Residential exposure to air pollution and incidence of leukaemia in the industrial area of Viadana, Northern Italy.

BACKGROUND: Exposure to air pollution has been proposed as one of the potential risk factors for leukaemia. Work-related formaldehyde exposure is suspected to cause leukaemia. METHODS: We conducted a nested register-based case-control study on leukaemia incidence in the Viadana district, an industrial area for particleboard production in Northern Italy. We recruited 115 cases and 496 controls, frequency-matched by age, between 1999 and 2014. We assigned estimated exposures to particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and formaldehyde at residential addresses, averaged over the susceptibility window 3rd to 10th year prior to the index date. We considered potential confounding by sex, age, nationality, socio-economic status, occupational exposures to benzene and formaldehyde, and prior cancer diagnoses. RESULTS: There was no association of exposures to PM10, PM2.5, and NO2 with leukaemia incidence. However, an indication of increased risk emerged for formaldehyde, despite wide statistical uncertainty (OR 1.46, 95%CI 0.65-3.25 per IQR-difference of 1.2 µg/m3). Estimated associations for formaldehyde were higher for acute (OR 2.07, 95%CI 0.70-6.12) and myeloid subtypes (OR 1.79, 95%CI 0.64-5.01), and in the 4-km buffer around the industrial facilities (OR 2.78, 95%CI 0.48-16.13), although they remained uncertain. CONCLUSIONS: This was the first study investigating the link between ambient formaldehyde exposure and leukaemia incidence in the general population. The evidence presented suggests an association, although it remains inconclusive, and a potential significance of emissions related to industrial activities in the district. Further research is warranted in larger populations incorporating data on other potential risk factors.

The descriptive epidemiology of melanoma in Italy has changed - for the better.

A recent research project using data from a total of 40 cancer registries has provided new epidemiologic insights into the results of efforts for melanoma control in Italy between the 1990s and the last decade. In this article, the authors present a summary and a commentary of their findings. Incidence increased significantly throughout the study period in both sexes. However, the rates showed a stabilization or a decrease in men and women aged below 35 years. The risk of disease increased for successive cohorts born until 1973 (women) and 1975 (men) while subsequently tending to decline. The trend towards decreasing tumor thickness and increasing survival has continued, but a novel favorable prognostic factor has emerged since 2013 for patients - particularly for males - with thick melanoma, most likely represented by molecular targeted therapies and immune checkpoint inhibitors. Due to this, the survival gap between males and females has been filled out. In the meanwhile, and despite the incidence increase, dermatologists have not lowered their threshold to perform skin biopsy. Skin biopsy rate has increased because of the increasingly greater volume of dermatologic office visits, but the proportion of skin biopsies out of dermatologic office visits has remained constant. In summary, an important breakthrough in melanoma control in Italy has taken place. Effective interventions have been implemented across the full scope of care, which involve many large local populations - virtually the whole national population. The strategies adopted during the last three decades represent a valuable basis for further steps ahead in melanoma control in Italy.

Mid-term trends and recent birth-cohort-dependent changes in incidence rates of cutaneous malignant melanoma in Italy.

In Oceania, North America and north-western Europe, after decades of increase, cutaneous malignant melanoma (CMM) rates began to stabilise or decline before 2000. Anecdotal evidence suggests that the reversal of the incidence trend is extending to southern Europe. To obtain a formal confirmation, this nationwide study from Italy investigated the incidence trends by birth cohort. Twenty-one local cancer registries covering a population of 15 814 455 provided incidence data for primary CMM registered between 1994 and 2013. Trends in age-standardised rates were analysed using joinpoint regression models and age-period-cohort models. Age-standardised incidence showed a consistent increase throughout the period (estimated annual percent change, 3.6 [95% confidence interval, 3.2-4.0] among men and 2.5 [2.0-3.1] among women). This pattern was confirmed by a sensitivity analysis with removal of low-risk populations of southern Italy. The rates, however, showed a stabilisation or a decrease in men and women aged below 35. Using the cohort of 1949-the median cohort with respect to the number of cases for both genders-as a reference, the incidence rate ratio increased for successive cohorts born until 1973 (women) and 1975 (men), and subsequently tended to decline. For the most recent cohorts in both genders, the risk of disease returned to the level of the cohort of 1949. The changes observed in the latest generations can be interpreted as the earliest manifestations of a birth-cohort-dependent incidence decrease. Our study adds to previous data indicating that the reversal of the long-term upward incidence trend of CMM is extending to southern Europe.

