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The article presents the research performed by an Italian multi-disciplinary team jointly with a group of citizen scientists. The research was part of the project CitieS-Health (Citizen Science for Urban Environment and Health) funded by the EU under the Horizon2020 Programme. Aria di Ricerca in Valle del Serchio, one of the project five pilot studies, was performed in eight municipalities of Valle del Serchio (Lucca, Tuscany) and addressed the prevalence of chronic kidney diseases in the context of potential industrial pollution on health and, in particular, the presence of heavy metals in the environment. Since long, health and environmental issues have been of concern for the local residents who over the years promoted many initiatives to ensure adequate monitoring and appropriate policy interventions. Inspired by the PNS (Post-Normal Science) approach, and in particular the idea of Extended Peer Community, the study addressed local concerns and expectations integrating a multiplicity of competences, knowledges and perspectives. Researchers from Social Sciences and Humanities -- namely history, sociology and ethics -- collaborated with others from the health sector -- epidemiology in particular -- and with citizens in all the phases of the work: from the definition of the research objective to the collection, analysis and dissemination of the research results, and the suggestion of policy recommendations. [ABSTRACT FROM AUTHOR]

This study, carried out by a multidisciplinary research team, deals with the participatory regeneration process of a marginal residential area in the city of Rome. The research focuses on the theme of urban health and the improvement of indoor and outdoor living conditions according to a people-oriented approach. The work was carried out on two fronts: desk research based on urban, health and socio-demographic sources, and a series of field studies. An operational protocol valid in informal contexts, which escape official censuses, was thus elaborated in order to assign objective values of social and housing discomfort, to measure the concept of urban welfare and to identify possible regeneration strategies for the informal habitat.

Objectives: to describe indicators, data sources, and levels of geographical stratification used within the framework of the CCM project "Epidemiological Surveillance and Control of COVID-19 in Metropolitan Urban Areas and for the containment of SARS-CoV-2 circulation in the immigrant population in Italy"., Design: population-based observational study based on data from the Integrated Covid-19 Surveillance System and the archive of hospital discharge records., Setting and Participants: interregional collaborative project. Resident population in 5 Italian Regions (Piedmont, Emilia-Romagna, Tuscany, Lazio, and Sicily)., Main Outcomes Measures: crude and age-standardized rates of diagnostic test utilization and positivity, hospitalization (in any department and in intensive care unit), and mortality in COVID-19 cases., Results: starting from the set of 11 indicators from the Italian National Institute for Health, Migration and Poverty (INMP) project "Epidemiology of SARS-CoV-2 Infection (COVID-19) and Use of Health Services in the Immigrant Population and Vulnerable Population Groups in Italy", the five most effective indicators for CCM purposes were identified. The INMP project highlighted higher rates of test access and positivity among Italians compared to foreigners, higher standardized hospitalization rates among foreigners, and higher standardized mortality rates among Italians, with geographical and temporal heterogeneity. The intersection between the DEGURBA (degree of urbanisation) classification and altimetric zones defined five levels of territorial stratification characterized by decreasing population density. Approximately 81% of the population involved in the CCM project resided in the first two levels; 43% of Italians lived in areas with intermediate population density in hilly or plain areas, while 48% of foreigners were concentrated in densely populated areas., Conclusions: sharing the collaborative approach and a research methodology already tested, integrated with the analysis of disaggregated indicators by morphological, functional, and administrative characteristics of the residential territory, allowed for assessing differences in the impact of the pandemic between Italians and foreigners residing in more or less densely populated areas.

The link between the urban contexts’ features and the Public Health outcomes, opens to a challenging scenario about the Urban Health issue. The research purpose is to describe a critical literature review, aimed to correlate the Public Health outcomes with the environmental risk factors, and for each of them, define Evidence-Based Design Strategies and Actions, capable to reduce those risk, improving the urban quality and attractiveness of places. Furthermore, the main focus of the paper is to underline the cities’ ability to be resilient to the on-going climate change phenomena, and the definition of the urban context’s features representing best practices i.e. of Nature-Based Solutions, to enhance the ecosystemic quality, and to reach healthiness, safety and security of the urban spaces.

