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Abstract: Background: The association between smoking habits and asthma is complex because subjects with asthma could avoid smoking, whereas smoking could increase asthma severity or incidence. Purpose: The relation between asthma in childhood (0–10 years) and smoking initiation in the second decade (11–20 years) was investigated using the database of the Italian Study on Asthma in Young Adults, performed in 1998–2000 on people aged 20–45 years. Methods: The cumulative incidence of smoking initiation was compared among (1) subjects not reporting asthma attacks in the first 20 years of life (n = 17,384), (2) subjects reporting asthma onset in the first decade and no disease remission by the age of 20 years (n = 305), (3) subjects reporting asthma onset in the first decade and remission in the first and second decades (n = 573). Results: Among men, the cumulative incidence of smoking onset was higher among nonasthmatics (49%) than among asthmatics (35.6%), and intermediate among asthmatics with disease remission (44.2%) (p = .001). These differences were larger in males born between 1953 and 1965, and tended to decrease in males born between 1966 and 1979: cumulative incidence of smoking onset decreased from 54.3% to 43.8% in nonasthmatics, whereas it remained stable in asthmatics (from 36.8% to 35%). Women, instead, had similar cumulative incidence of smoking initiation, irrespective of asthma onset or remission (p = .849). Conclusion: Asthma in childhood reduces smoking initiation during the subsequent teenage in men, but not in women. This protective effect tends to fade when asthma remission occurs. In the last decades, smoking initiation has decreased among nonasthmatic males, but not among asthmatic males. [Copyright &y& Elsevier]

Summary: Background: Immigration usually implies a complete change of the environment where one lives. Hence, studies on immigrants may help to disentangle genetic and environmental determinants of disease. We investigated whether the incidence of allergic and respiratory symptoms differed for Italian and immigrant children living in one area of Northern Italy. Methods: In December 2006, all the children (3–14 years) living in the Viadana district were surveyed through a parental questionnaire (response rate = 99%, n = 3854). Retrospective incidences of several symptoms were compared across different ethnic groups. Results: Parental asthma, allergic rhinitis and eczema were less frequent in immigrant children than in Italian children. Wheezing and eczema incidences were lower in children born to foreign parents (especially if born abroad, incidence rate ratio (IRR) = 0.47, 95% CI: 0.26–0.82 and IRR = 0.43, 95% CI: 0.23–0.83, respectively), with respect to Italian children, while the occurrence of nasal allergies was similar among the ethnic groups. The greatest incidence of persistent cough/phlegm was observed in children born in Italy to foreign parents (IRR = 1.98, 95% CI: 1.06–3.71) and in children whose parents had chronic bronchitis (IRR = 2.57, 95% CI: 1.52–4.33). Conclusions: Considering the distribution of parental atopic diseases and the low disease prevalence in the immigrants’ countries of origin, we suggest that nasal allergies may be more sensitive than wheezing or eczema to the change in the environment related to migration. Genetic or environmental factors clustered into families seem to have a role on chronic bronchitis. [ABSTRACT FROM AUTHOR]

Summary: Rationale and objectives: Response to mailed epidemiological surveys has decreased in recent decades. Since subjects with respiratory symptoms are usually early responders to surveys performed in Southern Europe, this trend could bias prevalence estimates. The present study aimed at evaluating the impact of non-response bias on prevalence estimates of respiratory symptoms and smoking habits. Methods: In 9 centres, participating in the Italian Study on Asthma in Young Adults (ISAYA), random samples of people aged 20–45 years were administered a mailed questionnaire between 1998 and 2000. Non-responders were contacted again first by mail and then by phone. Cumulative response percentage was 30.5%, 52.4% and 72.7% (18,873/25,969), respectively, after the 1st, 2nd and 3rd contact. Results: The prevalence of self-reported current asthma, asthma-like symptoms, and chronic cough/phlegm was more than halved from the first contact (5.6%, 17.8%, 14.6% respectively) to the third contact (2.7%, 6.4%, 6.9%). This pattern was less pronounced when considering allergic rhinitis and past asthma, whose prevalence decreased, respectively, from 21.5% to 15.6% and from 3.5% to 2.6%. At the same time the proportion of current smokers increased from 29.2% to 38%, while the proportion of ex-smokers decreased from 16.5% to 10.1%. In a multinomial logistic model current asthma, asthma-like symptoms, chronic cough/phlegm and smoking habits, and to a lower extent past asthma and allergic rhinitis, were significant predictors of late response. Conclusions: In Italy when response percentage is low, the prevalence of current asthma, chronic cough/phlegm and ex-smokers is overestimated, while the proportion of current smokers is underestimated. [Copyright &y& Elsevier]

