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Objectives. Environmental pollution is associated to morbidity and mortality for chronic-degenerative diseases. Recent data point out a relationship between proximity to industrial plants and mortality due to neoplasms. The aim of this study was to compare mortality due to chronic-degenerative diseases in an area of Tuscany (Bassa val di Cecina) characterized by the presence of two neighbouring municipalities similar for size but with substantial differences in industrial activities: Rosignano (site of chemical, energy production and waste processing industries) and Cecina (with no polluting activity). Materials and methods. Standardized mortality rates for the 2001 - 2010 decade were calculated; data of the whole Tuscany were assumed as reference. Environmental levels of pollutants were obtained by databases of ARPAT (Tuscany regional agency for environment preservation). Maximum tolerated pollutant levels settled by national laws were assumed as reference. Results. In the whole Bassa val di Cecina, significantly elevated standardized mortality rates due to mesothelioma, ischemic heart diseases, cerebrovascular diseases and Alzheimer and other degenerative diseases of nervous system were observed. In the municipality of Rosignano, a significant excess of mortality for all these groups of diseases was confirmed. On the contrary, the municipality of Cecina showed only significantly higher mortality rates for ischemic heart diseases. Elevated levels of heavy metals in sea-water and of particulate matter PM10 and Ozone in air were detected in Rosignano. Conclusions. The present study shows an excess of mortality for chronic-degenerative diseases in an area with elevated concentration of polluting factories. Proximity to industrial plants seems to represent a risk factor for those diseases.
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International Journal of Occupational Medicine and Environmental Health 2017;30(4):1 – 13
1 Bassa Val di Cecina Hospital, Cecina (LI), Italy
Cardiovascular and Coronary Care Unit
2 National Research Council (CNR), Pisa, Italy
Institute of Clinical Physiology
3 National Institutes of Health, Phoenix, Arizona, USA
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases
4 University of Pisa, Pisa, Italy
Department of Endocrinology and Metabolism
5 National Research Council (CNR), Pisa, Italy
Institute of Geosciences and Earth Resources
Objectives: Environmental pollution is associated with morbidity and mortality for chronic-degenerative diseases. Recent
data points out a relationship between proximity to industrial plants and mortality due to neoplasms. The aim of this study
has been to compare mortality due to chronic-degenerative diseases in the area of Tuscany (Bassa Val di Cecina), Italy,
characterized by the presence of 2 neighboring municipalities similar in terms of size but with substantial differences in
industrial activities: Rosignano (the site of chemical, energy production and waste processing industries) and Cecina (with
no polluting activity). Material and Methods: Standardized mortality rates for the 2001–2010 decade were calculated;
the data of the whole Tuscany was assumed as reference. Environmental levels of pollutants were obtained by databases
of the Environmental Protection Agency of Tuscany Region (Agenzia Regionale per la Protezione Ambientale della Tos-
cana – ARPAT). Maximum tolerated pollutant levels set by national laws were assumed as reference. Results: In the whole
brovascular diseases and Alzheimer and other degenerative diseases of nervous system were observed. In the municipality
Received: March 20, 2016. Accepted: June 28, 2016.
Corresponding author: C. Marabotti, Bassa Val di Cecina Hospital, Cardiovascular and Coronary Care Unit, via Montanara 1, 57023 Cecina (LI), Italy (e-mail:
Nofer Institute of Occupational Medicine, Łódź, Poland
IJOMEH 2017;30(4)
Rosignano Solvay, situated in close proximity of the in-
dustrialsite(Figure 2). In1999,theWorldHealthOrga-
nization(WHO)identied thecommunityof Rosignano
Solvay as a “priority pollution hotspot in the Mediterra-
nean”[6].Ontheother hand, Cecina(12kmsouth)has
an economy prevailingly based on tourism, agriculture and
trade. An epidemiological evaluation of pollution-related
mortality in this area seems particularly interesting, since
inhabitants may be differently exposed to pollutants:
from the maximum, represented by people who are both
workingand livingin proximity ofpolluting factories,to
the minimum, represented by people who are neither liv-
ingnear, norworking in polluting industries. Bothcom-
ing in the proximity of polluting activities may represent
A retrospective evaluation of both mortality rates due to
chronic-degenerative diseases and environmental expo-
sure to pollutants in this area has therefore been designed.
The aims of this study have been:
to evaluate the possible excess in mortality due to po-
tentially pollution-related diseases in the whole Bas-
sa Val di Cecina and in the 2 main municipalities of
the area (Rosignano Marittimo and Cecina) with dif-
ferent industrial impact,
toinvestigatethepotential links betweenthepossible
excess in mortality rates and environmental release and
detection of pollutants,
to discuss the pathophysiological mechanisms linking
environment pollution to the diseases responsible for
the excess in mortality.
The relationship between ambient pollution and morbidity
and mortality due to neoplasms and chronic respiratory dis-
eases has been demonstrated by a large number of epide-
miological observations [1,2]. More recently, an association
between environmental pollution (particularly due to heavy
metals contamination of water) and cardiovascular diseases
has also been reported [3]. The residential proximity to po-
for mortality due to pollution-related diseases [4]. In par-
ticular,workerslivingin contaminated areas(i.e.,inclose
proximity to polluting industrial activities) may have both
professional exposure during working hours and environ-
mutingworkers, travelling onadailybasisfromtheirresi-
dence (somewhat far from polluting industrial activities) to
dentworkers[5].Thedistrictnamed Bassa ValdiCecina,
including 10 municipalities with approx. 82 000 inhabitants,
issituatedonthecoastofTuscany,Italy, afew kilometers
south of the towns of Leghorn and Pisa (Figure 1).
