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ISDE Italia News edited by ISDE Italy (International Society of Doctors for the Environment, Italy) Number 344 (8th May 2009) In this issue……… - “The toxicology of climate change: environmental contaminants in a warming world” by Noyes, McElwee et al. - “Global warming enhanced stratification and mass mortality events in the Mediterranean” by R. Coma, M. Ribes, E. Serrano, E. Jime’nez., J. Salat and J. Pascual. - “Global climate change and children's health” by K.M. Shea and the Committee on Environmental Health. - Seminar of the World Medical Association on climate change and health care. - “Effects of climate change on environmental factors in respiratory allergic diseases” by G. D'Amato, L. Cecchi. - Healthy hospitals-healthy planet: how the health sector can reduce its climate footprint. - “Children’s environmental health in the twenty-first century. Challenges and solutions” by J. Pronczuk and S. Surdu. - WHO third international conference on CEH: register now! - Nanoparticles in newborns. - “The neurological effects of air pollution in children” by J. Sunyer. - INCHES launches international film competition. - “Conflict of interest, disclosure, and trial reports” by Bruce M. Psaty. - Heal calls for action on pesticides-free public places. - Heal helps European consumers to learn about harmful chemicals in everyday products. - Occupational health and safety section American public health association meeting. - “A note of optimism” by Paul Saoke, Executive Director Physicians for Social Responsibility (PSR)-KenyA. - 6th annual Global Health & Development conference "Achieving global goals through innovation". - WONCA Europe 2009 conference. - Closing the gap in a generation: health equity through action on the social determinants of health. - Global Health Watch 2: the people's health movement alternative world health report. THE TOXICOLOGY OF CLIMATE CHANGE: ENVIRONMENTAL CONTAMINANTS IN A WARMING WORLD by Noyes, McElwee et al. Source: Environment International In Press, Corrected Proof: www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V7X-4W329BN1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_ve rsion=1&_urlVersion=0&_userid=10&md5=bdf9bce898b4ec7ad8e60811a6dde37f Climate change induced by anthropogenic warming of the earth's atmosphere is a daunting problem. This review examines one of the consequences of climate change that has only recently attracted attention: namely, the effects of climate change on the environmental distribution and toxicity of chemical pollutants. A review was undertaken of the scientific literature (original research articles, reviews, government and intergovernmental reports) focusing on the interactions of toxicants with the environmental parameters, temperature, precipitation, and salinity, as altered by climate change. Three broad classes of chemical toxicants of global significance were the focus: air pollutants, persistent organic pollutants (POPs), including some organochlorine pesticides, and other classes of pesticides. Generally, increases in temperature will enhance the toxicity of contaminants and increase concentrations of tropospheric ozone regionally, but will also likely increase rates of chemical degradation. While further research is needed, climate change coupled with air pollutant exposures may have potentially serious adverse consequences for human health in urban and polluted regions. Climate change producing alterations in: food webs, lipid dynamics, ice and snow melt, and organic carbon cycling could result in increased POP levels in water, soil, and biota. There is also compelling evidence that increasing temperatures could be deleterious to pollutant- exposed wildlife. For example, elevated water temperatures may alter the biotransformation of contaminants to more bioactive metabolites and impair homeostasis. The complex interactions between climate change and pollutants may be particularly problematic for species living at the edge of their physiological tolerance range where acclimation capacity may be limited. In addition to temperature increases, regional precipitation patterns are projected to be altered with climate change. Regions subject to decreases in precipitation may experience enhanced volatilization of POPs and pesticides to the atmosphere. Reduced precipitation will also increase air pollution in urbanized regions resulting in negative health effects, which may be exacerbated by temperature increases. Regions subject to increased precipitation will have lower levels of air pollution, but will likely experience enhanced surface deposition of airborne POPs and increased run-off of pesticides. Moreover, increases in the intensity and frequency of storm events linked to climate change could lead to more severe episodes of chemical contamination of water bodies and surrounding watersheds. Changes in salinity may affect aquatic organisms as an independent stressor as well as by altering the bioavailability and in some instances increasing the toxicity of chemicals. A paramount issue will be to identify species and populations especially vulnerable to climate-pollutant interactions, in