Residential proximity to an industrial incinerator and risk of soft-tissue sarcoma, 1999-2014.

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.

Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015.

OBJECTIVE: The incidence of vulvar squamous cell carcinoma has increased for decades in most Western countries - a trend virtually restricted to women aged <50 or 60 years. In southern Europe, conversely, the trends have been insufficiently studied. This article reports a study from Italy. METHOD: Thirty-eight local cancer registries, currently covering 15,274,070 women, equivalent to 49.2% of the Italian national female population, participated. Invasive cancers registered between 1990 and 2015 with an International Classification of Diseases for Oncology, 3rd revision, topography code C51 and morphology codes compatible with vulvar squamous cell carcinoma (n = 6294) were eligible. Incidence trends were analysed using joinpoint regression models, with calculation of the estimated annual percent change (EAPC), and age-period-cohort models. RESULTS: Total incidence showed a regular and significant decreasing trend (EAPC, -0.96; 95% confidence interval (CI), -1.43 to -0.48). This was entirely accounted for by women aged ≥60 years (EAPC, -1.34; 95% CI, -1.86 to -0.81). For younger women, the EAPC between 1990 and 2012 was 1.20 (95% CI, 0.34 to 2.06) with a non-significant acceleration thereafter. This pattern did not vary substantially in a sensitivity analysis for the effect of geographic area and duration of the registry. The age-period-cohort analysis revealed a risk decrease in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945. CONCLUSIONS: The decreasing trend observed among older women and the resulting decrease in total rate are at variance with reports from most Western countries. Age-period-cohort analysis confirmed a decreasing trend for earliest birth cohorts and an opposite one for recent ones.

Tropical land carbon cycle responses to 2015/16 El Niño as recorded by atmospheric greenhouse gas and remote sensing data.

The outstanding tropical land climate characteristic over the past decades is rapid warming, with no significant large-scale precipitation trends. This warming is expected to continue but the effects on tropical vegetation are unknown. El Niño-related heat peaks may provide a test bed for a future hotter world. Here we analyse tropical land carbon cycle responses to the 2015/16 El Niño heat and drought anomalies using an atmospheric transport inversion. Based on the global atmospheric CO2 and fossil fuel emission records, we find no obvious signs of anomalously large carbon release compared with earlier El Niño events, suggesting resilience of tropical vegetation. We find roughly equal net carbon release anomalies from Amazonia and tropical Africa, approximately 0.5 PgC each, and smaller carbon release anomalies from tropical East Asia and southern Africa. Atmospheric CO anomalies reveal substantial fire carbon release from tropical East Asia peaking in October 2015 while fires contribute only a minor amount to the Amazonian carbon flux anomaly. Anomalously large Amazonian carbon flux release is consistent with downregulation of primary productivity during peak negative near-surface water anomaly (October 2015 to March 2016) as diagnosed by solar-induced fluorescence. Finally, we find an unexpected anomalous positive flux to the atmosphere from tropical Africa early in 2016, coincident with substantial CO release.This article is part of a discussion meeting issue 'The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications'.

The impact of overdiagnosis on thyroid cancer epidemic in Italy,1998-2012.

AIMS: In Italy, incidence rates of thyroid cancer (TC) are among the highest worldwide with substantial intracountry heterogeneity. The aim of the study was to examine time trends of TC incidence in Italy and to estimate the proportion of TC cases potentially attributable to overdiagnosis. METHODS: Data on TC cases reported to Italian cancer registries during 1998-2012 aged <85 years were included. Age-standardised incidence rates (ASR) were computed by sex, period, and histology. TC overdiagnosis was estimated by sex, period, age, and Italian region. RESULTS: In Italy between 1998-2002 and 2008-2012, TC ASR increased of 74% in women (from 16.2 to 28.2/100,000) and of 90% in men (from 5.3 to 10.1/100,000). ASR increases were nearly exclusively due to papillary TC (+91% in women, +120% in men). In both sexes, more than three-fold differences emerged between regions with highest and lowest ASR. Among TC cases diagnosed in 1998-2012 in Italy, we estimated that overdiagnosis accounted for 75% of cases in women and 63% in men and increased over the study period leading to overdiagnosis of 79% in women and 67% in men in 2008-2012. Notably, overdiagnosis was over 80% among women aged <55 years, and substantial variations were documented across Italian regions, in both genders. CONCLUSION(S): Incidence rates of TC are steadily increasing in Italy and largely due to overdiagnosis. These findings call for an update of thyroid gland examination practices in the asymptomatic general population, at national and regional levels.