The particularity of this district is the presence, just in
the middle of the area, of 2 neighboring mid-sized mu-
nicipalities (where majority of population is concen-
trated), similar in terms of the number of inhabitants
(about 30 000 each) but with considerably different eco-
nomic background. In the municipality of Rosignano
Marittimo an important industrial site is located, includ-
ing several factories, dealing with chemical production,
disposal and recovery of hazardous and urban wastes,
energy production. About a half of the inhabitants live in
inseawaterandofparticulatematterwhichcontainsparticlesofdiameter≤10mm(PM10) and ozone in air were detected
in Rosignano. Conclusions: This study shows an excess of mortality for chronic-degenerative diseases in the area with el-
Key words:
Heavy metals, Particulate matters, Environmental pollution, Mesothelioma, Ischemic heart disease,
Neurologic degenerative diseases
IJOMEH 2017;30(4) 3
All-cause mortality, mortality for chronic-degenerative
diseases and mortality for respiratory diseases potentially
pollution-related were evaluated. In particular, the follow-
Related Health Problems, 10th revision (ICD-10) codes
were investigated: malignant neoplasms (as a whole, C00–
C75, and the single codes of each neoplastic disease), dia-
betes mellitus (E10–E14), ischemic heart diseases (I20–
I25), acute myocardial infarction (I21), other forms of
ischemic heart disease (I20, I22–I25), cerebrovascular
Demographic and mortality data source
Mortality rates for the years 2001 to 2010 were obtained by
les elaborated by the Institute for Oncological Study and
Prevention (Istituto per lo Studio e la Prevenzione Onco-
logica–ISPO) for theareaof BassaValdiCecinaand for
the municipalities of Rosignano Marittimo and Cecina. Stan-
dardized mortality rates in the whole area and in the 2 largest
municipalities were compared to the corresponding rates of
Tuscany as a whole, assumed as a reference.
Bassa Val di Cecina
Val di Cornia
Santa Luce
Marittimo Castelle
Castelle Marittimo
n – Bassa Val di Cecina area
– the 2 largest municipalities in the area of Bassa Val di Cecina: Rosignano Marittimo (with high degree of industrial concentration) and Cecina
(with very low level of industrial concentration)
Fig. 1. Studied area of Italy in the study of association of environmental pollution with morbidity and mortality
for chronic-degenerative diseases
IJOMEH 2017;30(4)
chemical factory
energy production factory
urban and industrial waste disposal plant
monitoring stations for sea-water and sediments sampling
monitoring station for air quality
Drain channel
Fine river
Cecina river
Fig. 2. Studied area – Bassa Val di Cecina, Italy
IJOMEH 2017;30(4) 5
residential area; the other 2 were “background” stations,
one placed in the urban area, the other – on the top of a hill,
trial plants. Data was available for the years 2002–2010.
Levels of particulate matter (which contains particles of di-
ozone,nitrogendioxide(NO2),nitrogenoxides(NOx), sul-
furdioxide(SO2)andcarbon monoxide (CO) weremoni-
tored. It is relevant to note that PM2.5 were monitored only
byoneofthe “background” stations,farfromboth urban
area and industrial plants.
Due to the low potential exposition to ambient pollution,
no permanent air monitoring system is active in Cecina.
In the years 2013–2014, a mobile monitoring station was
placed within the residential area of Cecina [11]. Even
if this period does not correspond to that of the study,
that data could be useful to have a comparison with data
obtained in the neighboring municipality of Rosignano
Marittimo, with higher industrial exposure.
Quality of air was evaluated according to the criteria of
the Directive 2008/50/EC of the European Parliament and
of the Council of 21 May 2008 on ambient air quality and
cleaner air for Europe [18].
Pollution of the sea in front of Rosignano Marittimo was
evaluated by a system of monitoring stations located in
cal factory declaring pollutants release to water [12].
Water and sediment sampling was extended north-
ward, according to the direction of prevailing streams.
The only southward monitoring station is situated
about12 km southof Cecina. Bothwater and sediment
analyses were available for the years 2002 to 2010. More-
over, in the years 2004 and 2005, a study of metals bioac-
cumulation in water-ltering animals (mussels – Mytilus
galloprovincialis) was performed in the shoals in front of
Rosignano Marittimo [13].
Pollution of groundwater was evaluated during sampling
campaigns performed between 1995 and 2008, in the area
diseases (I60–I69), hypertensive diseases (I10–I15), dis-
eases of arteries, arterioles and capillaries (I70–I78),
Alzheimer and other degenerative diseases of nervous
system (G30–G32), other forms of dementia (F00–F03),
motor neuron disease (G12.2), multiple sclerosis (G35),
chronic lower respiratory diseases (J40–J47), lung diseases
due to external agents (J60–J70).
An indicator estimating the proportion of workers pro-
fessionally exposed to pollutants (in the whole area and
in the 2 largest municipalities) was obtained by relating
the number of subjects employed in industrial activi-
ties with the number of inhabitants. Demographic data
was collected by 2011 Population Census [7]. The num-
berof industrial workerswas obtained by 2011 Industry
Services Census [8]. Both datasets were elaborated by
the National Institute for Statistics (Istituto Superiore di
Statistica – ISTAT).
Pollutants release and detection
Data about the presence of polluting industrial activities
and about the amount of pollutants release (in air, water
and soil) was collected from the European Pollution Re-
lease and Transfer Register (E-PRTR) [9]. Data was avail-
able for the years 2001, 2004 and from 2005 to 2013. Since
development of pollution-related diseases requires time,
emission of pollutants in the same decade of mortality
analysis may be considered as only a general indicator of
pollutants exposure.
Data about air and water contamination was collected
from databases of the Environmental Protection Agency
of Tuscany Region (Agenzia Regionale per la Protezione
Ambientale della Toscana – ARPAT) [10–13] and reports
of the National Research Council (Consiglio Nazionale
delle Ricerche – CNR), Institutes of Geosciences and
Earth Resources and of Biophysics (Pisa, Italy) [14–17].
Air pollution was evaluated, in Rosignano Marittimo,
by 4 permanent monitoring stations [10]. Two of them were
located at the border of industrial plants, neighboring to the
IJOMEH 2017;30(4)
industrial workers (2.42%). As previously mentioned,
the majority of population (73.12%) was concentrat-
ed in the 2 largest municipalities: Rosignano Marit-
timo had 32 494 inhabitants (15 759 males, 16 735 fe-
males), Cecina had 28 864 inhabitants (13 292 males,
15572 females). Thenumber of industrialworkers was,
respectively, 1199 (3.76% of municipality population)
Mortality rates
cantly different, as compared to regional data.
