(Projects submitting final reports after 1 January 2014 must use this format.)
LIFE12 ENV/IT/000834
MIDTERM Report
Covering the project activities from 01/07/2013 to 31/01/2015
Reporting Date
25/03/2015
LIFE MED HISS Mediterranean Health Interview Survey Study
Project Data
Project location Turin (Italy)
Project start date: 01/07/2013
Project end date: 30/06/2016
Total budget € 1,598,283 Euro
EC contribution: € 790,788 Euro
(%) of eligible costs 50.00%
Beneficiary Data
Name Beneficiary AGENZIA REGIONALE PER LA PROTEZIONE
AMBIENTALE DEL PIEMONTE
Contact person Mr. Ennio Cadum
Postal address Via Sabaudia 164, 10095 Grugliasco (TO), Italy
Telephone +39 011 19680760
Fax: +39 011 19681591
E-mail [email protected];
Project Website www.medhiss.eu
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 2/60
1. List of contents 1. List of contents ................................................................................................................... 2
List of abbreviations................................................................................................................... 3
2. Executive Summary ........................................................................................................... 4
3. Introduction ...................................................................................................................... 12
4. Administrative part........................................................................................................... 14
4.1 Description of the management system ......................................................................... 14
4.2 Evaluation of the management system........................................................................... 18
5. Technical part ................................................................................................................... 20
5.1. Technical progress, by task ........................................................................................... 21
5.2 Dissemination actions .................................................................................................... 35
5.3 Evaluation of Project Implementation............................................................................ 41
5.4 Analysis of long-term benefits ....................................................................................... 47
6. Comments on the financial report .................................................................................... 51
6.1. Summary of Costs Incurred........................................................................................... 51
6.2. Accounting system ........................................................................................................ 53
6.3. Partnership arrangements (if relevant) .......................................................................... 55
6.4. Auditor's report/declaration........................................................................................... 55
7. Annexes................................................................................................................................ 58
8. Financial report and annexes................................................................................................ 60
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 3/60
List of abbreviations
CB Coordinating Beneficiary
AB Associated Beneficiary
CTM Chemical Transport Model
ICD International Classification of Diseases
SC Steering Committee
NHIS National Health Interview Survey
ARPAP Agenzia Regionale per la Protezione dell’Ambiente del Piemonte
ENEA Italian National Agency for New Technologies, Energy and Sustainable
Economic Development
CREAL Fundació Centre de Recerca en Epidemiologia Ambiental
UPMC Université Pierre et Marie Curie
INSERM Institut National de la Santé et de la Recherche Médicale
NIJZ National Institute of Public Health Slovenia
SEPI SCaDU Epidemiology ASL TO3
MINNI National Integrated Modelling system for International Negotiation on
atmospheric pollution
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 4/60
2. Executive Summary
2.1 Project objectives
MED HISS is a LIFE project involving four European countries (Italy, France, Slovenia and
Spain). MED HISS aims to set up a cheap European surveillance system of air pollution long
term effects, contributing to the scientific knowledge needed for the development of European
environmental policy and legislation. The long term health effect surveillance system
proposed is based mainly on National Health Interview Survey (NHIS), already available.
These surveys are representative of each national population and covering both urban and
rural areas.
The original idea of the project was to follow-up the surveys (for the four countries involved
in the project) by a linkage with mortality and, wherever possible, morbidity data registers, to
assign to each subject the individual health status. It is possible to attribute to each subject a
defined level of air pollution exposure at municipality level, in terms of annual level of
particulate PM10, PM2.5 and gases NO2, O3 using data derived from available national
dispersion models.
These data sets (concerning the cohorts) contain information that allows a full control of
confounding factors at individual level: it’s possible, in other words, to control for other
factors that are linked to the same health effects (either if they are not the environmental risk
factors of interest), for example controlling for smoking habits.
In this way, air pollution long term effects can be evaluated in a proper way for a wide range
of diseases using individual data and applying statistical methods to analyze cohorts in
epidemiology.
Restrictive privacy policies, arisen in Spain and Slovenia after the project’s start didn’t allow
the linkage between individual data (the Spanish and Slovenian surveys) and mortality and
morbidity data registers. Therefore, it was necessary to set up an alternative study design,
mentioned in the proposal as a possible “mitigation measure” based on aggregated data: the
ecological approach.
If this strategy will provide results comparable with individual approach, it will offer the
opportunity to use an alternative surveillance system, permitting to overcome privacy
policies barriers. Last but not least, it offers the opportunity to test an even cheaper
surveillance system.
The ecological approach is based on the use of available data (mortality/morbidity and
potential confounders) not at individual level but at aggregated level (called area). The air
pollution exposure is then assigned at the desired level, municipality or area, following the
same scheme planned for the individual approach. In fact, the available dispersion models
(currently used for air pollution forecasting and hind casting) provide data on a regularly
spaced grid. A specific focus of the project is to examine in depth the exposure assessment:
one of the tasks is to improve the models at the ground level, integrating them with
monitoring stations’ data and, after that, assign exposure to each municipality on the basis of
the built-up area, to assign exposure where people really live. The improvement derived on
this issue will be relevant for both approaches, individual and ecological.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 5/60
To guarantee the comparison between the two approaches, the project coordinator
(ARPAP- Italy) will carry on the individual study on the whole national territory and both
approaches (individual and ecological) on the Piedmont region.
By now, preliminary results performed on the Italian cohort (i.e. using individual data)
confirm the results obtained by other published cohorts results, specifically recruited for air
pollution health effects studies. This is an encouraging suggestion for the potential
effectiveness of MED HISS surveillance system, and for the hypothesis to build a cheap
system using NHIS data available for each EU country, provided that the data could be linked
with individual data on mortality and morbidity.
The final results of both studies, individual and ecological, will be available at the end of year
2015.
Despite the privacy problems encountered, MED HISS project is still relevant and aims at
contributing to the updating and the development of European Union environmental policy
and legislation, in term of European usable measure of adverse chronic air pollution health
effects. When the directive 2008/50/CE will be updated, it could take into account results
from MED HISS project.
An Health Impact Assessment (HIA) procedure, based on the estimates obtained, will be
performed in all project countries to calculate the attributable cases.
The current understanding of the association between air pollution long-term exposure and
adverse health effect is presently mainly based on cohort studies coming from USA, Canada,
Japan, China. Few studies with restrictions on age of cohort recruited, on kind of pollutant
studied, and with a poor geographical variability have been conducted so far in Europe.
ESCAPE project, even if based mainly on urban cohorts and which results have been
published after MED HISS project’s start, allows a comparison with MED HISS final outputs.
The European HIA currently obtained using risks from American cohorts could give biased
results: MED HISS is a demonstration project with the aim to guarantee to the EU a source of
information for HIA based on direct measurements.
The aim is to assess the feasibility of the adopted approach to spread it in other European
countries, in order to create a European cohort database of individual characteristic and air
pollution data exposure with a specific attention to the exposure assessment and to the
standardization of confounding factors.
An efficient management system have been set up to help participants to reach the planned
objectives: 1. the organization of periodic contacts with ARPAP staff; 2 the planning of
interventions on administrative and financial aspects during technical meetings; 3 the constant
use of the private area of the Website (Platform) to share and check documents, have
contributed to finalize a firm management and to achieve the financial deadlines.
The Steering Committee, with representative of all partners and external experts has a
transversal role with decision power and oversaw project implementation. The participation of
the two external experts, as inferable from the meetings minutes, is providing a good
scientific debate.
The stakeholders communication strategy should guarantee a strong relationship with
European actors in order to support European policy frameworks and strategies development.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 6/60
2.2 Key deliverables and outputs
In Table 1 we list all the deliverables and outputs already produced or in progress, but with a
deadline foreseen in the next 9 months.
The MED HISS project is going on without serious obstacles that would affect the reaching of
the above described objectives of the project by its deadline. There is a delay in the
acquisition of Slovenian data dispersion modelling, due to the validation procedure that is
much more time consuming than foreseen and to the legislative and administrative national
restrictions for health data access, a slight delay in the acquisition of the updated Italian
outcomes, due to administrative procedure, and of the exposure and health French data
acquisition, for the changed assignation of the French partner (for this we are asking an
amendment to add INSERM as a project’s partner).
Even if there is a delay in data processing (for both environmental and health parts), a subset
of them have been already acquired and procedures have been set-up, permitting to develop
and test the statistical strategy to be adopted in the final analyses. Statistical analyses are
ongoing and the environmental and health data-processing will be ended, in order to respect
the deadlines concerning the main output of the project (statistical analyses, map and HIA).
Using this scheme, preliminary analyses on Italian cohort have been already done and
presented at the Mid Term workshop in Barcelona (October 2014). These analyses have
been done for each subject using the exposure to PM2.5 modelled for year 2005 at
municipality level, and 8 years of follow-up on mortality and hospitalization. Statistical
methodology used was Cox model, using a set of confounders chosen for a direct comparison
with literature.
All health and environmental data will be in the final form by the end of June 2015. The
meeting already scheduled in Lubiana (on July 2015) represents now a Milestone
corresponding to the end of data collection and processing. In this meeting also advanced
forms of statistical protocol and of HIA protocol will be discussed and finalised.
Key outputs of the project are the following:
- acquisition of modelling exposure data, testing a methodology for the integration of data
from monitoring stations and an exposure assessment on the built-up area;
- individual study of the cohorts, Italian and French, recruited for institutional purpose and
followed for a medium-long period;
- ecological study as a test for an surveillance system, even cheaper than the individual study;
- map to describe and disseminate MED HISS results to stakeholders, in order to extend the
pilot study to other EU countries;
- an efficient management system based mainly on sharing common procedures for reporting
and a defined timing;
- implementation of the Private area of the website (Platform) to collect documents useful for
a good performance of the management-reporting system;
- a stakeholders map will describe the network of scientific and political key actors, essential
for the implementation of the pilot aspects of the project;
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 7/60
- website published, implemented in march 2015 and currently updated;
- notice board in English, Italian, French and Spanish language have been produced until
today.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 8/60
Name of the
deliverable
Output
produced
Associat
ed
action Due date Status
Annex
The meetings
foreseen for the
project:
KO meeting
Turin, 2013
B2 meeting Paris,
2014
B1 meeting
Bologna, 2014
B3 meeting
Barcelona, 2014
B4 meeting
Lubiana, July
2015
D3 meeting
Barcelona,
December 2015
Minutes B1/B2/
B3/B4/
D3
Completed on
time. For kick-off
meeting there
were 3 months of
delay.
Annex 25 -
Minutes of
the
meetings
(Minutes of
kick-off,
first action
meetings,
MID
TERM
workshop)
Air pollution
mapping protocol Protocol B 1 31/12/2013 Completed on time. Annex A-
Air
pollution
mapping
protocol
Air pollution data
set Datasets B 1 31/03/2015 Completed for
Spain and Italy by
30/06/2014.
To be completed
for Slovenia and
France.
Exposure
assessment study Report on
results
obtained
B 1 31/03/2015 Completed on
time
Annex 6–
Exposure
assessment
study
The map of air
pollution data at
municipality scale
for each country
and each pollutant
Map at
municipality
level
B 1 31/12/2014 Done for Spain.
Ongoing for Italy,
Slovenia and
France . New
deadline:
30/06/2015
First results
at the end
of Annex 6-
Exposure
Assessment
study Health data
collection protocol Protocol B2 Required in
letter
ENV/E4/FD/
SEB/ps
Completed on time. Annex B –
Survey and
health data
protocol
Report on health
data available and
health data
endpoints
Report B2 30/06/2014 Completed on
time for Italy,
postponed for
France after the
Annex 9-
Individual
approach
data
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 9/60
amendment available
and health
endpoints
Annex 10-
Ecological
approach
health
endpoints
Final report on
population data
after linkage
procedures
Report B 2 31/12/2014 Intermediate
follow up
completed for
Italy.
Ongoing for
French partner.
Deadline
postponed to
30/06/2015
Feasibility study
for a common air
quality map for
epidemiological
purposes
Report B3 30/09/2015 Ongoing.
Confirmed.
