[The contaminated sites in the SENTIERI Project: an update of legislative, contamination, and sources of environmental exposure aspects in Italy]. / I siti contaminati del Progetto SENTIERI: aggiornamenti legislativi, caratteristiche della contaminazione e fonti di esposizione ambientale.

In Italy, the problem of contaminated sites was introduced for the first time at a regulatory level with the 'Ronchi Decree' No. 22 of 1997. Subsequently, the regulations that defined most of the contaminated Sites of National Interest (SINs) were Law No. 426 of 09.12.1998 and Law no. 179 of 31.07.2002. Today, the reference directive is the Legislative Decree 152/2006 'Consolidated Environmental Act', which in Part IV, Title V 'Remediation of contaminated sites', dictates the administrative and technical procedures for the remediation of contaminated sites. Over time, there have been numerous regulatory updates that have changed the selection criteria for the SINs, leading some of these to be downgraded to Sites of Regional Interest (SIRs). The SINs in their entirety are managed by the Italian Ministry of the Environment, today called 'of the Ecological Transition', while the pass to the competence of the territorially concerned Regions SIRs regarding the verification and eventual remediation operations. Currently, in Italy there are 42 SINs and 17 SIRs. All the information derived from the various environmental regulations and that found in the context of the remediation procedures made it possible to define the exposure of the population residing in the areas adjacent to the SINs and SIRs as well as the elaboration of sheets containing all the site-specific information.

[SENTIERI Project: air pollution and health impact of population living in industrial areas in Italy]. / Valutazione dell'impatto dell'inquinamento atmosferico sulla salute della popolazione residente nelle aree industriali italiane incluse nel Progetto SENTIERI.

OBJECTIVES: to estimate the impact of PM2.5 and PM10 in the Italian industrial areas included in the SENTIERI project characterized by industrial plants with combustion processes deriving from point emissions. DESIGN: using satellite data, the Population Weighted Exposure (PWE) to PM2.5 and PM10 for 2011 and 2015 was estimated. The concentration-response functions available were used to estimate the number of premature deaths attributable to exposure to industrial emissions. The counterfactual levels recommended by the new WHO Air Quality Guidelines were used. SETTING AND PARTICIPANTS: for the selection of industrial plants, the European database on emissions of the European Pollutant Release and Transfer Register was used. Residents in areas of 1 km x 1 km and 4 km x 4 km around the selected industrial plants were considered. MAIN OUTCOME MEASURES: the number of premature deaths from non-accidental causes, cardiovascular and respiratory diseases, and lung cancer was estimated. RESULTS: residents were exposed to PM2.5 values of 17.3 µg/m3 (Northern Italy: 23.3) and to 24.3 µg/m3 (Northern Italy: 30.3) of PM10. PWE for both pollutants tends to increase as the size of the area under study is reduced and it is generally higher everywhere in 2011 than in 2015, with values that are always higher than the average (overall) in the Norther Italy. In 2011, 1,709 (IC95% 1,309-1,903) and 1,611 (IC95% 1,225-2,353) non accidental premature deaths were estimated attributable to PM2.5 and PM10, respectively, in residents close to the industrial plants (1 km x 1 km). Deaths attributable to exposure to PM2.5 and PM10 tend to follow a North-Central-South&Islands gradient for all observed causes and for both years of analysis. CONCLUSIONS: although exposure assessment of the population by using random-forest model does not allow to disentangle the contribution of the industrial component, the results of the study are suggestive of an impact on health from PM exposure in the industrial areas considered, with a greater impact in the vicinity of the plants, recommending the implementation of urgent impact reduction actions.

[From the selection of priority pollutants to the analysis of health data in the SENTIERI Project]. / Dalla selezione degli inquinanti prioritari alla lettura dei dati sanitari nel Progetto SENTIERI.

OBJECTIVES: evaluation of mortality and hospitalization of residents in five Italian National Priority Contaminated Sites, studied in the SENTIERI Project, for those pathologies which, on the basis of the assessments of international agencies and bodies, are known to have an aetiological connection with exposure to specific environmental pollutants. DESIGN: ecological study. SETTING AND PARTICIOANTS: resident population in the sites of Trieste and Piombino (steel plants), and Falconara, Livorno, and the industrial area of Milazzo (petrochemical plants and/or refineries). Data extracted from the Sixth SENTIERI Report. MAIN OUTCOME MEASURES: mortality (2013-2017) and hospitalization (2014-2018) for associated causes by exposure to specific pollutants detected in the soil and water matrices. RESULTS: the results obtained do not show common patterns between the excesses found in Trieste and Piombino Sites (steel plants) nor among Livorno, Falconara, and Milazzo (petrochemicals and/or refineries). Livorno and Trieste sites, having a larger population, show the greatest number of excesses. CONCLUSIONS: the proposed approach can be a useful tool, in addition to others, for the study of the health profile of residents in contaminated sites, being also the basis for aetiological epidemiological studies.