The definition of spatial units of data aggregation is a challenge for research in Urban Health, aiming help visualizing inequities and build an analytical chain that also integrates demographic, socioeconomic, cultural and environmental data. We present a case study comparing the administrative and the spatial divisions obtained by the test of the influence of access to the Primary Health Units (PHU) on the city of Belo Horizonte, elucidating algorithms and concepts used. It is demonstrated the potential of future research on the city's territory, its correlation with Health, regarding the possible the control of spatial conditions to locate and access PUH, waving to the enrichment of the debate on the directions of Urban Health in Brazil and the early stages of a Geodesign.DOI: https://doi.org/10.20365/disegnarecon.20.2018.7

Urbanization is one of the leading global trends of the 21st century that has a significant impact on health. Non-communicable diseases (NCDs), are the result of a combination of genetic, physiological, environmental and behavioural factors. These diseases are related to rapid unplanned urbanization, unhealthy diets and a lack of physical activity. This report presents a project (Active and green city project) that wants to rethink the city in terms of health and sustainable quality of life. The first objective is the implementation of physical activity and sustainable nutrition to improve the health of citizens by strengthening the cultural identity of the city. The project aims to be a practical response to the various call to actions of the scientific societies.

Background: one of the most affected European countries by the COVID-19 epidemic is Italy; data show the strong geographical heterogeneity of the epidemic., Objectives: to propose an analysis strategy to ascertain the non-random nature of the spatial spread of COVID-19 cases infection and identify any territorial aggregations, in order to enhance contact tracing activities in specific areas of the Lazio Region (Central Italy) and a large urban area as Rome., Methods: all cases of COVID-19 of the Lazio Region notified to the Regional Service for Epidemiology, Surveillance, and Control of Infectious Diseases (Seresmi) with daily updates from the beginning of the epidemic to April 27, 2020 were considered. The analyses were carried out considering two periods (the first from the beginning of the epidemic to April 6 and the second from the beginning of the epidemic to April 27) and two different levels of spatial aggregation: the entire Lazio region excluding the Municipality of Rome, where the 377 municipalities represent the area units, and the Municipality of Rome, where the area units under study are the 155 urban areas (ZUR). The Scan statistic of Kulldorff was used to ascertain the non-random nature of the spatial spread of infected cases and to identify any territorial aggregations of cases of COVID-19 infection, using a retrospective spatial analysis in two overlapping periods., Results: analysis was conducted at regional level in the two survey periods and revealed the presence of 7 localized clusters. In the Municipality of Rome, a single cluster (Historic Centre) was identified in the first period which includes 7 urban areas, while in the second period two distinct clusters (Omo and Farnesina) were observed., Conclusions: Scan statistics are an important surveillance tool for monitoring disease outbreaks during the active phase of the epidemic and a useful contribution to epidemiological surveillance during the COVID-19 epidemic in a specific territory.

Objectives: to describe hospitalisation, access to emergency care, and mortality of people living in marginalized urban areas which include public housing buildings in the North-West suburb of Rome, and to compare the results with those observed among people living in the neighbouring area., Design: cross sectional study., Setting and Participants: resident population in the XIII and XIV Municipality of Rome, subdivided into five urban areas, in 2011-2018., Main Outcome Measures: hospitalisation, access to emergency care, and mortality rates and rates ratios based on hospital discharges and emergency department visits derived from the Health Information Systems and from the Mortality Registry of Lazio Region (Central Italy), stratified by urban areas., Results: the results show a higher use of hospital assistance and emergency care services as well a higher mortality among residents of urban areas characterized by marginalization and social disadvantage in the North-West suburb in Rome, compared to the surrounding area. The association is stronger for the residents of ex-Bastogi, a compound particularly marginalised and socially disadvantaged, where excesses in hospitalisation, emergency care admission, and mortality of +60%, +150%, and +140%, respectively, occurred., Conclusions: the excesses of hospital use, emergency care visits, and mortality observed among the residents of marginalized urban areas suggest the need to reorganize the preventive and primary care services considering the socioeconomic disadvantage in such housing contexts. The use of both qualitative and quantitative approaches allows to understand the complexity of such contexts.