Abstract: Emissions related to wood production processes are a recognized health hazard for professionally exposed subjects. The health effects of living close to wood industries are not known, particularly in the pediatric population. We aimed at investigating if living close to chipboard industries is a health hazard for the children in the Viadana district (Northern Italy). In December 2006, all the children (3–14years) living in the Viadana district, where two big chipboard industries are located, were surveyed through a parental questionnaire (n =3854). The children were geocoded, and the distance of their houses/schools from the closest wood plant was computed. Independently of sex, age, nationality, residential area, traffic, parents'' education, passive/parental smoking, questionnaire compiler and his/her environmental concern, the children living at <2km from chipboard industries had a greater prevalence of respiratory (OR=1.33, 95%CI: 1.11, 1.60), cough/phlegm (OR=1.43, 95%CI: 1.08, 1.88), nose/throat/mouth (OR=1.47, 95%CI: 1.23, 1.75), eye (OR=1.24, 95%CI: 1.04, 1.48) symptoms, school-days lost (OR=1.24, 95%CI: 1.04, 1.48), and emergency (OR=2.14, 95%CI: 1.47, 3.11) and hospital (OR=2.21, 95%CI: 1.17, 4.18) admissions. There was an inverse dose–response relationship between the adverse health outcomes considered and the distance from the plants. The attributable fractions for the children living close to the chipboard industries were substantial, ranging from 13% (eye symptoms) to 27% (cough/phlegm). The present findings suggest that emissions from chipboard industries might have a serious impact on children''s health status and should therefore be reduced and closely monitored. [Copyright &y& Elsevier]

Background: Epidemiologic evidence related to asthma control in patients from the general population is scanty. Objectives: We sought to assess asthma control in several European centers according to the Global Initiative for Asthma (GINA) guidelines and to investigate its determinants. Methods: In the European Community Respiratory Health Survey II (1999-2002), 1241 adults with asthma were identified and classified into inhaled corticosteroid (ICS) users and non-ICS users in the last year. Control was assessed in both groups by using the GINA proposal (controlled, partly controlled, and uncontrolled asthma), and it was related to potential determinants. Results: Only 15% (95% CI, 12% to 19%) of subjects who had used ICSs in the last year and 45% (95% CI, 41% to 50%) of non-ICS users had their asthma under control; individuals with uncontrolled asthma accounted for 49% (95% CI, 44% to 53%) and 18% (95% CI, 15% to 21%), respectively. Among ICS users, the prevalence of uncontrolled asthma showed great variability across Europe, ranging from 20% (95% CI, 7% to 41%; Iceland) to 67% (95% CI, 35% to 90%; Italy). Overweight status, chronic cough and phlegm, and sensitization to Cladosporium species were associated with poor control in ICS users. About 65% and 87% of ICS users with uncontrolled and partly controlled asthma, respectively, were on a medication regimen that was less than recommended by the GINA guidelines. Conclusion: Six of 7 European asthmatic adults using ICSs in the last year did not achieve good disease control. The large majority of subjects with poorly controlled asthma were using antiasthma drugs in a suboptimal way. A wide variability in asthma control emerged across Europe. Clinical implications: Greater attention should be paid to asthma management and to the implementation of the GINA guidelines. [Copyright &y& Elsevier]

Summary: Background: A major reason of the poor control of asthma is that patients fail to adhere to their treatment. The aim of the study was to identify factors affecting changes in asthma treatment adherence in an international cohort. Methods: A follow-up study was carried out by means of a structured clinical interview in 971 subjects with asthma from 12 countries who participated in both the European Community Respiratory Health Survey: ECRHS-I (1990–94) and ECRHS-II (1998–2002). Subjects were considered adherent if they reported they normally took all the prescribed drugs. A logistic model was used to study the adjusted effect of the determinants. Results: The net change in adherence to anti-asthmatic treatment per 10 years of follow-up was −2% (95% CI: −9.5, 5.5), 7.5% (−2.6, 17.6), 15.0% (6.6, 23.5) and 19.8% (4.1, 35.5), respectively, in Nordic, Mediterranean, Continental and extra-European areas. Among the 428 non-adherent subjects in ECRHS-I, having regular consultations with health care professionals was the strongest predictor of increased adherence (OR 3.32; 95% CI: 1.08–10.17). Among the 543 adherent subjects in ECRHS-I, using inhaled corticosteroids significantly predicted a persistence of adherence (OR 2.04; 95% CI: 1.11–3.75). No effect of gender, age, duration of the disease, smoking habit and educational level was observed. Conclusions: Our findings highlight the key role of doctors and nurses in educating and regularly reviewing the patients and support the efforts for an improvement of clinical communication. [Copyright &y& Elsevier]

