SENTIERI Project Research Articles

The contaminated sites in the SENTIERI Project: an update of legislative, contamination, and sources of environmental exposure aspects in Italy

In Italy, the problem of contaminated sites was introduced for the first time at a regulatory level with the 'Ronchi Decree' No. 22 of 1997. Subsequently, the regulations that defined most of the contaminated Sites of National Interest (SINs) were Law No. 426 of 09.12.1998 and Law no. 179 of 31.07.2002. Today, the reference directive is the Legislative Decree 152/2006 'Consolidated Environmental Act', which in Part IV, Title V 'Remediation of contaminated sites', dictates the administrative and technical procedures for the remediation of contaminated sites. Over time, there have been numerous regulatory updates that have changed the selection criteria for the SINs, leading some of these to be downgraded to Sites of Regional Interest (SIRs). The SINs in their entirety are managed by the Italian Ministry of the Environment, today called 'of the Ecological Transition', while the pass to the competence of the territorially concerned Regions SIRs regarding the verification and eventual remediation operations. Currently, in Italy there are 42 SINs and 17 SIRs. All the information derived from the various environmental regulations and that found in the context of the remediation procedures made it possible to define the exposure of the population residing in the areas adjacent to the SINs and SIRs as well as the elaboration of sheets containing all the site-specific information.

SENTIERI Project: air pollution and health impact of population living in industrial areas in Italy

to estimate the impact of PM2.5 and PM10 in the Italian industrial areas included in the SENTIERI project characterized by industrial plants with combustion processes deriving from point emissions. using satellite data, the Population Weighted Exposure (PWE) to PM2.5 and PM10 for 2011 and 2015 was estimated. The concentration-response functions available were used to estimate the number of premature deaths attributable to exposure to industrial emissions. The counterfactual levels recommended by the new WHO Air Quality Guidelines were used. for the selection of industrial plants, the European database on emissions of the European Pollutant Release and Transfer Register was used. Residents in areas of 1 km x 1 km and 4 km x 4 km around the selected industrial plants were considered. the number of premature deaths from non-accidental causes, cardiovascular and respiratory diseases, and lung cancer was estimated. residents were exposed to PM2.5 values of 17.3 µg/m3 (Northern Italy: 23.3) and to 24.3 µg/m3 (Northern Italy: 30.3) of PM10. PWE for both pollutants tends to increase as the size of the area under study is reduced and it is generally higher everywhere in 2011 than in 2015, with values that are always higher than the average (overall) in the Norther Italy. In 2011, 1,709 (IC95% 1,309-1,903) and 1,611 (IC95% 1,225-2,353) non accidental premature deaths were estimated attributable to PM2.5 and PM10, respectively, in residents close to the industrial plants (1 km x 1 km). Deaths attributable to exposure to PM2.5 and PM10 tend to follow a North-Central-South&Islands gradient for all observed causes and for both years of analysis. although exposure assessment of the population by using random-forest model does not allow to disentangle the contribution of the industrial component, the results of the study are suggestive of an impact on health from PM exposure in the industrial areas considered, with a greater impact in the vicinity of the plants, recommending the implementation of urgent impact reduction actions.

Methodological approaches to evaluate the over-time mortality in SENTIERI epidemiological surveillance system: a focus on cohort analyses

The SENTIERI Project analyses the health profile of the populations residing in Italian national priority contaminated sites in specific calendar periods using a cross-sectional approach. An aspect that has not been evaluated so far is the analysis over a long period, for understanding the changes in health profiles over time and studying them also in function of the changes occurred in the territories. This article studies temporal trends by birth cohort and calendar period for overall mortality and lung cancer mortality from 1980 to 2018, separately for men and women, for three sites: Priolo (Sicily Region, Southern Italy), Pitelli (Liguria Region, Northern Italy), and Terni-Papigno (Umbria Region, Central Italy). A method for selecting the temporal model that best fits the data is then proposed. General mortality presents complex temporal profiles when considering cumulative risks, and usually the most important temporal axis is the birth cohort for cumulative SMRs (i.e., after adjusting for trends in the reference population). For lung cancer, the most important time axis is the birth cohort and the age-cohort model is the most appropriate, in particular for men of Priolo and Terni.

