Geographical information system and environmental epidemiology: a cross-sectional spatial analysis of the effects of traffic-related air pollution on population respiratory health

<p>Abstract</p> <p>Background</p> <p>Traffic-related air pollution is a potential risk factor for human respiratory health. A Geographical Information System (GIS) approach was used to examine whether distance from a main road (the Tosco-Romagnola road) affected respiratory health status.</p> <p>Methods</p> <p>We used data collected during an epidemiological survey performed in the Pisa-Cascina area (central Italy) in the period 1991-93. A total of 2841 subjects participated in the survey and filled out a standardized questionnaire on health status, socio-demographic information, and personal habits. A variable proportion of subjects performed lung function and allergy tests. Highly exposed subjects were defined as those living within 100 m of the main road, moderately exposed as those living between 100 and 250 m from the road, and unexposed as those living between 250 and 800 m from the road. Statistical analyses were conducted to compare the risks for respiratory symptoms and diseases between exposed and unexposed. All analyses were stratified by gender.</p> <p>Results</p> <p>The study comprised 2062 subjects: mean age was 45.9 years for men and 48.9 years for women. Compared to subjects living between 250 m and 800 m from the main road, subjects living within 100 m of the main road had increased adjusted risks for persistent wheeze (OR = 1.76, 95% CI = 1.08-2.87), COPD diagnosis (OR = 1.80, 95% CI = 1.03-3.08), and reduced FEV₁/FVC ratio (OR = 2.07, 95% CI = 1.11-3.87) among males, and for dyspnea (OR = 1.61, 95% CI = 1.13-2.27), positivity to skin prick test (OR = 1.83, 95% CI = 1.11-3.00), asthma diagnosis (OR = 1.68, 95% CI = 0.97-2.88) and attacks of shortness of breath with wheeze (OR = 1.67, 95% CI = 0.98-2.84) among females.</p> <p>Conclusion</p> <p>This study points out the potential effects of traffic-related air pollution on respiratory health status, including lung function impairment. It also highlights the added value of GIS in environmental health research.</p

The non-octarepeat copper binding site of the prion protein is a key regulator of prion conversion

The conversion of the prion protein (PrP(C)) into prions plays a key role in transmissible spongiform encephalopathies. Despite the importance for pathogenesis, the mechanism of prion formation has escaped detailed characterization due to the insoluble nature of prions. PrP(C) interacts with copper through octarepeat and non-octarepeat binding sites. Copper coordination to the non-octarepeat region has garnered interest due to the possibility that this interaction may impact prion conversion. We used X-ray absorption spectroscopy to study copper coordination at pH 5.5 and 7.0 in human PrP(C) constructs, either wild-type (WT) or carrying pathological mutations. We show that mutations and pH cause modifications of copper coordination in the non-octarepeat region. In the WT at pH 5.5, copper is anchored to His96 and His111, while at pH 7 it is coordinated by His111. Pathological point mutations alter the copper coordination at acidic conditions where the metal is anchored to His111. By using in vitro approaches, cell-based and computational techniques, we propose a model whereby PrP(C) coordinating copper with one His in the non-octarepeat region converts to prions at acidic condition. Thus, the non-octarepeat region may act as the long-sought-after prion switch, critical for disease onset and propagation

Residential Proximity to a Major Roadway Is Associated with Features of Asthma Control in Children