Estudos dos compostos orgânicos voláteis precursores de ozônio na cidade de São Paulo / Studies of the volatile organic compounds precursors of ozone in São Paulo city

O ozônio é o principal problema de poluição do ar na cidade de São Paulo. Este estudo, que foi realizado em uma estação de monitoramento da qualidade do ar da Companhia de Tecnologia de Saneamento Ambiental (CETESB), enfoca a elucidação dos principais compostos orgânicos voláteis precursores de ozônio na atmosfera paulistana. Foram coletadas 36 amostras nos meses de agosto e setembro de 2006, nos quais o consumo de etanol era de aproximadamente 50 por cento nesta época. Foram quantificadas 69 espécies de compostos orgânicos voláteis, nos quais os dez compostos mais importantes na formação de O3 foram: 1-buteno (6,8 por cento), eteno (6,5 por cento), formaldeído (6,1 por cento), acetaldeído (5,5 por cento), tolueno (4,8 por cento), 1-etil-4-metilbenzeno (3,7 por cento), trans-2-penteno (3,7 por cento), propeno (3,7 por cento), trans-2-buteno (3,5 por cento) e 1-metilciclopenteno (3,5 por cento). As classes mais abundantes em concentração no ar foram: alcanos (45 por cento), alcenos (26 por cento), aromáticos (14 por cento), aldeídos (13 por cento) e alcadienos (2 por cento).

Ozone is the main problem of air pollution in the city of São Paulo. This study, which was carried out in the Brazilian Basic Sanitation Engineering Company (CETESB, acronym in Portuguese) monitoring station of air quality, focused on the elucidation of the main volatile organic compounds ozone precursors in São Paulo atmosphere. Thirty-six samples were collected in August and September 2006, when the consumption of ethanol was about 50 percent, 69 species of volatile organic compounds were quantified, the ten major urban pollutants compounds in the formation of O3 were: 1-butene (6.8 percent), ethylene (6.5 percent), formaldehyde (6.1 percent), acetaldehyde (5.5 percent), toluene (4.8 percent), 1-ethyl-4-methylbenzene (3.7 percent), trans-2-pentene (3.7 percent), propylene (3.7 percent), trans-2-butene (3.5 percent), and 1-methylcyclopentene (3.5 percent). The most abundant classes of air concentration were: alkanes (45 percent), alkenes (26 percent), aromatics (14 percent), aldehydes (13 percent), and alkadyenes (2 percent).

Volatile organic compounds in a residential and commercial urban area with a diesel, compressed natural gas and oxygenated gasoline vehicular fleet.

Air samples were collected in a typical residential and commercial area in Rio de Janeiro, Brazil, where buses and trucks use diesel and light duty vehicles use compressed natural gas, ethanol, and gasohol (gasoline blended with ethanol) as fuel. A total of 66 C3-C12 volatile organic compounds (VOCs) were identified. The most abundant compounds, on a mass concentration basis, included propane, isobutane, i-pentane, m,p-xylene, 1,3,5-trimethylbenzene, toluene, styrene, ethylbenzene, isopropylbenzene, o-xylene and 1,2,4-trimethylbenzene. Two VOCs photochemical reactivity rankings are presented: one involves reaction with OH and the other involves production of ozone.

Interpreting satellite column observations of formaldehyde over tropical South America.

Space-borne column measurements of formaldehyde (HCHO), a high-yield oxidation product of volatile organic compounds (VOCs), represent important constraints for quantifying net regional fluxes of VOCs. Here, we interpret observed distributions of HCHO columns from the Global Ozone Monitoring Experiment (GOME) over tropical South America during 1997-2001. We present the first comparison of year-long in situ isoprene concentrations and fire-free GOME HCHO columns over a tropical ecosystem. GOME HCHO columns and in situ isoprene concentrations are elevated in the wet and dry seasons, with the highest values in the dry season. Previous analysis of the in situ data highlighted the possible role of drought in determining the elevated concentrations during the dry season, inferring the potential of HCHO columns to provide regional-scale constraints for estimating the role of drought on isoprene emissions. The agreement between the observed annual cycles of GOME HCHO columns and Along-Track Scanning Radiometer firecount data over the Amazon basin (correlations typically greater than 0.75 for a particular year) illustrates the potential of HCHO column to provide quantitative information about biomass burning emissions.

Emission factors for gas-powered vehicles traveling through road tunnels in São Paulo, Brazil.

