Tag Archives: Italy

Drinking Water Arsenic Inversely Associated with Suicide Rates, Italy

Pompili M, Vichi M, Dinelli E, Erbuto D, Pycha R, Serafini G, Giordano G, Valera P, Albanese S, Lima A, De Vivo B, Cicchella D, Rihmer Z, Fiorillo A, Amore M, Girardi P, Baldessarini RJ. Arsenic: Association of regional concentrations in drinking water with suicide and natural causes of death in Italy. Psychiatry research. 2017 Jan 18;249:311-317. doi: 10.1016/j.psychres.2017.01.041.

Arsenic, as a toxin, may be associated with higher mortality rates, although its relationship to suicide is not clear. Given this uncertainty, we evaluated associations between local arsenic concentrations in tapwater and mortality in regions of Italy, to test the hypothesis that both natural-cause and suicide death rates would be higher with greater trace concentrations of arsenic. Arsenic concentrations in drinking-water samples from 145 sites were assayed by mass spectrometry, and correlated with local rates of mortality due to suicide and natural causes between 1980 and 2011, using weighted, least-squares univariate and multivariate regression modeling. Arsenic concentrations averaged 0.969 (CI: 0.543-1.396) µg/L, well below an accepted safe maximum of 10µg/L. Arsenic levels were negatively associated with corresponding suicide rates, consistently among both men and women in all three study-decades, whereas mortality from natural causes increased with arsenic levels. Contrary to an hypothesized greater risk of suicide with higher concentrations of arsenic, we found a negative association, suggesting a possible protective effect, whereas mortality from natural causes was increased, in accord with known toxic effects of arsenic. The unexpected inverse association between arsenic and suicide requires further study.

Cooperation Needed to Address Chronic Water Supply Interruptions

Dettori M, Piana A, Castiglia P, Loria E, Azara A. Qualitative and quantitative aspects of drinking water supply in Sardinia, Italy. A descriptive analysis of the ordinances and public notices issued during the years 2010-2015.Annali di igiene : medicina preventiva e di comunità. 2016 Jul-Aug;28(4):296-303. doi: 10.7416/ai.2016.2109.

BACKGROUND: The aim of the study is to analyze the regional district ordinances and the warnings regarding qualitative and quantitavive drinking water abnormalities discovered by the Sardinian Municipalities and the Water Managing Authority between 2010 and 2015 in order to describe and identify the causes leading to an interruption or a limitation of the drinking water supply.

METHODS: We carefully reviewed all ordinances and warnings of non-potable water and service interruption published between 2010 and 2015 by the websites of 377 Sardinian Municipalities and by the main regional newspapers, the Water Managing Authority and the Regional Health Trusts.

RESULTS: From 2010 to 2015, 738 warnings/ordinances regarding drinking water supply limitation or interruption were issued. The warnings involved more than half (n. 191, 50.7%) of the 377 Sardinian Municipalities. Considering that these Municipalities included the main Sardinian cities we estimated that 80.3% of the population was affected by the issue. During the 6 years we observed a progressive increase of Municipalities involved beginning with 25 and reaching up 110 in 2014. The initial 29 warnings rose to 256 in 2014 along with an increased number of abnormal values, parameters and standards of the drinking water. Regarding the ordinances issued by the 191 Mayors we noticed that the legal limits were exceeded in 23 cases. Among those, we underline the abnormal levels of chlorites and trihalomethanes (22% of cases), the turbidity, the abnormal concentration of total chemical substances and the abnormal level of coliforms, Escherichia coli, manganese, aluminum, nitrites and iron.

CONCLUSIONS: According to our observations, the Sardinian drinking water supply system is affected by a major inconvenience and the data suggest that qualitative abnormalities are mainly due to water purification treatments used in addition to the poor water supply network in existence. Considering these results, a cooperation between all Authorities involved would be desirable in order to analyze official data and provide a careful evaluation of population exposure and real risks related to the level of every parameter considered.

Environmental Standards for PFOA

Valsecchi S, Conti D, Crebelli R, Polesello S, Rusconi M, Mazzoni M, Preziosi E, Carere M, Lucentini L, Ferretti E, Balzamo S, Simeone MG, Aste F. Deriving environmental quality standards for perfluorooctanoic acid (PFOA) and related short chain perfluorinated alkyl acids. Journal of hazardous materials.2016 Apr 22. pii: S0304-3894(16)30396-X. doi: 10.1016/j.jhazmat.2016.04.055.