When compared to the Tuscany region, the area of Bas-
sa Val di Cecina showed signicantly higher standard-
ized mortality rates due to mesothelioma (C45), ischemic
heart diseases (I20–I25), other forms of ischemic heart
disease (I20, I22–I25), cerebrovascular diseases (I60–I69)
and Alzheimer and other degenerative diseases of nervous
system (G30–G31) (Table 1). In the municipality of Ros-
ignanoMarittimo, asignicantexcessofmortalityforall
er mortality rates for ischemic heart diseases (I20–I25)
and other forms of ischemic heart disease (I20, I22–I25).
of Bassa Val di Cecina. Sampling of water and sediments
from both the Cecina River and from wells located in
the coastal area were analyzed [14–17]. Pollutants bioac-
the Cecina River [14].
Quality of the sea and groundwater was evaluated
according to criteria settled by Italian national
law (DM 260/2010) [19].
Statistical analysis
The Chi2 test was used for comparing the mortality rates
for each ICD-10 code between each area and the whole
Tuscany region. For diseases resulting in the excess of
mortality, a post-hoc analysis to evaluate the statistical sig-
pollution level was performed.
The95% condenceinterval forthe mortalityrates was
calculated and rates were compared by the z-test. Analy-
ses were performed in the whole population and then
tests because all analyses were preplanned and of inde-
pendent interest.
Data is presented as count and percentage. Analyses were
performed using SPSS (v. 21, IBM Corp., USA).
Geographic and demographic data
Most of Bassa Val di Cecina is occupied by a coastal
plan crossed by 2 rivers, Cecina and Fine, owing near
the 2 largest communities (Cecina and Rosignano Solvay,
inside the Bassa Val di Cecina area and no industrial plant
most of its course is outside the Bassa Val di Cecina terri-
tory. A geothermal power plant and a chemical factory are
located in the upper course of the river.
The area of Bassa Val di Cecina is inhabited by 82 023 peo-
ple (39 404 males, 42 619 females); 1986 subjects were
industry workers
Areas are proportional to the number of inhabitants.
Fig 3.Inhabitantsandindustryworkersinthearea
of Bassa Val di Cecina, Italy
IJOMEH 2017;30(4) 7
Table 1.Standardizedmortalityratios(SMR)inTuscany,BassaValdiCecina,RosignanoandCecina,Italy,in2001–2010forthediseasesshowingsignicantexcess
in comparison to the reference population
Respondents and area
Standardized mortality ratio
[deaths/100 000 population×year]
ischemic heart diseases
other forms of ischemic
heart diseases
(I20, I22–I25)
cerebrovascular diseases
Alzheimer and other
degenerative diseases of
nervous system
Tuscany (reference) 1.21 (1.12–1.30) 55.34 (54.81–55.87) 30.96 (30.59–31.33) 53.32 (52.84–53.8) 7.97 (7.79–8.15)
Bassa Val di Cecina 2.51 (1.66–3.36) 65.72 (62.03–69.41) 40.13 (37.4–42.86) 57.16 (53.85–60.47) 9.66 (8.37–10.95)
Rosignano 3.69 (2.11–5.27) 62.40 (56.84–67.96) 36.47 (32.46–40.48) 60.22 (54.9–65,54) 12.36* (10.1–14.62)
Cecina 1.93 (0.59–3.27) 72.95 (66.22–79.68) 45.31 (40.36–50.26) 55.13 (49.63–60.63) 7.57 (5.55–9.59)
Tuscany (reference) 2.11 (1.93–2.29) 79.04 (78.03–80.05) 43.31 (42.59–44.03) 79.04 (78.03–80.05) 7.41 (7.12–7.7)
Bassa Val di Cecina 4.64 (2.9–6.38) 88.33 (81.49–95.17) 52.46 (47.38–57.54) 63.80 (58.16–69.44) 8.38 (6.43–10.33)
Rosignano 6.87 (3.59–10.15) 83.24 (72.94–93.54) 46.97 (39.56–54.38) 66.67 (57.71–75.63) 10.55 (7.2–13.9)
Cecina 3.64 (0.87–6.41) 99.01 (86.24–111.8) 58.59 (49.16–68.02) 61.14 (51.58–70.7) 6.32 (3.26–9.38)
Tuscany (reference) 0.49 (0.41–0.57) 37.77 (37.24–38.3) 22.42 (22.04–22.8) 48.59 (48.01–49.17) 8.20 (7.97–8.43)
Bassa Val di Cecina 0.63 (0.21–1.05) 48.43 (44.59–52.27) 31.51 (28.56–34.46) 51.54 (47.59–55.49) 10.56 (8.81–12.31)
Rosignano 0.94 (0.18–1.7) 46.09 (40.4–51.78) 28.83 (24.5–33.16) 54.60 (48.21–60.99) 13.65 (10.56–16.74)
Cecina 0.52 (0–1.27) 54.38 (47.39–61.37) 36.80 (31.37–42.23) 50.66 (43.99–57.33) 8.21 (5.55–10.87)
* p < 0.05 as compared to Cecina.
IJOMEH 2017;30(4)
situated in the municipality of Rosignano Marittimo: 6 of
them in the close proximity of the urban settlement, while
Pollutants release
Mean yearly pollutants releases in the municipality of
Rosignano Marittimo (as obtained by E-PRTR database)
are reported in the Table 2.
Release to air: chemical factories released, yearly,
large amounts of carbon monoxide and carbon di-
oxide, ammonia, non-methane volatile organic com-
pounds, hydrochlorofluorocarbons and nitrogen oxides.
For 3 years (2001, 2004 and 2007) one chemical plant
declaredthe release of84kg,48kgand16kgofmer-
cury to atmosphere, respectively.
The analysis of data disaggregated by gender showed, in
mesothelioma in males and for ischemic heart diseases,
other forms of ischemic heart disease and Alzheimer dis-
excess of mortality for ischemic heart diseases and other
forms of ischemic heart disease was observed in both gen-
ders (Table 1).
