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      Environmental Pollution from Illegal Waste Disposal and Health Effects: A Review on the “Triangle of Death”

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          Abstract

          The term “triangle of death” was used for the first time by Senior and Mazza in the journal The Lancet Oncology referring to the eastern area of the Campania Region (Southern Italy) which has one of the worst records of illegal waste dumping practices. In the past decades, many studies have focused on the potential of illegal waste disposal to cause adverse effects on human health in this area. The great heterogeneity in the findings, and the bias in media communication has generated great healthcare doubts, anxieties and alarm. This paper addresses a review of the up-to-date literature on the “triangle of death”, bringing together the available information on the occurrence and severity of health effects related to illegal waste disposal. The Scopus database was searched using the search terms “waste”, “Campania”, “Naples”, “triangle of death” and “human biomonitoring”. Despite the methodological and sampling heterogeneity between the studies, this review examines the evidence from published data concerning cancer incidence, childhood mortality and birth defects, so that the current situation, knowledge gaps and research priorities can be established. The review aims to provide a contribution to the scientific community, and to respond to the concerns of the general population.

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          The Blood Exposome and Its Role in Discovering Causes of Disease

          Background: Since 2001, researchers have examined the human genome (G) mainly to discover causes of disease, despite evidence that G explains relatively little risk. We posit that unexplained disease risks are caused by the exposome (E; representing all exposures) and G × E interactions. Thus, etiologic research has been hampered by scientists’ continuing reliance on low-tech methods to characterize E compared with high-tech omics for characterizing G. Objectives: Because exposures are inherently chemical in nature and arise from both endogenous and exogenous sources, blood specimens can be used to characterize exposomes. To explore the “blood exposome” and its connection to disease, we sought human blood concentrations of many chemicals, along with their sources, evidence of chronic-disease risks, and numbers of metabolic pathways. Methods: From the literature we obtained human blood concentrations of 1,561 small molecules and metals derived from foods, drugs, pollutants, and endogenous processes. We mapped chemical similarities after weighting by blood concentrations, disease-risk citations, and numbers of human metabolic pathways. Results: Blood concentrations spanned 11 orders of magnitude and were indistinguishable for endogenous and food chemicals and drugs, whereas those of pollutants were 1,000 times lower. Chemical similarities mapped by disease risks were equally distributed by source categories, but those mapped by metabolic pathways were dominated by endogenous molecules and essential nutrients. Conclusions: For studies of disease etiology, the complexity of human exposures motivates characterization of the blood exposome, which includes all biologically active chemicals. Because most small molecules in blood are not human metabolites, investigations of causal pathways should expand beyond the endogenous metabolome. Citation: Rappaport SM, Barupal DK, Wishart D, Vineis P, Scalbert A. 2014. The blood exposome and its role in discovering causes of disease. Environ Health Perspect 122:769–774; http://dx.doi.org/10.1289/ehp.1308015
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            A review of waste management practices and their impact on human health.

            L. GIUSTI (2009)
            This work reviews (i) the most recent information on waste arisings and waste disposal options in the world, in the European Union (EU), in Organisation for Economic Co-operation and Development (OEDC) countries, and in some developing countries (notably China) and (ii) the potential direct and indirect impact of waste management activities on health. Though the main focus is primarily on municipal solid waste (MSW), exposure to bioaerosols from composting facilities and to pathogens from sewage treatment plants are considered. The reported effects of radioactive waste are also briefly reviewed. Hundreds of epidemiological studies reported on the incidence of a wide range of possible illnesses on employees of waste facilities and on the resident population. The main conclusion of the overall assessment of the literature is that the evidence of adverse health outcomes for the general population living near landfill sites, incinerators, composting facilities and nuclear installations is usually insufficient and inconclusive. There is convincing evidence of a high risk of gastrointestinal problems associated with pathogens originating at sewage treatment plants. In order to improve the quality and usefulness of epidemiological studies applied to populations residing in areas where waste management facilities are located or planned, preference should be given to prospective cohort studies of sufficient statistical power, with access to direct human exposure measurements, and supported by data on health effect biomarkers and susceptibility biomarkers.
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              Health effects of residence near hazardous waste landfill sites: a review of epidemiologic literature.

              M Vrijheid (2000)
              This review evaluates current epidemiologic literature on health effects in relation to residence near landfill sites. Increases in risk of adverse health effects (low birth weight, birth defects, certain types of cancers) have been reported near individual landfill sites and in some multisite studies, and although biases and confounding factors cannot be excluded as explanations for these findings, they may indicate real risks associated with residence near certain landfill sites. A general weakness in the reviewed studies is the lack of direct exposure measurement. An increased prevalence of self-reported health symptoms such as fatigue, sleepiness, and headaches among residents near waste sites has consistently been reported in more than 10 of the reviewed papers. It is difficult to conclude whether these symptoms are an effect of direct toxicologic action of chemicals present in waste sites, an effect of stress and fears related to the waste site, or an effect of reporting bias. Although a substantial number of studies have been conducted, risks to health from landfill sites are hard to quantify. There is insufficient exposure information and effects of low-level environmental exposure in the general population are by their nature difficult to establish. More interdisciplinary research can improve levels of knowledge on risks to human health of waste disposal in landfill sites. Research needs include epidemiologic and toxicologic studies on individual chemicals and chemical mixtures, well-designed single- and multisite landfill studies, development of biomarkers, and research on risk perception and sociologic determinants of ill health.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                22 January 2015
                February 2015
                : 12
                : 2
                : 1216-1236
                Affiliations
                [1 ]Department of Public Health, “Federico II” University, Naples 80131, Italy; E-Mails: triassi@ 123456unina.it (M.T.); rossellaalfan@ 123456gmail.com (R.A.); antonio.nardone@ 123456unina.it (A.N.); oreste.caporale@ 123456libero.it (O.C.)
                [2 ]Department of Traslational Medical Science, “Federico II” University, Naples 80131, Italy; E-Mail: illario@ 123456unina.it
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: pmontuor@ 123456unina.it ; Tel: +039-081-746-3027.
                Article
                ijerph-12-01216
                10.3390/ijerph120201216
                4344663
                25622140
                4323e5ef-fd1b-4482-a019-354c80f97af1
                © 2015 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 December 2014
                : 15 January 2015
                Categories
                Review

                Public health
                campania region,landfill,incineration,waste,human health,human biomonitoring
                Public health
                campania region, landfill, incineration, waste, human health, human biomonitoring

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