Background: Few studies have investigated the long-term association between inhaled corticosteroids (ICSs) and lung function decline in asthma. Objective: To evaluate whether prolonged treatment with ICSs is associated with FEV1 decline in adults with asthma. Methods: An international cohort of 667 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1999 to 2002. Spirometry was performed on both occasions. FEV1 decline was analyzed according to age, sex, height, body mass index, total IgE, time of ICS use, and smoking, while adjusting for potential confounders. Results: As ICS use increased, the decline in FEV1 was lower (P trend = .025): on average, decline passed from 34 mL/y in nonusers (half of the sample) to 20 mL/y in subjects treated for 48 months or more (18%). When adjusting for all covariates, there was an interaction (P = .02) between ICS use and total IgE: in subjects with high (>100 kU/L) IgE, ICS use for 4 years or more was associated with a lower FEV1 decline (23 mL/y; 95% CI, 8-38 compared with nonusers). This association was not seen in those with lower IgE. Conclusion: Although confirming a beneficial long-term association between ICSs and lung function in asthma, our study suggests that subjects with high IgE could maximally benefit from a prolonged ICS treatment. Clinical implications: This study adds further evidence to the beneficial effect of inhaled steroids on lung function in asthma; future studies will clarify whether calibrating the corticosteroid dose according to the level of total IgE is a feasible approach in asthma management. [Copyright &y& Elsevier]

Background: Studies have demonstrated considerable variations in classic Kaposi sarcoma (CKS) incidence within Europe, with some of the highest incidences found in the Mediterranean area. As a Mediterranean area, northern Sardinia has a high CKS frequency. Objective: In order to determine CKS incidence in people born in and residing in northern Sardinia, a clinical prospective epidemiologic study was carried out between 1977 and 2003 by the Department of Dermatology, University of Sassari. We also evaluated a correlation between malaria prevalence in 1934, estimated on the eight historical sub-areas of the Sassari province, and the standardized morbidity ratio from 1977 to 2003. Results: A total of 332 patients with CKS were identified. Incidence among the northern Sardinian population ≥40 years of age was 4.06/100,000 persons/year and it was almost stable through the years. The male to female ratio showed a significant decline from 3.6 to 2.5 (P = .03). Females had a statistically decreased risk of developing CKS compared to males (adjusted incidence rate ratio = 0.27; 95% CI: 0.21-0.34), and the risk of developing CKS increased exponentially with age. The prevalence of malaria in each sub-area ranged from 9% to 91%. The standardized morbidity ratio for CKS in the years between 1977 and 2003 ranged from 0.27 to 1.76; the regression coefficient was −0.85 (95% CI: −2.94-1.24), yielding a nonsignificant relationship between the two diseases. Limitations: These results were obtained from patients with CKS in northern Sardinia and may not be applicable to other populations. Conclusions: The northern Sardinian population consistently has a very high incidence of CKS, while in our data, the correlation between malaria and CKS remains open to question. [Copyright &y& Elsevier]

Summary: Background: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. Methods: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20–45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan–Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953–58, 1959–63, 1964–68, 1969–73, 1974–78). Probability to quit smoking was also evaluated among ever-smokers. Results: Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4–44.0%) in men and 52.7% (50.4–54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8–59.1%) in men and 68.7% (66.6–70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974–78). Also the probability to quit smoking significantly increased from the 1953–58 birth cohort to the 1969–73 one. Conclusions: Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke. [Copyright &y& Elsevier]