BACKGROUND: While several studies suggest that traffic-related air pollutants are detrimental for respiratory health, few studies have examined relationships between residential proximity to a major roadway and asthma control in children. Furthermore, a major limitation of existing research is reliance on self-reported outcomes. We therefore determined the spatial relationship between the distance from a major roadway and clinical, physiologic and inflammatory features of asthma in a highly characterized sample of asthmatic children 6-17 years of age across a wide range of severities. We hypothesized that a closer residential proximity to a major roadway would be associated with increased respiratory symptoms, altered pulmonary function and a greater magnitude of airway and systemic inflammation. METHODOLOGY/PRINCIPAL FINDINGS: 224 children 6-17 years with confirmed asthma completed questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, exhaled breath condensate collection and venipuncture. Residential distance from a major roadway was determined by mapping the geographic coordinates of the residential address in Geographic Information System software. The distance between the home address and the nearest major roadway was calculated according to the shortest distance between the two points (i.e., "as the crow flies"). Asthmatic children living in closer proximity to a major roadway had an increased frequency of wheezing associated with increased medication requirements and more hospitalizations even after controlling for potential confounders. These children also had increased airway resistance, increased airway inflammation reflected by a lower breath condensate pH, and higher plasma EGF concentrations. CONCLUSIONS/SIGNIFICANCE: These findings suggest that closer residential proximity to a major roadway is associated with poorer asthma control in school-age children. Assessment of residential proximity to major roadways may be useful in the clinical evaluation of asthma in children

A CASE-CROSSOVER ANALYSES ON THE EFFECTS OF AIR POLLUTANTS ON HOSPITALIZATION FOR RESPIRATORY AND CARDIOVASCULAR DISEASE, IN MASSA AND CARRARA, TUSCANY, ITALY (2005-2009)

Introduction: several studies have reported significant associations between outdoor air pollution and health outcome, such as deaths and hospital admissions for respiratory and cardiovascular diseases. Objectives: to analyse the short-term effects of air pollutants levels on hospital admissions for respiratory and cardiovascular diseases occurred in Massa-Carrara (Italy) during 2005-2009. Methods: hospital admissions for respiratory and cardiovascular diseases, ambient air pollution data (PM10, NO2, O3 and CO) and meteorological parameters were collected from July 2005 to December 2009 in the area of Massa-Carrara, northern Tuscany (Italy). A time-stratified case-crossover design was implemented and conditional regression models were fitted, adjusting for meteorological data and a set of time-dependent variables. The associations between exposure and hospitalised events were analysed taking into account different lag patterns in order to evaluate immediate or delayed effects of pollutants. Stratified analyses were conducted to identify more susceptible subgroups. Results: 7,931 admissions in local hospitals for respiratory diseases and 18,521 for cardiovascular diseases were identified for residents in Massa-Carrara. Respiratory hospital admissions were associated to 0,1 mg/m3 increase in CO (OR=1.035 95%CI= 1.017-1.053, lag0), to 10 µg/m3 PM10 increase during warm season (OR=1.05 CI=1.01-1.10, lag 4); children (0-14 years) respiratory admissions were associated to NO2 (OR=1.14 CI=0.979-1.343, lag1) and to O3 (OR=1.09 CI=1.01-1.17, lag3). Cardiovascular admissions were associated to NO2 (OR=1.029 CI=1.004-1.056, lag0), to PM10 (OR=1.029 CI=1.001-1.058, lag1) and to CO (OR=1.035 CI= 1.005-1.067, lag4) during warm season. Conclusions: this study confirmed the adverse effects of outdoor air pollution on cardiovascular and respiratory health. Elder people and children had higher risks of disease, mainly during warm season

