Istituto Superiore di Sanità - Environmental Epidemiology Unit

Institutional activities - Institutional activities

Institutional activities include training and consulting for public institutions operating in the fields of public health and/or environment (i.g.: Ministries, regional or municipal administrations, prevention departments of local health units, environmental protection agencies, Court Houses). In particular, members of the unit, as epidemiologic experts of the Istituto Superiore di Sanità, sit in specific boards of the Ministry for Health, the Ministry for the Environment or of the European Community. Specific boards deal with: air pollution in urban areas; classification and labeling of toxicants; waste disposal.

Intervention area - Intervention area

Environmental epidemiology studies the relationships between the health status of populations and their exposures to pollutants present and/or measurable in different environmental matrices (air, water, soil). The activity of the Unit is mostly focused on involuntary exposures, namely: exposure to environmental pollutants deriving from industrial activities; exposure to vehicle exausts in urban areas; exposure to toxicants in drinkable water; exposure to toxic agents released in soil and groundwater tables by waste dumpings. Within this frame the study of populations experiencing high level exposures to some given agents (high risk groups) deserves considerable interest. At an international level the International Society for Environmental Epidemiology (ISEE) promotes the study of the relationship between health and environment and represents a forum for the discussion of problems that are distinctive of environmental epidemiology. The Associazione Italiana di Epidemiologia (AIE) is the national reference institution. ISEE and AIE contributed to improving specifical knowledge and refining methods; following the production of knowledge, subsequent work was aimed at providing an activity frame for environmental epidemiology. The following issues are of special interest: contribution to decision making; risk communication to populations and administrators; ethical problems and equity issues in risk distribution.

Research activities - Research activities

Research activities are focused on: estimating associations between environmental exposures and occurrence of disease in the populations at study; evaluating such associations on the etiological ground. A considerable interest is for the areas at elevated risk of environmental crisis and for the sites of national interest for environmental reclamation. Research and institutional activities in this field are carried out jointly. Collaborations are active with: national and international research institutes; WHO-ECEH(European Centre for Environment and Health); Ministry of Health; Ministry for the Environment. Similarly, intense work is done to disseminate the scientific information produced with emphasis on risk communication; most attention is paid to populations living in polluted areas and to committes and organizations active in the defence of the environment. In 2003 the first experience of international cooperation with a developing country was started in Ecuador. The studies carried out by the Unit concern three main issues: health status of populations living in polluted areas, cancer risk of industrial origin and possible adverse effects of electromagnetic fields. Special focus is paced on: methodological aspects of environmental epidemiology; thorough analysis of implications of this approach on the ground of risk communication; ethical and legal consequences.

Scientific Cooperation ISS - IFA - Scientific Cooperation ISS - IFA

Collaboration Agreement between the Istituto Superiore di Sanità (ISS) and the IFA Ecuador - Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral, concerning joint development of investigations, training activities, dissemination and advising on environmental and health issues.

Scientific Responsible for the Collaboration Agreement: Dr. Pietro Comba, Director of the Environmental Epidemiology Unit, Department of the Environment and Primary Prevention, ISS. Dr. Raúl Harari, Director of IFA. IFA is an Ecuadorian Non Governmental Organization, that since more than ten years, has been carrying out studies on occupational and environmental health at national and international level. It is recognised by international institutions like ILO, ICOH and the Collegium Ramazzini.

First Collaboration Agreement: November 2004 - November 2007 Collaboration Agreement Extension: November 2007 - November 2010

Collaboration Agreement Goals The technical-scientific collaboration between ISS and IFA on environmental health issues is aimed at carrying out the following activities: epidemiology research addressed to improve the knowledge of the Ecuadorian environmental and health problems; training and upgrading of Ecuadorian personnel specialised on occupational and environmental health activities; dissemination of scientific articles, investigation results, experiences and joint activities; exchange of formal and informal communications aimed to strengthen exchanges between the two Institutions; strengthening of inter-institutional relationship coordinated by the scientific responsible of the collaboration agreement.