the context of the many other physical, chemical, and biological stressors that will be altered with climate change. Moreover, it will be important to predict tipping points that might trigger or accelerate synergistic interactions between climate change and contaminant exposures. GLOBAL WARMING ENHANCED STRATIFICATION AND MASS MORTALITY EVENTS IN THE MEDITERRANEAN by R. Coma, M. Ribes, E. Serrano, E. Jime’nez., J. Salat and J. Pascual. Summer conditions in the Mediterranean Sea are characterized by high temperatures and low food availability. This leads to ‘‘summer dormancy’’ in many benthic suspension feeders due to energetic constraints. Analysis of the most recent 33-year temperature time series demonstrated enhanced stratification due to global warming, which produced a 40% lengthening of summer conditions. Many biological processes are expected to be affected by this trend, culminating in such events as mass mortality of invertebrates. Climatic anomalies concomitant with the occurrence of these events represent prolonged exposure to warmer summer conditions coupled with reduced food resources. Simulation of the effects of these conditions on a model organism demonstrated a biomass loss of >35%. Losses of this magnitude result in mortality similar to that noted in field observations during mass mortality events. These results indicate that temperature anomalies are the underlying cause of the events, with energetic constraints serving as the main triggering mechanism. If you are interest to this article you can ask it to our secretariat at [email protected] GLOBAL CLIMATE CHANGE AND CHILDREN'S HEALTH by K.M. Shea and the Committee on Environmental Health. Source: Pediatrics, October 2007. There is a broad scientific consensus that the global climate is warming, the process is accelerating, and that human activities are very likely (>90% probability) the main cause. This warming will have effects on ecosystems and human health, many of them adverse. Children will experience both the direct and indirect effects of climate change. Actions taken by individuals, communities, businesses, and governments will affect the magnitude and rate of global climate change and resultant health impacts. This technical report reviews the nature of the global problem and anticipated health effects on children and supports the recommendations in the accompanying policy statement on climate change and children's health. Info: http://pediatrics.aappublications.org/cgi/content/full/120/5/e1359 SEMINAR OF THE WORLD MEDICAL ASSOCIATION ON CLIMATE CHANGE AND HEALTH CARE The World Medical Association is organizing a seminar on "Climate Change and Health Care" that will be held at Danish Engineers Building, Kalvebod Brygge in Copenhagen on 1st September 2009. The World Medical Association (WMA) is an international organization representing physicians since 1947, when physicians from 27 different countries met at the First General Assembly of the WMA in Paris. The organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behaviour and care by physicians, at all times. This was particularly important to physicians after the Second World War, and therefore the WMA has always been an independent confederation of free professional associations. Funding has been by the annual contributions of its members, which has now grown to approximately 80 National Medical Associations. The WMA provides a forum for its member associations to communicate freely, to co-operate actively, to achieve consensus on high standards of medical ethics and professional competence, and to promote the professional freedom of physicians worldwide. This unique partnership facilitates high-calibre, humane care to patients in a healthy environment, enhancing the quality of life for all people in the world. The purpose of the WMA is to serve humanity by endeavoring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world. Info: www.wma.net/e/; [email protected]; [email protected]; [email protected] EFFECTS OF CLIMATE CHANGE ON ENVIRONMENTAL FACTORS IN RESPIRATORY ALLERGIC DISEASES by G. D'Amato, L. Cecchi. Source: Clinical & Experimental Allergy Volume 38 Issue 8 , Pages 1245 - 1410 (August 2008). A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by human activity, have an impact on the biosphere and the human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between asthma and environmental factors, such as meteorological variables, airborne allergens and air pollution. However, there is also considerable evidence that subjects affected by asthma are at an increased risk of developing obstructive airway exacerbations with exposure to gaseous and particulate components of air pollution. It is not easy to evaluate the impact of climate change and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations. However, the global rise in asthma prevalence and severity suggests that air pollution and climate changes could be contributing. Pollen allergy is frequently used to study the interrelationship between air pollution, rhinitis and bronchial asthma. Epidemiological studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated to an increase in the frequency of