Introduction: Describing and monitoring socioeconomic inequalities in health are the prerequisite for planning equity policies. In Italy, some cities have integrated personal information from the municipal registries with Census data and with data from healthcare information systems to set up Longitudinal Metropolitan Studies (LMS). Under the coordination of the Italian National Institute for Health, Migration, and Poverty (NIHMP), six cities in the LMS network have contributed to the present monograph: Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome. MORTALITY RESULTS. Significant socioeconomic differences by level of education were seen in all the participating centres. People who live alone or in single-parent households are more likely to die, as are those living in a substandard dwelling. Immigrants resident in the six cities included in the study showed lower all-cause mortality than Italians (males: MRR 0.83; 95%CI 0.78-0.90 - females: MRR 0.70; 95%CI 0.64-0.77). Sub-Saharan Africans experienced a significant higher mortality than Italians (males: MRR 1.33; 95%CI 1.12-1.59 - females: MMR 1.69; 95%CI 1.31-2.17). Immigrants had a neonatal and post-neonatal mortality risk about 1.5 times higher than Italians (neonatal: OR 1.71; 95%CI 1.22-2.39 - post-neonatal: OR 1.63; 95%CI 1.03-2.57). A difference between Italians and immigrants was also observed for mortality in children aged 1-4 years, though less marked (OR 1.24; 95%CI 0.73-2.11). Excesses concerned particularly immigrants from North Africa and from sub-Saharan Africa as well as those residing in Italy for >5 years. HOSPITALISATION RESULTS. Hospitalisation rates are lower for immigrants than for Italians, except when due to infectious diseases, blood disorders, and, among women, for reasons linked to pregnancy and childbirth. Avoidable hospitalisation rates of adults from low migratory pressure Countries are lower than or equal to those of Italians. On the contrary, adults from low migratory pressure Countries show higher avoidable hospitalisation rates compared to Italians in every cohort, with the exception of Rome (RR 0.81; 95%CI 0.78-0.85), with RR ranging from 1.08 (95%CI 0.96-1.22) in Venice to 1.64 (95%CI 1.47-1.83) in Modena., Conclusions: Maternal and child health is the most critical area of health for immigrant population. Considering the importance that the issue of health equity has taken on in the political agenda, the data presented in this volume are a great asset, particularly in light of the long recession and the social crisis that have impacted the Country.

Nowadays, the majority of world population lives in urban areas and this portion is going to increase in the coming decades. The health impact of urban areas is well established and described in scientific literature. Italian health and hygiene legislation dealing with urban health is fragmented and not coordinated with the regulation about environment and city planning. The overlapping of legal competences between different authorities and the conflict of attribution between the Central State and Regional Governments deeply contributed to generate uncertainty. The authors here analyse the Italian regulatory framework and depict its lacks in terms of public health protection.

Introduction: Obesity is a major public health problem because it is a risk factor for various chronic diseases and its incidence is constantly increasing due to changes in diet and lifestyle. In Italy, studies show that 32% of the population aged between 18 and 69 years is overweight and 10% is obese. The aim of this study was to measure the anthropometric characteristics of a sample population of the city of Rome (Italy) and correlate these with dietary habits and socio-demographic characteristics of participants in order to evaluate their specific health and educational needs., Methods: A cross-sectional study was conducted in February 2015 by administering an ad-hoc questionnaire to subjects over 18 years of age attending a General Practitioner's practice in Rome (Italy). The questionnaire collected demographic, clinical and anthropometric data, and information regarding dietary habits., Results: The sample consisted of 150 individuals with a mean age of 47,8 years. Fifty nine percent were women. The mean Body Mass Index (BMI) was 26.7. The average blood pressure was 131/80 mmHg. BMI values were higher in respondents with a lower educational level and BMI was significantly associated with the quality of the source of nutrition information used., Conclusions: Poor and unreliable information regarding proper nutrition can correlate with the risk of overweight and the consequent development of chronic diseases. The family or community nurse could play a critical role in prevention, by helping to provide correct information for specific populations and by planning training and prevention activities with the GP.

