Salvatore Scondotto

Incidence of pleural mesothelioma in a community exposed to fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy)

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.

Health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy): mortality and hospitalization from current data

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.

Mortality and morbidity study of petrochemical employees in a polluted site

BackgroundThe area of Gela was included among the 57 Italian polluted sites of national interest for environmental remediation because of its widespread contamination from a petrochemical complex. The present study investigates mortality and morbidity of the cohort of Gela petrochemical workers with the aim of disentangling occupational from residential risk.MethodsMortality was assessed for 5,627 men hired from 1960, year of the plant start-up, to 1993; it was followed up for vital status in the period 1960–2002. Morbidity was analysed for 5,431 workers neither dead nor lost to follow-up from 1960 to 2001 and was based on Hospital Discharge Records in the period 2001–2006. The work experience was classified in terms of job categories such as blue collars, white collars, and both – workers who shifted from blue to white collar (95%) or vice versa. An ad hoc mobility model was applied to define qualitative categories of residence in Gela, as residents and commuters. Standardized Mortality Ratios (SMRs) and Mortality Rate Ratios (MRRs) were computed, the latter by using a Poisson regression model. Morbidity was analyzed in terms of Hospital Discharge Odds Ratios (HDORs) through a logistic regression model. While performing the internal comparisons, white collars was the reference category for the job analysis, and commuters was the reference category for the residential analysis.ResultsIn the light of epidemiological evidence about health risk from petrochemical industries in both occupational and environmental settings, and/or on the basis of information about occupational and residential contamination and health risk in the area of Gela, noteworthy results are shown for lung cancer [MRR: 2.11 (CI 90%; 0.96-4.63) in blue collars; 1.71 (1.09-2.69) in residents], respiratory diseases [HDOR: 2.0 (1.0-3.0) in blue collars; 1.4 (0.96-2.06) in residents] and genitourinary diseases [HDOR: 1.34 (1.06-1.68) in blue collars; 1.23 (1.04-1.45) in residents].ConclusionsThe results support a role of the exposures in the occupational and residential settings, the latter due to the local ascertained contamination, in affecting the workers’ health. These results underline the urgent need of water, soil, air and food-chain monitoring programs, to discover active sources of exposure and consequently define public health interventions.

The fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy): health impact and clues for environmental remediation

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.

β-Thalassemia heterozygote state detrimentally affects health expectation

BACKGROUND Thalassemia minor (Tm) individuals, are generally considered healthy. However, the prognosis of Tm individuals has not been extensively studied. The aim of this study was to evaluate the prognosis of Tm versus controls without β-thalassemia carrier state. METHODS A total of 26,006 individuals seeking thalassemia screening at the AOOR Villa Sofia-V. Cervello, Palermo (Italy) were retrospectively studied. Logistic penalised regression model was used to estimate risk of potential complications and survival techniques were used to study mortality. RESULTS We identified a total of 4943 Tm and 21,063 controls. Tm was associated with significantly higher risks of hospitalisation for cirrhosis (OR 1·94, 95% CI 1·30 to 2·90, p = 0·001), kidney disorders (OR 2·11, 95% CI 1·27 to 3·51, p = 0·004), cholelithiatis (OR 1·39, 95% CI 1·08 to 1·79, p = 0·010), and mood disorders (OR 2·08, 95% CI 1·15 to 3·75, p = 0·015). No statistically difference in life expectancy between thalassemia minor and control group was found (HR 1·090, 95% CI 0·777 to 1·555, p < 0·590; log-rank test p = .426). CONCLUSION This study shows that Tm affects the prognosis of Tm carriers regarding health expectation. Probably, iron overload and anaemia for several years may be at the basis of these effects.

Short-term effects of desert and non-desert PM10 on mortality in Sicily, Italy

BACKGROUND Increased PM10 concentrations are commonly observed during Saharan dust advections. Limited epidemiological evidence suggests that PM10 from anthropogenic and desert sources increase mortality. We aimed to evaluate the association between source-specific PM10 (non-desert and desert) and cause-specific mortality in Sicily during 2006-2012 period. METHODS Daily PM10 concentrations at 1-km2 were estimated in Sicily using satellite-based data, fixed monitors and land use variables. We identified Saharan dust episodes using meteorological models, back-trajectories, aerosol maps, and satellite images. For each dust day, we estimated desert and non-desert PM10 concentrations. We applied a time-series approach on 390 municipalities of Sicily to estimate the association between PM10 (non-desert and desert) and daily cause-specific mortality. RESULTS 33% of all days were affected by Saharan dust advections. PM10 concentrations were 8 μg/m3 higher during dust days compared to other days. We found positive associations of both non-desert and desert PM10 with cause-specific mortality. We estimated percent increases of risk (IR%) of non-accidental mortality equal to 2.3% (95% Confidence Interval [CI]: 1.4, 3.1) and 3.8% (3.2, 4.4), per 10 μg/m3 increases in non-desert and desert PM10 at lag 0-5, respectively. We also observed significant associations with cardiovascular (2.4% [1.3, 3.4] and 4.5% [3.8, 5.3]) and respiratory mortality (8.1% [6.8, 9.5], and 6.3% [5.4, 7.2]). We estimated higher effects during April-September, with IR% = 4.4% (3.2, 5.7) and 6.3% (5.4, 7.2) for non-desert and desert PM10, respectively. CONCLUSIONS Our results confirm previous evidence of harmful effects of desert PM10 on non-accidental and cardio-respiratory mortality, especially during the warm season.