Background: Asthma and allergy might influence the choice of keeping pets, leading to apparent protective effects of pets on allergic disease. Objective: We investigated the effects of asthma and allergy on subsequent pet keeping in childhood and adulthood. Methods: Information about asthma and pet keeping at ages 0 to 4, 5 to 15, 20 to 44, and 26 to 56 years was provided by 9812 subjects participating in the 9-year follow-up of the European Community Respiratory Health Survey. Results: In childhood asthma debut at younger than 5 years was associated with less cat keeping at 5 to 15 years (odds ratio [OR], 0.60; 95% CI, 0.44-0.82), an effect only observed when the parents did not have asthma or allergy (P interaction = .045). Childhood asthma did not influence adult pet ownership, unless there were adult symptoms. Adults less often acquired cats at follow-up if they had 3 or more asthma symptoms (OR, 0.78; 95% CI, 0.64-0.95), were taking asthma medication (OR, 0.48; 95% CI, 0.31-0.74), had hay fever (OR, 0.75; 95% CI, 0.62-0.91), had atopy (OR, 0.75; 95% CI, 0.61-0.91), or had specific IgE to cat (OR, 0.57; 95% CI, 0.39-0.82) at baseline. Adults who already had pets usually continued keeping the same type of pet, except that the presence of 3 or more asthma symptoms was associated with less subsequent dog keeping (OR, 0.69; 95% CI, 0.53-0.89). Pet removal between surveys to reduce allergen was reported by 4.7%. Conclusion: Selective avoidance subsequent to asthma or allergy was observed for childhood cat keeping and adult cat acquisition. Avoidance would produce an apparent protective effect of cats on childhood asthma (large OR, 0.83). Avoidance was generally not observed for dogs or birds. Clinical implications: A part of the protective effects of childhood cats on asthma and allergy can be attributed to selective avoidance. [Copyright &y& Elsevier]

Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient''s severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable. [Copyright &y& Elsevier]

Background: Cross-sectional studies show that the prevalence of IgE sensitization is lower in older age groups than younger age groups. This could reflect either a decrease in sensitization with aging or a higher prevalence of sensitization in more recent birth cohorts. Objective: To assess change in IgE sensitization and mean total IgE in young adults as they age. Methods: Serum specific IgE to common allergens and total IgE were measured on 2 occasions about 9 years apart in 6371 young adults living in 28 centers, mainly in Western Europe, who took part in the European Community Respiratory Health Survey II. Outcomes were analyzed by using generalized estimating equations, and adjustments were made for differences between laboratory measures on the 2 occasions. Results: Overall, there was no net change in the prevalence of sensitization to at least 1 of house dust mite, grass, or cat (net change per 10 years of follow-up, −0.1%; 95% CI, −1.7% to 1.5%), although there was a fall in mean total IgE (ratio of geometric mean total IgE, 0.86; 95% CI, 0.79 to 0.93). There was evidence that sensitization to at least 1 allergen was higher in more recent cohorts, and this was largely explained by a higher prevalence of sensitization to grass. Conclusion: The disease burden associated with IgE sensitization in adults, and particularly with IgE sensitization to grass, is likely to continue to increase for some time despite current evidence that the increase in allergy seen in children may have ceased. [Copyright &y& Elsevier]

Background Cross-sectional studies have reported a lower prevalence of sensitization in older adults, but few longitudinal studies have examined whether this is an aging or a year-of-birth cohort effect. Objective We sought to assess changes in sensitization and total IgE levels in a cohort of European adults as they aged over a 20-year period. Methods Levels of serum specific IgE to common aeroallergens (house dust mite, cat, and grass) and total IgE levels were measured in 3206 adults from 25 centers in the European Community Respiratory Health Survey on 3 occasions over 20 years. Changes in sensitization and total IgE levels were analyzed by using regression analysis corrected for potential differences in laboratory equipment and by using inverse sampling probability weights to account for nonresponse. Results Over the 20-year follow-up, the prevalence of sensitization to at least 1 of the 3 allergens decreased from 29.4% to 24.8% (−4.6%; 95% CI, −7.0% to −2.1%). The prevalence of sensitization to house dust mite (−4.3%; 95% CI, −6.0% to −2.6%) and cat (−2.1%; 95% CI, −3.6% to −0.7%) decreased more than sensitization to grass (−0.6%; 95% CI, −2.5% to 1.3%). Age-specific prevalence of sensitization to house dust mite and cat did not differ between year-of-birth cohorts, but sensitization to grass was most prevalent in the most recent ones. Overall, total IgE levels decreased significantly (geometric mean ratio, 0.63; 95% CI, 0.58-0.68) at all ages in all year-of-birth cohorts. Conclusion Aging was associated with lower levels of sensitization, especially to house dust mite and cat, after the age of 20 years. [ABSTRACT FROM AUTHOR]