Scientific Cooperation ISS - WHO - - Activities from 2009 to 2011

1.
Environmental health in contaminated sites. SENTIERI Project - National epidemiological study on Italian Polluted Sites (IPSs) - is part of the National Strategic Programme "Environment and Health", funded by the Italian Ministry of Health (started in 2008, ended in 2011) concerning the evaluation of the health status of populations living in IPSs of national concern fro remediation. Concrete actions and contributions undertaken by ISS/WHO were:

► Conferences of the Strategic Programme:
- National Strategic Programme "Environment and Health". Preliminary results. Istituto Superiore di Sanità. Rome, February 4-5, 2010. Abstract Book. Bilingual edition (English/Italian).

- Conclusion of the National Strategic Programme "Environment and Health". Notiziario dell'Istituto Superiore di Sanità 2011. vol 24, no. 6, pgs. 11-15.

► Methodology and results of the Strategic Programme presented in international scientific meetings:
- Fazzo L, De Santis M, Mitis F, Benedetti M, Martuzzi M, Comba P, Fusco M. Study of cancer incidence in areas characterized by dumping waste sites in Campania (Italy). International Society for Environmental Epidemiology (ISEE) 21st Annual Conference. Dublin, August 25-29, 2009. Symposium Abstracts. Epidemiology 2009; 20(6):S126.

- Fifth Ministerial Conference on Environment and Health “Protecting children’s health in a changing environment” Parma, 2010. The Italian strategic programme “Environment and health”. Standing coffee (SC04). Thursday, 11 March 2010. 13:30.

- Comba, P; Iavarone, I; Bianchi, F et al. Multicentre Mortality Study of Contaminated Sites of National Concern in Italy. ISEE 22nd Annual Conference. WHO-ISS Symposium. Health in Contaminated Sites: Experiences, Needs, Priorities in Epidemiology. Seoul, Korea, 28 August-1 September 2010. Epidemiology 2011; 22(1):S58-S59.

- Pirastu R, Mitis F, Iavarone I et al. SENTIERI project: mortality study of residents in Italian polluted sites (IPSs). Environ Health Perspect 2011. Abstracts of the 23rd Annual Conference of the International Society of Environmental Epidemiology (ISEE). September 13 - 16, 2011, Barcelona, Spain.

► Publications on SENTIERI Project:
- Pirastu R, Ancona C, Iavarone I, Mitis F, Zona A, Comba P; SENTIERI Working Group. SENTIERI Project. Mortality study of residents in Italian polluted sites: evaluation of the epidemiological evidence. Epidemiol Prev 2010; 34(5-6 Suppl 3):1-96.

- Comba P, Iavarone I, Bianchi F et al. SENTIERI Project: rationale. Epidemiol Prev 2010; 34(5-6 Suppl 3):9-15.

- Comba P, Iavarone I, Bianchi F et al. Evaluation of the epidemiological evidence of the association between specific causes of mortality and exposure. Epidemiol Prev 2010; 34(5-6 Suppl 3):16-20.

- Ancona C, Ascoli V, Benedetti M et al. Results of the evaluation. Epidemiol Prev 2010; 34(5-6 Suppl 3):21-6.

- Comba P, Iavarone I, Bianchi F et al. Concluding remarks. Epidemiol Prev 2010; 34(5-6 Suppl 3):27-31.

- Pirastu R, Iavarone I, Pasetto R, Zona A, Comba P. SENTIERI Project. Mortality study of residents in Italian polluted sites: Results. Epidemiol Prev 2011; 34(5-6 Suppl 4):1-199.

- Comba P, Bianchi F, Conti S et al. SENTIERI Project: rationale and objectives. Epidemiol Prev 2011; 34(5-6 Suppl 4):17-19.