The heterozygote state for β-thalassemia detrimentally affects health outcomes: Correspondence

To the Editor: b-Thalassemia is a hereditary blood disorder decreasing hemoglobin synthesis. b-Thalassemia is classified into three phenotypes, depending on the severity of symptoms: (1) thalassemia major (TM); (2) thalassemia intermedia (TI); and (3) thalassemia minor (Tm). In TM, signs and symptoms appear within the first two years of life and patients develop life-threatening anemia (hemoglobin (Hb) <7.0 g/dL). TM patients are lifetime transfusion-dependent. Over time, chronic blood transfusions can lead to severe body iron accumulation that, in spite of chelation treatments, may result in liver, cardiac, and endocrinological complications. In TI, the signs and symptoms appear after the first two year of life. Affected individuals have mild to moderate anemia (Hb 7.0 to 9.0 g/dL) and they may need occasionally blood transfusions. The clinical consequences may include endocrinopathies, bone disease, thromboembolism, pulmonary hypertension, cerebrovascular and neuronal damage, liver fibrosis or cirrhosis, and increased risk of hepatocellular carcinoma. Tm individuals are usually considered healthy and they do not need blood transfusions because of this condition. Here we provide data on complications and mortality in Tm individuals compared to a control group (Ctr). We performed a retrospective review of all subjects voluntarily seeking thalassemia screening at the Regional Centre for Thalassemia, Azienda Ospedali Riuniti Villa Sofia-V. Cervello, Palermo (Italy) from January 2000 to July 2014. Our unit is the Hub Centre for Prenatal Diagnosis and Screening of Thalassemias for the whole Sicily. By using data on hospital admissions and mortality provided by Department Health Services and Epidemiological Observatory (DHSEO) of the Sicilian Region, we captured hospital admissions for different complications, as Diagnosis Codes according to the ICD-9-CM, from January 2004 until December 2013. Information on hospital admission and mortality before January 2004, for all individuals included in the study, were not available at the DHSEO because data were not computerized. Logistic penalized regression model (LPRM) was used to estimate the risk to develop different complications. The considered model takes into account the effect of group (Tm vs. Ctr), sex (M vs. F), age, and interaction between sex and age on the occurrence of a single complication. The variable relative to a specific complication was set to zero when the complication was not present and 1 when the complication was present at least once regardless of the number of admissions for the specific disease. A Cox regression model, Kaplan–Meier curves, and a log-rank test were used to investigate difference in survival between the two groups of interest. Overall, 26 006 individuals were included in this retrospective review: 4943 subjects had Tm, while 21 063 were normal controls proven negative for the b-thalassemia carrier state. Hematological data showed statistical significant differences between the two groups for all variables considered (Supporting Information Table 1). The risks of hospital admission for cholelithiasis, cirrhosis, mood disorders, and kidney disease were significantly higher in the Tm group vs. control (Table 1). No statistically significant differences were found for arrhythmia, diabetes, and ischemic cardiomyopathy (results not reported). The probability of hospital admission for cholelithiasis, cirrhosis, mood disorders, and kidney disease increased with age and with hospitalization for other causes (Table 1; Supporting Information Figure 1). The probability of hospital admissions for cirrhosis and kidney diseases was greater in males, while that for cholelithiasis was greater in females, with no gender differences identified for mood disorders (Table 1; Supporting Information Figure 1). The risk of death in the Tm group was similar to that of the control group (HR 1 090, 95% CI 0.777 to 1.555, P< .590; log-rank test P5 .426; Supporting Information Table 1 and Figure 2), as reported by Gallerani et al. These findings in a large cohort of Italian individuals suggest that Tm increases significantly the risk of hospitalization for cirrhosis, kidney disorders, cholelithiasis, and mood disorders when compared with a control group. The statistically significant increased risk of hospitalization for cirrhosis may be related to long-term enhanced iron absorption in the Tm versus control group, probably due to ineffective erythropoiesis and erythroid hyperplasia. Different reports suggested the existence of a kidney disorders in Tm. The increased risk of hospitalization for kidney diseases shown in our present study further supports the notion that kidney diseases is more common in Tm. Borgna-Pignatti et al. suggested that women with Tm have significantly higher prevalence of cholethiasis. They also detected an increased risk of hospitalization for cholelithiasis in females with Tm, which seemed to increase with age perhaps as a consequence of lifetime mild hemolysis and/or ineffective erythropoiesis. The increased risk of hospitalization for mood disorders in the Tm group, shown in the present study, is in accordance with the report by Kes ̧kek et al., 2013, which found higher Hamilton Depression Rating scores (HDRS) in Tm individuals vs. healthy controls (P< .001). The cause of mood disorders in Tm individuals is not clear. In conclusion, this large retrospective study shows that the b-thalassemia carrier state affects health expectations and outcomes, perhaps as a consequence of mild iron overload and anemia. Large

L’esperienza della Sicilia nella costruzione e nell’uso di un indice sintetico di posizione socioeconomica per la stima della salute nella popolazione

L’esperienza della Sicilia nella costruzione e nell’uso di un indice sintetico di posizione socioeconomica per la stima della salute nella popolazione - A regional socioeconomic index by municipality was build for the fist time. From last census (2001) was considerated education, employment, family, house condition ad immigration. Socioeconomic index was used to describe mortality in general people, highlighting that the social and economic disadvantage is a mortality predictor factor, different in both gender. Moreover it was used to adjust the estimates of mortality and morbidity in residents near the risk areas of Sicily. Key words: socioeconomic position, deprivation, mortality, risk area, petrochemical, epidemiology, Sicily. Parole chiave: posizione socioeconomica, deprivazione, mortalita, area a rischio, petrolchimico, epidemiologia, Sicilia.