Objectives: to compare the meta-analysis and the pooled analysis approach to study short-term effects of air pollution on human health in Emilia-Romagna Region (Central Italy) cities, characterised by strong homogeneity of environmental and sociodemographic features., Methods: application of fixed-effects meta-analysis and fixed-effects pooled analysis on time-series data of seven cities in Emilia-Romagna in the period 2006-2010. The relationship among adverse health events (deaths due to natural causes, cardiovascular disease, cerebrovascular disease and respiratory disease) and concentrations of PM10, PM2.5 and NO2 was investigated by means of GAM models, using the EpiAir protocol., Results: the pooled analysis application entailed a gain in terms of precision of effect estimates in respect to meta-analysis approach. The interval widths of pooled analysis are lower than those of meta-analytic estimates, with percentage reductions between 7% and 43%. This power increase led to a major number of statistically significant pooled analysis estimates. It has been a generally good correspondence between the two methods in terms of direction and strength of the association among health outcomes and the various pollutants. An exception is the PM10 effect estimate on respiratory mortality, where the meta-analytic estimate was significantly higher and not in line with literature data., Conclusions: the study highlighted the increase in accuracy and stability of effect estimates obtained from a pooled analysis compared to a meta-analysis in a regional context such as the Emilia-Romagna Region, characterised by the absence of heterogeneity in exposure to pollutants and other confounders. In this context, the pooled approach is to be considered preferable to meta-analysis.

Objectives: Multiple factors influence individuals' health status. Their impact is difficult to quantify as it is their interaction. Aim of the current work is to develop guidelines to support designers to promote health in the residential environment and to apply them through an evaluation system to certify the level of health performance., Design: Politecnico di Milano, in collaboration with the Local Health Authorities of Milan and Empoli through analysis of needs performance and numerous multidisciplinary meetings, has produced a design guide (Healthy Design Guide - HeDe) and an evaluation system to certify the level of health performance. This system was tested on the Milan metropolitan area., Setting: The experiment was carried out on a sample of 30 private residences, with an overall floor area ranging between 90 and 150 square meters, new or recently renovated., Results: The tool works but at the same time it also shows that too often design choices are made for aesthetic or economic reasons rather than a real need for health and wellness., Conclusions: It is becoming increasingly important to strengthen synergies and multidisciplinary collaborations to achieve shared performance indications and to make a systematic review of the regulatory tools to protect public health.

The SESPIR Project (Epidemiological Surveillance of Health Status of Resident Population Around the Waste Treatment Plants) assessed the impact on health of residents nearby incinerators, landfills and mechanical biological treatment plants in five Italian regions (Emilia-Romagna, Piedmont, Lazio, Campania, and Sicily). The assessment procedure took into account the available knowledge on health effects of waste disposal facilities. Analyses were related to three different scenarios: a Baseline scenario, referred to plants active in 2008-2009; the regional future scenario, with plants expected in the waste regional plans; a virtuous scenario (Green 2020), based on a policy management of municipal solid waste (MSW) through the reduction of production and an intense recovery policy. Facing with a total population of around 24 million for the 5 regions, the residents nearby the plants were more than 380,000 people at Baseline. Such a population is reduced to approximately 330.000 inhabitants and 170.000 inhabitants in the regional and Green 2020 scenarios, respectively. The health impact was assessed for the period 2008-2040. At Baseline, 1-2 cases per year of cancer attributable to MSW plants were estimated, as well as 26 cases per year of adverse pregnancy outcomes (including low birth weight and birth defects), 102 persons with respiratory symptoms, and about a thousand affected from annoyance caused by odours. These annual estimates are translated into 2,725 years of life with disability (DALYs) estimated for the entire period. The DALYs are reduced by approximately 20% and 80% in the two future scenarios. Even in these cases, health impact is given by the greater effects on pregnancy and the annoyance associated with the odours of plants. In spite of the limitations due to the inevitable assumptions required by the present exercise, the proposed methodology is suitable for a first approach to assess different policies that can be adopted in regional planning in the field of waste management. The greatest reduction in health impact is achieved with a virtuous policy of reducing waste production and a significant increase in the collection and recycling of waste.

