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.

Negative effects of a high tumour necrosis factor-α concentration on human gingival mesenchymal stem cell trophism: The use of natural compounds as modulatory agents

Background: Adult mesenchymal stem cells (MSCs) play a crucial role in the maintenance of tissue homeostasis and in regenerative processes. Among the different MSC types, the gingiva-derived mesenchymal stem cells (GMSCs) have arisen as a promising tool to promote the repair of damaged tissues secreting trophic mediators that affect different types of cells involved in regenerative processes. Tumour necrosis factor (TNF)-α is one of the key mediators of inflammation that could affect tissue regenerative processes and modify the MSC properties in in-vitro applications. To date, no data have been reported on the effects of TNF-α on GMSC trophic activities and how its modulation with anti-inflammatory agents from natural sources could modulate the GMSC properties. Methods: GMSCs were isolated and characterized from healthy subjects. The effects of TNF-α were evaluated on GMSCs and on the well-being of endothelial cells. The secretion of cytokines was measured and related to the modification of GMSC-endothelial cell communication using a conditioned-medium method. The ability to modify the inflammatory response was evaluated in the presence of Ribes nigrum bud extract (RBE). Results: TNF-α differently affected GMSC proliferation and the expression of inflammatory-related proteins (interleukin (IL)-6, IL-10, transforming growth factor (TGF)-β, and cyclooxygenase (COX)-2) dependent on its concentration. A high TNF-α concentration decreased the GMSC viability and impaired the positive cross-talk between GMSCs and endothelial cells, probably by enhancing the amount of pro-inflammatory cytokines in the GMSC secretome. RBE restored the beneficial effects of GMSCs on endothelial viability and motility under inflammatory conditions. Conclusions: A high TNF-α concentration decreased the well-being of GMSCs, modifying their trophic activities and decreasing endothelial cell healing. These data highlight the importance of controlling TNF-α concentrations to maintain the trophic activity of GMSCs. Furthermore, the use of natural anti-inflammatory agents restored the regenerative properties of GMSCs on endothelial cells, opening the way to the use and development of natural extracts in wound healing, periodontal regeneration, and tissue-engineering applications that use MSCs

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

Guidelines for Helath Impact Assessment (HIA) in Italy: pathway to achieve a national standard

Context Italy today has a number of shortcomings either in regulatory and legislative recommendations about HIA. In addition, the health component is often disregarded or treated poorly in Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) studies. The current situation prompted some regional and national institutions to collaborate for the submission of a project proposal to the Ministry of Health. The project is addressed to define HIA guidelines and disseminate them, together with specially developed HIA tools, all over the nation and among professionals and public officers. The overall aim is the inclusion of the public health assessment in Environmental Impact Studies (EIS). Methods At first, workshop sessions will provide basic knowledge and skills to manage with the Rapid-HIA tools developed by another Italian HIA project (titled "VISPA"). Then, real cases will be run in workgroups and distance-learning will improve training over 3-year. After, the first Italian online platform for professionals and experts on HIA will be provided and will include a computer-based Rapid-HIA tool, the mapping of HIAs georeferred and utilities for experts. At last HIA Guidelines will be issued. A deliberative process will validate a general Guideline and a more specific one, addressed to create a public health component into EIS. Results Public health professionals as well as applicants for EIS and stakeholders will be trained. The homogeneity of HIA tools for public health evaluation will be achieved as well as the mapping of HIAs at a wide scale. A platform, strongly web 2.0 oriented, will strengthen the networks of experts and the capacity building process. Discussion The Guidelines will be the first Italian super-regional, shared, tool that will introduce HIA in evaluations and proposals. In addition, the standardization and qualification of public health professionals\u27 evaluations as well as of impact studies by proponents will be satisfie

Guidelines for Health Impact Assessment (HIA)in Italy :pathway to achieve a national standard

Context Italy today has a number of shortcomings either in regulatory and legislative recommendations about HIA. In addition, the health component is often disregarded or treated poorly in Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) studies. The current situation prompted some regional and national institutions to collaborate for the submission of a project proposal to the Ministry of Health. The project is addressed to define HIA guidelines and disseminate them, together with specially developed HIA tools, all over the nation and among professionals and public officers. The overall aim is the inclusion of the public health assessment in Environmental Impact Studies (EIS). Methods At first, workshop sessions will provide basic knowledge and skills to manage with the Rapid-HIA tools developed by another Italian HIA project (titled "VISPA"). Then, real cases will be run in workgroups and distance-learning will improve training over 3-year. After, the first Italian online platform for professionals and experts on HIA will be provided and will include a computer-based Rapid-HIA tool, the mapping of HIAs georeferred and utilities for experts. At last HIA Guidelines will be issued. A deliberative process will validate a general Guideline and a more specific one, addressed to create a public health component into EIS. Results Public health professionals as well as applicants for EIS and stakeholders will be trained. The homogeneity of HIA tools for public health evaluation will be achieved as well as the mapping of HIAs at a wide scale. A platform, strongly web 2.0 oriented, will strengthen the networks of experts and the capacity building process. Discussion The Guidelines will be the first Italian super-regional, shared, tool that will introduce HIA in evaluations and proposals. In addition, the standardization and qualification of public health professionals\u27 evaluations as well as of impact studies by proponents will be satisfied