The evidence that in Northern Italy significant sources of perfluoroalkylacids (PFAA) are present induced the Italian government to establish a Working Group on Environmental Quality Standard (EQS) for PFAA in order to include some of them in the list of national specific pollutants for surface water monitoring according to the Water Framework Directive (2000/60/EC). The list of substances included perfluorooctanoate (PFOA) and related short chain PFAA such as perfluorobutanoate (PFBA), perfluoropentanoate (PFPeA), perfluorohexanoate (PFHxA) and perfluorobutanesulfonate (PFBS), which is a substitute of perfluorooctanesulfonate. For each of them a dossier collects available data on regulation, physico-chemical properties, emission and sources, occurrence, acute and chronic toxicity on aquatic species and mammals, including humans. Quality standards (QS) were derived for the different protection objectives (pelagic and benthic communities, predators by secondary poisoning, human health via consumption of fishery products and water) according to the European guideline. The lowest QS is finally chosen as the relevant EQS. For PFOA a QS for biota was derived for protection from secondary poisoning and the corresponding QS for water was back-calculated, obtaining a freshwater EQS of 0.1μgL-1. For PFBA, PFPeA, PFHxA and PFBS threshold limits proposed for drinking waters were adopted as EQS.

Drinking Water Nitrate and Colorectal Cancer Risk

Studies such as this are an enormous undertaking and authors are to be commended for their effort. Assessing actual exposure is typically the weakest component as personal interviews and after-the-fact surveys are known to be unreliable. Water system monitoring records are not intended to represent human exposure. This could sway the subtle associations reported here up or down. At best it can be concluded that additional study should be considered. But even if the associations reported here were much higher or much lower, such results could be misleading given the inherent limitations of the study design. This comment is not intended as a criticism of this work. But recognition of the realities associated with this type of epidemiological study. Learn what we can from it and then move on.

Espejo-Herrera N, Gràcia-Lavedan E, Boldo E, Aragonés N, Pérez-Gómez B, Pollán M, Molina AJ, Fernández T, Martín V, La Vecchia C, Bosetti C, Tavani A, Polesel J, Serraino D, Gómez Acebo I, Altzibar JM, Ardanaz E, Burgui R, Pisa F, Fernández-Tardón G, Tardón A, Peiró R, Navarro C, Castaño-Vinyals G, Moreno V, Righi E, Aggazzotti G, Basagaña X, Nieuwenhuijsen M, Kogevinas M, Villanueva CM. Colorectal cancer risk and nitrate exposure through drinking water and diet. International Journal of Cancer. 2016 Mar 8. doi: 10.1002/ijc.30083.

Ingested nitrate leads to the endogenous synthesis of N-nitroso compounds (NOCs), animal carcinogens with limited human evidence. We aimed to evaluate the risk of colorectal cancer (CRC) associated with nitrate exposure in drinking water and diet. We conducted a case-control study in Spain and Italy during 2008-2013. Hospital-based incident cases and population-based (Spain) or hospital-based (Italy) controls were interviewed on residential history, water consumption since age 18, and dietary information. Long-term waterborne ingested nitrate was derived from routine monitoring records, linked to subjectś residential histories and water consumption habits. Dietary nitrate intake was estimated from food frequency questionnaires and published food composition databases. Odd ratios (OR) were calculated using mixed models with area as random effect, adjusted for CRC risk factors, and other covariables. Generalized additive models (GAMs) were used to analyze exposure-response relationships. Interaction with endogenous nitrosation factors and other covariables was also evaluated. We analyzed 1869 cases and 3530 controls. Average waterborne ingested nitrate ranged from 3.4 to 19.7 mg/day, among areas. OR (95% CIs) of CRC was 1.49 (1.24, 1.78) for >10 vs. ≤5 mg/day, overall. Associations were larger among men vs. women, and among subjects with high red meat intake. GAMs showed increasing exposure-response relationship among men. Animal-derived dietary nitrate was associated with rectal, but not with colon cancer risk. In conclusion, a positive association between CRC risk and waterborne ingested nitrate is suggested, mainly among subgroups with other risk factors. Heterogeneous effects of nitrate from different sources (water, animal and vegetables) warrant further research.

Arsenic Study Trolls for a Health Crisis

The methods used in this study cannot answer the questions being asked about arsenic health effects at low concentrations. The “controversy” over arsenic concerns the questionable claims of harm at low concentrations (< 50 ug/L) based on theoretical extrapolations and poorly conducted ecological studies. Epidemiology simply cannot say much definitely below about 100 ug/L. Clearly, a more productive approach is needed for assessing the need for arsenic removal from drinking water. 