The objective of this study was to improve the vehicular emissions inventory for the light- and heavy-duty fleet in the metropolitan area of São Paulo (MASP), Brazil. To that end, we measured vehicle emissions in road tunnels located in the MASP. On March 22-26, 2004 and May 04-07, 2004, respectively, CO, CO2, NOx, SO2, and volatile organic compounds (VOCs) emissions were measured in two tunnels: the Janio Quadros, which carries light-dutyvehicles; and the Maria Maluf, which carries light-duty vehicles and heavy-duty diesel trucks. Pollutant concentrations were measured inside the tunnels, and background pollutant concentrations were measured outside of the tunnels. The mean CO and NOx emission factors (in g km(-1)) were, respectively, 14.6 +/- 2.3 and 1.6 +/- 0.3 for light-duty vehicles, compared with 20.6 +/- 4.7 and 22.3 +/- 9.8 for heavy-duty vehicles. The total VOCs emission factor for the Maria Maluf tunnel was 1.4 +/- 1.3 g km(-1). The main VOCs classes identified were aromatic, alkane, and aldehyde compounds. For the heavy-duty fleet, NOx emission factors were approximately 14 times higher than those found for the light-duty fleet. This was attributed to the high levels of NOx emissions from diesel vehicles.

Human herpesvirus type 8 infection in an area of Northern Italy with high incidence of classical Kaposi's sarcoma.

Previous studies have reported a large variation in the incidence of classical Kaposi's sarcoma across different Districts of the province of Mantua (Northern Italy). To assess whether such differences might be explained by different anti-HHV8 antibody prevalence, a serological study was conducted in 343 healthy elderly individuals resident in two adjacent Districts, at the highest and the lowest classical Kaposi's sarcoma incidence rate, respectively. Qualitative and quantitative determinations of IgG antibodies against both latent and lytic HHV-8 antigens were performed by indirect immunofluorescence assay. The assay's sensitivity was studied in 26 patients with classical Kaposi's sarcoma. Overall, anti-HHV8 antibodies were detected in 25 out of 26 patients (96%), confirming the high sensitivity of this assay. The prevalence of anti-HHV-8 antibodies was higher among individuals living in the District had a high incidence of classical Kaposi's sarcoma compared to those living in the District with low incidence (19.4% vs 9.8%, and 15.9% vs 8%; P<0.05, for latent and lytic antibodies, respectively). Anti-lytic antibody GMT was higher in people living in the District at high incidence rate compared to those of the other area (328.9 vs. 180.4; P<0.01). A higher prevalence of HHV-8 infection was found among persons living in municipalities surrounded by watercourses (OR 2.2, 95% CI: 1.10-4.32). In conclusion, variation in HHV-8 prevalence appears to explain differences in the incidence rates of classical Kaposi's sarcoma observed in different areas of the province.

Química atmosférica na Amazônia: a floresta e as emissões de queimadas controlando a composição da atmosfera amazônica / Atmospheric chemistry in Amazonia: the forest and the biomass burning emissions controlling the composition of the Amazonian atmosphere

Entender os processos naturais que regulam a composição da atmosfera é crítico para que se possa desenvolver uma estratégia de desenvolvimento sustentável na região. As grandes emissões de gases e partículas durante a estação seca provenientes das queimadas alteram profundamente a composição da atmosfera amazônica na maior parte de sua área. As concentrações de partículas de aerossóis e gases traço aumentam por fatores de 2 a 8 em grandes áreas, afetando os mecanismos naturais de uma série de processos atmosféricos na região amazônica. Os mecanismos de formação de nuvens, por exemplo, são profundamente alterados quando a concentração de núcleos de condensação de nuvens (NCN) passa de 200 a 300 NCN/cm³ na estação chuvosa para 5.000-10.000 NCN/centímetro cúbico na estação seca. As gotas de nuvens sofrem uma redução de tamanho de 18 a 25 micrômetros para 5 a 10 micrômetros, diminuindo a eficiência do processo de precipitação e suprimindo a formação de nuvens. A concentração de ozônio, um gás importante para a saúde da floresta amazônica passa de cerca de 12 partes por bilhão em volume (ppb) (concentração típica ao meio do dia na estação chuvosa) para valores em regiões fortemente impactadas por queimadas de até 100 ppb, nível que pode ser fitotóxico para a vegetação. O balanço de radiação é fortemente afetado, com uma perda líquida de até 70 por cento da radiação fotossinteticamente ativa na superfície.