pollen-induced respiratory allergy, prevalent in people who live in urban areas compared with those who live in rural areas. Meteorological factors (temperature, wind speed, humidity, etc.) along with their climatological regimes (warm or cold anomalies and dry or wet periods, etc.), can affect both biological and chemical components of this interaction. In addition, by inducing airway inflammation, air pollution overcomes the mucosal barrier priming allergen-induced responses. In conclusion, climate change might induce negative effects on respiratory allergic diseases. In particular, the increased length and severity of the pollen season, the higher occurrence of heavy precipitation events and the increasing frequency of urban air pollution episodes suggest that environmental risk factors will have a stronger effect in the following decades… It is hoped that a greater awareness of the health effects of DEP will encourage a reduction of diesel engine use and/or scientists to find technologies that are able to substantially decrease the release of exhaust particles. Unfortunately, a sudden change in fossil fuel emission is extremely unlikely and we will have to face the unhealthy effects of particulate matter for a long time. Fortunately, the issue of greenhouse gases seems to be at a turning point. The last release of the IPCC stated that climate change is very likely due to human activity, according to an impressive amount of data published in the last few years and policy makers now seem to take into greater consideration (?!?) preventive measures (like the Kyoto protocol) and alternative energy sources. Desirable positive effects of these measures may be achieved in the following decades, but global temperature will continue to increase in the short term. Info: [email protected] HEALTHY HOSPITALS-HEALTHY PLANET: HOW THE HEALTH SECTOR CAN REDUCE ITS CLIMATE FOOTPRINT Health Care Without Harm (HCWH) Europe has published a new report: "Healthy Hospitals-Healthy Planet: How the Health Sector Can Reduce Its Climate Footprint", a joint discussion draft published by the World Health Organization and Health Care Without Harm. This report was written by Josh Karliner and Conni Matthiessen, with contributions from around the world. The report was released at the World Federation of Public Health Associations meeting in Istanbul. This report will be a good starting point for our new climate portfolio and enable HCWH and its new climate and energy advisor Pendo to approach the health care sector and to work for change with different stakeholders. If you are interest to this report you can ask it to our secretariat at [email protected] Info: [email protected]; [email protected] CHILDREN’S ENVIRONMENTAL HEALTH IN THE TWENTY-FIRST CENTURY. CHALLENGES AND SOLUTIONS by J. Pronczuk and S. Surdu. In the twenty-first century, the global burden of disease trends are the result of complex interaction among rapid industrialization and urbanization, unsustainable use of natural resources, and population growth. In addition, global environmental changes due to climate change, ozone depletion, desertification/deforestation, loss of biodiversity, and increased used of some biotechnologies are having an important impact on human health. Many other factors also play an important role in the population’s health response to global environmental threats, including poverty, malnutrition, poor sanitation, and infectious diseases. Worldwide, the burden of environmental disease is much higher for children than adults, especially in young children under 5 years of age. Quantification of the burden of diseases attributable to environment shows that environmental risk factors can contribute to more than one-third of the disease burden in children, a fraction of disease that could be prevented. Children are often exposed to multiple environmental threats combined with other behavioral, social, and economic risk factors. Many of the environmental health risk factors are shared among children’s home, school, and community. Therefore, an integrated approach should be considered in order to create healthy environments for children. The promotion of safe environments for children has to involve decision makers, nongovernmental organizations (NGOs), families, and various sectors including health, education, housing, environment, agriculture, industry, transport, and energy. Multiple initiatives have been proposed from collection, evaluation, and dissemination of information on children’s health and the potential environmental threats to research, monitoring, risk assessment, and policies to improve the environmental conditions and ultimately children’s growth and development. If you are interest to this article you can ask it to our secretariat at [email protected] WHO THIRD INTERNATIONAL CONFERENCE ON CEH: REGISTER NOW! WHO Third International Conference on Children's Health and the Environment will take place in Busan (South Korea) from 7 to 10 June 2009. The event aims at extending the recognition of children’s environmental health (CEH) needs, providing a platform for the exchange of scientific experiences, for learning about research efforts and promoting