Background Animal cancer registry data are important for monitoring animal health, for prevention and research in veterinary medicine, and for comparative oncology. Since people and animals share the same environment and are exposed to many common risk factors, cancer patterns in animals may have a sentinel function for human health. We collected cancer cases among livestock, pets and wildlife in the Aosta Valley region in Italy from January 2004 to May 2024 to assess the feasibility of a regional animal cancer registry.Methods The clinical variables of every case were recorded and submitted to quality assessment. The tumour frequencies in the three animal populations were analysed.Results During the study period, we identified 106 farm animals (8%), 1154 pets (91%) and eight wild animals (1%) with tumours. The most frequent cancer sites in livestock were liver (10 cases of hepatocellular carcinoma, 20.8%) and eye (eight cases of squamous cell carcinoma, 16.7%). Cancers of the skin (56 cases in dogs, 11.76%; 61 cases in cats, 23%) and mammary gland (94 cases in dogs, 19.7%) were most frequent in pets. The skin was the most frequent site in wild animals (two of eight cases).Limitations Critical issues concerned the collection of incident cases in livestock and wildlife and the completeness of denominators in pets.Conclusions This study demonstrated the feasibility of a registry based on an innovative model of collaboration between epidemiologists and veterinarians.

BackgroundSocio-economic inequalities are a major determinant of chronic disease risk and access to preventive services. Deprivation indices can quantify these disparities, but very few studies have considered them when examining the relationship between breast cancer incidence, prognosis, and particulate matter as a potential effect modifier. Moreover, these indices have rarely been used as active tools in service delivery. Digital health technologies offer an opportunity to embed equity into chronic disease prevention through the real-time integration of socio-economic metrics. The ELISAH project developed a digital prevention framework that incorporates a Deprivation Index to support strategies targeting breast cancer and other chronic diseases.MethodsA descriptive, policy-oriented analysis was conducted using the ELISAH framework as a case study. Nationally validated Deprivation Indices were embedded into the ELISAH platform, which integrates socio-economic, demographic, environmental, and behavioral data. A conflict-sensitive version was developed to address the needs of internally displaced populations and service disruptions in fragile health systems. The Index was configured to support both population-level equity mapping and individual-level tailoring of preventive interventions.ResultsThe Deprivation Index has been technically integrated into the digital platform and piloted in both urban and conflict-affected settings. Early implementation confirmed the feasibility of harmonizing socio-economic indicators with digital engagement data and environmental exposures. The platform’s architecture enables dynamic monitoring of inequalities and the implementation of adaptive prevention strategies. While comprehensive outcome data are pending full-scale deployment, pilot mapping has established proof-of-concept for embedding equity into digital health systems by design.DiscussionEmbedding a Deprivation Index within a digital prevention platform demonstrates how equity can be incorporated into both policy-oriented observational studies and as an active design principle. This dual application supports personalized interventions and real-time, equity-driven resource allocation. The ELISAH approach highlights the potential of digital health tools to address socio-economic and conflict-related disparities in chronic disease prevention.ConclusionIntegrating a Deprivation Index into digital prevention systems offers a scalable model for addressing health inequalities in chronic disease management. The ELISAH framework demonstrates the feasibility of making equity a foundational element of digital platforms, enabling personalized prevention, informed policy planning, and improved resilience in both stable and crisis-affected health systems.

Influenza can cause serious complications in individuals with chronic diseases. Although vaccination is strongly recommended for the high-risk population, uptake remains suboptimal. This retrospective cohort study assessed the relationship between demographic, clinical, and socio-economic (SE) factors and influenza vaccination uptake among high-risk patients in the Apulia region over four influenza seasons (2019–2023). Data on comorbidities, vaccination history, and demographics were extracted from the User Fee Exemption Registry, the Immunization Information System, and the Total Population Register, respectively. Each geocoded case was linked to the Italian National Deprivation Index to determine SE status at the census tract level. Descriptive statistics, logistic regression, and multilevel mixed general linear models were used to analyze factors associated with vaccination uptake. Vaccination coverage among people with longstanding illnesses was 35.5

The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sitting room or a small office, in number of particles (particles/cm3). We compared the real time and time-integrated measurements of the aerosol generated by the e-cigarette types Just Fog and JUUL. Real time (10s average) number of particles (particles/cm3) in 8 different aerodynamic sizes was measured using an optical particle counter (OPC) model Profiler 212-2. Tests were conducted with and without a Heating, Ventilating Air Conditioning System (HVACS) in operation, in order to evaluate the efficiency of air filtration. During the vaping sessions the OPC recorded quite significant increases in number of particles/cm3. The JUUL e-cig produced significantly lower emissions than Just Fog with and without the HVACS in operation. The study demonstrates the rapid volatility or change from liquid or semi-liquid to gaseous status of the e-cig aerosols, with half-life in the order of a few seconds (min. 4.6, max 23.9), even without the HVACS in operation. The e-cig aerosol generated by the JUUL proved significantly lower than that generated by the Just Fog, but this reduction may not be sufficient to eliminate or consistently reduce the health risk for vulnerable non e-cig users exposed to it.