The concept map of SENTIERI Project: a communication interactive digital tool of the national epidemiological surveillance system of Italian contaminated sites

This paper describes the development and the envisioned use of concept maps in the framework of the SENTIERI communication strategies as an information and scientific communication tool applied to epidemiological surveillance in contaminated sites. The concept map of SENTIERI 2019-2022 was designed and implemented to foster access to complex scientific information ensuring usability of the contents and communication with the various stakeholders. The concept map aims to promote environmental health literacy in contaminated sites. The methodology adopted to create the map includes the following phases: 1. choice of a dynamic focus question; 2. selection of the representative terms of the addressed topics; 3. elaboration of the glossary of the selected terms; 4. representation of the links among the selected terms; 5. identification of the significant propositions that make explicit the meaning of each link. Online access to the map is guaranteed by the Mindomo software. The use of the concept map promotes active learning of the topics that characterize SENTIERI 2019-2022 through knowledge paths chosen because of the specific interests and learning purposes. The concept map derives from the integration of specific approaches of the epidemiological discipline with those of the social sciences and offers the possibility of developing site-specific maps through the interactions with local actors and the integration of elements related to emerging problems as well as institutional and local interests.

SENTIERI Project: a systematic review on the association between sources of environmental exposure in contaminated sites and health outcomes

the epidemiological surveillance programme carried out in the Italian Contaminated Sites (SENTIERI Project) is based on an a priori evaluation of the epidemiological evidence of a causal association between environmental exposures and health outcomes. to produce an updated review of the epidemiological evidence (January 2009-May 2020) on the association between environmental exposures and health outcomes predefined and published by the SENTIERI working group. a systematic review was conducted on MEDLINE, EMBASE, and Web of Science. Additional searches were conducted on the websites of relevant organizations. The sources of environmental exposure considered were the ones included in SENTIERI Projects (chemicals, petrochemicals and refineries, steel plants, power plants, port area, waste, mines and source of asbestos). a total of 16,817 records were identified and, after the screening process, 14 systematic reviews were identified: two IARC Monograph, two WHO Reports, one WHO/UNEP Report, and 15 observational studies. Living in proximity of contaminated sites was associated with specific diseases (mortality or incidence), with a high heterogeneity across environmental sources. For some exposures, data suggests a gender differential effect for some causes of disease. compared to a previous evidence evaluation, this systematic review shows a higher number of diseases associated with residential exposure to some contaminated sites (petrochemical facilities, waste, mines, and sources of asbestos). According to the results of this review, the a priori evidence evaluation was updated and used to interpret the epidemiological data of the Sixth SENTIERI Project Report.

Global evaluation of the mortality and hospitalization in the Italian contaminated sites included in the SENTIERI project

Since 2006, epidemiological surveillance of populations living in Italian contaminated sites has been ongoing (SENTIERI Project). Updated global estimates of mortality (2013-2017) and hospitalization (2014-2018) are reported. The excess deaths (observed-expected) for the main groups of diseases were calculated for all the 46 sites together. Through a random-effect meta-analysis of the standardized mortality and hospitalization rates (SMR/SHR), the pooled SMR/SHR for all the sites and their groupings were estimated. In the 46 sites, 8,342 exceeding deaths (1,668/year) were estimated, 4,353 in males and 3,989 in females, resulting in an excess risk of 2% in both genders. The risk of hospitalization for all causes was in excess of 3%. These excesses are mainly attributable to malignant tumours. In subgroups of sites, exceeding SMRs were observed for all mesotheliomas and pleural mesotheliomas, lung and colorectal cancers in both genders. SHR for all causes were observed in excess in the first year of life (+8%), in the group 0-19 and 20-29 years (+3-5%); no excesses of mortality were observed in the group 0-29 years.

