceduti; SMR = 187; IC 95% = 149-233), in particolare per le pneumoconiosi (42 deceduti; SMR = 13313; IC 95% = 9595-17996; dei quali 41 deceduti per asbestosi; SMR = 43385; IC 95% = 31134-58857), per tumore maligno della pleura (24 decessi; SMR = 2617; IC 95% = 1677-3893), per tumore del polmone (84 decessi; SMR = 153; IC 95% = 122-189) e per tumore maligno del peritoneo (9 decessi; SMR = 1985; IC 95% = 908-3769). Un incremento non statisticamente significativo è stato osservato per il tumore del retto (6 decessi; SMR = 157; IC 95% = 58-342). In conclusione, i risultati del presente studio, coerentemente con l'insieme dell'evidenza epidemiologica relativa agli effetti sulla salute dell'esposizione a cemento-amianto, mostrano un'aumentata mortalità per asbestosi, cancro polmonare, mesotelioma pleurico e peritoneale.

The association between cancer incidence and the residence near polluting facilities in an industrial area nearby Taranto has been investigated. Age, sex and occupational exposure were controlled as confounding variables in a case-control study (658 cases, 2092 controls). High risks were evidenced close to the steel mill (OR: 3.54), coke plant (OR: 4.80), mineral deposit (OR: 3.33) and shipbuilding (OR: 4.29) for pleural neoplasm, and to the steel mill (OR: 1.65) and shipbuilding (OR: 1.79) for lung cancer. After adjustment for occupational exposure, increasing trends of risk were observed both for lung and bladder cancers. Cancer risks were evidenced near industrial sites and the introduction of "occupational exposure" as a confounder modified significantly the risks with respect to distance from the source of pollution, particularly for pleural, lung and bladder cancers.

È stata indagata l'associazione tra incidenza dei tumori e residenza in prossimità di siti inquinati tramite uno studio caso-controllo (658 casi, 2092 controlli) condotto nell'area industriale di Taranto. Le analisi sono state aggiustate per variabili confondenti (età, sesso ed esposizione occupazionale). Si è osservato un aumento del rischio per tumore della pleura in prossimità della cokeria (OR: 4,80), del deposito di minerali (OR: 3,33), dell'acciaieria (OR: 3,54) e dei cantieri navali (OR: 4,29), e in questi ultimi due siti anche per tumore del polmone (OR: 1,65 e 1,79). Aggiustando le stime per esposizione occupazionale si è osservato un aumento di rischio per i tumori del polmone e della vescica. L'introduzione dell'esposizione occupazionale come confondente ha modificato significativamente i rischi nelle distanze dalle sorgenti inquinanti, in particolare per i tumori della pleura, del polmone e della vescica.

Cancer incidence was investigated in an area which has been affected by the illegal practices of dumping hazardous waste and setting fire to mismanaged waste. For the 35 municipalities of this area that are served by a Cancer Registry, municipal standardized incidence ratios (SIR) and hierarchical Bayesian estimators (BIR) were computed. Moreover, municipal spatial clustering and a Poisson regression by municipality index of waste-related exposure were performed for 10 cancer types. Increased municipality SIRs were found for some cancer types. The BIRs confirmed the increases for liver cancer in two municipalities. Statistically significant clusters were detected for liver, lung, leukaemia and soft tissue sarcomas. In the regression analysis, testis cancer showed significant trend with the index of waste-related exposure (RR = 1.18).

È stata investigata l'incidenza oncologica in un'area interessata da pratiche illegali di smaltimento e di combustione incontrollata di rifiuti. Per i 35 comuni di quest'area serviti da un Registro Tumori sono stati calcolati i rapporti standardizzati di incidenza (standardized incidence ratios, SIR) e gli stimatori bayesiani (BIR). Per 10 sedi tumorali sono state eseguite, inoltre, analisi di cluster spaziali e di regressione con un indice municipale di esposizione a rifiuti. SIR in eccesso sono stati osservati per diverse sedi tumorali; i BIR hanno confermato gli eccessi di tumore epatico in due comuni. I tumori epatici e polmonari, le leucemie e i sarcomi dei tessuti molli hanno mostrato cluster significativi. Nell'analisi di regressione il tumore del testicolo ha mostrato un trend in eccesso significativo (RR = 1,18).

The aim of the present study was to evaluate the possible association between occurrence of soft tissue sarcomas in Verona (Italy) and residence near a steel foundry, whose emissions of dioxin-like compounds may be relevant. Exposure to total suspended particulate (TSP) emitted from the plant as estimated by ADMS-urban dispersion model was used as an indirect index of exposure to dioxin-like compounds. Verona municipality was divided in six subareas according to the decreasing levels of estimated TSP exposure, and soft tissue sarcomas cases were mapped according to residence at time of diagnosis. Standardized incidence ratios were computed. No statistically significant departures between observed and expected cases were detected as illustrated by trend-test results.

Lo scopo dello studio è stato di valutare la possibile associazione tra l'incidenza dei sarcomi dei tessuti molli a Verona (Italia) e la residenza in prossimità di una fonderia le cui emissioni di sostanze diossino-simili possono essere rilevanti. L'esposizione al particolato sospeso totale (TSP) emesso dalla fonderia, stimato secondo il modello di dispersione ADMS-urban, è stato usato come un indicatore indiretto dell'esposizione alle sostanze diossino-simili. Il comune di Verona è stato suddiviso in sei sottoaree secondo i livelli decrescenti di esposizione stimati tramite il TSP e i casi di sarcomi dei tessuti molli sono stati mappati secondo la residenza al momento della diagnosi. Sono stati stimati i tassi standardizzati di incidenza. Non è stato osservato uno scostamento significativo tra gli osservati e gli attesi come dimostrato dai risultati del trend-test.