Epidemiological research as a driver of prevention: the Sibaté study

Although asbestos exposure and risks can be prevented, only five countries in Latin America have banned asbestos, including Colombia. Beginning in 2011, a collaboration between the Istituto Superiore di Sanità in Italy and Universidad de los Andes in Colombia was established, bringing together relevant expertise aiming to improve our understanding of the asbestos problem. An important result of this collaboration was a recently published study conducted in Sibaté, Colombia, a municipality where an asbestos-cement facility has operated since 1942. The evidence collected suggests the presence of a mesothelioma cluster in Sibaté. Landfilled zones with an underground layer of friable asbestos were also discovered in the urban area of the municipality. The importance of this type of collaboration can go beyond understanding the impact of asbestos at the local level, which is crucial, and may also contribute in solving unanswered questions of the problem in countries that banned asbestos decades ago

Occupational Burden of Asbestos-related Cancer in Argentina, Brazil, Colombia, and Mexico

Background: An estimate at the national level of the occupational cancer burden brought about by the industrial use of asbestos requires detailed routine information on such uses as well as on vital statistics of good quality. A causal association with asbestos exposure has been established for mesothelioma and cancers of the lung, larynx, and ovary. Objectives: The aim of this study was to provide estimates of the occupational burden of asbestos-related cancer for the Latin American countries that are or have been the highest asbestos consumers in the region: Argentina, Brazil, Colombia, and Mexico. Methods: The burden of multifactorial cancers has been estimated through the approach suggested for the World Health Organization using the population attributable fraction. The following data were used: • Proportion of workforce employed in each economic sector • Proportion of workers exposed to asbestos in each sector • Occupational turnover • Levels of exposure • Proportion of the population in the workforce • Relative risk for each considered disease for 1 or more levels of exposure Data on the proportion of workers exposed to asbestos in each sector are not available for Latin American countries; therefore, data from the European CAREX database (carcinogen exposure database) were used. Findings: Using mortality data of the World Health Organization Health Statistics database for the year 2009 and applying the estimated values for population attributable fractions, the number of estimated deaths in 5 years for mesothelioma and for lung, larynx, and ovary cancers attributable to occupational asbestos exposures, were respectively 735, 233, 29, and 14 for Argentina; 340, 611, 68, and 43 for Brazil; 255, 97, 14, and 9 for Colombia, and 1075, 219, 18, and 22 for Mexico. Conclusions: The limitations in compiling the estimates highlight the need for improvement in the quality of asbestos-related environmental and health data. Nevertheless, the figures are already usable to promote a ban on asbestos use

International scientific cooperation on asbestos-related disease prevention in Latin America.

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Towards integration of epidemiological and social sciences approaches in the study of communities affected by asbestos exposure. Preface

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Cancer mortality and congenital anomalies in a region of Italy with intense environmental pressure due to waste

Objectives: Waste management in the Campania region has been characterised, since the 1980s, by widespread uncontrolled and illegal practices of waste dumping, generating concerns over the health implications. The objective of this study was to evaluate possible adverse health effects of such environmental pressure. Methods: The health effects of waste-related environmental exposures in Campania were assessed in a correlation study on nine causes of death (for the years 1994-2001) and 12 types of congenital anomaly (CA) (1996-2002) in 196 municipalities of the provinces of Naples and Caserta. Poisson regression was used to analyse the association between health outcomes and environmental contamination due to waste, as measured through a composite index, adjusting for deprivation. Results: Statistically significant excess relative risks (ERR, %) in high-index compared with low-index (unexposed) municipalities were found for all-cause mortality (9.2 (95% CI 6.5 to 11.9) in men and 12.4 (9.5 to 15.4) in women and liver cancer (19.3 (1.4 to 40.3) in men and 29.1 (7.6 to 54.8) in women). Increased risks were also found for all cancer mortality (both sexes), stomach and lung cancer (in men). Statistically significant ERRs were found for CAs of the internal urogenital system (82.7 (25.6 to 155.7)) and of the central nervous system (83.5 (24.7 to 169.9)). Conclusion: Although the causal nature of the association is uncertain, findings support the hypothesis that waste-related environmental exposures in Campania produce increased risks of mortality and, to a lesser extent, CA