Report of
descriptive
statistics of
variables that will
be used in the
analysis
Report B 3 30/09/2015 Not due.
Confirmed.
Annex 8–
Preliminary
results
PM2.5 year
2005 Italy
Report of the
statistical
modelling that will
be used in the
analysis
Protocol B4 30/09/2015 Ongoing.
Confirmed.
Annex 7-
Statistical
protocol
(draft)
Reports on
morbidity and
mortality analysis
Reports B5/B6 31/10/2015
–
15/12/2015
Not due.
Confirmed.
Two draft papers
for scientific
journals
Draft papers B5/B6 31/12/2015 Not due.
Confirmed.
Protocol for the
HIA procedures Protocol B7 30/06/2015 Ongoing.
Confirmed.
Annex 11 –
List useful
for
literature
review
Annex 12 -
HIA
protocol
(draft)
Preliminary
assessments of the
impact on overall
and country-
Report B7 31/12/2015 Not due.
Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 10/60
specific mortality
and morbidity
Report on
epidemiological
evidences to
support EU policy
on environment
Report C1 Added in
the
Inception
Report
Completed on
time.
Annex F-
Epidemiolo
gical
evidences
to support
EU policy
Presentation of
epidemiological
air pollution map
to European Union
and local
stakeholders
Map C1 30/09/2015 Postponed to
31/12/2015
Annual conference
of the
International
Society for
Environmental
Epidemiology
communication
(oral or poster)-
ISEE
Abstracts D1 20/08/2015 Ongoing.
Confirmed.
Annex 20 –
Abstracts
ISEE 2015
Development of
website and
maintenance of it
Website
second
revision,
usage report,
documents
uploaded
D2 31/03/2015 Completed on
time the
development of
website. It is
currently used and
updated
Minutes of the SC
meetings/teleconfe
rences/videoconfer
ences
Minutes E1 Completed on
time those
foreseen until now
Annex 27 –
Minutes of
the Steering
Committee
meetings
Monitoring
protocol of the
project
Protocol E2 Required in
letter
ENV/E4/FD/
SEB/ps
Completed on
time.
Annex C -
Monitoring
protocol of
the project
Monitoring reports
of the project
progress
Reports E2 Required in
letter
ENV/E4/FD/
SEB/ps
Completed on
time (those due
until March 2015)
Annex 3 –
Monitoring
reports
Videoconferences
to monitor the
status of the
project every 6
months
Minutes E2 Completed on
time those
foreseen until now
Annex 3 –
Monitoring
reports
Progress report
(one at the end of
2014 and one at
the end of 2015)
Report E2 Completed on
time progress
report 2014
Annex 3 –
Monitoring
reports
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 11/60
2.3 Summary of the report
The present report describes the state of the art of MED HISS project after 19 months (out of
36).
The report is structured in: Summary, Introduction, Administrative part, Technical part -
containing the Technical progress per task, the Dissemination actions, the Evaluation of
project implementation and the Analysis of long-term benefits - and finally the Comment on
the Financial report.
All of the technical actions (Action B1 – B7) are still in progress.
Elaboration of environmental data (Action B.1) is in the closing stage, with a small delay due
to the update of the models and to the inclusion of external experts’ suggestions for all the
countries involved.
The Action B.2 is ongoing. After the approval of the protocol, the health necessary data
collection is in the progress for all countries, including those with legislative impediment on
privacy policies that will not be able to enrol individual data and for French partner waiting
the amendment.
Individual Italian data (used to obtain preliminary results) will be improved adding more
years of exposure and extending the follow up period. Major evaluation about the need of
standardized variables for the confounding control and the statistical methodologies are
ongoing (Action B.3 and B.4). The objective is the comparison among European surveys.
These aspects are under discussion, and will be finalized in a protocol scheduled for
September 2015 and discussed during Action B4 meeting (Action B.4) on July. The B4
protocol will deal with both studies, ecological and individual.
Also the protocol concerning the Health Impact Assessment is under discussion (Action B.7).
Results on mortality and morbidity endpoints (Action B.5 and B.6) will be available by the
end of 2015.
The administrative part reports in detail the successful management process adopted, the
coordination scheme and the organization of the project team. The management system is also
evaluated according to the problems encountered and the solutions adopted thanks to a joint
effort from the partnership. The financial part is a comment on the financial report, including
an overview of costs incurred, information on the accounting system, and allocation of costs
per action. As a general comment, we are in line with what was scheduled in the original
proposal, as breakdown of budget posts.
The current report covers about an half of the entire project (from 01/07/2013 to 31/01/2015,
19 out of 36 months) and report a cost of € 662.698, about the 40% of the total cost of the
project.
Dissemination activity strictly related to stakeholders strategy represents the engine to exploit
the potentiality of our pilot project.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 12/60
3. Introduction
Environmental problem/issue addressed
The European Commission is engaged since many years in evaluating air pollution health
impact in Europe and promoting effective measures for its reduction.
Many studies have demonstrated chronic health effects of air pollution. A better knowledge of
long term effects of fine and coarse particles is mandatory in order to contribute to the policy
on the environment and health (the Environment and Health Action Plan) integrating and
supporting EC legislation in this field, to plan mitigation actions and to implement efficient
practical measures.
In this scenario MED HISS addresses several favoured indicative actions:
- Integration and harmonization among the environmental data and health information;
- Development of best practice examples about using environmental monitoring data to
protect human health.
Outline the hypothesis to be demonstrated / verified by the project
The problems targeted by the MED HISS project are to estimate long-term health effects of
air pollution in Mediterranean area exposed to high air pollution levels, providing new
evidence to support EU legislation and implementing an epidemiological cheaper surveillance
system to monitor these effects over time. The Health Impact Assessment, HIA, is the final
output of the project and the results will be used for communication and dissemination to non
technical targets (policy makers and stakeholders).
Technical and methodological solution
MED HISS surveillance system is based on linking exposure information, mortality and
hospital admissions registries and National Health Interview Surveys (if individual linkage is
not available and alternative/comparable approach will be implemented using as confounding
variables characteristics from aggregated area).
The priority of MED HISS is human monitoring, data linkage with environmental chemicals
(PM10, PM2.5, NO2, O3) and health status of the population.
To reach this goal, in MED HISS project data are acquired, beside health data considering a
cohort representative of the whole population (both urban and rural areas), air pollution data
from national deterministic dispersion models in Catalonia (CALIOPE), France (CHIMERE),
Italy (MINNI) and Slovenia (ARSO) that are able to give an estimate on a regularly spaced
grid, even in places where fixed monitoring stations are not available.
In addition to measure adverse health risks of air pollution HIA will be used to more
extensive communication.
Expected results and environmental benefits
Main expected result is the demonstration of the feasibility of the development of a cheap
surveillance system in Europe. By the development of recommendations and best practice
examples about using available health and environmental data, MED HISS aim to augment
the usefulness of the epidemiologic methods to update EU about health risks related to air
pollution.
First of all we will have the comparison between the risks estimated by MED HISS with the
published one; secondary, we will estimate the attributable cases; third, the “lesson learned”
will be shared with all the stakeholders.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 13/60
In addition to the above mentioned results, the project could have a direct impact on the
European initiatives and discussion on air quality, health effects, and the need to air quality
management. To achieve that, we are aware of the necessity of a large involvement of
stakeholders at international, national and local level. In that way we will improve their
sensitivity to the target problem, and stirred the attention of media (international journals,
national, local and online journals) towards the results produced by MED HISS.
Expected longer term results
The outcomes of the project are believed to have the following impacts:
1. Future contribution to implementation, updating and development of European Union
environmental policy and legislation on air quality: the results of the project could
demonstrate that actual experimented environmental level have health consequences. A future
environmental-health policy could have direct impact on air; as well as indirect impacts on
various economic sectors, including car industry for the production of low polluting vehicles,
producers of heating systems employing less fossil fuels and biomasses, heavy industry with
control of emissions and targeted energy use.
2. Integration of the environment into other policies: the MED HISS work done on the
usability of information arising from NHIS about life style factors will promote also a
sensitization about the need of this kind of information in the studies about the effects of
environmental factors. Moreover, the restrictive privacy policies, arisen in Spain and Slovenia
after the project’s start, suggest a punctual consideration. It will be necessary to stress a clear
individuation of the subjects able to better manage these particular issues, linked to
environmental policies.
3. Future EU (and Global) applicability and reproducibility of demonstrated technology: the
same multidisciplinary methodology developed in MED HISS could be employed in future in
other countries to evaluate the beneficial effects of new policies (if any), in other geographical
areas (including in Eastern EU) to evaluate the effects of air pollution. If privacy regulation
will be less severe on the use of these data, each European country could have a cohort
representative of the whole population to monitor the health effects of air pollution or other
environmental issues at municipality scale.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 14/60
4. Administrative part
4.1 Description of the management system
The project- management system has been structured in the following actions:
- Co-ordination and management (Action E1)
- Monitoring of the project (Action E2)
- Administration of budget (Action E3)
- Networking with other projects (Action E4)
- After-LIFE communication plan (Action E.5)
Action E1: The Project Manager is also the Coordinator of the project and belongs to the
Coordinating Beneficiary ARPAP. The Project Manager can rely upon one person supporting
the administrative and financial activities of the project. For each partner there is an
administrative staff that deals with all the financial and administration issues of the project.
We have already described with detailed information the Organization chart of the project
team and the project management structure in the Inception Report. It is useful here to
report that ARPAP conferred 4 technical temporary contracts: the personnel were asked to
monitor the following specific areas: “environmental data - exposure assessment” “air
pollution models and exposure assessment”, “survey data, health data and follow up”,
“technical coordination, communication and dissemination”. Each of the 4 contracted people
mentioned is working under the supervision of senior referents from ARPAP and from Italian
ABs, ENEA and SEPI.
ITALIAN PARTNERSHIP
Arpa Piemonte: public employee
+
Public employee from:
Department of Environmental Epidemiology or Department of Air Quality
as supervisor of the technical activity of 4 temporary contracts:
Martina Gandini (“env data, exp assessment”); Stefania Ghigo (“models, exp assessment”)
Cecilia Scarinzi (“health status…”)
SEPI (survey data, health data, follow up)
(socio economical variables) ENEA (air quality models)
Maria Rowinski: in charged of “technical coord, communication and dissemination” tasks.
CREAL (Spain), UPMC (France), NIJZ (Slovenia) are the partner
involved for the validation and choice of National data
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 15/60
The Project coordinator is responsible for the full implementation of the project and maintains
the contacts with the Commission and stakeholders in order to achieve the project activities
and to disseminate the project results. According to the Grant Agreement, each AB is directly
involved in the technical implementation of one or more tasks of the project.
The Steering committee, with representatives of all partners and integrated by two external
experts, has a transversal role with decision power and oversaw project implementation. At
each meeting or videoconference we foreseen a SC meeting, documented by the Minutes. The
work plan set down is regularly updated following the general scheme of the Gantt chart
(Annex 1- GANTT). Moreover the Gantt Chart had been and will be discussed and shared at
each meeting, for reassurance about the general consensus.
Formal agreements between the coordinating beneficiary and all the partners have been
established following the Life+ guidelines. The dates of all agreements were illustrated in the
Inception Report and a copy of all agreements were annexed and sent to the European
Commission.
National Institute of Public Health Slovenia (IVZ) communicated that the Institution changed
its name into NIJZ, with differences regarding only its status and organisation, after the
signature of the grant agreement by the Acting Director Marija Magajne. However this did not
change the role and the duties of NIJZ in the project. For this reason we made a formal
amendment. The revised Partnership Agreement was signed on December 2014 and a copy
was sent to the European Commission and to the Monitoring Team (Prot. ARPAP 3458
19/01/2015. However, a copy of the revised Partnership Agreement is enclosed to the present
Report (Annex 2 – Partnership Agreement NIJZ).
A second amendment has been requested by UPMC in order to add INSERM as
additional partner of the project. Following the reorganization of the UMR-S in France in
January 2014, the team of UPMC, “EPAR: Epidemiology of allergic and respiratory diseases”
changed its assignation from UMR-S 707 “Epidémiologie, système d'information,
modélisation” to UMR-S 1136 “Institute Pierre Louis of Epidemiology and Public Health”.