protective and preventatives "policies". It will also enable us to work out why existing global efforts have not progressed more rapidly and what needs to be done, both in developing and industrialized countries. What are the international commitments for reducing mercury exposure? How to lower the blood lead levels of concern in children? Do nanoparticles represent an emerging risk? How to move towards a safer use of radiation in paediatrics? What are the roles of CEH specialized centres? Will long term studies, collaborative research, training and other tools accelerate progress on CEH? How can we influence and develop healthier policies? These and many other issues will be addressed by health and environment professionals including researchers, scientists, policy-makers and government representatives, mainly from the surrounding Western Pacific and South-East Asian countries and many other Member States, as well as organizations around the world concerned about children and the environment that will be at BEXCO. Info: www.ceh2009.org NANOPARTICLES IN NEWBORNS IPEN in view of ICCM-2 is preparing a new event titled "Nanoparticles in Newborns. A new intergenerational risk". Nanosized particles are very tiny, less than 100nm in diameter. Their hazards are known in part from their historical occurrence as waste byproducts of industry and combustion, but recently engineered forms have been developed for a range of uses, including some important medical uses but also many trivial applications. Synthetic nanomaterials are now incorporated into consumer products such as sporting clothes, stain resistant textiles, sunscreens, electronics and packaging. As a relatively new technology, nanomaterials remain unregulated and unlabelled. Info: [email protected] THE NEUROLOGICAL EFFECTS OF AIR POLLUTION IN CHILDREN by J. Sunyer Source: Eur Respir J 2008; 32: 535–537. Environmental exposures in utero and during early life may permanently change the body’s structure, physiology and metabolism, and lead to diseases in adult life Infants are particularly vulnerable because of their rapid growth and cell differentiation, immaturity of metabolic pathways and development of vital organ systems. The central nervous system has unprotected barriers and a broad time window of onformation, leading to a long period of vulnerability in the developmental process and to susceptibility to any environmental insult. Research conducted among a limited series of pollutants (including lead, mercury and polycyclic aromatic hydrocarbons (PAH)) shows that early-life exposure to chemicals at current environmental levels can be neurotoxic years or even decades after exposure... it is time for multidisciplinary research in human populations (including neurobehavioural and lung examination, and assessments of individual exposure to air pollutants and antioxidants, and of the genetic contribution) to further investigate the suspicion that our urban air is neurotoxic for our children... INCHES LAUNCHES INTERNATIONAL FILM COMPETITION Professionals and amateurs alike are today being urged to get their cameras ready for the world’s first environmental health film competition. As part of the 10th Anniversary celebrations starting from 15 September 2008, the International Network on Children’s Health, Environment and Safety (INCHES) is launching an International Film Competition on Health and Environment, sponsored by several organisations. The competition, called “Focus on Children in a Healthy Environment” and centred on the themes “Climate” and “Environmental Health” will run until 1 March, 2009 and is open to all nationalities and ages. Several cashprizes of 2500 euros will be awarded to the winners of both categories. There are also separate cash prizes for films up to 5 minutes of duration and up to 15 minutes. Peter van den Hazel, INCHES’ chair of the board, said: “The last decade has shown highly successful activities in the children’s environmental health field, generating huge interest on children’s environmental health. The new technologies of showing films on the internet gives us possibilities to reach out to more young people and increase significant public awareness of environmental health issues globally. We are again extremely grateful to those organizations who will be promoting this important event”. To restore Planet Earth and its children back to health requires sound science, health assessments and child specific policies, suggested Mr. Van Den Hazel. “I hope the films submitted for this competition will help catalyze the political and social changes needed to reach our goals and targets on issues from saving children from hazardous environmental situations, such as poor water quality and sanitation, air pollution, waste and poverty reduction,” he said. Info: www.inchesnetwork.net/filmcompetition.html; [email protected] CONFLICT OF INTEREST, DISCLOSURE, AND TRIAL REPORTS by Bruce M. Psaty. Source: JAMA, 14th April 2009. "When I was an assistant professor, my previous training had not prepared me for the unexpected attention that 2 articles, both from the same study, were to receive. One article provided evidence that abruptly stopping blockers