D’Ippoliti D, Santelli E, De Sario M, Scortichini M, Davoli M, Michelozzi P. Arsenic in Drinking Water and Mortality for Cancer and Chronic Diseases in Central Italy, 1990-2010. PLoS One. 2015 Sep 18;10(9):e0138182. doi: 10.1371/journal.pone.0138182.

BACKGROUND: In several volcanic areas of Italy, arsenic levels exceed European regulatory limits (10 μg/L in drinking water). There is still uncertainty about health risks from arsenic at low-medium doses (<100 μg/L).

OBJECTIVES: A large population-based study using an administrative cohort of residents in the Viterbo province (Central Italy), chronically exposed to low-medium arsenic levels via drinking water, was investigated to evaluate the effects of a lifetime exposure to arsenic on mortality from cancers and chronic diseases.

METHODS: The study population consisted of 165,609 residents of 17 municipalities, followed from 1990 until 2010. Average individual arsenic exposure at the first residence (AsI) was estimated through a space-time modeling approach using residential history and arsenic concentrations from water supply. A time-dependent Cumulative Arsenic dose Indicator (CAI) was calculated, accounting for daily water intake and exposure duration. Mortality Hazard Ratios (HR) were estimated by gender for different diseases using Cox proportional models, adjusting for individual and area-level confounders. A flexible non-parametric approach was used to investigate dose-response relationships.

RESULTS: Mean AsI exposure was 19.3 μg/L, and average exposure duration was 39.5 years. Associations of AsI and CAI indicators with several diseases were found, with greatest risks found for lung cancer in both sexes (HR = 2.61 males; HR = 2.09 females), myocardial infarction, peripheral arterial disease and COPD in males (HR = 2.94; HR = 2.44; HR = 2.54 respectively) and diabetes in females (HR = 2.56). For lung cancer and cardiovascular diseases dose-response relationship is modelled by piecewise linear functions revealing effects even for doses lower than 10 μg/L, and no threshold dose value was identified as safe for health.

CONCLUSIONS: Results provide new evidence for risk assessment of low-medium concentrations of arsenic and contribute to the ongoing debate about the threshold-dose of effect, suggesting that even concentrations below 10 μg/L carry a mortality risk. Policy actions are urgently needed in areas exposed to arsenic like in the Viterbo province, to comply with current EU regulations.

POU Reverse Osmosis Units Require Careful, On-Going Maintenance

Sacchetti R, De Luca G, Guberti E, Zanetti F. Quality of Drinking Water Treated at Point of Use in Residential Healthcare Facilities for the Elderly. International Journal of Environmental Research and Public Health. 2015 Sep 9;12(9):11163-77. doi: 10.3390/ijerph120911163.

Municipal tap water is increasingly treated at the point of use (POU) to improve the acceptability and palatability of its taste. The aim of this study was to assess the bacteriologic and nutritional characteristics of tap water treated at the point of use in residential healthcare facilities for the elderly. Two types of POU devices were used: microfiltered water dispensers (MWDs) and reverse-osmosis water dispensers (ROWDs). All samples of water entering the devices and leaving them were tested for the bacteriological parameters set by Italian regulations for drinking water and for opportunistic pathogens associated with various infections in healthcare settings; in addition, the degree of mineralization of the water was assessed. The results revealed widespread bacterial contamination in the POU treatment devices, particularly from potentially pathogenic species. As expected, the use of ROWDs led to a decrease in the saline content of the water. In conclusion, the use of POU treatment in healthcare facilities for the elderly can be considered advisable only if the devices are constantly and carefully maintained.

Drinking Water Lithium Not Related to Local Suicide Rates; Italy.

Pompili M, Vichi M, Dinelli E, Pycha R, Valera P, Albanese S, Lima A, De Vivo B, Cicchella D, Fiorillo A, Amore M, Girardi P, Baldessarini RJ. Relationships of local lithium concentrations in drinking water to regional suicide rates in Italy. World J Biol Psychiatry. 2015 Jul 31:1-8.

Objectives: Higher natural concentrations of lithium in drinking water may be associated with lower local rates of suicide.

Methods: Lithium concentrations in drinking water were assayed by mass spectrometry at 145 sites in Italy, and compared with reported local suicide rates for men and women between 1980 and 2011.

Results: Lithium concentrations in drinking water averaged 5.28 [CI: 4.08-6.48] μg/L (0.761 [0.588-0.934] μEq/L) and ranged from 0.110 to 60.8 μg/L (1.58 to 8.76 μEq/L). Lithium concentrations and local suicide rates were not significantly inversely related, except in 1980-1989, particularly among women.

Conclusions: A proposed association between trace lithium concentrations in drinking water and risk of suicide was only partially supported, and mechanisms for potential clinical effects of trace levels of lithium are unknown.