Polluting activities
Seven polluting industrial activities are included
in E-PRTR database for the area of Bassa Val di Ce-
cina: 3 chemical production factories, 2 plants for en-
ergy production from fossil fuels (natural gas), 1 plant
for disposal and recovery of industrial and hazardous
waste, 1 landll for urban waste. All polluting sites are
Table 2. Yearly release of pollutants in Rosignano Marittimo (Italy), 2001–2010, as reported in the European Pollutant Release
and Transfer Register (E-PRTR) [9]
Substance release into environment
air water soil
Carbonmonoxide(CO)[t/103] 87.83±212.01 0 0
Carbondioxide(CO2) [t/103] 2099.78±249.0 0 0
Ammonia (NH3) [t] 257.11±83.41 0 0
Hydrochlorouorocarbons(HCFCs)[t] 9.31±10.15 0 0
Nitrogenoxides(NOx) [t] 733.56±208.41 0 0
Nitrogenoxide(NO)[t] 25.32±14.92 0 0
Non-methanevolatileorganiccompounds(NMVOC)[t] 197.78±118.21 0 0
Arsenic (As) [t] 0 1.94±0.56 0
Mercury(Hg)[kg] 16.44±29.96 88.09±49.07 0
Cadmium(Cd)[kg] 0 108.44±49.66 0
Lead (Pb) [t] 0 4.17±1.89 0
Chromium (Cr) [t] 0 2.82±1.17 0
Nickel(Ni)[t] 0 1.79±0.83 0
Copper (Cu) [t] 0 2.21±0.82 0
Zinc (Zn) [t] 0 12.97±4.02 0
M – mean; SD – standard deviation.
IJOMEH 2017;30(4) 9
to the period 1940–1970, when mercury cell electrolysis
was used in chemical industries of the area [12]. High level
ofnickelin sedimentswasthe onlyabnormalparameter
found in the monitoring station located South [12].
Highlevels of chromium,arsenic andnickel were found
in mussels gathered in front of Rosignano Marittimo [13].
As far as groundwater pollution is concerned, high lev-
els of chromium (of natural origin) [14], organic nitrates
(due to the use of organic fertilizers) [17], boron and
mercury [15,16] (both released by chemical and geother-
mal plants situated in the upper course of the river) were
found in water and sediments of the Cecina River basin.
Elevated organic mercury concentrations were also docu-
larly in eels – Anguilla anguilla) [15].
Soil pollution: since industrial plants do not release pol-
lutants to soil, no data has been collected. Partial data is
available only for asbestos contamination; in 2007, the En-
vironmental Protection Agency of Tuscany Region (AR-
PAT) took a census of the sites containing asbestos in
Tuscany. Unfortunately, the resulting database is limited
to public buildings and industrial plants (no informa-
tion is provided about the presence of asbestos in private
buildings) and is only a list of sites, with no indication of
the amount of asbestos in each site [20].
This retrospective study reports a signicant excess in
mortality due to ischemic heart diseases, cerebrovascular
disease, Alzheimer disease and mesothelioma in the area
of Tuscany coast with a high concentration of industrial
plants. In the same area, reports of E-PRTR pointed out
the release of considerable amount of pollutants both in
seawater (mostly metals) and in air (nitrous and nitrogen
oxides, ammonia, carbon monoxide and dioxide). Envi-
ronmental monitoring showed critical levels of several
pollutants: PM10 and ozone in air, mercury and other met-
als in seawater and sediments. All pollutants but mercury
Urbanwaste landll releasedlarge amountsof methane
to air on the annual basis. Electric power plants released
carbon dioxide, nitrous oxide and nitrogen oxides.
Release to water: one out of the 3 chemical plants declared
releases of pollutants to water, particularly concerning
heavy and transitional metals. Yearly releases (mean (M)
± standard deviation (SD)) of potentially dangerous met-
als in the evaluated period are reported in the Table 2.
Release of pollutants occurs directly into the sea, through
a drainage sewer, in close proximity to the residential area.
Release to soil: No industrial plant declared pollutant re-
lease to soil.
Environmental pollutants tracing
Air pollution: when compared to European parameters for
ambient air quality, high levels of PM10 (from 2003 to 2006)
and ozone (from 2007 on), expressed both as average an-
nual levels and as absolute number of exceedances, were
detected in Rosignano Marittimo, in the 2 monitoring sta-
tions placed at the borders between industrial and urban
area [10].
No exceeding was reported during the temporary monitor-
ing of air pollution performed in Cecina in 2013–2014 [11].
Water pollution: the analysis of the seawater column
showed, in front of Rosignano, levels of Mercury higher
than the limits settled by national regulations [12]. Simi-
lar values were found in all the sampling stations north-
ward (in the direction of prevailing currents) as well as in
the one situated southward [12].
al plants in Rosignano showed levels of mercury, cadmium,
limits [12]. High levels of metals in sediments were also
found in northward sampling sites, according to the direc-
tion of prevailing sea currents [12]. In 1982, a core sam-
pling study performed on sediments 1.5 nautical miles off-
shore the drain channel showed highly elevated concentra-
tions of mercury at a depth approximately corresponding
IJOMEH 2017;30(4)
air pollutants were detected in Rosignano Marittimo.
Moreover, in one cohort study, Norwegian men exposed
to nitrogen oxides showed signicantly higher mortality
for ischemic heart disease [28].
has been hypothesized many years ago, since aluminum de-
posits were detected in neurons of affected patients show-
miological studies showed that chronic aluminum exposure
Similar evidences have been reported also for other metals,
largely released in the area of the study. An altered cerebral
zinc homeostasis is associated with generation of extracel-
lular β-amyloid plaques and neuronal neurobrillary tan-
gles [31], while an increase in non-ceruloplasmin-bound cop-
per has been reported both in animal models and in humans
affected by Alzheimer disease [32]. Finally, both groundwa-
ter arsenic levels and chronic low-level cumulative exposure
to lead (as assessed by bone lead content) appears to be as-
sociated with cognitive decline humans [33,34].
Afurther, althoughindirect, possible link between envi-
ronmental pollution and Alzheimer disease could reside
in the effect of the above reported circulatory abnormali-
ties, potentially responsible of vascular dementia.
A few differences have been observed in mortality rates re-
ported in the 2 largest municipalities of the studied district.
In particular, an increased mortality for mesothelioma, Al-
zheimer disease and cerebrovascular diseases were observed
only in Rosignano Marittimo, while both municipalities
shared an increased mortality due to ischemic heart disease.
