Human biomonitoring to define occupational exposure and health risks in waste incinerator plants

Contribution to the research on the relationship between exposure to ambient pollutants and diseases comes from human biomonitoring data collection and interpretation. The 21 biomonitoring studies reviewed are mainly aimed at providing either information on exposure amongst worker subgroups, serving as a reference, or information on the relationship between exposure and toxicity. Attention was also paid to the relationship between internal biomarker dose and environmental pollution levels through a combined use of biomonitoring epidemiological study design and environmental monitoring. Marker levels of internal dose (in blood and urine), DNA damage and oxidative stress tend to be higher mostly in highly exposed workers, i.e. those employed in furnace maintenance, residue transfer, cleaning operations, metal disposal and all activities where there is direct contact with fly ash. The presence of old furnaces or non-upgraded plants was associated with acute and chronic health problems in workers

Progetto Moniter: un modello di VIS per gli impianti di incenerimento

The Emilia-Romagna regional government decided to develop a monitoring and surveillance system, known as MonITER (Incineration Monitoring on the Emilia-Romagna Territory), in 8 areas characterized by the presence of municipal waste incinerating plants.The project was divided into 7 lines, among these the number 6 developed a procedure of Health Impact Assessments (HIA) to support the planning of new facilities for incineration or combustion. Line number 6 is divided into 3 actions action 1 aimed to developing and validating a participative HIA methodology, as well tools for the impact assessment and recommendations for implementing HIA on future plants; action 2 analysed connected issues on communication; action 3 was focused to developing a methodology for integrating HIA models into existing tools for mandatory impact assessment.Tailoring the HIA model development to the waste management context has highlighted the fundamental differences of the HIA approach with the other mandatory assessment tools, being theoretically founded on the principles of public involvement, equity, sustainable development and ethical use of evidence.Il Progetto Moniter della Regione Emilia-Romagna (delibera 466/2007) ha realizzato un sistema di sorveglianza ambientale e di valutazione epidemiologica nelle aree circostanti gli otto inceneritori di rifiuti urbani della regione. Il progetto ? articolato in sette linee progettuali (LP). La LP6 ha elaborato un percorso di Valutazione di impatto sulla salute (VIS) applicabile alla pianificazione di impianti di incenerimento o combustione di futura realizzazione. Essa si articola in 3 azioni: l\u27azione 1 ha condotto una specifica ricerca di materiali e metodi finalizzata alla stesura e validazione di una procedura di VIS partecipativa, degli strumenti di supporto al processo di valutazione e delle raccomandazioni per l\u27applicazione della VIS a futuri impianti; l\u27azione 2 ha approfondito l\u27analisi della comunicazione; l\u27azione 3 si ? occupata dell\u27elaborazione di modelli per l\u27integrazione della VIS nelle altre forme di valutazione esistenti nel territorio. Analizzando il tema dei rifiuti ? emerso con forza che la novit? della VIS rispetto alle altre valutazioni normate risiede nell\u27applicazione dei valori di fondo che la ispirano: partecipazione pubblica, equit?, sviluppo sostenibile e uso etico delle prove scientifiche

Vis di impianti di incenerimento di rifiuti solidi urbani. Indagine Policy Delphi

Il presente Working Paper contiene il rapporto di ricerca dell’indagine Policy Delphi realizzata per contribuire alla definizione di un modello di Valutazione di Impatto Sanitario(VIS). L’esigenza di condurre questa indagine è nata per validare i contenuti teorici e metodologici della VIS proposta nell’ambito del Progetto Moniter, monitoraggio degli inceneritori nel territorio dell´Emilia-Romagna, promosso da Regione Emilia-Romagna (RER) e Agenzia per l’Ambiente regionale (con delibera 536 del 21.04.2008 della Giunta regionale). Il progetto Moniter ha l’obiettivo di "organizzare un sistema di sorveglianza ambientale e valutazione epidemiologica nelle aree circostanti gli impianti di incenerimento in Emilia- Romagna", di sistematizzare cioè le conoscenze esistenti, di uniformare le metodologie di monitoraggio ambientale degli impianti di incenerimento rifiuti, di acquisire nuove conoscenze relative alle caratteristiche qualitative e quantitative degli inquinanti emessi dagli impianti e presenti in ambiente e, soprattutto, di integrare le conoscenze ambientali con quelle epidemiologiche e sanitarie. Quest´ultimo aspetto, che rende il progetto Moniter un´attività sperimentale innovativa in Italia, si realizza attraverso la definizione di criteri per la realizzazione della Valutazione di Impatto Sanitario di impianti di combustione. L’Assessorato Politiche per la Salute della RER ha affidato tale compito all’unità operativa di Epidemiologia Ambientale del CNR di Pisa, afferente all’Istituto di Fisiologia Clinica (IFC). La particolare applicazione del metodo Policy Delphi, realizzata per la costruzione del modello di VIS da Antonio Tintori e Pietro Demurtas con la supervisione scientifica di Adriana Valente e Loredana Cerbara dell’IRPPS in collaborazione con l’IFC, ha garantito un approccio multidisciplinare alla complessità dell’obiettivo decisionale, e dimostra come una metodologia ideata per la ricerca sociale possa rivelarsi efficace nell’analisi di fenomeni afferenti a molteplici ambiti disciplinari. Tutti i documenti riferiti al progetto Moniter sono consultabili al sito internet: http://www.arpa.emr.it/monite