Background: Evidence on the longitudinal association of airway responsiveness with respiratory diseases is scarce. The best indicator of responsiveness is still undetermined. Objective: We investigated the association of airway responsiveness with the incidence of asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis. Methods: We studied 3851 subjects who underwent spirometry and methacholine challenge tests both at baseline (1991-1993), when they were 20 to 44 years old, and at follow-up (1999-2002) in the European Community Respiratory Health Survey. Airway responsiveness was defined based on the methacholine dose-response slope on both occasions. Incidence rate ratios for the association of airway responsiveness with disease occurrence were computed by using Poisson regression. Results: With respect to reference (slope of the fourth quintile or greater), subjects with the greatest degree of airway responsiveness (slope less than the first quintile) showed the greatest risk of developing asthma, COPD, and allergic rhinitis (incidence rate ratios of 10.82, 5.53, and 4.84, respectively; all P < .01). A low slope predicted disease occurrence, even in subjects who did not reach a 20% decrease in FEV1 at the cumulative dose of 1 mg of methacholine (PD20 >1 mg). A decrease in slope over time was an independent predictor of disease risk. Conclusion: Airway responsiveness predicted new-onset asthma, COPD, and allergic rhinitis. Our study supports the use of a continuous noncensored indicator of airway responsiveness, such as the slope of the methacholine dose-response curve, in clinical practice and research because it showed clear advantages over PD20. [Copyright &y& Elsevier]

Background: Rhinitis is an increasingly common condition with a heavy health care burden, but relatively little is known about its risk factors. Objective: To examine the association between early-life factors and the development of rhinitis in the European Community Respiratory Health Study (ECRHS). Methods: In 1992-1994, community-based samples of 20-44-year-old people were recruited from 48 centers in 22 countries. On average, 8.9 years later, 28 centers reinvestigated their samples. Onset of rhinitis was reported by 8486 participants in interviewer-led questionnaires. Cox regression was used to assess independent predictors of rhinitis at ages ≤5, 6-10, 11-20, and ≥21 years. Results: The crude lifelong incidence of rhinitis was 7.00/1000/year (men) and 7.95/1000/year (women) (P = .002). Women developed less rhinitis in later childhood (hazard ratios [HR], 0.63; 95% CI, 0.47-0.85) and more rhinitis in adulthood (HR, 1.36; 95% CI, 1.11-1.66) than did men. In atopic subjects, siblings were associated with lower risk of rhinitis throughout life (pooled HR, 0.94; 95% CI, 0.91-0.98 per 1 sibling). Early contact with children in the family or day care was associated with less incidence of rhinitis, predominantly before age 5 years (HR, 0.84; 95% CI, 0.72-0.99). Early childhood pets or growing up on a farm was associated with less incidence of rhinitis in adolescence (HR, 0.50; 95% CI, 0.37-0.68). Combining these factors showed evidence of a dose-response relationship (trend P = .0001). Conclusions: Gender is a strong risk factor for rhinitis, with age patterns varying according to atopic status. Protective effects of early contact with children and animals were suggested for incident rhinitis, with risk patterns varying by age window and atopic status. [ABSTRACT FROM AUTHOR]

Background: Little is known about factors associated with lung function decline in asthma. Objective: To identify the determinants of FEV1 decline in adults with asthma with and without airflow obstruction at baseline. Methods: An international cohort of 638 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1998 to 2002. Spirometry was performed on both occasions. FEV1 decline was related to potential determinants evaluated at baseline and during the follow-up by random intercept linear regression models. The analyses were stratified by the presence of airflow obstruction (FEV1/forced vital capacity < 0.70) at baseline. Results: In the group of individuals without airflow obstruction (n = 544), a faster FEV1 decline was observed for subjects with intermediate body mass index (BMI) than for lean and obese subjects. FEV1 decline was associated with weight gain independently of baseline BMI, and this association was stronger in men (20; 95% CI, 10-30, mL/y/kg gained) than in women (6; 95% CI, 1-11, mL/y). In the group of individuals with airflow obstruction (n = 94), the absence of allergen sensitization and a low BMI at baseline were associated with a faster FEV1 decline, whereas weight gain was not associated with decline. Conclusions: The detrimental effect of weight gain on FEV1 decline is particularly relevant in subjects with asthma who still do not have an established airflow obstruction. Our findings support the importance of weight management in asthma and recommend weight loss in overweight or obese individuals with asthma. [Copyright &y& Elsevier]

