Anica Casetta

Mercury, arsenic and selenium exposure levels in relation to fish consumption in the Mediterranean area

In order to assess mercury (Hg), selenium (Se) and arsenic (As) exposure in the Mediterranean area, total mercury (THg), monomethylmercury (MeHg), Se and As levels were measured in umbilical cord blood and breast milk from Italian (n=900), Slovenian (n=584), Croatian (n=234) and Greek (n=484) women. THg, MeHg, As, and Se levels were also determined in blood samples of the same mothers from Italy and Croatia. In addition, THg and MeHg were determined in the same womens hair from all the countries involved in this study and As and Se levels were determined in the mothers urine samples from Italy, Croatia and Greece. Besides recording the consumption of other food items, the frequencies of fish consumption were assessed by detailed food frequency questionnaires, since fish represents an important source of Hg, Se and As in humans. The highest levels of THg and As were found in cord blood (Med((THg))=5.8 ng/g; Med((As))=3.3 ng/g) and breast milk (Med((THg))=0.6 ng/g; Med((As))=0.8 ng/g) from Greek women, while the highest Se levels were found in cord blood (Med=113 ng/g) from Italy. Significant linear correlations were found between Hg, Se and As in blood, cord blood and breast milk. In addition, significant relations were found between the frequencies of total fish consumption and biomarkers of As, MeHg and Se exposure, with the strongest Spearman rank coefficients between frequencies of total fish consumption and THg levels in cord blood (r(s)=0.442, p<0.001) or THg levels in hair (r(s)=0.421, p<0.001), and between frequencies of total fish consumption and As levels in cord blood (r(s)=0.350, p<0.001). The differences in Hg and As exposure between countries were probably due to different amounts of fish consumption and the consumption of different species of fish of different origin, while the highest Se levels in women from Italy were probably the consequence of the more frequent consumption of different non specific food items. Moreover, fish consumption, the possible common source of As, Hg and Se intake, could explain the correlations between the elements determined in cord blood, mothers blood or breast milk.

The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study

Background: The prevalent use of antidepressants (ATDs) in patients with Amyotrophic Lateral Sclerosis (ALS) varies across cross-sectional and clinic-based published studies. This population-based cohort study assesses the real-world prevalence of the use of ATDs, its trajectory and the association of incident use with clinical characteristics. Methods: All patients with incident ALS in the Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources including health databases. Diagnosis was validated through clinical documentation review. ATDs prescriptions from 2000 to 2011 were obtained from regional database. The trajectory was estimated through generalized estimating equations for repeated measures logistic regression and the Hazard ratio (HR) of initiating ATDs through multivariate proportional hazard Cox regression. Results: In this cohort of 261 ALS cases, age-, sex-adjusted prevalence of the use of ATDs was 37.3%, higher than in general population. The trajectory increased by 16% in 1-year period across diagnosis. Age ≤67 years at diagnosis (HR 1.28, 95% CI 0.84-1.95) and bulbar onset (1.43, 95% CI 0.90-2.26) were positively associated with initiating ATDs after diagnosis. Conclusions: More than one-third of patients used ATDs. Depression may occur more frequently than previously reported. Depression may precede motor alterations and be related to both ALS diagnosis and progression.

Mortality in a cohort of asbestos-exposed workers undergoing health surveillance

BACKGROUND The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health surveillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality. OBJECTIVES To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy. METHODS Standardized Mortality Ratios (SMR), with 95% Confidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994). RESULTS A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60). CONCLUSIONS This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure.

[Cancer mortality of residents near a steel factory in Udine (Friuli Venezia Giulia Region, Northern Italy)].