This UMR-S 1136 is a joint research unit, namely an administrative entity created by the
signature of a contract between one or more research establishments. UPMC (as a University)
and the Institut National de la Santé et de la Recherche Médicale (INSERM as a research
establishment) signed a contract to create the joint research unit « Institut Pierre Louis
d'Epidémiologie et de Santé Publique ».
The new structure changed the responsibility assignment and the team EPAR is now under
INSERM’s responsibility for all development tasks.
Contrary to FP7 and H2020 programs, Joint Research Units are not admitted in LIFE+
project. Therefore, to allow a joint work with EPAR participation, there is the need to allow
INSERM to be partner of the project, with a new financial and implementation distribution of
French funding (without modifications of the total budget).
The meetings were organized in order to involve all the ABs and in order to have the time, at
each institutional seat, to discuss and solve any technical or administrative problem eventually
encountered.
Since the project start four meetings were organized:
•Kick off meeting, 18-19 November 2013, Turin
•Health data protocol meeting, 20-21 January 2014, Paris
•Environmental data protocol meeting, 26 February 2014, Bologna
•Mid term meeting, 29-30 October 2014, Barcelona
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 16/60
Next meeting is planned in Slovenia, under the supervision of NIJZ, on July 2015.
At each meeting a specific part was devoted to the administrative and financial aspects of the
LIFE+ programme reporting. All the materials are uploaded and shared on the private area of
the website.
At the Mid Term Meeting organised in October 2014 in Barcelona the CB shared with the
ABs in details the dead lines for the Mid Term Report finalisation, giving a Time plan about
E1, E2 and E3 Actions.
Action E2:
Monitoring activities were carried out by the CB and consisted in evaluating the efficacy of
planned actions and verifying that the project’s objectives had been achieved. In order to
prepare comprehensive and compliant financial reports, the LIFE MED HISS Consortium
established a reliable system for collecting administrative and financial data of each AB.
In the website www.medhiss.eu, we organised a private area, named Platform, where ABs are
invited to upload time sheets, invoices, contracts, financial statements and any other useful
file, for Life + reporting purposes. Every quarter the CB checked all the files uploaded,
registered the information, requested clarifications where needed. The private area was useful
also to share Guidelines, Templates, link to Life+ Toolkit on the Internet as well as internal
Minutes, Letters from the European Commission, the Inception Report with the Annexes
already sent. The CB was able to monitor costs and to compare them to the budget on a
continuous basis.
We sent The Platform instructions (and Platform accounts) on May 2014 and we were able
during the Second Monitoring visit in Turin, in December 2014, to show all data acquired.
Also for the future, a regular consultation of the material uploaded into the platform will give
a quick view of the administrative and financial reporting status of each partner.
A check list focusing on administrative and financial reporting was distributed on January
2014 to check the compliance of the AB to the Common Provisions rules. This document has
been updated and discussed during the Mid Term Meeting (Annex 26 - Updated Financial
check list).
Internal audits before the draft of the Mid Term Report, to check available information
uploaded into the Platform, have been performed in June and in October 2014.
As suggested in the letter ENV/E4/FD/SEB/ps, a monitoring protocol was developed (Annex
C – Monitoring protocol), together with the first monitoring report (Annex 4 of the Inception
Report). A second monitoring report is now enclosed, together with the intermediate Progress
Report (Annex 3 – Monitoring reports).
The ABs were able to discuss about E Actions issues during:
• the Kick off meeting in Turin, November 2013 (the data collection; time sheets
examples, Common provisions distributed, financial reporting file commented);
• Health data protocol meeting, Paris, January 2014 (health data available, individual
information on confounders, grant agreements and methods of payment, eligible costs
from C.P. 2013, the EC letter received after the monitoring visit);
• Environmental data protocol meeting, Bologna, February 2014 (environmental data
available, air pollution information based on models vs monitoring stations, the VAT
declaration, financial statement files, check list – guidance for financial reporting
distributed, Platform of the web site);
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 17/60
• the teleconference of the Steering Committee to discuss “POLICY data exchange
through the www.medhiss.eu reserved area (= Platform)”, April 2014;
• the internal meeting ARPAP-SEPI we had in May 2014 to finalize the B2 Report with
Italian information and to connect B2 data with B1 available data by June 2014;
• the teleconference / phone call we had in June 2014 with CREAL and UPMC to have
clarifications about ecological approach protocol and about individual data collection;
• the Mid Term Meeting organised in October 2014 in Barcelona, where the CB shared
with the ABs the dead lines for the Mid Term Report finalisation about all Actions.
Action E3: The budget has been distributed according to the original plan to the ABs. A
continuous monitoring of the expenses has been conducted. Financial reports have been
prepared for the Inception Report, the Monitoring visits and the present Mid Term Report.
An extensive comment on Financial data is reported at Financial part of the present Report.
Action E4: Networking with other projects
A lot of projects and programmes on air quality and health are currently ongoing in the
Mediterranean. To achieve synergies between MED HISS and such initiatives, networking
activities to present our project has been held through the presence in many events, such as
projects communication conferences or meetings.
As indicator of project we list hereafter the 10 projects contacted and events shared:
1. MED-Particles - LIFE10 ENV/IT/327 final conference, Rome (Italy), 9-10 July 2013
2. International Society for Environmental Epidemiology ISEE conference 2013, Basel
(Switzerland), 19-23 August 2013
3. EPIAIR2 presentation project (together with the ESCAPE results), September 2013
4. Kick off meeting LIFE+ projects call 2012, Rome (Italy), November 2013
5. Aggiornamento e divulgazione: attività inerenti l’inquinamento atmosferico ed i suoi
effetti (course organized by ARPA), Turin (Italy), 2nd December 2013
6. Presentation at the Italian ministry of health within the final conference of the Italian
EPIAIR2 project, Rome (Italy), 16 December 2013
7. EXPAH - Population Exposure to PAH LIFE09 ENV/IT/000082, 11 June 2014
8. MAPEC - Monitoring of Air Pollution Effects on children to support public health
policies, Local workshop LIFE12 ENV/IT/000614, Turin (Italy), 14 October 2014
9. Poster session at ISEE-EUROPE 2014 | Young Researchers Conference on
Environmental Epidemiology CREAL, Barcelona, 20-21 October, 2014
10. Conférence PART’AERA et la qualitè de l’air, Turin (Italy), 12 March 2015
Networking activities focused on strengthen Italian cooperation through the participation of
national an international projects. One of communication activities objectives is to create new
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 18/60
liaison between stakeholders through the sharing of competences within networking activities
and the participation to national and international events. A complete list of contacts and
ongoing relationships is published on project website networking page
(www.medhiss.eu/node/9).
The following network will be contacted and informed about the project: European Health
Examination Survey Network (EHES), The European Community Health Indicators
Monitoring system in Europe Network (ECHIM), the European Union Health Surveys
Information Database Network (EUHSID) through the MEDHISS newsletter no.1 and
through the newborn twitter MEDHISS channel, before the end of March 2015.
ACTION E.5: After-LIFE communication plan
An after-LIFE communication plan will be written by the end of the project to set out in
details how the project will continue disseminating and communicating the results after its
end. Results obtained from the previous scheduled dissemination actions made during the
project lifetime, will be evaluated in order to identify lacks and possible improvements and a
report containing an after-LIFE communication plan will be ready within June 2016.
The results of the project will continue to be actively disseminated by the beneficiary and the
project partners within the Layman’s report and the website www.medhiss.eu, that will be
maintained for five years after the end of the project.
The MEDHISS Twitter channel will continue to spread project results and to communicate
with stakeholders; a strong collaboration between all partners is assumed also after the end of
the project.
We hope that our pilot project will produce the knowledge basis to build a European
surveillance system through a MED HISS 2 project.
4.2 Evaluation of the management system
The management system adopted has been generally successful. Each action has a beneficiary
responsible of the implementation, as in the e_proposal approved. It was necessary to increase
the responsibility of CREAL for the ecological study design: the restrictive privacy policies,
arisen in Spain and Slovenia after the project’s start did not allow to link individual data
(Surveys) to mortality and morbidity data registers. It was therefore necessary to set up this
alternative study design, and CREAL assumed the responsibility of the Protocol and of study
implementation and finalisation.
Whenever the Project Coordinator or any of the partners recognized delays or deviations from
the expected milestones, all the possible measures to be undertaken were evaluated by the
Project Coordinator. The management process has been facilitated by generally solid
collaborative relationship among partners. The partners participated to technical meetings
sharing their competence and experience.
The Project Coordinator, in charge of keeping the contacts with the EC and the monitor,
informed partners about specific requests and communication to/from the EC.
A particular attention is now due to the management of the amendment required by French
partner in order to include in the project the INSERM unit. Thanks to this amendment French
data will be provided by the INSERM. However, this will not affect the overall success of the
project.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 19/60
The communication with the Commission has been handled by e-mail and correspondence
letters. We had frequents contacts (~ 80 e-mails) with the tutor Simone Pagni of the LIFE
ENV Monitoring Expert, Neemo EEIG – Timesis, who monitored the activities and the
compliance of the project deliverables and milestones with what declared in the proposal.
Moreover, he gave advice on relevant problems as the amendment required and now
terminated for NIJZ and the participation of UPMC with the associated INSERM to the
activities foreseen in the project, now in resolution not with a joint unit research but with the
amendment to involve the new partner INSERM.
We had a First monitoring visit in December 2013 with the tutor of the project (Dr Simone
Pagni). We received from the EC some specific recommendation concerning financial aspects
and about the necessity of provide a protocol for E2 Action and progress reports in order to
allow a proper evaluation of the progress made overall in the project and in the single action.
We had a Second monitoring visit on 11th December 2014 to check the status of the project.
ENEA and SEPI, the Italian Partners, were involved and took part to it. As a consequence the
European Commission sent us a letter Ref. Ares(2015)42016 - 07/01/2015 (Annex 4 – Letter
of the Commission 2015) that highlighted that no significant changes to the work plan have
been introduced.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 20/60
5. Technical part
The two issues targeted by the MED HISS project are:
1. to estimate long-term health effects of air pollution in four Mediterranean countries
(France, Italy, Slovenia and Spain), providing new evidence to support EU legislation
2. to implement an epidemiological cheap surveillance system to monitor these effects
over time.
During the development of MED HISS activities it became clearer that the main output was
the second of the above mentioned issues, i.e. the set up of a cheap surveillance system.
The proposed low-cost approach, suitable for surveillance, is based on linkable resources as
exposure from National air pollution prediction models, mortality and hospital admissions
registries and NHISs, mandatory and therefore available in all European countries. In
particular, NHISs contain representative samples of the general population, covering both
urban and rural areas. Each individual is linkable to mortality and hospital admissions
information. The measure of exposure is assigned through the national deterministic
dispersion models (in France-CHIMERE, in Italy-MINNI, in Slovenia-ARSO and in Spain-
CALIOPE) integrated with monitoring stations information. Where this approach could not be
set up, an ecological study - an even cheaper system - will be tested. It’s accuracy will be
validated in Piedmont (Italy), where both type of studies are carried on.
Preliminary results on Italian country, at current status based on PM2.5 and one year of
exposure, confirm the robustness of the system set up (Annex 8 - Preliminary results PM2.5
year 2005 Italy).
Some issues need further evaluation: how to use information deriving from all the year of
exposure and how to deal urban/rural differences. Both these aspects are under discussion and
a final decision will be included in action B4 protocol, that will be finalized by the end of
September 2015.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 21/60
5.1. Technical progress, by task
B.1 Pollutant data mapping
The objective of this action is to build up a map at municipality scale of air pollution for each
country involved in the MED HISS project, combining two sources of information: air quality
monitoring network and air quality numerical models. Due to the delay in the starting of the
project, the beginning of this action was slightly postponed; the first action meeting was held
in Bologna on 26th February 2014.