Abstract: PM2.5 is the breathable fraction of the particulate matter and some adverse health effects, such as respiratory functionality, cardiological diseases and cancer, can be in some measure attributable to this risk factor exposure. Some of the most carcinogen compounds transported by PM2.5 are nitro-compounds. In this study, a strengthened in vitro bioassay — able to predict the mutagenic/carcinogenic activity of the environmental mixtures — was conducted on PM2.5 organic extracts to define the nitro-compounds burden. PM2.5 air pollution was daily monitored, during 2006, in three cities located in the Northern part of Italy (Torino, Pavia and Verona) and the mutagenic properties of the PM2.5 organic extracts were assessed with the Ames test. The bacterial used in this study were three Salmonella typhimurium strains: TA98, nitroreductase-less mutant TA98NR and YG1021 carrying a nitroreductase-producing plasmid. The annual PM2.5 mean level measured in Torino was 46.5 (±31.6) μg/m3, in Pavia 34.8 (±25.1) μg/m3, and in Verona 37.3 (±27.8) μg/m3, while the mutagenicity expressed as TA98 net reverants/m3 was 28.0 (±22.1), 28.3 (±24.9), and 34.2 (±30.9) respectively. Monthly pool bioassays, conducted with the three different strains, showed a greater mutagenic response of the YG1021 in each city. The relationship among the mutagenic answers for YG1021:TA98:TA98NR was about 6:3:1 (p <0.001). Over nitroreductase activity enhanced the response of 2.2, 2.0 and 1.7 times for Torino, Pavia, and Verona (ANOVA Torino p <0.05) respectively. Without nitroreductase activity the genotoxicity was limited. These biological findings are able to describe a relevant role played by the nitro compounds in the mutagenic properties of the urban PM2.5 in the Padana plain; moreover the bacterial nitroreductase plays a predominant role in DNA interaction primarily for Torino PM2.5 extracts. [Copyright &y& Elsevier]

Abstract: PM2.5 is one of the most important aspects of environmental health. This air pollutant is breathable and it is implicated in several chronic adverse health effects such as the decrease of respiratory functionality and cancer. Several in vitro bioassays are able to predict the mutagenic/carcinogenic activity of the environmental pollutants and mixtures of them. In this study PM2.5 air pollution was daily monitored in three cities located in the Northern part of Italy and the mutagenic properties of the PM2.5 organic extracts were also assessed. Samplings lasted 14 months and cover the period of the Winter Olympic Games of “Torino 2006”. In this work, the levels of PM2.5, its mutagenic properties (detected with Salmonella typhimurium assay), the role of the Olympic Games as environmental factor and some meteorological data are discussed. The mean concentration of PM2.5 measured in Torino was 45.4 (±30.6) µg/m3, in Pavia 37.6 (±25.6) µg/m3, in Verona 43.1 (±28.5) µg/m3. Findings of the monthly pool bioassay were in Torino 107 (±104) net revertans/m3, in Pavia 108 (±89) net revertans/m3, in Verona 128 (±109) net revertans/m3. The Olympic Games period data show that PM2.5 pollution and its load of mutagenic potential are different and partially independent phenomena. The Olympic Games had not a great impact on the PM2.5 pollution. The exclusive PM2.5 gravimetric analysis shows a potential human risk if compared with the latest international guide values but it does not describe exhaustively the human health risk associated to the presence of this particular air pollutant. Moreover, the chemical and biological activity qualification of the PM organic extracts as a whole, can instead improve the knowledge. [Copyright &y& Elsevier]

Abstract: Dusts are one of the main air pollutants emitted during cement manufacturing. A substantial part of these are breathable particles that are less than 10μm in diameter (PM10), which represent a potential threat for the health of the exposed population. This study aimed at evaluating the short-term effects of PM10 concentrations on the health of children, aged 6–14 years, who attended the schools in Fumane (Italy), in proximity (1.2km) to a large cement plant. School absenteeism was used as a proxy indicator of child morbidity. Time series of daily school absences and PM10 concentrations were collected for 3 school-years from 2007 to 2010 (541 school-days, 462 children on average). The associations between PM10 concentrations and school absence rates in the same day (lag0) and in the following 4 days (lag1 to lag4) were evaluated using generalised additive models, smoothed for medium/long term trends and adjusted for day of the week, influenza outbreaks, daily temperature and rain precipitations. The average concentration of PM10 in the period was 34 (range: 4–183) μg/m3. An average 10μg/m3 increase of PM10 concentration in the previous days (lag0–4) was associated with a statistically significant 2.5% (95%CI: 1.1–4.0%) increase in the rate of school absences. The highest increase in the absence rates (2.4%; 95%CI: 1.2–3.5%) was found 2 days after exposure (lag2). These findings provide epidemiological evidence of the acute health effects of PM10 in areas with annual concentrations that are lower than the legal European Union limit of 40μg/m3, and support the need to establish more restrictive legislative standards. [Copyright &y& Elsevier]