Silicosis mortality in Italy: temporal trends 1990-2012 and spatial patterns 2000-2012

The present study investigates the occurrence of silicosis in Italy and its temporal trends and spatial patterns using mortality data. The aim is to give a contribution, albeit with a conservative estimate inferred from mortality data, to epidemiological knowledge of silicosis in Italy. Trends in mortality due to silicosis from 1990 to 2012 were evaluated and a municipal cluster analysis was performed. It shows that mortality due to silicosis is declining but still not eradicated and that one of its main features is regional variability: in this respect, the cluster analysis performed allowed to identify 34 different geographic areas. The results obtained may help display a more detailed picture of silicosis epidemiology and contribute to the fight against exposure to silica, an undisputable public health commitment

COMPARISON OF BAYESIAN-UTILITARIAN AND MAXIMIN PRINCIPLE APPROACHES

Abstract. The Precautionary Principle implies the adoption of a set of rules aimed at avoiding possible future harm associated with suspected, but not ascertained, risk factors. Several philosophical, economical and societal questions are implied by precaution-based public health decision making. The purpose of the present paper is to specify the scope of the principle examining the notion of uncertainty involved, and the implication of different approaches to the decision-making process. The Bayesian-utilitarian approach and the approach based on the maximin principle will be considered, and the different meaning of prudence in the two settings will be discussed. In the Bayesian-utilitarian approach the small number of attributable cases will end up in a low average expected value, easily regarded as acceptable in a cost-benefit analysis. In a maximin approach, on the other hand, the issue will be to consider the high etiologic fraction of a rare disease in the highest category of exposure. In the light of the aforementioned cautions in interpretation, the core difference between the two approaches has to do with the choice between averaging knowledge or equitably distributing technological risks. The Precautionary Principle implies adoption of a set of rules aimed at avoiding possible future harm associated with suspected, but not ascertained, risk factors A recent World Health Organization (WHO) workshop extensively discussed a central issue in the implementation of the Precautionary Principle, namely to define what is meant by "prudent approach to risk" [2]. It was stated, among other things, that adoption of the Precautionary Principle implies some sort of immediate action followed by a second stage of undertakings, including scientific investigations and search for alternatives. Action inspired by precaution is characterized by uncertainty, and the policy framework should thus regularly be reviewed

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 reme- diation. Finally, it is now necessary to properly tune the response of the health system tothe community needs in terms of diagnostic procedures and medical treatment

Environmental health literacy within the Italian Asbestos project: experience in Italy and Latin American contexts

The adoption of multidisciplinary approaches to foster scientific research in public health and strengthen its impact on society is nowadays unavoidable. Environmental health literacy (EHL) may be defined as the ability to search for, understand, evaluate, and use environmental health information to promote the adoption of informed choices, the reduction of health risks, the improvement of quality of life and the protection of the environment. Both public health and environmental health literacy involve access to and dissemination of scientific information (including research findings), individual and collective decision-making and critical thinking. Specific experiences in environmental health literacy have been developed within the Italian National Asbestos Project (Pro-getto Amianto) in Latin American countries where the use of asbestos is still permitted, and in Italy where a specific effort in EHL has been dedicated to the risks caused by the presence of fluoro-edenite fibers in the town of Biancavilla (Sicily). Taking into account the different geographical and socio-economic contexts, both public health and environ-mental health literacy were addressed to a wide range of stakeholders, within and outside the health domain

Arretium or Arezzo? A Neural Approach to the Identification of Place Names in Historical Texts

This paper presents the application of a neural architecture to the identification of place names in English historical texts. We test the impact of different word embeddings and we compare the results to the ones obtained with the Stanford NER module of CoreNLP before and after the retraining using a novel corpus of manually annotated historical travel writings