- Pirastu R, Zona A, Ancona C et al. Mortality results in SENTIERI Project. Epidemiol Prev 2011; 34(5-6 Suppl 4):29-152.

- Martuzzi M, Mitis F, Pirastu R et al. Global burden of mortality in Italian polluted sites. Epidemiol Prev 2011; 34(5-6 Suppl 4):153-162.

- Comba P, Bianchi F, Conti S et al. SENTIERI Project: discussion and conclusions. Epidemiol Prev 2011; 34(5-6 Suppl 4):163-171.

2.
WHO Sicily projects (coordinated by WHO-ECEH, Rome Office):
a -- Cohort studies in areas of high environmental risk in Sicily (2007-2011), to assist the Sicilian region in the management of risk areas;

b -- Health impact assessment and monitoring of environment and health conditions in the Sicilian high risk areas (2011-2013), aimed at implementing policy actions to address industrial contamination in the three contaminated sites in Sicily, asbestos contamination, and use of HIA.

► WHO Meetings jointly implemented with the proposed Collaborating Centre:
- WHO meeting on "Contaminated sites and health: Feasibility Workshop" planned in Syracuse, Italy, on 17-18 November 2011. The event was the kick-off meeting of the new project "Health impact assessment and monitoring of environment and health conditions in the Sicilian high risk areas". The proposed Collaborating Centre had a major role in organizing and planning the activities of the meeting.

- Caciolli S, Giovannangeli R, Musmeci L (eds). National Meeting "Health and environment in Italy". Istituto Superiore di Sanità. Roma, 5-6 December, 2011. Abstract book. ISTISAN Congressi 11/C9. Istituto Superiore di Sanità, Roma, 2011.

► Publications jointly planned with the proposed Collaborating Centre in the framework of the WHO Project "Cohort studies in areas of high environmental risk in Sicily:

- Signorino G, Pasetto R, Gatto E et al. Gravity models to classify commuting vs. resident workers. An application to the analysis of residential risk in a contaminated area. Int J Health Geogr. 2011 Jan 27;10:11.

- Fazzo L, Nicita C, Cernigliaro A et al. Mortality from asbestos-related causes and incidence of pleural mesothelioma among former asbestos cement workers in San Filippo del Mela (Sicily). Epidemiol Prev 2010; 34; 87-92.

- Fazzo L, Puglisi F, Pellegrino A et al. Mortality and morbidity cohort study of residents in the neighbourhood of Milazzo industrial area (Sicily). Epidemiol Prev 2010; 34; 80-6.

- Zona A, Bruno C, Villari C et al. Health surveillance for subjects with past occupational exposure to asbestos: the experience of Local Health Unit Messina 5 (Sicily). Epidemiol Prev 2010; 34; 94-9.

- Comba P, Bruno C, Fazzo L, Pasetto R, Zona A. Occupational and residential cohorts. In Mudu P, Terracini B, Martuzzi M (eds). Human health in areas with industrial contamination. WHO Regional Office for Europe, Copenhagen. In press.

- Pirastu R, Pasetto R. Review of epidemiological evidence on health effects of residence near petrochemical plants. In Mudu P, Terracini B, Martuzzi M (eds). Human health in areas with industrial contamination. WHO Regional Office for Europe, Copenhagen. 2011. In press.

3.
Environmental burden of disease
Multinational European Environmental Burden of Disease project in the European region (in collaboration with the WHO Regional Office for Europe, Bonn, Germany, and WHO, Geneva, Switzerland (started in 2009, ended in 2011). Project aimed at quantifying, at European level, the burden of diseases associated to exposure to environmental risk factors such as benzene, PM, Ozone, traffic noise, indoor radon, lead, dioxins, formaldehyde and second hand smoke. Concrete actions and contributions undertaken by ISS/WHO were:

- Report of the first project meeting WHO European Centre for Environment and Health. Bonn, Germany 12–13 February 2009. Quantification, comparison and ranking of environmental stressors within and between participating countries.