Sorveglianza delle malformazioni congenite in Italia: un approfondimento nella provincia di Siracusa

Objective: the study describes briefly the current situation of the surveillance of congenital anomalies in Italy and gives an insight into the province of Siracusa in order to better characterise health status of populations residing in an area at high environmental risk. Participants: the authors, who coordinate the Italian registries of congenital malformations, have collaborated with the Eastern Sicily Registry of congenital malformations (ISMAC) and the registry of diseases of the Siracusa province. Design and setting: data collected by the ISMAC Registry were used to calculate the prevalence of malformed newborns, resident in the municipalities of the province of Siracusa between 1991-2000. This prevalence was compared to that observed in rithe rest of the Siracusa province (RSP), in the whole area covered by the ISMAC Registry (ESR) and to the mean prevalence at birth of the North-East, Emilia Romagna, Toscana and Campania Registries (IR). Comparisons were made for all malformations and for groups of malformations (with the exclusion of groups with a 10 year frequence <10 cases in the province of Siracusa). In addition, heterogeneity among the municipalities of the province and temporal trends were statistically tested. Main outcome measures: total, groups and specific congenital malformations. Results: Results were statistically borderline considering all malformations when the Priolo-Augusta-Melilli area was compared to IR and ESR (standardized morbidity ratio SMRIR=1.1, SMRESR=1.2) and statistically significant when compared to RSP (prevalences ratio PRRSP=1.9). Significant excesses resulted in this area also for hypospadias (SMRIR= 1.9, SMRESR= 2.4,PRRSP= 2.5) and anomalies of the digestive system (SMRIR= 2.1,SMRESR= 1.9, PRRSP= 2.6). Conclusion: Following these results a case-control study on malformations observed in excess has been activated and a protocol for the surveillance of sensitive diseases in areas at environmentalrisk is being elaborated.Obiettivo: offrire una sintesi sullo stato della sorveglianza delle malformazioni congenite in Italia e un approfondimento nella provincia di Siracusa, con lo scopo di contribuire alla definizione di una metodologia per lo studio dello stato di salute di popolazioni residenti in aree ad alto rischio di crisi ambientale. Partecipanti: con gli autori, che svolgono funzione di coordinamento nazionale dei registri delle malformazioni congenite, hanno collaborato l\u27Indagine siciliana sulle malformazioni congenite (ISMAC) e il Registro territoriale di patologia della provincia di Siracusa. Disegno e setting: i dati rilevati dal registro ISMAC sono stati utilizzati per calcolare la prevalenza dei nati malformati del periodo 1991-2000, residenti nei comuni della provincia di Siracusa, e confrontati con i dati analoghi osservati nel resto della provincia di Siracusa (RSP), nella Sicilia Orientale (ESR) e con la prevalenza media osservata dai Registri del Nord-Est Italia, Emilia-Romagna, Toscana e Campania (IR). I confronti sono stati effettuati per il totale delle malformazioni rilevate e per gruppi di malformazioni (escludendo i gruppi con meno di 10 casi nella provincia nel decennio). Inoltre sono stati valutati statisticamente l\u27eterogeneit? fra comuni della provincia e i trend temporali. Outcome principale: malformazioni congenite, totali, in gruppi e selezionate. Risultati: per il totale delle malformazioni ? emerso un risultato al limite della significativit? nei comuni di Augusta-Priolo-Melilli rispetto agli standard IR ed ESR (rapporto standardizzato di morbosit? RSMIR = 1,1; RSMESR = 1,2) e statisticamente significativo rispetto a RSP (rapporto tra prevalenze RPRSP=1,9). La stessa area ? risultata in eccesso significativo per le ipospadie, sia nei confronti degli standard esterni che verso il resto della provincia (RSMIR = 1,9; RSMESR = 2,4; RPRSP = 2,5) e per le anomalie del sistema digerente (RSMIR = 2,1; RSMESR = 1,9; RPRSP = 2,6). Conclusione: sulla base dei risultati ottenuti ? stato attivato uno studio caso-controllo sulle patologie osservate in eccesso ed ? in corso di elaborazione un protocollo per la sorveglianza di patologie sensibili in aree riconosciute a rischio ambientale

Infant Mortality in 27 Italian Municipalities With Solid Waste Incinerators (1981-2001)