The Project Epidemiological Surveillance of Health Status of Resident Population Around the Waste Treatment Plants (SESPIR) included five Italian regions (Emilia-Romagna, Piedmont, Lazio, Campania, and Sicily) and the National Institute of Health in the period 2010-2013. SESPIR was funded by the Ministry of Health as part of the National centre for diseases prevention and control (CCM) programme of 2010 with the general objective to provide methods and operational tools for the implementation of surveillance systems for waste and health, aimed at assessing the impact of the municipal solid waste (MSW) treatment cycle on the health of the population. The specific objective was to assess health impacts resulting from the presence of disposal facilities related to different regional scenarios of waste management. Suitable tools for analysis of integrated assessment of environmental and health impact were developed and applied, using current demographic, environmental and health data. In this article, the methodology used for the quantitative estimation of the impact on the health of populations living nearby incinerators, landfills and mechanical biological treatment plants is showed, as well as the analysis of three different temporal scenarios: the first related to the existing plants in the period 2008-2009 (baseline), the second based on regional plans, the latter referring to MSW virtuous policy management based on reduction of produced waste and an intense recovery policy.

Background: the body of evidence on health effects of residential exposure to urban waste incinerators suggests association with reproductive outcomes and some cancers, but the overall evidence is still limited., Objectives: we evaluated the impact of two incinerators on hospital admissions for respiratory and cardiovascular diseases in a cohort of people living nearby two incineration plants in Lazio Region (Central Italy) using a before-and-after design., Methods: the study area was defined as the 7-km radius around the incinerators. People who were resident in the area from 1996 to 2008 were enrolled in a retrospective longitudinal study. All addresses were geocoded. A Lagrangian dispersion model (SPRAY) for PM₁₀ (ng/m³) was used for incinerators exposure assessment. Average annual concentration of background PM₁₀ (μg/m³) was estimated on a regional basis by means of RAMS and FARM models. Both PM₁₀ exposures were estimated at the residential address. All subjects were followed for hospital admissions in the period before (1996-2002) and after (2003-2008) the activation of the plants. The association between exposure to emissions from incinerators and hospitalizations in the two periods was estimated using the multivariate Cox model (for repeated events), adjusting for age, area-level socioeconomic status, distance from industries, traffic roads and highways. An interaction term between the period of follow-up (before or after the activation of the plants) and the exposure levels was used to test the effect of the incinerators., Results: 47,192 subjects resident in the study area were enrolled. No clear association between pollution exposure from incinerators and cause-specific morbidity of residents in highest concentration areas was found when compared to the reference group. However, an effect of PM₁₀ on respiratory diseases and chronic obstructive pulmonary disease was suggested. The effect was due to excesses of hospitalizations for the same causes among men living in highest exposure areas in respect to the reference group (hazard ratio - HR: 1.26; 95%CI 0.99-1.60, and HR: 1.86; 95%CI 1.04-3.33, respectively). There were associations between exposure to background pollution from other sources and hospitalizations for diseases of the circulatory system (HR: 1.08; 95%CI 1.03-1.13) and respiratory diseases (HR: 1.07; 95%CI 1.02-1.11) (for a unitary increment of PM₁₀, μg/m³)., Conclusions: living in areas with high PM₁₀ levels due to incinerators was associated with increased morbidity levels for respiratory disorders among men. The study area is critical from an environmental point of view, hence an epidemiological surveillance is recommended.

Epidemiologic and clinical studies have linked elevated concentrations of particulate matter to adverse health effects. In particular, has been demonstrated an association between UFPs exposure and occurrence of acute respiratory infections, lung cancer, chronic chronic obstructive pulmonary diseases and cardiovascular diseases. Recently, the exposure to particulate air pollution has been linked to cognitive decline. In this work, we used the Mini-Mental State Examination (MMSE) in a preliminary assessment of cognitive function in individuals who have lived and carried out work in heavily urbanized areas, where ambient levels of particulate air pollution were frequently above the standard of the law. The results showed the presence of mild-moderate cognitive impairment in 39.4% of the subjects examined compared to the control group.