From the selection of priority pollutants to the analysis of health data in the SENTIERI Project

evaluation of mortality and hospitalization of residents in five Italian National Priority Contaminated Sites, studied in the SENTIERI Project, for those pathologies which, on the basis of the assessments of international agencies and bodies, are known to have an aetiological connection with exposure to specific environmental pollutants. ecological study. SETTING AND PARTICIOANTS: resident population in the sites of Trieste and Piombino (steel plants), and Falconara, Livorno, and the industrial area of Milazzo (petrochemical plants and/or refineries). Data extracted from the Sixth SENTIERI Report. mortality (2013-2017) and hospitalization (2014-2018) for associated causes by exposure to specific pollutants detected in the soil and water matrices. the results obtained do not show common patterns between the excesses found in Trieste and Piombino Sites (steel plants) nor among Livorno, Falconara, and Milazzo (petrochemicals and/or refineries). Livorno and Trieste sites, having a larger population, show the greatest number of excesses. the proposed approach can be a useful tool, in addition to others, for the study of the health profile of residents in contaminated sites, being also the basis for aetiological epidemiological studies.

Sustainability of Italian seaports located near contaminated sites: results of an exploratory analysis.

Ports are strategic areas of economic importance, but they are also very critical contexts. Many Italian ports are included in contaminated sites of concern for remediation, with the presence of pressure factors that overload the burden capacity of local ecosystems and communities. The aim of this study is to characterize Italian seaport areas through a general theoretical path on the theme of ports-sustainability-local communities, identifying the ports located in municipalities included in contaminated sites studied by the SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites). Many of the selected ports, are being part of complex industrial areas, where, in addition to the port area, there are other sources of environmental contamination potentially harmful to health. Excesses risk were observed for mesothelioma and for respiratory diseases, pathologies for which there is epidemiological evidence of an excess of risk associated with residence in port areas. The strong environmental pressures that characterize these areas make it necessary to adopt adequate environmental and health protection measures.

Air pollution and health impact of population living in industrial areas in Italy: SENTIERI project

Air pollution and health impact of population living in industrial areas in Italy: SENTIERI project

Cancer incidence and congenital anomalies evaluation in the contaminated sites of Sesto San Giovanni - the SENTIERI Project.

The Italian Institute for Environmental Protection and Research defines national priority contaminated sites (NPCSs) as land where hazardous substances are likely to pose a risk to human health. SENTIERI was the first national project evaluating the health status of residents in NPCSs. We have extended, for the site of Sesto San Giovanni, the evaluation to cancer incidence and congenital anomalies (CAs). We have found an overall significant negative association between living in the NPCS and overall cancer incidence in all ages and no association in paediatric, adolescent and young adults' population. We have found an excess risk for bladder cancer, leukaemia, lymphoid leukaemia and chronic lymphocytic leukaemia in men and for lung and breast cancer in women. For the paediatric and adolescent population, we have found an excess in embryonic tumours. Total CAs were not different from expected, while we have found excesses regarding ear, face and neck, digestive system and chromosomal defects.

SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report

SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report

Environmental and individual exposure and the risk of congenital anomalies: a review of recent epidemiological evidence.

Environmental and individual exposure and the risk of congenital anomalies: a review of recent epidemiological evidence.

Cancer incidence in children and young adults living in industrially contaminated sites: from the Italian experience to the development of an international surveillance system.