The B1 action consists of four sub-actions: B1.1: protocol, B1.2: data collection, B1.3: air
quality mapping, B1.4: exposure assessment. B1.1 protocol has been finalized and already
delivered with the Inception Report (“Annex A- Air pollution mapping protocol”). This
protocol covers the whole action B.1.
After the definition of a common protocol (Annex A- Air pollution mapping protocol), sub-
action B1.2 have been carried on. ENEA and CREAL provided data respectively for Italy and
Spain by the end of June 2014. ENEA provided MINNI modelling system output, statistical
scores and observed data of NO2(x), PM2.5, PM10 and O3 monthly mean concentrations for
the years 1999, 2003, 2005, 2007, 2010. A new release of 2010 MINNI output and statistical
scores has been delivered by ENEA at the end of December 2014. ARPAP collected Italian
cartographic data (municipality and built-up area boundaries). CREAL provided CALIOPE
modelling system output, statistical scores and observed data of NO2(x), PM2.5, PM10 and
O3 monthly mean concentrations for the years 2009, 2010, 2011, 2012, 2013 and also
cartographic data (municipality and small area boundaries, built-up areas). A new release of
CALIOPE output, statistical scores and observed data has been delivered by CREAL at the
end of January 2015. NIJZ provided data coming from monitoring stations and cartographic
information by the end of June 2014; output of Slovenian modelling system will be available
by the end of June 2015. This delay is due to serious temperature bug of current operational
version (ALARO-0), that we have been able to bypass for the operational purposes but not in
the case of hindcasting and are fixing. Some improvements have been obtained with new
version of meteorological model (ALARO-1), that is still in testing phase and not yet in full
operational mode. In March the decision regarding the use of version (ALARO-0 or ALARO-
1) will be made on the basis on more test cases of both versions. Therefore at the beginning of
April they will start with meteorological and consequently chemical-dispersion hindcast. Due
to the low number of monitoring stations on the Slovenian territory, it is likely that
assimilation procedure will not be done for PM2.5 and NO2. For PM10 the number of
monitoring stations is higher, so the opportunity to assimilate data will be evaluated. All
national models comply with the INSPIRE directive 2007/2/EC.
Until now UPMC was not able to acquire the exposure data arising from CHIMERE, but we
are confident that this problem could be overcome with the participation of INSERM as new
partner, thanks to the amendment necessary for the project.
Descriptive statistics of collected variables are attached (Annex 5-Descriptive statistics on
pollutant data collected).
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 22/60
According to the protocol (Annex A- Air pollution mapping protocol), statistical scores
between simulated and observed data have been analysed by ARPAP in order to evaluate the
“goodness of fit” of CTM models for epidemiological purposes. Concerning annual mean
concentrations, results about the CALIOPE model output, that is already assimilated ( that is
observed data are included in the modelling system), show a good compliance between model
and observed data for all the pollutants. MINNI output results show a quite good accordance
for the O3 and NO2 concentrations and an acceptable one for the PM10 and PM2.5
concentrations; the analysis highlights some underestimations of concentration level in the
medium-small towns.
Thus to provide a more realistic representation of pollutant spatial distribution, ARPAP
combined MINNI model output with air quality monitoring data (sub-action B1.3). According
to the protocol, three different data fusion techniques have been tested on the Northern Italy
domain for the year 2010. Looking at preliminary results, it seems that the performance of
kriging with external drift methodology (ked) is better than the one of the other two methods,
especially in situation where the spatial coverage of monitoring stations is low. Moreover the
ked is computationally the most efficient technique. If necessary, this methodology will be
applied also to Slovenian data. For Spain, as reported above, this step was not necessary since
monitoring stations are already included in the CALIOPE model.
In order to provided the exposure assessment at municipality level (sub-action B1.4), the
gridded assimilated concentrations fields are up-scaled from the grid point to the municipality
one. ARPAP carry out Spain exposure assessment at municipality and small-area level for all
the pollutants and for the years 2009, 2010, 2011, 2012, 2013. Up-scaling procedure is also
ready for Italy. For Slovenia it will be done in the next three months. The final exposure
assessment for Slovenia and Italy will be available at the end of June 2015. Details are given
in Annex 6 – Exposure assessment study.
During the Mid Term workshop held in Barcelona at the end of October 2014, the external
expert Xavier Querol suggested to carry out an analysis of the “urban delta” - namely of
possible bias between simulated data and those observed from monitoring stations located in
big cities. A sensitivity analysis included in the protocol of Action B.4 (Annex 7- Statistical
protocol(draft)) will be done using data from monitoring stations instead up-scaled
concentrations in Spanish cities with more than 250000 inhabitants.
The final data produced as output of action B.1 will be pooled in action B.3 with data from
action B.2 according a specific protocol, included in initial steps of statistical protocol of
action B.4 (Annex 7-Statistical protocol(draft)).
The map of PM2.5 of Italy for year 2005 at municipality level has been already produced and
pooled with health data (Action B.2), in order to perform preliminary analyses on mortality
and hospital admission using one year of exposure and seven years of follow-up for each
subject. These preliminary results have been presented at the Mid Term workshop in
Barcelona. A summary is attached to the report (Annex 8 - Preliminary results PM2.5 year
2005 Italy).
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed
Actual (approved in
inception report)
B.1 Pollutant data
mapping
Actual
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 23/60
Name of the deliverable Deadline from
inception report
Status
Minutes of first action meeting 28/02/2014 Done
Air pollution mapping protocol 28/02/2014 Done
Air pollution data set 30/06/2014 (except
NIJZ)
Done (except France
and NIJZ)
Exposure assessment study 31/03/2015 Done
The map of air pollution data at
municipality scale for each
country and each pollutant
31/03/2015 Postponed to
30/06/2015 for
Slovenia, Italy (for
which processing step
is ongoing) and France
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 24/60
B.2 Survey and health data collection
The aim of this action is to produce a validated database containing health information.
Database contains cross-sectional data from NHISs linked to follow-up data for mortality and
morbidity; other health information systems are also possible to link. Length of follow-up
could be different across different health outcomes or different countries, but the coverage of
pollutant exposure data and latency for each health endpoint should have been guaranteed
(this procedure is shown in Action B.3).
These results will be used in the implementation of individual-level approach (for statistical
details see Action B.4): an analysis based on individual record linkage between NHISs and
health information systems, among partners where individual linkage is possible.
A second database is in progress, incorporating observed and expected data on mortality
and morbidity in addition to socio-demographic and health characteristics (e.g. percentages of
smokers in an area) of all areas of interest (municipality or small area of each Nation/Region,
as defined in B.4).
This information will be joined to exposure data and analyzed following an ecological
approach, that will be implemented in Spain and Slovenia and tested in Piedmont region.
The latter approach, taking municipality or small areas as the unit of analysis, is an alternative
analysis that may be useful for countries that are not able to access the individual data from
the NHISs or that are not able to link these data to the mortality/hospitalization registries.
In Italy that is carrying on also an analysis at individual-level, the results of both approaches
on Piedmont region will be compared to assess the validity of the ecological analysis.
As indicators of progress we prepared a protocol for health data collection (“Annex B –
Survey and health data protocol” using all the published evidence on long-term health effects
of air pollution and taking into account the available health data in all the countries involved
in the project), a report on health data available and health endpoints for individual analysis
(Annex 9 – Individual approach: data available and health endpoints), and the descriptive
results of ecological analysis (Annex 10 - Ecological approach: health endpoints). Up to now
UPMC was not able to acquire health data but we trust that this problem will be solved thanks
to the amendment and the participation to the project of INSERM unit.
The protocol for health data collection contains:
• identification of the NHISs that are going to be used (definition and size of the population
involved, survey information gathered),
• identification of linkable databases with predictable available years,
• definition of health outcomes of interest,
• identification of possible confounders and effect modifiers, including co-morbidities.
The report about health data available and health endpoints contains:
• harmonization of confounders, effect modifiers and co-morbidities variables, necessary
because of variation across countries in measurement and classification of variables,
• percentages of successfully linked individuals (in countries where it is possible),
• basic summary statistics on health endpoints.
An alternative data source for the same health information, a compulsory additional individual
information requested from European Commission (as information on emigration), a
definition of other susceptible sub-population and other specific health endpoint will be
evaluated.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 25/60
Italian update of follow-up for mortality and morbidity causes (related to the resolution of
administrative problems for data capture), in addition to the formal inclusion of INSERM as
new partner (after the finalization of amendment) has caused a delay of three months for the
“final report on population data”. This delay however does not affect the success and the
compliance of the deadline of the related actions (subsequent Actions B.5, B.6 and B.7).
These three actions started thanks to the evidence we already had and to the fact that we
planned a buffer period for actions in order to manage possible delays. Finally we will be able
to increase the work of the partnership on this action if it will be necessary.
The usage of health data information after the end of the project, as specified afterwards,
could ensure updated results of long-term effects of air pollution and continuous
surveillance’s process.
The Italian cohort derives from the NHIS of years 1999 and 2000. The individuals in the
survey have been already linked with mortality and hospital admissions with seven/nine years
of follow-up (1999-2007, with exception of 2004 and 2005 years, for mortality and 1999-
2007 for hospital admissions). Therefore, thanks to the map of PM2.5 of Italy for year 2005 at
municipality level already produced, preliminary analyses on individual study have been
carried on. Statistical methodology and variables used derived from the literature review.
These preliminary results have been presented at the Mid Term workshop in Barcelona. A
summary is attached to the report (Annex 8 - Preliminary results PM2.5 year 2005 Italy).
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed
Actual (approved in
inception report)
B.2 Survey and Health
data collection
Actual
Name of the deliverable Deadline from
inception report
Status
Minutes of second action meeting 07/02/2014 done
Health data collection protocol 25/03/2014 done
Report on health data available and
health endpoints
30/06/2014 Done for Italy (postponed
for France)
Final report on population data after
linkage procedures
31/03/2015 rescheduled on 30/06/2015
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 26/60
B.3 Pooling country specific data
In this action, data collected in actions B.1 and B.2 are pooled together. Harmonization of
variables coming from NHISs is in progress, according to the timetable. For sake of
simplicity, protocol concerning this aspect will be included in the protocol for action B.4
Annex 7- Statistical protocol (draft).
This can be performed taking into account an optimal set considering other European NHIS’s.
The task is done with under the supervision of SEPI, and thanks to the networking outside
LIFE programme with the European projects DEMETRIQ (DEveloping MEthodologies To
Reduce IneQualities in Determinants for Health) and EUROTHINE (Tackling Health
INequalitiesin Europe: an integrated approach). The same harmonization will be done among
partners that will carry on the “ecological study”.
Where useful, country-specific results (Actions B.5, B.6 and B.7) will be produced where
variables/levels were aggregated.
In order to assign to each individual a seasonal or annual mean value for each pollutant in the
period under study, health and pollutant data are linked in this action.
Feasibility study to create a common shared European air quality map useful for
epidemiological purposes is in progress. It will be interactive, permitting to have an
instrument to share all the elements arisen from this project.
Mid Term workshop took place in October 2014. Minutes are attached to this report (Annex
25 – Minutes of the meetings).
Indicators of progress will be scheduled in the third trimester of 2015.
For their relevance to adjust the hazard and their use in the scientific literature, the
standardization of socio-economic variables will aim to ensure as much international
comparability as was possible on the basis of national surveys.
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed B.3 Pooling country
specific data Actual (approved in
the inception report)
Name of the deliverable Deadline from
inception report
Status
Minutes of the MID TERM
Workshop (Barcelona) 01/12/2014
Done
Feasibility study for a common air
quality map for epidemiological
purposes
30/09/2015
Not due. Confirmed.
Report of descriptive statistics of
variables that will be used in the
analysis
30/09/2015 Not due. Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 27/60
B.4 Development of the statistical modelling strategy for the analysis of the
long-term effects of air pollutants on health endpoints
The aim of this action is to develop statistical models useful to analyze the data collected and
standardized in the three previous actions. Two different types of analyses will be carried on.
For the individual study, a first level of analysis will be carried on using Cox proportional
hazard model, in order to have a comparison with results from literature, with the annual
average of PM10, PM2.5, NO2 and O3 (seasonal value) in turn as predictors, while adjusting
for individual confounders defined in Action B.3. Basic and sensitivity analyses will be
implemented to obtain literature comparable results and European-specific risks.