might increase the risk of coronary events. The other suggested that, compared with the use of high-dose diuretics, which is now no longer recommended, the use of blockers might be associated with a lower risk of coronary events in hypertensive patients. While the news media’s coverage of the risk study was transient, the pharmaceutical industry had a more sustained interest in the other publication. My family and I were invited to a first-class resort, where I presented the results at a sponsored conference...". If you are interesting to this article you can ask it to our secretariat at [email protected] HEAL CALLS FOR ACTION ON PESTICIDES-FREE PUBLIC PLACES During the internationally know, Week Without Pesticides (20-30 March), the Health & Environment Alliance (HEAL) and the Mouvement pour les Droits et le Respect des Génerations Futures (MDRGF) launched a postcard action urging municipalities in France to phase out the use of pesticides in parks, school and sports grounds. At the same time, HEAL released the results of a poll revealing that half the UK population is concerned about pesticides, not only on their food but also in public places. This compares with a similar poll in France where 80% favoured pesticide-free public spaces. Both actions are part of HEAL’s "Sick of pesticides" campaign. It aims at encouraging governments across Europe to eliminate avoidable cancer risks by bringing bans on spraying in public areas and phasing out the most hazardous substances as soon as possible. Info: www.env-health.org/a/3262; www.env-health.org/a/3260; www.mdrgf.fr; www.pesticidescancer.eu HEAL HELPS EUROPEAN CONSUMERS TO LEARN ABOUT HARMFUL CHEMICALS IN EVERYDAY PRODUCTS On Friday 13th March 2009, the Health and Environment Alliance (HEAL) together with partners celebrated the European consumer day by launching new materials and website for the public on the new consumer’s right to know about harmful chemicals in products as established by the REACH chemicals law. Entitled “Harmful chemicals in the products you buy? Your right to know”, the leaflet explains how the new 'right to know' works, and how consumers can use it. It includes a sample letter to a manufacturer or retailer to obtain information on whether harmful chemicals are present in the product. It should take consumers not more than five minutes to prepare. The leaflet also gives examples of chemicals of high concern that are typically found in different consumer products. The leaflet, sample letter and more information in several languages were published within HEAL’s Chemicals Health Monitor project and can be found on the project website, Take Action! Centre, Use Your Right To Know! Info: www.env-health.org; www.chemicalshealthmonitor.org/spip.php?article363; www.chemicalshealthmonitor.org/spip.php?rubrique75; www.chemicalshealthmonitor.org/spip.php?rubrique111; www.chemicalshealthmonitor.org/spip.php?rubrique112 OCCUPATIONAL HEALTH AND SAFETY SECTION AMERICAN PUBLIC HEALTH ASSOCIATION MEETING Planning for the Occupational Health and Safety (OSH) section's APHA 2009 programme is already underway. With a new administration and the promise of positive changes in the public health and labor arenas, it will be exciting to meet again in Philadelphia on 7-11 November 2009 to discuss forward motion in our field. How can we capture the energy that will be in motion as we turn around years of neglect into a new agenda for workers' rights in health and safety? By all standards we are expecting the 2009 APHA meeting to be historic and monumental, and we are asking you to consider participating in the scientific program. Using feedback given by members at the 2008 APHA meeting, the OSH program committee has prepared a call for abstracts for the 2009 meeting. The OHS section agenda will emphasize two themes: “Research to Practice (R2P)” and “Occupational Health Disparities”. Info: http://apha.confex.com/apha/137am/ohs.htm; [email protected]; [email protected]; [email protected]; [email protected] A NOTE OF OPTIMISM by Paul Saoke, Executive Director Physicians for Social Responsibility (PSR)-KenyA. This is truly a momentous epoch in world history. It demonstrates the power of humanity faced with a common destiny. I am watching Nixon Cooper on CNN now - the 106 year old woman cited by Obama - the face of this election and I remember what my good friend Michelle Roberts told me in September when we visited Obama's office. Her own mother was 97 and her greatest jhoy was to see a man of colour nominated to compete for US Presidency on a major political party ticket. I salute the people of America, young, old and middle aged but not forgetting the children for whom this was done. Had they a chance to cast their balot then the race would have been over many months ago. I must also thank President George Bush for creating the conditions that made this phenomena happen. Perhaps this was a divine message to signal to the American people and the world that the market orligarchs were ruining the planet and their intransigence to pay attention to the myriad hurricanes and tornados, the tsunamis, the earthquakes that keep tearing the earth's crust etc. Like everybody else I