The geopolitical conflict between Russia and Ukraine has disrupted Europe’s natural gas supplies, driving up gas prices and leading to a shift towards biomass for residential heating during colder months. This study assessed the consequent air quality and toxicological impacts in Milan, Italy, focusing on fine particulate matter (PM2.5, dp < 2.5 μm) emissions. PM2.5 samples were analyzed for their chemical composition and assessed for their oxidative potential using the dithiothreitol (DTT) assay across three periods reflecting residential heating deployment (RHD): pre-RHD, intra-RHD, and post-RHD periods. During the intra-RHD period, PM2.5 levels were significantly higher than those in other periods, with concentrations reaching 57.94 ± 7.57 μg/m3, indicating a deterioration in air quality. Moreover, levoglucosan was 9.2 times higher during the intra-RHD period compared to the pre-RHD period, correlating with elevated levels of elemental carbon (EC) and polycyclic aromatic hydrocarbons (PAHs). These findings were compared with previous local studies before the conflict, underscoring a significant rise in biomass-related emissions. DTT assay levels during the intra-RHD were 2.1 times higher than those observed during the same period in 2022, strongly correlating with biomass burning emissions. Our findings highlight the necessity for policies to mitigate the indirect health effects of increased biomass burning emissions due to the energy crisis triggered by the geopolitical conflict.

IntroductionThe increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors.Materials and methodsUsing data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area.ResultsThe study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50–69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II–III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and “other diseases” in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50–69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest.ConclusionThe integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.

Due to the growing popularity of electronic cigarettes (ECs) and heated tobacco products (HTPs) as alternatives to conventional cigarettes (CCs), there is an increasing need to monitor the emissions of these new devices. ECs generate significant concentrations of second-hand aerosol (ECSHA), which is visible in dense clouds and can be smelled. Particulate matter (PM) is an important component of CC, HTP and EC aerosols, and Optical Particle Counters (OPCs) enable its real-time measurement, which is expressed either as the number of particles or as mass. This study specifically addresses the limitations associated with EC mass measurement using OPC technology and identifies the strict necessity of the measurement of a corresponding density (k factor) not only for each specific PM source but also for the desired PM size. Therefore, a standard measurement requires the simultaneous operation of the OPC equipment and a certified reference instrument. Four different OPCs were used. Crucially, this study also proves that this setup may be inapplicable because the extreme volatility of EC-generated aerosols makes it impractical to gauge the correct EC k factor.

Exposure to atmospheric particulate matter and nitrogen dioxide has been linked to SARS-CoV-2 infection and death. We hypothesized that long-term exposure to farming-related air pollutants might predispose to an increased risk of COVID-19-related death. To test this hypothesis, we performed an ecological study of five Italian Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna and Sicily), linking all-cause mortality by province (administrative entities within regions) to data on atmospheric concentrations of particulate matter (PM2.5 and PM10) and ammonia (NH3), which are mainly produced by agricultural activities. The study outcome was change in all-cause mortality during March–April 2020 compared with March–April 2015–2019 (period). We estimated all-cause mortality rate ratios (MRRs) by multivariate negative binomial regression models adjusting for air temperature, humidity, international import-export, gross domestic product and population density. We documented a 6.9% excess in MRR (proxy for COVID-19 mortality) for each tonne/km2 increase in NH3 emissions, explained by the interaction of the period variable with NH3 exposure, considering all pollutants together. Despite the limitations of the ecological design of the study, following the precautionary principle, we recommend the implementation of public health measures to limit environmental NH3 exposure, particularly while the COVID-19 pandemic continues. Future studies are needed to investigate any causal link between COVID-19 and farming-related pollution.

Objective: Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. Methods: Cross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017-2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017-2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. Results: Nicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30-3.74) mu g/m(3) and increased during nighttime (1.45 IQR:0.65-4.79 mu g/m(3)), in enclosed venues (2.97 IQR:0.80-5.80 mu g/m(3)), in venues with more than two smokers (2.79 IQR:1.03-6.30 mu g/m(3)), in venues in countries with total indoor smoking bans (1.20 IQR:0.47-4.85 mu g/m(3)), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49-5.34 mu g/m(3)). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues' degree of enclosure. Conclusions: Our results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.

Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.