this paper is based upon work from COST Action ICSHNet. Children's environmental health is on the 2030 Agenda for Sustainable Development. The incidence of childhood cancer is increasing worldwide and in Europe. Yet, the aetiology of most childhood cancers, including the role of environmental carcinogens, is still largely unknown. Contaminated areas, especially of industrial origin, are of high concern due to complex mix of hazardous pollutants and their potential health impacts on human populations, notably in children. to describe cancer risk in children and young adults (YA) residing in national priority contaminated sites (NPCSs) in Italy and to provide a suitable framework for a development of cancer surveillance in industrially contaminated sites (ICSs) in Europe. this study is based on a collaborative work of the Italian Institute of Health (ISS) and the Italian Association of Cancer Registries (AIRTUM), in the context of the SENTIERI project (Epidemiological study of residents in National Priority Contaminated Sites). Incidence rates were standardised according to the European standard population. The number of observed cases was compared to the expected cases derived from the age-, sex-, and cancer-specific incidence rates of the national pool of AIRTUM registries for the period 2006-2013. Standardized incidence ratios (SIRs) and 90% confidence intervals (CIs) were computed. The study reports the cancer profile in all combined 28 NPCSs covered by 22 cancer registries. 1,050 cases of malignant tumours (MTs) were recorded among 3,161,786 person-years in people aged 0-29 years in 28 NPCSs (SIR: 1.03; 90%CI 0.98-1.09), with an age-standardised incidence rate of 317 per million. Excess risks were observed for: MT of the central nervous system in the age-group <1 year (SIR: 3.2; 90%CI 1.4-6.3); soft tissue sarcoma in the age-group 0-14 years (SIR: 1.6; 90%CI 1.1-2.3); acute myeloid leukaemia in the agegroup 0-14 years (SIR: 1.7; 90%CI 1.1-2.4); non-Hodgkin lymphoma in the age-group 20-24 years (SIR 1.5; 90%CI 1.1-2.1), and germ cell tumours of male gonads in the age-group 20-29 years (SIR: 1.33; 90%CI 1.1-1.5). A deficit of cases was observed for Hodgkin lymphomas in the age-group 20-29 years (SIR 0.8; 90%CI 0.6-1.0). this study, which is based on standardized methods and accredited information sources, supports the hypothesis that living in an NPCS increases the risk of some cancer types in children and young adults. Further work will concern groups of NPCSs characterised by common sources of contamination/key carcinogenic pollutants. In fact, in a novel project proposal we aim to monitor the cancer profile in children living in ICSs in Europe. The new project, based on the SENTIERI-AIRTUM methodology, will build on the networking activities of the COST Action on Industrially Contaminated Sites and Health Networking (ICSHNet) and childhood cancer studies coordinated by the International Agency for research on Cancer (IARC).

Environmental justice in the epidemiological surveillance system of residents in Italian National Priority Contaminated Sites (SENTIERI Project)

descriptive evaluation of distributional justice in the epidemiological surveillance system of populations residing in Italian National priority Contaminated Sites (NPCSs) of SENTIERI project. Analysis of the feasibility of monitoring different Environmental Justice dimensions in SENTIERI. descriptive study and ecological meta-analysis. SETTING AN PARTICIPANTS: residents in 298 municipalities included in 44 NPCSs in SENTIERI. Description of their level of deprivation and mortality analysis by deprivation level in the first period evaluated in SENTIERI, years 1995-2002. an index of multiple deprivation at municipality level DI-SENTIERI, built using 4 indicators based on variables from the Italian 2001 Census, was used to describe deprivation in communities living in NPCSs. The risk of mortality for all causes and all tumors in the pool of NPCSs municipalities by deprivation level was assessed using meta-Standardized Mortality Ratios (meta-SMRs). sixty percent of municipalities (No. 179) in NPCSs belong to the two more deprived quintiles. The socioeconomic disadvantage of communities resident in NPCS has a North-South gradient: the proportion of municipalities belonging to the two more deprived quintiles is 29% in the North, 68% in the Centre, 92% in the South. Meta-SMRs for all causes in less deprived municipalities were 98 (90%CI 95-100) in men e 101 (90%CI 97-104) in women, the values for all cancers were 99 (90%CI 94-103) in men and 100 (90%CI 95-105) in women. The corresponding estimates in more deprived municipalities were, respectively in men and women, 103 (90%CI 101- 104) and 102 (90%CI 100-104) for all causes, 104 (90%CI 102-106) and 102 (90%CI 100-104) for all cancers. residents in NPCSs are exposed to environmental stressors and are generally more deprived. The socioeconomic disadvantage is mostly affecting Central and Southern Italy populations. Furthermore, in these deprived communities the risk of mortality for all diseases and all cancers is higher. Populations living in NPCSs are affected by distributional injustice. To monitor the different dimensions of Environmental Justice, the DI-SENTIERI should be developed and other socioeconomic indicators implemented.