State of health of populations residing in geothermal areas of Tuscany

OBJECTIVE The limited scientific knowledge on relationship between exposure and health effects in relation to geothermal activity motivated an epidemiologic investigation in Tuscan geothermal area. The study aims to describe the health status of populations living in Tuscany municipalities where concessions for exploitation of geothermal resources were granted. DESIGN This is an ecological study, so it is not useful to produce evidence to sustain a judgment on the cause-effect link. The major limits of this type of study are the use of the residence at municipal level as a proxy of exposure to both environmental and socioeconomic factors and the use of aggregated data of health outcomes that can lead to the well-known ecological fallacy. SETTING AND PARTICIPANTS Sixteen municipalities were included in the study area: eight are part of the so-called “traditional” geothermal area, defined as Northern Geothermal Area (NGA) and eight located in the Amiata Mountain defined as Southern Geothermal Area (SGA). In 2000-2006, the average resident population in the overall area was approximately 43,000 inhabitants. Thirty one geothermal power plants were active, with a production capacity of 811 MW, 5 of them with 88 MW located in the SGA. Statistical analyses on the entire geothermal area, NGA and SGA subareas, and the sixteen municipalities were performed. MAIN OUTCOME MEASURES MORTALITY DATA were obtained from Tuscany Regional Mortality Registry for the 1971-2006 period, analysing 60 causes of death, of interest for population health status or consistent with “Project SENTIERI” criteria. HOSPITAL DISCHARGE RECORDS of residents in Tuscany Region in 2004-2006, anywhere admitted to hospital, were analyzed considering only the main diagnosis, excluding repeated admissions for the same cause. The causes taken into account are the same analysed for mortality were considered. Age-standardized mortality rates (TSDM) and the temporal trends of TSDM for four periods (1971-1979, 1980- 1989, 1990-1999, 2000-2006) were computed. Age-standardized mortality/hospitalization ratios (SMR/SHR), with and without adjustment for the deprivation index based on 2001 census data, were calculated: mortality in the years 2000-2006 and hospitalization in 2004-2006. The expected number of events were computed using rates of residents in neighbouring municipalities (municipalities included in 50 km radius circle centred on the study area). Bayesian estimates of mortality/hospitalization ratios (BMR/BHR) at municipal level only and relating maps of the Bayesian risk estimators were elaborated. CONGENITAL MALFORMATIONS (MC) were analysed using data from Tuscan Registry of Birth Defect in 1992-2006 period, relative to outcomes of pregnancies in women resident in the municipalities of study area, wherever the birth or termination of pregnancy occurred. The ratio between observed and expected cases (O/A), with expected defined according to regional rate, were calculated and O/A Bayesian estimates (BMR) are showed only at municipal level . The low weight and the males/females ratio at birth were analysed using data from Tuscany Birth Certificates, covering period 2001-2007, excluding biths occurred in facilities outside Tuscany Region. For Low birth weight ( 64 years). Among females resident in SGA a mortality excess from digestive system diseases was observed (72 observed, 55 expected). The hospitalization in the overall Geothermal Area did not show any excess for all causes and all tumours in both genders. Statistically significant excesses for hospital admission from stomach cancer among males (49 observed, 38 expected) and females (42 observed, 28 expected), and from lymphohematopoietic tumours among females, particularly from lymphatic leukaemia (15 observed, 5 expected), were observed. As mortality analysis highlighted, also hospital admissions by geothermal areas and gender showed a worst picture in SGA than in NGA. In the latter, a significant excess of hospital admissions from all causes among females (1,357 observed, 1,284 expected) but not among males (1,193 observed, 1,141 expected) and an excess - close to statistical significance - from all tumours only among females (297 observed; 272 expected) were observed. Furthermore, statistically significant excesses of hospital admissions from digestive system diseases in both genders (M: 392 observed, 350 expected; F: 300 observed, 268 expected), from dementias (16 observed, 8 expected) and from lymphhematopoietic cancers among females, particularly from lymphatic leukaemia (9 observed, 2 expected), were observed. In the SGA, statistically significant excesses of hospital admissions for stomach cancer (M: 32 observed, 21 expected, not significant after adjusting by DI; F: 29 observed, 18 expected), for respiratory diseases (M: 408 observed, 351 expected; F: 339 observed, 277 expected) and for renal failure (M: 61 observed, 41 expected; F: 52 observed, 34 expected) were observed in both genders. Among males, statistically significant excesses of hospital admissions for liver cancer (23 observed, 14 expected), Parkinson’s disease (10 observed, 4 expected) and genitourinary diseases (312 observed, 282 expected) emerged; among females statistically significant excesses of hospital admissions for oesophagus cancer (4 observed, 1 expected), for circulatory disorders of the brain (235 observed, 209 expected), for chronic-obstructive pulmonary disease (70 observed, 42 expected), and an excess close to the statistical significance for cancer of the central nervous system (22 observed, 14 expected) was observed. Congenital malformations results, which take into account births and pregnancy interruption after prenatal anomaly diagnosis show a statistically significant excess of urogenital anomalies in the SGA. Analysis of low birth weight, preterm birth and ratio O/A in males, showed no deviations from the regional references. CONCLUSIONS Overall this descriptive epidemiological study showed that the health status picture of Geothermal Area is not dissimilar from the one observed in neighbouring communities, with the exception of a worst general mortality among males. However, some mortality and hospitalization excesses are worth of note, most evident in the geothermal area of Amiata (SGA) compared to that of the province of Pisa (NGA). The overall results, showing more critical traits for males and a substantial non alignment of mortality and hospitalization, are suggestive of an etiological role of occupational exposures or individual lifestyles, even if effects of environmental factors cannot be excluded. Among the causes of death and hospitalization which showed excesses, acute respiratory diseases, with mortality excess among females in the SGA, circulatory disorders of the brain, with mortality excess among females in the NGA, respiratory system diseases and renal failure, with hospitalization excess in the SGA in both genders, are proposed for further insights. In fact, these excesses observed in areas characterized by documented presence of pollutants of different sources and great concern of the local communities, reinforced the indications for improving environmental quality and environment and health monitoring. Recommendations to the regional and local authorities for ad hoc epidemiological investigations and public health interventions were released