Objective: Recently, an epidemiological study was carried out to verify the hypothesis of an association between infant mortality and residence near incinerators (Tango, 2004). Limits to the study were represented by rarity of death events and heterogeneity of infant mortality. However, availability of mortality data and of an incinerator database has allowed performing an exploratory investigation. Materials and Methods: Infant mortality was investigated over 2 periods (1981-1991, 1992-2001) in 27 municipalities with active incinerators in the 1981-2001 time frame. For each municipality the observed/expected ratio (O/E) was obtained. To calculate expected mortality, municipalities were included inside a 50-km radius circle. A pooled estimation of the O/E ratio obtained by meta-analysis was performed for the 27 municipalities. A multiple metaregression model was used to analyze the study, activity and latency periods, the incinerator burning capacity, the number of resident newborns, the residence density, the deprivation index. Results: Mortality analysis was performed on resident population for the whole period on approximately 250,000 infants under 1 year of age. In the overall period 1673 cases of infant mortality were observed. The pooled estimation of the O/E ratio resulted 1.04 (CI 95%: 0.97-1.11) for total cases. The multiple metaregression model showed the incinerator burning capacity as a statistically significant factor (P=0.011). Municipalities having incinerators with a burning capacity >50,000 ton/year showed a higher mortality excess (O/E=1.11, CI 95% 1.03-1.20) compared to municipalities with incinerators of <50,000 ton/year (O/E=0.95; CI 95%: 0.86-1.04). Conclusions: Findings call for further insight by analytic epidemiologic studies to confirm possible association between infant mortality and living near incinerators

A methodological proposal for the application of the best HIA model in a controversial context: waste incineration

Background HIA is a flexible tool to increase public knowledge and participation in the management of environment and health risks. It also contributes widly to collect, increase and interpret information on environment and health. Aims The pilot study under development establishes a collaboration between the National Research Council and Emilia-Romagna Region to achieve two goals: 1) develop Guidelines for HIA to be applied to evaluate the impacts incinerators and combustion plants, within the MONITER project; 2) identify the best HIA model among the available ones Materials and Methods In practice two main distinct actions are performed: 1) Build up a protocol to highlight the relevant criteria for an effective HIA model implemented in the context of waste incinerator plants; 2) Validate the selected model performing two rapid HIA in different temporal settings (retrospective and concurrent), in a selected area in the Emilia Romagna region. These actions are detailed in the following activities: a) An in depth analysis of literature and selected materials to obtain a conceptual framework and thus build a HIA model focused on incineration health effects; b) Synopsis representation of existing models to facilitate a comparison with the main requirements necessary to perform the best HIA. Main requirements are produced implementing a Model Selection Tool (an ad hoc validated questionnaire for the consensus development); c) Application of selected models that meet fundamental requirements. A rapid retrospective HIA: to increase understanding of health impacts in the implementation of similar projects; to enlarge the evidence base for prospective HIAs; a Rapid concurrent HIA: to identify opportunities for improvement in the process trough the establishment of a comprehensive steering group involving an environment and health network still acting in the selected area. d) Implementation of a Multi-Stage Analysis, based on the application of Delphy methodology to test the validity of selected models. Expected results To identify the level of existing uncertainty and controversial views about the HIA application in the context of incineration and community health; to make available recommendations for the selection of HIA best model in similar proposals.. Conclusions Among the added values that can be obtained by the HIA process, we intend to identify procedure able to promote a transparent decision-making process and an extensive stakeholders participation; we also intend to rise awareness among decision makers, to include health into policy planning.

Adverse reproductive outcomes associated with exposure to a municipal solid waste incinerator

 Introduction. The association between reproductive health outcomes and exposure to municipal solid waste incinerators (MSWIs) is inconclusive. This study investigates the association between exposure to a MSWI and various reproductive outcomes (preterm birth, low birth weight, small for gestational age, and sex ratio), taking into account other sources of pollution (industrial plants, highway, major roads with high traffic flows) and maternal factors, including the socioeconomic status. Methods. PM10 concentration maps were used for the exposure assessment to the MSWI and to other sources of pollution in the study area. Information on resident births and maternal covariates were selected from the delivery certificates referred to the period 2001-2010. Mothers’ addresses were geocoded in order to attribute the individual level of exposure. Odds ratio (OR) with a 95% confidence interval (CI) adjusted for maternal covariates and exposure to other pollutant sources were calculated. Results. A total of 3,153 newborns to 2,401 mothers residing in area during the study period were analyzed. A risk of preterm birth associated with increased exposure was detected (OR=1.61; 95%CI: 0.88-2.94; p test for trend 0.098). When newborns to primiparous women were considered an OR of 2.18 (95%CI: 1.05-4.53) and a significant trend were observed (p=0.033). No significant results for the other investigated outcomes were observed. Conclusions. The study detected a slight association between exposure at MSWI and preterm births. The results are in agreement with those of a previous multi-site study with similar design, and they strengthen the recommendation to consider gestational age in studies and surveillance in areas with MSWIs and similar sources of pollution

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\u27s 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 and SEA 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 of the 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

Assessment of health risks of policies

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessmentwith special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.