Objective: construction of environmental indicators of air pollution suitable for epidemiological surveillance in 25 Italian cities for EpiAir2 project (2006-2010) and presentation of the results from a 10 years of surveillance system (2001-2010) in 10 Italian cities., Design: data on particulate matter (PM10 and its fine fraction PM2.5), nitrogen dioxide (NO2), and ozone (O3), measured in the 2006-2010 calendar period, were collected. Meteorological data needed to estimate unbiased measures of the effect of pollutants are: temperature, relative humidity (estimated "apparent temperature"), and barometric pressure. In continuity with the previous EpiAir project, the same criteria for the selection of monitoring stations were applied and standard methods to estimate daily environmental indicators were used. Furthermore, it was checked the adequacy of the selected data to represent the population exposure., Setting and Participants: EpiAir2 project, relative to the period 2006-2010, involves the cities of Milano, Mestre-Venezia, Torino, Bologna, Firenze, Pisa, Roma, Taranto, Cagliari, and Palermo, already included in the previous study. The city of Treviso, Trieste, Padova, Rovigo, Piacenza, Parma, Ferrara, Reggio Emilia, Modena, Genova, Rimini, Ancona, Bari, Brindisi, and Napoli are added to the previous group., Results: particulate matter concentrations have decreased in most cities during the study period, while concentrations of NO2 and ozone do not show a similar clear trend. The analysis of the trend showed annual mean values of PM10 higher than 40 µg/m(3) in some areas of the Po Valley, and annual mean values of NO2 higher than 40 µg/m(3) in the cities of Trieste, Milano, Padova, Torino, Modena, Bologna, Roma, and Napoli., Conclusion: the enlargement of the EpiAir project to 13 other cities has highlighted critical issues related to the different geographical areas under study. Results of EpiAir2 project point out the need of a monitoring system of air pollution concentrations in both urban and industrial sites, in order to obtain reliable estimates of exposure for resident populations and to evaluate the related time trend.

Objectives: to estimate the short-term impact of air pollutants on adult population of 23 Italian cities on the calendar period 2006- 2009 as part of the EpiAir2 project., Design, Materials and Methods: for each city, the short-term impact of air pollution on mortality was estimated. In particular, it was calculated the number of deaths attributable to particulate matter levels (PM10 and PM2.5) exceeding different thresholds deriving from the European Union legislation and the World Health Organization guidelines (PM10: 20 and 40 µg/m(3), reduction of 20% up to 20 µg/m(3) and more than 35 days per year with daily average above 50 µg/m(3); PM2.5: 10, 18 and 25 µg/m(3), reduction of 20% up to 18 µg/m(3)). The impact evaluation was done combining the effect estimates of air pollutant, the observed mortality level and the air pollution concentration measured by the ambient monitors. Regarding effects, the posterior city-specific distributions arising from a Bayesian metanalysis was employed. Uncertainty around the impact estimates was obtained by Monte Carlo methods., Results: overall, in the 23 cities considered in the present study attributable deaths to short-term effects of PM10 concentrations above 20 µg/m(3) as annual average and of PM2.5 concentrations above 10 µg/m(3) on the period 2006-2009 was respectively 0.9% (assuming independence among cities the 80% credibility interval is 0.4-1.4) and 0.8% (80%CrI 0.2-1.3) of natural mortality. The impact was larger for the cities of the river Po valley, the Florence area and the large conurbations of Rome, Naples and Palermo: considering PM10 1.0% (80%CrI 0.4-1.5) vs. 0.4% (80%CrI 0.2-0.7) of natural deaths among the other cities in the study. Pollution reduction actions as prescribed by the European Union legislation, i.e. a 20% reduction up to 20 µg/m(3) for PM10 and up to 18 µg/m(3) for PM2.5, would have saved, over all the cities covered by this study, 42% and 51% of all attributable deaths, respectively., Conclusions: during the study period, air pollution exposure was responsible for a relevant impact on mortality in the enrolled cities. Policies based on percent reduction of PM10 and PM2.5 as prescribed by the European Union could substantially reduce the short term impact on population mortality.