The goal of this study was to characterize changes in components and toxicological properties of PM2.5 during the nationwide 2019-Coronavirus (COVID-19) lockdown restrictions in Milan, Italy. Time-integrated PM2.5 filters were collected at a residential site in Milan metropolitan area from April 11th to June 3rd at 2020, encompassing full-lockdown (FL), the followed partial-lockdown (PL2), and full-relaxation (FR) periods of COVID-19 restrictions. The collected filters were analyzed for elemental and organic carbon (EC/OC), water-soluble organic carbon (WSOC), individual organic species (e.g., polycyclic aromatic hydrocarbons (PAHs), and levoglucosan), and metals. According to online data, nitrogen dioxide (NO2) and benzene (C6H6) levels significantly decreased during the entire COVID-19 period compared to the same time span in 2019, mainly due to the government-backed shutdowns and curtailed road traffic. Similarly, with a few exceptions, surrogates of tailpipe emissions (e.g., traffic-associated PAHs) as well as re-suspended road dust (e.g., Fe, Mn, Cu, Cr, and Ti) were relatively lower during FL and PL2 periods in comparison with year 2019, whereas an increasing trend in mass concentration of mentioned species was observed from FL to PL2 and FR phases due to the gradual lifting of lockdown restrictions. In contrast, comparable concentrations of ambient PM2.5 and black carbon (BC) between lockdown period and the same time span in 2019 were attributed to the interplay between decreased road traffic and elevated domestic biomass burning as a result of adopted stay-home strategies. Finally, the curtailed road traffic during FL and PL2 periods led to ~25% drop in the PM2.5 oxidative potential (measured via 2′,7′-dichlorodihydrofluorescein (DCFH) and dithiothreitol (DTT) assays) with respect to the FR period as well as the same time span in 2019. The results of this study provide insights into the changes in components and oxidative potential of PM2.5 in the absence of road traffic during COVID-19 restrictions.

Introduction: Although smoking restrictions at child-related settings are progressively being adopted, school outdoor entrances are neglected in most smoke-free policies across Europe. Objectives: To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region. Methods: In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017-October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06 mu g/m(3) as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (Trs) score, smoking prevalence (2017-2018), and United Nations M49 geographical region. Results: There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in 43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory's limit of quantification <0.06 mu g/m(3) (Interquartile range:<0.06-0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and Eastern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (p<0.05). Conclusions: Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools. (C) 2020 The Authors. Published by Elsevier B.V.

In this study, we investigated the impact of biomass burning on the oxidative potential of PM2.5 in the metropolitan area of Milan, Italy. PM2.5 samples were collected on quartz filters during cold (December 2018-February 2019) and warm (May 2019-July 2019) seasons at the Municipality of Bareggio, a small town located approximately 14 km northwest of the Milan city center. The PM2.5 constituents were chemically analyzed, and its corresponding oxidative potential was measured by means of the dithiothreitol (DTT) assay. Total PM2.5 mass concentration was significantly higher in winter (71.82 +/- 4.17 mu g/m(3)) compared to summer (16.67 +/- 0.27 mu g/m(3)), mainly a result of enhanced biomass burning emissions combined with higher atmospheric stability and lower mixing during the cold season. The enhanced biomass burning activities during the winter period also resulted in very high polycyclic aromatic hydrocarbons (PAHs) concentrations (72.81 +/- 16.59 ng/m(3)) which were more than 150-fold higher than the warm period values (0.40 +/- 0.07 ng/m(3)). PAH concentrations were highly correlated with chemical markers of biomass burning (i.e., levoglucosan (R-2 = 0.79), and K+/K (R-2 = 0.87)) in the winter period. Spearman correlation analysis between DTT and PM2.5 chemical species showed a dominant role of secondary organic aerosols (SOA) and vehicular emissions in summer-time PM2.5 oxidative potential (i.e., the capacity of PM2.5 species to oxidize target molecules), while in the wintertime, the DTT values were highly correlated with chemical markers of biomass burning, vehicular activities, and re-suspended road dust. Multiple linear regression (MLR) analysis identified biomass burning (41%) as the dominant contributor to DTT, followed by SOA (20%), re-suspended road dust (18%), and vehicular emissions (16%). Our results underscore the importance of biomass burning to the overall oxidative potential of PM2.5 in the metropolitan area of Milan, urging the need to promulgate effective mitigation policies targeting these emissions.

In a 2 year prospective study, 17 tissue expanders were placed on the extremities of 17 patients. The aim was to cover soft tissue defects in the forearm of 8 patients after chinese flap dissection, which was used either as a free or reversed flap. In 8 of the remaining patients, the expanded skin was placed directly on the affected region as a local fasciocutaneous flap. In 1 patient it was determined intra-operatively that the prepared extended skin was not necessary to treat the patient. The tissue expander was successfully used to cover skin defects, both directly and indirectly, in the lower extremity (7 cases) and in the upper extremity (9 cases). Neither infection nor necrosis was observed in the flaps and the cosmetic results, particularly in the forearm, were satisfactory.