[The concept map of SENTIERI Project: a communication interactive digital tool of the national epidemiological surveillance system of Italian contaminated sites]. / La mappa concettuale: uno strumento digitale interattivo per la comunicazione del sistema di sorveglianza epidemiologica SENTIERI nei siti contaminati.

This paper describes the development and the envisioned use of concept maps in the framework of the SENTIERI communication strategies as an information and scientific communication tool applied to epidemiological surveillance in contaminated sites. The concept map of SENTIERI 2019-2022 was designed and implemented to foster access to complex scientific information ensuring usability of the contents and communication with the various stakeholders. The concept map aims to promote environmental health literacy in contaminated sites. The methodology adopted to create the map includes the following phases: 1. choice of a dynamic focus question; 2. selection of the representative terms of the addressed topics; 3. elaboration of the glossary of the selected terms; 4. representation of the links among the selected terms; 5. identification of the significant propositions that make explicit the meaning of each link. Online access to the map is guaranteed by the Mindomo software. The use of the concept map promotes active learning of the topics that characterize SENTIERI 2019-2022 through knowledge paths chosen because of the specific interests and learning purposes. The concept map derives from the integration of specific approaches of the epidemiological discipline with those of the social sciences and offers the possibility of developing site-specific maps through the interactions with local actors and the integration of elements related to emerging problems as well as institutional and local interests.

Spatial distribution of kidney disease in the contaminated site of Taranto (Italy).

BACKGROUND: Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. METHODS: Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. RESULT: Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. CONCLUSION: Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.

[Index contaminants and target organs]. / Inquinanti indice e organi bersaglio.

SENTIERI Project evaluates the health impact of environmental exposures on residential population of National Priority Contaminated Sites (NPCSs). It takes into account a priori etiological hypotheses, based on the epidemiological evidence of an association between those exposures and selected diseases or causes of death. Building on the previous chapter, this one acts as a blueprint for future causal inferences based on scientific evidence relating to the health effects of exposure to specific pollutants present in the sites. In order to select the relevant pollutants, we make use of data concerning soil, aquifers, the food chain and the atmosphere. For each pollutant, we indicate cancer site and target organs, for non-neoplastic diseases, based on scientific assessment by international Agencies. We have chosen to focus on two sites: Brescia-Caffaro and Priolo. This method may conceivably be used by SENTIERI in the future to carry out more specific studies and provides the basis for a systematic analysis of contaminated sites.

[Environmental characterization and exposure evaluation]. / Prospettive nella caratterizzazione ambientale e valutazione dell'esposizione.

As certified by the World Health Organization (WHO), exposure assessment represents a key stage in epidemiological studies that aim to evaluate health risks linked to contaminated sites. The assessment procedure is contingent on the availability of data relating to environmental and food compartments and on any other available scientific evidence, such as data on toxicity and human biomonitoring. This chapter outlines the procedure that should be adopted in order to conduct an accurate exposure assessment and presents three case studies involving different types of contaminated sites where this approach was applied.

Promotion of environmental public health and environmental justice in communities affected by large and long lasting industrial contamination: methods applied and lessons learned from the case study of Porto Torres (Italy).

Introduction: Communities affected by large scale and long lasting industrial contamination are often keen to understand whether their health has been impaired by such contamination. This requires answers that integrate environmental public health and environmental justice perspectives. At these sites, exposure scenarios from environmental contamination over time by multiple chemicals, often involving different environmental matrices, are complex and challenging to reconstruct. Methods: An approach for describing the health of such communities in association with environmental contamination is presented, with the methods applied across the three domains of environmental contamination, population exposure and toxicology, environmental and social epidemiology, and environmental public health communication. The approach is described with examples from its application to the case study of Porto Torres, a town with a substantial industrially conditioned evolution. Results: Activities in the field of environmental contamination, population exposure and toxicology focus on the collection and systematization of available contamination data, the identification of priority pollutants based on their toxicological profiles, the qualitative assessment of the likelihood of exposure for the population to priority pollutants and their known health effects. Environmental and social epidemiology methods are applied to describe the health profiles and socioeconomic conditions of the local population, taking into account multiple health outcomes from local information systems and considering specific diseases based on exposure and toxicological assessments. The environmental public health communication methods are directed to produce a communication plan and for its implementation through interaction with local institutional and social actors. The interpretation of health profiles benefits from a transdisciplinary analysis of the results. Discussion: The proposed approach combines the needs of environmental public health and environmental justice allowing the integration of multidisciplinary knowledge to define recommendations for reducing and/or preventing hazardous environmental exposures and adverse health effects, stimulating the interactions between stakeholders, and making the study results more accessible to citizens.