Acausal link betweenproximity toindustrial plantsand
mesothelioma seems conrmed by the presented data,
showing increased mortality for mesothelioma only in
the industrialized area of Rosignano Marittimo. In this
area, almost 4% of residents is employed in industrial
activities and may represent a subset at the highest risk
of contracting an asbestos-related illness. As known,
mesothelioma may develop after a long latency after
(both in the sea and freshwater) were more elevated in
the industrialized area of Rosignano Marittimo.
Several mechanisms could support a possible pathogene tic
link between environmental pollution and the increased
mortality rates for these illnesses.
On the one hand, the wide use of asbestos in industry,
as a component of tools for thermal insulation, is a well-
known strong risk factor for mesothelioma, so that this
type of pleural cancer has been recognized as an accurate
indicator of asbestos contamination [21]. On the other
hand, pollution due to transitional and heavy metals (re-
leased in large amounts in seawater by chemical plants
situated in Rosignano Marittimo, and objectively detected
both in water and sediments) could contribute to explain
the increased mortality from both Alzheimer disease and
cardiovascular diseases.
The hypothesis that metal environment contamination
mightrepresent acommon risk factor for thisheteroge-
neous group of diseases deserves a few comments.
Strongepidemiological studies supporta causal link be-
tween chronic environmental exposure to xenobiotic
metals (arsenic, lead, cadmium and mercury) and cardio-
vascular morbidity [22,23]. All heavy metals may reduce
antioxidant cellular pool, increasing the intracellular con-
centration of reactive oxygen species and promoting lipid
peroxidation and both cell membrane and DNA damages.
Moreover, some heavy metals may also affect tradition-
al cardiovascular risk factors. For instance, chronic lead
overload (both evaluated by its blood and bone levels) is
associated to arterial hypertension and dyslipidemia [22].
dothelialdamage markers[24] and early carotid athero-
sclerotic changes [25] have been reported in chronically
exposed subjects to heavy metals.
A possible role of air-released pollutants may also be sup-
posed. Actually, previous studies showed that cardiovas-
cular morbidity and mortality are related to both particu-
late matter and ozone [26,27]; high levels of both these
IJOMEH 2017;30(4) 11
bescrutinizedinfuturestudies, signicant differencesin
socio-economic status (as expressed by the Social and Ma-
terial Vulnerability Index), calculated by ISTAT [36] have
not been observed between the 2 municipalities of Rosig-
nano Marittimo and Cecina.
Authors wish to thank Antonio Lombardi and Maria Gloria
Marinari (Prevention Department, AUSL 6, Leghorn, Italy)
co Meyer, Florence, Italy) for their support in collecting epide-
miological data.
Authors particularly appreciated the invaluable contribution of
Fabrizio Bianchi (Environmental Epidemiology, CNR Institute
of Clinical Physiology, Pisa, Italy) to the interpretation and dis-
cussion of results.
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... AUTHORS' RESPONSE ( Dear Editor, Judging by their first comment, Colleagues from the Cancer Research and Prevention Institute (Istituto per lo Studio e la Prevenzione Oncologica -ISPO) are likely to misinterpret the design of our study "Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial differences in environmental pollution" [1,2]. One of our aim actually was "to investigate the potential links between the possible excess in mortality rates and environmental release and detection of pollutants." ...
... We are comforted to observe that, in the Table attached to the letter, the same mortality excesses are observed when the updated European reference population is used. With regard to the questions about the International Statistical Classification of Diseases and Related Health Problems, its 10th revision (ICD 10) defining the coding for ischemic heart diseases, our intention was to separate 2 all localizations (even if pleural forms were largely prevailing). As our study group includes clinical cardiologists, we are absolutely aware that mortality for ischemic heart diseases is heavily affected by differences in performance of acute illnesses care and, even more, by differences in behavioral risk factors (smoke, dietary habits, physical inactivity). ...
... The relationship between environmental pollution and morbidity and mortality from neoplasms and respiratory diseases has been demonstrated in various epidemiological studies [64]. More recently, an association between environmental data and chronic degenerative diseases has been documented, including cardiovascular disease [65]. This study was conducted in a cohort of Italian adult subjects living in Tuscany. ...
Full-text available
In the last few years, many studies have focused on the effects of environmental contaminant exposure during the prenatal period or infancy as predictors of health outcomes in the future. In these time windows, due to their rapid growth, and physiologic and metabolic development, we can observe a higher vulnerability to the effects of environment, with respect to adulthood. The evidence of possible influences, partly mediated by epigenetic mechanisms, involve neurobehavioral responses and immune, endocrine, and respiratory systems, acting directly on the child or indirectly when mediated by placental transfer or breast feeding. In particular, due to a greater intake of air, food, and fluids relative to body weight, crawling behaviors and short stature, the risk of excessive exposure is greater in children. However, data on the long-term implications of early exposures are scarce. Additionally, so that physicians and institutions for child care and assistance of pregnant women can take actions to counteract the effects of chemical pollution (i.e., by educational opportunities), a risk assessment perspective that responds to the biocomplexity of the human being is needed. The present paper provides an overview of physiologic and behavioral characteristics during the perinatal period and in childhood, suggesting in a more integrated way, the need of a new risk-assessment approach to managing chronic disease in pediatric patients.
... La presencia tanto de plaguicidas y otros contaminantes emergentes en el agua, es un riesgo potencial importante para la salud, ya que puede estar contribuyendo a la incidencia de enfermedades crónico degenerativas (Scarsi et al., 2017). Más del 50% de las PTAR en México han sido calificadas a nivel global por tener un pésimo funcionamiento, debido a que ninguna aplica medidas específicas para la remoción de contaminantes emergentes. ...
... Exposure to air pollutants appear to play a major role in the development and/or acceleration of Alzheimer's disease (AD) (Calderón-Garcidueñas et al., 2002, 2008a, 2008bGonzález-Maciel et al., 2017;Jung et al., 2015;Maher et al., 2016;Chen et al., 2017;Marabotti et al., 2017). MMC residents who live under high levels of air pollution show an early brain imbalance in genes involved in oxidative stress, inflammation, and innate and adaptive immune responses (Calderón-Garcidueñas et al., 2012). ...
... LETTER TO THE EDITOR ( [1]. As we are operating the Tuscan Regional Mortality Registry, the Tuscan Cancer Registry and the Tuscan Mesothelioma Registry at the Cancer Research and Prevention Institute (Istituto per lo Studio e la Prevenzione Oncologica -ISPO), it is necessary to send a few considerations and questions regarding the study design and the health data presented in the paper. ...