Introduction: Second-hand smoke exposure in the home is a serious cause of ill-health for children. Behaviour change interventions have been developed to encourage parents to keep homes smoke-free. This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas. Methods: This paper presents a pre-post study of this intervention. Using internet connected monitors developed with the Dylos DC1700, daily SMS and weekly email feedback provided for 16 days to participants recruited in four European countries. Participants were recruited based on their stage of change, in order to target those most able to achieve smoke-free homes. The primary outcome measure was median change in mean fine particulate matter (PM2.5) concentration between baseline and follow-up periods, while secondary outcome measures included change in time over the World Health Organisation (WHO) guideline limit for PM2.5 exposure over 24 h (25 mu g/m(3)) in those periods and the number of homes where PM2.5 concentrations reduced. Telephone interviews were conducted with participants in Scotland post-intervention to explore intervention experience and perceived effectiveness. Results: Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM2.5. The median reduction experienced was 4.1 mu g/m(3) (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback. Discussion: Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

Aim: The current study examined symptoms of irritation reported by non-smokers passively exposed to e-cigarette aerosols and their timing and association with the concentrations of volatile organic compounds (VOCs) produced. Methods: 40 healthy non-smoking adults were exposed to e-cigarette aerosols for 30 min in a 35 m(3) room. Second-hand e-cigarette aerosol (SHA) was produced by an experienced e-cigarette user using a standardized topography and two resistance settings (exposure 0.5 Ohm and 1.5 Ohm), in addition to a control session (no emissions). PM2.5 and PM1.0 were continuously measured over the duration of exposure, while Volatile Organic Compounds (VOCs) were recorded at 0, 15 and 30 min (t(0), t(15) and t(30)) of exposure. Each participant completed an irritation questionnaire at to, t(15), t(30) of exposure and t(60) (30 min post-exposure) on ocular, nasal, throat-respiratory symptoms of irritation and general complaints. Kruskal-Wallis H test for PM comparisons, repeated measures ANOVA for VOCs and Generalized Estimating Equations for symptoms of irritation and association with VOCs were used for statistical analysis. Results: 20 males and 20 females, with a mean age of 24.6 years (SD = 4.3) and exhaled CO < 7 ppm participated. PM concentrations in both experimental sessions were higher than the Control (p < 0.001). The most commonly reported symptoms were burning, dryness, sore throat, cough, breathlessness and headache. During both experimental sessions, ocular, nasal, throat-respiratory symptoms and general complaints increased significantly (p < 0.05). Ocular and nasal symptoms returned to baseline by t(60) (p > 0.05) while throat-respiratory symptoms were still significantly higher at t(60) (p = 0.044). VOCs were significantly associated with reported nasal and throat-respiratory symptoms in both experimental sessions (p < 0.05). Conclusion: A 30-min exposure to SHA provoked symptoms of sensory irritation and general complaints that lasted up to 30 min after the exposure and were positively associated with the concentrations of the VOC mixture emitted.

Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.

In this study, the temporal variations of sources of black carbon (BC) concentrations were evaluated in the metropolitan area of Milan, Italy, during three distinct seasons over 2017-2018. We measured BC concentrations using Aethalometers at two sampling sites, one in the city center of Milan, and one in the less densely populated suburb of Bareggio, approximately 14 km to the west of Milan's urban center. PM samples were also collected for elemental carbon (EC) and C-14 analyses. The Aethalometer model was used to apportion BC concentrations to the fossil fuel combustion (BCff) and biomass burning (BCbb) originated BC. Additionally, radiocarbon C-14 analysis was performed on the PM samples, allowing us to refine our estimates of the contributions of both BCff and BCbb to total BC concentrations and assess the dependence of the mass absorption cross section (MAC) of BC on its source. Overall, our results indicated that the annually averaged BC concentrations were higher at the Bareggio site (2763 +/- 1050 ng m(-3)) than at the Milan site (1921 +/- 876 ng m(3)). The Aethalometer model results demonstrated that in all of the sampling seasons, fossil-fuel-originated BC (BCff) concentrations were slightly higher in Milan (e.g., a summertime average of 1045 +/- 150 ng/m(3)) than in Bareggio (e.g., a summertime average of 940 +/- 89 ng/m(3)); however, black carbon (BCbb) concentrations from biomass burning were considerably higher at Bareggio (e.g., a wintertime average of 3284 +/- 713 ng/m(3)) than in Milan (e.g., a wintertime average of 1154 +/- 103 ng/m(3)). Diurnal variation plots indicated that both in Milan and Bareggio, BCff peaked during the morning and, to a lesser extent, afternoon traffic rush hours, while BCbb peaked during nighttime when residential wood burning for heating purposes is prominent. Our results also highlight the significant impact of residential wood burning on ambient BC concentrations in the Milan metropolitan area.

Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 μm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 μg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 μg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.