Ecological meta-analytic study of kidney disease in Italian contaminated sites.

INTRODUCTION: Environmental heavy metals exposure has been associated with kidney disease. There is also some evidence that exposure to solvents may be a risk factor for kidney disease. We estimated the risk of hospitalization for kidney diseases (ICD-9 580-586) and chronic kidney disease (CDK, ICD-9 585) in residents in thirty-four Italian National Priority Contaminated Sites (NPCSs) polluted by heavy metals. METHODS: Random-effects model meta-analyses of SHR (Standard Hospitalization Ratio) computed for each NPCS was performed for all the NPCSs together, and separately, according to the presence/absence of selected industrial activities (petrochemical/refinery and steel plants), and the presence/absence of solvents contamination. RESULTS: Pooled SHRs of overall NPCSs were in excess in both genders. Statistically significant excesses were found for CKD in both genders, and for kidney diseases in females, residing in NPCSs with the combined presence of heavy metals and solvents contamination. The pooled SHRs for CKD and kidney diseases were not statistically significant in excess in NPCSs with petrochemical/refinery and steel plants, and only petrochemical/refinery plants. CONCLUSIONS: The results are suggestive of a possible kidney disease risk in population living in the above-mentioned NPCSs. Epidemiological surveillance and remediation actions in these areas are recommended.

Analysis of major pollutants and physico-chemical characteristics of PM2.5 at an urban site in Rome.

Air quality data from a one year study at an urban roadside location in Rome are reported for major pollutants. Continuous concentration data of carbon monoxide, ozone, nitrogen dioxide, aromatic hydrocarbons and natural radioactivity were measured in the urban air of Rome from January 2016 to January 2017. Moreover, PM2.5 mass concentration and physico-chemical characteristics of single constituent particles are herein reported. Gaseous pollutants, except ozone, and PM2.5 showed maximum concentrations in December due to high atmospheric stability. O3 and NO2 trend analysis showed photochemical smog episodes in June and September. In September, during a photochemical smog episode the aromatic hydrocarbons contribution to ozone formation was experimentally proven. Pearson's coefficient among aromatic hydrocarbons and the ratio Toluene/Benzene (T/B) showed that pollutants were under the influence of vehicular traffic. Physico-chemical characterization of PM2.5 single particles, carried out by field emission scanning electron microscope combined with energy dispersive X-ray spectroscopy, displayed the presence of particle diversity from natural and anthropogenic origin. Four principal components in the PM2.5 were identified: carbonaceous particles, Ca-sulphates, soil dust and building structure particles, metal particles. The principal source of carbonaceous particles in this urban area consists of the motor vehicle exhausts and the heating systems in winter. Traces of S and sometimes S, Na, K were detected on varying percentages of carbonaceous particles. These data suggested that the carbonaceous particles act as vehicles for strong acids, prevalently H2SO4 and alkaline metal sulphates. A Saharan dust contribution to PM2.5 was found in different periods. Metal particles included iron oxide particles, metals oxide particles and Fe-rich metal compounds. The identification of chemical composition of individual particles provide useful information to determine their origin and formation processes.

Italian survey on human behaviour for inhalation exposure assessment.

In order to support risk management in identifying effective mitigation measures, exposure assessment related to environmental pollution needs to integrate monitoring of pollution levels and control data with information on population behaviour and lifestyle. With this aim, a sample population survey was carried out in a Northern Italian city, collecting data on human behavioural factors influencing inhalation exposure. Questionnaires gathering data on dwelling characteristics, and weekly individual diaries on personal behaviour, such as places frequented and daily activities, were used. Data collection was carried out in two different seasons, spring-summer and fall-winter. A sample of 270 families, randomly selected from the municipal registry, was enrolled for each seasonal observation. The study allowed quantification of variability in human behaviour revealing seasonal variation and differences due to age and gender. Daily activity patterns were described and probability distributions of inhalation rates were obtained for all observed population groups. A probabilistic exposure model was developed and the resulting exposure distributions for the two seasonal periods were compared. Results confirm that exposure estimates are strongly biased if variability in human behaviour is not taken into account.

Cancer incidence in Priolo, Sicily: a spatial approach for estimation of industrial air pollution impact.

The territory around the industrial Sicilian area of Priolo, Italy, has been defined as a contaminated site (CS) of national priority for remediation because of diffuse environmental contamination caused by large industrial settlements. The present study investigates the spatial distribution of cancer into the CS territory (period 1999-2006). Different geographical methods used for the evaluation of the impact of industrial air pollutants were adopted. Using the database of Syracuse Province Cancer Registry, gender-specific standardised incidence ratios were calculated for 35 tumour sites for the CS overall and for each municipality included in the CS. A cluster analysis for 17 selected neoplasms was performed at micro-geographical level. The identification of the priority index contaminants (PICs) present in environmental matrices and a review of their carcinogenicity have been performed and applied in the interpretation of the findings. The area has a higher cancer incidence with respect to the provincial population, in particular excess is registered among both genders of lung, bladder and breast cancers as well as skin melanoma and pleural mesothelioma and there is an a priori evidence of association with the exposure to PICs. The study highlights the need to provide different approaches in CSs where several exposure pathways might be relevant for the population. The presence of potential sources of asbestos exposure deserves specific concern.