am hopeful of positive policies aimed at stalling the deterioration of the already over-burdened planet. And I am optimistic that even though gains in the reversal might not be realized in our lifetime, the process might have started with the first eighteen year old man who cast the first ballot in these historic election. I am optimistic that even though we have weak environmental control instruments - of course weakened by the Bush administration - pressure is going to ease (albeit by a few units) on all of us who have been struggling to hold off the race towards global destruction. I am optimistic that even though the power of nations (according to the Bush and neo-conservative doctrine) has been measured by their military strength, international conflicts will be resolved through diplomatic negotiations. I am optimistic that even though peoples and nations have not been treated equally, Obama's triumph is a vindication of history. I am optimistic that even though Obama now carries the world on his shoulders and America on his lap, this dawn of a new era, cheered by most of us round the globe is a covenant to do right, make amends, and move forward righteously for the benefit of all humanity and their progeny. Let us all rededicate our efforts and make fresh commitments to change the world. AND YES WE CAN. 6TH ANNUAL GLOBAL HEALTH & DEVELOPMENT CONFERENCE "ACHIEVING GLOBAL GOALS THROUGH INNOVATION" On 18-19 April 2009, in Yale University, New Haven, Connecticut, USA, 2,500 conference participants were joined for a stimulating international conference organized by “Unite For Sight”, a Nonprofit Organization Featured Weekly on CNN International and Recently In The New York Times Info: http://www.uniteforsight.org/conference WONCA EUROPE 2009 CONFERENCE Wonca Europe and the Swiss Society of General Medicine SSMG/SGAM will be pleased to welcome you to the 15th Wonca Europe Conference 2009 in Basel which will be held together with the 32nd national SSMG/SGAM Congress. It is a great pleasure and honor for the SSMG/SGAM to organize this very important European conference in Switzerland, for the first time in its history. We promise you a very exciting conference to the theme of «The Fascination of Complexity – Dealing with Individuals in a Field of Uncertainty». A deep understanding of complexity and a virtuous handling of uncertainty are very important competencies in the daily practice of family doctors. The conference will highlight topics related to teaching, research, quality in family medicine and daily practice of family doctors. A substantial number of presentations will match the main topic of complexity and uncertainty. We invite you all to present your research and teaching activities and to discuss specific items out of your daily practices and health systems. We are looking forward to your abstract submissions. And do not forget Basel and its surrounding countryside, either! Switzerland with its rich culture, its famous mountains and its marvellous cities is well worth the visit! The Swiss family doctors will be pleased to welcome you all to the Wonca Europe Conference 2009 on 16–19 September 2009 in Basel (Switzerland), the very highly regarded annual «come together» of family doctors of Europe and beyond. Info: http://www.congress-info.ch/wonca2009/home.php CLOSING THE GAP IN A GENERATION: HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH This is a WHO’s publication. Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others. Info: http://www.who.int/social_determinants/final_report/en/ GLOBAL HEALTH WATCH 2: THE PEOPLE'S HEALTH MOVEMENT ALTERNATIVE WORLD HEALTH REPORT The Global Secretariat of the People’s Health Movement (PHM) jointly with the Secretariat of the Global Health Watch 2 (GHW2) call upon all PHM country circles and networks to participate in the launching of the GHW2. Global Health Watch is a collaboration of leading popular movements and nongovernmental organizations comprising civil society activists, community groups, health workers and academics. It was initiated by the People’s Health Movement, Global Equity Gauge Alliance and Medact. It has compiled the second edition of its alternative world health report – a hard-hitting, evidence-based analysis of the political economy of health and health care – as a challenge to major global bodies that influence health. Its monitoring of institutions including the World Bank, the World Health Organization and UNICEF reveals that while some important initiatives are being taken, much more needs to be done to have any hope of meeting the UN’s health related Millennium Development Goals. Info: http://www.phmovement.org/cms/en/node/862 This newsletter is ISDE Italy's Official Press Organ edited by Roberto Romizi e Silvia Caruso. If you want to receive this newsletter or unsubscribe or send any suggestion, please contact: [email protected] Past numbers are available in the ISDE Italy website www.isde.it International Society of Doctors for the Environment - ISDE Italy International Society of Doctors for the Environment www.isde.org Via della Fioraia, 17/19 - 52100 Arezzo (Italy) Tel. +39 0575 22256, Fax +39 057528676, E-mail: [email protected]