Further improvements of the model and sensitivity analyses are under discussion among all
the partners in the protocol (Annex 7 – Statistical protocol (draft))
As future work, dose-response function will be evaluated.
The second part of the statistical protocol will deal with ecological study, to overcome the
linkage limitations due to the restrictive legislation in Spain and Slovenia, but which are likely
to interest other EU countries. In the ecological study both outcomes and confounders are
collected at an aggregated level (municipality or small areas). A draft version of the protocol
which is circulating among all the partners is attached (Annex 7 – Statistical protocol (draft))
Italy partner permits a comparison between the two methodologies using a sub-area, the
Piedmont region.
The statistical strategy will be discussed during the fourth action meeting that will be held on
15th and 16th July, 2015 in Lubiana, to check the status of work.
Indicators of progress will be scheduled in the third trimester of 2015.
Comparison among individual and ecological approaches’ results (Actions B.5, B.6 and B.7)
will lead to ensure the interchangeability of the two methodological approaches with the
prevalence of the ecological model if privacy laws become more restrictive and more
widespread.
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed B.4 Development of the
statistical modelling
strategy for the analysis of
the
long-term effects of air
pollutants on health
endpoints
Actual
(approved in the
inception report)
Name of the deliverable Deadline from
inception report
Status
Minutes of fourth action meeting
15/07/2015 Organizing on 15th
and 16th
July.
Evaluation of statistical
modeling details completed
30/09/2015 Not due. Confirmed.
Report of the statistical modelling
that will be used in the analysis 30/09/2015
Not due. Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 28/60
B.5 Health effects of air pollutant on total and cause-specific mortality. Country-specific
results and meta-analysis
The aim of this action is to put in practice the methodological framework defined under
Action B.4, with reference to the mortality endpoints defined under Action B.2.
In particular, for Italian, Piedmont and French cohorts, Cox proportional hazard model on
total or cause-specific mortality causes will be implemented. Survival results will be regressed
against PM10, PM2.5, NO2 and O3 (seasonal effect) in turn, while adjusting for individual
modifiers as described in the protocol of Action B4.
Using Spanish, Slovenian and Piedmont data a Poisson model will be implemented; mortality
rates of areas will be regressed against PM10, PM2.5, NO2 and O3 (seasonal effect) in turn,
while adjusting for individual modifiers if available.
The result of the analysis will be the percent increase in risk of death associated to 10 ug/m3
of each pollutant.
If the ecological analyses will reveal that is also a robust method, the ecological approach’s
results will be meta-analyzed, otherwise only country-specific estimates will be considered.
Results will be discussed at the 2015 Barcelona meeting (Action D.3).
Indicators of progress will be scheduled at the end of this year.
Literature, updated of follow-up and new standardized surveys could guarantee the update of
project’s results.
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed
B.5 Health effects of air
pollutant on total and cause-
specific mortality. Country-
specific results and meta-
analysis
Actual
(approved in
the inception
report)
Name of the deliverable Deadline from
inception report
Status
Report on mortality analysis 15/12/2015 Not due. Confirmed.
One draft paper for scientific
journals 31/12/2015 Not due. Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 29/60
B.6 Health effects of air pollutant on total and cause-specific hospitalizations. Country-
specific results and meta-analysis
The aim of this action is to perform the statistical analysis of health effect of air pollutant on
hospital admissions for all natural causes, all cancers, lung cancers, cardiovascular diseases,
respiratory disease, asthma and other outcomes defined in actions B2/B3.
The analysis, like for mortality, will be performed using a Cox-proportional hazard model for
Italian, Piedmont and French cohorts, and a Poisson model for Spanish, Slovenian and
Piedmont data referred to area instead inhabitant as statistical unit.
A final report will be produced with the main country-specific and overall results of the
project, if in Piedmont the comparison among individual and ecological approaches
guarantees the robustness of the second type of analysis.
Results will be discussed at the 2015 Barcelona meeting (Action D3).
Indicators of progress will be scheduled at the end of this year.
Literature, update of follow-up and new standardized surveys could guarantee the update of
project’s results.
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed
B.5 Health effects of air
pollutant on total and cause-
specific hospitalizations.
Country-specific results and
meta-analysis
Actual
(approved in
the inception
report)
Name of the deliverable Deadline from
inception report
Status
Report on morbidity analysis 15/12/2015 Not due. Confirmed.
One draft paper for scientific
journals 31/12/2015 Not due. Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 30/60
B.7 Health impact assessment
This action aims to apply the known methods of health impact assessment in air pollution to
give an estimate of this problem in four European countries. Studies like the present one use
existing evidence to estimate the proportion of mortality and morbidity (cases attributable to
air pollution) that could be prevented if average ambient concentrations were reduced to target
concentrations. This will be done for the health outcomes whose risks are calculated in actions
B.5 and B.6. and for specific age groups.
The external expert (Nino Kunzli) that has a wide and well known experience in HIA will
supervise the methodology and will follow and monitor all the steps of this action.
This action started on 1st January 2015.
For comparability purposes, a preliminary review of epidemiological literature has been made
(Annex 11 - List useful for literature review).
Counterfactual scenarios will be defined based on EU directives and WHO recommendation.
A draft version of the protocol is attached (Annex 12 – HIA protocol (draft)).
We will follow findings from literature review and the results from epidemiological analysis
of this project to define risk coefficients to apply in impact calculations. The assessment will
address long-term effects of mortality and morbidity for some specific causes, in terms of
counts, years of life lost and DALY’s. This evaluation will be made on surveys’ population
and whole exposed population, by subgroups of interest.
E.g., quantitative impact assessment will be implemented using methods taking into account
the background incidence rate of a disease in the general population of each country and the
number of people exposed, the excess cases attributable to different counterfactual levels of
pollution will be calculated, starting from values of excess risk in the exposed population,
which derives from the epidemiological findings of the project.
A Bayesian approach will be used for calculating the total attributable number of cases. To do
this, for each country we will use national risk estimates shrunken on the pooled meta-
analytical ones, to guarantee statistically significant results even where the size of the cohort
could not guarantee a significant risk estimate.
Concerning ecological study, a methodology for the calculation of attributable number of
cases will be discussed and inserted in the protocol in the next months.
Action 2013 2014 2015 2016
Number/name of
action
III IV I II III IV I II III IV I II
Proposed B.7 Health impact
assessment
Actual (approved in
the inception report)
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 31/60
Name of the deliverable Deadline from
inception report
Status
Protocol for the HIA procedures 30/06/2015
Not due. Confirmed.
Preliminary assessments of the
impact on overall and country-
specific mortality
31/12/2015 Not due. Confirmed.
Preliminary assessments of the
impact on overall and country-
specific morbidity
31/12/2015 Not due. Confirmed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 32/60
C.1 Monitoring of the impact of the project
Communication with stakeholders is always critical for organizations, the first step was
creating a website and a list of stakeholders based on a “stakeholders analysis” (see Annex E -
Stakeholders mailing list of Inception Report). Starting from this Annex our working group
decided to create different mailing lists targeted on local, national and international levels,
with partners contribution. This should be an effective strategy to identify key stakeholders,
then disseminate MED HISS message and reach the desired effect (Annex 28-
STAKEHOLDERS strategy_draft).
For Italian and Spanish partners, the stakeholders involvement is already established in the
framework of consolidated and permanent relationships. For the other partners, LIFE MED
HISS is the chance to create or to strengthen links with regional and national stakeholders.
The mid term report will be published on the project website and available to stakeholders
once sent to the Commission.
Our stakeholders communication activities planning includes some phases:
1. Build an ongoing “Map of stakeholders” (Annex 13-STAKEHOLDERS map)
2. Build four “Targeted mailing lists” (Annex 14-Targeted mailing lists)
3. Drafting 3 or 4 newsletter to address to “targeted mailing list” (newsletter n.1 – Annex 15
–Newsletter n.1_draft)
4. Draft of the epidemiological map “Interactive map draft” (deliverable shifted to December
2015) Annex 16-Interactive map ideas
5. Match with partners a strategy to involve stakeholders in long-term planning thanks also
to the production of a factsheet
1. The stakeholders map has been built to study the relationship between subjects to focus
and monitor a stakeholders communication ongoing strategy: categorizing stakeholders
based on their influence on strategic technical goals provides a road map for allocating
communication resources to run stakeholders management. The more influence a
stakeholder has in helping to meet strategic objectives, the more time and attention it
should receive.
2. Everyone of the four “targeted mailing list” is based on direct or indirect involvement and
the brainstorming with key contributors has helped building an exhaustive list of
stakeholders to identify key points of contacts.
Here are the ongoing main “targeted mailing lists”:
- MEDHISS Stakeholder list SLOVENIA (number of persons: 17)
- MEDHISS Stakeholder list CREAL (number of contacts: 5)
- MEDHISS Stakeholder list UPMC (number of institutions and groups of interest:
14)
- European Community Health Indicators and Monitoring' (ECHIM), contact
persons in member states (number of persons: 97)
A targeted mailing list of NGO and environmental associations will be finalized in April
2015.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 33/60
3. The first newsletter will be sent by the end of April 2015 to the “Stakeholders mailing list
of Inception Report” and to the “targeted mailing lists” and will reached about at least 400
stakeholders contacts.
4. The preliminary work in preparation of the “pollutant data map” has been done and a
document with the structure of the map has been draft (Annex 16-Interactive map ideas).
The map will be ready to be presented to stakeholders and to the public at the end of year
2015 (with a delay of three month comparing to what declared in e-proposal).
5. Every project partner will be contacted to point out its main stakeholders network and to
describe together with the coordinating beneficiary its particular stakeholders
communication strategy. The production of a factsheet clearly describing the vision of the
project will help this pilot project to develop its potentialities.
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed C.1 Monitoring of the
impact of the project Actual (approved in
the inception report)
Name of the deliverable Deadline from
inception report Status
Report on epidemiological
evidences to support EU policy on
environment Initially not required
Delivered with
inception report (Annex
F- Epidemiological
evidences to support
EU policy)
Presentation of epidemiological
air pollution map to European
Union and local stakeholders 30/09/2015
Postponed to
31/12/2015 for
technical problems
with Slovenian
modeling system Report on the assessment of the
usefulness of the pollutant data
map 31/05/2016 Not due. Confirmed
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 34/60
C.2 The Assessment of the socio-economic impact of the project actions on the local
economy and population
This Action is provided for last quarter of 2015. At the current status of the project, there are
no reason to foresee a delay with this action.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 35/60
5.2 Dissemination actions
The objective of the LIFE-MED HISS project is to contribute to the development of an
innovative method to set up a surveillance system. The communication plan aims at
facilitating exchanges of experience through an active dissemination to the stakeholders of the
results.
Dissemination activity will support communication of information and awareness raising in
this fields and promote the dissemination results of projects under the EU area. This will
increase the participation in stakeholder consultations or policy discussions related to health
and environment legislative acts.
The purpose of the project is to bridge the gap between the idea of our pilot project and its
realisation and large-scale application to support future projects and encourage an ongoing
methodological research. The dissemination of results is essential for ensuring that project
results would be widely applied.
D.1 Dissemination to policy and decision makers and to the public
Decision and policy makers at local (city or region specific), national (Italy, France, Slovenia,
Spain) and European (EU) levels has been informed during the pass off the project. ARPAP,
the project coordinator, is the technical executive branch of the Piedmont region, and has
frequent contacts with local stakeholders of the most polluted Italian areas.
List of deliverables:
1. As project coordinators we have assured the correct use of LIFE logo on documents,
visual supports and durable goods, giving instructions about it to all partners during
kick-off meeting and mid-term workshop.
2. As project coordinators we have checked all partners correct erection of notice boards
and we have received from the partners 6 notice board photos (Annex G -
Photos_notice board). At present 3 national language version are available (French,
Italian and Spanish).