Objectives: this study aims at presenting the results from the Italian EpiaAir2 Project on the short-term effects of air pollution on adult population (35+ years old) in 25 Italian cities., Design: the short-term effects of air pollution on resident people died in their city were analysed adopting the time series approach. The association between increases in 10µg/m(3) in PM10, PM2.5, NO2 and O3 air concentration and natural, cardiac, cerebrovascular and respiratory mortality was studied. City-specific Poisson models were fitted to estimate the association of daily concentrations of pollutants with daily counts of deaths. The analysis took into account temporal and meteorological factors to control for potential confounding effect. Pooled estimates have been derived from random effects meta-analysis, evaluating the presence of heterogeneity in the city specific results., Setting and Participants: it was analysed 422,723 deaths in the 25 cities of the project among people aged 35 years or more, resident in each city during the period 2006-2010., Main Outcome Measures: daily counts of natural, cardiac, cerebrovascular, and respiratory mortality, obtained from the registries of each city. Demographic information were obtained by record linkage procedure with the civil registry of each city., Results: mean number of deaths for natural causes ranged from 513 in Rovigo to 20,959 in Rome. About 25% of deaths are due to cardiac diseases, 10% to cerebrovascular diseases, and 7% to respiratory diseases. It was found an immediate effect of PM10 on natural mortality (0.51%; 95%CI 0.16-0.86; lag 0-1). More relevant and prolonged effects (lag 0-5) have been found for PM2.5 (0.78%; 95%CI 0.12-1.46) and NO2 (1.10%; 95%CI 0.63-1.58). Increases in cardiac mortality are associated with PM10 (0.93%; 95%CI 0.16-1.70) and PM2.5 (1.25%; 95%CI 0.17-2.34), while for respiratory mortality exposure to NO2 has an important role (1.67%; 95%CI 0.23-3.13; lag 2-5), as well as PM10 (1.41%; 95%CI - 0.23;+3.08). Results are strongly homogeneous among cities, except for respiratory mortality. No effect has been found for cerebrovascular mortality and weak evidence of association has been observed between ozone and mortality., Conclusions: a clear increase in mortality associated to air pollutants was observed. More important are the effects of NO2 (on natural mortality), mostly associated with traffic emissions, and of PM2.5 (on cardiac and respiratory mortality). Nitrogen dioxide shows an independent effect from the particulate matter, as observed in the bi-pollutant models.

Objective: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project., Design: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analysis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September)., Setting and Participants: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006- 2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005)., Main Outcome Measures: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 µg/m(3) and interquartile range (IQR) of the concentration of each pollutant were calculated., Results: reported results were related to an increment of 10 µg/m(3) of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75% at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0- 5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57% at lag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005)., Conclusion: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period.

Objective: to describe transport policies adopted in recent years (2006-2010) by some Italian municipalities and their effectiveness., Design and Setting: survey data refer to fifteen cities participating in the EpiAir2 project: Torino, Milano, Venezia, Bologna, Firenze, Pisa, Roma, Taranto, Palermo, Cagliari, Trieste, Genova, Ancona, Napoli, and Bari., Results: this survey revealed strengths and weaknesses of the way in which these Italian cities address the promotion of sustainable mobility. As a general rule, the vehicle fleets have been renewed with a reduction of old-emission-standard vehicles. Italian cities reported a considerable delay in the development of underground and tram systems, and suburban rail networks, compared to other European urban areas. Regarding other aspects of urban mobility (supply/demand for public transport, low traffic and pedestrian zones, bike paths, car and bike sharing), this survey highlighted a great heterogeneity among Italian cities., Conclusion: differences between Italian cities are partly explained by structural and cultural features and also by local governance, specifically the political capability to design and adopt effective policies concerning urban transportation systems and their environmental impact. Various and fragmented initiatives are signs that Italy has not formulated a comprehensive and integrated strategy about sustainable mobility in urban areas yet.

Introduction: The adverse health effects associated with waste treatment processes are of great concern as large population groups and workers may be exposed to refuse-derived toxic substances. The main effects are respiratory and gastrointestinal infections, reduced lung function, irritations, allergic reactions, and injuries., Objective: To evaluate morbidity and mortality among a cohort of municipal waste workers in Rome., Methods: All 6839 workers (18.6% women) involved in waste collection, transportation and landfill disposal employed since 01/01/1994, with a minimum period of employment of five years were enrolled and with follow-up until 31/12/2009. The assessment of vital status was carried out through linkages with information systems (municipality records, mortality and hospital information systems), and through contacts with municipalities of residence. Gender specific standardized mortality (SMR) and hospitalization (SHR) ratios were calculated, using regional population mortality (and hospitalization) rates., Results: Overall, in this cohort workers had the same mortality as the population of the Region. Hospitalizations for natural causes were significantly higher than expected among workers involved in transportation (SHR = 1.25, 95% CI = 1.13-1.38) and in waste collection (SHR(men) = 1.14, 95% CI = 1.07-1.22; SHR(women) = 1.65, 95% CI = 1.47-1.84). Among women there was an excess of hospitalizations for respiratory diseases (SHR = 1.95, 95% CI = 1.33-2.77), for digestive system disorders (SHR = 1.37, 95% CI = 1.03-1.79) and for injuries and intoxications (SHR = 2.28, 95% CI = 1.69-2. 99)., Conclusions: The study did not find any increased mortality among the workers of either sexes. Female workers deserve further surveillance mainly due to an increased risk of trauma and respiratory and gastrointestinal disorders.