... Exposure to air pollutants appear to play a major role in the development and/or acceleration of Alzheimer's disease (AD) (Calderón-Garcidueñas et al., 2002, 2008a, 2008bGonzález-Maciel et al., 2017;Jung et al., 2015;Maher et al., 2016;Chen et al., 2017;Marabotti et al., 2017). MMC residents who live under high levels of air pollution show an early brain imbalance in genes involved in oxidative stress, inflammation, and innate and adaptive immune responses (Calderón-Garcidueñas et al., 2012). ...
Mexico City (MC) young residents are exposed to high levels of fine particulate matter (PM2.5), have high frontal concentrations of combustion-derived nanoparticles (CDNPs), accumulation of hyperphosphorylated aggregated α-synuclein (α-Syn) and early Parkinson's disease (PD). Swallowed CDNPs have easy access to epithelium and submucosa, damaging gastrointestinal (GI) barrier integrity and accessing the enteric nervous system (ENS). This study is focused on the ENS, vagus nerves and GI barrier in young MC v clean air controls. Electron microscopy of epithelial, endothelial and neural cells and immunoreactivity of stomach and vagus to phosphorylated ɑ-synuclein Ser129 and Hyperphosphorylated-Tau (Htau) were evaluated and CDNPs measured in ENS. CDNPs were abundant in erythrocytes, unmyelinated submucosal, perivascular and intramuscular nerve fibers, ganglionic neurons and vagus nerves and associated with organelle pathology. ɑSyn and Htau were present in 25/27 MC gastric,15/26 vagus and 18/27 gastric and 2/26 vagus samples respectively. We strongly suggest CDNPs are penetrating and damaging the GI barrier and reaching preganglionic parasympathetic fibers and the vagus nerve. This work highlights the potential role of CDNPs in the neuroenteric hyperphosphorylated ɑ-Syn and tau pathology as seen in Parkinson and Alzheimer's diseases. Highly oxidative, ubiquitous CDNPs constitute a biologically plausible path into Parkinson's and Alzheimer's pathogenesis.
Full-text available
Dementia is an umbrella term for a range of conditions that affect how the brain works and, in particular, the ability to remember, think and reason. It mainly affects older people, both men and women, and gets worse over time. In recent years, there has been growing interest in the possibility that exposure to outdoor air pollution could increase the risk of dementia. COMEAP reviewed epidemiological and experimental studies and concluded that it is likely that air pollution contributes to a decline in mental ability and dementia in older people. The most likely way this occurs is through effects on the circulatory system. It is known that air pollutants, particularly fine particles, can affect the heart and blood vessels, including those of the brain. These effects are linked to vascular dementia, which is caused by damage to the blood vessels in the brain. Experimental studies suggest that air pollution may also stimulate immune cells in the brain, which can then damage nerve cells. It is also likely that some nano-sized (ultrafine) particles can enter the brain, either by transport along the olfactory nerve or by entering the circulation and crossing the blood-brain barrier. These particles may cause direct damage. Nonetheless, based on the available evidence, it does not seem likely that this is an important mechanism for the development of dementia. Recommendations were made for further research which would help develop the evidence on this important topic.
One of the most studied functions of Nrf2 is its role in the maintenance of redox homeostasis in cells during oxidant stress. However, the role of Nrf2 in tissue and organism homoeostasis goes far beyond protection during oxidative conditions. In this chapter, we provide an overview of the regulation of inflammation and immune responses by Nrf2. We discuss the regulatory functions and mechanisms of action of Nrf2 on innate and adaptive immune responses, immune surveillance, and immune response in inflammatory diseases, and experimental models of disease. We also summarize the consequences of the deficiency or deregulation of Nrf2 axis and how they are related to the development and aggravation of diseases.
Excessive fat accumulation in adipocytes leads to obesity, which is a major contributing risk factor for many metabolic diseases such as metabolic syndrome, type 2 diabetes, and cardiovascular diseases. A number of studies showed that overnutrition causes oxidative stress and chronic low-grade inflammation, which both play a crucial role both in obesity prevention and in the development of obesity-related complications. Adipose tissue, especially in the visceral compartment, is considered not only as an energy depository tissue, but also as an active endocrine organ releasing a variety of biologically active molecules known as adipokines, with many of them having pro-inflammatory properties. Here, we summarize current data on the relationship between oxidative stress and inflammation in obesity, with emphasis on metabolic switches and the involvement of redox-responsive signaling pathways such as NF-κB and Nfr2. Experimental data suggest the dual role of Nrf2 signaling in prevention and aggravation of obesity and obesity-related inflammation; the potential mechanisms of Nrf2 duality are discussed.
Increased oxidative stress and inflammation are involved in the pathogenesis of several disorders including cancers and neurodegenerative diseases. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway plays an important role in mediating protection against oxidative and xenobiotic stresses. It is well established that the Nrf2 pathway induces the transcription of major phase II and cytoprotective antioxidant genes that may play a beneficial role against cancers and degenerative disorders. However, while activation of Nrf2 can provide some protection against oxidative stress and inflammation, hyperactivation of Nrf2 is associated with multiple diseases and can promote the survival and proliferation of cancer cells. Therefore, modulation of the Nrf2 pathway (inhibitors/activators) may represent a promising therapeutic strategy to counteract oxidative stress and inflammation in cancers and neurodegenerative diseases.
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Copper is an essential micronutrient for physiological cell functioning and central nervous system (CNS) development. Indeed, it is a cofactor of many proteins and enzymes in a number of molecular pathways, including energy generation, oxygen transportation, hematopoiesis, cellular growth and metabolism, and signal transduction. This is because it serves as a catalyst of reduction-oxidation (redox) reactions in these processes. When copper is kept under control, bound to special proteins, it yields key properties. However, when it spirals out of control, it is exchanged among small compounds (it is loosely bound to them), and its redox activity makes it dangerous for cell viability, promoting oxidative stress. Copper homeostasis in the CNS is securely synchronized, and perturbations in brain copper levels are known to underlie the pathoetiology of wide a spectrum of common neurodegenerative disorders, including Alzheimer's disease. The main objective of this review is to provide some of the most relevant evidence gleaned from recent studies conducted on animal models and humans, and to discuss the evidence as it pertains to a new concept: Aberrant copper metabolism, which appears to have a genetic basis, is a modifiable risk factor accelerating Alzheimer's disease and initiation/progression of cognitive deficits in a percentage of susceptible persons.