Abstract: Pollutants emitted from wood processing factories may be harmful to the health of the population. The aim of this prospective cohort study was to evaluate whether proximity to wood factories was associated with the risk of hospital admissions in children living in the Viadana district (Italy), where two big chipboard industries and other smaller wood factories (sawmills, multi-strata layer manufacturing) are located. In 2006, children (3–14 years) living in the Viadana district were surveyed through a parental questionnaire (n =3854), their home/school addresses were geocoded and the distances to the wood industries were calculated. Hospital discharge records for the years 2007–2009 were obtained. Cox proportional hazard regression models were used to estimate the association between hospitalization rates and distance to the factories, adjusting for sex, age, nationality, parents’ education, exposure to passive smoking and reported traffic near home. During the 3-year follow-up, the risk of hospitalization for all diagnoses (Hospitalization Hazard Ratio, HHR=1.55; 95% CI: 1.24–1.95) and for respiratory diseases (HHR=1.80; 95% CI: 1.14–2.86) was greater in the children living close (<2km) to the chipboard industries, with respect to the children who lived at ≥2km from any wood factory. The children living close to the smaller wood factories were also at increased risk of hospitalization for respiratory diseases (HHR=1.74; 95% CI: 1.06–2.85). This study highlights a health problem for the children living close to chipboard and wood factories in the Viadana district. Further research should develop accurate exposure models based on objective measurements of air pollution in order to confirm these findings. [Copyright &y& Elsevier]

Abstract: Increased prevalence of respiratory and irritation symptoms was found in children who live near a large wood industrial park. Proximity to the wood industries was used as indicator of exposure. This study describes a sensitivity analysis for the results of the survey. All the children (3–14years) living in the area were surveyed through a parental questionnaire (n =3854) and their addresses were geocoded. The distances from each child''s home and school to the closest industry were combined, weighted and used as an indicator of exposure. A sensitivity analysis was performed to check 1) the robustness of the results to the choice of weights used for defining the exposure indicator, 2) the effect of outliers on risk estimates and 3) the sensitivity on the functional form used for modeling the dose–response function. The choice of the weights did not influence the association between proximity to the industries and respiratory symptoms. Excluding the subjects who lived far away from the industries showed that in a radius of 5km from the industries the study did not had enough power to estimate a gradient in the dose–response function. Besides, results were sensitive to the choice of the functional form used for modeling the minimum distance. The sensitivity analyses confirmed the overall increasing trend of respiratory symptoms with proximity to the industries and pointed out that all the assumptions made for defining a proxy of exposure need to be carefully checked. [Copyright &y& Elsevier]

Abstract: Introduction: When pollution data from a monitoring network is not available, mapping the spatial distribution of disease can be useful to identify populations at risk and to suggest a potential role for suspected emission sources. We aimed at obtaining a continuous spatial representation of the prevalence of symptoms that are potentially associated with the exposure to the pollutants emitted from the wood factories in the children who live in the district of Viadana (Northern Italy). Methods: In 2006, all the parents of the children aged 3–14years residing in the Viadana district (n=3854), filled in a questionnaire on respiratory symptoms, irritation symptoms of the eyes and skin, use of health services. The children''s residential addresses were also collected and geocoded. Generalized additive models and local weighted regression (LOWESS) were used to estimate the distribution of the symptoms, to test for spatial trends of the symptoms'' prevalence and to control for potential confounders. Permutation tests were used to identify the areas of significantly increased risk (“hot spots”). Results: The prevalence of respiratory symptoms, eye symptoms and the use of health services showed a statistically significant spatial variation (p<0.05), but skin symptoms did not. Symptoms'' prevalence was lower in the northern part of the district, where no wood factories were present, and it was higher in the southern part, where the two big chipboard industries were located. Hot spots were identified fairly near to one of the two chipboard industries in the district. Conclusions: The north-to-south trend in the prevalence of respiratory and eye symptoms, but not of skin symptoms, as well as the location of hot spots, are consistent with the potential exposure to air pollutants both emitted by the wood factories and related to traffic. In these “high risk areas” monitoring of pollution and preventive actions are clearly needed. [Copyright &y& Elsevier]