- EBoDE project organized a side event at the WHO EURO Fifth Ministerial Conference on Environment and Health “Protecting children’s health in a changing environment”, Parma, Italy, on March 10-12, 2010. The side event presented the main results (1), discussed policy implications (2) and overall importance of the environmental burden of disease in Europe (3) together with links with the WHO Environmental Burden of Disease programme:

(1) Few environmental factors are responsible for most of the environmental burden of disease (see poster)

(2) Europe leads the management of chemical risks – with marginal impact on environmental burden of disease (see poster)

(3) According to the EBoDE project: Environmental factors contribute significantly to the burden of disease in Europe (see poster)

The results of the EBoDE project were published as report: “European perspectives on Environmental Burden of Disease: Estimates for nine stressors in six countries”. Hänninen O, Knol A (eds). THL Reports 1/2011, Helsinki, Finland 2011.

4.
Impact of waste treatment on human health (started 2004, ended 2011).
The main project concerned “The study on the health impact of waste treatment in Campania region, Italy (Impact of waste treatment on human health in Campania region (Italy), which is available in the “External resources” of the below reported WHO web-site address . The project was funded by the Civil Protection Department of the Presidency of the Council of Ministers, coordinated by the WHO Centre for Environment and Health, Rome Office, with the participation of the National Institute of Health (Department of Environment and Primary Prevention).
Most of the activities and publications jointly planned and implemented by WHO and ISS can be found on the WHO Regional Office for Europe website. Moreover, in the last two years the following papers were jointly implemented and published ISS/WHO:

- Fazzo L, De Santis M, Mitis F et al. Ecological studies of cancer incidence in an area interested by dumping waste sites in Campania (Italy). Ann Ist Super Sanita 2011;47(2):181-91.

- Martuzzi M, Mitis F, Bianchi F, Minichilli F, Comba P, Fazzo L. Cancer mortality and congenital anomalies in a region of Italy with intense environmental pressure due to waste. Occup Environ Med 2009; 66; 725-32.

5.
International multicenter study on mobile phone use and cancer risk (INTERPHONE), coordinated by the International Agency for Research on Cancer (IARC), (started 2000, ended 2010).
Interphone is an international multicentre case-control studies conducted in 13 countries aimed to verify whether mobile phone use increases the risk of glioma, meningioma and acoustic neurinoma. Concrete actions and contributions undertaken by the international scientific group (including also the proponent part of ISS), coordinated by IARC, were publications, reports and press releases. Results of the study were included in the recent evaluation of carcinogenicity of radiofrequency electromagnetic fields.
During the last two years the following papers were jointly implemented and published by the national study groups under the coordination of IARC:

- The INTERPHONE Study Group. Acoustic neuroma risk in relation to mobile telephone use: Results of the INTERPHONE international case-control study. Cancer Epidemiol 2011; 35; 453-464.

- INTERPHONE Study Group. Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. Int J Epidemiol 2010; 39; 675-94.

- Vrijheid M, Mann S, Vecchia P et al. Determinants of mobile phone output power in a multinational study - implications for exposure assessment. Occup Environ Med 2009;66; 664-71.

- Vrijheid M, Richardson L, Armstrong BK et al. Quantifying the impact of selection bias caused by nonparticipation in a case-control study of mobile phone use. Ann Epidemiol 2009;19; 33-41.

- Vrijheid M, Armstrong BK, Bédard D et al. Recall bias in the assessment of exposure to mobile phones. J Expo Sci Environ Epidemiol 2009; 19; 369-81.

6.
Other publications/reports on environmental health issues:
- World Health Organization. Health and environment in Europe: progress assessment. 2010. WHO Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. ISBN 978 92 890 4198 0.