3. The project website is the main MED HISS dissemination instrument and has
regularly been updated since the beginning of the project by ARPAP. The
circulation/sharing of progress reports is guarantee by the publication on the reserved
area (platform). The dissemination/circulation of project reports and publications is
guaranteed by the regular update of MED HISS website. Reports are available to the
public through the project website.
4. Local, national and European stakeholders will be updated through some newsletters
(Annex 15 –Newsletter n.1_draft) about project news and results thanks to the
production of targeted mailing lists (Annex 14-Targeted mailing lists). Local
authorities and population are particularly sensitive to environmental problems
according to the importance of the impact of air pollution on human health.
5. The MED HISS Mid term meeting took place in Barcelona at the end of October
2014, all project partners has been invited and the two external experts too. The
meeting has been foreseen throughout the project life to summarize and discuss Action
B1 and B2 mid term early objectives.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 36/60
The Agenda of the meeting comprised a collection of opinions on the state of the art of
the project, to point out main difficulties and the way to overcome them, following
meeting date and venue. We include Barcelona meeting photos and PART’AERA
networking photos (Annex 17-Photos Barcelona meeting and PART’AERA
networking)
6. ARPAP has published two web news: DORS-Piedmont Region Health Promotion
Documentation Center (www.dors.it/pag.php?idcm=5374) and ISS-Istituto Superiore
di Sanità (www.epicentro.iss.it/temi/ambiente/ambiente-indice.asp). In addition a note
on MED HISS project was published on EU - LIFE Programme website
http://ec.europa.eu/environment/life/project/Projects/index.cfm?fuseaction=search.dsp
Page&n_proj_id=4518 (Annex 18-Press cuttings).
7. The future incremental use of Social Media (we will create by the end of April 2015
@MEDHISS Twitter user) network will increase the number of contact and improve
the effectiveness of dissemination actions.
ISEE-Europe has organized a 2-day Young Researchers Conference in Environmental
Epidemiology on Monday 20 and Tuesday 21 October 2014 at CREAL, Barcelona.
The conference has covered all areas of research in environmental epidemiology. A main
theme of the conference has been the “Exposome” due to the increasing interest in this area of
research in environmental epidemiology. The format of the meeting has promoted discourse
and has included invited and submitted presentations, posters and extensive discussion time.
ARPAP has presented three posters of which one on MED HISS project. (Annex 19-ISEE
2014 poster).
ISEE meeting 2015, that will be held in São Paulo, Brazil, from August 30th to September
3rd, ARPAP has decided to give every partner the possibility, either if not present in São
Paulo, to propose an abstract according to the technical attitude in MED HISS framework.
During the conference ARPAP will present two abstracts to the international framework for
the creation of a wider international network (Annex 20-Abstracts ISEE 2015).
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed D.1 Dissemination to
policy and decision
makers and to the public Actual (approved
in the inception
report)
Name of the deliverable Deadline from
inception report
Status
Annual conference of the
International Society for
Environmental Epidemiology
communication (oral or poster)
20/08/2015 Abstract submitted
(Annex 20-Abstracts
ISEE 2015)
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 37/60
D.2 Web design, development and results displaying
The project website www.medhiss.eu has been revised once in the first half of 2014 and a
second improvement is previewed in March-April 2015: the contents have already in part
been reviewed and the information has been updated. All “news and events” section has being
rebuilt together with Social Media functionalities. A new tool to visualize photos will be
installed in by the end of April 2015.
List of deliverables:
1. As project coordinator we have built the website and correctly published the LIFE
logo on website and project documents.
2. Notice boards national language version have been published in the private area of
the website (presently available the Italian, French and Spanish version) and soon
available for the public from the public area.
3. The website has been regularly updated: the number of visits of the website has been
monitored through a counter. The website has been published under the ARPA
Piemonte website as a link to the project. Number of feedbacks on the project’s results
in the website have been monitored (number of the visits of websites, until now:
around 2500). The information on progress and results have been regularly updated. A
collaboration tools (see Platform) has been built and regularly implemented.
4. Four mailing list have been published in the platform, available to all partners for
download.
5. Meetings photographs have been regularly published on the website.
6. Press cuttings overview ( Annex 18-Press cuttings).
7. Links Social Media: Goto meeting, Doodle e Twitter, link to MEDHISS website
project on every Linkedin personal profile of MEDHISS working group participant.
Project website published under ARPA Piemonte website and its updating:
http://www.arpa.piemonte.it/approfondimenti/temi-ambientali/ambiente-e-
salute/dipartimento-tematico/progetti-1/progetto-medhiss
Exchange of documents and information is guaranteed by the reserved part of the website
(Platform).
Action 2013 2014 2015 2016
Number/name of action III IV I II III IV I II III IV I II
Proposed D.2 Web design,
development and results
displaying Actual (approved
in the inception
report)
Name of the deliverable Deadline from
inception report
Status
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 38/60
Development of website 28/02/2014 Completed on time Reports of activities related to the
website use 31/03/2016 Not due. Confirmed
Reports and minutes uploaded
31/05/2016
Confirmed. Until now
all the minutes and
reports have been
uploaded on the
website
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 39/60
D.3 Conference spanning the topics of the project
The Conference spanning the topics of MED HISS project is provided for last quarter of
2015. At the current status of the project, there are no reason to foresee a delay with this
action.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 40/60
D.4 Layman’s report developing for dissemination
According to the scheduled timetable, this action did not start yet. We confirm that the
expected start will be at the beginning of 2016. At the current status of the project, there are
no reason to foresee a delay with this action.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 41/60
5.3 Evaluation of Project Implementation
In the following section, a summary of the methodology applied is presented, together with
the results attained within each Action and their evaluation. In terms of cost-efficiency, it will
be described more in detail in the financial section. However, it is important to note that the
expenditures for all actions are generally consistent with those reported in the original
proposal.
Task Foreseen in the
revised proposal Achieved Evaluation
Definition of a
common operational
and standardized
protocol on
methodology to
combine monitoring
and modelling data
for air quality
mapping / Action B.1
Definition of an
operational and
standardized protocol
on methodology to
upscale air quality
data from grid scale to
city-specific scale/
Action B.1
YES.
These two
protocols were
merged in the
“Pollutant data
mapping
protocol”,
already presented
in the inception
report. The
protocol
indicates the type
of data that have
been collected,
the comparison
of CTM’s model
with monitoring
stations data,
data fusion
techniques to
integrated the
two sources of
information and
exposure
assessment
methodology.
YES. The partners involved
contributed to the draft of the
protocol.
Country-specific
report on basic
summary statistics on
the variables collected
(mean, standard
deviation, median,
minimum, 5th
percentile, 95th
percentile, maximum)
by year and by season
/Action B.1
YES. Descriptive
statistics have
been reported
both for
modelling CTMs
data and
monitoring
network
YES (except
for France)
Report was finalized by ARPAP
on the basis of data provided by
all partners (postponed for
UPMC and INSERM)
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 42/60
Map at municipality
scale / Action B.1
YES.
Action B1
protocol is
applied to
transpose air
pollution level
from grid to
municipality
scale.
YES for
Spain. For
Italy is
ongoing. For
Slovenia and
France it will
be produced
by the end of
June 2015
According to the protocol, the
map was produced for Spain and
is ongoing for Italy.
Other issues arise concerning
goodness of fit of the model in
cities with more than 250.000
inhabitants. The use of only
monitoring stations will be
performed as sensitivity analysis
in Action B4 protocol.
Health data collection
protocol / Action B2
YES. Data
collection has
been performed
both for
individual and
ecological study
YES Report was finalized by ARPAP
on the basis of data provided by
all partners and under the
supervision of SEPI
Report on health data
available and health
endpoints / Action B2
YES YES (except
France)
Only an amendment could lead
to the achievement of the results
related to the individual analysis
in France thanks to the
collaboration of INSERM
Final report on
population data after
linkage procedures /
Action B2
YES Not yet,
according to
the delayed
timetable
SEPI is the leading of this action
that has been scheduled again
due to legislative limitation
For each type of data,
definition and
dissemination of an
operational and
standardized protocol
/ Action B.3
Information gathered
for EU countries not
covered by this LIFE
project /Action B.3
YES Not yet.
According to
the timetable,
this work is in
progress
ARPAP is leading this action,
with the contribution of SEPI,
mainly for what concern
information gathered for EU
countries not covered by MED
HISS. This is done thanks to the
networking outside LIFE
programme with the European
projects DEMETRIQ and
EUROTHINE
For each type of data,
report on the pooled
data base with
information on the
pooling process and
summary statistics /
Action B.3
For each pooled
dataset the final
percentage of record
successfully linked
/Action B.3
YES Not yet.
According to
the timetable,
this work
needs to be
done.
The report will be produced at
the end of this action.
For what concern map, it is in
progress thanks to the issues
arising from this project. It will
be a map with information useful
also for the other EU countries to
set up this surveillance system.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 43/60
A common air quality
map for
epidemiological
purposes /Action B.3
An analytical protocol
on data analysis
/Action B.4
YES Not yet.
According to
the timetable,
this work is in
progress
A draft version of the protocol is
circulating, both for individual
and ecological study. It will be in
an advanced version for Lubiana
meeting
Exploratory results on
the health effects of
air pollutants and of
possible sensitivity
analyses /Action B.4
YES.
Preliminary
results on
individual study
have been
obtained for Italy
using exposure
assessment
development in
Action B1 and
statistical
methodology
derived from
literature review.
In progress Preliminary results of analysis of
PM2.5, year 2005 for Italy have
been presented at the Mid Term
workshop in Barcelona (Annex 8
- Preliminary results PM2.5 year
2005 Italy).
At least four (natural,
cardiac,
cerebrovascular,
respiratory mortality)
concentration
(exposure)-response
functions will be
available for each
pollutant, between
exposure to particles
and mortality
endpoints /Action B.5
YES Not yet.
According to
the timetable,
this work is in
progress
The methodology for the
exposure-response functions will
be included in Action B.4
protocol.
At least six (natural
causes, all cancers,
lung cancers,
cardiovascular
diseases, respiratory
disease, asthma)
concentration
(exposure)-response
functions will be
available for each
pollutant, between
exposure to particles
and morbidity
endpoints /Action B.6
YES Not yet.
According to
the timetable,
this work is in
progress
The methodology for the
exposure-response functions will
be included in Action B.4
protocol.
One Literature review YES Not yet. The literature review is in
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 44/60
of the impact
coefficients to be
applied for
comparison /Action
B.7
Protocol definition for
the HIA procedures
/Action B.7
Implementation of
spreadsheets for HIA
calculation /Action
B.7
Assessment of the
impact on overall and
site-specific mortality
/Action B.7
Assessments of the
impact on overall and
site-specific morbidity
Overall Health Impact
Assessments of
simulated scenarios of
reductions in
emissions
According to
the timetable,
this work is in
progress
progress, as well as the protocol
definition for the HIA
procedures
Possible revision of
local environmental
policies taking into
account long term
health effects of air
pollution /Action C.1
Possible prevention
programs directed to
sub-population groups
particularly affected
by long term health
effects of air pollution
/Action C.1
Assessment of the
usefulness of the
pollutant data map
/Action C.1
Build four “Targeted
mailing lists” /Action
YES
Not yet.
According to
the timetable
this work will
be ended by
the end of
December
2015
The map is in progress: the idea
is to create an interactive map,
merging all the information
pointed out by MED HISS
project, realized as a user
friendly tool
The mailing lists are an ongoing
product that should be updated
from time to time
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 45/60
C.1
Build an ongoing
“Map of stakeholders”
/Action C.1
Drafting 3 or 4
newsletter to address
to “targeted mailing
list” /Action C.1
Match with partners a
strategy to involve
stakeholders in long-
term planning thanks
also to the production
of a factsheet /Action
C.1
NO YES,
completed in
part
The concrete part of the work
will be done in the next months,
according to the fact that the
project results are not available
now: we wish a good
cooperation between partners to
reach exhaustive results in
stakeholders communication
For each of the
scenarios, report on
socio-economical
impact of the increase
of air pollution in
population /Action
C.2
Socio-economic
impact measurement
of particular
subpopulations
/Action C.2
YES Not yet.