Applying the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the evidence in environmental health: the SENTIERI Project case study

Introduction: SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites) had examined the epidemiological literature (1998-2009) to a priori assess the strength of the causal association between environmental exposures and health outcomes.The a priori evaluation increases the confidence in the causal interpretation of the observed associations, containing the post hoc observations and multiple comparisons problems. We updated the evidence of SENTIERI Project adopting the GRADE approach for summarising and rating the overall quality of evidence in a transparent and systematic way. Methods: We conducted a systematic review of studies on the association between residence near a petrochemical plant/refinery and risk of lung cancer. We searched Pubmed, Embase and other databases to identify relevant studies (2010-2015). Three reviewers extracted data independently and assessed risk of bias-RoB using a modified version of the Cochrane risk of bias tool. For each study 9 domains (e.g. population selection, exposure assessment, confounding) were classified in terms of RoB (Low, Probably low, Probably high, High) and then, applying the GRADE, the quality of the overall evidence and the strength of evidence were rated. Results: We identified 1690 records, 7 studies met inclusion criteria. Out of the 9 items, exposure and confounding assessments were rated Probably High/High for risk of bias in 3 studies; in most domains the RoB was Probably Low/Low. The quality of overall evidence was rated as moderate and strength of evidence across all studies was classified as limited. Conclusions: SENTIERI Project adopted the GRADE methodology to update the a priori evaluation of the strength of the epidemiological evidence to be used in the interpretation of study results. This example responds to the demand in environmental health for the adoption of a structured, transparent and reproducible synthesis of the evidence, it also documents its feasibility.

Cancer incidence in Italian contaminated sites.

The incidence of cancer among residents in sites contaminated by pollutants with a possible health impact is not adequately studied. In Italy, SENTIERI Project (Epidemiological study of residents in National Priority Contaminated Sites, NPCSs) was implemented to study major health outcomes for residents in 44 NPCSs. The Italian Association of Cancer Registries (AIRTUM) records cancer incidence in 23 NPCSs. For each NPCSs, the incidence of all malignant cancers combined and 35 cancer sites (coded according to ICD-10), was analysed (1996-2005). The observed cases were compared to the expected based on age (5-year period,18 classes), gender, calendar period (1996-2000; 2001-2005), geographical area (North-Centre and Centre-South) and cancer sites specific rates. Standardized Incidence Ratios (SIR) with 90% Confidence Intervals were computed. In both genders an excess was observed for overall cancer incidence (9% in men and 7% in women) as well as for specific cancer sites (colon and rectum, liver, gallblad-der, pancreas, lung, skin melanoma, bladder and Non Hodgkin lymphoma). Deficits were observed for gastric cancer in both genders, chronic lymphoid leukemia (men), malignant thyroid neoplasms, corpus uteri and connective and soft-tissue tumours and sarcomas (women). This report is, to our knowledge, the first one on cancer risk of residents in NPCSs. The study, although not aiming to estimate the cancer burden attributable to the environment as compared to occupation or life-style, supports the credibility of an etiologic role of environmental exposures in contaminated sites. Ongoing analyses focus on the interpretation of risk factors for excesses of specific cancer types overall and in specific NPCSs in relation to the presence of carcinogenic pollutants.

Review of epidemiological studies on individual and environmental risk factors in the aetiology of congenital heart defects

among all congenital malformations, congenital heart defects (CHDs) are the main cause of neonatal mortality and infant mortality and morbidity, thus representing a major public health burden. Several epidemiological studies suggested the role of environmental factors in the genesis of CHDs. to collect the recently literature (2011-2015) on the increasing risk of CHDs in the offspring of exposure to industries, mines, landfills, and incinerators and individual risk factors (cigarette smoking, alcohol use, occupational exposure, socioeconomic status, and air pollution). a search was carried out in PubMed following SENTIERI project criteria to evaluate evidence by selecting English and Italian articles regarding human studies. 2,066 abstracts were collected and examined individually. Systematic reviews of epidemiological and individual studies reporting association estimates between the outcome (CHDs) and at least one of the risk factors were selected. studies on industries and landfills exposures provided limited evidence of increased risk of CHDs associated with the proximity of maternal residence to the sites. Inadequate evidence was found for positive association between exposure to mines or incinerators and risk of CHDs. Regarding maternal cigarette smoking, literature provided sufficient evidence of an increased risk of CHDs in offspring. A limited evidence of an increased risk of CHDs among pregnant women working in agriculture or exposed to solvents and polycyclic aromatic hydrocarbons emerged. Sufficient epidemiological evidence emerged for the association between CHDs and maternal exposure to high concentrations of NO2 and SO2. meta-analysis results should be interpreted with caution as they are based on a few studies, some of which are subject to high heterogeneity. For future research, epidemiological studies including spontaneous abortions and voluntary termination of pregnancy, an accurate individual exposure characterisation and an adequate control of the main confounding variables are needed.