Scientific Cooperation ISS - WHO - - Activities from 1997 to 2008

► Conferences of the Strategic Programme:
- Kick-off meeting of the National Strategic Programme "Environment and Health". Notiziario dell'Istituto Superiore di Sanità 2008, June, vol 21, no. 6 pgs 16-19.

► Methodology and results of the Strategic Programme presented in international scientific meetings:
- Pirastu R, Conti S, Musmeci L, Bianchi F, Martuzzi M, Comba P. SENTIERI. Mortality in Italian Contaminated Sites. International Society for Environmental Epidemiology (ISEE) 20th Annual Conference, Pasadena (USA) 2008.

► Guidelines, manuals, methodologies concerning environmental health issues in contaminated sites:
- Cori L, Cocchi M, Comba P (eds). Epidemiological studies in sites of national interest for environmental remediation in Italian regions funded by European Union structural funds. Rapporti ISTISAN 05/1. 2005. iii, 153 pgs (in Italian).
Contribution by WHO: Metodi e strumenti per studi epidemiologici di mortalità su base geografica in Italia (Methods and intruments to perform epidemiological studies in Italy based on geographical analysis of mortality data). MartuzziM, Mitis F. pgs 68-74.

- Bianchi F, Comba P (eds). Epidemiologic studies in polluted sites: scientific background, methodology, management, and aspects of equity. Rapporti ISTISAN 06/19. 2006. ii, 199 pgs (in Italian).
Contribution by WHO: Valutazione di impatto sanitario: uno strumento di valutazione e di partecipazione (Health impact assessment: a tool for evaluation and participation). Martuzzi M, Cocchi M. pgs 71-77.

- Comba P, Bianchi F, Iavarone I, Pirastu R (eds). Health impact in contaminated sites: methods and instruments for research and evaluation. Rapporti ISTISAN 07/50. 2007. ii, 217 pgs (in Italian)
Contribution by WHO: Analisi di correlazione geografica tra esiti sanitari ed esposizione a rifiuti in un'area con sorgenti diffuse: il caso delle province di Napoli e Caserta. Minichilli F, Mitis F. pgs 166-177.

- Cori L, Fazzo L, Linzalone N, Mitis F, Bianchi F, Comba P. Studi su ambiente e salute: la prospettiva epidemiologica (Studies on environment and health: the perspective of epidemiology). Notiziario dell'Istituto Superiore di Sanità 2007, February, vol 20, no. 2.

- Bianchi F, Biggeri A, Cadum E, Comba P, Forastiere F, Martuzzi M, Terracini B. Environmental epidemiology and polluted areas in Italy. Epidemiol Prev 2006; May-Jun; 30(3):146-52.

- Belli S, Benedetti M, Comba P, Lagravinese D, Martucci V, Martuzzi M, Morleo D, Trinca S, Viviano G. Case control study on cancer risk associated to residence on the neighbourhood of a petrochemical plant. Eur J Epidemiol 2004; 19: 49-54.

► Research project "Cohort studies in areas of high environmental risk in Sicily" (2007-2011), coordinated by WHO-ECEH, Rome Office, to assist the Sicilian region in the management of risk areas:
- Pasetto R, Saitta P, Bracci C. Development of an epidemiological study in a polluted site: the unexpected contribution of sociological and medico-legal approaches. Epidemiol Prev 2008; Nov-Dec; 32(6):325-7.

► Impact of waste treatment on human health in the Campania Region:
- Fazzo L, Belli S, Minichilli F, Mitis F, Santoro M, Martina L, Pizzuti R, Comba P, Martuzzi M, Bianchi F; Working Group. Cluster analysis of mortality and malformations in the Provinces of Naples and Caserta (Campania Region). Ann Ist Sup Sanita 2008; 44(1):99-111.

- Comba P, Bianchi F, Fazzo L, Martina L, Menegozzo M, Minichilli F, Mitis F, Musmeci L, Pizzuti R, Santoro M, Trinca S, Martuzzi M; Health Impact of Waste Management Campania Working Group. Cancer mortality in an area of Campania (Italy) characterized by multiple toxic dumping sites. Ann N Y Acad Sci 2006; 1076:449-61.