OBJECTIVES to evaluate the association between distance of residence from a steel factory, a point source of air pollution within an industrial area in Udine (Friuli Venezia Giulia Region, Northern Italy), and cancer mortality. DESIGN retrospective study. To evaluate the association between mortality rates and distance from the source, a Stone test analysis for all cases occurred in the entire area was conducted. The significance level was determined using Monte Carlo simulations. SETTING AND PARTICIPANTS a GIS mapped residential history of Friuli Venezia Giulia population was completed. Among residents within 5 km from the principal industrial plant of the area from 1989 to 2012, deaths caused by cancer were selected. Furthermore, according to the prevalent wind direction, an analysis was conducted also in a subgroup of residents located into the South-Western quadrant. A set of 8 bands with increasing distance from the point-source was defined. The total population was 37,473 inhabitants. MAIN OUTCOME MEASURES in each band, observed and expected cancer-related deaths (calculated on the basis of mortality rates in the entire area) and standardized mortality ratios (SMRs) were computed to test for decline in risk of mortality at different distances from the main chimney. Stone test, in which a decline in risk of disease with an increase in distance from the source of pollution is tested, was used. RESULTS the risk for all cancers and lung cancer was higher than expected. For male residents located within 2 km into the South-Western quarter there were 21 observed deaths from lung cancer vs. 13 expected (SMR: 1.62; p-value=0.02). CONCLUSION despite the fact that in the whole area cancer mortality is not increased, this study seems to support evidence of an excess of cancer deaths, especially lung cancer among males, near a steel factory. However, the study has limitations because of the small number of cases and the lack of individual exposure data and information about confounders (e.g., smoke habits and professional exposure). Therefore, a possible cause-effect interpretation of this association should be considered with caution.

Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance

ObjectivesTo compare a local cohort of 2488 men occupationally exposed to asbestos and enrolled in a public health surveillance program with the 1995–2009 cancer incidence of the general population of Friuli Venezia Giulia (FVG) region, Northeast Italy, we conducted a historical cohort study.MethodsStandardized incidence ratios (SIRs), with 95% confidence interval (95% CI), for specific cancer sites were estimated in the cohort and in subgroups of workers employed in shipbuilding between 1974 and 1994. For internal comparisons, we calculated incidence rate ratios (IRRs) for all cancers, lung cancer and mesothelioma, by level of exposure to asbestos and sector of employment adjusted for smoking habits and age at start of follow-up.ResultsAmong cohort members the SIR was 8.82 (95% CI 5.95–12.61) for mesothelioma and 1.61 (95% CI 1.26–2.04) for lung cancer. In subgroup analyses, the SIR for lung cancer in subjects hired in shipbuilding between 1974 and 1984 was 2.09 (95% CI 1.32–3.13). In the overall cohort, a borderline increased incidence was also found for stomach cancer (SIR = 1.53 95% CI 0.96–2.31). Internal comparisons within the cohort show that among men with high asbestos exposure level the relative risk was almost threefold for lung cancer (IRR = 2.94 95% CI 1.01–8.57).ConclusionsThis cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974 and 1984.

Relation of Fish Consumption to Biomarkers of Mercury, Selenium and Arsenic Exposure from Mediterranean Women

In order to assess mercury (Hg), selenium (Se) and arsenic (As) exposure in the Mediterranean area, total mercury (THg), monomethylmercury (MeHg), Se and As levels were measured in umbilical cord blood and breast milk from Italian (n=900), Slovenian (n=584), Croatian (n=234) and Greek (n=484) women. THg, MeHg, As, and Se levels were also determined in blood samples of the same mothers from Italy and Croatia. In addition, THg and MeHg were determined in the same womens hair from all the countries and As levels were determined in the mothers urine samples from Italy, Croatia and Greece. In addition to recording the consumption of other food items, the frequencies of fish consumption were assessed by detailed food frequency questionnaires, since fish can represents an important source of mercury, selenium and arsenic in humans. The highest levels of THg and As were found in cord blood (Med(THg) =5.8 ng/g ; Med(As) =3.3 ng/g) and breast milk (Med(THg) =0.6 ng/g ; Med(As) =0.8 ng/g) from Greek women, while the highest Se levels were found in cord blood (Med=113 ng/g) and mother’s blood (Med=117 ng/g) from Italy. Significant linear correlations were found between different biomarkers of Hg, As and Se exposure. In addition, significant relations were found between the frequencies of total fish consumption and Hg, As and Se biomarkers of exposure, possibly explaining the correlations between the elements determined in cord blood, mothers blood or breast milk. Moreover, the differences in As and Hg exposure between countries were probably due to different amounts of fish consumption and the consumption of different species of fish of different origin.