Perceived Risk in the Population Living near the Turin Incinerator: Comparison between before and at Three Years of Operation.

When the Turin incinerator went into operation in 2013, it was accompanied by surveillance of health effects that included a human biomonitoring survey of 394 residents. They responded to items investigating their awareness of environmental and health issues and perception of environmental health risks. In this study, we compared the questionnaire responses before plant startup and at 3 years of operation. To accomplish this, we investigated changes in perceived risk and evaluated the efficacy of communication strategies. A total of 344 participants equally distributed in an exposed and an unexposed group responded to the follow-up questionnaire. Survey items investigated the perception of a relationship between illness and exposure to environmental pollution, feeling at risk of developing an illness, and concern about natural and anthropogenic hazards. The proportion of 'certain' and 'very probable' responses was compared to the total using the difference-in-differences method. Analyses showed an overall decrease in the differences between the two groups, which suggests that the communication actions undertaken for the exposed group were effective. Future communication plans should also include initiatives targeting the unexposed group.

Land Use Regression Models for Ultrafine Particles in Six European Areas.

Long-term ultrafine particle (UFP) exposure estimates at a fine spatial scale are needed for epidemiological studies. Land use regression (LUR) models were developed and evaluated for six European areas based on repeated 30 min monitoring following standardized protocols. In each area; Basel (Switzerland), Heraklion (Greece), Amsterdam, Maastricht, and Utrecht ("The Netherlands"), Norwich (United Kingdom), Sabadell (Spain), and Turin (Italy), 160-240 sites were monitored to develop LUR models by supervised stepwise selection of GIS predictors. For each area and all areas combined, 10 models were developed in stratified random selections of 90% of sites. UFP prediction robustness was evaluated with the intraclass correlation coefficient (ICC) at 31-50 external sites per area. Models from Basel and The Netherlands were validated against repeated 24 h outdoor measurements. Structure and model R2 of local models were similar within, but varied between areas (e.g., 38-43% Turin; 25-31% Sabadell). Robustness of predictions within areas was high (ICC 0.73-0.98). External validation R2 was 53% in Basel and 50% in The Netherlands. Combined area models were robust (ICC 0.93-1.00) and explained UFP variation almost equally well as local models. In conclusion, robust UFP LUR models could be developed on short-term monitoring, explaining around 50% of spatial variance in longer-term measurements.

[Human biomonitoring and variation of haematic parameters in a population exposed to PCB and dioxin near a steel plant in the lower Susa Valley]. / Biomonitoraggio umano e variazione dei parametri ematici in una popolazione esposta a PCB e diossine presso un'acciaieria in bassa Val di Susa.

OBJECTIVE: to evaluate the degree of exposure to PCB in a population resident in the lower Susa Valley and its effects on general and endocrine homeostasis. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES: in the lower Susa Valley (Piedmont, Italy), there is a steel secondary casting plant (i.e. by fusion of scrap iron), active since the '50s. The emissions of PCB and dioxin coming from the furnace were found in samples of herb, pulse and ground in a preliminary environmental characterisation study. During 2005-2006 we run an epidemiologic study of biomonitoring (measuring as outcome common haematochemical parameters, hormonal parameters, haematic PCB) on a sample of subjects resident in the municipalities with higher levels of PCB and dioxin contamination (exposed subjects), that was compared with another sample (unexposed) of subjects residing in other areas of the Susa Valley. RESULTS: the final sample consisted of 244 subjects (119 unexposed and 125 exposed), balanced by gender, age, education and representative of the Susa Valley population. The greater part of hormonal and toxic parameters showed worse values among exposed than among unexposed, including PCB median value (2.30 µg/l among exposed vs. 1.90 µg/l among unexposed). The difference however was not statistically significant and the values were lower than the population reference values (7.2 µg/l). Haematic PCB values were significantly and positively correlated with age and alcohol consumption and not significantly with male gender. The distribution of the principal haematochemical parameters (hemochrome, total, LDL and HDL cholesterol, triglycerides, glucose, creatinine, bilirubin, transaminases, gamma-glutamiltranspeptidase, proteine electrophoresis) showed also, on the whole, worse values among exposed compared to unexposed, even if the difference was not statistically significant for single values. CONCLUSIONS: the exposed population showed higher values of PCB haematic values and alterations of the hormonal and common heamatochemical parameters compared to unexposed population, even if within reference limits.

Guidelines for preoperative assessment: impact on clinical practice and costs.

OBJECTIVE: To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented. DESIGN: We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization. MAIN MEASURES: Mean number of tests prescribed, preoperative assessment cost per patient. RESULTS: The application of preoperative guidelines would decrease the mean number of tests prescribed from 20 laboratory and 1.9 instrumental to, respectively, 3 and 1.4 per patient. Tests deemed inappropriate by guidelines did not add any relevant clinical information to our study. Economic analysis estimates a reduction of 63% in cost per patient for preoperative tests by introducing guideline criteria (from 69 euros to 26 euros). As regards the cost per patient for preoperative evaluation and hospital stay (115 euros considering only variable costs, 580 euros including all costs), the application of the guidelines would reduce costs by 41-52% according to different cost evaluation approaches for hospital stay. CONCLUSION: Preoperative guidelines fully introduced in practice could notably increase efficiency without affecting the quality of care.

Survival after pleural malignant mesothelioma: a population-based study in Italy.

AIMS AND BACKGROUND: The study analyzed survival after malignant mesothelioma in the population-based Registry of Malignant Mesothelioma of Piedmont (NW Italy, 4.5 million total population). It focused on possible differences related to period of diagnosis a proxy of changes in diagnostic or therapeutic procedures. METHODS: Cases were actively searched in pathology units and files of hospital admissions and discharges. In 1990-1998, 693 incident cases were diagnosed in residents in the region: 590 of them had a histologic diagnosis of pleural mesothelioma in life and were included in the study. Vital status was ascertained at the municipality of residence as of January 1, 2000. RESULTS: Fifty-eight cases were alive (9.8%) and 20 were lost (3.6%) at the end of the follow-up. Median survival was 0.71 years (95% CI, 0.64-0.78). Cumulative survival was 35.9% at 1 year (95% CI, 32.0-39.8) and 14.2% at 2 years (95% CI, 11.2-17.1). Survival was associated to age (longer survival for younger subjects at diagnosis; P <0.0001) and to histology (longer survival for epithelial mesothelioma, shorter for fibrous and intermediate for mixed or unspecified types; P <0.0001). There was no difference in survival for period of diagnosis. The results were confirmed in multivariate analyses. Analyses according to type of hospital (with vs without thoracic surgery) did not show any statistically significant difference. DISCUSSION: The study on survival after malignant mesothelioma is the second largest of the three population-based studies in the world, which showed results similar to ours. Survival measured in published clinical series ranged between 18.4% and 57.6% at 1 year for pleural and 24.1% and 33.8% for peritoneal mesothelioma. The most striking effect of the present study was the absence of improvement in survival with period of diagnosis. Either there was no change in treatment efficacy or the effect was limited to small subgroups and could not be noticed when the analysis included larger categories.