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There is epidemiological evidence that metal contaminants may play a role in the development of atherosclerosis and its complications. Moreover, a recent clinical trial of a metal chelator had a surprisingly positive result in reducing cardiovascular events in a secondary prevention population, strengthening the link between metal exposure and cardiovascular disease (CVD). This is, therefore, an opportune moment to review evidence that exposure to metal pollutants, such as arsenic, lead, cadmium, and mercury, are significant risk factors for CVD. Methods We reviewed the English-speaking medical literature to assess and present the epidemiological evidence that 4 metals having no role in the human body (xenobiotic), mercury, lead, cadmium, and arsenic, have epidemiologic and mechanistic links to atherosclerosis and CVD. Moreover, we briefly review how the results of the Trial to Assess Chelation Therapy strengthen the link between atherosclerosis and xenobiotic metal contamination in humans. Conclusions There is strong evidence that xenobiotic metal contamination is linked to atherosclerotic disease and is a modifiable risk factor.
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A detailed hydrogeochemical study of groundwater in the Cecina coastal plain (Livorno province, Italy) and its inner sectors was undertaken in 2008, as chemical analyses carried out on groundwater since 2006 have revealed Cr(VI) concentrations of up to 49 μg/L (well above the permissible limit of 5 μg/L). Ophiolite outcrops are present throughout the study area, and their fragments likely represent a significant portion of the existing multilayered aquifer skeleton. Waters delivered by the serpentinite outcrops have a typically Mg–HCO3 composition, whereas those of the coastal plain are prevailingly of the Ca/Mg–HCO3 type with significant Mg contents. Significant NO3 contamination characterises the studied coastal plain, and an interesting negative correlation exists between Cr(VI) and both NO3 and SO4 deriving from the widespread use of (NH4)2SO4 as a farm fertilizer. Chromium speciation calculations carried out using the EQ3NR code reveal that the prevailing Cr(VI) species in solution is CrO42−; however, CaCrO4° and MgCrO4° neutral complexes represent significant percentages (up to 42 %). These findings suggest that the mobility and consequently the bioavailability of Cr(VI) can be significantly enhanced by these neutral complexes, which are not considered to be affected by adsorption/desorption processes. The Cr(VI) source, investigated by means of the Mg/SiO2 molar ratio, seems to be represented mainly by Mg-bearing minerals of the chlorite group. Petrographic observations confirm the occurrence of this mineral group. The interaction between rainwater and the local serpentinite rock was simulated at different \(P_{{{\text{CO}}_{ 2} }}\) and \(P_{{{\text{O}}_{ 2} }}\) conditions by reaction path modelling using the EQ3/6 software package. \(P_{{{\text{O}}_{ 2} }}\) was varied in accordance with the assumption that redox conditions are determined in part by NO3. Results are in good agreement with experimental data on spring waters and subordinately with data on some coastal plain groundwater, which plot in a rather wide \(P_{{{\text{CO}}_{ 2} }}\) and \(P_{{{\text{O}}_{ 2} }}\)field. Although the dissolved Cr content is mostly of natural origin, fertilization may affect its fate.
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Although ozone (O3) and other pollutants have been associated with cardiovascular morbidity and mortality, the effects of O3 on out-of-hospital cardiac arrest (OHCA) have rarely been addressed and existing studies have presented inconsistent findings. The objective of this study was to determine the effects of short-term exposure to air pollution including O3 on the occurrence of OHCA, and assess effect modification by season, age, and gender. A total of 5973 Emergency Medical Service-assessed OHCA cases in Stockholm County 2000-10 were obtained from the Swedish cardiac arrest register. A time-stratified case-crossover design was used to analyse exposure to air pollution and the risk of OHCA. Exposure to O3, PM2.5, PM10, NO2, and NOx was defined as the mean urban background level during 0-2, 0-24, and 0-72 h before the event and control time points. We adjusted for temperature and relative humidity. Ozone in urban background was associated with an increased risk of OHCA for all time windows. The respective odds ratio (confidence interval) for a 10 µg/m(3) increase was 1.02 (1.01-1.05) for a 2-h window, 1.04 (1.01-1.07) for 24-h, and 1.05 (1.01-1.09) for 3 day. The association with 2-h O3 was stronger for events that occurred outdoors: 1.13 (1.06-1.21). We observed no effects for other pollutants and no effect modification by age, gender, or season. Short-term exposure to moderate levels of O3 is associated with an increased risk of OHCA.
Background— Long-term exposure to ingested arsenic has been documented to induce peripheral vascular disease, ischemic heart disease, and cerebral infarction in a dose-response relationship. This study further examined the biological gradient between ingested inorganic arsenic and carotid atherosclerosis. Methods and Results— We studied 199 male and 264 female adult residents from the southwestern area of endemic arseniasis in Taiwan. The extent of carotid atherosclerosis was assessed by duplex ultrasonography. Diabetes mellitus was determined by oral glucose tolerance test, hypertension by mercury sphygmomanometers, and serum lipid profiles by autoanalyzers. Information regarding the consumption of high-arsenic artesian well water, cigarette smoking, and alcohol consumption was obtained through standardized questionnaire interviews. Logistic regression analysis was used to estimate the odds ratio and its 95% CI of carotid atherosclerosis for various risk factors. Three indices of long-term exposure to ingested arsenic, including the duration of consuming artesian well water, the average arsenic concentration in consumed artesian well water, and cumulative arsenic exposure, were all significantly associated with prevalence of carotid atherosclerosis in a dose-response relationship. The biological gradient remained significant after adjustment for age, sex, hypertension, diabetes mellitus, cigarette smoking, alcohol consumption, waist-to-hip ratio, and serum levels of total cholesterol and LDL cholesterol. The multivariate-adjusted odds ratio was 3.1 (95% CI 1.3 to 7.4) for those who had a cumulative arsenic exposure of ≥20 mg/L-years compared with those without exposure to arsenic from drinking artesian well water. Conclusions— Carotid atherosclerosis is associated with ingested inorganic arsenic, showing a significant biological gradient.