Stochastic modelling of human exposure to food chemicals and nutrients within the "Montecarlo" project: an exploration of the influence of brand loyalty and market share on intake estimates of intense sweeteners from sugar-free soft drinks.

To get a more realistic view of exposure to food chemicals, risk managers are getting more interested in stochastic modelling as an alternative to deterministic approaches based on conservative assumptions. It allows to take into account all the available information in the concentration of the chemical present in foods and in food consumption patterns. Within the EC-funded "Montecarlo" project, a comprehensive set of mathematical algorithms was developed to take into account all the necessary components for stochastic modelling of a variety of food chemicals, nutrients and ingredients. An appropriate computer software is being developed. Since the concentration of food chemicals may vary among different brands of the same product, consumer behaviour with respect to brands may have an impact on exposure assessments. Numeric experiments were carried out on different ways of incorporating indicators of market share and brand loyalty in the mathematical algorithms developed within the stochastic model of exposure to intense sweeteners from sugar-free beverages. The 95th percentiles of intake were shown to vary according to the inclusion/exclusion of these indicators. The market share should be included in the model especially if the market is not equitably distributed between brands. If brand loyalty data are not available, the model may be run under theoretical scenarios.

Environmental concentrations of fibers with fluoro-edenitic composition and population exposure in Biancavilla (Sicily, Italy).

INTRODUCTION: The town of Biancavilla (Sicily) was included in the National Priorities List of Contaminated Sites due to environmental dispersion of amphibole fibers owing to the extraction of materials from a local quarry. The present report summarizes results from several, hitherto unpublished, environmental surveys carried out in the area, as well as from published analyses of the chemistry and composition of fibers. METHODS: Data included here comprises environmental fiber concentrations by scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) analysis in soil, indoor and outdoor air, personal monitoring, as well as a chemical characterization of the fibers. The full chemical structure and spectroscopic characterization of fibers were obtained through a multi-analytical approach: SEM-EDS, X-ray powder diffraction (XRPD), as well as Mössbauer (MS) and Fourier transform infrared (FT-IR) spectroscopies. RESULTS: Data analyzed provided a spatial and temporal picture of fiber concentrations in Biancavilla, and a qualitative assessment of population exposure. Results suggest that until 2000, the population had been exposed to high levels of amphibole fibers. Mitigation measures adopted since 2001, gradually reduced exposure levels to about 0.1-0.4 ff/l. Previous studies on fibrous amphiboles from Biancavilla reported considerable chemical variability. Differences in composition, especially concerning the presence of Si, Ca, Fe, and Na, were found both within and between samples. Compared to the previously investigated prismatic fluoro-edenite, these fibrous fluorine amphiboles consistently showed higher average values of Si and Fe content, whereas Ca was significantly lower, which we consider a distinctive characteristic of the fluorine fibrous variety. CONCLUSIONS: The population of Biancavilla had been highly exposed to a suite of fibrous amphiboles for over 50 years. Dust mitigation measures have gradually reduced exposure, but continuous environmental follow-up is necessary in order to monitor exposure levels and prevent adverse health effects for future generations.

Mesothelioma incidence in the neighbourhood of an asbestos-cement plant located in a national priority contaminated site.

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.

Health Impact Assessment practice and potential for integration within Environmental Impact and Strategic Environmental Assessments in Italy.

Avoiding or minimizing potential environmental impact is the driving idea behind protecting a population's health via Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). However, both are often carried out without any systematic approach. This paper describes the findings of a review of HIA, EIA andSEA experiences carried out by the authors, who act as institutional competent subjects at the national and regional levels in Italy. The analysis of how health is tackled in EIA and SEA procedures could support the definition of a protocol for the integration of HIA with EIA and SEA. Although EIA and SEA approaches include the aim of protecting health,significant technical and methodological gaps are present when assessing health systematically, and their basic principles regarding assessment are unsatisfactory for promoting and addressing healthcare concepts stated by the WHO. HIA is still poorly integrated into the decision-making process, screening and monitoring phases are only occasionally implemented, and operational details are not well-defined. The collaborative approach of institutions involved in environment and health is a core element in a systematic advancement toward supporting effective decisions and effective protection ofthe environment and health. At the Italian national level, the definition of guidelines and tools for HIA, also in relation with EIA and SEA, is of great interest.