- Martuzzi M, Bianchi F, Comba P, Fazzo L, Martina L, Minichillli F, Mitis F, Pizzuti R, Santoro M; Gruppo di lavoro Impatto sanitario del ciclo dei rifiuti in Campagnia. Patologia neoplastica e malformazioni congenite nelle province della Campania con maggiore presenza di discariche (Cancer mortality and occurrence of congenital malformations in the provinces of Campania Region most interested by the presence of landfills). Notiziario Istituto Superiore di Sanità 2005; 18(6):3-8

- Altavista P, Belli S, Bianchi F, Binazzi A, Comba P, Del Giudice R, Fazzo L, Felli A, Mastrantonio M, Menegozzo M, Musmeci L, Pizzuti R, Savarese A, Trinca S, Uccelli R. Cause-specific mortality in an area of Campania with numerous waste disposal sites. Epidemiol Prev 2004; Nov-Dec; 28(6):311-21

- Bianchi F, Comba P, Martuzzi M, Palombino R, Pizzuti R. Italian "triangle of death". Lancet Oncol 2004; Dec; 5(12):710

► The precautionary principle in environmental health
- Comba P, Martuzzi M, Botti C. The precautionary principle in decision-making: the ethical values. In Martuzzi M, Tickner J (eds).The precautionary principle: protecting public health, the environment and the future of our children. Geneva: WHO; 2004. pgs 85-92.

- Comba P, Martuzzi M, Botti C. Comparison of Bayesian-utilitarian and maximin principle approaches. Int J Occup Med Environ Health 2004; 17(1):193-6.

► Asbestos-related health impact assessment
- Mastrantonio M, Belli S, Binazzi A, Carboni M, Comba P, Fusco P, Grignoli M, Iavarone I, Martuzzi M, Nesti M, Trinca S, Uccelli R. La mortalità per tumore maligno della pleura nei comuni italiani (1988-1997). [Mortality from malignant pleural neoplasms in Italy (1988-1997)]. Rapporti ISTISAN 02/12. 2002; 27.

- Martuzzi M, comba P, De Santis M, Iavarone I, Di Paola M, Mastrantonio M, Pirastu R. Asbestos-related lung cancer mortality in Piedmont, Italy. Am J Ind Med 1998; 33; 565-70.

- Comba P, Di Paola M, Martuzzi M, Pirastu R. Asbestos-related mortality in Italy: a geographical approach. Med Lav 1997; 88; 293-301.

► Health and environment in Italy, reports and evaluations:
The WHO Rome Office supported important environment and health studies in the host country, raising the understanding and the political profile of environment and health in the national political agenda. This activity included the development of the first national assessment report on environment and health (Ambiente e salute in Italia - Environment and health in Italy. 1997. Il Pensiero Scientifico Editore)

- Cislaghi C, Comba P, Iavarone I, Pirastu R, Settimi L, Di Paola M, Mastrantonio M, Forastiere F, Michelozzi P, Nesti M. Aree ad elevato rischio di crisi ambientale. pgs.401-544. In Bertollini R, Faberi M, Di Tanno N (eds). Ambiente e salute in Italia. Il Pensiero Scientifico Editore. Organizzazione Mondiale della Sanità, Centro Europeo Ambiente e Salute, Divisione di Roma, 1997.

- World Health Organization, European Centre for Environment and Health. Health in Italy in the 21st Century. 1999. Overall coordination and supervision: Bertollini R (WHO/ECEH) and Silano V (Ministry of Health, Repubblica Italiana). Information, advice, data and support was provided throughout the preparation of this report by the National Institute of Health (ISS).