R45 - Tumor incidence analysis in contaminated site Trento North. The data of Sentieri Project

R45 - Tumor incidence analysis in contaminated site Trento North. The data of Sentieri Project

Cancer incidence in Italian Polluted Sites

Background Cancer incidence is of interest when studying the health impact of sites contaminated by chemical carcinogens, as most areas in SENTIERI Project are. SENTIERI studied mortality in sites of national interest for environmental remediation (Italian Polluted Sites-IPSs).Incidence data,in comparison with mortality,have better diagnostic quality,are not influenced by survival factors and allow the study of non-fatal and rare neoplasms Aim To examine cancer incidence in residents in IPSs included in SENTIERI Project. The study is a joint effort of the Italian Health Institute (ISS) and the Italian Association of Cancer Registries (AIRTUM-www.registri-tumori.it) Methods 22 IPSs (148 municipalities,2 millions residents) out of 44 (298 municipalities) included in SENTIERI Project are served by a AIRTUM network Cancer Register (CR). Standardized incidence ratios (SIR) and 90% Confidence Intervals (90% CI) were calculated (1996-2005) for 37 cancer sites (single or grouped). Expected number of cases in each polluted site was estimated by applying incidence rates of pool of Italian CRs Results In all IPSs combined an increased incidence for all cancer sites among males (SIR 1.05, 90% CI 1.04-1.05) and females (SIR 1.03, 1.02-1.04) was detected.Increased risks in both genders were also observed for oesophageal (males: SIR 1.15,1.08-1.24; females SIR 1.18, 1.04-1.34), liver (males: SIR 1.47,1.42-1.52; females SIR 1.18,1.38-1.51), gallbladder (males: SIR 1.12,1.04-1.21; females SIR 1.18,1.04-1.18), lung (males: SIR 1.06,1.04-1.08; females SIR 1.18, 1.10-1.18), bladder (males: SIR 1.09,1.07-1.12; females SIR 1.17, 1.11-1.24) and central nervous system (males: SIR 1.10,1.04-1.17; females SIR 1.07,1.01-1.15) neoplasms Conclusions The incidence results adds to the mortality study confirming that living in IPSs adversely affects health status of residents. In some IPSs the increased incidence is coherent with the a priori evidence evaluation completed in SENTIERI Project

The Health Profile of Populations Living in Contaminated Sites: Sentieri Approach

SENTIERI project (Epidemiological Study of Residents in Italian Contaminated Sites) studied mortality in the sites of national interest for environmental remediation (National Priority Contaminated Sites—NPCSs). SENTIERI described mortality of residents in NPCSSs, and it specifically focused on causes of death for which environmental exposure is suspected or ascertained to play an etiologic role. The epidemiological evidence of the causal association was classified a priori into one of these three categories: Sufficient (S), Limited (L), and Inadequate (I). Mortality in the period 1995−2002 was studied for 63 single or grouped causes at the municipal level by computing: crude rate, standardized rate, standardized mortality ratios (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as references for SMR calculations and 90% CI accompanied SMR values. The deprivation index was constructed using 2001 national census variables for the following socioeconomic domains: education, unemployment, dwelling ownership, and overcrowding. SENTIERI results will allow the priorities setting in remediation intervention so as to prevent adverse health effects from environmental exposure. This paper's objective is to present the rationale, methods, advantages, and limitations underlying SENTIERI project and to describe data and resources required to apply a similar approach in other countries.