Background: An integrated network for the management of acute ST-elevation myocardial infarction (STEMI) allows a pre-hospital diagnosis and facilitates the best strategy to provide the most effective reperfusion therapy. This study aims to assess the network impact on timing and mode of reperfusion in the metropolitan area of Cagliari., Methods: From January 1, 2008 to December 31, 2010 all patients affected by STEMI with symptom onset <12h were enrolled. We evaluated modality of hospital access, reperfusion therapies, and time for avoidable delay. The first medical contact-to-balloon time (FMC-to-balloon) was compared between patients without ECG transmission (No-ECG group) and those with ECG transmission and direct transport to the cath-lab (Cath-Lab-ECG group) or the emergency room/intensive cardiac care unit (ER/ICCU-ECG group)., Results: Out of 622 patients enrolled, 324 (52.1%) arrived to hospital by emergency medical systems. In this group a pre-hospital diagnosis was made in 79.3% of cases (n = 257); among them, 138 patients (53.7%) had a direct access to cath-lab, 99 to ICCU (38.5%), and 20 (7.8%) to ER. In the whole study population an urgent coronary angiography was performed in 612 patients (98.4%) and a primary percutaneous coronary intervention (p-PCI) in 589 (96.2%). In the Cath-Lab-ECG group the FMC-to-balloon was 89 ± 29 min (median 87 min, interquartile range 72-100), significantly lower than in the ER/ICCU-ECG group [122 ± 39 min (115 min)] and the No-ECG group [150 ± 54 min (139 min)] (p<0.01). A FMC-to-balloon ≤90 min was achieved in 66.4% of Cath-Lab-ECG patients, 22.1% of ER/ICCU-ECG patients, and 8.3% of No-ECG patients (Cath-Lab-ECG vs ER/ICCU-ECG, p<0.01)., Conclusions: Our results show that an integrated network provides a pre-hospital diagnosis in the majority of STEMI. However, only a direct transport to the cath-lab allows to achieve a FMC-to-balloon ≤90 min in a large proportion of patients. Out of this condition, adherence to guideline-recommended time of ≤90 min is significantly lower.

Background: Exposure of children to passive tobacco smoking in the household setting has been demonstrated to cause respiratory diseases. Early atherosclerosis has also been demonstrated in young people previously exposed to passive tobacco smoking. Functional damage can initiate at the fetal age due to maternal smoking, with a tendency towards over-time progress. To date only scant data are available about indoor parental smoking attitudes and their changes after campaigns against smoke and risk factors in exposed youths. Questionnaires are useful tools in order to search for information on cigarette smoking and parental household lifestyle. In this study, we asked pupils of primary schools for providing information on their relatives' every 5 years throughout the period 1994-2009., Methods: A multiple-choice answer questionnaire about sharing household parental smoking was administered to all primary school children (mean age 10.5 ± 0.5 years) of the city of Agrigento (Sicily, Italy)., Results: A total of 2221 questionnaires were collected from 637 children in 1994, 687 in 1999, 516 in 2004, and 381 in 2009. Important findings show a significant reduction in both smoking parents and exposure to passive tobacco smoking (from 64% in 1994 to 45% in 2009, p<0.00001). In 2009, 22% of mothers and 39% of fathers resulted to be smokers in the household setting yet., Conclusions: In agreement with the 2011 Italian DOXA survey on the general population, the present study demonstrates a negative trend in the prevalence of household smoker parents (predominantly mothers) and exposure of children to passive tobacco smoking. These results likely reflect such a greater awareness about smoke-related risks in children, and the effectiveness of medical campaigns against cardiovascular risk factors as well.