- Iavarone I, Martuzzi M, Mastrantonio M. L'ambiente e la salute. In Ministero dell'Ambiente. Relazione sullo stato dell'ambiente. 2001. pgs. 347-370.

► International multicenter study on mobile phone use and brain cancer risk (INTERPHONE), coordinated by the International Agency for Research on Cancer (IARC):
- Cardis E, Richardson L, Deltour I et al. The INTERPHONE study: design, epidemiological methods, and description of the study population. Eur J Epidemiol 2007;22(9):647-64.

- Vrijheid M, Cardis E, Armstrong BK et al. Validation of short term recall of mobile phone use for the Interphone study. Occup Environ Med 2006; 63(4):237-43.

►Health impact of air pollution in urban environment:
WHO-ISS jointly planned and implemented health impact assessment of air pollution in populations living in urban areas

- Martuzzi M, Mitis F, Iavarone I, Serinelli M. Health impact of PM10 and ozone in 13 Italian cities. World Health Organization - Regional Office for Europe. Copenhagen 2006 (E88700).

- Mitis F, Iavarone I, Martuzzi M. Health impact of ozone in 13 Italian cities. Epidemiol Prev 2007; 31; 323-32.

► Other publications in collaboration with the International Agency for Research on Cancer, WHO:
- Ward E, Boffetta P, Andersen A et al. Update of the follow-up of mortality and cancer incidence among European workers employed in the vinyl chloride industry. Epidemiology 2001; 12(6):710-8.

- 't Mannetje A, Kogevinas M, Luce D et al. Sinonasal cancer, occupation, and tobacco smoking in European women and men. Am J Ind Med 1999; 36(1):101-7.

- Leclerc A, Luce D, Demers PA et al. Sinonasal cancer and occupation. Results from the reanalysis of twelve case-control studies. Am J Ind Med 1997; 31(2):153-65.

► Dealing with uncertainty: Setting the agenda for the 5th Ministerial Conference on Environment and Health, 2009. Report of a WHO Meeting. Copenhagen, Denmark, 15-16 December 2005. World Health Organization 2006. EUR/06/5067987.

Bibliography - Cancer Mortality in an Area of Campania (Italy) Characterized by Multiple Toxic Dumping Sites.

PIETRO COMBA, FABRIZIO BIANCHI, LUCIA FAZZO, LUCIA MARTINA, MASSIMO MENEGOZZO, FABRIZIO MINICHILLI, FRANCESCO MITIS, LOREDANA MUSMECI, RENATO PIZZUTI, MICHELE SANTORO, STEFANIA TRINCA, MARCO MARTUZZI, AND “HEALTH IMPACT OF WASTE MANAGEMENT CAMPANIA” WORKING GROUP.

Bibliography - Mortalità nei lavoratori della coorte del petrolchimico di Gela 1960-2002

Pasetto R, Biggeri A, Comba P, Pirastu R. Epidemiol Prev 2007; 31(1): 39-45

Bibliography - STUDI SU AMBIENTE E SALUTE: LA PROSPETTIVA EPIDEMIOLOGICA

Liliana Cori, Lucia Fazzo, Nunzia Linzalone, Francesco Mitis, Fabrizio Bianchi e Pietro Comba. Notiziario dell'Istituto Superiore di Sanità. Volume 20 - Numero 2 Febbraio 2007.

Bibliography - Consensus Conference "Sorveglianza sanitaria delle popolazioni esposte a fibre di tremolite nel territorio della ASL 3 - Lagonegro (PZ)". Roma 22 – 23 febbraio 2005

Marina Musti, Caterina Bruno, Filippo Cassano, Angelo Caputo, Gabriella Cauzillo, Domenica Cavone, Luca Convertini, Antonio De Blasio, Barbara De Mei, Mario Marra, Giuseppe Montagano, Biagio Schettino, Amerigo Zona e Pietro Comba. Ann Ist Super Sanità 2006 Vol. 42, No. 4: 469-476.