According to
the timetable
this work will
be done
starting from
October 2015
One mid-term
workshop /Action D.1
Number of invited
institution that will
follow the initiatives
(with participation to
the meeting, link to
the web
site or email
exchange) /Action
D.1
At least one
conference for each
country /Action D.1
YES YES (mid
term
workshop)
The two other
tasks will be
completed
when public
conferences
will be held
Alle partners will attend the
conferences: we wish a good
cooperation between partners to
reach exhaustive results in
dissemination activities
Project website
published under
ARPA Piemonte
website and its
YES YES Whenever necessary the
coordinator could add new
sections to the website
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 46/60
updating /Action D.2
Exchange of
documents and
information /Action
D.2
The reserved area (platform) is
currently used and could be
implemented until the end of the
project
Two events
(preparatory
conference and final
conference) organized
and held /Action D.3
YES Not yet.
According to
the timetable
this work will
be done
starting from
October 2015
Layman’s report in
electronic format and
paper copies / Action
D.4
Publishing of
Layman’s report on
the project website
/Action D.4
YES Not yet.
According to
the timetable
this work will
be done
starting from
January 2016
Coordination between
the project and the
Commission /Action
E.1
Coordination of all
project actions
/Action E.1
Smooth and efficient
information flow
between actions;
YES Due to the
nature of
coordination,
this task will
cover the
whole
duration of
the project
The implementation of a Private
area into the website (Platform)
gave the possibility to better
coordinate and monitor the
project implementation, giving
access to useful information.
Operative tasks met in
compliance with
agreed time schedules
/Action E.2
Milestones met in
compliance with time
schedule /Action E.2
Efficient work-flow
among actions /Action
E.2
YES Due to the
nature of the
monitoring,
this task will
cover the
whole
duration of
the project
The partners involved
contributed to the good
development of the project and
contributed to the reporting.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 47/60
Formal approval of
financial report /
Action E3
Positive approval for
each report / Action
E3
YES To be
approved
The budget has been distributed
according to the original plan to
the ABs. A continuous
monitoring of the expenses has
been conducted. Financial
reports have been prepared for
the Inception Report, Monitoring
visits and the present Mid Term
Report.
Exchange of
documents and
information / Action
E4
YES YES One of communication activities
objectives is to create new
liaison between stakeholders
through the sharing of
competences within networking
activities and the participation to
national and international events.
5.4 Analysis of long-term benefits
5.4.1 Environmental benefits
MED HISS project has widely used dispersion models, required by the Directive 2008/50/CE.
These models are being used for epidemiological purposes, with a procedure using grid values
to have municipality values which takes into account information from monitoring stations.
The assignment of the exposure on the basis of the built-up area provide exposure data closer
to what is currently experienced by population. In this way exposure is refined to a level
where people really live.
MED HISS project will provide evidence on long-term effect and impact of PM2.5, PM10,
NO2, O3 in the Mediterranean area. Estimates will be express in terms of exposure contrast
between categories of pollution. Therefore, future legislation could potentially take into
account output of the project when discussing new threshold levels.
5.4.2 Long-term benefits and sustainability
The results of the MED HISS project may have long term results on the following areas:
- Environment and health. When new policies on air pollution will be evaluated at EU level,
the results from MED HISS project of long term health effect on a European cohort may be
taken into account. The impact of air pollution on population health can be estimated directly
on a European cohort.
- Social. The effects of air pollution tend to be higher for people of lower socioeconomic
position. This is due to greater exposure level as well as higher susceptibility due to more
frequent lifestyle (smoking, physical activity, obesity) in people of lower social class. Any
improvement in environmental pollution will provide a larger benefit to less advantaged
people thus providing more environmental justice.
- Economic. We see no direct economic impact.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 48/60
- Occupational. Thanks to MED HISS a research group has been set up and can be
consolidated, particularly if this pilot study will be widened to other EU countries, which are
able to set up this surveillance system. Temporary employers are playing a key role in the
overall success of the project. This experience can be consolidated. The participation to ISEE
young in Barcelona permitted to share MED HISS objective with other young researchers.
If MED HISS2 will have future, other employers will be necessary to maintain the
surveillance system that has been set up with MED HISS.
5.4.3 Replicability, demonstration, transferability, cooperation: Potential for technical and
commercial application (transferability reproducibility, economic feasibility, limiting
factors) including cost-effectiveness compared to other solutions, benefits for
stakeholders, drivers and obstacles for transfer, if relevant: market conditions,
pressure from the public, potential degree of geographical dispersion, specific target
group information, high project visibility (eye-catchers), possibility in same and other
sectors on local and EU level, etc.
The project is developing instruments and methods that imply a large applicability and
portability for the evaluation of the long-term effects of environmental exposures. The same
methodology of using data from already existing cohorts from NHISs, followed for mortality
and morbidity outcomes could be employed in future in the same areas to evaluate the
beneficial effects of new policies potentially in all the other EU countries. The key point is
that there should not be legislative impediment to perform this linkage. This low-cost
approach we are setting up could reveal even lower costs if the ecological study will ensure
robust results.
5.4.4 Best Practice lessons: briefly describe the best practice measures used and if any
changes in the followed strategy could lead to possible adjustment of the best
practices;
The first best practice lesson to address to the development of MED HISS is the privacy
regulation, which permits to link data from NHIS’s with deaths and hospital admissions. The
analyses of both individual and ecological studies setup a core of variables to be used as
confounders in this kind of study. Thanks to the networking with DEMETRIQ, this core of
variables covers also other European countries. Moreover, it permits to have a standard which
can be reached also by smaller cohorts (recruited in a different way), which want to follow
back analyses on long-term effects of air pollution.
If ecological analyses will show results which are robust enough, a gold standard of variables
to have at an ecological levels to include in this type of analyses will be produced.
A second best practice is the improvement of dispersion models, integrating them with
monitoring network data, with the use of data-fusion techniques. Moreover, the assignment of
the exposure on the basis of the built-up area is a key point when assigning pollution levels to
population.
5.4.5 Innovation and demonstration value: Describe the level of innovation, demonstration
value added by EU funding at national and international level (including technology,
processes, methods & tools, organisational & co-operational aspects);
The MED HISS project can be considered a pilot study that is estimating long-term effect of
air pollution in Mediterranean area and implementing an ongoing surveillance system in the
participating countries.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 49/60
It can be seen as a pilot since the final objective of our study is to demonstrate the feasibility
of this new approach and its possible application in other EU member countries. This is
possible thanks to its relative cheapness in comparison to traditional cohort studies
(considering that only the cost of the ACS study in the USA summed up to several million
dollars alone) and its applicability to other European countries.
This can generate, if applied elsewhere, a European surveillance system on the whole EU.
The proposed linkage of national health interview surveys with mortality, morbidity and air
pollution data modelling has a high degree of portability in other EU countries, since that
health interview surveys are performed in every country of the EU and provided that national
institutions may provide health follow-up of individual involved. What is done in this project
on air pollution could be exported also to other thematic areas, like the socio economic one.
The information available in the Health Interview Survey include also many variables on
socio economic side, useful for addressing the issue of Equity.
Problems encountered with privacy policies give the opportunity to test an even cheaper
approach (i.e. ecological study). If at the end of the project it will provide results consistent
with individual study, privacy problems could be overcome also in other EU countries,
providing the possibility to have all potential confounders at least at ecological level.
A second demonstration character is present in the project and is dealing with the pilot study
of feasibility that will be done for simplifying the exposure assessment approach. Air
pollution national dispersion models are very complex, but generally do not consider the
exposure of the population needed for epidemiological purposes. We integrated air pollution
models already available with information from monitoring stations through statistical
methods to get better exposure assessment estimates of the population (action B.1 and B.3),
that can be used also for other contexts and approaches.
A third demonstration character is the possibility of this project to assess the urban- rural
difference of exposure to air pollution and the influence of this difference on risk estimates.
At the moment there is no data on this issue and the project may help to demonstrate it with
the data that will be gathered.
The proposed methodology has a high degree of portability in different EU urban contexts
and the project can be seen as a demonstration that a EU wide assessment (including all EU
countries) can be conducted.
The project development will be monitored by means of specific internal audits and check
lists provided to the beneficiary responsible for the involved actions.
5.4.6 Long term indicators of the project success: describe the quantifiable indicators to be
used in future assessments of the project success, e.g. the conservation status of the
habitats / species.
The results of the MED HISS project may have long term results on the following areas:
- Environment and health. When new policies on air pollution will be evaluated at EU level, the
results from MED HISS project of long term health effect on a European cohort may be taken
into account. The impact of air pollution on population health can be estimated directly on a
European cohort.
- Social. The effects of air pollution tend to be higher for people of lower socioeconomic
position. This is due to greater exposure level as well as higher susceptibility due to more
frequent lifestyle (smoking, physical activity, obesity) in people of lower social class. Any
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 50/60
improvement in environmental pollution will provide a larger benefit to less advantaged
people thus providing more environmental justice.
- Economic. We see no direct economic impact.
- Occupational. Thanks to MED HISS a research group has been set up and can be
consolidated, particularly if this pilot study will be widened to other EU countries, which are
able to set up this surveillance system. Temporary employers are playing a key role in the
overall success of the project. This experience can be consolidated. The participation to ISEE
young in Barcelona permitted to share MED HISS objective with other young researchers.
If MED HISS2 will have future, other employers will be necessary to maintain the
surveillance system that has been set up with MED HISS
Quantitative long-term indicators of the expected project success are reported below, with
reference to the three years after the project end:
• Number of countries which positively reply to the “join our project” survey
• Number of publications achieved after the end of the project
• Number of times the project representatives are invited at conferences, seminars, other
events
• Number of times the map is delivered (if the output will be in a static form) and/or
consulted (if there will be also an on-line version)
• Number of times the MED HISS publications are cited
• Number of times the project results are taken into consideration in policy on
EU/National/local levels
• Number of visits of MED HISS website
• Number of requests for clarifications, update, dissemination and scientific material
(publications, Layman’s report, etc.)
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 51/60
6. Comments on the financial report "Standard Payment Request and Beneficiary's Certificate" - duly signed original has been
submitted (Annex 31). "Consolidated Cost Statement for the Project" - signed original has
been submitted (Annex 30). "Financial Statement of the Individual Beneficiary" signed,
originals have been submitted by the coordinating beneficiary and by each associated
beneficiary (Annex 29).
Consolidated Cost Statement for the Project has been shared with all the ABs and have
been calculated using the financial data that were uploaded on the Platform for the Mid
Term Report purposes. During the months of February 2015 and March 2015 we had
frequent contacts with all ABs in order to check each data of each reporting file to be
signed. Individual financial French data here enclosed (that are the signed and dated forms
we received on last day) are slightly higher than those already reported in the Consolidated
Cost Statement for the Project, already signed by our Director Ing. Angelo Robotto.
Supporting documents, and further information or clarifications, requested in previous
letters from the Commission (e.g. VAT declarations.) have been submitted: Annex 21, 22,
23a, 23b, 24.
6.1. Summary of Costs Incurred
The following table refers to the project costs from 01/07/2013 to 31/01/2015: they represent
the costs linked to the activities conducted during 19 of 36 months.
PROJECT COSTS INCURRED
Cost category Budget according to the
grant agreement*
Costs incurred within
the project duration
%**
1. Personnel € 1.308.815 € 547.189 42%
2. Travel € 56.000 € 17.418 31%
3. External assistance € 62.500 € 29.880 48%
4. Durables: total non-
depreciated cost € 33.400 € 21.323 64%
- Infrastructure sub-
tot. € 0
- Equipment sub-tot. € 0
- Prototypes sub-tot. € 0
5. Consumables € 22.600 € 4.264 19%
6. Other costs € 11.500 € 159 1%
7. Overheads € 103.468 € 42.465 41%
TOTAL € 1.598.283 € 662.698 41% *) If the Commission has officially approved a budget modification indicate the breakdown of the revised budget
Otherwise this should be the budget in the original grant agreement.
**) Calculate the percentages by budget lines: e.g. the % of the budgeted personnel costs that were actually
incurred
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 52/60
The original grant agreement foreseen a Total of 1.598.283 Euro taking into account the not
depreciated costs for the durables goods.