Abstract: Background: Exposure to air pollutants emitted by wood industries has been associated with increased prevalence of respiratory and irritation symptoms. Objectives: To study whether proximity to wood industries was associated with risk of hospitalization for respiratory diseases in children. Methods: In December 2006, the large majority of the children (3–14years) living in the Viadana district (Northern Italy) were surveyed through a parental questionnaire (n=3854). Hospital discharge records for respiratory diseases (2002–2006) were obtained from the local Health Unit. The children were geocoded and the distance from their home/school to the wood industries was used as exposure indicator. Poisson regression models were used to assess the association between the distance and hospitalizations. Results: The hospitalization rates for respiratory diseases increased with proximity to the wood industries: they were 7.55 (95% CI 5.58, 10.22) ×1000 person-year for those who lived far from any wood industry, 11.84 (95% CI 8.87, 15.81) ×1000 person-year for those <2km from the small wood factories and 16.61 (95% CI: 13.57, 20.33) ×1000 person-year for those living within 2km from the two big chipboard industries. Conclusions: Proximity to wood industries is associated with a higher risk of hospitalization for respiratory diseases and respiratory symptoms in children. Studies with direct measures of exposure are needed and a follow-up of exposed population is advisable. [Copyright &y& Elsevier]

Abstract: Objective: Recently, self-reported asthma was combined with reported age of onset to investigate the disease''s natural history. To assess the validity of reported results, we investigated the reliability of the method. Study Design and Settings: The European Community Respiratory Health Survey was a longitudinal study with interviews in 1991/93 and in 2000/02. Lifelong asthma and age of asthma onset were assessed through self-administered questionnaires. Responses of 10,933 participants in the follow-up were combined to separate true from false incident cases. The repeatability of questions was assessed and the bias in cumulative incidence (CI) estimation was quantified. Results: Age at onset had excellent reliability (mean difference between the two interviews=−0.20, weighted κ =0.88) allowing the differentiation of false and true incident cases. Given this information, lifelong asthma question''s reliability was very high (agreement=0.96, κ =0.83). Misclassified subjects had respiratory conditions similar to the asthmatics. Baseline asthma was underreported and, if ignoring the onset age, the CI was severely overestimated (observed 5.82%, actual 3.02%). Conclusion: Questionnaire-based longitudinal studies make more reliable estimates possible when all the retrospective information is used: the reported age of onset plays a key role and should be accounted for when investigating the natural history of diseases. [Copyright &y& Elsevier]

The follow-up of cohorts of adults from more than 20 European centres of the former ECRHS I (1989–1992) investigates long-term effects of exposure to ambient air pollution on respiratory health, in particular asthma and change of pulmonary function. Since PM2.5 is not routinely monitored in Europe, we measured PM2.5 concentrations in 21 participating centres to estimate ‘background’ exposure in these cities. Winter (November–February), summer (May–August) and annual mean (all months) values of PM2.5 were determined from measuring periods between June 2000 and November 2001. Sampling was conducted for 7 days per month for a year. Annual and winter mean concentrations of PM2.5 vary substantially being lowest in Iceland and highest in centres in Northern Italy. Annual mean concentrations ranged from 3.7 to 44.9 μg m−3, winter mean concentrations from 4.8 to 69.2 μg m−3, and summer mean concentrations from 3.3 to 23.1 μg m−3. Seasonal variability occurred but did not follow the same pattern across all centres. Therefore, ranking of centres varied from summer to winter. Simultaneously, NO2 concentrations were measured using passive sampling tubes. Annual mean NO2 concentrations range from 4.9 to 72.1 μg m−3 with similar seasonal variations across centres and constant ranking of centres between seasons. The correlation between annual NO2 and PM2.5 concentrations is fair (Spearman correlation coefficient rs=0.75), but when considered as monthly means the correlation is far less consistent and varies substantially between centres.The range of PM2.5 mass concentrations obtained in ECRHS II is larger than in other current cohort studies on long-term effects of air pollution. This substantial variation in PM2.5 exposure will improve statistical power in future multi-level health analyses and to some degree may compensate for the lack of information on within-city variability. Seasonal means may be used to indicate potential differences in the toxicity across the year. Across ECRHS cities annual NO2 might serve as a surrogate for PM2.5, especially for past exposure assessment, when PM2.5 is not available. [Copyright &y& Elsevier]