Background: Solid waste incinerators (SWI) emit several pollutants among which polychlorodibenzodioxins and furans (PCDD/Fs), polychlorobiphenyls, metals, monocyclic and polycyclic aromatic hydrocarbons (PAHs). Aim of the study: To present a systematic review of peer-reviewed literature on human biological monitoring of exposure and effect following potential exposure to SWI pollutants to bring together evidences and to highlight strengths and deficiencies of the studies conducted so far. Methods: Relevant studies on biomonitoring of individuals living near or working at SWIs were selected through three steps: (1) a literature search in the Medline, CAplus, and Embase database; (2) the retrieved abstracts were screened by four independent reviewers; (3) the full text of the relevant papers was read, papers were pooled in studies, and then analyzed to highlight strengths and weaknesses. Studies with the strongest epidemiological design and/or the largest sample size were identified as reference studies. Results: One hundred and thirty-two papers, pooled in 82 studies, were included in the review: 67 on general population, 52 on SWI workers, and 14 on both groups. The most frequently investigated biomarkers were PCDD/Fs in plasma (87). Several studies presented limitations, such as a small samples size, scarce information on confounders, and a poor statistical analysis. Some earlier studies showed an increase of PCDD/Fs, lead, and PAHs in individuals (mainly workers) exposed to emissions from old SWIs; studies from the year 2000 showed no increase of biomarkers or biomarkers within the range of the general population; decreasing trends were observed in prospective studies. Conclusions: Most studies presented methodological pitfalls; reference studies showed no or a limited evidence of the impact of SWI on exposure and effect biomarkers.

Smoking and pregestational diabetes (PGD) are recognized risk factors for adverse pregnancy outcomes, but to date, no population-based study has investigated their joint effects. Using hospital discharges, we identified all women with PGD delivering in Emilia-Romagna region during 2007–2010 matched 1 : 5 with parturients without diabetes. Our study endpoints were preterm births and congenital anomalies. We measured interaction between PGD and maternal smoking, by calculating excess prevalence and prevalence ratio due to interaction, relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (S). Analyses were performed in the overall study population and in the subgroup whose PGD was validated through diabetes registers. The study included 992 women with PGD (10.5% smokers) and 4788 comparison women (11.9% smokers). The effects of PGD and maternal tobacco smoking were greater than additive for both preterm birth (excess prevalence due to interaction = 11.7%, excess ratio due to interaction = 1.5, RERI = 2.39, AP = 0.51, S = 2.82) and congenital anomalies (excess prevalence due to interaction = 2.2%, excess ratio due to interaction = 1.3, RERI = 1.33, AP = 0.49, S = 5.03). Joint effect on both endpoints was confirmed in the subgroup whose PGD status was validated. In conclusion, we found that maternal tobacco smoking and PGD intensify each other’s effect on preterm birth and congenital anomalies.

Recent data suggest a general trend in decreased occupational exposure to perchlorethylene (PCE) in the dry-cleaning sector. The aims of this study were to confirm this trend to lower exposure levels in a group of Italian dry cleaners and to evaluate the current occupational PCE exposure in these works using noninvasive biological indices. Environmental exposure was assessed by personal sampling in 60 operators working in 21 dry cleaning shops in North Italy. PCE in the exhaled alveolar air (PCEalv), urinary concentration of PCE and of trichloroacetic acid (TCA) (PCEu and TCAu respectively), were measured as biological exposure indices. Median PCE environmental concentration in the whole sample was 10.6 mg/m³ (i.e., less than the 25% of the levels measured in the same area in a previous study). All values were less than 10% of the occupational limits. PCEu measured in samples collected at the end of the work shift resulted the biological markers having the strongest correlation with environmental PCE (r = 0.81). PCEalv also resulted in a high correlation (r = 0.66), while a lower correlation was found for TCAu measured at the end shift (r = 0.32). According to our results, PCEu can be proposed as a valid, noninvasive, and easily reliable exposure index to evaluate PCE exposure at the low levels currently observed in dry cleaners, therefore representing a promising alternative to invasive blood sample collections needed to determine PCE blood concentration.

In Italy, the National Health Service offers specialized evidence-based support to smokers who would like to quit through smoking cessation (SC) services. We conducted a two-year prospective study, involving all 288 subjects treated for smoking cessation at the SC service of Reggio Emilia, to assess the association of referral sources and waiting times with the risk of treatment failure, by following participants up to one year after the quit date. We performed Cox-regression analysis, including demographic and smoking-related characteristics as confounding variables. The treatment failure rate at 12 months was 59.4% (171/288), including only 12 subjects lost to follow-up. The main mode of entry was self-referral (42.4%), followed by 32.6% from general practice, 17.4% from hospital and 7.6% from other sources. Only 27.8% participants were involved in the SC-program within 60 days of the first contact, as the guidelines suggest. The risk of treatment failure at 12 months showed little association with the type of referral source, while it correlated with waiting times ≥ 60 days (hazard ratio = 1.59; 95% confidence interval 1.10–2.29). This study provides evidence of long-term high quit rates from a SC service, with few subjects lost to follow-up and biochemical verification of almost all abstinent subjects. Timeliness in care provision could further improve the outcome.