Overall, effective costs were about the 40% of the total projected costs. The project has
arrived to the 19th
month of 36: about 53% of its implementation.
Some actions are still to come, mainly C and D, with related costs. We provided in
“Consumables” all the costs useful to the organization of Dissemination conferences, that are
still to come. We provided in “Other costs” the budget to attend the ISEE 2015 Conference
and to print the Layman’s Report. This expensed are related to activities that haven’t been yet
undergone.
Comments for specific budget categories:
− Personnel: as mentioned in the Inception Report, a delay occurred in the starting
months of the project; this fact had slightly affected this cost item. The budget of the
project allowed the provision of temporary contracts both for CB and ABs: by now we
have balanced expenses for permanent staff and for temporary staff (on average, we
spent 41% of the budget devoted to permanent staff, and 43% devoted to temporary
staff). Some differences among ABs are attributable to the role played in the project
and to the involvement in the different Actions, as well as to a certain delay in the
starting of the project.
We are aware that the daily rates reported in the e_proposal for ARPAP were
understated, for each public employee. In the Inception Report we provided
documentation on that. Now the estimates of the daily rates are more robust, due to the
number of months used for the calculation.
We are monitoring this problem using an automatic file that updates the summary
financial info on the basis of the data uploaded in the financial statement file, in order
to view the current daily rate for each person, for each year, at each instant of the
project.
However, we can state that the costs now reported are the real costs for personnel
employed in ARPAP, which has the same National Contract of organizations
belonging to National Health Service. We have already reported these costs in other
funded projects, given that the daily rates were online with the ones reported from
other Partners, belonging to other organizations of National Health Service.
− Travel and subsistence: up to now, four meetings have been held, in Turin, Paris,
Bologna and Barcelona. The costs reported to attend the meetings were, in general,
lower than foreseen. The Mid Term Meeting in Barcelona was very important to
finalize the activities on going and also for the Mid Term Reporting and so we had a
good participation. Moreover, most of the meetings are foreseen for future, namely: 1.
Fourth action meeting in Ljubiana; 2. Participation to international conference in
2015; 3. Preparatory meeting for final conference in Barcelona; 4. Dissemination
national conference; 5. Final conference. In all these events, an extensive participation
is foreseen. For this reason, even though the incurred costs up to March 2015 are
relatively low compared with the total costs, the projected costs have not changed in
the present report.
− External assistance: only two partners had a budget for External assistance: ARPAP
spent the budget for the Web page development and CREAL used a portion of the
budget to finalize Action B1 Activities. The remaining necessity foreseen are still
valid.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 53/60
− Durables goods: ARPAP, CREAL and ENEA spent a portion of their budget to
acquire the informatics equipment necessary to the project. If additional needs will
arise, the Consortium will evaluate how to manage them. The depreciation calculating
methods are reported in the Annex 21.
− Consumables and Other costs: only a small amount of funding has been spent so far
for this category, in line with the general comment above mentioned.
As a general comment, we believe we are in line with what was scheduled in the original
proposal, as breakdown of budget posts. The current report covers about an half of the
entire project (from 01/07/2013 to 31/01/2015, 19 out of 36 months), and given the
explanations provided above, we expect to have total costs equal to the previewed ones,
with no need for substantial changes in the budget requested to the EC. Maybe small
changes will be necessary with the progressing of the project, especially little shifts of
costs from one cost category to another, but it is not feasible to report them in the present
report. Finally, the 150% threshold (expenditure of the first pre financing already
received) has been reached.
6.2. Accounting system
In order to put in place an accounting system for the project, we started from the
administration procedures used by each ABs. The public partners turned out to have a
dedicated cost centre accounting system for traceability of expenditure and income of the
project (Annex 22- Accounting system). In addition, we are using the costs accounting system
based on the MS-Excel file published under the project tools section of LIFE+ website. Each
AB is responsible for the compilation of the financial form. The files are uploaded on the
mentioned Platform (Private area of the website) about every quarter. After the review of the
CB, the MS-Excel files are summed up to produce the total costs of the project.
During each review the CB had to verify/will verify:
- person-time reported into financial statement (sheet “Personnel”) according to time sheets
and according to technical activities;
- costs covered by invoices correctly reported in the file (number of invoices, date);
- invoices reporting the name of the project and the code Life LIFE12 ENV/IT/000834;
- stamp on the invoices/sheets with the name of the project and the code Life LIFE12
ENV/IT/000834;
- an estimate of the overheads correctly reported;
- costs already covered by the budget, otherwise we should ask for an advice to the
monitoring team/the FDO;
- methods to estimate the depreciation, if necessary.
At the same time, taking into account the Financial check list currently used for the project
(Annex 26 - Updated Financial check list), the CB should give advice about the
documents/file/declaration needed and linked to the expenses reported, to be storage.
During each meeting a time was devoted to these aspects and to collect from the ABs the
documents eventually needed.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 54/60
Each AB filled in time sheets according to LIFE+ rules. We have already enclosed some time
sheet to the Inception Report. Each AB briefly described the time recording system used, as
shown in the Annex 23a - Time registration system and Annex 23b. The same in case of
durables (informatics equipment) (Annex 21 - Depreciation calculation).
Each Partner gave us the VAT declaration, where relevant for the reporting financial data
(Annex 24 - VAT declaration).
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 55/60
6.3. Partnership arrangements (if relevant)
Above mentioned the method
6.4. Auditor's report/declaration
We are currently contracting the external financial audit, as requested in the terms of the
Mid Term Report:
Massimo Lucii
STUDIO LUCII
Via Sarzanello n. 226
19038, Sarzana (SP), Italia
6.5 Summary of costs per action
(Projects submitting final reports after 1 January 2014 must use this format.)
Action
no. Short name of action
1.
Personnel
2.
Travel and
subsistence
3.
External
assistance
4.a
Infra-
structure
4.b
Equipment
*
4.c
Prototype
5.
Purchase or
lease of land
6.
Consumables
7.
Other costs
TOTAL
B1 Pollutant data mapping € 191.438 € 1.903 € 20.000 € 19.760 € 243 € 233.344
B2
Survey and health data collection € 158.438 € 4.507 € 1.563 € 703 € 165.210
B3 Pooling country specific data € 30.599 € 8.200 € 1.526 € 40.325
B4
Development of the statistical modelling strategy for the analysis
€ 21.359 € 5.000 € 26.359
B5
Health effects of air pollutant on total and cause-specific mortality
€ 1.450 € 1.450
B6
Health effects of air pollutant on total and cause-specific hospitalizations
€ 1.450 € 1.450
B7 Health impact assessment € 7.359 € 7.359
C1
Monitoring of the impact of the project € 4.059 € 4.059
C2
Assess the socio-economic impact of the project actions € 579 € 579
D1
Dissemination to policy and decision makers and to the public
€ 25.599 € 39 € 25.638
D2
Web design, development and results displaying € 17.059 € 4.880 € 159 € 22.098
D3
Conference spanning the topics of the project € 0
D4
Layman's report developing for dissemination € 0
E1
Co-ordination and management € 32.500 € 186 € 32.686
E2 Monitoring of the project € 19.850 € 2.622 € 1.753 € 24.226
E3 Administration of budget € 25.399 € 25.399
E4 Networking with other projects € 10.049 € 10.049
TOT € 547.189 € 17.418 € 29.880 € 0 € 21.323 € 0 € 0 € 4.264 € 159
Over-
heads € 42.465
TOTAL € 547.189 € 17.418 € 29.880 € 0 * € 21.323 € 0 € 0 € 4.264 € 159 € 662.698
*Equipment: non-depreciated costs
(Projects submitting final reports after 1 January 2014 must use this format.)
Some comments:
We spent about all the budget foreseen for the B1 and B2 Action, according to the Gantt
Chart (92% and 86% respectively). Action B3 and B4 are ongoing whereas B5 and B6 have
just started. We provided a draft protocol for Action B7.
Not all C and D Actions are on going by now, according to the Gantt Chart. In particular the
main activities to provide a website and a Platform (Private area) for the project have been
implemented.
We already consumed the 103%, 121% and 115% of E1, E2 and E3 foreseen costs; it is
worthy of note that E Actions costs includes K.O. meeting organisation costs in Turin, the
travel and subsistence costs correlated, the time spent to implement a system to control for the
managing of the budget, and to check the availability of administrative/financial data form the
ABs. Most of the E2 activities were undertaken from the ARPAP staff, with time spent and
correlated costs (higher costs than foreseen, according to higher daily rates reported now
compared with the costs estimated for the e_proposal, as already mentioned).
We had to use a lot of these costs to finalize the reporting for the present Report: we can state
that by now all the activities related to E Actions have been fully implemented.
We already consumed the 58% of the budget provided for E4 action.
Travel and subsistence costs and Consumable costs related to the meetings (for B1, B2 and
B3 Actions) were generally lower than prevented.
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 58/60
7. Annexes The text of this report is completed by 39 annexes organized in the following three areas:
administrative, technical and dissemination.
7.1 Administrative annexes The administrative documents are:
-Annex 1- GANTT
-Annex 2- Partnership Agreement NIJZ
-Annex 3- Monitoring reports
-Annex 4- Letter of the European Commission 2015
- Annex 21 - Depreciation calculation
- Annex 22 - Accounting system
- Annex 23a - Time registration system
- Annex 23b - Time registration system ENEA
- Annex 24 - VAT declarations
- Annex 26- Updated Financial check list
- Annex 29 -Financial Statement of the Individual Beneficiaries
- Annex 30 - Consolidated Cost Statement for the Project
- Annex 31 - Standard Payment Request and Beneficiary's Certificate
Administrative annexes already included in the Inception Report are:
- Annex C - Monitoring protocol of the project
- Annex D - Monitoring report of the project
7.2 Technical annexes The technical documents are:
-Annex 5- Descriptive statistics on pollutant data collected
-Annex 6- Exposure assessment study
-Annex 7- Statistical protocol (draft)
-Annex 8- Preliminary results PM2.5 year 2005 Italy
-Annex 9- Individual approach: data available and health endpoints
-Annex 10- Ecological approach: health endpoints
- Annex 11- List useful for literature review
- Annex 12- HIA protocol (draft)
- Annex 16- Interactive map ideas
- Annex 25- Minutes of the meetings
- Annex 27 - Minutes of the Steering Committee meetings
Technical documents already included in the Inception Report are:
- Annex A- Air pollution mapping protocol
- Annex B - Survey and health data protocol
7.3 Dissemination annexes The documents related to communication and dissemination are:
- Annex 13- STAKEHOLDERS map
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 59/60
-Annex 14- Targeted mailing lists
-Annex 15- Newsletter n.1_draft
-Annex 17- Photo Barcelona meeting and PART’AERA networking
-Annex 18- Press cuttings
-Annex 19- ISEE 2014 poster
-Annex 20- Abstract ISEE 2015
- Annex 28- STAKEHOLDERS strategy_draft
Dissemination annexes already included in the Inception Report are:
- Annex E - Stakeholders mailing list
- Annex F - Epidemiological evidences to support EU policy
- Annex G - Photos_notice board
7.4 Final table of indicators -Annex 32-. Outcome indicators tables
LIFE MED HISS MID TERM Report- from 01/07/2013 to 31/01/2015 60/60
_________________________________________________________________
8. Financial report and annexes
- "Standard Payment Request and Beneficiary's Certificate" - duly signed original has
been submitted (Annex 31).
- "Consolidated Cost Statement for the Project" - signed original has been submitted
(Annex 30).
- "Financial Statement of the Individual Beneficiary" signed, originals have been
submitted by the coordinating beneficiary and by each associated beneficiary (Annex
29).
- Supporting documents, and further information or clarifications, requested in previous
letters from the Commission (e.g. VAT declarations.) have been submitted: Annex 21,
22, 23a, 23b, 24.
For detailed guidance on preparation of the financial report and annexes we referred to
the financial management guidance document available on the following website:
http://ec.europa.eu/environment/life/toolkit/pmtools/index.htm
shared and commented with the ABs.
Top Related