Zinc, the essential trace element, is known to play multiple biological functions in human organism. This metal is a component of many structural as well as regulatory and catalytic proteins. The precise regulation of zinc homeostasis is essential for central nervous system and for the whole organism. Zinc plays a significant role in the brain development and in the proper brain function at every stage of life. This article is a review of knowledge about the role of zinc in central nervous system (CNS) function. The influence of this biometal on etiopathogenesis, prevention and treatment of selected brain diseases and disorders was discussed. Zinc imbalance can result not only from insufficient dietary intake, but also from impaired activity of zinc transport proteins and zinc dependent regulation of metabolic pathways. It is known that some neurodegenerative processes are connected with zinc dyshomeostasis and it may influence the state of Alzheimer's disease, depression and ageing-connected loss of cognitive function. The exact role of zinc and zinc-binding proteins in CNS pathogenesis processes is being under intensive investigation. The appropriate zinc supplementation in brain diseases may help in the prevention as well as in the proper treatment of several brain dysfunctions.
Background: The purpose of the study was to examine the link between geographic information system (GIS)-estimated regional specific groundwater levels and neuropsychological functioning in a sample of individuals with and without cognitive impairment. Methods: This cross-sectional study design analyzed data from 1390 participants (733 Alzheimer's disease, 127 Mild Cognitive Impairment, and 530 with normal cognition) enrolled in the Texas Alzheimer's Research and Care Consortium. GISs analyses were used to estimate regional specific groundwater arsenic concentrations using the Environmental Systems Research Institute and arsenic concentrations from the Texas Water Development Board. Results: In the full cohort, regional specific arsenic concentrations were positively associated with language abilities (p = 0.008), but associated with poorer verbal memory, immediate (p = 0.008), and delayed (p < 0.001), as well as poorer visual memory, immediate (p = 0.02), and delayed (p < 0.001). The findings varied by diagnostic category with arsenic being related with cognition most prominently among mild cognitive impairment cases. Conclusions: Overall, estimated regional specific groundwater arsenic levels were negatively associated with neuropsychological performance.
The paper describes the degradation of the groundwater resources in the Cecina area, where seawater intrusion, B contamination and NO3 pollution are all affecting the heavily exploited Pleistocene aquifer. Over-pumping has brought water levels to about 0m.a.s.l. as far as about 7km from the shore line, thereby promoting the seawater intrusion. The intrusion, which is characterized by cation exchange phenomena and Ca–Cl type waters, enters the plain mostly through the shallower horizons. The saline front, which advanced from 0.5 to 1km in 4a, has by now reached the foot of the hills to the east of the town, where it is also affecting wells of the local aqueduct. Boron contamination, linked to past discharge of industrial waste transported downstream by the river, reached concentrations as high as 3.5mg/L in the mid-1980s. Although a decreasing trend is now under way, B content is still close to 1mg/L. The presence of high NO3, which, together with the seawater intrusion, represents a major issue for groundwater management in the area, is linked to the widespread utilization of fertilizers. Nitrate concentration, which reaches a maximum of about 300mg/L in the shallow aquifer horizons and then decreases rather regularly with depth, is strongly influenced by precipitation. However, irrigation also contributes significantly to transporting the NO3 contamination to depth, as clearly shown by δ18O data. The severe decline in the quality of the groundwater resource in the Cecina area is further compounded by an overall decrease in water availability in the region of Tuscany, as evidenced by long-term monitoring of precipitation and fluvial discharge.
The groundwater B concentration in the alluvial aquifer of the upper Cecina River basin in Tuscany, Italy, often exceeds the limit of 1mgL−1 set by the European Union for drinking water. On the basis of hydrogeological and geochemical observations, the main source of the B contamination of groundwater has been attributed to past releases into streams of exhausted, B-rich geothermal waters and/or mud derived from boric acid manufacturing in Larderello. The releases were discontinued 25–30 years ago.This study confirms that the B dissolved in groundwater is anthropogenic. In fact, the δ11B values of groundwater B match the range −12.2‰ to −13.3‰ of the Turkish B mineral (colemanite) processed in boric acid manufacturing, in the course of which no significant isotopic effects have been observed. This isotopic tracing of the Cecina alluvial aquifer occurs just below the confluence of the Possera Creek, which carries the B releases from Larderello. Strontium isotope ratios support this conclusion.At about 18km from the Possera Creek confluence, the groundwater δ11B drops to much more negative values (−22‰ to −27‰), which are believed to be produced by adsorption–desorption interactions between dissolved B and the aquifer matrix. The δ11B of B fixed in well bottom sediments shows a similar variation. At present, desorption is prevailing over adsorption because the releases of B-rich water have ceased. A theoretical model is suggested to explain the isotopic trends observed.Thus, B isotopes appear to be a powerful tool for identifying the origin of B contamination in natural waters, although isotopic effects associated with adsorption–desorption processes may complicate the picture, to some extent.
Background: The current population of older Americans has accumulated substantial lifetime lead doses, which raises concern about the possibility of adverse cognitive outcomes. We evaluated whether cumulative lead dose from environmental exposures is associated with cognitive function and decline, and whether such effects are persistent, reversible, or progressive. Methods: We used longitudinal linear modeling to evaluate associations of tibia lead concentration with cognitive function and decline in sociodemographically diverse, community-dwelling adults aged 50–70 years who were randomly selected from neighborhoods in Baltimore. Six summary measures of cognitive function were created from standard tests in the following domains: language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory. Results: The mean (SD) tibia lead level was 18.8 (11.6) μg/g. In models adjusted for demographic characteristics, socioeconomic status (SES), and race/ethnicity, higher tibia lead was associated with a progressive decline in eye-hand coordination. Tibia lead was associated with persistently impaired cognitive function in all 6 domains, although these associations weakened after increasing covariate control. In fully adjusted stratified analysis among white persons, persistent effects were apparent in eye-hand coordination, executive functioning, and verbal memory and learning. Conclusions: The study presents the strongest evidence to date of the effects of cumulative lead dose on adult cognitive function independent of SES. The study population was relatively young and the average total duration of follow-up short (<30 months); these findings may represent the lower bound of the impact of cumulative lead dose on cognitive function of older adults.