[Policies for the promotion of sustainable mobility and the reduction of traffic-related air pollution in the cities participating in the EpiAir2 project].

to describe transport policies adopted in recent years (2006-2010) by some Italian municipalities and their effectiveness.survey data refer to fifteen cities participating in the EpiAir2 project: Torino, Milano, Venezia, Bologna, Firenze, Pisa, Roma, Taranto, Palermo, Cagliari, Trieste, Genova, Ancona, Napoli, and Bari.this survey revealed strengths and weaknesses of the way in which these Italian cities address the promotion of sustainable mobility. As a general rule, the vehicle fleets have been renewed with a reduction of old-emission-standard vehicles. Italian cities reported a considerable delay in the development of underground and tram systems, and suburban rail networks, compared to other European urban areas. Regarding other aspects of urban mobility (supply/demand for public transport, low traffic and pedestrian zones, bike paths, car and bike sharing), this survey highlighted a great heterogeneity among Italian cities.differences between Italian cities are partly explained by structural and cultural features and also by local governance, specifically the political capability to design and adopt effective policies concerning urban transportation systems and their environmental impact. Various and fragmented initiatives are signs that Italy has not formulated a comprehensive and integrated strategy about sustainable mobility in urban areas yet

Community Concern about the Health Effects of Pollutants: Risk Perception in an Italian Geothermal Area

Geothermal fluids for electricity and heat production have long been exploited in the Mt. Amiata area (Tuscany, Italy). Public concern about the health impact of geothermal plants has been present from the outset. Several factors influence the way people perceive risk; therefore, the objective of the present research is to develop indicators of risk perception and assess indices differences in relation to some questionnaire variables. A cross-sectional survey was conducted in the Amiata area on 2029 subjects aged 18-77. From the questionnaire section about risk perception from environmental hazards, four indicators were developed and analysed. A total of 64% of the subjects considered the environmental situation to be acceptable or excellent, 32% serious but reversible, and 4% serious and irreversible; as the values of the various perception indicators increased, an upward trend was observed in the averages. Risk perception was higher among women and young people, and was associated with higher education. Those who smelled bad odours in their surroundings reported higher risk perception. Furthermore, risk perception was higher in four municipalities. The results represent the basis for further investigations to analyse the link among risk perception indicators, exposure parameters, and health status