Nuovi strumenti per valutare l\u27impatto sulla salute

XXXXLa Valutazione di impatto sulla salute (VIS) consiste in "Una combinazione di procedure, metodi e strumenti con i quali si possono stimare gli effetti potenziali sulla salute di una popolazione di una politica, programma o progetto, e stimare la distribuzione di tali effetti all\u27interno della popolazione". Il percorso di VIS pertanto permette di individuare soluzioni alternative o misure utili a ridurre gli impatti sulla salute e supporta cos? il decisore nelle scelte, anche in contesti complessi

HIA methodology to support Regional Health Authorities in urban planning. Poster presentato alla Conferenza Urban development and extractive industries: what can HIA offer?

Since 2007 the Emilia-Romagna Region has been implementing the MONITER Project aimed at defining an environment epidemiological surveillance and evaluation system in the areas where municipal incinerators are located. In this context, the Emilia-Romagna Region launched a Project Line to promote the adoption of Health Impact Assessment (HIA) as a tool to include the evaluation of environmental health issues during the planning process. Experience and knowledge gained on HIA resulted in an enrichment of local cultural, political and administrative context. This process has been proposed to public bodies so that they can include HIA in urban planning, including a specific focus on stakeholder involvement

La valutazione di Impatto sulla salute uno strumento a supporto delle decisioni

XXXLa valutazione di impatto della salute, VIS, serve a fornire informazioni a chi pianifica e a chi decide riguardo alle conseguenze di ci? che si decide. Questo compito semplice e relativamente logico non ? sempre facile da trasformare in azioni appropriate. Dietro a ciascuno dei tre elementi, la VIS, la pianificazione e ele decisioni ci sono metodi, strumenti, esperienze conecrete e impianti teorici che devono essere esaminati e conosciuti, per poter supportare al meglio le attivit? da svolgere

Human gingival mesenchymal stem cell trophism is modulated by inflammatory microenvironment: effects of ribes nigrum bud extract

Adult mesenchymal stem cells (MSCs) play a crucial role in the maintenance of tissue homeostasis and in promoting regenerative processes. Among the different MSC types, the gingival mesenchymal stem cells (GMSCs) have arisen as a promising tool to promote the repair of damaged tissues secreting trophic, regeneration-promoting mediators. TNF-α is one of the key mediators of inflammation that could affect tissue regenerative processes and modify the MSC properties in in vitro application. Herein, we investigated 1) the effects of TNF-alpha on GMSC trophism and 2) the ability of Ribes Nigrum bud extract (RBE) to modulate the effect of this cytokine on GMSC properties. GMSC were isolated and characterized from health subjects. TNF-α affected GMSC proliferation and the expression of inflammatory-related protein (IL-6, IL-10, TGF-β, and COX-2) in dependence on its concentration. A high TNF-α concentration decreased the GMSC viability and impaired the trophic effect of GMSCs on endothelial cells, likely by enhancing the amount of pro-inflammatory mediators in GMSC secretome. GMSC incubation with RBE changed secretoma cell composition so restoring the GMSC beneficial effects on endothelial viability and motility. These results demonstrated that a high TNF-α concentration, as occurred under chronic inflammatory conditions, decreased the GMSC well-being and alter their trophic activity impairing GMSC-endothelial cell communication. These data highlight that the control of inflammatory microenvironment is crucial to guarantee MSC-driven reparative processes. Furthermore, the use of natural anti-inflammatory agents restored the GMSC regenerative properties on endothelial cells opening the way to the use and the development of natural extracts in wound healing, periodontal regeneration and tissue engineering application that use MSC

Rapid HIA to support decision making in the Public Administration in Italy THE Vispa PROJECT

Since a decade HIA background and practice is growing up in Italy. The Ministry of Health endorsed the promotion and development of HIA practice funding the VISPA project to adapt HIA processes and tools in Public Administration (PA) activities and to prepare recommendations in view of national guideline. Methods/approaches. The feasibility of a rapid HIA protocol for plans and projects embedded in the PA decision-making process was tested involving 34 trained operators in six different Italian Regions. Twenty-eight casestudies regarding waste, city planning, energy, industrial districts and farms, were selected by a screening-scoping exercise. The developed toolkit supported the involved Public Officials during the phases of assessment, appraisal and reporting of results. Results. The proposed rapid HIA was always feasible with few exceptions. Positive outputs were achieved in terms of capacity building, identification of relevant subject, integration with other assessment tools. A final step-by-step procedure was validated and actors, tools and timing were identified. An audio-video guide was released to facilitate the use and transferability of the products. Conclusions. The experimental approach adopted highlighted a positive feedback. The burdensome of the application was recognised and critical issues appeared the citizen participation and the inter-departments cooperation